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Qiu W, Cai A, Nie Z, Wang J, Ou Y, Feng Y. Cardiometabolic factors and population risks of cardiovascular disease in community-dwelling adults with varied blood pressure statuses. Diabetes Obes Metab 2024; 26:3261-3271. [PMID: 38738333 DOI: 10.1111/dom.15653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/24/2024] [Accepted: 04/28/2024] [Indexed: 05/14/2024]
Abstract
AIMS To examine the differential associations between cardiometabolic risk factors and cardiovascular disease (CVD), and to evaluate the population-attributable fractions (PAFs) for CVD among community-dwelling adults with varied blood pressure (BP) statuses. METHODS This prospective cohort study included participants without prevalent CVD from a subcohort of the China Patient-Centred Evaluative Assessment of Cardiac Events Million Persons Project. Participants were divided into four BP groups according to the American College of Cardiology/American Heart Association guidelines. The study exposure comprised the selected cardiometabolic risk factors, including waist circumference (WC), body mass index, (BMI) heart rate, fasting blood glucose (FBG), low-density lipoprotein cholesterol, and remnant cholesterol. The outcome was hospitalizations for CVD. Cox proportional hazard models were conducted, and the PAFs were calculated in the analysis. RESULTS Among the 94 183 participants (39.0% were men, mean age: 54.2 years), 26.6% had Stage 1 hypertension and 30.8% had Stage 2 hypertension. A total of 6065 hospitalizations for CVD were captured after a median follow-up of 3.5 years. BP (per 1-standard deviation [SD]: hazard ratio [HR] 1.34, 95% confidence interval [CI] 1.29, 1.40), FBG (per 1-SD: HR 1.16, 95% CI 1.14, 1.19) and WC (per 1-SD: HR 1.41, 95% CI 1.36, 1.47) were three major contributors to CVD events. BP status significantly modified the associations of abdominal obesity, suboptimal BMI, suboptimal heart rate and abnormal FBG with CVD, with stronger associations with CVD observed in optimal BP groups compared to hypertensive groups (p for risk factor-by-BP group interaction <0.05). Participants with all cardiometabolic risk factors were at the highest risk for CVD, accounting for 35.6% (95% CI 30.0, 40.8) of the PAF for CVD. Among the risk factors, BP control explained the highest PAF for CVD (15.1%, 95% CI 8.2, 21.4) The overall PAFs of cardiometabolic risk factors for CVD were higher among the normotensive participants compared to the hypertensive participants. CONCLUSIONS The awareness and control rates of hypertension were extremely low among Southern Chinese adults. BP status significantly modified the associations between cardiometabolic risk factors and CVD, and the overall PAFs for CVD were higher among people with normal BP. Dedicated efforts are needed to improve the management of cardiometabolic factors.
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Affiliation(s)
- Weida Qiu
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Anping Cai
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Zhiqiang Nie
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
- Global Health Research Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Jiabin Wang
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Yanqiu Ou
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Yingqing Feng
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
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Zhang X, Wang X, Wang M, Qu H, Hu B, Li Q. Prevalence, awareness, and treatment of isolated diastolic hypertension in the United States. Eur J Intern Med 2023; 112:93-99. [PMID: 37002149 DOI: 10.1016/j.ejim.2023.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/06/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Isolated diastolic hypertension (IDH) is recognized as a risk factor for cardiovascular disease, yet its clinical epidemiology remains poorly understood due to insufficient recognition. This study aims to describe the trend in the prevalence, awareness, and treatment of IDH in the United States from 2001 to 2018. METHODS This cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES) conducted in nine consecutive two-year cycles from 2001-2002 to 2017-2018, comprising a sample of 48,742 adults aged over 18 years. IDH was defined as a diastolic blood pressure ≥ 80 mm Hg with a systolic BP < 130 mm Hg by the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines. RESULTS In the nationally representative dataset, 8.9% of participants had IDH in 2017-2018, a decreased of 3.6% (95% confidence interval [CI], -2.6% to -5.0%, P<0.0002) since 2001-2002. IDH prevalence was highest among Mexican American (10.5%), individuals aged 40-59 (12.3%), increased with body mass index (BMI) (11.2% among those BMI ≥30.0 kg/m2), and tended to be higher in men (12.3%). A multiple regression analysis showed that men, white race/ethnicity, young and middle-aged people (aged 18-59), and increasing BMI were independently associated with increased risks of IDH. Among IDH patients, there was a modest increase in awareness (P<0.0002), from 22.4% (95%CI, 18.4% to 27.1%) in 2001-2002 to 35.0% (95%CI, 28.2% to 42.5%) in 2017-2018, with the largest percentage increases among non-Hispanic white and men. IDH treatment increased by 7.6% (95%CI, 3.1% to 12.1%) between 2001-2002 and 2017-2018, with the greatest increases occurring in Mexican American and men. CONCLUSION IDH prevalence is decreasing from 2001-2002 to 2017-2018 in the United States. Despite the significantly increased in both awareness and treatment, they remain below 50%.
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Affiliation(s)
- Xuexue Zhang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China; China Academy of Chinese Medical Sciences, Beijing, China
| | - Xujie Wang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China; China Academy of Chinese Medical Sciences, Beijing, China
| | - Miaoran Wang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China; China Academy of Chinese Medical Sciences, Beijing, China
| | - Hua Qu
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
| | | | - Qiuyan Li
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
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Ho VS, Cenzer IS, Nguyen BT, Lee SJ. Time to benefit for stroke reduction after blood pressure treatment in older adults: A meta-analysis. J Am Geriatr Soc 2022; 70:1558-1568. [PMID: 35137952 PMCID: PMC9106841 DOI: 10.1111/jgs.17684] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 12/24/2021] [Accepted: 01/09/2022] [Indexed: 12/19/2022]
Abstract
Background Hypertension treatment in older adults can decrease mortality, cardiovascular events, including heart failure, cognitive impairment, and stroke risk, but may also lead to harms such as syncope and falls. Guidelines recommend targeting preventive interventions with immediate harms and delayed benefits to patients whose life expectancy exceeds the intervention's time to benefit (TTB). Our objective was to estimate a meta‐analyzed TTB for stroke prevention after initiation of more intensive hypertension treatment in adults aged ≥65 years. Methods Studies were identified from two Cochrane systematic reviews and a search of MEDLINE and Google Scholar for subsequent publications until August 31, 2021. We abstracted data from randomized controlled trials comparing standard (untreated, placebo, or less intensive treatment) to more intensive treatment groups in older adults (mean age ≥ 65 years). We fit Weibull survival curves and used a random‐effects model to estimate the pooled annual absolute risk reduction (ARR) between control and intervention groups. We applied Markov chain Monte Carlo methods to determine the time to ARR thresholds (0.002, 0.005, and 0.01) for a first stroke. Results Nine trials (n = 38,779) were identified. The mean age ranged from 66 to 84 years and study follow‐up times ranged from 2.0 to 5.8 years. We determined that 1.7 (95%CI: 1.0–2.9) years were required to prevent 1 stroke for 200 persons (ARR = 0.005) receiving more intensive hypertensive treatment. Heterogeneity was found across studies, with those focusing on tighter systolic blood pressure control (SBP < 150 mmHg) showing longer TTB. For example, in the SPRINT study (baseline SBP = 140 mmHg, achieved SBP = 121 mmHg), the TTB to avoid 1 stroke for 200 patients treated was 5.9 years (95%CI: 2.2–13.0). Conclusions More intensive hypertension treatment in 200 older adults prevents 1 stroke after 1.7 years. Given the heterogeneity across studies, the TTB estimates from individual studies may be more relevant for clinical decision‐making than our summary estimate. See related Editorial by Mark A. Supiano in this issue.
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Affiliation(s)
- Vanessa S Ho
- College of Medicine, California Northstate University, Elk Grove, California, USA.,Medical Student Training in Aging Research (MSTAR) Program, Division of Geriatrics, School of Medicine, University of California, San Francisco, California, USA
| | - Irena S Cenzer
- Division of Geriatrics, School of Medicine, University of California, San Francisco, California, USA
| | - Brian T Nguyen
- Division of Geriatrics, School of Medicine, University of California, San Francisco, California, USA.,Geriatrics, Palliative and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA.,Northern California Institute for Research and Education, San Francisco, California, USA
| | - Sei J Lee
- Medical Student Training in Aging Research (MSTAR) Program, Division of Geriatrics, School of Medicine, University of California, San Francisco, California, USA.,Division of Geriatrics, School of Medicine, University of California, San Francisco, California, USA.,Geriatrics, Palliative and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
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Huang M, Long L, Tan L, Shen A, Deng M, Peng Y, Yang W, Li H, Wei Y, Li M, Liao F, Liu C, Lu A, Qu H, Fu C, Chen K. Isolated Diastolic Hypertension and Risk of Cardiovascular Events: A Systematic Review and Meta-Analysis of Cohort Studies With 489,814 Participants. Front Cardiovasc Med 2022; 8:810105. [PMID: 35071370 PMCID: PMC8766994 DOI: 10.3389/fcvm.2021.810105] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 12/03/2021] [Indexed: 12/12/2022] Open
Abstract
Background: The association between isolated diastolic hypertension (IDH) and cardiovascular events has been inconsistently reported. This meta-analysis of cohort studies was designed to investigate the effect of the 2018 European Society of Cardiology (ESC) definition of IDH on the risk of composite cardiovascular events, cardiovascular mortality, all-cause mortality, and all strokes including ischemic stroke (IS) and hemorrhagic stroke (HS). Methods: PubMed, Embase, the Cochrane Library, and Web of Science were searched from inception to July 6, 2021. Cohort studies that investigated the association between IDH and cardiovascular events risk, compared to normotension, were included. Pooled hazard ratios (HRs) and 95% CIs were calculated using a random-effects models and heterogeneity was evaluated using Q-test and I 2 statistic. The robustness of the associations was identified using sensitivity analysis. The methodological quality of the studies was assessed using the Newcastle-Ottawa scale. Publication bias was assessed using funnel plot, trim-and-fill method, Begg's test, and Egger's test. Results: A total of 15 cohort studies (13 articles) including 489,814 participants were included in this meta-analysis. The follow-up period ranged from 4.3 to 29 years. IDH was significantly associated with an increased risk of composite cardiovascular events (HR 1.28, 95% CI: 1.07-1.52, p = 0.006), cardiovascular mortality (HR 1.45, 95% CI: 1.07-1.95, p = 0.015), all strokes (HR 1.44, 95% CI: 1.04-2.01, p = 0.03), and HS (HR 1.64, 95% CI: 1.18-2.29, p = 0.164), but not associated with all-cause mortality (HR 1.20, 95% CI: 0.97-1.47, p = 0.087) and IS (HR 1.56, 95% CI: 0.87-2.81, p = 0.137). Subgroup analysis further indicated that IDH in the younger patients (mean age ≤ 55 years) and from Asia were significantly associated with an increased risk of composite cardiovascular events, while the elderly patients (mean age ≥ 55 years), Americans, and Europeans were not significantly associated with an increased risk of composite cardiovascular events. Conclusion: This meta-analysis provides evidence that IDH defined using the 2018 ESC criterion is significantly associated with an increased risk of composite cardiovascular events, cardiovascular mortality, all strokes and HS, but not significantly associated with all-cause death and IS. These findings also emphasize the importance for patients with IDH to have their blood pressure within normal, especially in the young adults and Asians. Trial Registration: PROSPERO, Identifier: CRD42021254108.
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Affiliation(s)
- Mingyan Huang
- Department of Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China.,National Clinical Research Center for Cardiovascular Diseases of Traditional Chinese Medicine, Beijing, China.,Beijing University of Traditional Chinese Medicine Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Linzi Long
- Department of Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China.,Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Ling Tan
- Department of Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China.,National Clinical Research Center for Cardiovascular Diseases of Traditional Chinese Medicine, Beijing, China
| | - Aling Shen
- Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Mi Deng
- Department of Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China.,National Clinical Research Center for Cardiovascular Diseases of Traditional Chinese Medicine, Beijing, China
| | - Yuxuan Peng
- Department of Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China.,National Clinical Research Center for Cardiovascular Diseases of Traditional Chinese Medicine, Beijing, China.,Beijing University of Traditional Chinese Medicine Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Wenwen Yang
- Department of Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China.,National Clinical Research Center for Cardiovascular Diseases of Traditional Chinese Medicine, Beijing, China
| | - Hongzheng Li
- Department of Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China.,National Clinical Research Center for Cardiovascular Diseases of Traditional Chinese Medicine, Beijing, China.,Beijing University of Traditional Chinese Medicine Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Yue Wei
- Department of Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China.,National Clinical Research Center for Cardiovascular Diseases of Traditional Chinese Medicine, Beijing, China
| | - Meng Li
- Beijing University of Traditional Chinese Medicine Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Feifei Liao
- Department of Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China.,National Clinical Research Center for Cardiovascular Diseases of Traditional Chinese Medicine, Beijing, China.,Beijing University of Traditional Chinese Medicine Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Chao Liu
- Beijing University of Traditional Chinese Medicine Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Aimei Lu
- Department of Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China.,National Clinical Research Center for Cardiovascular Diseases of Traditional Chinese Medicine, Beijing, China.,Beijing University of Traditional Chinese Medicine Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Hua Qu
- Department of Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China.,National Clinical Research Center for Cardiovascular Diseases of Traditional Chinese Medicine, Beijing, China.,National Medical Products Administration (NMPA) Key Laboratory for Clinical Research and Evaluation of Traditional Chinese Medicine, Beijing, China
| | - Changgeng Fu
- Department of Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China.,National Clinical Research Center for Cardiovascular Diseases of Traditional Chinese Medicine, Beijing, China
| | - Keji Chen
- Department of Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China.,National Clinical Research Center for Cardiovascular Diseases of Traditional Chinese Medicine, Beijing, China
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Li WW, Lew D, Quach L. Efficacy of a Culturally and Linguistically Competent Community Health Coach Intervention for Chinese with Hypertension. Asian Pac Isl Nurs J 2020; 5:111-119. [PMID: 33324728 PMCID: PMC7733636 DOI: 10.31372/20200503.1087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose: To develop and pilot test the efficacy of a culturally and linguistically sensitive, community health coach (CHC)-based intervention in Chinese immigrants in improving blood pressure control and medication adherence. Design: This study was conducted in 2017 with a cross-sectional design (n = 23). A CHC intervention was implemented using one 25-minute group educational presentation plus one 10-minute question and answer session at baseline, followed by four, 10-minute bi-weekly group question-and-answer sessions. Findings: There was a significant reduction in both systolic and diastolic blood pressure from baseline to week 8: Systolic BP −17.33 (±11.32) (p < 0.005) and diastolic BP −9.58 (±6.57) (p < 0.005). The mean score for medication adherence was 10.56 (±3.24) (possible range 3–15) at baseline and there was no significant change at week 8 (mean 10.89 ± 3.95) (p = 0.86). Conclusion: The CHC-based hypertension management program showed significant reductions in both systolic and diastolic blood pressures in Chinese immigrants. Since the proposed CHC-based hypertension management program is low cost and easy to establish, further investigation is recommended to generate more results for comparison. Practice Implications: There is potential for the CHC intervention to be implemented in clinical settings to help Chinese immigrants at large achieve optimal blood pressure control.
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Affiliation(s)
- Wen-Wen Li
- San Francisco State University, United States
| | - Donna Lew
- American Heart Association, United States
| | - Linda Quach
- San Francisco State University, United States
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6
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Mahajan S, Zhang D, He S, Lu Y, Gupta A, Spatz ES, Lu J, Huang C, Herrin J, Liu S, Yang J, Wu C, Cui J, Zhang Q, Li X, Nasir K, Zheng X, Krumholz HM, Li J. Prevalence, Awareness, and Treatment of Isolated Diastolic Hypertension: Insights From the China PEACE Million Persons Project. J Am Heart Assoc 2019; 8:e012954. [PMID: 31566101 PMCID: PMC6806046 DOI: 10.1161/jaha.119.012954] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Characterizing and assessing the prevalence, awareness, and treatment patterns of patients with isolated diastolic hypertension (IDH) can generate new knowledge and highlight opportunities to improve their care. Methods and Results We used data from the China PEACE (Patient-centered Evaluative Assessment of Cardiac Events) Million Persons Project, which screened 2 351 035 participants aged 35 to 75 years between 2014 and 2018. IDH was defined as systolic and diastolic blood pressure of <140 and ≥90 mm Hg; awareness as self-reported diagnosis of hypertension; and treatment as current use of antihypertensive medications. Of the 2 310 184 participants included (mean age 55.7 years; 59.5% women); 73 279 (3.2%) had IDH, of whom 63 112 (86.1%) were untreated, and only 6512 (10.3%) of the untreated were aware of having hypertension. When compared with normotensives, participants who were <60 years, men, at least college educated, had body mass index of >28 kg/m2, consumed alcohol, had diabetes mellitus, and prior cardiovascular events were more likely to have IDH (all P<0.01). Among those with IDH, higher likelihood of awareness was associated with increased age, women, college education, body mass index of >28 kg/m2, higher income, diabetes mellitus, prior cardiovascular events, and Central or Eastern region (all P<0.05). Most treated participants with IDH reported taking only 1 class of antihypertensive medication. Conclusions IDH affects a substantial number of people in China, however, few are aware of having hypertension and most treated participants are poorly managed, which suggests the need to improve the diagnosis and treatment of people with IDH.
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Affiliation(s)
- Shiwani Mahajan
- NHC Key Laboratory of Clinical Research for Cardiovascular Medications National Clinical Research Center of Cardiovascular Diseases Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.,Central China Subcenter of the National Center for Cardiovascular Diseases Henan China.,Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT.,Section of Cardiovascular Medicine Department of Internal Medicine Yale School of Medicine New Haven CT
| | - Danwei Zhang
- NHC Key Laboratory of Clinical Research for Cardiovascular Medications National Clinical Research Center of Cardiovascular Diseases Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Siyun He
- NHC Key Laboratory of Clinical Research for Cardiovascular Medications National Clinical Research Center of Cardiovascular Diseases Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.,Central China Subcenter of the National Center for Cardiovascular Diseases Henan China.,Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT.,Department of Biostatistics School of Public Health Yale University New Haven CT
| | - Yuan Lu
- NHC Key Laboratory of Clinical Research for Cardiovascular Medications National Clinical Research Center of Cardiovascular Diseases Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.,Central China Subcenter of the National Center for Cardiovascular Diseases Henan China.,Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT
| | - Aakriti Gupta
- NHC Key Laboratory of Clinical Research for Cardiovascular Medications National Clinical Research Center of Cardiovascular Diseases Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.,Central China Subcenter of the National Center for Cardiovascular Diseases Henan China.,Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT.,Section of Cardiovascular Medicine Columbia University New York NY
| | - Erica S Spatz
- NHC Key Laboratory of Clinical Research for Cardiovascular Medications National Clinical Research Center of Cardiovascular Diseases Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.,Central China Subcenter of the National Center for Cardiovascular Diseases Henan China.,Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT.,Section of Cardiovascular Medicine Department of Internal Medicine Yale School of Medicine New Haven CT
| | - Jiapeng Lu
- NHC Key Laboratory of Clinical Research for Cardiovascular Medications National Clinical Research Center of Cardiovascular Diseases Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Chenxi Huang
- NHC Key Laboratory of Clinical Research for Cardiovascular Medications National Clinical Research Center of Cardiovascular Diseases Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.,Central China Subcenter of the National Center for Cardiovascular Diseases Henan China.,Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT
| | - Jeph Herrin
- Section of Cardiovascular Medicine Department of Internal Medicine Yale School of Medicine New Haven CT
| | - Shuling Liu
- NHC Key Laboratory of Clinical Research for Cardiovascular Medications National Clinical Research Center of Cardiovascular Diseases Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.,Central China Subcenter of the National Center for Cardiovascular Diseases Henan China.,Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT
| | - Jingwei Yang
- NHC Key Laboratory of Clinical Research for Cardiovascular Medications National Clinical Research Center of Cardiovascular Diseases Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Chaoqun Wu
- NHC Key Laboratory of Clinical Research for Cardiovascular Medications National Clinical Research Center of Cardiovascular Diseases Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Jianlan Cui
- NHC Key Laboratory of Clinical Research for Cardiovascular Medications National Clinical Research Center of Cardiovascular Diseases Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Qiuli Zhang
- NHC Key Laboratory of Clinical Research for Cardiovascular Medications National Clinical Research Center of Cardiovascular Diseases Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Xi Li
- NHC Key Laboratory of Clinical Research for Cardiovascular Medications National Clinical Research Center of Cardiovascular Diseases Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.,Central China Subcenter of the National Center for Cardiovascular Diseases Henan China
| | - Khurram Nasir
- NHC Key Laboratory of Clinical Research for Cardiovascular Medications National Clinical Research Center of Cardiovascular Diseases Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.,Central China Subcenter of the National Center for Cardiovascular Diseases Henan China.,Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT.,Section of Cardiovascular Medicine Department of Internal Medicine Yale School of Medicine New Haven CT
| | - Xin Zheng
- NHC Key Laboratory of Clinical Research for Cardiovascular Medications National Clinical Research Center of Cardiovascular Diseases Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.,Central China Subcenter of the National Center for Cardiovascular Diseases Henan China
| | - Harlan M Krumholz
- NHC Key Laboratory of Clinical Research for Cardiovascular Medications National Clinical Research Center of Cardiovascular Diseases Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.,Central China Subcenter of the National Center for Cardiovascular Diseases Henan China.,Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT.,Section of Cardiovascular Medicine Department of Internal Medicine Yale School of Medicine New Haven CT.,Department of Health Policy and Management Yale School of Public Health New Haven CT
| | - Jing Li
- NHC Key Laboratory of Clinical Research for Cardiovascular Medications National Clinical Research Center of Cardiovascular Diseases Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.,Central China Subcenter of the National Center for Cardiovascular Diseases Henan China
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Ayalon-Dangur I, Shohat Z, Gafter-Gvili A, Shiber S, Grossman A. Blood pressure response to medical treatment in the emergency department - a retrospective cohort study. Clin Exp Hypertens 2016; 38:608-612. [PMID: 27676286 DOI: 10.3109/10641963.2016.1174256] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES It is unclear whether blood pressure (BP) without target organ damage should be decreased in patients in the emergency department (ED). It is also uncertain whether any certain class of medications has an advantage over the other in this setting. This study addressed both these questions. METHODS In this retrospective cohort study, all patients attending a tertiary care ED with elevated BP were evaluated. All patients with target organ damage as well as those with significant active co-morbidities, such as myocardial ischemia, were excluded. Baseline characteristics and response of BP to therapy were compared between those treated and untreated in the ED. In addition, BP response to therapy was compared between different classes of antihypertensive medications. RESULTS Overall, 438 patients were included in the final analysis (62% female), of which 275 (63%) were treated in the ED. Antihypertensive medications were more commonly prescribed in the ED for those with higher systolic and diastolic BP, but other baseline characteristics were similar between the two groups. Only systolic BP significantly decreased in those treated with antihypertensive medications compared with those untreated. The most commonly used classes were angiotensin converting enzyme inhibitors (ACEis) and calcium channel blockers (CCBs). Use of either of these drug classes was not associated with a significant decrease in either systolic or diastolic BP compared with the use of other drug classes. CONCLUSIONS Antihypertensive drug therapy is more commonly prescribed in the ED in individuals with both elevated systolic and diastolic BP, but leads to a significant decrease only in systolic BP. Use of either ACEis or CCBs is not associated with a significant decrease in either systolic or diastolic BP compared with other drug classes.
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Affiliation(s)
- I Ayalon-Dangur
- a Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Z Shohat
- b Bio-statistical Institute, Rabin Medical Center , Beilinson Campus, Petah Tikva , Israel
| | - A Gafter-Gvili
- a Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.,c Department of Internal Medicine A , Rabin Medical Center , Petah Tikva , Israel
| | - S Shiber
- a Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.,d The Department of Emergency Medicine , Rabin Medical Center , Beilinson Campus, Petah Tikva , Israel
| | - A Grossman
- a Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.,e Department of Internal Medicine E , Rabin Medical Center , Petah Tikva , Israel
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8
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Solanki C, Pandey P, Rao KVLN. Predictors of aneurysmal rebleed before definitive surgical or endovascular management. Acta Neurochir (Wien) 2016; 158:1037-44. [PMID: 27068042 DOI: 10.1007/s00701-016-2784-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 03/21/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Aneurysmal rebleed is the most dreaded complication following subarachnoid hemorrhage. Being a cause of devastating outcome, the stratification of risk factors can be used to prioritize patients, especially at high volume centers. METHOD A total of 99 patients with aneurysmal rebleed were analyzed in this study both prospectively and retrospectively from August 2010 to July 2014. In the control group, 100 patients were selected randomly from the patient registry. A total of 25 variables from the demographic, historical, clinical and radiological data were compared and analyzed by univariate and multivariate logistic regression analysis. RESULTS Significant independent predictors of aneurysm rebleed were the presence of known hypertension (p = 0.023), diastolic blood pressure of >90 mmHg on admission (p = 0.008); presence of loss of consciousness (p = 0.013) or seizures (p = 0.002) at first ictus; history of warning headaches (p = 0.005); higher Fisher grade (p < 0.001); presence of multiple aneurysms (p = 0.021); irregular aneurysm surface (0.002). CONCLUSIONS Identification of high risk factors can help in stratifying patients in the high risk group. The risk stratification strategy with early intervention can prevent rebleeds. This in turn may translate into better outcomes of patients with intracranial aneurysms.
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Affiliation(s)
- Chirag Solanki
- Department of Neurosurgery, NIMHANS (National Institute of Mental Health and Neuroscinences), Bengaluru, Karnataka, 560029, India
| | - Paritosh Pandey
- Consultant Neurosurgeon, Manipal Hospital, Bengaluru, Karnataka, India
| | - K V L N Rao
- Department of Neurosurgery, NIMHANS, Bengaluru, Karnataka, 560029, India.
- Department of Neurosurgery, Faculty Block, Neurosurgery office, NIMHANS campus, Bengaluru, Karnataka, 560029, India.
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Cao Y, Liu LT, Wu M. Is Chinese herbal medicine effective for elderly isolated systolic hypertension? A systematic review and meta-analysis. Chin J Integr Med 2016; 23:298-305. [PMID: 27225294 DOI: 10.1007/s11655-016-2257-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Indexed: 10/21/2022]
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10
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Hypertension phenotypes and incident cardiovascular disease and mortality events in a decade follow-up of a Middle East cohort. J Hypertens 2016; 33:1153-61. [PMID: 25699976 DOI: 10.1097/hjh.0000000000000540] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the association of hypertension phenotypes, with the risk of cardiovascular disease (CVD) and mortality. METHODS We examined the risk of hypertension phenotypes, that is, isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), systolic-diastolic hypertension (SDH), controlled blood pressure (CBP), and uncontrolled blood pressure (UBP) among 6974 middle-aged and 882 elderly participants. Cox regression analysis was used to estimate the hazard ratio for hypertension phenotypes, considering those with normotension as the reference. RESULTS During more than 10 years of follow-up, in the middle-aged group, 490 CVD events and 152 deaths occurred; corresponding rates for the elderly group were 194 and 183, respectively. In middle-aged patients, ISH, SDH, and UBP increased the risk of CVD, whereas UBP increased the risk of mortality due to CVD and any cause (hazard ratio 5.67 and 2.95, respectively) and IDH increased only the risk of total mortality in the middle-aged group (hazard ratio 2.01; all P values <0.05). In elderly patients, ISH, SDH, and UBP significantly increased the risks of CVD. IDH (hazard ratio 3.20 and 2.01), SDH (hazard ratio 3.80 and 3.23) and CBP (hazard ratio 2.86 and 1.87) increased the risks of CVD and all-cause mortality in this group, respectively (all P values <0.05). CONCLUSION In both middle-aged and elderly population, ISH, SDH, and UBP increase the risk of CVD. Controlling of BP to less than 140/90 mmHg decreases the risk of mortality events among the middle-aged population; however, it is not suitable for the elderly as it was associated with higher risk of mortality.
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Prevalence, awareness, treatment and control of high blood pressure among Chinese rural population in Haimen, Jiangsu. J Hum Hypertens 2015; 30:225-30. [DOI: 10.1038/jhh.2015.107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 08/25/2015] [Accepted: 09/07/2015] [Indexed: 12/22/2022]
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Li H, Kong F, Xu J, Zhang M, Wang A, Zhang Y. Hypertension subtypes and risk of cardiovascular diseases in a Mongolian population, inner Mongolia, China. Clin Exp Hypertens 2015; 38:39-44. [PMID: 26268426 DOI: 10.3109/10641963.2015.1060981] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND There have been no reports about the effects of hypertension subtypes on the future cardiovascular events among Mongolian people, China. METHODS AND RESULTS From June 2003 to July 2012, we conducted a prospective study to assess the association of hypertension subtypes with future risk of cardiovascular events including stroke and coronary heart disease among a Mongolian cohort of 2589 adults in China. According to the baseline blood pressure levels, the subjects were divided into those with normal blood pressure, prehypertension, isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and combined systolic and diastolic hypertension (SDH). Cox proportional hazards models were used to evaluate the association between blood pressure subtypes and risk of cardiovascular diseases. After adjustment for age and gender, hazard ratios (95% confidence intervals) of cardiovascular diseases were 1.75 (0.92-3.33), 2.11 (0.95-4.70), 2.14 (1.01-4.56) and 5.31 (2.86-9.77) for pre-hypertension, ISH, IDH and SDH, respectively, compared with normal blood pressure. Furthermore, after adding other cardiovascular risk factors to adjustment, hazard ratios (95% confidence intervals) of cardiovascular diseases were 1.74 (0.92-3.31), 2.00 (0.88-4.54), 2.20 (1.02-4.74) and 4.92 (2.62-9.26) for pre-hypertension, ISH, IDH and SDH, respectively, compared with the normal blood pressure group. CONCLUSIONS IDH and SDH were significantly associated with the increased risk of cardiovascular diseases; this study suggests that carefully monitoring and actively treating the subjects with IDH should be an important strategy for CVD prevention among Mongolian population.
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Affiliation(s)
- Hongmei Li
- a Department of Epidemiology , School of Public Health, Medical College of Soochow University , Suzhou , China
| | - Fanlong Kong
- a Department of Epidemiology , School of Public Health, Medical College of Soochow University , Suzhou , China
| | - Juan Xu
- a Department of Epidemiology , School of Public Health, Medical College of Soochow University , Suzhou , China
| | - Mingzhi Zhang
- a Department of Epidemiology , School of Public Health, Medical College of Soochow University , Suzhou , China
| | - Aili Wang
- a Department of Epidemiology , School of Public Health, Medical College of Soochow University , Suzhou , China
| | - Yonghong Zhang
- a Department of Epidemiology , School of Public Health, Medical College of Soochow University , Suzhou , China
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Gooding HC, Milliren CE, Austin SB, Sheridan MA, McLaughlin KA. Child Abuse, Resting Blood Pressure, and Blood Pressure Reactivity to Psychosocial Stress. J Pediatr Psychol 2015; 41:5-14. [PMID: 25979082 DOI: 10.1093/jpepsy/jsv040] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 04/13/2015] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE Childhood trauma is associated with hypertension in adults. It is unknown whether childhood trauma predicts elevated blood pressure earlier in development. We investigated whether the trauma of child abuse was associated with blood pressure in adolescents. METHODS The sample included 145 adolescents aged 13-17 years, 40% with exposure to child abuse. The mean age of participants was 14.93 years (SD = 1.33); 58% were female. The majority self-identified as non-Hispanic White (43%), with the remainder identifying as non-Hispanic Black (17%), Hispanic (17%), or other/mixed race (23%). We used established age/sex/height-specific cutoffs to determine the prevalence of prehypertension and hypertension in the sample. We used two-sample t tests to examine associations of abuse with resting systolic blood pressure (SBP) and diastolic blood pressure (DBP) and blood pressure reactivity to the Trier Social Stress Test and a frustration task. We used linear regression to adjust for potential confounders including sociodemographic variables, body mass index, smoking, and psychopathology. RESULTS Mean resting SBP and DBP were 114.07 mmHg and 61.35 mmHg in those with a history of abuse and 111.39 mmHg and 56.89 mmHg in those without a history of abuse. This difference was significant for DBP only. Twelve percent of participants met criteria for prehypertension or hypertension based on resting blood pressure values; this did not differ between those with and without an abuse history. Child abuse was associated with lower DBP and SBP reactivity to laboratory stress tasks and reduced DBP reactivity to frustration. These associations were robust to adjustment for potential confounders. CONCLUSIONS Child abuse is associated with higher resting DBP and blunted DBP and SBP reactivity to laboratory stress in adolescence. These findings suggest a potential pathway by which child abuse leads to hypertension.
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Affiliation(s)
- Holly C Gooding
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School,
| | | | - S Bryn Austin
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Department of Social and Behavioral Sciences, Harvard School of Public Health
| | - Margaret A Sheridan
- Department of Pediatrics, Harvard Medical School, Division of Developmental Medicine, Boston Children's Hospital, and
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Yang Y, He Y, Li Q, Wang Y, Peng Z, Xu J, Ma X. Preconception blood pressure and risk of preterm birth: a large historical cohort study in a Chinese rural population. Fertil Steril 2015; 104:124-30. [PMID: 25936235 DOI: 10.1016/j.fertnstert.2015.03.024] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 03/24/2015] [Accepted: 03/24/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To examine the relationship between preconception blood pressure (BP) and the risk of preterm birth (PTB) using a historical cohort of reproductive-aged women and girls from a Chinese rural population. DESIGN A historical cohort study established between 2010 and 2013 in People's Republic of China. SETTING Local family-planning service agencies and maternal-child care service centers. PATIENT(S) A total of 367,425 reproductive-aged women and girls who participated in the National Free Pre-pregnancy Checkups in 2010-2012 and subsequently had a live birth before October 2013. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Incidence rates of PTB in reproductive-aged women and girls across preconception BP levels. RESULT(S) Preterm births were defined as babies born alive at 28 to 37 weeks of pregnancy. Compared with the participants with a systolic BP of <120 mm Hg, the multivariable-adjusted odds ratio (OR) for PTB was 0.99 (95% confidence interval [CI]: 0.95-1.03]), 1.21 (95% CI: 1.11-1.32), 1.47 (95% CI: 1.22-1.77), 1.80 (95% CI: 1.25-2.59), and 1.81 (95% CI: 1.20-2.73) for the participants with systolic BP of 120-129, 130-139, 140-149, 150-159, and ≥160 mm Hg, respectively. When the participants with normal BP were used as the reference, the adjusted OR for PTB was 1.04 (95% CI: 1.01-1.08), 1.38 (95% CI: 1.25-1.53), and 1.54 (95% CI: 1.21-1.97) for the participants with prehypertension, stage-1 hypertension, and stage-2 hypertension, respectively. In addition, isolated systolic and diastolic hypertension increased the risk of PTB by 55% and 30%, respectively. CONCLUSION(S) Our results indicated a strong linear and independent relationship between BP levels and the risk of PTB in Chinese reproductive-aged women and girls. Maternal hypertension before pregnancy can significantly increase the risk of PTB.
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Affiliation(s)
- Ying Yang
- National Research Institute for Family Planning, Beijing, People's Republic of China
| | - Yuan He
- National Research Institute for Family Planning, Beijing, People's Republic of China
| | - Qian Li
- National Research Institute for Family Planning, Beijing, People's Republic of China; Graduate School of Peking Union Medical College, Beijing, People's Republic of China
| | - Yuanyuan Wang
- National Research Institute for Family Planning, Beijing, People's Republic of China
| | - Zuoqi Peng
- National Research Institute for Family Planning, Beijing, People's Republic of China
| | - Jihong Xu
- National Research Institute for Family Planning, Beijing, People's Republic of China
| | - Xu Ma
- National Research Institute for Family Planning, Beijing, People's Republic of China; Graduate School of Peking Union Medical College, Beijing, People's Republic of China.
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Wang Y, Xing F, Liu R, Liu L, Zhu Y, Wen Y, Sun W, Song Z. Isolated diastolic hypertension associated risk factors among Chinese in Anhui Province, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:4395-405. [PMID: 25913184 PMCID: PMC4410254 DOI: 10.3390/ijerph120404395] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 03/29/2015] [Accepted: 03/31/2015] [Indexed: 12/25/2022]
Abstract
Objective: To explore potential risk factors of isolated diastolic hypertension (IDH) among young and middle-aged Chinese. Methods: A community-based cross-sectional study was conducted among 338 subjects, aged 25 years and above, using random sampling technique. There were 68 cases of IDH, 46 cases of isolated systolic hypertension (ISH), 89 cases of systolic and diastolic hypertension (SDH), and 135 of subjects with normal blood pressure. Cases and controls were matched on sex by frequency matching. Demographic characteristics, blood pressure and other relevant information were collected.Results: Compared with controls, patients with IDH and ISH had significant higher level of triglyceride, high density lipoprotein, blood glucose and body mass index (BMI) (p < 0.05); while patients with SDH had significantly higher level of total cholesterol, triglyceride, glucose and BMI (p < 0.05). Linear mixed effects model showed that drinking tea, family history of hypertension (FHH), higher blood glucose, triglyceride and low density lipoprotein were related with elevated diastolic blood pressure (DBP) (p < 0.01); HFH, blood glucose, creatinine and BMI have positive effect on systolic blood pressure (SBP) (p < 0.05). Conclusions: Drinking tea, FHH, high levels of triglyceride, high density lipoprotein, blood glucose and BMI are associated with IDH among young and middle-aged Chinese.
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Affiliation(s)
- Yanchun Wang
- School of Public Health, Wannan Medical College, Wuhu 241002, China.
- The Department of Pathology, School of Medicine, The Fourth Affiliated Hospital, Zhejiang University, Yiwu 322000, China.
| | - Fengjun Xing
- School of Public Health, Wannan Medical College, Wuhu 241002, China.
| | - Rongjuan Liu
- School of Public Health, Wannan Medical College, Wuhu 241002, China.
| | - Li Liu
- School of Public Health, Wannan Medical College, Wuhu 241002, China.
| | - Yu Zhu
- School of Public Health, Wannan Medical College, Wuhu 241002, China.
| | - Yufeng Wen
- School of Public Health, Wannan Medical College, Wuhu 241002, China.
| | - Wenjie Sun
- School of Food Science, Guangdong Pharmaceutical University, Zhongshan 528458, China.
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA.
| | - Ziwei Song
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA.
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Musinguzi G, Van Geertruyden J, Bastiaens H, Nuwaha F. Uncontrolled hypertension in Uganda: a comparative cross-sectional study. J Clin Hypertens (Greenwich) 2015; 17:63-9. [PMID: 25040204 PMCID: PMC8031822 DOI: 10.1111/jch.12371] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 06/05/2014] [Accepted: 06/07/2014] [Indexed: 11/29/2022]
Abstract
In a community survey, 4432 persons aged 15 years and older in two districts in Uganda were studied. Blood pressure was measured and predictors for subtypes of uncontrolled hypertension (HTN) were assessed using bivariate and multivariate logistic regression modeling. Prevalence of uncontrolled HTN was 20.2% and the subgroups of isolated systolic HTN (ISH), isolated diastolic HTN (IDH), and systolic-diastolic HTN (SDH) were 7.2%, 4.2%, and 8.8%, respectively. No difference was observed between the sexes. For all HTN subtypes, middle (35-49 years) and older age (50+) groups had a higher prevalence compared with younger subjects (15-34 years) (all P<.001). IDH prevalence in older age was not higher compared with younger age (P=.417). After multivariate analysis, middle age predicted all subtypes of HTN and old age predicted ISH and SDH. Alcohol consumption predicted IDH and SDH. Uncontrolled HTN in this population increases in the order IDH, ISH, and SDH, with more than 1 in 5 having uncontrolled HTN.
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Affiliation(s)
- Geofrey Musinguzi
- Department of Disease Control and Environmental Health, School of Public HealthCollege of Health Sciences, Makerere UniversityKampalaUganda
- International Health Unit, University of Antwerp, Antwerp, BelgiumAntwerpBelgium
| | | | - Hilde Bastiaens
- Department of Primary and interdisciplinary care, University of AntwerpAntwerpBelgium
| | - Fred Nuwaha
- Department of Disease Control and Environmental Health, School of Public HealthCollege of Health Sciences, Makerere UniversityKampalaUganda
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Overall cardiovascular prognosis of isolated systolic hypertension, isolated diastolic hypertension and pulse pressure defined with home measurements: the Finn-home study. J Hypertens 2014; 32:518-24. [PMID: 24477096 DOI: 10.1097/hjh.0000000000000070] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The overall cardiovascular prognosis of isolated systolic hypertension, isolated diastolic hypertension and pulse pressure defined with home blood pressure (BP) measurements remains unclear. METHODS A prospective nationwide study was initiated in 2000-2001 on 1924 randomly selected participants aged 44-74 years. We determined home and office BP at baseline and classified the individuals into four groups according to their home BP levels: normotension, isolated diastolic hypertension, isolated systolic hypertension and systolic-diastolic hypertension. The primary endpoint was incidence of a composite cardiovascular event. RESULTS After a median follow-up of 11.2 years, 236 individuals had suffered a cardiovascular event. In multivariable Cox proportional hazard models, the relative hazards and 95% confidence intervals (CIs) for cardiovascular events were significantly higher in participants with isolated diastolic hypertension (relative hazard 1.95; 95% CI, 1.06-3.57; P=0.03), isolated systolic hypertension (relative hazard 2.08; 95% CI, 1.42-3.05; P<0.001) and systolic-diastolic hypertension (relative hazard 2.79; 95% CI, 2.02-3.86; P<0.001) than in participants with normotension. Home (relative hazard 1.21; 95% CI, 1.05-1.40; P=0.009 per 10 mmHg increase), but not office (relative hazard 1.10; 95% CI, 1.00-1.21, P=0.06) pulse pressure, adjusted for mean arterial pressure, was an independent predictor of cardiovascular risk. CONCLUSION Isolated diastolic and systolic hypertension defined with home measurements are associated with an increased cardiovascular risk. Close follow-up and possible treatment of these patients is therefore warranted. Home-measured pulse pressure is an independent predictor of cardiovascular events while office-measured pulse pressure is not, which fortifies the view that home BP provides more accurate risk prediction than office BP.
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Sun Z, Han X, Zheng L, Zhang X, Li J, Hu D, Sun Y. Subtypes of hypertension and risk of stroke in rural Chinese adults. Am J Hypertens 2014; 27:193-8. [PMID: 24162730 DOI: 10.1093/ajh/hpt197] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hypertension is a definitive risk factor for stroke. We examined the associations between hypertension subtypes and stroke incidence in rural Chinese adults. METHODS We conducted a prospective study in a sample of 38,949 rural Chinese adults aged ≥35 years and free from stroke at baseline. The subtypes of hypertension were defined as isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), systolic and diastolic hypertension (SDH), and managed hypertension (MHT). The relative risks of stroke with the subtypes of hypertension, compared with normotensive subjects, were estimated using the Cox model after adjusting for age, sex, and other confounders. RESULTS The prevalence of hypertension was as follows: SDH = 18.6%, ISH = 10.2%, IDH = 5.8%, and MHT = 0.4%. During a total of 168,023 person-years of follow-up, 858 subjects developed stroke. The incidence rate per 100,000 person-years of overall first-ever stroke was 510.6. The SDH group was at the highest risk of stroke among all the hypertensive subjects. The hazard ratio was 2.13 (95% confidence interval (CI) = 1.78-2.55) for all stroke, 2.74 (95% CI = 2.08-3.60) for hemorrhagic stroke, and 1.92 (95% CI = 1.50-2.45) for ischemic stroke. CONCLUSIONS SDH patients warrant the most attention for prevent of stroke. However, ISH and IDH are also independent predictors of stroke. The risk factors for stroke, especially hypertension, were not controlled in the rural population we studied. More aggressive efforts to control the risk factors for stroke in rural areas are needed.
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Affiliation(s)
- Zhaoqing Sun
- Division of Cardiology, Shengjing Hospital of China Medical University, Shenyang, P.R. China
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Wang L, Chen CM, Liao WC, Hsiao CY. Evaluating a community-based stroke nursing education and rehabilitation programme for patients with mild stroke. Int J Nurs Pract 2013; 19:249-56. [PMID: 23730856 DOI: 10.1111/ijn.12064] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
This study evaluated whether mild stroke patients who received a community-based stroke nursing intervention had better stroke knowledge, behaviour and self-efficacy than those who were exposed to traditional education programmes. The intervention group consisted of sixty five stroke patients randomly selected from seven communities who received three 2-hour stroke interventions per week for 8 weeks. The normal care group consisted of sixty two stroke patients randomly selected from a medical centre who received a general stroke education programme. The stroke patients in two groups were assessed at baseline, after intervention and at the 6-month follow-up. At the 6-month follow-up, the intervention group demonstrated an improvement in the knowledge of stroke risk factors compared with the normal care group. Three months after education, the intervention group exhibited changes in the knowledge of stroke, social participation and self-efficacy compared with those at baseline. Also, self-efficacy was correlated with the knowledge of stroke risk factors after intervention and at the 6-month follow-up; self-efficacy was correlated with social participation after the 6-month follow-up. A community-based stroke nursing intervention might have effects on changes in the knowledge of stroke risk factors, social participation and self-efficacy.
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Affiliation(s)
- Lee Wang
- Department of Public Health, Chung-Shan Medical University, Taichung, Taiwan.
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Wu X, Zhu B, Fu L, Wang H, Zhou B, Zou S, Shi J. Prevalence, incidence, and mortality of stroke in the chinese island populations: a systematic review. PLoS One 2013; 8:e78629. [PMID: 24250804 PMCID: PMC3826735 DOI: 10.1371/journal.pone.0078629] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 09/13/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In China, there are 2.5 million new stroke cases each year and 7.5 million stroke survivors. However, stroke incidence in some island populations is obviously lower compared with inland regions, perhaps due to differences in diet and lifestyle. As the lifestyle in China has changed significantly, along with dramatic transformations in social, economic and environmental conditions, such changes have also been seen in island regions. Thus, we analyzed stroke in the Chinese island regions over the past 30 years. METHODS We conducted a systematic review to identify reliable and comparable epidemiologic evidence about stroke in the Chinese island regions between 1980 and 2013. Two authors independently assessed the eligibility and the quality of the articles and disagreement was resolved by discussion. Owing to the great heterogeneity among individual study estimates, a random-effects or fixed-effects model was used to incorporate the heterogeneity among records into a pooled estimate for age-standardized rates. Age-standardized rates were calculated by the direct method with the 2000 world population if included records provided the necessary information. RESULTS During the past three decades, the overall pooled age-standardized prevalence of stroke is 6.17 per 1000 (95% CI 4.56-7.78), an increase from 5.54 per 1000 (95% CI 3.88-7.20) prior to 2000 to 8.34 per 1000 (95% CI 5.98-10.69) after 2000. However, this difference was not found to be statistically significant. The overall pooled age-standardized incidence of stroke is 120.42 per 100,000 person years (95% CI 26.17-214.67). Between 1982 and 2008, the incidence of stroke increased and mortality declined over time. CONCLUSIONS Effective intervention and specific policy recommendations on stroke prevention should be required, and formulated in a timely fashion to effectively curb the increased trend of stroke in Chinese island regions.
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Affiliation(s)
- Xiaomei Wu
- Department of Clinical Epidemiology and Center of Evidence Based Medicine, Institute of Cardiovascular, The First Hospital of China Medical University, Shenyang, China
| | - Bo Zhu
- Liaoning Academy of Safety Sciences, Shenyang, China
- Department of Environmental and Occupational Health, School of Public Health, China Medical University, Taichung, Taiwan
| | - Lingyu Fu
- Department of Clinical Epidemiology and Center of Evidence Based Medicine, Institute of Cardiovascular, The First Hospital of China Medical University, Shenyang, China
| | - Hailong Wang
- Department of Clinical Epidemiology and Center of Evidence Based Medicine, Institute of Cardiovascular, The First Hospital of China Medical University, Shenyang, China
| | - Bo Zhou
- Department of Clinical Epidemiology and Center of Evidence Based Medicine, Institute of Cardiovascular, The First Hospital of China Medical University, Shenyang, China
| | - Safeng Zou
- Department of Neurology, Dalian Municipal Central Hospital, Dalian, China
| | - Jingpu Shi
- Department of Clinical Epidemiology and Center of Evidence Based Medicine, Institute of Cardiovascular, The First Hospital of China Medical University, Shenyang, China
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Hong H, Wang H, Liao H. Prehypertension is associated with increased carotid atherosclerotic plaque in the community population of Southern China. BMC Cardiovasc Disord 2013; 13:20. [PMID: 23510396 PMCID: PMC3618079 DOI: 10.1186/1471-2261-13-20] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 02/19/2013] [Indexed: 11/10/2022] Open
Abstract
Background The proceeding of blood pressure (BP) from normal level to the hypertension has been found to be associated with increased cardiovascular events and multiple vascular risk factors. However, whether the process is associated with increased carotid atherosclerotic plaque per se or not is still unclear. Methods Nine hundred and forty-two participants aged from 46 to 75 were enrolled from community population in Southern China. Their metabolic risk factors, carotid intima-media thickness (cIMT) and atherosclerotic plaque formation were analyzed and stratified by different blood pressure levels according to JNC-7 or ESH/ESC-2007 classification. Results From low BP level to higher BP level, multiple metabolic risk factors increased linearly. Prehypertension in JNC-7 classification (or normal BP and high normal BP in ESH/ESC-2007 classification) was correlated with thicker cIMT and more plaque formation than normotension (or optimal BP) (p < 0.001). After adjusting multiple metabolic factors, the differences were still significant (p < 0.05). Furthermore, prehypertensive participants had a trend to be thicker carotid IMT (OR and its 95% CI: 1.65, 0.97-2.82, p = 0.067) and significantly higher carotid plaque occurrence (OR and its 95% CI: 2.36, 1.43-3.88, p = 0.001) than normotensive ones. However, there was no significant difference of cIMT and plaque formation between normal BP and high normal BP (p > 0.05). Plaque formation in prehypertension was as significant as that in hypertension. Conclusion Prehypertension is associated with significantly increased carotid atherosclerotic plaque and is a primary stratify risk factor for carotid atherosclerosis which could cause ischemic stroke in middle-aged and elderly population in Southern China.
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Affiliation(s)
- Hua Hong
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, P. R. China.
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Hemodynamic circulatory patterns in young patients with predominantly diastolic hypertension. ACTA ACUST UNITED AC 2013; 7:157-62. [PMID: 23403215 DOI: 10.1016/j.jash.2013.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 12/31/2012] [Accepted: 01/02/2013] [Indexed: 11/24/2022]
Abstract
To evaluate the spectrum of hemodynamic patterns in patients with isolated diastolic hypertension-predominantly diastolic hypertension, we re-analyzed a previously reported cohort of 189 non-medicated hypertensive individuals that were assessed by impedance cardiography. We selected 46 patients who were less than 50 years old and had pulse pressure less or equal than 45 mm Hg confirmed by ambulatory blood pressure monitoring. The selected cohort had a mean age of 39.7 years and was 47% men. Three distinct groups were identified: a high cardiac index (CI) "hyperdynamic" group, with normal to near normal systemic vascular resistance (SVR); an intermediate CI and SVR group; and a "vasotonic" group, with low CI and high SVR. Heart rate was similar among the three groups. Stroke volume index (SVI) was significantly higher in the hyperdynamic group (61.8, 49.7, and 39.7 mL/m(2) in the high, intermediate, and low CI groups, respectively). The hyperdynamic group had greater total arterial compliance index than the vasotonic group (1.3 ± 0.3 vs 0.92 ± 0.2 mL/m(2) mm Hg for high vs low CI, respectively; P < .001). In conclusion, isolated diastolic hypertension-predominantly diastolic hypertension patients can have diverse hemodynamic patterns that cannot be predicted based on peripherally measured blood pressure and heart rate alone. This hemodynamic complexity must be taken into account when considering the genetic and pathophysiologic mechanisms of hypertension.
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Nakagawa K, Koenig MA, Asai SM, Chang CW, Seto TB. Disparities among Asians and native Hawaiians and Pacific Islanders with ischemic stroke. Neurology 2013; 80:839-43. [PMID: 23365055 DOI: 10.1212/wnl.0b013e3182840797] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To evaluate disparities in cardiovascular risk factors among Asians and Native Hawaiians and other Pacific Islanders (NHPI) in Hawaii who are hospitalized with ischemic stroke. METHODS We performed a retrospective study on consecutive patients hospitalized for ischemic stroke at a single tertiary center in Honolulu between 2004 and 2010. The prevalence of cardiovascular risk factors was compared for NHPI, Asians, and whites who were hospitalized for ischemic stroke. RESULTS A total of 1,921 patients hospitalized for ischemic stroke were studied. NHPI were less likely to be older (odds ratio [OR] 0.95, 95% confidence interval [CI] 0.94-0.96), more likely to be female (OR 1.55, 95% CI 1.07-2.24), and more likely to have diabetes (OR 2.74, 95% CI 1.87-4.00), hypertension (OR 1.98, 95% CI 1.27-3.10), and obesity (OR 1.82, 95% CI 1.25-2.65) than whites. NHPI had higher low-density lipoprotein levels (114 ± 50 mg/dL vs 103 ± 45 mg/dL, p = 0.001) and lower high-density lipoprotein levels (38 ± 11 mg/dL vs 45 ± 15 mg/dL, p < 0.0001) than whites. Compared with Asians, NHPI were less likely to be older (OR 0.95, 95% CI 0.94-0.97) and more likely to have diabetes (OR 1.88, 95% CI 1.35-2.61), previous stroke or TIA (OR 1.57, 95% CI 1.09-2.25), and obesity (OR 6.05, 95% CI 4.31-8.48). CONCLUSIONS Asians, NHPI, and whites with ischemic stroke have substantially different cardiovascular risk factors. Targeted secondary prevention will be important in reducing disparities among these racial groups.
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Tse LA, Fang XH, Wang WZ, Qiu H, Yu ITS. Incidence of ischaemic and haemorrhagic stroke and the association with smoking and smoking cessation: a 10-year multicentre prospective study in China. Public Health 2012; 126:960-6. [PMID: 23062630 DOI: 10.1016/j.puhe.2012.07.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 05/11/2012] [Accepted: 07/31/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To examine the effects of cigarette smoking and smoking cessation on the incidence of ischaemic and haemorrhagic stroke in a multicentre prospective cohort study among Chinese. STUDY DESIGN A multicentre population-based prospective cohort study. METHODS The incidence of, and deaths from, stroke were monitored among 26,607 participants (12,560 men and 14,047 women) who were enrolled in 1986 and free from stroke until 2000. Cox's proportional hazard model was performed to obtain the hazard ratio (HR) of cigarette smoking for stroke risk after adjustment for major confounders. RESULTS After an average of 9.5 years of follow-up, 1108 subjects developed stroke. The excess risk of all types of stroke (total stroke) among male current smokers [HR 1.39, 95% confidence interval (CI) 1.15-1.67] was mainly due to a significantly elevated risk of ischaemic stroke (HR 1.49, 95% CI 1.17-1.90). A significantly increased risk for total stroke and ischaemic stroke was observed among men who smoked >15 cigarettes/day and men who had smoked for >25 years. The rate of smoking cessation was very low among Chinese men (7.2%) and women (1.5%). Smoking cessation did not appear to reduce the risk of haemorrhagic stroke, but may reduce the risk of ischaemic stroke; however, the possibility that this result was due to chance cannot be excluded (HR 0.74, 95% CI 0.26-2.08). CONCLUSION This study confirmed that cigarette smoking is a major determinant for the incidence of ischaemic and haemorrhagic stroke in Chinese men, and emphasizes the need for improved strategies to help people quit smoking.
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Affiliation(s)
- L A Tse
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, PR China
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Wang C, Liu Y, Yang Q, Dai X, Wu S, Wang W, Ji X, Li L, Fang X. Body Mass Index and Risk of Total and Type-Specific Stroke in Chinese Adults: Results from a Longitudinal Study in China. Int J Stroke 2012; 8:245-50. [PMID: 23039874 DOI: 10.1111/j.1747-4949.2012.00830.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background The prevalence rate of overweight and obese has been escalating over the past two decades in China. Even so, the association between obesity and stroke still remains unclear to some extent. Aims The aim of this study was to elucidate the association between body mass index and stroke in a large Chinese population cohort. Methods A cohort of 26 607 Chinese people, aged over 35 years, was investigated in 1987. Baseline information of body weight and height was used to calculate BMI (weight in kilograms divided by height in meters squared, kg/m2). Cox proportional hazards model was fitted to estimate hazard ratios of stroke adjusted for age, educational level, smoking and alcohol consumption. Results The 11-year follow-up revealed (241 149 person-years) a total of 1108 stroke events (614 ischemic, 451 hemorrhagic, and 44 undefined stroke). Body mass index ≥ 30·0 was an independent risk factor for stroke both in men and women. Compared with normal weight, hazard ratios for total stroke were 0·74 in men underweight (95% confidence interval: 0·53∼1·03), 1·63 overweight (95% confidence interval: 1·35∼1·96), and 2·20 with obesity (95% confidence interval: 1·47∼3·30); and with ischemic stroke, hazard ratios were 0·52 in those underweight (95% confidence interval: 0·30∼0·89), 208 overweight (95% confidence interval: 1·65∼2·62), and 3·80 with obesity (95% confidence interval: 2·47∼5·86). In women, the corresponding hazard ratios for total stroke were 0·79 underweight (95% confidence interval: 0·58∼1·07), 1·42 overweight (95% confidence interval: 1·16∼1·73), and 1·57 with obesity (95% confidence interval: 1·06∼2·31); and for those with ischemic stroke, 0·92 underweight (95% confidence interval: 0·59∼1·43), 1·90 overweight (95% confidence interval: 1·44∼2·50), and 2·42 with obesity (95% confidence interval: 1·50∼3·93). There appeared an evident dose-response relationship between body mass index and the risk of developing stroke, which still appeared, however, adjusted low for hypertension, diabetes, and heart disease. Decreased risk for stroke in the leanest group was confined to men only. No association was found between body mass index and hemorrhagic stroke in both genders. Conclusions Our data suggest that body mass index was an independent risk factor for total and ischemic stroke but not for hemorrhagic stroke in both genders. Association between body mass index and stroke was extremely mediated by hypertension, diabetes, and heart disease. Decreased risk for the leanest group was confined to men.
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Affiliation(s)
- Chunxiu Wang
- Department of Evidence-Based Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yunhai Liu
- Department of Neurology, Institute of Neurology, The Xiangya Hospital, Central South University, Changsha, China
| | - Qidong Yang
- Department of Neurology, Institute of Neurology, The Xiangya Hospital, Central South University, Changsha, China
| | - Xiuying Dai
- Department of Neurology, Ningxia Medical College, Yinchuan, Ningxia, China
| | - Shengping Wu
- Department of Neuroepidemiolology, Beijing Neurosurgical Institute, Beijing, China
| | - Wenzhi Wang
- Department of Neuroepidemiolology, Beijing Neurosurgical Institute, Beijing, China
| | - Xunming Ji
- Department of Neurosugery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Lin Li
- Department of Pharmacology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xianghua Fang
- Department of Evidence-Based Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
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Wei D, He WY, Lv QZ. Effect of nisoldipine and olmesartan on endothelium-dependent vasodilation in essential hypertensive patients. CNS Neurosci Ther 2012; 18:400-5. [PMID: 22533725 DOI: 10.1111/j.1755-5949.2012.00304.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
AIMS To investigate whether nisoldipine and olmesartan improve endothelial function, decrease asymmetric dimethylarginine (ADMA) and alleviate the inflammatory and oxidative process. METHODS Fifty-five essential hypertensive patients were randomized to receive nisoldipine or olmesartan for 8 weeks according to a parallel-group, active-controlled, single blind study, and 28 matched normotensive subjects served as healthy controls. Flow-mediated dilation (FMD), and plasma levels of nitric oxide (NO), endothelin-1 (ET-1), high-sensitive C-reactive protein (hs-CRP), 8-isoprostane (also named 8-isoPGF2α), and ADMA were determined. RESULTS At baseline, the plasma levels of ADMA, ET-1, hs-CRP, and 8-isoPGF2α were markedly higher in patients with essential hypertension than in normotensive subjects (P < 0.05). A significant positive correlation was observed between plasma levels of ET-1 and ADMA in patients with essential hypertension, but not in normotensive subjects. The NO plasma concentrations were significantly lower in patients with essential hypertension than in normotensive subjects. Furthermore, hypertensive subjects demonstrated significantly lower FMD than healthy control (P < 0.05). Nisoldipine and olmesartan significantly and similarly reduced blood pressure in patients with essential hypertension (P < 0.001). At the end of the 8-week treatment, plasma ADMA and ET-1 levels were decreased significantly (P < 0.01). FMD increased significantly in nisoldipine or olmesartan-treated patients (P < 0.05). A significant decrease in plasma hs-CRP contents was observed in patients receiving nisoldipine (P < 0.05). CONCLUSION The findings demonstrate that nisoldipine and olmesartan both improve FMD in patients with essential hypertension. This may be associated with decreased circulating levels of CRP, ET-1, and ADMA.
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Affiliation(s)
- Duo Wei
- Department of Pharmacy, Zhongshan, Hospital, Fudan University, Shanghai, China
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Arima H, Murakami Y, Lam TH, Kim HC, Ueshima H, Woo J, Suh I, Fang X, Woodward M. Effects of Prehypertension and Hypertension Subtype on Cardiovascular Disease in the Asia-Pacific Region. Hypertension 2012; 59:1118-23. [DOI: 10.1161/hypertensionaha.111.187252] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure defined blood pressure (BP) levels of 120 to 139/80 to 89 mm Hg as prehypertension and those of ≥140/90 mm Hg as hypertension. Hypertension can be divided into 3 categories, isolated diastolic (IDH; systolic BP <140 mm Hg and diastolic BP ≥90 mmHg), isolated systolic (systolic BP ≥140 mm Hg and diastolic BP <90 mmHg), and systolic-diastolic hypertension (systolic BP ≥140 mm Hg and diastolic BP ≥90 mmHg). Although there is clear evidence that isolated systolic hypertension and systolic-diastolic hypertension increase the risks of future vascular events, there remains uncertainty about the effects of IDH. The objective was to determine the effects of prehypertension and hypertension subtypes (IDH, isolated systolic hypertension, and systolic-diastolic hypertension) on the risks of cardiovascular disease (CVD) in the Asia-Pacific Region. The Asia Pacific Cohort Studies Collaboration is an individual participant data overview of cohort studies in the region. This analysis included a total of 346570 participants from 36 cohort studies. Outcomes were fatal and nonfatal CVD. The relationship between BP categories and CVD was explored using a Cox proportional hazards model adjusted for age, cholesterol, and smoking and stratified by sex and study. Compared with normal BP (<120/80 mmHg), hazard ratios (95% CIs) for CVD were 1.41 (1.31–1.53) for prehypertension, 1.81 (1.61–2.04) for IDH, 2.18 (2.00–2.37) for isolated systolic hypertension, and 3.42 (3.17–3.70) for systolic-diastolic hypertension. Separately significant effects of prehypertension and hypertension subtypes were also observed for coronary heart disease, ischemic stroke, and hemorrhagic stroke. In the Asia-Pacific region, prehypertension and all hypertension subtypes, including IDH, thus clearly predicted increased risks of CVD.
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Affiliation(s)
- Hisatomi Arima
- From the George Institute for Global Health (H.A., Y.M., M.W.), University of Sydney, Sydney, New South Wales, Australia; School of Public Health/Department of Community Medicine (T.H.L.), University of Hong Kong, Hong Kong, China; Department of Preventive Medicine (H.C.K., I.S.), Yonsei University College of Medicine, Seoul, Korea; Department of Preventive Medicine (H.C.K.), Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Health Science (H.U.), Shiga University of
| | - Yoshitaka Murakami
- From the George Institute for Global Health (H.A., Y.M., M.W.), University of Sydney, Sydney, New South Wales, Australia; School of Public Health/Department of Community Medicine (T.H.L.), University of Hong Kong, Hong Kong, China; Department of Preventive Medicine (H.C.K., I.S.), Yonsei University College of Medicine, Seoul, Korea; Department of Preventive Medicine (H.C.K.), Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Health Science (H.U.), Shiga University of
| | - Tai Hing Lam
- From the George Institute for Global Health (H.A., Y.M., M.W.), University of Sydney, Sydney, New South Wales, Australia; School of Public Health/Department of Community Medicine (T.H.L.), University of Hong Kong, Hong Kong, China; Department of Preventive Medicine (H.C.K., I.S.), Yonsei University College of Medicine, Seoul, Korea; Department of Preventive Medicine (H.C.K.), Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Health Science (H.U.), Shiga University of
| | - Hyeon Chang Kim
- From the George Institute for Global Health (H.A., Y.M., M.W.), University of Sydney, Sydney, New South Wales, Australia; School of Public Health/Department of Community Medicine (T.H.L.), University of Hong Kong, Hong Kong, China; Department of Preventive Medicine (H.C.K., I.S.), Yonsei University College of Medicine, Seoul, Korea; Department of Preventive Medicine (H.C.K.), Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Health Science (H.U.), Shiga University of
| | - Hirotsugu Ueshima
- From the George Institute for Global Health (H.A., Y.M., M.W.), University of Sydney, Sydney, New South Wales, Australia; School of Public Health/Department of Community Medicine (T.H.L.), University of Hong Kong, Hong Kong, China; Department of Preventive Medicine (H.C.K., I.S.), Yonsei University College of Medicine, Seoul, Korea; Department of Preventive Medicine (H.C.K.), Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Health Science (H.U.), Shiga University of
| | - Jean Woo
- From the George Institute for Global Health (H.A., Y.M., M.W.), University of Sydney, Sydney, New South Wales, Australia; School of Public Health/Department of Community Medicine (T.H.L.), University of Hong Kong, Hong Kong, China; Department of Preventive Medicine (H.C.K., I.S.), Yonsei University College of Medicine, Seoul, Korea; Department of Preventive Medicine (H.C.K.), Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Health Science (H.U.), Shiga University of
| | - Il Suh
- From the George Institute for Global Health (H.A., Y.M., M.W.), University of Sydney, Sydney, New South Wales, Australia; School of Public Health/Department of Community Medicine (T.H.L.), University of Hong Kong, Hong Kong, China; Department of Preventive Medicine (H.C.K., I.S.), Yonsei University College of Medicine, Seoul, Korea; Department of Preventive Medicine (H.C.K.), Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Health Science (H.U.), Shiga University of
| | - Xianghua Fang
- From the George Institute for Global Health (H.A., Y.M., M.W.), University of Sydney, Sydney, New South Wales, Australia; School of Public Health/Department of Community Medicine (T.H.L.), University of Hong Kong, Hong Kong, China; Department of Preventive Medicine (H.C.K., I.S.), Yonsei University College of Medicine, Seoul, Korea; Department of Preventive Medicine (H.C.K.), Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Health Science (H.U.), Shiga University of
| | - Mark Woodward
- From the George Institute for Global Health (H.A., Y.M., M.W.), University of Sydney, Sydney, New South Wales, Australia; School of Public Health/Department of Community Medicine (T.H.L.), University of Hong Kong, Hong Kong, China; Department of Preventive Medicine (H.C.K., I.S.), Yonsei University College of Medicine, Seoul, Korea; Department of Preventive Medicine (H.C.K.), Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Health Science (H.U.), Shiga University of
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Zhang B, Gao C, Hou Q, Yin J, Xie L, Pu S, Yi Y, Gao Q. Different independent susceptibility markers for first-ever cerebral infarction and myocardial infarction in young patients. J Neurol 2012; 259:1420-5. [PMID: 22218649 DOI: 10.1007/s00415-011-6368-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2011] [Revised: 12/05/2011] [Accepted: 12/08/2011] [Indexed: 11/29/2022]
Abstract
Cerebral infarction (CI) and myocardial infarction (MI) share some common features, but there are other differences in risk factors. The aim of our study is to determine whether there are some significantly independent susceptibility markers for them. All consecutive patients between the ages of 18 and 45 years with first-ever CI and MI during 2001-2010 were recruited to participate in the study. Using multivariate logistic regression modeling, we explore many different data, such as age at onset, sex ratio, numbers of patients with history of hypertension, smoking, drinking, and serum lipid, uric acid, prealbumin (PA), and white blood cell (WBC) count levels. Logistic regression analysis adjusted for confounders confirmed the following independent susceptibility markers for young CI patients: hypertension, admission serum PA levels, daily alcohol [odds ratio (OR), 0.251; 95% confidence interval (CI), 0.097-0.648, p = 0.004; OR, 0.994; 95% CI, 0.988-0.999, p = 0.031; OR, 0.150; 95% CI, 0.047-0.473, p = 0.001], and for MI patients: age at onset, current smoking, serum WBC, and glucose levels (OR, 1.293; 95% CI, 1.146-1.457, p = 0.000; OR, 8.914; 95% CI, 3.575-22.231, p = 0.000; OR, 1.344; 95% CI, 1.169-1.544, p = 0.000; OR, 1.149; 95% CI, 1.022-1.291, p = 0.020). We conclude that there are some significantly different independent susceptibility markers for young CI and MI patients.
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Affiliation(s)
- Bin Zhang
- The Second Affiliated Hospital of GuangZhou Medical University, GuangZhou, Guangdong Province, China
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Franklin SS, Wilkinson IB, McEniery CM. Unusual hypertensive phenotypes: what is their significance? Hypertension 2011; 59:173-8. [PMID: 22184330 DOI: 10.1161/hypertensionaha.111.182956] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Stanley S Franklin
- School of Medicine, Heart Disease Prevention Program, Sprague Hall 112, University of California, Irvine, Irvine, CA 92697-4101, USA.
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Residual beneficial effects after a 3-year integrated intervention on stroke in China: a 10-year prospective follow-up. J Hypertens 2011; 29:2220-5. [PMID: 21897292 DOI: 10.1097/hjh.0b013e32834b19a9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate whether an intervention program designed to reduce stroke incidence would have long-term residual effects on reducing all-cause and cause-specific mortalities, including cancer 10 years after the intervention was completed. METHODS This is a posttrial analysis. We prospectively observed the mortality of a community-based trial of primary prevention of stroke in China performed between July 1987 and June 1990 by extending the follow-up to 30 June 2000. At the baseline, 26,607 adults aged 35 years or above and free from stroke were recruited from five cites of mainland China; 13,212 and 13,395 were assigned into intervention and control group, respectively. Participants in intervention group received a regularly integrated intervention including lifestyle intervention and hypertensive drug treatment. The controls did not receive intervention provided by the investigators. RESULTS During the 10-year posttrial follow-up period, we observed a significant reduction on overall deaths [hazard ratio 0.91; 95% confidence interval (CI) 0.83, 0.99] and stroke mortality (hazard ratio 0.79; 95% CI 0.63, 1.00). An insignificant late trial beneficial effect was observed for hypertensive disease (hazard ratio 0.69; 95% CI 0.30, 1.58), ischemic heart disease (hazard ratio 0.87; 95% CI 0.64, 1.17), other nonmalignant diseases, and most cancer sites. CONCLUSION This study demonstrates that a 3-year integrated intervention program successful for stroke prevention had long-term residual beneficial effects on reducing overall disease burdens among urban Chinese population, especially for the deaths from stroke. However, whether the integrated intervention also leads to reduced mortality of cardiovascular diseases and cancer would have to be confirmed by future larger studies.
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Fayad A, Yang H. Is Peri-Operative Isolated Systolic Hypertension (ISH) a Cardiac Risk Factor? Curr Cardiol Rev 2011; 4:22-33. [PMID: 19924274 PMCID: PMC2774582 DOI: 10.2174/157340308783565410] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2007] [Revised: 12/06/2007] [Accepted: 12/08/2007] [Indexed: 01/09/2023] Open
Abstract
We are presenting a review of Isolated Systolic Hypertension (ISH) as a cardiovascular risk factor with emphasis on the perioperative period. Isolated systolic hypertension is associated with aging and is the most frequent subtype (65%) among patients with uncontrolled hypertension. ISH is strongly associated with increased risks of cardiac and cerebrovascular events exceeding those in comparably aged individuals with diastolic hypertension. Patients with ISH show an increase in left ventricular (LV) mass and an increase in the prevalence of left ventricular hypertrophy (LVH). These LV changes increase cardiovascular events and frequently lead to diastolic dysfunction (DD). Treatment to reduce elevated systolic blood pressure has been shown to reduce the risk of cardiovascular events. In the perioperative setting, essential hypertension has not been found to be a significant risk factor for cardiac complications. Most of the studies were based on the definition of essential hypertension and underpowered in sample size. The significance of perioperative ISH, however, is not well studied, partly due to its recognition only fairly recently as a cardiovascular risk factor in the non-surgical setting, and partly due to the evolving definition of ISH. Perioperative cardiac complications remain a significant problem to the healthcare system and to the patient. Although the incidence of perioperative cardiac complications is prominent in high-risk patients as defined by the Revised Cardiac Risk Index (RCRI), the bulk of the cardiac complications actually occur in low-risk group. Currently, little understanding exists on the occurrence of perioperative cardiac complications in low- risk patients. A factor such as ISH, with its known pathophysiological changes, is a potential perioperative risk factor. We believe ISH is an under-recognized perioperative risk factor and deserves further studying. Our research group has recently been funded by the Heart Stroke Foundation (HSF) to examine ISH as a perioperative risk factor (PROMISE Study).
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Affiliation(s)
- Ashraf Fayad
- Department of Anesthesiology and Perioperative Medicine, University of Ottawa, 1053 Carling Ave. (B3), The Ottawa Hospital, Ottawa, Ontario, Canada, K1Y 4E9
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Effects of blood pressure lowering on major vascular events among patients with isolated diastolic hypertension: the perindopril protection against recurrent stroke study (PROGRESS) trial. Stroke 2011; 42:2339-41. [PMID: 21700945 DOI: 10.1161/strokeaha.110.606764] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Despite clear evidence that blood pressure (BP) lowering is effective for prevention of cardiovascular events among patients with isolated systolic hypertension and systolic-diastolic hypertension, there is ongoing uncertainty about its effects in those with isolated diastolic hypertension. The objective of the present analysis is to determine whether BP lowering provides benefits to patients with isolated diastolic hypertension. METHODS Patients with cerebrovascular disease and hypertension at baseline (n=4283) were randomly assigned to either active treatment (perindopril in all participants plus indapamide for those with neither an indication for nor a contraindication to a diuretic) or matching placebo(s). The primary outcome was total major vascular events. RESULTS There were 1923 patients with isolated systolic hypertension (systolic BP ≥ 140 mm Hg and diastolic BP < 90 mm Hg), 315 with isolated diastolic hypertension (systolic BP <140 mm Hg and diastolic BP ≥ 90 mm Hg), and 2045 with systolic-diastolic hypertension (systolic BP ≥ 140 mm Hg and diastolic BP ≥ 90 mm Hg) at baseline. Active treatment reduced the relative risk of major vascular events by 27% (95% CI, 10% to 41%) among patients with isolated systolic hypertension, by 28% (-29% to 60%) among those with isolated diastolic hypertension, and by 32% (17% to 45%) among those with systolic-diastolic hypertension. There was no evidence of differences in the magnitude of the effects of treatment among different types of hypertension (P homogeneity=0.89). CONCLUSIONS BP lowering is likely to provide a similar level of protection against major vascular events for patients with isolated diastolic hypertension as for those with isolated systolic hypertension and systolic-diastolic hypertension. Clinical Trial Registration Information- This trial was not registered because patients were enrolled before July 1, 2005.
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Sharma VK, Tsivgoulis G, Teoh HL, Ong BKC, Chan BPL. Stroke risk factors and outcomes among various Asian ethnic groups in Singapore. J Stroke Cerebrovasc Dis 2010; 21:299-304. [PMID: 20971656 DOI: 10.1016/j.jstrokecerebrovasdis.2010.08.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Revised: 08/22/2010] [Accepted: 08/25/2010] [Indexed: 12/31/2022] Open
Abstract
Data on interethnic differences in the Asian stroke population are limited. We evaluated the relationships among various cardiovascular risk factors, stroke subtypes, and outcomes in a multiethnic Singaporean population comprising consecutive ischemic stroke patients presenting to our tertiary center over a 1-year period. Strokes were classified based on criteria used in the Trial of Org 10172 in Acute Stroke Treatment (TOAST). Functional independence at hospital discharge was defined as a modified Rankin Scale (mRS) score of 0-2. The ethnic distribution of the study population (n = 481; mean age, 64.1 ± 11.9 years) was 74% Chinese, 17% Malay, and 9% Indian. The prevalence of risk factors was similar in the 3 ethnic groups except for diabetes (Chinese, 39.8%; Malay, 67.5%; Indian, 52.3%; P < .001). Hypertension and hypercholesterolemia were the most common cardiovascular risk factors. Lacunar stroke was the most frequent stroke subtype (47.9%). Large-artery atherosclerotic infarctions were more prevalent in Indians (25.0%), whereas lacunar infarctions occured more frequently in Chinese (51.8%; P < .01). No differences in in-hospital mortality and functional independence at discharge were seen among the 3 ethnic groups. Despite the differences in risk factors and in stroke subtypes classified by location or underlying etiology, short-term outcome measures were similar in the 3 different Asian ethnicities in Singapore.
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Affiliation(s)
- Vijay K Sharma
- Division of Neurology, Department of Medicine, National University Hospital, Singapore.
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Hsu YH, Mao CL, Wey M. Antihypertensive Medication Adherence Among Elderly Chinese Americans. J Transcult Nurs 2010; 21:297-305. [DOI: 10.1177/1043659609360707] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study explored the level of antihypertensive medication adherence and examined certain demographic attributes and influential factors in relation to antihypertensive medication nonadherence among Chinese American elders using a descriptive cross-sectional survey design. Findings revealed that 52% of the elderly Chinese Americans adhered to their antihypertensive medications. Gender, education, years of residency in the United States, years of diagnosed hypertension, and perceived safety of taking antihypertensive medications did not contribute to the differences in medication adherence. Forgetfulness, medication adverse effects, language difficulties, and cultural barriers were the influential factors that hinder antihypertensive medication adherence. Developing effective and culturally appropriate strategies for Chinese American elders is recommended.
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Affiliation(s)
- Ya-Hui Hsu
- Santa Clara Valley Health and Hospital System, San Jose, CA, USA
| | | | - Mercy Wey
- San Jose State University, San Jose, CA, USA,
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Song SW, Liu AJ, Bai C, Su BL, Ma XJ, Shen FM, Duan JL, Su DF. Blood pressure reduction combining baroreflex restoration for stroke prevention in hypertension in rats. Front Pharmacol 2010; 1:6. [PMID: 21713105 PMCID: PMC3112284 DOI: 10.3389/fphar.2010.00006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2010] [Accepted: 05/06/2010] [Indexed: 11/13/2022] Open
Abstract
Blood pressure reduction is an important and effective strategy in stroke prevention in hypertensives. Recently, we found that baroreflex restoration was also crucial in stroke prevention. The present work was designed to test the hypothesis that a combination of blood pressure reduction and baroreflex restoration may be a new strategy for stroke prevention. In Experiment 1, the effects of ketanserin (0.3, 1, 3, 10 mg/kg), amlodipine (0.3, 1, 2, 3 mg/kg) and their combination (1 + 0.3, 1 + 1, 1 + 2, 1 + 3 mg/kg) on blood pressure and baroreflex sensitivity (BRS) of stroke-prone spontaneously hypertensive rats (SHR-SP) were determined under conscious state. It was found that both amlodipine and ketanserin decreased blood pressure dose-dependently. Ketanserin enfanced BRS from a very small dose but amlodipine enfanced BRS only at largest dose used. At the dose of 1 + 2 mg/kg (ketanserin + amlodipine), the combination possessed the largest synergism on blood pressure reduction. In Experiments 2 and 3, SHR-SP and two-kidney, two-clip (2K2C) renovascular hypertensive rats received life-long treatments with ketanserin (1 mg/kg) and amlodipine (2 mg/kg) or their combination (0.5 + 1, 1 + 2, 2 + 4 mg/kg). The survival time was recorded and the brain lesion was examined. It was found that all kinds of treatments prolonged the survival time of SHR-SP and 2K2C rats. The combination possessed a significantly better effect on stroke prevention than mono-therapies. In conclusion, combination of blood pressure reduction and baroreflex restoration may be a new strategy for the prevention of stroke in hypertension.
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Affiliation(s)
- Shu-Wei Song
- Department of Pharmacology, School of Pharmacy, Second Military Medical UniversityShanghai, China
- Department of Nephrology, Changzheng Hospital, Kidney Center of PLA, Second Military Medical UniversityShanghai, China
| | - Ai-Jun Liu
- Department of Pharmacology, School of Pharmacy, Second Military Medical UniversityShanghai, China
| | - Chong Bai
- Department of Respiratory Diseases, Second Military Medical UniversityShanghai, China
| | - Bei-Lin Su
- Department of Pharmacology, School of Pharmacy, Second Military Medical UniversityShanghai, China
| | - Xiu-Juan Ma
- Department of Pharmacology, School of Pharmacy, Second Military Medical UniversityShanghai, China
| | - Fu-Ming Shen
- Department of Pharmacology, School of Pharmacy, Second Military Medical UniversityShanghai, China
| | - Jun-Li Duan
- Department of Gerontology, Xinhua Hospital, Shanghai Jiaotong UniversityShanghai, China
| | - Ding-Feng Su
- Department of Pharmacology, School of Pharmacy, Second Military Medical UniversityShanghai, China
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Risk factors and prevention of stroke in the Chinese population. J Stroke Cerebrovasc Dis 2010; 20:395-400. [PMID: 20656505 DOI: 10.1016/j.jstrokecerebrovasdis.2010.02.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Revised: 01/11/2010] [Accepted: 02/15/2010] [Indexed: 11/24/2022] Open
Abstract
Stroke is the leading cause of long-term disability and the second-leading cause of death in China. Stroke is now a major public health burden for China. Hypertension, diabetes mellitus, abnormal lipid metabolism, smoking, and other definite risk factors of stroke are becoming of increasing concern. Prevention strategies for stroke occurrence and recurrence in China remain insufficient. This article reviews recent studies on modifiable risk factors and strategies for primary and secondary prevention of stroke in the Chinese population.
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Abstract
Hypertension is the most prevalent of the modifiable risk factors for stroke. The benefits of blood pressure (BP) lowering on primary and secondary prevention of stroke are undeniable. Despite this, BP control in hypertensive individuals and patients with prior cerebrovascular events is suboptimal. Noncompliance, inappropriate antihypertensive usage and under-utilization of medications contribute significantly to inadequate BP control. Recently, elegantly designed studies that assessed the preventive role of BP lowering in patients with cerebrovascular disease have helped clarify management issues in terms of BP targets and effective antihypertensive regimens. Current evidence suggests that BP targets for primary and secondary prevention are suboptimal and need reassessment. The effect of BP modulation in acute stroke is still not completely understood. Although the thresholds for BP treatment in acute stroke have been recommended, BP targets are as yet ill-defined. The available evidence supports early lowering of blood pressure following stroke. This review discusses the impact of blood pressure on stroke incidence and outcomes, outlines the recommendations for blood pressure lowering in stroke and delineates questions that still need to be addressed.
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Affiliation(s)
- Monica Saini
- Division of Neurology, Department of Medicine, University of Alberta, AB, Canada.
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Abstract
1. Following rapid economic development in China, the epidemiological characteristics, management and prevention strategies for stroke are changing. In the present article, we review recent epidemiological data, as well as studies into the management and prevention of stroke in China. 2. The main findings of the studies reviewed suggest that stroke mortality in China has been reduced significantly. The percentage of haemorrhagic strokes in China is significantly higher than that reported in Western countries. The incidence and subtype of stroke varied widely in different regions in China. Some of the modifiable risk factors for stroke are on the increase in China, including hypertension. 3. Management of stroke is slowly being developed and standardized, as evidenced by the establishment of stroke units and improvements in emergency care. Studies on primary and secondary stroke prevention remain insufficient. Well-designed epidemiological surveys and clinical trials for stroke prevention and management are urgently needed in China.
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Affiliation(s)
- Qian Jia
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Kelly TN, Gu D, Chen J, Huang JF, Chen JC, Duan X, Wu X, Yau CL, Whelton PK, He J. Hypertension subtype and risk of cardiovascular disease in Chinese adults. Circulation 2008; 118:1558-66. [PMID: 18809800 PMCID: PMC2735390 DOI: 10.1161/circulationaha.107.723593] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND We examined the relationship between hypertension subtype and cardiovascular disease incidence and mortality in Chinese adults. METHODS AND RESULTS We conducted a prospective cohort study in a nationally representative sample of 169 871 Chinese men and women aged >or=40 years. Data on systolic (SBP) and diastolic blood pressure (DBP) and other variables were obtained at a baseline examination in 1991 with the use of standard protocols. Follow-up evaluation was conducted in 1999-2000, with a response rate of 93.4%. Hypertension subtypes were defined as combined systolic and diastolic hypertension (SBP >or=140 and DBP >or=90 mm Hg), isolated systolic hypertension (SBP >or=140 and DBP <90 mm Hg), isolated diastolic hypertension (SBP <140 and DBP >or=90 mm Hg), and 2 categories of treated hypertension (SBP <140 and DBP <90 mm Hg or SBP >or=140 and/or DBP >or=90 mm Hg). After participants with missing BP values were excluded, 169 577 adults were included in the analyses. Compared with normotensives, relative risks (95% CIs) of cardiovascular disease incidence and mortality were 2.73 (2.60 to 2.86) and 2.53 (2.39 to 2.68) for combined systolic and diastolic hypertension, 1.78 (1.69 to 1.87) and 1.68 (1.58 to 1.78) for isolated systolic hypertension, 1.59 (1.43 to 1.76) and 1.45 (1.27 to 1.65) for isolated diastolic hypertension, 2.01 (1.64 to 2.48) and 1.61 (1.28 to 2.03) for treated hypertension with SBP <140 and DBP <90 mm Hg, and 3.37 (3.07 to 3.69) and 2.88 (2.60 to 3.19) for treated hypertension with SBP >or=140 and/or DBP >or=90 mm Hg, respectively, after adjustment for important covariables. CONCLUSIONS Our results indicate that all hypertension subtypes are associated with significantly increased risk of cardiovascular disease in Chinese adults. Primary prevention of hypertension should be a public health priority in the Chinese population.
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Affiliation(s)
- Tanika N. Kelly
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Dongfeng Gu
- Cardiovascular Institute and Fuwai Hospital of the Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Chen
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | - Jian-feng Huang
- Cardiovascular Institute and Fuwai Hospital of the Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ji-chun Chen
- Cardiovascular Institute and Fuwai Hospital of the Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiufang Duan
- Cardiovascular Institute and Fuwai Hospital of the Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xigui Wu
- Cardiovascular Institute and Fuwai Hospital of the Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - C. Lillian Yau
- Department of Biostatistics, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Paul K. Whelton
- President’s Office, Loyola University Medical Center, Maywood, IL, USA
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA
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Gu D, Kelly TN, Wu X, Chen J, Duan X, Huang JF, Chen JC, Whelton PK, He J. Blood pressure and risk of cardiovascular disease in Chinese men and women. Am J Hypertens 2008; 21:265-72. [PMID: 18188156 DOI: 10.1038/ajh.2007.59] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND We examined the relationship between systolic and diastolic blood pressure (BP) and the incidence of cardiovascular disease (CVD) in a nationally representative cohort of 169,871 men and women > or = 40 years of age in China. METHODS Data on BP and other variables were obtained at a baseline examination in 1991 using standard protocols. Follow-up evaluation was conducted in 1999-2000, with a response rate of 93.4%. RESULTS After adjustment for age, sex, cigarette smoking, alcohol consumption, physical activity, body mass index, education, geographic region, urbanization, and time-dependent history of diabetes, a strong and linear association between both systolic and diastolic BP and incidence of CVD, coronary heart disease and stroke were observed (all P < 0.0001). For example, the relative risks (95% confidence interval (CI)) of CVD incidence were 1.09 (1.00-1.18), 1.25 (1.16-1.35), 1.49 (1.38-1.62), 2.15 (1.99-2.31), 3.01 (2.78-3.27), and 4.16 (3.84-4.51) for those with systolic/diastolic BP of 110-119/75-79, 120-129/80-84, 130-139/85-89, 140-159/90-99, 160-179/100-109, and > or = 180/110 mm Hg compared to those with BP <110/75 mm Hg. Increases in systolic BP were associated with a greater risk of CVD compared to corresponding increases in diastolic BP. The linear trend for increased CVD risk being related to higher BP levels was observed in all subgroups of gender, age, body weight, and cigarette smoking. CONCLUSIONS Our results indicate that there is a strong, linear, and independent relationship between BP levels and the risk of CVD in Chinese adults. Systolic BP is a stronger predictor of CVD risk compared to diastolic BP.
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Abstract
BACKGROUND AND PURPOSE Arterial baroreflex is one of the most important mechanisms in the regulation of cardiovascular activities. Arterial baroreflex function can be expressed as baroreflex sensitivity (BRS). The present study was designed to test 2 hypotheses: (1) BRS is a new independent predictor for the incidence of stroke in hypertension, and (2) restoration of BRS can prevent stroke in hypertension. METHODS First, 82 stroke-prone spontaneously hypertensive rats (SHR-SP) aged 28 to 30 weeks were used. After measuring blood pressure and BRS, the survival time was observed. Second, 12 SHR-SP aged 8 months were used. Blood pressure and BRS were determined separately before and after intragastric administration of ketanserin (0.3 and 3.0 mg/kg). Third, SHR-SP aged 5 months were treated with ketanserin for 12 weeks (0.3 mg and 3.0 mg/kg per day). At the end of the treatment, blood pressure and BRS were determined and the end-organ damage was evaluated. Last, SHR-SP aged 3 months were treated with ketanserin (0.3 and 3.0 mg/kg per day) for life and the survival time was recorded. RESULTS Stroke was significantly delayed in rats with high BRS than those with low BRS (time to 50% death was 1.47-fold longer than low BRS group; P<0.01). Ketanserin of 3.0 mg/kg per day decreased blood pressure and enhanced BRS, whereas 0.3 mg/kg per day only enhanced the BRS. Fatal stroke incidences were markedly reduced by treatment with both doses (P<0.0001 versus control group). CONCLUSIONS The present study provides evidence that BRS is an independent predictor for stroke in hypertension. Restoration of BRS may be a new strategy for the prevention of stroke.
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Affiliation(s)
- Ai-Jun Liu
- Department of Pharmacology, School of Pharmacy, Second Military Medical University, Shanghai, China
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Liu M, Wu B, Wang WZ, Lee LM, Zhang SH, Kong LZ. Stroke in China: epidemiology, prevention, and management strategies. Lancet Neurol 2007; 6:456-64. [PMID: 17434100 DOI: 10.1016/s1474-4422(07)70004-2] [Citation(s) in RCA: 563] [Impact Index Per Article: 33.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In this review, we examine the current status of stroke epidemiology, prevention, and management strategies in mainland China. The main findings suggested that total age-adjusted incidence of first-ever stroke in China is not very different from that in developed countries. Stroke incidence, mortality, and prevalence varied widely among different regions within China, with a noticeable north-south gradient. The proportion of intracerebral haemorrhage was high and reached 55% in one city. Hypertension is the most important risk factor for stroke. The mass approach combined with a high-risk approach for stroke prevention showed encouraging effects, and various unconventional local therapeutic traditions are commonly used to treat stroke in China. Several national guidelines on stroke prevention and treatment have been developed. Because of methodological limitations in the epidemiology studies, data are unreliable in terms of making any firm conclusions. Up-to-date, well-designed, and well-done epidemiological studies and therapeutic trials in China are urgently needed.
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Affiliation(s)
- Ming Liu
- Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
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Importancia de la presión arterial diastólica en relación con la edad. HIPERTENSION Y RIESGO VASCULAR 2007. [DOI: 10.1016/s1889-1837(07)71692-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Serna Candel C, Moreno Pérez O, Moltó Jordà JM. Evidencia científica en el tratamiento de la hipertensión arterial crónica en la prevención del ictus. Med Clin (Barc) 2006; 127:626-33. [PMID: 17145030 DOI: 10.1157/13094428] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Hypertension represents a relative risk of stroke up to 5 times. It is associated to ischaemic and haemorrhagic stroke. Hypertension produces an increase in brain vessels resistance and loss of the physiological mechanism of autoregulation, and it can be measured with transcranial doppler. Clinical trials have established that reducing blood pressure is effective in primary prevention of ischaemic and haemorrhagic stroke in hypertensive patients and in secondary prevention in hypertensive and non-hypertensive patients, even with small reductions in blood pressure. There is no evidence of superiority of a definite drug, although drugs that have proven efficacy in clinical trials are recommended in clinical practice.
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Affiliation(s)
- Carmen Serna Candel
- Servicio de Neurología, Hospital General Universitario de Alicante, Alicante, España.
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