高龄高血压患者血压水平对认知功能和生活自理能力的影响
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摘要
目的：探讨高龄高血压患者的认知功能(Cognitive function, CF)和生活自理能力(Activity of daily living, ADL)现状及血压水平对认知功能和生活自理能力的影响,为临床干预措施提供依据。
方法：选取2011年10月-2012年5月期间中南大学湘雅二医院老年心血管病区住院高龄高血压患者120例,其中男72例,女48例,年龄81-100岁,平均年龄85.2±3.8岁,平均收缩压(SBP)142.6±19.6mmHg,平均舒张压(DBP)76.5±11.0mmHg。研究对象按入院血压水平分成A组(SBP>150mmHg),B组(130 结果：
1基本特征的比较
三组患者基本特征除收缩压、舒张压、脉压外,其余均无统计学差异(P>0.05)。
2降压药物使用情况
所有入选对象中,CCB降压治疗人数最多,30人,其次是CCB+ACEI/ARB24人,单用ACEI/ARB23人,ACEI/ARB+利尿剂+CCB11人,ACEI/ARB+利尿剂7人,CCB+利尿剂3人,CCB+p阻滞剂3人,未规律服用降压药者16人。
3生化指标及ABI、c-FPWV、TCD比较
三组TC相比有显著性差异,A组、B组TC显著高于C组(P<0.05),A组和B组之间TC无显著性差异(P>0.05)。A组UACR显著高于B组和C组(P<0.05),B组和C组之间UACR无显著性差异(P>0.05)。A组ABI、TCD、c-fPWV较B组、C组有显著性差异(P<0.05),B组和C组两两之间比较无显著性差异(P>0.05)。三组血红蛋白(HB)、平均红细胞压积(HCT)、FBS、血K、Cr、ALT、AST、NT-proBNP、EF值、24小时尿电解质等指标相比均无统计学差异。
4MMSE、ADL评分比较
120例高龄高血压患者中,有认知功能减退者既MMSE评分异常者56人,占总人数的46.7%。生活自理能力有不同程度下降者88人,占总人数的73.3%。三组ADL评分无显著性差异,B组MMSE评分显著高于A、C组,A、C组之间MMSE评分无显著性差异(P>0.05)。
5在MMSE评分正常者与异常者之间进行单因素分析,结果两组在年龄、婚姻状况、吸烟史、脑血管病史、高血压病程、合并糖尿病、SBP、PP、ABI、CFPWV、TCD方面有显著统计学差异(P<0.05)。
6将单因素分析中P<0.1的因素作为自变量引入Logistic回归模型进行非条件Logistic回归分析,结果：仅年龄、PP、脑血管病史、TCD、UACR是影响认知功能的独立危险因素(P<0.05)。
7在ADL评分正常者与异常者之间进行单因素分析,结果两组在年龄、婚姻状况、合并糖尿病、ABI、CFPWV、MMSE评分方面有显著统计学差异(P<0.05)。
8将单因素分析中P<0.1的因素作为自变量引入Logistic回归模型进行非条件Logistic回归分析,结果：仅年龄、糖尿病病史、ABI是影响认知功能的独立危险因素(P<0.05)。
结论：
1高龄高血压患者血压水平与认知功能有关。年龄、脉压、脑血管病史、脑血流状态、24小时尿微量白蛋白是影响其认知功能的独立危险因素。应加强血压水平的调节与控制,以维持和提高高龄高血压患者的认知功能。
2高龄高血压患者血压水平不影响生活自理能力。年龄、糖尿病、ABI是影响其生活自理能力的独立危险因素。
Objective:
Study of the cognitive function and the ability of daily life status in the very elderly hypertensive patients and the effect of blood pressure levels on cognitive function and ability of daily life. Provide the evidence for clinical intervention measures.
Methods:We randomly assigned120patients from the Second Xiangya Hospital who were80years of age or older. The number of male was72, female48. Aged from81to100years old with an average age85.2±3.8years old. The average SBP was142.6±19.6mm Hg and DBP76.5±11.0mm Hg. The object is divided into group A(SBP>150mm Hg, DBP<110mm Hg), group B (130mm Hg Results:
1Comparison of basic characteristics:There was no significant difference among3groups except SBP, DBP and PP (P<0.05)
2Drug use condition:In all the selected object,30persons has taken CCB as antihypertensive medicine.24patients has taken CCB+ACEI/ARB,23patients has taken ACEI/ARB,11patients has taken ACEI/ARB+diuretic+CCB,7patients has taken ACEI/ARB+diuretic,3patients has taken CCB+diuretics,3patients has taken CCB+beta blocker,16patients has not regularly taken antihypertensive medicine.
3Comparison of biochemical and ABI, c-fPWV and TCD:The. TC level of group A and B are significantly higher than that in group C (P<0.05), but there were no significant difference between group A and group B; UACR, ABI, TCD and c-fPWV of group A is significantly higher than that in group B and C(P<0.05), but there were no significant difference between group B and C (P>0.05)
4In all the selected120patients,56persons had MCI, accounting for46.67%of the total numberand88people had a decrease in ADL, accounting for73.33%. There was no significant difference among3groups in ADL. Group B had significantly higher MMSE score than group A, C, and there was no statistical significance between group A, C.
5Comparison between normal cognition group and impaired cognition group:Univariant correlation analysis between the two groups showed that significant difference existed in age, marital status, smoking, history of cerebrovascular disease, diabetes mellitus, ABI, SBP, PP,UACR and LDH CFPWV and TCD (P<0.05).
6Multiple logistic regression analysis demonstrated that only age, PP, TCD and history of cerebrovascular disease were related to cognitive impairment.
7Comparison between normal ADL group and impaired ADL group: Univariant correlation analysis between the two groups showed that significant difference existed in age, smoking, diabetes mellitus, ABI, CFPWV TCD and MMSE(P<0.05).
8Multiple logistic regression analysis demonstrated that only age, diabetes mellitus and ABI were related to ADL impairment.
Conclusion:1The level of blood pressure is related to cognitive function in the very elderly hypertensive patients. Pulse pressure, age, history of cerebrovascular disease, cerebral blood flow and24hour urinary albumin is the independent risk factors of cognitive function. We Should contral the level of blood pressure in order to maintain and improve the cognitive function in the very elderly hypertensive patients.
2The level of blood pressure do not affect the ability of daily life directl. Age, diabetes, ABI are independent risk factors of ADL
方法：选取2011年10月-2012年5月期间中南大学湘雅二医院老年心血管病区住院高龄高血压患者120例,其中男72例,女48例,年龄81-100岁,平均年龄85.2±3.8岁,平均收缩压(SBP)142.6±19.6mmHg,平均舒张压(DBP)76.5±11.0mmHg。研究对象按入院血压水平分成A组(SBP>150mmHg),B组(130
1基本特征的比较
三组患者基本特征除收缩压、舒张压、脉压外,其余均无统计学差异(P>0.05)。
2降压药物使用情况
所有入选对象中,CCB降压治疗人数最多,30人,其次是CCB+ACEI/ARB24人,单用ACEI/ARB23人,ACEI/ARB+利尿剂+CCB11人,ACEI/ARB+利尿剂7人,CCB+利尿剂3人,CCB+p阻滞剂3人,未规律服用降压药者16人。
3生化指标及ABI、c-FPWV、TCD比较
三组TC相比有显著性差异,A组、B组TC显著高于C组(P<0.05),A组和B组之间TC无显著性差异(P>0.05)。A组UACR显著高于B组和C组(P<0.05),B组和C组之间UACR无显著性差异(P>0.05)。A组ABI、TCD、c-fPWV较B组、C组有显著性差异(P<0.05),B组和C组两两之间比较无显著性差异(P>0.05)。三组血红蛋白(HB)、平均红细胞压积(HCT)、FBS、血K、Cr、ALT、AST、NT-proBNP、EF值、24小时尿电解质等指标相比均无统计学差异。
4MMSE、ADL评分比较
120例高龄高血压患者中,有认知功能减退者既MMSE评分异常者56人,占总人数的46.7%。生活自理能力有不同程度下降者88人,占总人数的73.3%。三组ADL评分无显著性差异,B组MMSE评分显著高于A、C组,A、C组之间MMSE评分无显著性差异(P>0.05)。
5在MMSE评分正常者与异常者之间进行单因素分析,结果两组在年龄、婚姻状况、吸烟史、脑血管病史、高血压病程、合并糖尿病、SBP、PP、ABI、CFPWV、TCD方面有显著统计学差异(P<0.05)。
6将单因素分析中P<0.1的因素作为自变量引入Logistic回归模型进行非条件Logistic回归分析,结果：仅年龄、PP、脑血管病史、TCD、UACR是影响认知功能的独立危险因素(P<0.05)。
7在ADL评分正常者与异常者之间进行单因素分析,结果两组在年龄、婚姻状况、合并糖尿病、ABI、CFPWV、MMSE评分方面有显著统计学差异(P<0.05)。
8将单因素分析中P<0.1的因素作为自变量引入Logistic回归模型进行非条件Logistic回归分析,结果：仅年龄、糖尿病病史、ABI是影响认知功能的独立危险因素(P<0.05)。
结论：
1高龄高血压患者血压水平与认知功能有关。年龄、脉压、脑血管病史、脑血流状态、24小时尿微量白蛋白是影响其认知功能的独立危险因素。应加强血压水平的调节与控制,以维持和提高高龄高血压患者的认知功能。
2高龄高血压患者血压水平不影响生活自理能力。年龄、糖尿病、ABI是影响其生活自理能力的独立危险因素。
Objective:
Study of the cognitive function and the ability of daily life status in the very elderly hypertensive patients and the effect of blood pressure levels on cognitive function and ability of daily life. Provide the evidence for clinical intervention measures.
Methods:We randomly assigned120patients from the Second Xiangya Hospital who were80years of age or older. The number of male was72, female48. Aged from81to100years old with an average age85.2±3.8years old. The average SBP was142.6±19.6mm Hg and DBP76.5±11.0mm Hg. The object is divided into group A(SBP>150mm Hg, DBP<110mm Hg), group B (130mm Hg
1Comparison of basic characteristics:There was no significant difference among3groups except SBP, DBP and PP (P<0.05)
2Drug use condition:In all the selected object,30persons has taken CCB as antihypertensive medicine.24patients has taken CCB+ACEI/ARB,23patients has taken ACEI/ARB,11patients has taken ACEI/ARB+diuretic+CCB,7patients has taken ACEI/ARB+diuretic,3patients has taken CCB+diuretics,3patients has taken CCB+beta blocker,16patients has not regularly taken antihypertensive medicine.
3Comparison of biochemical and ABI, c-fPWV and TCD:The. TC level of group A and B are significantly higher than that in group C (P<0.05), but there were no significant difference between group A and group B; UACR, ABI, TCD and c-fPWV of group A is significantly higher than that in group B and C(P<0.05), but there were no significant difference between group B and C (P>0.05)
4In all the selected120patients,56persons had MCI, accounting for46.67%of the total numberand88people had a decrease in ADL, accounting for73.33%. There was no significant difference among3groups in ADL. Group B had significantly higher MMSE score than group A, C, and there was no statistical significance between group A, C.
5Comparison between normal cognition group and impaired cognition group:Univariant correlation analysis between the two groups showed that significant difference existed in age, marital status, smoking, history of cerebrovascular disease, diabetes mellitus, ABI, SBP, PP,UACR and LDH CFPWV and TCD (P<0.05).
6Multiple logistic regression analysis demonstrated that only age, PP, TCD and history of cerebrovascular disease were related to cognitive impairment.
7Comparison between normal ADL group and impaired ADL group: Univariant correlation analysis between the two groups showed that significant difference existed in age, smoking, diabetes mellitus, ABI, CFPWV TCD and MMSE(P<0.05).
8Multiple logistic regression analysis demonstrated that only age, diabetes mellitus and ABI were related to ADL impairment.
Conclusion:1The level of blood pressure is related to cognitive function in the very elderly hypertensive patients. Pulse pressure, age, history of cerebrovascular disease, cerebral blood flow and24hour urinary albumin is the independent risk factors of cognitive function. We Should contral the level of blood pressure in order to maintain and improve the cognitive function in the very elderly hypertensive patients.
2The level of blood pressure do not affect the ability of daily life directl. Age, diabetes, ABI are independent risk factors of ADL
引文
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[1]钟海兰,陈秀梅.高龄老年高血压的研究进展[J].心血管病学进展,2009,30(1)：58-61.
[2]Lloyd Jones DM, Evans JC, Levy D. Hypertension in adults across the age spectrum:currentoutcomes and control in the community[J]. JAMA,2005,294: 466-472.
[3]路方红,刘振东,赵颖馨,等.老年高血压患者动态血压与靶器官损害的相关性.高血压杂志,2006,14(2)：114-118.
[4]Wang JG, Liu G, Wang X et al Long-lerm blood pressure control in older Chinese patients with isolated systolic hypertension:a progress report on the Syst-China trial[J]. J ttum Hypertens,1996,10:735-742.
[5]Papademetriou V, Farsang C, Elnfehh D, et al Stroke prevention with the angiotensin Ⅱ type 1-receptor blocker eandesartan in elderly patients with isolated systolic hypertension:the study on cognition and prognosis in the elderly (SCOPE)[J]. J Am Coll Cardiol,2004,44:1175-1180.
[6]诸葛铭宁,蔡玉琴,斯重阳,等.80岁以上老年人单纯收缩期高血压与颈动脉硬度.中国循环杂志,2010,25(6)：453-455.
[7]黄为民,刘丰,叶清维.动态脉压对高龄高血压病患者早期肾功能损害的影响.中华老年多器官疾病杂志,2008,7(1)：30-32.
[8]黄为民,刘丰,吴戴红.动态脉压对高龄高血压病患者左室肥厚和左室功能的影响.岭南心血管病杂志,2003,9(6)：392-394.
[9]李庆美,高红五.超高龄高血压患者动态血压和左室肥厚关系的研究.泰山医学院学报,2008,29(10)：801-804.
[10]崔华,范利,张力,等.高龄高血压患者动态血压及昼夜节律与胰岛素抵抗相关性的临床研究.中国老年学杂志,2005,12(25)：1464-1466.
[11]Shibao C,Gamboa A,Diedrich A,et al. Management of hypertension in the setting of autonomic failure:a pathophysiological approach[J]. Hypertension,2005,45(4): 469-476.
[12]Gunstad J,Cohen RA,Tate DF,et al.Blood pressure varability and white matter hyperrintensities in older adults with cardiovascular disease[J]. Blood Press,2005, 14(6):353-358.
[13]chirinos JA, Zambrano JP, Chakko s,et al.Aortic pressure augmentation predicts adverse cardiovascular events in patients with established coronary artery disease [J].Hypertension,2005,45(5):980-985.
[14]黄文湧,宋沈超,杨敬源,等,老年人慢性病对日常生活功能的影响,中国慢性病预防与控制,2000,8,(2)：81-83.
[15]刘振东,路方红,董元丽,等,老老年高血压患者血压昼夜节律及颈动脉粥样硬化与认知功能损害,中华高血压杂志,2009,17,(9)：821-824.
[16]KarioK,Pickering TG,Umeda Y,et al.Morning surge in blood pressure as a predictor of silentand clinical cerebrovascular disease in elderly hypertensives:a prospective study[J]. Circulation,2003,107(10):1401-1406.
[17]Kostis JB,Wilson AC,Freudenberger RS,et al.Long-term effect of diuretic-based therapy on fatal outcomes in subjects with isolated systolic hypertension with and without diabetes.Am J Cardiol,2005,95(1):29-35.
[18]Liu L,Wang JQGong L,et al.Comparison of active treatment and placebo in older Chinese patients with isolated systolic hypertension,systolic hypertension in China (Syst-China) collaborative group.J Hypertens,1998,16(12):1823-1829.
[19]Lithell H,Hansson L,Skoog I,et al.The Study on Cognition and Prognosis in the Elderly (SCOPE):principal results of a randomized double-blind intervention trial. J Hypertens,2003,21(5):875-886.
[20]Mancia G,De Backer G,Dominiczak A,et al.2007 Guidelines for the management of arterial hypertension:The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension(ESH) and of the European Society of Cardiol ogy(ESC).J Hypertens,2007,25:1105-1187.
[21]Beckett NS, Peters R, Fletcher AE, et al. For the HYVET Study Group.Treatment of Hypertension in Ptients 80 Years Of Age or Older.N Engl J Med,2008,358:1887-1898.
[22]Saruta T.The Japanese Society Hypertension guidelines of the management of hypertension[JSH 2004][J].Nippon Rinsho,2005; 63(6):952-958.
[23]刘力生,吴兆苏,朱鼎良,等,中国高血压防治指南2010年修订版,2010：12-31.
[24]Dufouil C,Chalmers J,Coskun O,et al.PROGRESS MRI Substudy Investigators: effects of blood pressure lowering on cerebral white matter hyperintensities in patients with stroke:the PROGRESS(Perindopril Protection Against Recurrent Stroke Study) Magnetic Resonance Imaging Substudy[J].Circulation,2005,112:1644-1650.
[25]Patel A,ADVANCE Collaborative Group,MacMabon S,et al.Efects of a fixed combination of perindopril an indapamide on macrovascular and microvasular outcomes in patients with type-2 diabetes mellitus(the ADVNCE trial):a randomised controlled trial[J]. Lancet,2007,370:829-840
[26]苏广智,魏立,宋远民,等.厄贝沙坦对高龄患者的降压疗效及靶器官保护作用,实用医学杂志,2010,27(3)：193-195.
[27]赵水平,胡大一.血管病诊疗指南解读[M].第2版.北京：人民卫生出版社,2007.231-239.
[28]Mancia G,de Backer G,Dominiczal A,et al.2007 Guidelines for the Management of Arteral Hypertension:The Task Force for the Management Of Arterial Hypertension of the European society of Hypertension (ESH) and of the European society of cardiology (ESC)[J].J Hypertens,2007,25(6):1105-1187.
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[30]Jamerson KA,Nwose O,Jean-louis L,et al. Initial angiotension-converting enzyme inhibitor/calcium channel bloker combination therapy achieves superior blood pressure control comppared with calcium channel blocker monotherapy in patients with stage 2 hypertension[J],AM J Hypertens,2004,17(6):495-501.
[31]齐志士,路文科,牛红霞.贝那普利联合拉西地平治疗老年高血压疗效分析.吉林医学,2011,32(24)：5036-5037.
[32]Elmer PJ,Obarzanek E,Vollmer WM, et al.The PREMIER collaborative Research Group. Effects of comprehensive lifestyle modification diet,weight, physical fitness, and blood pressure control:18-month results of a randomnized trial [J].Ann Int Med, 2006,144(19):485-495.
[33]Kostis JB,wilson Ac,shindler DM,et al.Persistence of normotension after discontinuation of lifestyle intervetion in the trial of TONE.Trial of Nonphamacologic Intervensions in the Eldedy[J].Am J Hypertens, 2002,15(8):732-734.
[34]杨林,孙静,栗艳,等.对高龄高血压患者危险因素的综合干预.中国中医急症,2009,18(10)：1724-1725.
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[1]钟海兰,陈秀梅.高龄老年高血压的研究进展[J].心血管病学进展,2009,30(1)：58-61.
[2]Lloyd Jones DM, Evans JC, Levy D. Hypertension in adults across the age spectrum:currentoutcomes and control in the community[J]. JAMA,2005,294: 466-472.
[3]路方红,刘振东,赵颖馨,等.老年高血压患者动态血压与靶器官损害的相关性.高血压杂志,2006,14(2)：114-118.
[4]Wang JG, Liu G, Wang X et al Long-lerm blood pressure control in older Chinese patients with isolated systolic hypertension:a progress report on the Syst-China trial[J]. J ttum Hypertens,1996,10:735-742.
[5]Papademetriou V, Farsang C, Elnfehh D, et al Stroke prevention with the angiotensin Ⅱ type 1-receptor blocker eandesartan in elderly patients with isolated systolic hypertension:the study on cognition and prognosis in the elderly (SCOPE)[J]. J Am Coll Cardiol,2004,44:1175-1180.
[6]诸葛铭宁,蔡玉琴,斯重阳,等.80岁以上老年人单纯收缩期高血压与颈动脉硬度.中国循环杂志,2010,25(6)：453-455.
[7]黄为民,刘丰,叶清维.动态脉压对高龄高血压病患者早期肾功能损害的影响.中华老年多器官疾病杂志,2008,7(1)：30-32.
[8]黄为民,刘丰,吴戴红.动态脉压对高龄高血压病患者左室肥厚和左室功能的影响.岭南心血管病杂志,2003,9(6)：392-394.
[9]李庆美,高红五.超高龄高血压患者动态血压和左室肥厚关系的研究.泰山医学院学报,2008,29(10)：801-804.
[10]崔华,范利,张力,等.高龄高血压患者动态血压及昼夜节律与胰岛素抵抗相关性的临床研究.中国老年学杂志,2005,12(25)：1464-1466.
[11]Shibao C,Gamboa A,Diedrich A,et al. Management of hypertension in the setting of autonomic failure:a pathophysiological approach[J]. Hypertension,2005,45(4): 469-476.
[12]Gunstad J,Cohen RA,Tate DF,et al.Blood pressure varability and white matter hyperrintensities in older adults with cardiovascular disease[J]. Blood Press,2005, 14(6):353-358.
[13]chirinos JA, Zambrano JP, Chakko s,et al.Aortic pressure augmentation predicts adverse cardiovascular events in patients with established coronary artery disease [J].Hypertension,2005,45(5):980-985.
[14]黄文湧,宋沈超,杨敬源,等,老年人慢性病对日常生活功能的影响,中国慢性病预防与控制,2000,8,(2)：81-83.
[15]刘振东,路方红,董元丽,等,老老年高血压患者血压昼夜节律及颈动脉粥样硬化与认知功能损害,中华高血压杂志,2009,17,(9)：821-824.
[16]KarioK,Pickering TG,Umeda Y,et al.Morning surge in blood pressure as a predictor of silentand clinical cerebrovascular disease in elderly hypertensives:a prospective study[J]. Circulation,2003,107(10):1401-1406.
[17]Kostis JB,Wilson AC,Freudenberger RS,et al.Long-term effect of diuretic-based therapy on fatal outcomes in subjects with isolated systolic hypertension with and without diabetes.Am J Cardiol,2005,95(1):29-35.
[18]Liu L,Wang JQGong L,et al.Comparison of active treatment and placebo in older Chinese patients with isolated systolic hypertension,systolic hypertension in China (Syst-China) collaborative group.J Hypertens,1998,16(12):1823-1829.
[19]Lithell H,Hansson L,Skoog I,et al.The Study on Cognition and Prognosis in the Elderly (SCOPE):principal results of a randomized double-blind intervention trial. J Hypertens,2003,21(5):875-886.
[20]Mancia G,De Backer G,Dominiczak A,et al.2007 Guidelines for the management of arterial hypertension:The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension(ESH) and of the European Society of Cardiol ogy(ESC).J Hypertens,2007,25:1105-1187.
[21]Beckett NS, Peters R, Fletcher AE, et al. For the HYVET Study Group.Treatment of Hypertension in Ptients 80 Years Of Age or Older.N Engl J Med,2008,358:1887-1898.
[22]Saruta T.The Japanese Society Hypertension guidelines of the management of hypertension[JSH 2004][J].Nippon Rinsho,2005; 63(6):952-958.
[23]刘力生,吴兆苏,朱鼎良,等,中国高血压防治指南2010年修订版,2010：12-31.
[24]Dufouil C,Chalmers J,Coskun O,et al.PROGRESS MRI Substudy Investigators: effects of blood pressure lowering on cerebral white matter hyperintensities in patients with stroke:the PROGRESS(Perindopril Protection Against Recurrent Stroke Study) Magnetic Resonance Imaging Substudy[J].Circulation,2005,112:1644-1650.
[25]Patel A,ADVANCE Collaborative Group,MacMabon S,et al.Efects of a fixed combination of perindopril an indapamide on macrovascular and microvasular outcomes in patients with type-2 diabetes mellitus(the ADVNCE trial):a randomised controlled trial[J]. Lancet,2007,370:829-840
[26]苏广智,魏立,宋远民,等.厄贝沙坦对高龄患者的降压疗效及靶器官保护作用,实用医学杂志,2010,27(3)：193-195.
[27]赵水平,胡大一.血管病诊疗指南解读[M].第2版.北京：人民卫生出版社,2007.231-239.
[28]Mancia G,de Backer G,Dominiczal A,et al.2007 Guidelines for the Management of Arteral Hypertension:The Task Force for the Management Of Arterial Hypertension of the European society of Hypertension (ESH) and of the European society of cardiology (ESC)[J].J Hypertens,2007,25(6):1105-1187.
[29]Neutel JM,smith DHG,weber MA,et al.Efficacy of combination therapy for systolic blood pressure in patients with severe systolic hypertension:the Systolic Evaluation of Lotrel Efficacy and comparative Therapies (SELECT)study[J]. Clin Hypertens(Greenwich),2005,7(11):641-646.
[30]Jamerson KA,Nwose O,Jean-louis L,et al. Initial angiotension-converting enzyme inhibitor/calcium channel bloker combination therapy achieves superior blood pressure control comppared with calcium channel blocker monotherapy in patients with stage 2 hypertension[J],AM J Hypertens,2004,17(6):495-501.
[31]齐志士,路文科,牛红霞.贝那普利联合拉西地平治疗老年高血压疗效分析.吉林医学,2011,32(24)：5036-5037.
[32]Elmer PJ,Obarzanek E,Vollmer WM, et al.The PREMIER collaborative Research Group. Effects of comprehensive lifestyle modification diet,weight, physical fitness, and blood pressure control:18-month results of a randomnized trial [J].Ann Int Med, 2006,144(19):485-495.
[33]Kostis JB,wilson Ac,shindler DM,et al.Persistence of normotension after discontinuation of lifestyle intervetion in the trial of TONE.Trial of Nonphamacologic Intervensions in the Eldedy[J].Am J Hypertens, 2002,15(8):732-734.
[34]杨林,孙静,栗艳,等.对高龄高血压患者危险因素的综合干预.中国中医急症,2009,18(10)：1724-1725.