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Chakraborty RN, Langade D, More S, Revandkar V, Birla A. Efficacy of Cilnidipine (L/N-type Calcium Channel Blocker) in Treatment of Hypertension: A Meta-Analysis of Randomized and Non-randomized Controlled Trials. Cureus 2021; 13:e19822. [PMID: 34963839 PMCID: PMC8695827 DOI: 10.7759/cureus.19822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Hypertension is one of the most common cardiovascular diseases, and the prevalence of hypertension continues to rise across the globe. National and international guidelines recommend angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs), diuretics, and beta-blockers for the management of hypertension. CCBs are among the most used antihypertensive medications and Cilnidipine is a newer dihydropyridine CCB shown to have a prolonged antihypertensive property. OBJECTIVE This meta-analysis of comparative randomized and non-randomized clinical trials evaluated the effect of Cilnidipine monotherapy or combination therapy on systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse rate (PR) over 48 weeks of therapy. STUDY DESIGN PubMed (MEDLINE) and Google scholar databases were searched to identify studies designed to evaluate the effects of Cilnidipine in the treatment of hypertensive patients. The study criteria for inclusion into the meta-analysis were all prospective, randomized, and non-randomized clinical studies published till March 2021, studies published in a peer-reviewed journal, the inclusion of patients with hypertension, assessment of blood pressure and heart rate, and a follow-up of four weeks or longer. The initial search identified 82 potential articles; of these, 24 met the inclusion criteria. Studies with <4 weeks treatment period and those not having a CCB were excluded. OUTCOMES Change in SBP, DBP, and PR from baseline at the end of therapy compared between the Cilnidipine and other CCB's. RESULTS Cilnidipine caused a significant reduction (p<0.05) in SBP, DBP, and PR at end of therapy, whereas the reduction in SBP, DBP, and PR with Cilnidipine was similar to other CCB's (p>0.05). The results of this meta-analysis revealed that there were no significant differences in the efficacy in the treatment of hypertensive patients with Cilnidipine and the other therapies. CONCLUSION Cilnidipine has similar anti-hypertensive effects compared with other first-line antihypertensive drugs commonly used in practice. We recommend Cilnidipine as a novel first-line CCB for the management of hypertension either as a monotherapy or as a combination therapy.
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Affiliation(s)
| | - Deepak Langade
- Pharmacology, School of Medicine, D Y Patil University, Navi Mumbai, IND
| | - Shyam More
- Community Medicine, School of Medicine, D Y Patil University, Navi Mumbai, IND
| | - Vaibhav Revandkar
- Medical Affairs, J. B. Chemicals and Pharmaceutical Limited, Mumbai, IND
| | - Ashish Birla
- Medical Affairs, J. B. Chemicals and Pharmaceutical Limited, Mumbai, IND
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Prevalence and Risk Factors of Central Obesity among Adults with Normal BMI in Shaanxi, China: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111439. [PMID: 34769955 PMCID: PMC8582888 DOI: 10.3390/ijerph182111439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 01/01/2023]
Abstract
(1) Background: The study aims to estimate the prevalence of normal weight with central obesity (NWCO) and to examine the relationship between NWCO and cardiovascular disease risk factors in adults of the province of Shaanxi. (2) Methods: A population-based cross-sectional survey was conducted among residents who were aged 18–80 years and had been living in Zhenba County, Shaanxi Province, for over six months in 2018. Descriptive data analysis and prevalence/frequency were conducted. Logistic regression analyses were used to detect the corresponding factors associated with central obesity. (3) Results: A total of 2312 participants (936 men and 1376 women) were analyzed. The prevalence of NWCO was 58.3%. NWCO was significantly associated with hypertension and dyslipidemia. Compared with normal weight non-central obesity (NWNO), the adjusted odds ratios (ORs) for hypertension were 1.47 (95% CI 1.10–1.98) in men and 1.55 (1.14–2.10) in women, and the corresponding odds ratios for dyslipidemia were 2.71 (1.77–4.13) in men and 1.84 (1.29–2.61) in women. Female sex, age over 58 years, and lower education level were also significantly predictors of abdominal obesity. (4) Conclusions: Body mass index alone as a measure of obesity is not sufficient for assessing health risks. Central obesity index should be used together for clinical assessment.
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Homocysteine, hypertension, and risks of cardiovascular events and all-cause death in the Chinese elderly population: a prospective study. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2021; 18:796-808. [PMID: 34754291 PMCID: PMC8558741 DOI: 10.11909/j.issn.1671-5411.2021.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Increased homocysteine levels are associated with the risk of cardiovascular disease (CVD) and death. However, their prevention has not been effective in decreasing CVD risk. This study investigated the individual and combined associations of hyperhomocysteinemia and hypertension with incident CVD events and all-cause death in the Chinese elderly population without a history of CVD. METHODS This prospective study was conducted among 1,257 elderly participants (mean age: 69 years). A questionnaire survey, physical examinations, and laboratory tests were conducted to collect baseline data. Hyperhomocysteinemia was defined as homocysteine level ≥ 15 µmol/L. H-type hypertension was defined as concomitant hypertension and hyperhomocysteinemia. Multivariate Cox regression analysis was used to evaluate individual and combined associations of hyperhomocysteinemia and hypertension with the risks of incident CVD events and all-cause death. RESULTS Over a median of 4.84-year follow-up, hyperhomocysteinemia was independently associated with incident CVD events and all-cause death. The hazard ratios (HRs) were 1.45 (95% CI: 1.01−2.08) for incident CVD events and 1.55 (95% CI: 1.04−2.30) for all-cause death. After adjustment for confounding factors, H-type hypertension had the highest HRs for incident CVD events and all-cause death. The fully adjusted HRs were 2.44 for incident CVD events (95% CI: 1.28−4.65), 2.07 for stroke events (95% CI: 1.01−4.29), 8.33 for coronary events (95% CI: 1.10−63.11), and 2.31 for all-cause death (95% CI: 1.15−4.62). CONCLUSIONS Hyperhomocysteinemia was an independent risk factor, and when accompanied by hypertension, it contributed to incident CVD events and all-cause death in the Chinese elderly population without a history of CVD.
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154
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Wang J, Tang M, Long Y, Song J, Chen L, Wang M, Li Y, Sun C, Yan Y. Prognostic Potential of Heart Rate and Hypertension in Multiple Myeloma Patients. Front Cardiovasc Med 2021; 8:681484. [PMID: 34646869 PMCID: PMC8502919 DOI: 10.3389/fcvm.2021.681484] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 08/09/2021] [Indexed: 01/13/2023] Open
Abstract
Background: The prognosis of patients with multiple myeloma (MM) is variable and partly depends on their cardiovascular status. The presence of arrhythmias can lead to worse outcomes. Therefore, this study aimed to evaluate the potential of heart rate (HR) and hypertension in predicating the outcomes of MM patients. Methods: This study retrospectively enrolled patients with MM between January 1, 2010, and December 31, 2018, at the First Affiliated Hospital of Xi'an Jiaotong University. The endpoint was all-cause mortality. The Pearson's chi-square test was used to assess the association between hypertension and outcomes. Univariate and multivariate Cox proportional hazards models were developed to evaluate the relationship between HR and all-cause mortality. Results: A total of 386 patients were included. The mean HR was 83.8 ± 23.1 beats per minute (bpm). Patients with HR >100 bpm had a higher all-cause mortality (79.4%, 50/63) than those with 60 ≤ HR ≤ 100 bpm (39.9%, 110/276) and <60 bpm (19.1%, 9/47) (p < 0.001). Subgroup analysis based on the International Staging System and sex revealed similar relationships (p < 0.01). When stratified by age, patients with HR >100 bpm had higher all-cause mortality than those with a lower HR when age was <65 years or 65-75 years (p < 0.001) but not >75 years. The proportion of patients with hypertension was 54.7% (211/386). However, hypertension was not associated with all-cause mortality in MM patients (χ2=1.729, p > 0.05). MM patients with HR >100 bpm had the highest all-cause mortality. Conclusions: The prognostic potential of HR may be useful in aiding risk stratification and promoting the management of these patients.
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Affiliation(s)
- Jie Wang
- Atrial Fibrillation Centre and Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Hematology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Manyun Tang
- Atrial Fibrillation Centre and Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yunxiang Long
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jingzhuo Song
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Limei Chen
- Department of Hematology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Mengchang Wang
- Department of Hematology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yongxin Li
- Department of Cardiovascular Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Chaofeng Sun
- Atrial Fibrillation Centre and Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yang Yan
- Department of Cardiovascular Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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155
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Huang S, Sun H, Yu J, Shi H, Ren L, He Y, Zhang M, Peng H, Guo H. The Interaction Between Self-Reported Sleep Duration and Physical Activity on Peripheral Artery Disease in Chinese Adults: A Cross-Sectional Analysis in the Tianning Cohort Study. Risk Manag Healthc Policy 2021; 14:4063-4072. [PMID: 34616193 PMCID: PMC8488049 DOI: 10.2147/rmhp.s332098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 09/16/2021] [Indexed: 12/13/2022] Open
Abstract
Purpose Sleep duration was associated with large artery atherosclerosis, but its association with atherosclerosis in lower extremity arteries was not well studied. Together with sleep, physical activity constitutes main component of our daily life and influences sleep. Here, we aimed to examine the independent and joint associations of sleep duration and physical activity with peripheral artery disease (PAD) in Chinese adults. Patients and Methods In Tianning cohort, night-time sleep duration and physical activity were assessed by the Pittsburgh Sleep Quality Index and the Global Physical Activity Questionnaire, respectively, for 5130 participants (51.0±15.6 years, 58.7% female). PAD was defined as ankle-brachial index (ABI) <0.9. General linear, and logistic regression models were used to assess the associations of sleep duration and physical activity with PAD. The biological interaction between sleep duration and physical activity on PAD was examined using additive model. Results Compared to participants sleeping 6-8.9 h, those sleeping ≥9 h had a 0.02 lower ABI (β=-0.02, P=0.007) and 38% higher odds of PAD (OR=1.38, P=0.035). Compared to physically active participants sleeping 6-8.9 h, among ≥9 h group, physically inactive individuals had significantly increased odds of PAD (OR=2.40, P<0.001), whereas physically active individuals did not (OR=1.15, P=0.472). On additive scale, attributable proportion due to interaction (0.40, 95% CI: 0.07, 0.73) indicated a significant interaction between sleep duration and physical activity on PAD. Conclusion Being physically active may attenuate the detrimental association between prolonged sleep duration and PAD. Moreover, we found a significant interaction between prolonged sleep duration and physical inactivity in the prevalence of PAD.
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Affiliation(s)
- Shujing Huang
- Department of Public Health, School of Medicine, Shihezi University, Shihezi, People's Republic of China
| | - Hongyan Sun
- Center for Disease Prevention and Control of Tianning District, Changzhou, People's Republic of China
| | - Jia Yu
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, People's Republic of China
| | - Hongfei Shi
- Center for Disease Prevention and Control of Tianning District, Changzhou, People's Republic of China
| | - Liyun Ren
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, People's Republic of China
| | - Yan He
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, People's Republic of China
| | - Mingzhi Zhang
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, People's Republic of China
| | - Hao Peng
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, People's Republic of China.,Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou, People's Republic of China
| | - Heng Guo
- Department of Public Health, School of Medicine, Shihezi University, Shihezi, People's Republic of China
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156
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Gong N, Zhou C, Hu J, Zhong X, Yi Z, Zhang T, Yang C, Lin Y, Tian J, Qin X, Hu L, Jiang J. High-Salt Diet Accelerated the Decline of Residual Renal Function in Patients With Peritoneal Dialysis. Front Med (Lausanne) 2021; 8:728009. [PMID: 34595194 PMCID: PMC8477204 DOI: 10.3389/fmed.2021.728009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 08/12/2021] [Indexed: 12/24/2022] Open
Abstract
Objective: This study aims to investigate the relationship between dietary salt intake and residual renal function in peritoneal dialysis (PD) patients. Methods: The daily salt intake of the patients was calculated based on a 3 day dietary record. Sixty-two patients were divided into three groups: 33 patients in the low salt intake group (salt intake <6.0 g/day), 17 in the medium salt intake group (salt intake 6.0 to <8.0 g/day), and 12 in the high salt intake group (salt intake ≥8.0 g/day). Regular follow-up was conducted every 3 months. Urine volume, peritoneal ultrafiltration volume, and other clinical indicators were recorded. Biochemical indexes were detected to evaluate the changes in residual renal function and peritoneal function during follow-up. Results: A positive correlation between dietary sodium intake and sodium excretion was found. During 12-month follow-up, a decrease of residual renal function showed a significant difference among the three groups (p = 0.041) (15.3 ± 27.5 vs. 12.5 ± 11.5 vs. 32.9 ± 18.4 L/W/1.73 m2 in the low-, medium-, and high salt intake groups, respectively). Consistently, a higher decline of residual renal function (adjusted β, 20.37; 95% CI, 2.83, 37.91) was found in participants with high salt intake (salt intake ≥8 g/day) compared with those in non-high salt intake. Conclusion: Our study showed that the sodium excretion by peritoneal dialysis was positively correlated with dietary sodium intake in PD patients. The high salt intake diet (salt intake ≥8 g/day) may lead to a faster decline of residual renal function in PD patients.
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Affiliation(s)
- Nirong Gong
- State Key Laboratory for Organ Failure Research, Division of Nephrology, National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Chun Zhou
- State Key Laboratory for Organ Failure Research, Division of Nephrology, National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jianxia Hu
- Division of Nephrology, Tungwah Hospital Affiliated to Sun Yat-Sen University, Dongguan, China
| | - Xiaohong Zhong
- State Key Laboratory for Organ Failure Research, Division of Nephrology, National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhixiu Yi
- State Key Laboratory for Organ Failure Research, Division of Nephrology, National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Tingting Zhang
- State Key Laboratory for Organ Failure Research, Division of Nephrology, National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Cong Yang
- State Key Laboratory for Organ Failure Research, Division of Nephrology, National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yanhong Lin
- State Key Laboratory for Organ Failure Research, Division of Nephrology, National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jianwei Tian
- State Key Laboratory for Organ Failure Research, Division of Nephrology, National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xianhui Qin
- State Key Laboratory for Organ Failure Research, Division of Nephrology, National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Liping Hu
- State Key Laboratory for Organ Failure Research, Division of Nephrology, National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jianping Jiang
- State Key Laboratory for Organ Failure Research, Division of Nephrology, National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
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157
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Lu Y, Wang L, Wang H, Gu J, Ma ZJ, Lian Z, Zhang Z, Krumholz H, Sun N. Effectiveness of an impedance cardiography guided treatment strategy to improve blood pressure control in a real-world setting: results from a pragmatic clinical trial. Open Heart 2021; 8:openhrt-2021-001719. [PMID: 34580169 PMCID: PMC8477318 DOI: 10.1136/openhrt-2021-001719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/02/2021] [Indexed: 11/06/2022] Open
Abstract
Objective To test the effectiveness of an impedance cardiography (ICG) guided treatment strategy on improving blood pressure (BP) control in real-world clinical practice. Design A single-centre, pragmatic randomised trial. Setting A hypertension clinic of the Peking University People’s Hospital in Beijing, China. Participants Adults who sought outpatient care for hypertension in the hypertension clinic at the Peking University People’s Hospital between June and December 2019. Interventions A computerised clinical decision support of recommending treatment choices to providers based on patients’ haemodynamic profiles measured by ICG. Main outcome measures Changes in systolic BP (SBP) and diastolic BP (DBP) levels at the follow-up visit 4–12 weeks after baseline. Secondary outcomes included achievement of BP goal of <140/90 mm Hg and the changes in BP by baseline BP, age, sex and body mass index (BMI). Results A total of 102 adults (mean age was 54±14 years; 41% were women) completed the study. The mean baseline SBP was 150.9 (SD of 11.5) mm Hg and mean baseline DBP was 91.1 (11.3) mm Hg. At the follow-up visit, the mean SBP and DBP decreased by 19.9 and 11.3 mm Hg in the haemodynamic group, as compared with 12.0 and 4.9 mm Hg in the standard care group (p value for difference between groups <0.001). The proportion of patients achieving BP goal of <140/90 mm Hg in the haemodynamic group was 67%, as compared with 41% in the standard care group (p=0.017). The haemodynamic group had a larger effect on BP reduction consistently across subgroups by age, sex, BMI and baseline BP. Conclusions An ICG-guided treatment strategy led to greater reductions in BP levels than were observed with standard care in a real-world population of outpatients with hypertension. There is a need for further validation of this strategy for improving blood pressure treatment selection. Trial registration number NCT04715698.
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Affiliation(s)
- Yuan Lu
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA.,Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, USA
| | - Luyan Wang
- Department of Cardiology and Hypertension, Peking University People's Hospital, Beijing, China
| | - Hongyi Wang
- Department of Cardiology and Hypertension, Peking University People's Hospital, Beijing, China
| | - Jianlei Gu
- SJTU-Yale Joint Center for Biostatistics, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Engineering Research Center for Big Data in Pediatric Precision Medicine, Shanghai, China
| | - Zheng J Ma
- SJTU-Yale Joint Center for Biostatistics, Shanghai Jiao Tong University, Shanghai, China.,Department of Research & Development, Beijing Li-Heng Medical Technologies, Ltd, Beijing, China
| | - Zheng Lian
- Department of Research & Development, Beijing Li-Heng Medical Technologies, Ltd, Beijing, China
| | - Zhiying Zhang
- Department of Cardiology, Beijing Tiantan Puhua Hospital, Beijing, China
| | - Harlan Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, USA.,Department of Health Policy and Management, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ningling Sun
- Department of Cardiology and Hypertension, Peking University People's Hospital, Beijing, China
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158
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Yu Y, Lan T, Wang D, Fang W, Tao Y, Li M, Huang X, Zhou W, Wang T, Zhu L, Bao H, Cheng X. The association of lipid ratios with hyperuricemia in a rural Chinese hypertensive population. Lipids Health Dis 2021; 20:121. [PMID: 34587966 PMCID: PMC8482679 DOI: 10.1186/s12944-021-01556-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 09/14/2021] [Indexed: 01/23/2023] Open
Abstract
Background Current studies support lipid ratios [the total cholesterol (TC)/high-density lipoprotein cholesterol (HDL-C) ratio; the triglyceride (TG)/HDL-C ratio; the low-density lipoprotein cholesterol (LDL -C)/HDL-C ratio; and non-HDL-C] as reliable indicators of cardiovascular disease, stroke, and diabetes. However, whether lipid ratios could serve as markers for hyperuricemia (HUA) remains unclear due to limited research. This study aimed to explore the association between lipid ratios and HUA in hypertensive patients. Methods The data from 14,227 Chinese hypertensive individuals in the study were analyzed. Multiple logistic regression analysis and smooth curve fitting models examined the relationship between lipid ratios and HUA. Results The results showed positive associations between the lipid ratios and HUA (all P < 0.001). Furthermore, lipid ratios were converted from continuous variables to tertiles. Compared to the lowest tertile, the fully adjusted ORs (95 % CI) of the TC/HDL-C ratio, the TG/HDL-C ratio, the LDL-C/HDL-C ratio, and non-HDL-C in the highest tertile were 1.79 (1.62, 1.99), 2.09 (1.88, 2.32), 1.67 (1.51, 1.86), and 1.93 (1.74, 2.13), respectively (all P < 0.001). Conclusions The study suggested that high lipid ratios (TC/HDL-C ratio, TG/HDL-C ratio, LDL-C/HDL-C ratio, and non-HDL-C) are associated with HUA in a Chinese hypertensive population. This study’s findings further expand the scope of the application of lipid ratios. These novel and essential results suggest that lipid ratio profiles might be potential and valuable markers for HUA. Trial registration No. ChiCTR1800017274. Registered July 20, 2018. Supplementary Information The online version contains supplementary material available at 10.1186/s12944-021-01556-z.
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Affiliation(s)
- Yu Yu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Tian Lan
- Department of Health Care Management, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Dandan Wang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Wangsheng Fang
- Wuyuan County Health Committee, Wuyuan of Jiangxi, Nanchang, China
| | - Yu Tao
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Minghui Li
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xiao Huang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Wei Zhou
- Center for Prevention and Treatment of Cardiovascular Diseases, Nanchang of Jiangxi, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Tao Wang
- Center for Prevention and Treatment of Cardiovascular Diseases, Nanchang of Jiangxi, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lingjuan Zhu
- Center for Prevention and Treatment of Cardiovascular Diseases, Nanchang of Jiangxi, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Huihui Bao
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China. .,Center for Prevention and Treatment of Cardiovascular Diseases, Nanchang of Jiangxi, The Second Affiliated Hospital of Nanchang University, Nanchang, China.
| | - Xiaoshu Cheng
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China. .,Center for Prevention and Treatment of Cardiovascular Diseases, Nanchang of Jiangxi, The Second Affiliated Hospital of Nanchang University, Nanchang, China.
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159
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Wu D, An J, Yu P, Lin H, Ma L, Duan H, Deng N. Patterns for Patient Engagement with the Hypertension Management and Effects of Electronic Health Care Provider Follow-up on These Patterns: Cluster Analysis. J Med Internet Res 2021; 23:e25630. [PMID: 34581680 PMCID: PMC8512186 DOI: 10.2196/25630] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/10/2021] [Accepted: 08/10/2021] [Indexed: 02/06/2023] Open
Abstract
Background Hypertension is a long-term medical condition. Electronic and mobile health care services can help patients to self-manage this condition. However, not all management is effective, possibly due to different levels of patient engagement (PE) with health care services. Health care provider follow-up is an intervention to promote PE and blood pressure (BP) control. Objective This study aimed to discover and characterize patterns of PE with a hypertension self-management app, investigate the effects of health care provider follow-up on PE, and identify the follow-up effects on BP in each PE pattern. Methods PE was represented as the number of days that a patient recorded self-measured BP per week. The study period was the first 4 weeks for a patient to engage in the hypertension management service. K-means algorithm was used to group patients by PE. There was compliance follow-up, regular follow-up, and abnormal follow-up in management. The follow-up effect was calculated by the change in PE (CPE) and the change in systolic blood pressure (CSBP, SBP) before and after each follow-up. Chi-square tests and z scores were used to ascertain the distribution of gender, age, education level, SBP, and the number of follow-ups in each cluster. The follow-up effect was identified by analysis of variances. Once a significant effect was detected, Bonferroni multiple comparisons were further conducted to identify the difference between 2 clusters. Results Patients were grouped into 4 clusters according to PE: (1) PE started low and dropped even lower (PELL), (2) PE started high and remained high (PEHH), (3) PE started high and dropped to low (PEHL), and (4) PE started low and rose to high (PELH). Significantly more patients over 60 years old were found in the PEHH cluster (P≤.05). Abnormal follow-up was significantly less frequent (P≤.05) in the PELL cluster. Compliance follow-up and regular follow-up can improve PE. In the clusters of PEHH and PELH, the improvement in PE in the first 3 weeks and the decrease in SBP in all 4 weeks were significant after follow-up. The SBP of the clusters of PELL and PELH decreased more (–6.1 mmHg and –8.4 mmHg) after follow-up in the first week. Conclusions Four distinct PE patterns were identified for patients engaging in the hypertension self-management app. Patients aged over 60 years had higher PE in terms of recording self-measured BP using the app. Once SBP reduced, patients with low PE tended to stop using the app, and a continued decline in PE occurred simultaneously with the increase in SBP. The duration and depth of the effect of health care provider follow-up were more significant in patients with high or increased engagement after follow-up.
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Affiliation(s)
- Dan Wu
- College of Biomedical Engineering and Instrument Science, Ministry of Education Key Laboratory of Biomedical Engineering, Zhejiang University, Hangzhou, China
| | - Jiye An
- College of Biomedical Engineering and Instrument Science, Ministry of Education Key Laboratory of Biomedical Engineering, Zhejiang University, Hangzhou, China
| | - Ping Yu
- School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia
| | - Hui Lin
- College of Biomedical Engineering and Instrument Science, Ministry of Education Key Laboratory of Biomedical Engineering, Zhejiang University, Hangzhou, China
| | - Li Ma
- General Hospital of Ningxia Medical University, Yinchuan, China
| | - Huilong Duan
- College of Biomedical Engineering and Instrument Science, Ministry of Education Key Laboratory of Biomedical Engineering, Zhejiang University, Hangzhou, China
| | - Ning Deng
- College of Biomedical Engineering and Instrument Science, Ministry of Education Key Laboratory of Biomedical Engineering, Zhejiang University, Hangzhou, China
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160
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Liu S, Yuan H, Jiang C, Xu J, Qiu X, Luo J. The blood pressure control and arteriosclerotic cardiovascular risk among Chinese community hypertensive patients. Sci Rep 2021; 11:19066. [PMID: 34561523 PMCID: PMC8463712 DOI: 10.1038/s41598-021-98745-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 09/14/2021] [Indexed: 12/04/2022] Open
Abstract
The present study aimed to describe the blood pressure (BP) control rate and 10-years arteriosclerotic cardiovascular disease (ASCVD) risk estimation among community hypertensive patients. A total of 196,803 subjects were enrolled. The control rates calculated as the intensive (SBP < 130 mmHg and DBP < 80 mmHg) and standard (SBP < 140 mmHg and DBP < 90 mmHg) threshold. Multivariable logistic analysis was employed to assess the associations between cardiovascular factors and BP control. Sensitivity, specificity and Youden’s index were used to identify the ability of high risk of ASCVD estimation by different thresholds. The control rate was 16.34% and 50.25% by the intensive and standard threshold, respectively. Besides regular medication, the risk factors for BP control included older age, male, unhealthy lifestyle, obesity, dyslipidemia and abnormal FPG. 25.08% of subjects had high risk of 10-years ASCVD estimation. The sensitivity, specificity and Youden’s index of intensive threshold was 84.37%, 16.15% and 0.51%, and were significantly different from 50.55%, 50.42% and 0.98% of the standard threshold, respectively. Half of community hypertensive patients did not control BP, and nearly a quarter have high risk of 10-years ASCVD risk estimation. The intensive threshold resulted in a one-third reduction in the control rate compared to the standard threshold. No matter which threshold was used, a single BP control status seemed not a suitable indicator for identification of high risk of 10-years ASCVD risk estimation.
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Affiliation(s)
- Shijun Liu
- Department of Chronic and Non-Infection Disease Control and Prevention, Hangzhou Center for Disease Control and Prevention, Mingshi Road No.568, Hangzhou, 310021, China.
| | - Hanyan Yuan
- Gongshu District Center for Disease Control and Prevention, Hangzhou, China
| | - Caixia Jiang
- Department of Chronic and Non-Infection Disease Control and Prevention, Hangzhou Center for Disease Control and Prevention, Mingshi Road No.568, Hangzhou, 310021, China
| | - Jue Xu
- Department of Chronic and Non-Infection Disease Control and Prevention, Hangzhou Center for Disease Control and Prevention, Mingshi Road No.568, Hangzhou, 310021, China
| | - Xin Qiu
- Department of Chronic and Non-Infection Disease Control and Prevention, Hangzhou Center for Disease Control and Prevention, Mingshi Road No.568, Hangzhou, 310021, China
| | - Jun Luo
- Department of Chronic and Non-Infection Disease Control and Prevention, Hangzhou Center for Disease Control and Prevention, Mingshi Road No.568, Hangzhou, 310021, China
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161
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Tam HL, Wong EML, Cheung K, Chung SF. Effectiveness of Text Messaging Interventions on Blood Pressure Control Among Patients With Hypertension: Systematic Review of Randomized Controlled Trials. JMIR Mhealth Uhealth 2021; 9:e24527. [PMID: 34550078 PMCID: PMC8495578 DOI: 10.2196/24527] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 01/04/2021] [Accepted: 08/05/2021] [Indexed: 01/26/2023] Open
Abstract
Background Controlling blood pressure (BP) is an international health concern, and high BP is a major contributor to cardiovascular disease mortality. Evidence has shown that educational interventions directed at patients potentially improve BP control and adherence to medications and lifestyle modifications. In addition, a text messaging intervention has a potential effect on BP control; however, the dosage of a text messaging intervention has not been determined in previous reviews, resulting in difficult application in practice. Objective This review aimed to identify the effectiveness of a text messaging intervention on hypertension management with a specific focus on the dosage of text messaging and the type of additional interventions with text messaging. Methods A systematic review was conducted and reported on in accordance with PRISMA guideline. Participants were aged 18 years and older and diagnosed with primary hypertension. The included studies used text messaging as a component of the intervention. We searched for randomized controlled trials published until June 30, 2020, from the following health-related electronic databases: Embase, Medline, CINAHL Complete, PsycINFO, and Scopus. Data were extracted for qualitative synthesis and meta-analysis. The Physiotherapy Evidence Database Scale was used to assess the methodological quality of each study, and the quality of the included studies was assessed independently by two authors. Results Twelve studies met the inclusion criteria. The overall methodological quality was fair (mean score 5.75). The frequency of text message delivery varied from daily to biweekly. Health education was identified in 4 studies as an additional intervention with text messaging. The overall results showed that the text messaging intervention significantly reduced systolic BP (SBP) but not diastolic BP (DBP). There was no significant difference in BP reduction between studies that lasted 6 months or less and those that lasted more than 7 months. Seven studies that lasted 6 months or less involving 1428 patients with hypertension were pooled for further meta-analysis. Text messages delivered at a lower frequency (once per week or less) had a small effect on SBP reduction (effect size 0.35, P<.01) and DBP reduction (effect size 0.28, P=.01). In addition, the use of a text messaging intervention halved the odds of uncontrolled BP among patients with hypertension in 6 months (odds ratio 0.46, P=.02). Conclusions This review found that a text messaging intervention was effective in BP control. One-way text messaging delivered in a weekly manner was suggested to be effective and required fewer resources. Future studies should use different forms of text message and be integrated into other interventions to improve adherence behaviors and BP control among patients with hypertension.
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Affiliation(s)
- Hon Lon Tam
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, China (Hong Kong).,Kiang Wu Nursing College of Macau, Macau, Macao
| | | | - Kin Cheung
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
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162
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Liu J, Ma X, Ren XL, Xiao H, Yan L, Li Z, Wang S. The Role of Blood Pressure in Carotid Plaque Incidence: Interactions With Body Mass Index, Age, and Sex-Based on a 7-Years Cohort Study. Front Physiol 2021; 12:690094. [PMID: 34497532 PMCID: PMC8420046 DOI: 10.3389/fphys.2021.690094] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/22/2021] [Indexed: 01/16/2023] Open
Abstract
Background: Although high blood pressure (BP) is a risk factor for carotid plaque, its long-term prognostic value might be underestimated due to its confounding interactions with BMI, age, and gender. Therefore, we conducted a 7-year prospective cohort study to evaluate the prognostic value of BP for the incidence of carotid plaque. Methods: The subjects enrolled in 2011 were free of carotid plaque at baseline and were followed up in 2018. Multivariate Cox proportional-hazards models were used to evaluate the association between BP and carotid plaque incidence. Results: During the follow-up study, the incidence of carotid plaque was 36.5%. The significant positive linear trend showed that subjects with higher BP levels at baseline were more likely to develop carotid plaques at the end. Especially in the female subpopulation, after confounders being adjusted, the carotid plaque was associated with higher BP (adjusted HR 1.52, 95% CI 1.02-2.26), pulse pressure (PP) (adjusted HR 1.15, 95% CI 0.76-1.75), and mean arterial pressure (MAP) (adjusted HR 1.44, 95% CI 1.00-2.08). The adjusted HRs of hypertension, PP, and MAP (HR 27.71, 95% CI 2.27-338.64; HR 14.47, 95% CI 1.53-137.18; HR 9.97, 95% CI 1.29-77.28) were significantly higher after the potential antagonistic interactions between BP categorical indicators and age being adjusted, respectively. Conclusion: High BP indicators might be associated with higher HRs of carotid plaque after adjusting interactions between BP indicators and BMI, age, and gender, which suggests that the incidence of carotid plaque in female adults with high BP indicators might increase significantly with the increase of age.
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Affiliation(s)
- Jian Liu
- Department of Healthcare, Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xuehua Ma
- Department of Healthcare, Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xue-Ling Ren
- Department of Respiratory, National Clinical Research Center for Geriatrics Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Hong Xiao
- Department of Healthcare, Central Military Commission, Beijing, China
| | - Leyuan Yan
- Department of Healthcare, Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhuorong Li
- Department of Healthcare, Central Military Commission, Beijing, China
| | - Shengshu Wang
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing, China
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163
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Current Status and Future Direction of Community-based Management of Hypertension in China. J Transl Int Med 2021; 9:61-64. [PMID: 34497743 PMCID: PMC8386325 DOI: 10.2478/jtim-2021-0022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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164
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Cai A, Zhu Y, Clarkson SA, Feng Y. The Use of Machine Learning for the Care of Hypertension and Heart Failure. JACC. ASIA 2021; 1:162-172. [PMID: 36338169 PMCID: PMC9627876 DOI: 10.1016/j.jacasi.2021.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/22/2021] [Accepted: 07/19/2021] [Indexed: 06/12/2023]
Abstract
Machine learning (ML) is a branch of artificial intelligence that combines computer science, statistics, and decision theory to learn complex patterns from voluminous data. In the last decade, accumulating evidence has shown the utility of ML for prediction, diagnosis, and classification of hypertension and heart failure (HF). In addition, ML-enabled image analysis has potential value in assessing cardiac structure and function in an accurate, scalable, and efficient way. Considering the high burden of hypertension and HF in China and worldwide, ML may help address these challenges from different aspects. Indeed, prior studies have shown that ML can enhance each stage of patient care, from research and development, to daily clinical practice and population health. Through reviewing the published literature, the aims of the current systemic review are to summarize the utilities of ML for the care of those with hypertension and HF.
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Key Words
- ANN, artificial neural network
- AUC, area under the curve
- CNN, convolutional neural network
- HFpEF, heart failure with preserved ejection fraction
- LRM, linear or logistic regression model
- LVDD, left ventricular diastolic dysfunction
- LVH, left ventricular hypertrophy
- ML, machine learning
- RF, random forest
- SVM, support vector machine
- algorithms
- heart failure
- hypertension machine learning
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Affiliation(s)
- Anping Cai
- Department of Cardiology, Guangdong Cardiovascular Institute, Hypertension Research Laboratory, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yicheng Zhu
- Department of Cardiology, Guangdong Cardiovascular Institute, Hypertension Research Laboratory, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Stephen A. Clarkson
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Yingqing Feng
- Department of Cardiology, Guangdong Cardiovascular Institute, Hypertension Research Laboratory, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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165
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Cai Z, Wu W, Chen Z, Fang W, Li W, Chen G, Chen Z, Wu S, Chen Y. Long-Term Body Mass Index Variability, Weight Change Slope, and Risk of Cardiovascular Outcomes: 7-Year Prospective Study in Chinese Hypertensive Subjects. Obes Facts 2021; 14:442-449. [PMID: 34461617 PMCID: PMC8546438 DOI: 10.1159/000512317] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 10/14/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The relationship between long-term body mass index (BMI) variability, weight change slope, and risk of cardiovascular outcomes in Chinese hypertensive patients has not been fully elucidated. METHODS A total of 20,737 patients with hypertension and three BMI measurements between 2006 and 2011 were included. Average real variability (ARV) was used to evaluate variability, and the subjects were divided into three groups: tertile 1 with BMI_ARV ≤0.86; tertile 2 with 0.86 < BMI_ARV ≤ 1.60; and tertile 3 with BMI_ARV >1.60. Cox proportional-hazards models were used to analyze the risk of cardiovascular and cerebrovascular diseases (CVD) in each group. RESULTS There were 1,352 cases of CVD during an average follow-up of 6.62 years. The 7-year cumulative incidence rates of CVD, stroke, and myocardial infarction (MI) in tertile 3 were 7.53, 6.13, and 1.56%, respectively. After adjustment for average BMI, weight change slope, and other traditional risk factors, the hazard ratio (HR) values for CVD, stroke, and MI in the highest tertile were 1.21 (95% CI 1.05-1.39), 1.21 (95% CI 1.04-1.38), and 1.20 (95% CI 0.88-1.62), respectively. Subgroup analysis showed that the HR values for CVD in tertile 3 were 1.71 (95% CI 1.06-2.75) and 0.98 (95% CI 0.61-1.58) in the positive and the negative weight change subjects, respectively. CONCLUSIONS Higher BMI variability was associated with increased risk of CVD in hypertensive subjects with weight gain but not in those with weight loss, independent of traditional cardiovascular risk factors.
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Affiliation(s)
- Zefeng Cai
- Shantou University Medical College, Shantou, China
| | - Weiqiang Wu
- Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Zekai Chen
- Shantou University Medical College, Shantou, China
| | - Wei Fang
- Shantou University Medical College, Shantou, China
| | - Weijian Li
- Shantou University Medical College, Shantou, China
| | | | - Zhichao Chen
- Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Youren Chen
- Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
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166
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Chen L, Chen J, Wu Y, Zhong J, Zhou F, Liu Y, Xu A, Li J, Cai H. Clinical Characteristics and Outcomes of Hypertensive Patients Infected with COVID-19: A Retrospective Study. Int J Gen Med 2021; 14:4619-4628. [PMID: 34429644 PMCID: PMC8380129 DOI: 10.2147/ijgm.s324077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/11/2021] [Indexed: 12/21/2022] Open
Abstract
Background Hypertension has been reported as the most prevalent comorbidity in patients with coronavirus disease 2019 (COVID-19). This retrospective study aims to compare the clinical characteristics and outcomes in COVID-19 patients with or without hypertension. Methods A total of 944 hospitalized patients with laboratory-confirmed COVID-19 were included from January to March 2020. Information from the medical record, including clinical features, radiographic and laboratory results, complications, treatments, and clinical outcomes, were extracted for the analysis. Results A total of 311 (32.94%) patients had comorbidity with hypertension. In COVID-19 patients with hypertension, the coexistence of type 2 diabetes (56.06% vs 43.94%), coronary heart disease (65.71% vs 34.29%), poststroke syndrome (68.75% vs 31.25%) and chronic kidney diseases (77.78% vs 22.22%) was significantly higher, while the coexistence of hepatitis B infection (13.04% vs 86.96%) was significantly lower than in COVID-19 patients without hypertension. Computed tomography (CT) chest scans show that COVID-19 patients with hypertension have higher rates of pleural effusion than those without hypertension (56.60% vs 43.40%). In addition, the levels of blood glucose [5.80 (IQR, 5.05–7.50) vs 5.39 (IQR, 4.81–6.60)], erythrocyte sedimentation rate (ESR) [28 (IQR, 17.1–55.6) vs 21.8 (IQR, 11.5–44.1), P=0.008], C-reactive protein (CRP) [17.92 (IQR, 3.11–46.6) vs 3.15 (IQR, 3.11–23.4), P=0.013] and serum amyloid A (SAA) [99.28 (IQR, 8.85–300) vs 15.97 (IQR, 5.97–236.1), P=0.005] in COVID-19 patients with hypertension were significantly higher than in patients without hypertension. Conclusion It is common for patients with COVID-19 to have the coexistence of hypertension, type 2 diabetes, coronary heart disease and so on, which may exacerbate the severity of COVID-19. Therefore, optimal management of hypertension and other comorbidities is essential for better clinical outcomes.
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Affiliation(s)
- Liqin Chen
- The Second Affiliated Hospital (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou University of Chinese Medicine, Guangzhou, 510006, Guangdong, People's Republic of China
| | - Jiankun Chen
- The Second Affiliated Hospital (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou University of Chinese Medicine, Guangzhou, 510006, Guangdong, People's Republic of China.,Guangzhou Key Laboratory of Traditional Chinese Medicine for Prevention and Treatment of Emerging Infectious Diseases, Guangzhou, 510006, Guangdong, People's Republic of China
| | - Yuwan Wu
- The Second Affiliated Hospital (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou University of Chinese Medicine, Guangzhou, 510006, Guangdong, People's Republic of China
| | - Jinyao Zhong
- The Second Affiliated Hospital (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou University of Chinese Medicine, Guangzhou, 510006, Guangdong, People's Republic of China
| | - Fuzhen Zhou
- The Second Affiliated Hospital (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou University of Chinese Medicine, Guangzhou, 510006, Guangdong, People's Republic of China
| | - Yuntao Liu
- The Second Affiliated Hospital (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou University of Chinese Medicine, Guangzhou, 510006, Guangdong, People's Republic of China.,Guangzhou Key Laboratory of Traditional Chinese Medicine for Prevention and Treatment of Emerging Infectious Diseases, Guangzhou, 510006, Guangdong, People's Republic of China
| | - Aiting Xu
- The People's Hospital of Yangjiang, Yangjiang, 529500, Guangdong, People's Republic of China
| | - Jiqiang Li
- The Second Affiliated Hospital (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou University of Chinese Medicine, Guangzhou, 510006, Guangdong, People's Republic of China.,Guangzhou Key Laboratory of Traditional Chinese Medicine for Prevention and Treatment of Emerging Infectious Diseases, Guangzhou, 510006, Guangdong, People's Republic of China
| | - Huayang Cai
- The Second Affiliated Hospital (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou University of Chinese Medicine, Guangzhou, 510006, Guangdong, People's Republic of China
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167
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Zhao Y, Yuan X, Zhong Y, Zhang Y, Zhang S, Li S, Zhao Y, Zheng W, Liu J, Xia Y, Yang Y, Liu Y, Chen F. Single-Nucleotide Polymorphisms in the 3' Untranslated Region of CORIN Associated With Cardiovascular Diseases in a Chinese Han Population: A Case-Control Study. Front Cardiovasc Med 2021; 8:625072. [PMID: 34409072 PMCID: PMC8365884 DOI: 10.3389/fcvm.2021.625072] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 07/05/2021] [Indexed: 12/13/2022] Open
Abstract
Background: Corin is a transmembrane serine protease that activates pro-forms of atrial and brain natriuretic peptides. Numerous studies have indicated that corin played an important role in cardiovascular diseases (CVDs). However, there have been few studies about the correlation between single-nucleotide polymorphisms (SNPs) in the 3' untranslated region (3'UTR) of CORIN and CVDs. The aims of this study were to investigate the associations of three SNPs (rs3749585, rs4695253, and rs12641823) in the 3'UTR of CORIN with CVDs and to find the seed regions of microRNAs (miRNAs) that bind to SNPs of CORIN. Methods and Results: A case–control study (n = 3,537) was performed in a Han population of northeastern China. CVDs included essential hypertension (EH), atrial fibrillation (AF), heart failure (HF), and coronary artery disease (CAD). Genotyping was performed using high-resolution melt analysis. In the EH-control study, rs3749585T was significantly associated with the risk of EH after adjusting for sex and age in allelic (padj = 0.049; OR: 1.113) and dominant (padj = 0.015, OR: 1.233) models. Rs4695253T was significantly associated with the risk of EH in the recessive model after adjusting for sex and age (padj = 0.005, OR: 2.084). Rs3749585T was significantly and negatively associated with AF in the dominant and additive models after adjusting for sex, age, EH, HF, T2DM, and CAD (dominant: padj = 0.009, OR: 0.762; additive: padj = 0.048, OR: 0.873). In the HF-control study and CAD-control study, none of the three SNPs was associated with HF and CAD after adjusting for covariates in any models (padj > 0.05). The levels of high-density lipoprotein (HDL) in rs4695253CC+CT were lower than the levels of HDL in rs4695253TT (42.47 ± 10.30 vs. 48.0 ± 10.24 mg/dl, padj = 0.008). The levels of total cholesterol (TC) in rs4695253CC+CT were lower than the levels of TC in rs4695253TT (164.01 ± 49.15 vs. 180.81 ± 43.92 mg/dl, padj = 0.036). Luciferase assay revealed that the relative luciferase activity of rs3749585CC-transfected cells was significantly decreased by miR-494-3p, in comparison to cells transfected with rs3749585TT (p < 0.001). A significant decrease in the relative luciferase activity of rs3749585TT reporter was observed as compared with rs3749585CC reporter in the presence of miR-1323 or miR-548o-3p (p = 0.017 and 0.012, respectively). Conclusions: We found significant associations between rs3749585T and rs4695253T and EH, between rs4695253T and the levels of TC and HDL, and between rs3749585T and AF. Hsa-miR-494-3p may serve as a potential therapeutic target for EH and AF patients in the future.
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Affiliation(s)
- Yichang Zhao
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xiaoyang Yuan
- Department of Clinical Laboratory, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yang Zhong
- Department of Cardiology, The Fifth People's Hospital of Dalian, Dalian, China
| | - Yutao Zhang
- Chinese Center for Disease Control and Prevention, National Institute of Occupational Health and Poison Control, Beijing, China
| | - Shushan Zhang
- Department of Ultrasonography, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Sisi Li
- Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases of Ministry of Education, Department of Epidemiology, School of Public Health and Health Management, Gannan Medical University, Ganzhou, China
| | - Yuanyuan Zhao
- Key Laboratory of Organ Transplantation, National Health Commission (NHC) Key Laboratory of Organ Transplantation, Key Laboratory of Organ Transplantation, Ministry of Education, Chinese Academy of Medical Sciences, Institute of Organ Transplantation, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Wenjun Zheng
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jinqiu Liu
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yunlong Xia
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yanzong Yang
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Ying Liu
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Feifei Chen
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
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Renal denervation in a patient with a highly tortuous renal artery using a guide extension catheter: a case report. BMC Cardiovasc Disord 2021; 21:388. [PMID: 34376149 PMCID: PMC8353827 DOI: 10.1186/s12872-021-02199-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/05/2021] [Indexed: 12/16/2022] Open
Abstract
Background Catheter-based renal denervation (RDN) has been introduced to treat resistant hypertension. Although the technology of RDN has been largely improved, denervation of tortuous renal arteries remains challenging. Case presentation This is a case report of a 49-year-old man with drug resistant hypertension. The patient was selected for RDN after ruling out possible causes of secondary hypertension. Computed tomography angiography showed a highly tortuous left renal artery. An Iberis multielectrode ablation catheter failed to reach the target vessel with a regular guiding catheter. A 5-French extension catheter was introduced into the proximal segment of the main left renal artery to provide extra support force, which enabled successful ablation of the highly tortuous left renal artery. His ambulatory blood pressure was significantly decreased at 1 month follow-up. Conclusions It is feasible and effective to use a guide extension catheter for denervation of highly tortuous renal arteries. The present study provides a useful method to ablate tortuous and angled renal arteries and branches.
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169
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Peng S, Lu W, Jiang X, Xu X, Wu Y. IgG deposits in the mesangium and capillary loops predict poor renal outcome in patients with IgA nephropathy: a single-center retrospective study. Ren Fail 2021; 42:902-911. [PMID: 32869693 PMCID: PMC7946043 DOI: 10.1080/0886022x.2020.1811120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Glomerular IgG deposition in patients with IgA nephropathy (IgAN) has been shown to be associated with poor renal survival; however, most published studies to date are too small-scale and inconsistent to provide guidance for clinical practice. Methods Based on renal biopsy findings, 742 patients were divided into the following groups: (i) IgA deposition alone (IgA) vs IgA + IgG deposition (IgA + IgG) and (ii) IgG co-deposition confined to the mesangium vs mesangium + capillary loops (CLs). The clinicopathological variables at biopsy and renal outcome were assessed. Results Of the 742 patients, 182 had IgG co-deposition and 51 had IgG deposits in the mesangium + CLs. Patients with IgG co-deposition were associated with severe clinical and pathological lesions, especially those with a location of IgG deposits in the mesangium +CLs. Kaplan–Meier analysis revealed that a lower renal cumulative survival rate was present in both patients with IgG co-deposition and those with a location of IgG deposits in the mesangium + CLs (all p < 0.05). Moreover, patients with a higher intensity of glomerular IgG deposits or C3 deposits or C1q deposits were also associated with a lower survival rate. A multivariate Cox regression model identified the location of IgG deposits in the mesangium + CLs as an independent risk factor for poor prognosis (HR, 2.11; 95% CI: 1.06–4.18; p = 0.005). Conclusions Glomerular IgG co-deposition and the location of glomerular IgG deposits in the mesangium + CLs were both associated with adverse renal outcomes, but only the location of glomerular IgG deposits in the CLs was an independent risk factor for poor prognosis in IgAN.
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Affiliation(s)
- Siqi Peng
- Department of Nephrology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Wen Lu
- Department of Nephrology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xiao Jiang
- Department of Nephrology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xingxin Xu
- Department of Nephrology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yonggui Wu
- Department of Nephrology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
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Yang S, Du Y, Liu Z, Zhang R, Lin X, Ouyang Y, Chen H. Triglyceride-Glucose Index and Extracellular Volume Fraction in Patients With Heart Failure. Front Cardiovasc Med 2021; 8:704462. [PMID: 34222388 PMCID: PMC8247445 DOI: 10.3389/fcvm.2021.704462] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/17/2021] [Indexed: 12/14/2022] Open
Abstract
Background: The triglyceride–glucose (TyG) index had been proposed as a reliable surrogate marker of insulin resistance. We aimed to evaluate the association between TyG index and myocardial fibrosis, which was quantified by extracellular volume (ECV) fraction using cardiovascular magnetic resonance (CMR) examination, and their prognostic value in patients with heart failure (HF). Methods: In this retrospective cohort study, 103 hospitalized HF patients were included. ECV fraction was calculated using CMR measurements and T1 mapping. TyG index was calculated using fasting triglyceride and blood glucose. The primary outcome events were defined as all-cause mortality and HF hospitalization during follow-up. Results: During the median follow-up of 12.3 months, 39 patients (37.9%) experienced primary outcome events and had higher levels of TyG index, N-terminal pro–B-type natriuretic peptide (NT-proBNP), and ECV fraction compared with those without events. Multivariate linear regression analysis showed that the TyG index was the significant factor determined for ECV fraction (rpartial = 0.36, P = 0.01). In multivariate Cox regression analysis, presence of diabetes [hazard ratio (HR) = 1.28, 95% confidence interval (CI) = 1.01–1.62], higher TyG index (HR = 2.01, 95% CI = 1.03–4.01), ECV fraction (HR = 1.73, 95% CI = 1.04–2.88), and NT-proBNP (HR = 2.13, 95% CI = 1.08–4.20) were independent risk factors for the primary outcome events. Conclusions: TyG index is a novel biomarker of myocardial fibrosis in HF patients and can be considered as a useful risk stratification metric in the management of HF.
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Affiliation(s)
- Shaomin Yang
- Department of Radiology, Shunde Hospital, Southern Medical University, Foshan, China
| | - Yongxing Du
- Department of Radiology, Shunde Hospital, Southern Medical University, Foshan, China
| | - Ziwei Liu
- Department of Radiology, Shunde Hospital, Southern Medical University, Foshan, China
| | - Rong Zhang
- Department of Radiology, Shunde Hospital, Southern Medical University, Foshan, China
| | - Xiaoxin Lin
- Department of Radiology, Shunde Hospital, Southern Medical University, Foshan, China
| | - Yufeng Ouyang
- Department of Radiology, Shunde Hospital, Southern Medical University, Foshan, China
| | - Haixiong Chen
- Department of Radiology, Shunde Hospital, Southern Medical University, Foshan, China
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171
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Shan R, Ning Y, Ma Y, Liu S, Wu J, Fan X, Lv J, Wang B, Li S, Li L. Prevalence and risk factors of atrioventricular block among 15 million Chinese health examination participants in 2018: a nation-wide cross-sectional study. BMC Cardiovasc Disord 2021; 21:289. [PMID: 34116630 PMCID: PMC8194203 DOI: 10.1186/s12872-021-02105-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/07/2021] [Indexed: 01/01/2023] Open
Abstract
Background Nationwide data on the prevalence of atrioventricular (AV) block are currently unavailable in China. Thus, we aimed to assess the prevalence and risk factors of AV block among Chinese health examination adults. Methods A total of 15,181,402 participants aged ≥ 18 years (mean age 41.5 ± 13.4 years, 53.2% men) who underwent an electrocardiogram as a part of routine health examination in 2018 were analyzed. AV block was diagnosed by physicians using 12-lead electrocardiogram. Overall and stratified prevalence (by age, sex, and city size) of all, first-, second- and third-degree AV block were calculated. Multivariable logistic regression analyses were performed to explore risk factors associated with AV block. Results AV block was observed in 88,842 participants, including 86,153 with first-degree, 2249 with second-degree and 440 with third-degree AV block. The age- and sex-standardized prevalence rate [95% confidence interval (CI)] of all, first-, second- and third-degree AV block were 7.06‰ (7.01–7.11), 6.84‰ (6.79–6.89), 0.18‰ (0.17–0.18) and 0.04‰ (0.03–0.04) respectively. After multivariable adjustment, the risk of AV block was positively associated with older age, being male, lower heart rate, higher body mass index, hypertension, diabetes and low high-density lipoprotein cholesterol. High total cholesterol was associated with a lower risk of AV block. Conclusion First-degree AV block is relatively common while severe AV block is rare in health examination adults. Besides, AV block was highly prevalent among the elderly. The risk of AV block was associated with older age, being male and metabolic factors. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02105-3.
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Affiliation(s)
- Ruiqi Shan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, 38 Xueyuan Road, Beijing, 100191, China
| | - Yi Ning
- Peking University Health Science Center Meinian Public Health Institute, 35 North Huayuan Road, Beijing, 100191, China. .,Meinian Institute of Health, Beijing, China.
| | - Yuan Ma
- Meinian Institute of Health, Beijing, China
| | - Siliang Liu
- Department of Anesthesiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jing Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, 38 Xueyuan Road, Beijing, 100191, China
| | - Xiaohan Fan
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Lv
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, 38 Xueyuan Road, Beijing, 100191, China.,Peking University Health Science Center Meinian Public Health Institute, 35 North Huayuan Road, Beijing, 100191, China.,Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China
| | - Bo Wang
- Peking University Health Science Center Meinian Public Health Institute, 35 North Huayuan Road, Beijing, 100191, China.,Meinian Institute of Health, Beijing, China
| | - Shijun Li
- Meinian Institute of Health, Beijing, China
| | - Liming Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, 38 Xueyuan Road, Beijing, 100191, China. .,Peking University Health Science Center Meinian Public Health Institute, 35 North Huayuan Road, Beijing, 100191, China. .,Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China.
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172
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Deng X, Hou H, Wang X, Li Q, Li X, Yang Z, Wu H. Development and validation of a nomogram to better predict hypertension based on a 10-year retrospective cohort study in China. eLife 2021; 10:66419. [PMID: 34047697 PMCID: PMC8163499 DOI: 10.7554/elife.66419] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/11/2021] [Indexed: 12/12/2022] Open
Abstract
Background Hypertension is a highly prevalent disorder. A nomogram to estimate the risk of hypertension in Chinese individuals is not available. Methods 6201 subjects were enrolled in the study and randomly divided into training set and validation set at a ratio of 2:1. The LASSO regression technique was used to select the optimal predictive features, and multivariate logistic regression to construct the nomograms. The performance of the nomograms was assessed and validated by AUC, C-index, calibration curves, DCA, clinical impact curves, NRI, and IDI. Results The nomogram140/90 was developed with the parameters of family history of hypertension, age, SBP, DBP, BMI, MCHC, MPV, TBIL, and TG. AUCs of nomogram140/90 were 0.750 in the training set and 0.772 in the validation set. C-index of nomogram140/90 were 0.750 in the training set and 0.772 in the validation set. The nomogram130/80 was developed with the parameters of family history of hypertension, age, SBP, DBP, RDWSD, and TBIL. AUCs of nomogram130/80 were 0.705 in the training set and 0.697 in the validation set. C-index of nomogram130/80 were 0.705 in the training set and 0.697 in the validation set. Both nomograms demonstrated favorable clinical consistency. NRI and IDI showed that the nomogram140/90 exhibited superior performance than the nomogram130/80. Therefore, the web-based calculator of nomogram140/90 was built online. Conclusions We have constructed a nomogram that can be effectively used in the preliminary and in-depth risk prediction of hypertension in a Chinese population based on a 10-year retrospective cohort study. Funding This study was supported by the Hebei Science and Technology Department Program (no. H2018206110).
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Affiliation(s)
- Xinna Deng
- Departments of Oncology & Immunotherapy, Hebei General Hospital, Shijiazhuang, China
| | - Huiqing Hou
- Physical Examination Center, Hebei General Hospital, Shijiazhuang, China
| | - Xiaoxi Wang
- Physical Examination Center, Hebei General Hospital, Shijiazhuang, China
| | - Qingxia Li
- Departments of Oncology & Immunotherapy, Hebei General Hospital, Shijiazhuang, China
| | - Xiuyuan Li
- Department of Foreign Language Teaching, Hebei Medical University, Shijiazhuang, China
| | - Zhaohua Yang
- Department of Pathology, Hebei Medical University, Shijiazhuang, China
| | - Haijiang Wu
- Department of Pathology, Hebei Medical University, Shijiazhuang, China.,Medical Practice-Education Coordination & Medical Education Research Center, Hebei Medical University, Shijiazhuang, China
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173
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Cai A, Liu L, Zhou D, Zhou Y, Tang S, Feng Y. The patterns of left ventricular alteration by adipose tissue distribution: implication for heart failure prevention. ESC Heart Fail 2021; 8:3093-3105. [PMID: 34037322 PMCID: PMC8318514 DOI: 10.1002/ehf2.13415] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/24/2021] [Accepted: 04/29/2021] [Indexed: 12/19/2022] Open
Abstract
AIMS The current study aimed to evaluate the associations between general and abdominal obesity with left ventricular (LV) structure and function and whether these associations differed by sex. METHODS AND RESULTS This is a community-based cross-sectional study, and 971 hypertensive individuals without overt cardiovascular disease were included. General obesity was defined as body mass index (BMI) ≥ 28 kg/m2 , and abdominal obesity was defined as waist circumference (WC) ≥ 90 cm for men and ≥85 cm for women. The associations between general and abdominal obesity with LV structure and function were examined using linear regression analysis, and the interaction by sex was performed. The mean age was 66.5 ± 11.4 years, and women accounted for 62%. General obese individuals (n = 205) were more likely to have concentric remodelling, LV hypertrophy, and worse diastolic function. Similar differences were observed in abdominal obese individuals (n = 593). General obesity was associated with LV end-diastolic volume, LV mass, left atrial volume, and septal E/e' ratio after adjusting for WC and clinical covariates; and abdominal obesity was associated with septal e' velocity after adjusting for BMI and clinical covariates. The associations between general obesity with LV structure and function did not differ by sex, while the magnitudes of the associations between abdominal obesity with LV mass and septal e' velocity were greater in men. CONCLUSIONS General and abdominal obesity were associated with different patterns of LV structural and functional alterations, stressing the importance of incorporating BMI and WC measurements into assessing obesity-related LV alterations.
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Affiliation(s)
- Anping Cai
- Department of Cardiology, Guangdong Cardiovascular Institute, Hypertension Research Laboratory, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Lin Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Hypertension Research Laboratory, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Dan Zhou
- Department of Cardiology, Guangdong Cardiovascular Institute, Hypertension Research Laboratory, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Yingling Zhou
- Department of Cardiology, Guangdong Cardiovascular Institute, Hypertension Research Laboratory, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Songtao Tang
- Community Health Center of Liaobu County, Dongguan, 523000, China
| | - Yingqing Feng
- Department of Cardiology, Guangdong Cardiovascular Institute, Hypertension Research Laboratory, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
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174
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Zhang H, Zhu Y, Hao M, Wang J, Wang Z, Chu X, Bao Z, Jiang X, Shi G, Wang X. The Modified Healthy Ageing Index Is Associated with Mortality and Disability: The Rugao Longevity and Ageing Study. Gerontology 2021; 67:572-580. [PMID: 34000721 DOI: 10.1159/000513931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 12/20/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The Healthy Ageing Index (HAI) has been shown not only to have wider applicability and predictive ability but also to adequately predict mortality in Western populations. There is still a lack of studies validating the applicability of the HAI in China. OBJECTIVE To evaluate the applicability of the HAI and validate whether the HAI is suitable for monitoring ageing in the elderly population in China. METHODS Data were obtained from the Rugao Longevity and Ageing Study. The modified HAI was constructed based on systolic blood pressure, chronic pulmonary diseases, cognitive function, fasting glucose, and kidney function. It was calculated in 1719 individuals aged 70-84 years at baseline. The adverse outcomes were mortality and disability. Demographic, physiologic, and clinical data were collected. Cox proportional hazards and logistic regression models were used to analyze the relationship between the modified HAI and adverse outcomes. RESULTS A total of 1,719 older adults were analyzed in our study. A total of 793 (46.13%) males were recruited. The mean age was 75.69 ± 3.93 years. At the 5-year follow-up, there were 266 deaths and 275 individuals with disabilities. In the multivariable models, the modified HAI was associated with mortality (hazard ratio = 1.11, 95% confidence interval [CI]: 1.03-1.20) and disability (odds ratio = 1.11, 95% CI: 1.05-1.18). In the sensitivity analyses, similar associations remained after imputing missing data using multiple imputation and excluding participants with major cardiovascular disease at baseline. CONCLUSION The modified HAI was a robust and independent predictor of adverse outcomes. It is a valid and feasible tool for monitoring ageing in older adults.
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Affiliation(s)
- Hui Zhang
- Ministry of Education Key Laboratory of Contemporary Anthropology, School of Life Sciences, Fudan University, Shanghai, China.,Human Phenome Institute, Fudan University, Shanghai, China
| | | | - Meng Hao
- Ministry of Education Key Laboratory of Contemporary Anthropology, School of Life Sciences, Fudan University, Shanghai, China
| | - Jiucun Wang
- Ministry of Education Key Laboratory of Contemporary Anthropology, School of Life Sciences, Fudan University, Shanghai, China.,Human Phenome Institute, Fudan University, Shanghai, China
| | | | | | - Zhijun Bao
- Shanghai Key Laboratory of Clinical Geriatric Medicine and Huadong Hospital Clinical Research Center for Geriatric Medicine, Fudan University, Shanghai, China
| | - Xiaoyan Jiang
- Key Laboratory of Arrhythmias of the Ministry of Education of China, Tongji University School of Medicine, Shanghai, China
| | | | - Xiaofeng Wang
- Ministry of Education Key Laboratory of Contemporary Anthropology, School of Life Sciences, Fudan University, Shanghai, China.,Human Phenome Institute, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine and Huadong Hospital Clinical Research Center for Geriatric Medicine, Fudan University, Shanghai, China.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
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175
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Wang Z, An J, Lin H, Zhou J, Liu F, Chen J, Duan H, Deng N. Pathway-Driven Coordinated Telehealth System for Management of Patients With Single or Multiple Chronic Diseases in China: System Development and Retrospective Study. JMIR Med Inform 2021; 9:e27228. [PMID: 33998999 PMCID: PMC8167615 DOI: 10.2196/27228] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/22/2021] [Accepted: 04/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background Integrated care enhanced with information technology has emerged as a means to transform health services to meet the long-term care needs of patients with chronic diseases. However, the feasibility of applying integrated care to the emerging “three-manager” mode in China remains to be explored. Moreover, few studies have attempted to integrate multiple types of chronic diseases into a single system. Objective The aim of this study was to develop a coordinated telehealth system that addresses the existing challenges of the “three-manager” mode in China while supporting the management of single or multiple chronic diseases. Methods The system was designed based on a tailored integrated care model. The model was constructed at the individual scale, mainly focusing on specifying the involved roles and responsibilities through a universal care pathway. A custom ontology was developed to represent the knowledge contained in the model. The system consists of a service engine for data storage and decision support, as well as different forms of clients for care providers and patients. Currently, the system supports management of three single chronic diseases (hypertension, type 2 diabetes mellitus, and chronic obstructive pulmonary disease) and one type of multiple chronic conditions (hypertension with type 2 diabetes mellitus). A retrospective study was performed based on the long-term observational data extracted from the database to evaluate system usability, treatment effect, and quality of care. Results The retrospective analysis involved 6964 patients with chronic diseases and 249 care providers who have registered in our system since its deployment in 2015. A total of 519,598 self-monitoring records have been submitted by the patients. The engine could generate different types of records regularly based on the specific care pathway. Results of the comparison tests and causal inference showed that a part of patient outcomes improved after receiving management through the system, especially the systolic blood pressure of patients with hypertension (P<.001 in all comparison tests and an approximately 5 mmHg decrease after intervention via causal inference). A regional case study showed that the work efficiency of care providers differed among individuals. Conclusions Our system has potential to provide effective management support for single or multiple chronic conditions simultaneously. The tailored closed-loop care pathway was feasible and effective under the “three-manager” mode in China. One direction for future work is to introduce advanced artificial intelligence techniques to construct a more personalized care pathway.
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Affiliation(s)
- Zheyu Wang
- Ministry of Education Key Laboratory of Biomedical Engineering, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Jiye An
- Ministry of Education Key Laboratory of Biomedical Engineering, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Hui Lin
- Ministry of Education Key Laboratory of Biomedical Engineering, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Jiaqiang Zhou
- Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Fang Liu
- General Hospital of Ningxia Medical University, Yinchuan, China
| | - Juan Chen
- General Hospital of Ningxia Medical University, Yinchuan, China
| | - Huilong Duan
- Ministry of Education Key Laboratory of Biomedical Engineering, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Ning Deng
- Ministry of Education Key Laboratory of Biomedical Engineering, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
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176
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Philip R, Beaney T, Appelbaum N, Gonzalvez CR, Koldeweij C, Golestaneh AK, Poulter N, Clarke JM. Variation in hypertension clinical practice guidelines: a global comparison. BMC Med 2021; 19:117. [PMID: 33975593 PMCID: PMC8114719 DOI: 10.1186/s12916-021-01963-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/17/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Hypertension is the largest single contributor to the global burden of disease, affecting an estimated 1.39 billion people worldwide. Clinical practice guidelines (CPGs) can aid in the effective management of this common condition, however, inconsistencies exist between CPGs, and the extent of this is unknown. Understanding the differences in CPG recommendations across income settings may provide an important means of understanding some of the global variations in clinical outcomes related to hypertension. AIMS This study aims to analyse the variation between hypertension CPGs globally. It aims to assess the variation in three areas: diagnostic threshold and staging, treatment and target blood pressure (BP) recommendations in hypertension. METHODS A search was conducted on the MEDLINE repository to identify national and international hypertension CPGs from 2010 to May 2020. An additional country-specific grey-literature search was conducted for all countries and territories of the world as identified by the World Bank. Data describing the diagnosis, staging, treatment and target blood pressure were extracted from CPGs, and variations between CPGs for these domains were analysed. RESULTS Forty-eight CPGs from across all World Bank income settings were selected for analysis. Ninety-six per cent of guidelines defined hypertension as a clinic-based BP of ≥140/90 mmHg, and 87% of guidelines recommended a target BP of < 140/90 mmHg. In the pharmacological treatment of hypertension, eight different first-step, 17 different second-step and six different third-step drug recommendations were observed. Low-income countries preferentially recommended diuretics (63%) in the first-step treatment, whilst high-income countries offered more choice between antihypertensive classes. Forty-four per cent of guidelines, of which 71% were from higher-income contexts recommended initiating treatment with dual-drug therapy at BP 160/100 mmHg or higher. CONCLUSION This study found that CPGs remained largely consistent in the definition, staging and target BP recommendations for hypertension. Extensive variation was observed in treatment recommendations, particularly for second-line therapy. Variation existed between income settings; low-income countries prescribed cheaper drugs, offered less clinician choice in medications and initiated dual therapy at later stages than higher-income countries. Future research exploring the underlying drivers of this variation may improve outcomes for hypertensive patients across clinical contexts.
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Affiliation(s)
- Richu Philip
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Thomas Beaney
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Nick Appelbaum
- Helix Centre for Design in Healthcare, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Carmen Rodriguez Gonzalvez
- Helix Centre for Design in Healthcare, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Charlotte Koldeweij
- Helix Centre for Design in Healthcare, Institute of Global Health Innovation, Imperial College London, London, UK
| | | | - Neil Poulter
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - Jonathan M Clarke
- Centre for Mathematics of Precision Healthcare, Department of Mathematics, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK.
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177
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Xiao S, Zhao C, Sun J, Dou Y, Teng M. Effect of high-quality nursing on negative psychological moods and quality of life of elderly patients with hypertension. Am J Transl Res 2021; 13:3710-3716. [PMID: 34017555 PMCID: PMC8129218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 12/08/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE This study was designed to determine the effect of high-quality nursing on negative psychological moods and quality of life of elderly patients with hypertension. METHODS In this prospective research, 89 hypertensive elderly patients were divided via random number table method, into a control group (n=44) with routine basic nursing and a research group (n=45) with high-quality nursing. The two groups were compared with respect to psychological status, quality of life, self-management ability and blood pressure control, as well as medication compliance and complications, before and after intervention. RESULTS Scores of Hamilton anxiety scale (HAMA) and Hamilton depression scale (HAMD) decreased in both groups after intervention, and the reduction was more significant in the research group (both P<0.05). After intervention, scores of various dimensions of generic quality of life inventory-74 (GQOLI-74), self-management ability and Morisky medication compliance scale (MMAS) increased in both groups, and the increase was more evident in the research group (all P<0.05). Systolic blood pressure (SBP) and diastolic blood pressure (DBP) decreased in both groups after intervention, with lower parameters in the research group (both P<0.05). The total incidence of complications in the research group was lower than that in the control group (P<0.05). CONCLUSION High-quality nursing for elderly hypertensive patients can significantly relieve their negative emotions and improve their quality of life, with a low incidence of complications.
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Affiliation(s)
- Shujun Xiao
- Department of General Practice, Hospital Affiliated 5 to Nantong University (Taizhou People’s Hospital)Taizhou, Jiangsu Province, China
| | - Chunzhi Zhao
- Department of General Practice, Hospital Affiliated 5 to Nantong University (Taizhou People’s Hospital)Taizhou, Jiangsu Province, China
| | - Jing Sun
- Department of Gastroenterology, Hospital Affiliated 5 to Nantong University (Taizhou People’s Hospital)Taizhou, Jiangsu Province, China
| | - Yangfeng Dou
- Department of General Practice, Hospital Affiliated 5 to Nantong University (Taizhou People’s Hospital)Taizhou, Jiangsu Province, China
| | - Maorong Teng
- Department of General Practice, Hospital Affiliated 5 to Nantong University (Taizhou People’s Hospital)Taizhou, Jiangsu Province, China
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Barriers to Access to Treatment for Hypertensive Patients in Primary Health Care of Less Developed Northwest China: A Predictive Nomogram. Int J Hypertens 2021; 2021:6613231. [PMID: 33953970 PMCID: PMC8062209 DOI: 10.1155/2021/6613231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 04/03/2021] [Indexed: 11/17/2022] Open
Abstract
Background This study aims to evaluate the risk factors associated with untreated hypertension and develop and internally validate untreated risk nomograms in patients with hypertension among primary health care of less developed Northwest China. Methods A total of 895 eligible patients with hypertension in primary health care of less developed Northwest China were divided into a training set (n = 626) and a validation set (n = 269). Untreated hypertension was defined as not taking antihypertensive medication during the past two weeks. Using least absolute shrinkage and selection operator (LASSO) regression model, we identified the optimized risk factors of nontreatment, followed by establishment of a prediction nomogram. The discriminative ability, calibration, and clinical usefulness were determined using the area under the receiver operating characteristic curve (AUC), calibration curve, and decision analysis. The results were assessed by internal validation in the validation set. Results Five independent risk factors were derived from LASSO regression model and entered into the nomogram: age, herdsman, family income per member, altitude of habitation, and comorbidity. The nomogram displayed a robust discrimination with an AUC of 0.859 (95% confidence interval: 0.812–0.906) and good calibration. The nomogram was clinically useful when the intervention was decided at the untreated possibility threshold of 7% to 91% in the decision curve analysis. Results were confirmed by internal validation. Conclusions Our nomogram showed favorable predictive accuracy for untreated hypertension in primary health care of less developed Northwest China and might help primary health care assess the risk of nontreatment in patients with hypertension.
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179
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Chen R, Yang J, Liu C, Sun M, Ke J, Yang Y, Shen Y, Yuan F, He C, Cheng R, Lv H, Tan H, Gao X, Zhang J, Huang L. Sex-Dependent Association Between Early Morning Ambulatory Blood Pressure Variations and Acute Mountain Sickness. Front Physiol 2021; 12:649211. [PMID: 33815152 PMCID: PMC8012890 DOI: 10.3389/fphys.2021.649211] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/01/2021] [Indexed: 01/14/2023] Open
Abstract
Background Acute high altitude (HA) exposure elicits blood pressure (BP) responses in most subjects, and some of them suffer from acute mountain sickness (AMS). However, a 24-h ambulatory BP (ABP) change and the correlation with the occurrence of AMS in different sexes are still unclear. Objectives This prospective study aimed to investigate HA induced BP responses in males and females and the relationship between AMS and 24-h ABP. Methods Forty-six subjects were matched according to demographic parameters by propensity score matching with a ratio of 1:1. All the subjects were monitored by a 24-h ABP device; the measurement was one period of 24 h BP. 2018 Lake Louise questionnaire was used to evaluate AMS. Results Both the incidence of AMS (14 [60.9%] vs. 5 [21.7%], P = 0.007) and headache (18 [78.3%] vs. 8 [34.8%], P = 0.003) were higher in females than in males. All subjects showed an elevated BP in the early morning [morning systolic BP (SBP), 114.72 ± 13.57 vs. 120.67 ± 11.10, P = 0.013]. The elevation of morning SBP variation was more significant in females than in males (11.95 ± 13.19 vs. −0.05 ± 14.49, P = 0.005), and a higher morning BP surge increase (4.69 ± 18.09 vs. −9.66 ± 16.96, P = 0.005) was observed after acute HA exposure in the female group. The increase of morning SBP was associated with AMS occurrence (R = 0.662, P < 0.001) and AMS score (R = 0.664, P = 0.001). Among the AMS symptoms, we further revealed that the incidence (R = 0.786, P < 0.001) and the severity of headache (R = 0.864, P < 0.001) are closely correlated to morning SBP. Conclusions Our study demonstrates that females are more likely to suffer from AMS than males. AMS is closely associated with elevated BP in the early morning period, which may be correlated to higher headache incidence in subjects with higher morning SBP.
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Affiliation(s)
- Renzheng Chen
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jie Yang
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Chuan Liu
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Mengjia Sun
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jingbin Ke
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yuanqi Yang
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yang Shen
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Fangzhengyuan Yuan
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Chunyan He
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Ran Cheng
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Hailin Lv
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Hu Tan
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xubin Gao
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jihang Zhang
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Lan Huang
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
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180
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Association of Depression with Uncontrolled Hypertension in Primary Care Setting: A Cross-Sectional Study in Less-Developed Northwest China. Int J Hypertens 2021; 2021:6652228. [PMID: 33854797 PMCID: PMC8019649 DOI: 10.1155/2021/6652228] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 03/03/2021] [Accepted: 03/18/2021] [Indexed: 12/14/2022] Open
Abstract
Background Hypertensive patients commonly experience comorbid depression, which is closely associated with adverse health outcomes. This study aimed to examine the association between depression and uncontrolled hypertension in primary care setting of Northwest China. Methods We used a stratified multistage random sampling method to obtain 1856 hypertensives subjects aged ≥18 years among primary care setting in Xinjiang, Northwest China, between April and October 2019. Depression was evaluated by Hospital Anxiety and Depression Scale (HADS), with a cut-off score ≥8. We related depression to uncontrolled hypertension, using multiple logistic regression, adjusting for minimally sufficient adjustment set of variables retrieved from a literature-based directed acyclic graphs (DAGs) and optimal adjustment set of variables derived from the least absolute shrinkage and selection operator (LASSO) regression. Results A total of 1,653 (89.1%) patients had uncontrolled hypertension. The prevalence of depression was 14.5% and 7.4% among patients with uncontrolled and controlled hypertension. Depression was associated with 1.12-fold increased odds of uncontrolled hypertension [odds ratio (OR) 2.12, 95% confidence interval (CI): 1.23-3.65]. The association remained significant even after adjusting for the minimal sufficient adjustment sets and the optimal adjustment set of variables. Conclusion Depression is significantly associated with uncontrolled hypertension in primary care setting of northwest China. The integrated management of depression and hypertension in the setting might be warranted.
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181
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Use of Salt-Restriction Spoons and Its Associations with Urinary Sodium and Potassium in the Zhejiang Province of China: Results of a Population-Based Survey. Nutrients 2021; 13:nu13041047. [PMID: 33804870 PMCID: PMC8063796 DOI: 10.3390/nu13041047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/02/2021] [Accepted: 03/20/2021] [Indexed: 01/31/2023] Open
Abstract
In China, a major source of sodium is salt added during cooking. In this context, use of a salt-restriction spoon (SRS) has been promoted in public health campaigns and by health care providers. To describe use of and factors associated with SRS use, knowledge of correct use, and actual correct use. This study is a population-based, representative survey of 7512 residents, aged 18 to 69 years, of China’s Zhejiang Province. The survey, which was conducted in 2017 using a multistage random sampling strategy, collected demographic information, SRS use, and physical measurements; a 24-h urine collection was obtained from 1,496 of the participants. The mean age of the participants was 44.8 years, 50.1% were females, and over 1/3 (35.3%) were classified as hypertensive. Mean 24-h urinary sodium and potassium excretions were 167.3(72.2) mmol/24 h and 38.2(18.2) mmol/24 h, respectively. Only 12.0% (899/7512) of participants once used or were currently using SRS; of the 899 users, 73.4% knew how to use the SRS correctly, and just 46.5% actually used it correctly. SRS use was more commonly associated with behavioral factors rather than socio-demographic factors. Initiation of SRS use by health care providers was associated with correct technical knowledge of SRS. Lower sodium-to-potassium ratio was associated with SRS use, while SRS use was not associated with urinary sodium and potassium excretion. Use of SRS was uncommon in Zhejiang Province of China. Given that a common source of sodium in China is salt added during cooking, use of SRS is an appealing strategy, ideally as part of a multi-component campaign.
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182
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Detecting response shift in health-related quality of life measurement among patients with hypertension using structural equation modeling. Health Qual Life Outcomes 2021; 19:88. [PMID: 33731139 PMCID: PMC7968327 DOI: 10.1186/s12955-021-01732-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 03/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Outcomes derived from longitudinal self-reported health-related quality of life measures can be confounded by response shift. This study was aimed to detect response shift among patients with hypertension attending a community-based disease management program. METHODS 240 consecutive consulting or follow-up patients with diagnosed hypertension were recruited. The Short Form 36-item Health Survey was self-administered at 12 community health service stations at baseline and four weeks after attending the program. The 4-step structural equation modeling approach assessed response shift. RESULTS Data from 203 (84.6%) patients were eligible for analyses (mean age 65.9 ± 10.8 years, 46.3% female). The results showed uniform recalibration of social functioning ([Formula: see text](1) = 22.98, P < 0.001), and non-uniform recalibration of role limitations due to physical problems ([Formula: see text](1) = 8.84, P = 0.003), and bodily pain ([Formula: see text](1) = 17.41, P < 0.001). The effects of response shift on social functioning were calculated as "small" (effect-size = 0.35), but changed the observed changes from improvement (effect-size = 0.25) to slight deterioration (effect-size = -0.10). After accounting for the response shift effect, the general physical health of participants was improved (effect-size = 0.37), while deterioration (effect-size = -0.21) in the general mental health was also found. CONCLUSIONS Recalibration existed among patients with hypertension attending the disease management program. The interventions in the program might act as a catalyst that induced the response shift. We conclude that response shift should be considered in hypertension research with longitudinal health-related quality of life data.
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183
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Zhou T, Su J, Tao R, Qin Y, Zhou J, Lu Y, Hua Y, Jin J, Guo Y, Chen Z, Li L, Wu M. The association between daily total physical activity and risk of cardiovascular disease among hypertensive patients: a 10-year prospective cohort study in China. BMC Public Health 2021; 21:517. [PMID: 33726720 PMCID: PMC7968198 DOI: 10.1186/s12889-021-10551-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 03/01/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The effect of high levels of physical activity and relationship between daily total physical activity and the risk of cardiovascular disease (CVD) among hypertensive people were not clear. This study aimed to explore the optimum level of physical activity for CVD prevention. METHODS Data used in the present study was derived from the sub-study of China Kadoorie Biobank study (CKB) in Jiangsu province of China. The CKB was a prospective cohort study established during 2004-2008. At baseline, 53,259 participants aged 35-74 years were recruited for the CKB Jiangsu sub-study conducted in Wuzhong district of Suzhou City. Among those 53,259 participants, the 20,179 hypertensive individuals were our study population. The outcome events were cardiovascular diseases (CVDs), while the independent variable was total daily physical activity. The Cox proportional hazard models were introduced to investigate the association between total physical activity and CVDs, reporting as hazard ratios (HR) and 95% confidence intervals (CIs). RESULTS During a 10.1-year follow-up, 2419 CVD cases were identified. After adjustment for potential confounding factors, compared with participants at the lowest level of daily total physical activity, the hazard ratios for CVDs were 0.87 (95%CI: 0.79-0.97), 0.73 (95%CI: 0.65-0.83) and 0.75 (95%CI: 0.65-0.85) for participants within 2, 3 and 4 quartiles of physical activity. Such a negative association between total physical activity and CVDs were also observed among participants by gender and age-group, but within patients with stage 1 hypertension only. Moreover, the association of physical activity with CVDs was U-shape and the lowest HR (0.63, 95%CI: 0.54-0.74) was observed at 35.4 MET-h/d of total physical activity. CONCLUSIONS Total daily physical activity was negatively associated with CVDs among hypertensive adults in China, and this association was U-shape. It has some public health implications that community-based total physical activity intervention campaigns can be of help for CVDs prevention among hypertensive people in China.
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Affiliation(s)
- Tingyu Zhou
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Jian Su
- Department of Non-communicable Chronic Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009, China
| | - Ran Tao
- Department of Non-communicable Chronic Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009, China
| | - Yu Qin
- Department of Non-communicable Chronic Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009, China
| | - Jinyi Zhou
- Department of Non-communicable Chronic Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009, China
| | - Yan Lu
- Department of Non-communicable Chronic Disease Control and Prevention, Suzhou City Center for Disease Control and Prevention, Suzhou, 215004, China
| | - Yujie Hua
- Department of Non-communicable Chronic Disease Control and Prevention, Suzhou City Center for Disease Control and Prevention, Suzhou, 215004, China
| | - Jianrong Jin
- Wuzhong District of Suzhou City Center for Disease Control and Prevention, Suzhou, 215100, China
| | - Yu Guo
- Chinese Academy of Medical Sciences, Beijing, 102308, China
| | - Zhengming Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK
| | - Liming Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, 100191, China
| | - Ming Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, 211166, China.
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184
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Sudharsanan N, Theilmann M, Kirschbaum TK, Manne-Goehler J, Azadnajafabad S, Bovet P, Chen S, Damasceno A, De Neve JW, Dorobantu M, Ebert C, Farzadfar F, Gathecha G, Gurung MS, Jamshidi K, Jørgensen JM, Labadarios D, Lemp J, Lunet N, Mwangi JK, Moghaddam SS, Bahendeka SK, Zhumadilov Z, Bärnighausen T, Vollmer S, Atun R, Davies JI, Geldsetzer P. Variation in the Proportion of Adults in Need of Blood Pressure-Lowering Medications by Hypertension Care Guideline in Low- and Middle-Income Countries: A Cross-Sectional Study of 1 037 215 Individuals From 50 Nationally Representative Surveys. Circulation 2021; 143:991-1001. [PMID: 33554610 PMCID: PMC7940589 DOI: 10.1161/circulationaha.120.051620] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 11/24/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Current hypertension guidelines vary substantially in their definition of who should be offered blood pressure-lowering medications. Understanding the effect of guideline choice on the proportion of adults who require treatment is crucial for planning and scaling up hypertension care in low- and middle-income countries. METHODS We extracted cross-sectional data on age, sex, blood pressure, hypertension treatment and diagnosis status, smoking, and body mass index for adults 30 to 70 years of age from nationally representative surveys in 50 low- and middle-income countries (N = 1 037 215). We aimed to determine the effect of hypertension guideline choice on the proportion of adults in need of blood pressure-lowering medications. We considered 4 hypertension guidelines: the 2017 American College of Cardiology/American Heart Association guideline, the commonly used 140/90 mm Hg threshold, the 2016 World Health Organization HEARTS guideline, and the 2019 UK National Institute for Health and Care Excellence guideline. RESULTS The proportion of adults in need of blood pressure-lowering medications was highest under the American College of Cardiology/American Heart Association, followed by the 140/90 mm Hg, National Institute for Health and Care Excellence, and World Health Organization guidelines (American College of Cardiology/American Heart Association: women, 27.7% [95% CI, 27.2-28.2], men, 35.0% [95% CI, 34.4-35.7]; 140/90 mm Hg: women, 26.1% [95% CI, 25.5-26.6], men, 31.2% [95% CI, 30.6-31.9]; National Institute for Health and Care Excellence: women, 11.8% [95% CI, 11.4-12.1], men, 15.7% [95% CI, 15.3-16.2]; World Health Organization: women, 9.2% [95% CI, 8.9-9.5], men, 11.0% [95% CI, 10.6-11.4]). Individuals who were unaware that they have hypertension were the primary contributor to differences in the proportion needing treatment under different guideline criteria. Differences in the proportion needing blood pressure-lowering medications were largest in the oldest (65-69 years) age group (American College of Cardiology/American Heart Association: women, 60.2% [95% CI, 58.8-61.6], men, 70.1% [95% CI, 68.8-71.3]; World Health Organization: women, 20.1% [95% CI, 18.8-21.3], men, 24.1.0% [95% CI, 22.3-25.9]). For both women and men and across all guidelines, countries in the European and Eastern Mediterranean regions had the highest proportion of adults in need of blood pressure-lowering medicines, whereas the South and Central Americas had the lowest. CONCLUSIONS There was substantial variation in the proportion of adults in need of blood pressure-lowering medications depending on which hypertension guideline was used. Given the great implications of this choice for health system capacity, policy makers will need to carefully consider which guideline they should adopt when scaling up hypertension care in their country.
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Affiliation(s)
- Nikkil Sudharsanan
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Michaela Theilmann
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Tabea K. Kirschbaum
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Jennifer Manne-Goehler
- Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Pascal Bovet
- Institute of Social and Preventive Medicine, Bern, Switzerland
| | - Simiao Chen
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | | | - Jan-Walter De Neve
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Maria Dorobantu
- Cardiology Department, Emergency Hospital of Bucharest, Bucharest, Romania
| | - Cara Ebert
- RWI - Leibniz Institute for Economic Research, Essen, Germany
| | | | - Gladwell Gathecha
- Division of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya
| | | | | | | | - Demetre Labadarios
- Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Julia Lemp
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Nuno Lunet
- Department of Public and Forensic Health Sciences and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Joseph K. Mwangi
- Department of Strategic National Public Health Programs, Ministry of Health, Nairobi, Kenya
| | | | | | - Zhaxybay Zhumadilov
- National Laboratory Astana, University Medical Centre, Nazarbayev University, Astana, Kazakhstan
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Sebastian Vollmer
- Department of Economics and Centre for Modern Indian Studies, University of Göttingen, Göttingen, Germany
| | - Rifat Atun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Justine I. Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, CA, USA
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185
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Liu Q. Impact of different dietary fat sources on blood pressure in Chinese adults. PLoS One 2021; 16:e0247116. [PMID: 33684108 PMCID: PMC7939266 DOI: 10.1371/journal.pone.0247116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/01/2021] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES To investigate the association between the source of dietary fat and blood pressure for Chinese people aged between 30-59 with the aim of elucidating methods of hypertension prevention. DESIGN Prospective cohort study using national survey data. PARTICIPANTS 1,104 adults aged between 30-59 with normal blood pressures in 2006 were included in the study. Adults with history of prehypertension, hypertension, or were taking hypertension drugs in 2006 were excluded. Participants with implausibly high or low daily total energy intakes (<600 kcal/d or >5000 kcal/d) were excluded. Pregnant women, breastfeeding women, and people with motor impairment were excluded. RESULTS People with abnormal blood pressure ingested a lower percent of dietary fat taken from seafood (P < 0.001) and a higher percent of dietary fat taken from fast food (P < 0.001). Dietary fat obtained from seafood and dairy products can be protective against abnormal blood pressure with a RR = 0.01 (95% CI: 0.001 to 0.25; P = 0.004) for seafood, and RR = 0.14 (95% CI: 0.04 to 0.44; P = 0.001) for egg, milk, and dairy products. CONCLUSION Seafood, egg, milk, and dairy products can be recommended as sources of dietary fat to reduce the incidence of hypertension and prehypertension while fast food should be avoided.
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Affiliation(s)
- Qiaoling Liu
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
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186
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Health-related quality of life and its related factors in coronary heart disease patients: results from the Henan Rural Cohort study. Sci Rep 2021; 11:5011. [PMID: 33658589 PMCID: PMC7930256 DOI: 10.1038/s41598-021-84554-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 01/08/2021] [Indexed: 01/31/2023] Open
Abstract
The aims were to identify the possible influencing factors of health-related quality of life (HRQoL) and its domain-specific scores in patients with coronary heart disease (CHD). A total of 1247 patients with CHD from the Henan Rural Cohort Study (n = 39,259) were included in this study. The Chinese version of the European Quality of Life Five Dimension Five level scale (EQ-5D-5L) and Visual Analogue Scale (VAS) were used to evaluate HRQoL in patients with CHD. Tobit regression, generalized linear models and binary logistic regression were applied to determine the potential factors influencing the EQ-5D utility, as well as each domain, and the VAS. CHD patients had lower per capita monthly actual income, and higher rates of diabetes mellitus, stroke, anxiety and poor sleep quality, which significantly decreased EQ-5D index and VAS scores. In addition, sex, older age, education, not having a spouse, ever drinking alcohol, a high-fat diet, physical activity, hypertension and depression affected the various domain-specific EQ-5D scores in CHD patients. CHD patients in rural areas have a lower HRQoL. Factors associated with the EQ-5D index, including each domain, and the VAS need attention. CHD patients in rural areas need to be managed systematically.
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187
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Chen Y, Ye P, Liu X, Gong C, Li C, Yuan Y, Zheng H, Xu X, Dong H, Kong Q, Yan Y, Mi J. Characteristics of pediatric inpatients with primary and secondary hypertension. Pediatr Investig 2021; 5:28-32. [PMID: 33778424 PMCID: PMC7983996 DOI: 10.1002/ped4.12249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/14/2021] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE Extensive population-based studies have explored the prevalence of primary hypertension (HTN) in children and adolescents. However, there is little published data on the characteristics of different types of pediatric HTN and the causes of secondary HTN. OBJECTIVE To investigate the characteristics of different types of pediatric HTN and the causes of secondary HTN in a hospital setting. METHODS The study cohort comprised pediatric inpatients (<18 years of age) discharged with a diagnosis of HTN from Beijing Children's Hospital during 2015-2020. Pediatric patients with HTN were allocated to secondary and primary HTN groups on the basis of comprehensive analyses of their diagnoses, family history of HTN, and findings on physical examination, as documented in their medical records. The Mann-Whitney U test, χ 2 and Fisher's exact test were used to assess differences in characteristics of patients with different HTN types and causes of secondary HTN. RESULTS Data of 1470 inpatients with HTN from 18 clinical departments were included in the analysis. Among them, 458 (31.2%) had primary HTN, and 1012 (68.8%) had secondary HTN. Compared with patients had primary HTN, children with secondary HTN were younger and had lower body mass indexes and longer lengths of stay. Moreover, children with primary HTN had mostly been managed by the Endocrinology and Cardiology Departments, 75.8% of them having obesity-related comorbidities. In contrast, most patients with secondary HTN had been managed by the Nephrology Department, renal diseases being the leading cause of their HTN (46.3%). INTERPRETATION Secondary HTN is more common than primary HTN in pediatric clinical settings, renal diseases being the leading cause of secondary HTN.
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Affiliation(s)
- Yijun Chen
- Department of Non‐communicable Disease ManagementBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Peiyu Ye
- Department of Non‐communicable Disease ManagementBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Xiaorong Liu
- Department of NephrologyBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Chunxiu Gong
- Department of Endocrinology, Genetics and MetabolismBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Caifeng Li
- Department of RheumatologyBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Yue Yuan
- Department of CardiologyBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Huyong Zheng
- Hematology Oncology CenterBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Xin Xu
- Information CenterBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Hongbo Dong
- Department of Non‐communicable Disease ManagementBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Qin Kong
- Information CenterBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Yinkun Yan
- Department of Non‐communicable Disease ManagementBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Jie Mi
- Department of Non‐communicable Disease ManagementBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
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Li C, Chen K, Cornelius V, Tomeny E, Wang Y, Yang X, Yuan X, Qin R, Yu D, Wu Z, Wang D, Chen T. Applicability and cost-effectiveness of the Systolic Blood Pressure Intervention Trial (SPRINT) in the Chinese population: A cost-effectiveness modeling study. PLoS Med 2021; 18:e1003515. [PMID: 33661907 PMCID: PMC7971845 DOI: 10.1371/journal.pmed.1003515] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 03/18/2021] [Accepted: 02/02/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The Systolic Blood Pressure Intervention Trial (SPRINT) showed significant reductions in death and cardiovascular disease (CVD) risk with a systolic blood pressure (SBP) goal of <120 mm Hg compared with a SBP goal of <140 mm Hg. Our study aimed to assess the applicability of SPRINT to Chinese adults. Additionally, we sought to predict the medical and economic implications of this intensive SBP treatment among those meeting SPRINT eligibility. METHODS AND FINDINGS We used nationally representative baseline data from the China Health and Retirement Longitudinal Study (CHARLS) (2011-2012) to estimate the prevalence and number of Chinese adults aged 45 years and older who meet SPRINT criteria. A validated microsimulation model was employed to project costs, clinical outcomes, and quality-adjusted life-years (QALYs) among SPRINT-eligible adults, under 2 alternative treatment strategies (SBP goal of <120 mm Hg [intensive treatment] and SBP goal of <140 mm Hg [standard treatment]). Overall, 22.2% met the SPRINT criteria, representing 116.2 (95% CI 107.5 to 124.8) million people in China. Of these, 66.4%, representing 77.2 (95% CI 69.3 to 85.0) million, were not being treated for hypertension, and 22.9%, representing 26.6 (95% CI 22.4 to 30.7) million, had a SBP between 130 and 139 mm Hg, yet were not taking antihypertensive medication. We estimated that over 5 years, compared to standard treatment, intensive treatment would reduce heart failure incidence by 0.84 (95% CI 0.42 to 1.25) million cases, reduce CVD deaths by 2.03 (95% CI 1.44 to 2.63) million cases, and save 3.84 (95% CI 1.53 to 6.34) million life-years. Estimated reductions of 0.069 (95% CI -0.28, 0.42) million myocardial infarction cases and 0.36 (95% CI -0.10, 0.82) million stroke cases were not statistically significant. Furthermore, over a lifetime, moving from standard to intensive treatment increased the mean QALYs from 9.51 to 9.87 (an increment of 0.38 [95% CI 0.13 to 0.71]), at a cost of Int$10,997 per QALY gained. Of all 1-way sensitivity analyses, high antihypertensive drug cost and lower treatment efficacy for CVD death resulted in the 2 most unfavorable results (Int$25,291 and Int$18,995 per QALY were gained, respectively). Simulation results indicated that intensive treatment could be cost-effective (82.8% probability of being below the willingness-to-pay threshold of Int$16,782 [1× GDP per capita in China in 2017]), with a lower probability in people with SBP 130-139 mm Hg (72.9%) but a higher probability among females (91.2%). Main limitations include lack of specific SPRINT eligibility information in the CHARLS survey, uncertainty about the implications of different blood pressure measurement techniques, the use of several sources of data with large reliance on findings from SPPRINT, limited information about the serious adverse event rate, and lack of information and evidence for medication effectiveness on renal disease. CONCLUSIONS Although adoption of the SPRINT treatment strategy would increase the number of Chinese adults requiring SBP treatment intensification, this approach has the potential to prevent CVD events, to produce gains in life-years, and to be cost-effective under common thresholds.
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Affiliation(s)
- Chao Li
- Department of Epidemiology and Health Statistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
- Global Health Trials Unit, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Kangyu Chen
- Department of Cardiology, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Victoria Cornelius
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - Ewan Tomeny
- Centre for Applied Health Research & Delivery, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Yang Wang
- Medical Research and Biometrics Centre, Fuwai Hospital, National Centre for Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaowei Yang
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
| | - Xiaodan Yuan
- Department of Health Education, Jiangsu Province Hospital of Integration of Chinese and Western Medicine, Nanjing, China
| | - Rui Qin
- Department of Health Education, Jiangsu Province Hospital of Integration of Chinese and Western Medicine, Nanjing, China
| | - Dahai Yu
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Zhenqiang Wu
- Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
| | - Duolao Wang
- Global Health Trials Unit, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Tao Chen
- Department of Epidemiology and Health Statistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
- Global Health Trials Unit, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- * E-mail:
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Incidence and Risk Factors of Hyperuricemia among 2.5 Million Chinese Adults during the Years 2017-2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052360. [PMID: 33671018 PMCID: PMC7957707 DOI: 10.3390/ijerph18052360] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 12/13/2022]
Abstract
Objective: To assess the incidence and risk factors of hyperuricemia among Chinese adults in 2017-2018. Methods: A total of 2,015,847 adults (mean age 41.2 ± 12.7, 53.1% men) with serum uric acid concentrations assayed on at least two separate days in routine health examinations during 2017-2018 were analyzed. Hyperuricemia was defined as fasting serum urate concentration >420 μmol/L in men and >360 μmol/L in women. The overall and sex-specific incidence rate were stratified according to age, urban population size, geographical region, annual average temperature and certain diseases. Logistic regression analyses were performed to explore risk factors associated with hyperuricemia. Results: 225,240 adults were newly diagnosed with hyperuricemia. The age- and sex-standardized incidence rate per 100 person-years was 11.1 (95%CI: 11.0-11.1) (15.2 for men and 6.80 for women). The risk of hyperuricemia was positively associated with younger age, being male, larger urban population size, higher annual temperature, higher body mass index, lower estimate glomerular filtration rate, hypertension, dyslipidemia and fat liver. Conclusions: The incidence of hyperuricemia was substantial and exhibited a rising trend among younger adults, especially among men. Socioeconomic and geographic variation in incidence were observed. The risk of hyperuricemia was associated with estimate glomerular filtration rate, fat liver and metabolic factors.
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Li AL, Peng Q, Shao YQ, Fang X, Zhang YY. The interaction on hypertension between family history and diabetes and other risk factors. Sci Rep 2021; 11:4716. [PMID: 33633182 PMCID: PMC7907071 DOI: 10.1038/s41598-021-83589-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 01/19/2021] [Indexed: 02/07/2023] Open
Abstract
To explore the individual effect and interaction of diabetes and family history and other risk factors on hypertension in Han in Shanghai China. The method of case–control study with l:l matched pairs was used, 342 cases of hypertension and 342 controls were selected and investigate their exposed factors with face-to-face. The method of epidemiology research was used to explore the individual effect and interaction of diabetes and family history and other risk factors on hypertension. The individual effect of family history (OR = 4.103, 95%CI 2.660–6.330), diabetes (OR = 4.219, 95%CI 2.926–6.083), personal taste (OR = 1.256, 95%CI 1.091–1.593), drinking behavior (OR = 1.391, 95%CI 1.010–1.914) and smoking behavior (OR = 1.057, 95%CI 1.00–1.117) were significant (p < 0.05). But individual effect of sex, education, occupation, work/life pressure, environmental noise, sleeping time and sports habit were not significant (p > 0.05). The OR of interaction between FH and DM to hypertension was 16.537 (95%CI 10.070–21.157), between FH and drinking behavior was 4.0 (95%CI 2.461–6.502), FH and sport habit was 7.668 (95%CI 3.598–16.344), FH and personal taste was 6.521 (95%CI 3.858–11.024), FH and smoking behavior was 5.526 (95%CI 3.404–8.972), FH and work/life pressure was 4.087 (95%CI 2.144–7.788). The SI of FH and DM was 2.27, RERI was 8.68, AP was 52.48% and PAP was 55.86%. FH and DM, personal taste, smoking behavior had positive interaction on hypertension, but FH and sport habits, drinking behavior, work/life pressure had reverse interaction on hypertension. FH and diabetes were very important risk factors with significant effect for hypertension. FH and diabetes, personal taste, smoking behavior had positive interaction on hypertension, but FH and sport habits, drinking behavior, work/life pressure had reverse interaction on hypertension.
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Affiliation(s)
- An-le Li
- Jiading District Center for Disease Control and Prevention, Shanghai, China.
| | - Qian Peng
- Jiading District Center for Disease Control and Prevention, Shanghai, China
| | - Yue-Qin Shao
- Jiading District Center for Disease Control and Prevention, Shanghai, China
| | - Xiang Fang
- Jiading District Center for Disease Control and Prevention, Shanghai, China
| | - Yi-Ying Zhang
- Jiading District Center for Disease Control and Prevention, Shanghai, China
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Liu W, Liu W, Wang S, Tong H, Yuan J, Zou Z, Liu J, Yang D, Xie Z. Prevalence and Risk Factors Associated with Hyperuricemia in the Pearl River Delta, Guangdong Province, China. Risk Manag Healthc Policy 2021; 14:655-663. [PMID: 33623455 PMCID: PMC7896760 DOI: 10.2147/rmhp.s293913] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/01/2021] [Indexed: 12/18/2022] Open
Abstract
Background In China, the prevalence of HUA in the Pearl River Delta (PRD) region of Guangdong Province has not been extensively investigated. Therefore, this study investigated the prevalence of HUA and its related factors among people aged 20–99 years in nine cities in the PRD. Materials and Methods We selected 6491 health check participants from 9 cities in the PRD and collected participants’ anthropometric and biochemical test results for a cross-sectional study. We included 6491 participants and assessed their blood pressure (BP), body mass index (BMI), total cholesterol (TC), triglycerides (TG), glucose (Glu) and serum uric acid (UA) to analyze the regional prevalence of HUA and its related factors. HUA was indicated when fasting serum UA level was >420 μmol/L in men and >360 μmol/L in women. Results Overall prevalence of HUA in our cohort was 34.05%; prevalence was higher in men than in women (41.53% vs 26.14%, P < 0.001). Characteristics associated with HUA were hypertension (odds ratio (OR), 5.506; 95% confidence interval (CI), 4.402–6.889), higher body mass index (BMI; OR: 1.746; 95% CI: 1.560–1.954), age 31–40 years (OR: 0.829; 95% CI: 0.706–0.973), age 61–70 years (OR: 1.434; 95% CI: 1.194–1.722) and age ≥71 years (OR: 1.742; 95% CI: 1.397–2.173). In all subjects, serum UA was positively correlated with Glu, TG and TC. After we adjusted for age, BMI and BP, multivariate logistic regression analysis showed that HUA risk factors were high TC (OR: 1.770; 95% CI: 1.459–2.147) and TG (OR: 1.961; 95% CI: 1.632–2.357) in men; and high Glu (OR: 1.508; 95% CI: 1.084–2.099), TC (OR: 1.341; 95% CI: 1.084–1.660) and TG (OR: 1.680; 95% CI: 1.290–2.187) in women. Conclusion The prevalence of HUA was relatively high in the PRD of Guangdong Province. Relevant governmental bodies should focus on early diagnosis, early treatment and early intervention.
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Affiliation(s)
- Weiqi Liu
- Department of Clinical Laboratory, Maternal and Children Health Care Hospital (Huzhong Hospital) of Huadu, Guangzhou, Guangdong, 510800, People's Republic of China
| | - Weiling Liu
- Department of Clinical Laboratory, Chancheng Centre Hospital, Foshan, Guangdong, 528000, People's Republic of China
| | - Shaoling Wang
- Department of Clinical Laboratory, Taishan People's Hospital, Jiangmen, Guangdong, 529200, People's Republic of China
| | - Huichun Tong
- Department of Clinical Laboratory, Boai Hospital of Zhongshan, Zhongshan, Guangdong, 528402, People's Republic of China
| | - Jianmin Yuan
- Department of Clinical Laboratory, Humen Hospital, Dongguan, Guangdong, 523899, People's Republic of China
| | - Zhenning Zou
- Department of Clinical Laboratory, Shenzhen Maternity & Child Healthcare Hospital, Shenzhen, Guangdong, 518028, People's Republic of China
| | - Jianwen Liu
- Department of Clinical Laboratory, Huiyang Sanhe Hospital, Huizhou, Guangdong, 516211, People's Republic of China
| | - Donghai Yang
- Department of Clinical Laboratory, Sanzhao Town Health Center, Jinwan District, Zhuhai, Guangdong, 519040, People's Republic of China
| | - Zhongxing Xie
- Department of Clinical Laboratory, The Second People's Hospital of Zhaoqing, Zhaoqing, Guangdong, 526060, People's Republic of China
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Wang Y, Shi GX, Tian ZX, Liu JH, Qi YS, Tu JF, Yang JW, Wang LQ, Liu CZ. Transcutaneous electrical acupoint stimulation for high-normal blood pressure: study protocol for a randomized controlled pilot trial. Trials 2021; 22:140. [PMID: 33588904 PMCID: PMC7885337 DOI: 10.1186/s13063-021-05039-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 01/09/2021] [Indexed: 01/09/2023] Open
Abstract
Background High-normal blood pressure (BP) is associated with increased all-cause, cardiovascular mortality and frequently progresses to hypertension. Transcutaneous electrical acupoint stimulation (TEAS) might be a non-pharmaceutical therapy option to control BP. This trial aims to determine the effectiveness and safety of TEAS combined with lifestyle modification for high-normal BP. Methods/design This prospective, randomized, and parallel clinical trial will be conducted in a community service center in China. Sixty participants with high-normal BP will be randomly allocated to receive TEAS plus lifestyle modification (intervention group) or lifestyle modification alone (control group) in a 1:1 ratio. In addition to lifestyle modification, the intervention group will receive TEAS at four acupoints for 30 min, 4 times weekly for 12 weeks for a total of 48 sessions at home. The control group will receive same lifestyle modification but no TEAS. The primary outcome will be the change in mean systolic blood pressure at 12 weeks from the baseline measurement. Secondary outcomes include the change of mean diastolic blood pressure, proportion of subjects with progression to hypertension, quality of life, body mass index, and waist circumference. Adverse events during the trial will be monitored. Discussion This trial will explore the feasibility and provide potential evidence for the effectiveness and safety of TEAS plus lifestyle modification for high-normal BP. Furthermore, this pilot trial is being undertaken to determine the feasibility of a full scale definitive randomized controlled trial. The results of this study will be published in a peer-reviewed journal. Trial registration Chinese Clinical Trial Registry, ChiCTR 1900024982. Registered on August 6, 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05039-5.
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Affiliation(s)
- Yu Wang
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Chaoyang District, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China
| | - Guang-Xia Shi
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Chaoyang District, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China
| | - Zhong-Xue Tian
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Chaoyang District, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China
| | - Jun-Hong Liu
- Nanyuan Community Health Service Center, Fengtai District, Beijing, China
| | - You-Sheng Qi
- Nanyuan Community Health Service Center, Fengtai District, Beijing, China
| | - Jian-Feng Tu
- Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Dongcheng District, Beijing, China
| | - Jing-Wen Yang
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Chaoyang District, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China
| | - Li-Qiong Wang
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Chaoyang District, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China.
| | - Cun-Zhi Liu
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Chaoyang District, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China
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COVID-19 patients with hypertension are at potential risk of worsened organ injury. Sci Rep 2021; 11:3779. [PMID: 33580165 PMCID: PMC7881102 DOI: 10.1038/s41598-021-83295-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 02/01/2021] [Indexed: 02/08/2023] Open
Abstract
In less than 6 months, COVID-19 spread rapidly around the world and became a global health concern. Hypertension is the most common chronic disease in COVID-19 patients, but its impact on these patients has not been well described. In this retrospective study, 82 patients diagnosed with COVID-19 were enrolled, and epidemiological, demographic, clinical, laboratory, radiological and therapy-related data were analyzed and compared between COVID-19 patients with (29 cases) or without (53 cases) hypertension. The median age of the included patients was 60.5 years, and the cohort included 49 women (59.8%) and 33 (40.2%) men. Hypertension (31 [28.2%]) was the most common chronic illness, followed by diabetes (16 [19.5%]) and cardiovascular disease (15 [18.3%]). The most common symptoms were fatigue (55 [67.1%]), dry cough (46 [56.1%]) and fever ≥ 37.3 °C (46 [56.1%]). The median time from illness onset to positive RT-PCR test was 13.0 days (range 3–25 days). There were 6 deaths (20.7%) in the hypertension group and 5 deaths (9.4%) in the nonhypertension group, and more hypertensive patients with COVID-19 (8 [27.6%]) than nonhypertensive patients (2 [3.8%]) (P = 0.002) had at least one comorbid disease. Compared with nonhypertensive patients, hypertensive patients exhibited higher neutrophil counts, serum amyloid A, C-reactive protein, and NT-proBNP and lower lymphocyte counts and eGFR. Dynamic observations indicated more severe disease and poorer outcomes after hospital admission in the hypertension group. COVID-19 patients with hypertension have increased risks of severe inflammatory reactions, serious internal organ injury, and disease progression and deterioration.
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194
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Bragg F, Halsey J, Guo Y, Zhang H, Yang L, Sun X, Pei P, Chen Y, Du H, Yu C, Clarke R, Lv J, Chen J, Li L, Chen Z. Blood pressure and cardiovascular diseases in Chinese adults with type 2 diabetes: A prospective cohort study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2021; 7:100085. [PMID: 34327415 PMCID: PMC8315364 DOI: 10.1016/j.lanwpc.2020.100085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/04/2020] [Accepted: 12/15/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Controversy persists about the relationship of blood pressure with cardiovascular diseases (CVD) in diabetes and associated disease burden. We assessed these associations among Chinese adults with type 2 diabetes (T2D). METHODS In 2004-08, the China Kadoorie Biobank recruited >512,000 adults aged 30-79 years from 10 localities across China, including 26,315 with T2D (based on self-report or plasma glucose measurement) but no prior CVD, followed-up for ~9 years. Cox regression yielded adjusted HR for major CVD and all-cause mortality associated with 10 mmHg higher usual (longer-term average) SBP. Attributable fractions were estimated to assess cardiovascular mortality burden due to uncontrolled hypertension (SBP ≥130 mmHg or DBP ≥80 mmHg). FINDINGS Overall, 75.7% of participants had self-reported (24.8%) or screen-detected (50.9%) (SBP ≥130 mmHg or DBP ≥80 mmHg) hypertension. Among individuals with self-reported hypertension, 82.3% were treated, of whom 9.3% achieved control. There were positive log-linear associations of blood pressure with CVD, with no evidence of a threshold down to ~120 mmHg for usual SBP. Each 10 mmHg higher usual SBP was associated with HR of 1.28 (95% CI 1.25-1.30), 1.18 (1.15-1.21), 1.17 (1.15-1.19) and 1.45 (1.38-1.52) for cardiovascular death (n=1807), major coronary event (n=1190), ischaemic stroke (n=4362) and intracerebral haemorrhage (n=469), respectively. There was an apparent J-shaped association with all-cause mortality (n=4503). In this diabetes population, uncontrolled hypertension accounted for 39% of cardiovascular deaths. INTERPRETATION Uncontrolled hypertension is common in Chinese adults with T2D, resulting in substantial excess risks of CVD. Improved hypertension management could avoid a large number of cardiovascular-related deaths. FUNDING Kadoorie Foundation, Wellcome Trust, MRC, BHF, CR-UK, MoST, NNSF.
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Affiliation(s)
- Fiona Bragg
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UK
| | - Jim Halsey
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UK
| | - Yu Guo
- Chinese Academy of Medical Sciences, Beijing 102308, China
| | - Hua Zhang
- Qingdao Center for Disease Control and Prevention, 175 Shandong Road, Qingdao 266033, China
| | - Ling Yang
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UK
| | - Xiaohui Sun
- Qingdao Center for Disease Control and Prevention, 175 Shandong Road, Qingdao 266033, China
| | - Pei Pei
- Chinese Academy of Medical Sciences, Beijing 102308, China
| | - Yiping Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UK
| | - Huaidong Du
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UK
| | - Canqing Yu
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - Robert Clarke
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK
| | - Jun Lv
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - Junshi Chen
- China National Center For Food Safety Risk Assessment, Beijing 100022, China
| | - Liming Li
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - Zhengming Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UK
| | - for the China Kadoorie Biobank (CKB) collaborative group (members listed in Supplementary appendix)
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UK
- Chinese Academy of Medical Sciences, Beijing 102308, China
- Qingdao Center for Disease Control and Prevention, 175 Shandong Road, Qingdao 266033, China
- School of Public Health, Peking University Health Science Center, Beijing, China
- China National Center For Food Safety Risk Assessment, Beijing 100022, China
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Liang WY, Wang LH, Wei JH, Li QL, Li QY, Liang Q, Hu NQ, Li LH. No significant association of serum klotho concentration with blood pressure and pulse wave velocity in a Chinese population. Sci Rep 2021; 11:2374. [PMID: 33504927 PMCID: PMC7840754 DOI: 10.1038/s41598-021-82258-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 01/19/2021] [Indexed: 01/14/2023] Open
Abstract
Klotho, an important anti-aging protein, may be related to elevated blood pressure (BP) and arterial stiffness. We aimed to investigate associations between the serum klotho concentration and peripheral/central BP and arterial stiffness based on the carotid–femoral pulse wave velocity (cfPWV) in a Chinese population. We invited all inhabitants aged ≥ 18 years in two Dali communities for participation. The SphygmoCor system was used to record radial arterial waveforms. Aortic waveforms were derived using a generalized transfer function. The central BP was assessed by calibrating the brachial BP, which was measured using an oscillometric device. The serum klotho concentration was measured using an enzyme-linked immunosorbent assay and logarithmically transformed. Of the 716 participants (mean age: 51.9 ± 12.6 years), 467 (65.2%) were women. The median serum klotho concentration was 381.8 pg/mL. The serum klotho concentration did not significantly differ between patients with and without hypertension (P > 0.05) and between those with and without arterial stiffness (cfPWV ≥ 10 m/s) (P > 0.05). After adjusting for confounders, the serum klotho concentration was not significantly associated with the peripheral or central BP (P > 0.05) and cfPWV (P > 0.05). Our data indicated that the serum klotho concentration was not associated with BP or cfPWV in the general Chinese population.
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Affiliation(s)
- Wan-Ying Liang
- Department of Gerontology, The First Affiliated Hospital of Dali University, Jiashibo Road 32, Dali, 671000, Yunnan Province, China
| | - Li-Hong Wang
- Department of Gerontology, The First Affiliated Hospital of Dali University, Jiashibo Road 32, Dali, 671000, Yunnan Province, China
| | - Jian-Hang Wei
- Department of Gerontology, The First Affiliated Hospital of Dali University, Jiashibo Road 32, Dali, 671000, Yunnan Province, China
| | - Qing-Lu Li
- Department of Gerontology, The First Affiliated Hospital of Dali University, Jiashibo Road 32, Dali, 671000, Yunnan Province, China
| | - Qi-Yan Li
- Department of Gerontology, The First Affiliated Hospital of Dali University, Jiashibo Road 32, Dali, 671000, Yunnan Province, China
| | - Quan Liang
- Department of Gerontology, The First Affiliated Hospital of Dali University, Jiashibo Road 32, Dali, 671000, Yunnan Province, China
| | - Nai-Qing Hu
- Department of Gerontology, The First Affiliated Hospital of Dali University, Jiashibo Road 32, Dali, 671000, Yunnan Province, China
| | - Li-Hua Li
- Department of Gerontology, The First Affiliated Hospital of Dali University, Jiashibo Road 32, Dali, 671000, Yunnan Province, China.
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Wu F, Zhang Y, Cheng Y, Lu Y, Jiang Y, Song W. Hypertension in a patient with medullary sponge kidney: A case report. Medicine (Baltimore) 2021; 100:e24305. [PMID: 33546058 PMCID: PMC7837938 DOI: 10.1097/md.0000000000024305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/24/2020] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Medullary sponge kidney (MSK) is a congenital renal disorder characterized by recurrent nephrolithiasis or nephrocalcinosis. Recently, it has been found that MSK can be also combined with other diseases, such as primary aldosteronism and Beckwith-Wiedemann, but whether it is associated with secondary hypertension remains unknown. PATIENT CONCERNS A 22-year-old hypertensive female presented to our hospital characterized by hypokalemia and hypertension. DIAGNOSIS The laboratory examination showed secondary aldosteronism. And the common causes for secondary aldosteronism include renal artery stenosis, glomerulonephritis, lupus nephropathy, and diabetic nephropathy, all of which were excluded except MSK. INTERVENTIONS She was treated with angiotensin-converting enzyme inhibitors. OUTCOMES Her blood pressure, serum potassium, and plasma renin levels were reversed after treatment with angiotensin-converting enzyme inhibitors. LESSONS We presumed that MSK may be associated with secondary hypertension, and the mechanism may be the activation of the renin-angiotensin-aldosterone system.
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Wang Z, Li C, Huang W, Chen Y, Li Y, Huang L, Zhang M, Wu D, Wang L, Duan H, An J, Deng N. Effectiveness of a pathway-driven eHealth-based integrated care model (PEICM) for community-based hypertension management in China: study protocol for a randomized controlled trial. Trials 2021; 22:81. [PMID: 33482896 PMCID: PMC7820518 DOI: 10.1186/s13063-021-05020-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 01/04/2021] [Indexed: 12/17/2022] Open
Abstract
Background The prevalence of hypertension is high and increasing in China in recent years. The treatment and control of hypertension calls for long-term management beyond hospital, which is hard to implement in traditional care settings. Integrated care combined with information technology can promote high-quality healthcare services across the life-course. However, few studies have applied a customized integrated care model in community-based hypertension management in China, catering to the emerging “three-manager” mode. This study aims to identify the effectiveness of a pathway-driven eHealth-based integrated model that implemented as a full-featured telehealth system to facilitate standardized management of hypertension in China. Methods The trial has been designed as a 1-year, non-blinded superiority trial with two parallel groups. A total of 402 hypertensive patients who meet the eligibility criteria will be recruited and randomized with a 1:1 allocation. All the participants will receive a mobile device for self-management, which is a part of our telehealth system. Participants in the control group will only use the device for BP measurement and receive regular follow-ups from care providers according to the guidelines. Participants in the intervention group will gain full access to the system and receive intervention based on the proposed model (a well-designed coordinated care pathway consisting of 9 tasks). Outcomes will be measured mainly on three occasions (at inclusion, at 6 months, and at 12 months). The primary outcome is mean change in systolic blood pressure over a 12-month period. Secondary outcomes include changes in diastolic blood pressure, biochemical indexes related to hypertension, lifestyles, self-management adherence, and hypertension awareness, as well as work efficiency of care providers. Discussion This study aims to investigate whether a pathway-driven eHealth-based integrated care model based on the “three-manager” mode will improve hypertension control in China. Success of the model would help improve the quality of present community-based management procedures and benefit more patients with uncontrolled hypertension. Trial registration Chinese Clinical Trial Registry ChiCTR1900027645. Registered on November 22, 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05020-2.
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Affiliation(s)
- Zheyu Wang
- College of Biomedical Engineering and Instrument Science, The Ministry of Education Key Laboratory of Biomedical Engineering, Zhejiang University, Hangzhou, 310027, China
| | - Chengling Li
- The First People's Hospital of Yibin, Yibin, China
| | | | - Yan Chen
- College of Biomedical Engineering and Instrument Science, The Ministry of Education Key Laboratory of Biomedical Engineering, Zhejiang University, Hangzhou, 310027, China
| | - Yuqiong Li
- The First People's Hospital of Yibin, Yibin, China
| | | | - Mei Zhang
- The First People's Hospital of Yibin, Yibin, China
| | - Dan Wu
- College of Biomedical Engineering and Instrument Science, The Ministry of Education Key Laboratory of Biomedical Engineering, Zhejiang University, Hangzhou, 310027, China
| | - Li Wang
- ZICT Technology Co.,Ltd., Shenzhen, China
| | - Huilong Duan
- College of Biomedical Engineering and Instrument Science, The Ministry of Education Key Laboratory of Biomedical Engineering, Zhejiang University, Hangzhou, 310027, China
| | - Jiye An
- College of Biomedical Engineering and Instrument Science, The Ministry of Education Key Laboratory of Biomedical Engineering, Zhejiang University, Hangzhou, 310027, China
| | - Ning Deng
- College of Biomedical Engineering and Instrument Science, The Ministry of Education Key Laboratory of Biomedical Engineering, Zhejiang University, Hangzhou, 310027, China.
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198
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Global epidemiology, health burden and effective interventions for elevated blood pressure and hypertension. Nat Rev Cardiol 2021; 18:785-802. [PMID: 34050340 PMCID: PMC8162166 DOI: 10.1038/s41569-021-00559-8] [Citation(s) in RCA: 444] [Impact Index Per Article: 148.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 02/07/2023]
Abstract
High blood pressure is one of the most important risk factors for ischaemic heart disease, stroke, other cardiovascular diseases, chronic kidney disease and dementia. Mean blood pressure and the prevalence of raised blood pressure have declined substantially in high-income regions since at least the 1970s. By contrast, blood pressure has risen in East, South and Southeast Asia, Oceania and sub-Saharan Africa. Given these trends, the prevalence of hypertension is now higher in low-income and middle-income countries than in high-income countries. In 2015, an estimated 8.5 million deaths were attributable to systolic blood pressure >115 mmHg, 88% of which were in low-income and middle-income countries. Measures such as increasing the availability and affordability of fresh fruits and vegetables, lowering the sodium content of packaged and prepared food and staples such as bread, and improving the availability of dietary salt substitutes can help lower blood pressure in the entire population. The use and effectiveness of hypertension treatment vary substantially across countries. Factors influencing this variation include a country's financial resources, the extent of health insurance and health facilities, how frequently people interact with physicians and non-physician health personnel, whether a clear and widely adopted clinical guideline exists and the availability of medicines. Scaling up treatment coverage and improving its community effectiveness can substantially reduce the health burden of hypertension.
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199
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Zheng L, Dai Y, Fu P, Yang T, Xie Y, Zheng J, Gao J, Niu T. Secular trends of hypertension prevalence based on 2017 ACC/AHA and 2018 Chinese hypertension guidelines: Results from CHNS data (1991-2015). J Clin Hypertens (Greenwich) 2021; 23:28-34. [PMID: 32970919 PMCID: PMC7891671 DOI: 10.1111/jch.14060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 09/03/2020] [Accepted: 09/07/2020] [Indexed: 12/01/2022]
Abstract
This study aimed to assess the impact of the 2017 American College of Cardiology and American Heart Association (ACC/AHA) guideline and the 2018 Chinese hypertension guidelines on the different secular trends for hypertension prevalence. A total of 82 665 eligible individuals aged ≥20 years were selected from nine cross-sectional study periods (1991-2015) from the China Health and Nutrition Survey (CHNS). Over the 24-year period, the long-term trend for the prevalence of the 2017 ACC/AHA-defined age-adjusted hypertension showed an increase from 32.2% (95% confidence interval (CI): 31.0%-33.3%) in 1991 to 60.0% (95% CI: 58.6%-61.3%) in 2015 (Ptrend < 0.001). According to the 2018 Chinese guideline for hypertension, the weighted hypertension prevalence increased from 10.0% (95% CI: 9.4%-10.5%) in 1991 to 28.7% (95% CI: 27.9%-29.6%) in 2015 (Ptrend < 0.001). However, slopes of increasing prevalence of hypertension were significantly greater according to the 2017 ACC/AHA guideline than that based on Joint National Committee (JNC 7) report (β = 1.00% vs β = 0.67% per year, respectively, P = 0.041). Based on the 2017 ACC/AHA definition, the prevalence of stage 1 hypertension and elevated blood pressure significantly increase from 22.3% and 6.9% in 1991 to 31.2% and 10.1% in 2015 (all P < 0.05), respectively. The secular trend for the prevalence of hypertension according to the 2017 ACC/AHA guideline showed a greater rate of increase compared with the prevalence based on the 2018 Chinese hypertension guidelines. Public health initiatives should focus on the current status of hypertension in China because of the possible high prevalence of hypertension and concomitant vascular risks.
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Affiliation(s)
- Liqiang Zheng
- Department of CardiologyShengjing Hospital of China Medical UniversityShenyangChina
- Department of Clinical EpidemiologyDepartment of LibraryShengjing Hospital of China Medical UniversityShenyangChina
| | - Yue Dai
- Department of Clinical EpidemiologyDepartment of LibraryShengjing Hospital of China Medical UniversityShenyangChina
| | - Peng Fu
- Department of CardiologyShengjing Hospital of China Medical UniversityShenyangChina
| | - Tiangui Yang
- Department of CardiologyShengjing Hospital of China Medical UniversityShenyangChina
| | - Yanxia Xie
- Department of Clinical EpidemiologyDepartment of LibraryShengjing Hospital of China Medical UniversityShenyangChina
- Department of ObstetricsNational Office for Maternal and Child Health Surveillance of ChinaWest China Second University HospitalSichuan UniversityChengduChina
| | - Jia Zheng
- Department of Clinical EpidemiologyDepartment of LibraryShengjing Hospital of China Medical UniversityShenyangChina
- Department of Clinical Epidemiologythe Fourth Affiliated Hospital of China Medical UniversityShenyangChina
| | - Jinyue Gao
- Department of Clinical EpidemiologyDepartment of LibraryShengjing Hospital of China Medical UniversityShenyangChina
| | - Tiesheng Niu
- Department of CardiologyShengjing Hospital of China Medical UniversityShenyangChina
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Zhao L, Meng X, Zhang QY, Dong XQ, Zhou XL. A narrative review of prehypertension and the cardiovascular system: effects and potential pathogenic mechanisms. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:170. [PMID: 33569472 PMCID: PMC7867937 DOI: 10.21037/atm-20-5482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
In 1939, Robinson and Brucer first proposed the concept of prehypertension (PHTN), which was defined as a systolic blood pressure of 120–139 mmHg and/or diastolic blood pressure of 80–89 mmHg. PHTN is a major global health risk that adversely affects human health, especially the cardiovascular system. People with PHTN have a higher risk of developing cardiovascular diseases, including stroke, coronary heart disease, myocardial infarction and total cardiovascular events. However, there are few systematic summaries of the relationship between PHTN and the cardiovascular system. Furthermore, because the definition of ‘normal BP’ and the advantages of more intensive BP control remain unclear, there is no consensus on optimal interventions. In an attempt to provide information for clinicians or professionals who are interested in reducing the risk associated with PHTN, we review the existing studies to provide references for them with the effects of PHTN on the cardiovascular system and the potential pathogenic mechanisms of PHTN, including inflammatory responses, insulin resistance, endothelial dysfunction, sympathovagal imbalance, activation of the renin-angiotensin system and others. PHTN is highly prevalent and has adverse effects on health. An effective public health strategy is important to prevent the progression of PHTN. We envisage that this information will increase the public attention of PHTN and help to provide more strategies to reduce the risk of cardiovascular events.
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Affiliation(s)
- Lin Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xu Meng
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qiong-Yu Zhang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xue-Qi Dong
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xian-Liang Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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