重视老年高血压的调控与管理

伴随我国人口老龄化进程加速,老年高血压患者的数量逐年增加。目前通常情况下,年龄≥65岁的高血压患者被定义为老年高血压。与中青年高血压患者相比,老年高血压患者的发病机制、临床表现具有特殊性,患者心脑血管事件显著增加。老年高血压多表现为单纯收缩期高血压、脉压增大、血压易波动、合并疾病多等特点,与年轻患者相比降压治疗的难度增加。老年高血压的治疗目的是保护靶器官、减少心脑血管事件,但老年人的降压获益与患者治疗耐受性以及降压治疗的潜在危害相关,在治疗时应选择个体化治疗方案并全面评估和密切监测患者情况,平稳降压,其降压目标可设为<150/90 mm Hg (1 mm Hg=0. 133 kPa)。     

面对新的高血压诊断标准,我国卒中预防策略会改变吗?

高血压是卒中最重要的危险因素。我国目前高血压控制情况不佳,高血压知晓率、治疗率和控制率均较低。2017年,美国成人高血压预防、监测、评估和管理指南更新了高血压诊断标准,将高血压阈值定为130/80 mm Hg(1 mm Hg=0. 133 kPa),并在该标准下制定了新的高血压治疗目标和管理策略。该指南主要基于收缩压干预试验(Systolic Blood Pressure Intervention Trial,SPRINT)研究结果,即与标准降压治疗相比,强化降压治疗可降低心血管事件发生率和全因死亡率。但同时,这一标准使高血压患者的数量大幅增加,且将影响大部分人群的治疗措施,包括老年人群和衰弱人群,在增加经济负担的同时增加了特殊人群的不良反应,不利于高血压防控和个体化治疗。故在此高血压标准下,结合现有证据,我国卒中预防策略尤其是一级预防应有所变化。     

拉西地平对原发性高血压患者颈动脉内膜中层厚度及血压的影响

目的探讨拉西地平对原发性高血压患者颈动脉内膜中层厚度（I MT）及血压的影响。方法对137例原发性高血压患者给予拉西地平治疗。同时进行动态血压监测及颈动脉超声检查,观察137例患者治疗前、治疗6个月后I MT及诊室血压[收缩压（SBP）、舒张压（DBP）]、24 h动态血压（清晨、白天、夜间,SBP、DBP）的变化等情况。结果 137例患者治疗6个月后I MT为（0.80±0.04）mm,治疗前为（1.12±0.06）mm,二者比较差异有统计学意义（P〈0.05）;治疗前、治疗6个月后诊室血压分别为SBP（148±10）mm Hg、DBP（100±9）mm Hg,SBP（118±12）mm Hg、DBP（80±6）mm Hg,二者比较差异均有统计学意义（均P〈0.05）。治疗前和治疗6个月后24 h动态血压清晨、白天、夜间分别为SBP（134±9）mm Hg、DBP（90±8）mm Hg,SBP（144±16）mm Hg、DBP（94±8）mm Hg,SBP（116±16）mm Hg、DBP（76±11）mm Hg和SBP（126±14）mm Hg、DBP（84±12）mm Hg,SBP（130±12）mm Hg、DBP（84±11）mm Hg,SBP（108±11）mm Hg、DBP（70±9）mm Hg,二者比较差异均有统计学意义（均P〈0.01）。结论应用拉西地平治疗原发性高血压患者,不仅可以有效地降压,而且有抗动脉粥样硬化的作用。     

五味降压散对自发性高血压大鼠血压、血脂的影响

目的:观察五味降压散对自发性高血压大鼠(spontaneously hypertensive rats,SHR)血压和血脂的影响。方法:40只14周龄SHR随机分为模型组、五味降压散组(五味组)、牛黄降压丸组(牛黄组)和缬沙坦组,另取10只血压正常大鼠设为正常对照组(正常组)。五味降压散3 g·kg~(-1)大鼠灌胃给药(相当于人临床每日用量的12倍),连续16周给药;每周测定大鼠血压1次以观察药物降低血压效果;腹主动脉采血,取血清,进行生化检测,观察降低血脂作用。结果:给药4周时,模型组收缩压为(218.28±20.81)mm Hg(1 mm Hg=0.133 k Pa),五味组收缩压为(201.07±9.85)mm Hg,两组差异无统计学意义(P>0.05);给药8周时,模型组收缩压为(211.13±17.01)mm Hg,五味组收缩压为(204.86±17.64)mm Hg,两组差异有统计学意义(P<0.05);给药16周时,模型组收缩压为(217.25±13.07)mm Hg,五味组收缩压为(195.83±15.76)mm Hg,两组差异有统计学意义(P<0.05)。与模型组比较,五味组的总胆固醇(1.57±0.05)mmol·L~(-1)、三酰甘油(0.55±0.72)mmol·L~(-1)、低密度脂蛋白胆固醇(0.27±0.02)mmol·L~(-1)显著低于模型组的(1.69±0.08)mmol·L~(-1)、(0.70±0.12)mmol·L~(-1)、(0.33±0.03)mmol·L-1(P<0.05)。结论:五味降压散可明显降低SHR血压、血脂,具有明显的降低血压、降低血脂作用。     

急性脑外伤治疗采用早期降压治疗的临床探讨

目的:探讨急性脑外伤治疗采用早期降压治疗的临床效果。方法:对本院2011年4月-2014年4月收治的120例急性脑外伤患者进行回顾性分析,按照患者的收缩压和舒张压与正常值差值情况分为九组,进行保守与手术治疗后比较各组的CT显示损伤灶面积扩展情况以及格拉斯哥昏迷评分(GCS)情况。结果:急性脑外伤患者的血压有不同程度的升高,通过控制血压,患者收缩压差值0~20 mm Hg和舒张压差值0~10 mm Hg组的CT显示损伤灶面积扩展情况及格拉斯哥昏迷评分(GCS)均优于比其他组,差异均有统计学意义(P<0.05)。结论:控制急性脑外伤患者的血压,有利于患者的恢复。     

盐酸马尼地平片治疗轻中度原发性高血压的疗效分析

目的:评价盐酸马尼地平片治疗轻中度原发性高血压的疗效。方法:采用随机双盲对照研究,入选高血压患者共80例,随机分为盐酸马尼地平组40例和苯磺酸氨氯地平组40例。两组每天分别服用盐酸马尼地平片5 mg和苯磺酸氨氯地平片5 mg,每日1次,共8周。结果:治疗8周后,盐酸马尼地平片组收缩压、舒张压分别下降(22.1±5.67)mm Hg和(16.8±1.32)mm Hg,苯磺酸氨氯地平片组分别下降为(22.5±5.38)mm Hg和(16.1±1.51)mm Hg,与治疗前相比差异均有统计学意义(P<0.05)。盐酸马尼地平片组心率下降为(0.3±0.55)次/min,苯磺酸氨氯地平片组心率下降为(0.5±0.46)次/min,与治疗前比较差异无统计学意义(P>0.05)。治疗8周后,盐酸马尼地平组的降压总有效率为82.5%(33/40),苯磺酸氨氯地平为80.0%(32/40),组间比较差异无统计学意义(P>0.05)。两组均无严重不良事件发生。结论:盐酸马尼地平片每日服用1次治疗轻中度原发性高血压,疗效显著,患者耐受性较好,不良反应少,值得临床推广使用。     

替米沙坦联合氢氯噻嗪治疗轻中度高血压的疗效观察

目的:探讨替米沙坦联合氢氯噻嗪治疗轻中度高血压的临床疗效。方法:选取2015年1月-2017年4月本院收治的82例轻中度高血压患者,采用随机数字表法分为对照组和观察组,每组41例。对照组采用氢氯噻嗪治疗,观察组采用替米沙坦联合氢氯噻嗪治疗,观察两组降压效果、血钾、血尿酸指标变化和不良反应情况。结果:治疗2、4、6周后,观察组SBP和DBP指标水平[(141.24±10.35)、(131.02±10.03)、(128.35±8.02)mm Hg,(111.24±11.34)、(90.25±10.24)、(84.96±6.57)mm Hg]均低于对照组[(149.24±11.02)、(139.57±11.23)、(136.98±9.47)mm Hg,(120.14±8.17)、(108.24±12.04)、(91.47±5.24)mm Hg],差异均有统计学意义(P<0.05)。观察组治疗总有效率(95.12%)高于对照组(78.05%),差异有统计学意义(P<0.05)。治疗后,观察组血钾(4.33±1.02)mmol/L、血尿酸(344.64±52.03)μmol/L水平与对照组[(4.25±1.34)mmol/L、(348.57±49.71)μmol/L]比较,差异均无统计学意义(P>0.05),且两组血钾、血尿酸指标水平均与治疗前比较,差异均无统计学意义(P>0.05)。观察组不良反应发生率(17.07%)略高于对照组(12.20%),但差异无统计学意义(P>0.05)。结论:替米沙坦联合氢氯噻嗪治疗轻中度高血压临床疗效可靠。     

体外膈肌起搏器联合无创通气治疗慢性阻塞性肺疾病的临床研究

目的:探究体外膈肌起搏器联合无创正压通气在慢性阻塞性肺疾病(COPD)患者中的临床效果及对肺功能的影响。方法:随机选取2016年1月-2018年3月本院收治的50例慢性阻塞性肺疾病患者,根据患者入院治疗单双号分为试验组与对照组,每组25例。对照组采用无创正压通气治疗,试验组采用体外膈肌起搏器联合无创正压通气治疗。分别观察两组临床治疗效果、肺功能(PaO_2、PaCO_2、PaO_2/FiO_2、FEV_1/FVC、FEV_1)、日常生活活动能力量表(ADL)评分。结果:治疗后2周,试验组临床治疗总有效率92.00%高于对照组68.00%,差异有统计学意义(P<0.05);试验组ADL评分(94.64±5.17)分高于对照组(85.71±4.31)分,差异有统计学意义(P<0.05);试验组PaCO_2(53.22±3.41)mm Hg、PaO_2(89.62±2.41)mm Hg、PaO_2/FiO_2(410.82±11.97)mm Hg均优于对照组(61.91±3.12)mm Hg、(80.87±2.87)mm Hg、(324.39±12.57)mm Hg,FEV_1/FVC、FEV_1均高于对照组,两组比较差异均有统计学意义(P<0.05)。结论:与单一使用无创正压通气治疗相比,给予COPD患者使用体外膈肌起搏器联合无创正压通气不仅利于提升临床治疗效果,更利于改善其肺功能,进而提升日常生活活动能力,具有独特的应用价值,值得临床进一步推广应用。     

苓桂术甘汤联合小剂量多巴胺在糖尿病肾病透析性低血压预防中的作用

目的:观察苓桂术甘汤联合多巴胺对终末期糖尿病肾病患者透析性低血压的预防作用。方法:22例行规律透析连续1个月且每次透析均出现低血压的终末期糖尿病肾病患者,按随机数字表法分为观察组和对照组各11例,所有患者继续给予规律性透析治疗3个月,第4个月开始对照组在透析开始时给予多巴胺,观察组患者在对照组基础上给予苓桂术甘汤。比较两组患者透析前、透析3 h以及透析结束3个时间点的收缩压平均值、舒张压平均值和动脉压平均值,比较两组患者前3个月和本次透析3个月发生透析性低血压的比例。结果:观察组用药3个月内发生透析性低血压比例为28.79%,显著低于对照组的100%,差异具有统计学意义(P<0.05)。用药后观察组透析3 h和透析结束后收缩压分别为(103.92±3.81)mm Hg(1 mm Hg=0.133 kPa)、(115.38±3.77)mm Hg,均高于对照组(91.69±3.74)mm Hg、(85.45±3.16)mm Hg,差异均有统计学意义(P<0.05)。用药后观察组透析3 h和透析结束后舒张压分别为(81.94±3.35、85.87±2.62)mm Hg,与对照组(75.12±3.24、70.16±2.59)mm Hg比较,差异均无统计学意义(P>0.05)。用药后观察组透析3 h和透析结束后动脉压分别为(89.26±3.30)mm Hg、(95.86±3.41)mm Hg,均高于对照组(80.12±3.11)mm Hg、(75.09±2.24)mm Hg,且差异均有统计学意义(P<0.05)。结论:苓桂术甘汤联合多巴胺对终末期糖尿病肾病透析患者有预防低血压的作用,有利于患者血压的稳定。     

急诊来院缺血性脑卒中急性期患者血压变异性与预后的临床研究

目的:研究缺血性脑卒中急性期(AIS)患者血压变异性与预后的相关性。方法:选择2014年1月-2015年6月在沈阳市第二中医医院急诊病区住院治疗的90例患者作为研究对象,对其分别按照收缩压、舒张压的24 h压差各分为3组,之后采用常规治疗,统计治疗后(30±1)d、(90±2)d、(180±3)d患者NIHSS及ADL评分变化情况,利用统计软件对结果进行分析。结果:治疗后(30±1)d时,24 h SBP SD<25 mm Hg组的NIHSS及ADL评分均明显优于SBP SD其他两组,且25 mm Hg≤24 h SBP SD<50 mm Hg组的NIHSS及ADL评分均明显优于24 h SBP SD≥50 mm Hg组;24 h DBP SD<15 mm Hg组均优于DBP SD其他两组,比较差异均有统计学意义(P<0.05或P<0.01)。在(90±2)d时,24 h SBP SD<25 mm Hg组的NIHSS及ADL评分均明显优于25 mm Hg≤24 h SBP SD<50 mm Hg组,25 mm Hg≤24 h SBP SD<50 mm Hg组均优于24 h SBP SD≥50 mm Hg组,15 mm Hg≤24 h DBP SD<30 mm Hg组均优于24 h DBP SD≥30 mm Hg组,比较差异均有统计学意义(P<0.05);24 h SBP SD<25 mm Hg组均明显优于24 h SBP SD≥50 mm Hg组,24 h DBP SD<15 mm Hg组均明显优于DBP SD其他两组,比较差异均有统计学意义(P<0.01)。在(180±3)d时,24 h SBP SD<25 mm Hg组的NIHSS及ADL评分均明显优于24 h SBP SD≥50 mm Hg组,24 h DBP SD<15 mm Hg组均明显优于DBP SD其他两组,且15 mm Hg≤24 h DBP SD<30 mm Hg组均明显优于24 h DBP SD≥30 mm Hg组,差异均有统计学意义(P<0.01);25 mm Hg≤24 h SBP SD<50 mm Hg组的ADL评分明显优于24 h SBP SD≥50 mm Hg组,差异有统计学意义(P<0.01)。结论:应重视缺血性脑卒中急性期患者,特别是具有较多合并症且舒张压24 h波动大于30 mm Hg患者血压变异性的调节,降低血压波动以改善患者预后。     

美国2017年高血压诊断标准有助于高血压防治理念与时俱进

高血压是导致中国居民心血管疾病发病和死亡风险增加首要且可改变的危险因素。由于大部分高血压患者病因不明,国内外高血压防治一直采用"以治为主"的策略,主要防治目标是提高高血压患者的知晓率、治疗率和控制率。因长期缺少遏制高血压发生的有效策略,我国高血压患病率在各个年龄组均不断增加,特别是在中青年人群有更明显的上升趋势。大量研究显示,血压值处于(130～139)/(80～89) mm Hg (1 mm Hg=0. 133 kPa)的人群最高危。2017年美国多个专业协会联合发布了全球高血压诊断新标准,将原140/90 mm Hg的高血压诊断标准下调至130/80 mm Hg,将发生高血压的高危人群直接纳入高血压范畴,并优先推荐生活方式的早期干预策略。本文对美国高血压诊断标准下调的动因和对我国高血压防治工作的借鉴意义进行分析和探讨。     

去肾交感神经术治疗难治性高血压

难治性高血压(resistant hypertension,RH)是指在改善生活方式基础上应用可耐受的足够剂量且合理的3种降压药物(包括一种噻嗪类利尿剂)治疗至少4周后,诊室和诊室外(包括家庭血压或动态血压监测)血压值仍在目标水平之上,或至少需要4种降压药物才能使血压达标,目前尚缺乏有效的治疗方案。去肾交感神经术(renal sympathetic denervation,RDN)作为RH的一种治疗手段,在病理生理机制上已被基础实验证实。早期Ⅰ代RDN的临床试验结果并不统一,Ⅱ代RDN改进了消融技术并在最近的高血压临床试验应用中得到了阳性结论,同时RDN用于治疗其他疾病的临床试验也产生了阳性结果。但由于目前尚无对肾交感神经活动的具体评估方法,无法准确筛选出适宜行RDN的人群,故其临床应用仍存在争议。     

Use of iodide to enhance the phytoextraction of mercury-contaminated soil

Low bioavailability of mercury (Hg) in soil is a restricting factor in phytoextraction of Hg-contaminated soil. Iodide is known to mobilize Hg in soil and, therefore, the aim of this study was to investigate the possibility to use iodide to increase phytoextraction of Hg. The sensitivity of willow to iodide was investigated in both hydroponics with 0-10 mM KI and in soil with 0.2 and 1 mM KI addition. The capacity to accumulate HgI(2) was compared with that of Hg(NO(3))(2) in hydroponics. Soil extractions with 0-2 mM KI were used to study mobilization of Hg in aged Hg-spiked soil. Additions of KI (0.2-1 mM) were used in pot tests with aged Hg-spiked soil as well as in field trials in an industrial Hg-contaminated soil to study whether iodide addition increased the accumulation of Hg from contaminated soil and the translocation of Hg to the shoots. The total Hg contents in plants, soils and extracts were analyzed by CVAAS. The results showed that too high KI concentration was toxic to plants. Moreover, KI was toxic to plants at lower concentrations in hydroponics than in soil additions. KI (85 microM) in hydroponics gave 50% growth decrease in terms of dry weight of shoot biomass, whereas 0.2 mM KI in soil addition could be tolerated by the plant without growth disturbance. Willow accumulated Hg from HgI(2) solution slower than that from Hg(NO(3))(2) solution. KI mobilized Hg in contaminated soil and thereby increased the bioavailability of Hg in soil. Up to 1 mM KI addition increased the Hg concentrations to about 5, 3 and 8 times, respectively, in the leaves, branches and roots. However, the Hg translocation to the shoots did not show an increase with KI addition. Only less than 1% of the total Hg accumulated in the plant was distributed in the shoots. We may conclude that iodide addition enhances the phytoextraction of Hg, however, the translocation of Hg to the shoots is still too low and therefore it will not be realistic to use this method for phytoextraction of Hg-contaminated soil in practice.     

Contemporary and preindustrial mass budgets of mercury in the Hudson Bay Marine System: the role of sediment recycling

Based on extensive sampling of the rivers, troposphere, seawater and sediments, mercury (Hg) mass budgets are constructed for both contemporary and preindustrial times in the Hudson Bay Marine System (HBS) to probe sources and pathways of Hg and their responses to the projected climate change. The contemporary total Hg inventory in the HBS is estimated to be 98 t, about 1% of which is present in the biotic systems and the remainder in the abiotic systems. The total contemporary Hg influx and outflux, around 6.3 t/yr each, represent a 2-fold increase from the preindustrial fluxes. The most notable changes are in the atmospheric flux, which has gone from a nearly neutral (0.1 t/yr) to source term (1.5 t/yr), increased river inputs (which may also reflect increased atmospheric deposition to the HBS watershed) and in the sedimentary burial flux which has increased by 2.4 t/yr over preindustrial values, implying that much of the modern Hg loading entering this system is buried in the sediments. The capacity to drive increased Hg loading from the atmosphere to sediment burial may be supported by the resuspension of an extraordinarily large flux (120 Mt/yr) of shallow water glacigenic sediments uncontaminated by anthropogenic Hg, which could scavenge Hg from the water column before being transported to the deeper accumulative basins. Under the projected climate warming in the region, the rate of the sediment recycling pump will likely increase due to enhanced Hg scavenging by increasing biological productivity, and thus strengthen atmosphere-ocean Hg exchanges in the HBS.     

24小时尿钠排泄与难治性高血压患者血压达标状态的相关性:单中心横断面研究

目的分析24 h尿钠排泄与难治性高血压(resistant hypertension,RH)患者诊室血压及家庭自测血压(home blood pressure monitoring,HBPM)达标状态的关系。方法通过北京协和医院心内科门诊RH数据库,收集2017年10月至2018年3月间在北京协和医院心内科门诊就诊的RH患者临床资料,进行横断面调查。检测患者24 h尿钠,记录患者同期诊室血压、HBPM水平及临床用药情况,以所有患者24 h尿钠水平四分位数为分界点,将研究对象分为低尿钠、低-中尿钠、中-高尿钠及高尿钠4组。采用多因素Logistic回归,分析影响RH血压达标状态的危险因素。结果共202例RH患者入选本研究,男性107例,女性95例,平均年龄(59. 87±16. 30)岁。24 h尿钠平均水平为(198. 92±96. 59) mmol,年轻患者及体质量指数高者尿钠水平更高(P均<0. 001)。随尿钠升高,降压药物的服用种类显著增多(P=0. 001),早晨及上午的HBPM达标率低(P=0. 040,0. 032)。多因素Logistic回归分析显示,24 h尿钠水平与诊室血压(OR=2. 356,95%CI:1. 004～5. 533,P=0. 049),HBPM早晨血压(OR=2. 408,95%CI:1. 026～5. 650,P=0. 030)及HBPM上午血压(OR=2. 299,95%CI:1. 031～5. 129,P=0. 033)达标状态独立相关,而与下午及夜间HBPM血压达标状态无显著相关(P均>0. 05)。结论 24 h尿钠是RH患者诊室血压及HBPM早晨及上午血压达标的独立相关因素,限制钠盐摄入对减少RH患者血压波动、促进血压达标有重要作用。     

Strategies to lower methyl mercury concentrations in hydroelectric reservoirs and lakes: A review

Mercury (Hg) concentrations in fish in lakes are elevated due to increased global cycling of Hg. A special case of elevated Hg concentrations in fish occurs in new hydroelectric reservoirs because of increased rates of converting Hg in the environment into methyl mercury (MeHg). People and wildlife that eat fish from hydroelectric reservoirs have an elevated risk of accumulating too much MeHg. Demand for electrical energy is leading to the creation of new reservoirs. In 2005, Canada derived 60% of its electricity from hydroelectric reservoirs. As a result, hydroelectric companies and governing agencies are exploring strategies to lower MeHg contamination. Strategies may involve lowering the source of Hg before flooding, the rate of Hg methylation, or MeHg bioaccumulation and biomagnification. Possible strategies reviewed in this article include selecting a site to minimize impacts, intensive fishing, adding selenium, adding lime to acidic systems, burning before flooding, removing standing trees, adding phosphorus, demethylating MeHg by ultraviolet light, capping and dredging bottom sediment, aerating anoxic bottom sediment and waters, and water level management. A preventative strategy is to limit the flooded area, especially wetland areas. Flooded upland areas that contain less carbon produce MeHg for a shorter time than wetland areas. Run-of-the-river reservoirs contain lower MeHg concentrations than reservoirs that flood vast areas, at the cost of exporting MeHg downstream. Managing water levels to flush systems during times of peak MeHg production may have benefits for the reservoir, but also transports MeHg downstream. Intensive fishing can lower MeHg in food webs by increasing fish growth rate. Additions of selenium can lower MeHg bioaccumulation, but the mechanisms are not well established and excess selenium causes toxicity. Liming can lower fish Hg concentrations in lakes acidified with sulphuric and nitric acid. Burning before flooding can lower the production of MeHg, but MeHg bioaccumulation may increase. The most promising strategy will be one that is agreeable to all affected people.     

Quantification and speciation of mercury in soils from the Tripuí Ecological Station, Minas Gerais, Brazil

Contents of total mercury, organic carbon, total sulfur, iron, aluminum and grain size and clay mineralogy were used along with Pearson's correlation and Hg thermal desorption technique to investigate the presence, distribution and binding behavior of Hg in soils from three depths from the Tripuí Ecological Station, located near Ouro Preto, Minas Gerais State, Brazil. The soils studied had predominantly medium and fine sand texture (0.59-0.062 mm), acid character and Hg contents ranging from 0.09 to 1.23 microg/g. The granulometric distribution revealed that Hg is associated with coarse sand (2-0.59 mm) and silt and clay (<0.062 mm) and presents similar Hg concentrations in both fractions. Mercury distribution in soil profiles showed that Hg was homogeneously distributed throughout the depths at most sites. Hg thermal desorption curves show that mercury occurs not only as Hg2+ predominantly bound to organic components in most of the samples, but also in the form of cinnabar in some. Pearson's correlation confirmed that mercury is associated with organic matter and sulfur and possibly with sulfur-bearing organic matter in most samples.     

500 years of mercury production: global annual inventory by region until 2000 and associated emissions

Since pre-industrial times, anthropogenic emissions of Hg have at least doubled global atmospheric Hg deposition rates. In order to minimize environmental and human health effects, efforts have been made to reduce Hg emissions from industries and power plants, while less attention has been paid to Hg mining. This paper is a compilation of available data on primary Hg production and associated emissions with regional and annual resolution since colonial times. Globally, approximately one million tons of metallic Hg has been extracted from cinnabar and other ores during the past five centuries, half already before 1925. Roughly half has been used for mining of gold and silver, but the annual Hg production peaked during a short period of recent industrial uses. Comparison with total historic Hg deposition from global anthropogenic emissions (0.1-0.2 Mtons) suggests that only a few percent of all mined Hg have escaped to the atmosphere thus far. While production of primary Hg has changed dramatically over time and among mines, the global production has always been dominant in the region of the mercuriferous belt between the western Mediterranean and central Asia, but appears to be shifting to the east. Roughly half of the registered Hg has been extracted in Europe, where Spanish mines alone have contributed one third of the world's mined Hg. Approximately one fourth has been mined in the Americas, and most of the remaining registered Hg in Asia. However, the Asian figures may be largely underestimated. Presently, the dominant Hg mines are in Almadén in Spain (236 t of Hg produced in 2000), Khaydarkan in Kyrgyzstan (550 t), Algeria (estimated 240 t) and China (ca. 200 t). Mercury by-production from mining of other metals (e.g. copper, zinc, gold, silver) in 2000 includes 48 t from Peru, 45 t from Finland and at least 15 t from the USA. Since 1970, the recorded production of primary Hg has been reduced by almost an order of magnitude to approximately 2000 t in the year 2000. Mining is thus still of similar magnitude as all current anthropogenic Hg emissions to the atmosphere, and mined Hg may account for more than one third of these emissions. Also before use, mercury is emitted from Hg mines locally during the mining and refining processes and from mining waste. Global direct emissions to the atmosphere amount to 10-30 t per year currently (up to 10 at Almadén alone), and probably exceed 10000 t historically. Termination of Hg mining will reduce associated local emissions to the atmosphere and biosphere. Since several economically viable Hg-free alternatives exist for practically all applications of Hg, the production and use of Hg can be further reduced and all primary production of Hg other than by-production terminated.