Chinese Hypertensive Patients Research Articles

Effects of sacubitril/valsartan versus olmesartan on left atrial structure in hypertensive patients without HFrEF: a randomized controlled trial

Background and purpose: Treatment with sacubitril plus valsartan attenuates cardiac remodeling in patients with heart failure with reduced ejection fraction (HFrEF). Evidence for potential effects of sacubitril/valsartan on left atrial remodeling in hypertensive patients without HFrEF, however, is limited. Therefore, we aimed to compare the effects of sacubitril/valsartan and olmesartan on the left atrial structure in Chinese hypertensive patients. Methods: This single-center randomized controlled trial was conducted at Nanjing First Hospital from June 2021 to February 2022. Adult patients (18–80 years of age) with essential hypertension but no HFrEF were randomized at a 1:1 ratio to receive sacubitril/valsartan or olmesartan. Initial dosage was 100 mg/day for sacubitril/valsartan and 20 mg/day for olmesartan. In patients who did not reach the target blood pressure (<140/90 mmHg) within a week, dosage was increased to 200 to 400 mg/day for sacubitril/valsartan and 40 mg/day for olmesartan. In patients who failed to reach the target blood pressure at 4 weeks, other antihypertensive drugs were used at physician’s discretion. The patients should reach the target blood pressure at 8 weeks. The primary endpoint was the change of left atrial volume index (LAVI) from baseline to 24 weeks. Secondary endpoints included the changes of left atrial diameter (LAD), left atrial emptying fraction (LAEF), left ventricular ejection fraction (LVEF), and left ventricular end-diastolic diameter (LVEDD) from baseline to 24 weeks. Results are shown as median and interquartile range (IQR). Results: A total of 153 patients were enrolled. The final analysis included 145 patients who completed the 24-week assessment: 71 and 74 in the sacubitril/valsartan and olmesartan groups, respectively. Demographic and key baseline characteristics (e.g., blood pressure) were comparable between the 2 groups. Target blood pressure was achieved in all 145 patients at 8 weeks. In comparison to the olmesartan group, the sacubitril/valsartan group had significantly greater change in LAVI (−4.19 [−2.87, −5.43] vs. −0.61 [−0.53, −1.13] mL/m2, P < 0.001), LAEF (1.00% [2.00%, 0%] vs. 0% [1.00%, −1.00%], P = 0.014), LVEDD (−2.00 [0, −3.00]mm vs. −1.00 [0, −1.00]mm, P < 0.001), and LVEF (1.00% [3.00%, 1.00%] vs. 0% [1.00%, 0%], P < 0.001), but not LAD, LAVI, LAEF, LVEDD, and LVEF at 24 weeks relative to the baseline. Conclusions: In comparison to olmesartan, sacubitril/valsartan resulted in more robust improvements in left atrial and ventricular structure and function in hypertensive patients without HFrEF.

Psychometric properties of the Chinese version of the Hypertension Belief Assessment Tool

BackgroundHypertension is prevalent in China. Hypertensive patients suffer from many health problems in life. Hypertension is a common chronic disease with long-term and lifelong characteristics. In the long run, the existence of chronic diseases will affect the patient’s own health beliefs. However, people’s health beliefs about Hypertension are not explicit. Therefore, it is vital to find a suitable instrument to comprehend and improve the health beliefs of hypertensive patients, thus, better control of blood pressure and improvement of patient’s quality of life are now crucial issues. This study aimed to translate the Hypertension Belief Assessment Tool (HBAT) into Chinese and examine the psychometric properties of the Chinese version of the Hypertension Belief Assessment Tool in hypertensive patients.MethodsThis is a cross-sectional study. We translated the HBAT into Chinese and tested the reliability and validity of the Chinese version among 325 hypertensive patients.ResultsThe Chinese version of the scale contains 21 items. The Exploratory Factor Analysis (EFA) revealed six factors and explained 77.898% of the total variation. A six-factor model eventually showed acceptable fit indices in the Confirmatory Factor Analysis (CFA). With modified Confirmatory Factor Analysis, the fit indices were Chi-square/Degree of Freedom (CMIN/DF) = 2.491, Comparative Fit Index (CFI) = 0.952, Incremental Fit Index (IFI) = 0.952, Root-mean-square Error of Approximation (RMSEA) = 0.068, Tucker Lewis Index (TLI) = 0.941. The HBAT exhibits high internal consistency reliability (0.803), and the scale has good discriminant validity.ConclusionThe results suggest that the HBAT is a reliable and valid instrument for assessing the beliefs of Chinese hypertensive patients.

Prevalence and associated risk factors of resistant hypertension among Chinese hypertensive patients in primary care setting

IntroductionHypertension (HT) is a major public health problem globally, and it is the commonest chronic disease with a prevalence of 27% among people aged 15 years or above in Hong Kong. There is emerging literature confirmed that patients with resistant hypertension (RHT) give its increased risk for adverse clinical outcomes and higher rate of documented target organ damage. This study aims to identify the prevalence of RHT among Chinese hypertensive patients managed in public primary care setting of Hong Kong and exploring its associated risk factors.MethodologyThis is a cross-sectional descriptive study. Chinese hypertensive patients aged 30 or above with regular follow-up between 1st July 2019 and 30th June 2020 in 10 public primary care clinics under the Hospital Authority of Hong Kong were included. Demographic data, clinical parameters and drug profile of patients were retrieved from its computerized record system. The prevalence of RHT was identified and the associated risk factors of RHT were explored by multivariate logistic regression analysis.ResultsAmong the 538 sampled Chinese hypertensive patients, the mean age was 67.4 ± 11.5 years old, and 51.9% were female. The mean duration of hypertension was 10.1 ± 6.4 years, with a mean systolic and diastolic blood pressure of 128.8 ± 12.3 and 72.9 ± 10.8 mmHg respectively. 40 out of 538 patients were found to have RHT, giving an overall prevalence of 7.43%. Four factors were found to be associated with increased risk of RHT, in ascending order of odds ratio: duration of hypertension (OR 1.08), male gender (OR 2.72), comorbid with type 2 diabetes mellitus (T2DM, OR 2.99), and congestive heart failure (CHF, OR 5.39).ConclusionThe prevalence of RHT among Chinese hypertensive patients in primary care setting of Hong Kong is 7.43%. RHT is more common in male patients, patients with longer duration of hypertension, concomitant T2DM and CHF. Clinicians should be vigilant when managing these groups of patients and provide aggressive treatment and close monitoring.

Association of adiposity indicators with cardiometabolic multimorbidity risk in hypertensive patients: a large cross-sectional study.

Cardiometabolic multimorbidity (CMM) has emerged as a prominent public health concern. Hypertensive patients are prone to develop comorbidities. Moreover, the accumulation of visceral adipose tissue is the main cause for the development of cardiometabolic diseases. The cardiometabolic index (CMI), lipid accumulation product (LAP), visceral adiposity index (VAI), and Chinese visceral adiposity index (CVAI) not only assess adipose tissue mass but also reflect adipose tissue dysfunction. So far, no study has been reported to evaluate the association of CMI, LAP, VAI, and CVAI with CMM risk in hypertensive patients. Therefore, this study aimed to assess the association between these adiposity indicators and the risk of CMM among Chinese hypertensive patients. In this cross-sectional study, a total of 229,287 hypertensive patients aged 35 years and older were included from the National Basic Public Health Service Project. All participants underwent a face-to-face questionnaire survey, physical examination, and the collection of fasting venous blood samples. Multivariable logistic regression models were performed to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Receiver operating characteristic curve was utilized to evaluate the identification ability for CMM. After adjusting for confounders, each 1-standard deviation increase in CMI, LAP, VAI, and CVAI was associated with a 14%, 8%, 12%, and 54% increased risk of CMM, respectively. When comparing the highest quartile of these indicators with the lowest quartile, individuals in the highest quartile of CMM, LAP, VAI, and CVAI had a 1.39-fold (95% CI 1.30, 1.48), 1.28-fold (95% CI 1.19, 1.37), 1.37-fold (95% CI 1.29, 1.46), and 2.56-fold (95% CI 2.34, 2.79) increased risk of CMM after adjusting for potential confounders. Notably, a nonlinear association was observed for CMI, LAP, and VAI with the risk of CMM (all P nonlinearity < 0.001). CVAI exhibited the highest area under the receiver operating characteristic curve (AUC) among all the included adiposity indices in this analysis. This study indicated the significant positive association of CMI, LAP, VAI, and CVAI with the risk of CMM in hypertensive patients. Among these indicators, CVAI demonstrated the most robust performance in predicting CMM risk and may serve as a valuable tool for identifying CMM risk in Chinese hypertensive patients.

Covid-19 vaccination coverage and associated factors among older hypertensive patients in Hangzhou, China.

Vaccination could provide effective protection against coronavirus disease 2019 (COVID-19). This study aims to describe the COVID-19 vaccination coverage and influential factors in Chinese older hypertensive patients. Using a cross-sectional design, participants were randomly selected from the electronic health records system during the pandemic era in Hangzhou, China. Logistic regression models were employed to compute the OR and 95% CI in order to assess the relationships between variables and the extent of COVID-19 vaccination coverage. As of 3 August 2022, among a sample of 77 970 individuals, 75.11% had completed the full COVID-19 vaccination, while 57.66% had received a booster dose. Disparities in coverage were observed across genders, regions and age groups. Unhealthy lifestyles, cardiovascular disease, cancer, uncontrolled blood pressure, abnormal fasting plasma glucose, dyslipidemia and renal dysfunction were risk factors for COVID-19 vaccination coverage. The coverage rates continuously declined along with the number of risk factors. The ORs for full and booster vaccination in subjects with ≥4 risk factors were 2.55 (2.12∼3.07) and 2.60 (2.16∼3.13), compared to individuals without risk factors. The COVID-19 vaccination program for older hypertensive patients must be strengthened further. Emphasis should be placed on patients who reside in urban areas, have comorbidities or multiple risk factors.

Association of cardiometabolic multimorbidity with all-cause and cardiovascular disease mortality among Chinese hypertensive patients.

Hypertension usually clusters with multiple comorbidities. However, the association between cardiometabolic multimorbidity (CMM) and mortality in hypertensive patients is unclear. This study aimed to investigate the association between CMM and all-cause and cardiovascular disease (CVD) mortality in Chinese patients with hypertension. The data used in this study were from the China National Survey for Determinants of Detection and Treatment Status of Hypertensive Patients with Multiple Risk Factors (CONSIDER), which comprised 5006 participants aged 19-91 years. CMM was defined as the presence of one or more of the following morbidities: diabetes mellitus, dyslipidemia, chronic kidney disease, coronary heart disease, and stroke. Cox proportional hazard models were used to calculate the hazard ratios (HR) with 95% CI to determine the association between the number of CMMs and both all-cause and CVD mortality. Among 5006 participants [mean age: 58.6 ± 10.4 years, 50% women (2509 participants)], 76.4% of participants had at least one comorbidity. The mortality rate was 4.57, 4.76, 8.48, and 16.04 deaths per 1000 person-years in hypertensive patients without any comorbidity and with one, two, and three or more morbidities, respectively. In the fully adjusted model, hypertensive participants with two cardiometabolic diseases (HR = 1.52, 95% CI: 1.09-2.13) and those with three or more cardiometabolic diseases (HR = 2.44, 95% CI: 1.71-3.48) had a significantly elevated risk of all-cause mortality. The findings were similar for CVD mortality but with a greater increase in risk magnitude. In this study, three-fourths of hypertensive patients had CMM. Clustering with two or more comorbidities was associated with a significant increase in the risk of all-cause and cardiovascular mortality among hypertensive patients, suggesting more intensive treatment and control in this high-risk patient group.

Cumulative blood pressure load and hypertensive nephropathy in Han Chinese hypertensive patients.

The study aims to assess the relationship between cumulative blood pressure load (cBPL) and the risk of renal function decline in hypertensive patients and determine the blood pressure (BP) threshold required to prevent hypertensive nephropathy. A single-center prospective cohort study was conducted on hypertensive patients. The cBPL was defined as the proportion of area beyond variable BP cutoffs under ambulatory BP monitoring. Renal events were defined as>25% (minor) or>50% (major) decline of baseline estimated glomerular filtration rate (eGFR). Cox regression analysis was conducted between cBPL, other ambulatory BP parameters, and renal events. The results revealed a total of 436 Han Chinese hypertensive patients were eligible for enrollment. During an average follow-up period of 5.1±3.3 years, a decline of>25% and>50% in eGFR was observed in 77 and eight participants, respectively. Cox regression analysis revealed that cSBPL140 (hazard ratio [HR], 1.102; 95% confidence interval [CI], 1.017-1.193; p=.017), cSBPL130 (HR, 1.076; 95% CI, 1.019-1.137; p=.008), and cSBPL120 (HR, 1.054; 95% CI, 1.010-1.099; p=.015) were independently associated with minor renal events. Similarly, cSBPL140 (HR, 1.228; 95% CI, 1.037-1.455; p=.017), cSBPL130 (HR, 1.189; 95% CI, 1.045-1.354; p=.009), and cSBPL120 (HR, 1.155; 95% CI, 1.039-1.285; p=.008) were independently associated with major renal events. In conclusion, cBPL is associated with renal function decline in hypertensive patients. Minimizing cBPL120 may decrease the risk of hypertensive nephropathy.

Association of Antihypertensive Drug-Related Gene Polymorphisms with Stroke in the Chinese Hypertensive Population.

Antihypertensive therapy is crucial for preventing stroke in hypertensive patients. However, the efficacy of antihypertensive therapy varies across individuals, partially due to therapy-related genetic variations among individuals. We investigated the association of antihypertensive drug-related gene polymorphism with stroke in patients with hypertension. Demographic information, medication, and outcome data were obtained from a hypertensive patient management system, and a PCR fluorescence probe technique was used to detect 7 gene polymorphic loci (CYP2D6∗10, ADRB1, CYP2C9∗3, AGTR1, ACE, CYP3A5∗3, and NPPA), and these loci were compared between patients with and without stroke. Logistic regression was performed to analyze the association of these genetic variations with stroke risk in hypertensive patients while controlling for potential factors. The prevalence of stroke in the hypertensive population in Changsha County of Hunan Province was 2.75%. The mutation frequencies of ADRB1 (1165G > C), CYP2D6∗10, CYP2C9∗3, AGTR1 (1166A > C), ACE (I/D), NPPA (2238T > C), and CYP3A5∗3 were 74.43%, 57.23%, 4.26%, 5.71%, 31.62%, 1.17%, and 69.58%, respectively. Univariate analysis revealed that ADRB1 polymorphism was associated with stroke (χ2 = 8.659, P < 0.05), with a higher stroke risk in the CC group than in the GC and GG groups (GC + GG). Multivariate unconditional logistic regression analysis showed that the CC genotype in ADRB1 (vs. the GC + GG genotype) was associated with an increased risk of stroke [odds ratio (OR) = 1.184, P<0.05] in hypertensive patients. No association was observed between CYP2D6∗10, CYP2C9∗3, AGTR1 (1166A > C), ACE (I/D), CYP3A5∗3, and NPPA (2238T > C) polymorphisms and stroke. ADRB1 (1165G > C) gene polymorphism is associated with the risk of stroke in Chinese hypertensive patients. The CC genotype is correlated with a higher risk of stroke than the GC + GG genotype.

Correlation Analysis of NAMPT rs61330082 Polymorphism in Type 2 Diabetes Mellitus Combined with Hypertension.

This study aimed to investigate the association of Nicotinamide phosphoribosyl transferase (NAMPT) rs61330082 polymorphism with co-morbid hypertension (HTN) and the progression of hypertension in Chinese patients with type 2 diabetes mellitus (T2DM). A total of 453 T2DM patients were genotyped for the polymorphism of rs61330082 using SNP-scan high-throughput technology. These patients were divided into T2DM group (261 patients) and T2DM combined with hypertension group (T2MH, 192 patients). The T2MH group was further categorized into Grade I, Grade II, and Grade III based on the results of the Hypertension Grade Score. Peripheral blood plasma urea, plasma creatinine, renin-angiotensin system (RAS) indexes, and lipid biochemistry indexes were measured in patients and analyzed in relation to NAMTP polymorphisms. We found that the presence of the NAMPT rs61330082-AA genotype was associated with a significantly increased risk of developing higher-grade hypertension in patients with T2MH. In addition, the A allele of the NAMPT rs61330082 gene displayed more associated in developing a higher grade of hypertension compared to the G allele. Also, the level of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-c) increased with hypertension grade in the NAMPT rs61330082-GG genotype. NAMPT rs61330082 polymorphism was significantly associated with the progression of hypertension grade in T2MH patients and also affected plasma creatinine and LDL-c levels.

Vitamin E and risk of first stroke in general hypertensive patients: a nested case–control study

Background: Epidemiological studies on the association between levels of plasma vitamin E and first stroke risk are inconclusive. Methods: A nested, case–control study was conducted utilizing data on 115,337 hypertensive patients from the H-type Hypertension and Stroke Prevention and Control Project. The current analysis comprised 2193 cases of first stroke and 2193 controls matched for age, sex, and study site. Results: The mean plasma concentration of vitamin E was 12.37 (3.61) μg/mL. The smoothing curve showed a linear correlation between plasma vitamin E levels and the risk of the first stroke. Hypertensive patients with plasma vitamin E levels ≥14.1 μg/mL (Q4) had an increased risk of first stroke (adjusted odds ratios [OR]: 1.18; 95% confidence interval [CI]: 1.01, 1.37) compared with those with plasma vitamin E &lt; 14.1 μg/mL (Q1–Q3). Sub-group analysis revealed that the relationship between plasma vitamin E (≥14.1.1 vs. P interaction = 0.035). Conclusions: This study suggests that higher levels of plasma vitamin E are associated with an elevated risk of first stroke among Chinese hypertensive patients.

Relationship between normal weight central obesity and arterial stiffness in Chinese adults with hypertension

Background and aimsNormal weight central obesity (NWCO) is a category of obesity that is characterized by having a normal BMI and presence of abdominal obesity. Recently, studies have reported that NWCO was associated with the cardiovascular diseases. The researches exploring the relationship between NWCO and arterial stiffness are limited. So this study intended to investigate the relationship between NWCO and arterial stiffness in Chinese adults with hypertension. Methods and resultsThis study is a sub-study of the China H-type Hypertension Registry Study. We included 8580 Chinese hypertensive patients with normal weight (18.5 kg/m2 ≤BMI <24 kg/m2). Central obesity was defined as waist-height ratio ≥0.5, and participants were categorized into two groups: NWCO and normal weight and no central obesity (NWNO). Using the brachial-ankle pulse wave conduction velocity (baPWV) assessed the arterial stiffness. Multiple linear regression analysis was used to evaluate relationship between NWCO and baPWV. Multiple logistic regression analysis was used to evaluate relationship between NWCO and arterial stiffness. Of 8580 participants, 4327 (50.4 %) were NWCO. The multiple linear regression analysis demonstrated that people with NWCO had higher baPWV value (total people: β = 38.33, 95%CI 22.82–53.84; men: β = 39.87, 95%CI 18.43–61.32; women: β = 29.65, 95%CI 7.20–52.09) compared with NWNO. The baPWV ≥1800 cm/s was defined as arterial stiffness, and the multiple logistic regression analysis showed that people with NWCO associated higher arterial stiffness risk (total people: OR = 1.25, 95%CI 1.12–1.39; men: OR = 1.29, 95%CI 1.11–1.50; women: OR = 1.18, 95%CI 1.01–1.38). ConclusionNWCO is significantly related to increased risk of arterial stiffness in Chinese adults with hypertension.

Evaluating smoking cessation interventions in China's primary care facility networks for hypertensive patients aged 45 years and older: A retrospective cohort study.

In China's aging population, hypertension, aggravated by smoking, constitutes a substantial health concern. However, the effectiveness of the national public health interventions for smoking cessation under the Essential Public Health Services remains unverified. Our aim was to examine smoking prevalence, the proportion of individuals receiving smoking cessation advice, its impact on successful cessation among Chinese hypertensive patients aged ≥45 years, and to discern disparities in the coverage and efficacy of smoking cessation interventions between primary care facilities and hospitals. Employing a longitudinal cohort approach, we examined four waves (2011-2018) of the China Health and Retirement Longitudinal Study (CHARLS). We surveyed a nationally representative cohort of hypertensive individuals, accounting for smoking status, cessation advice, healthcare preferences, and 11 pertinent covariates. Among the 4269 hypertensive patients, smokers were predominantly male, aged <65 years, with lower education and lower wealth. Smoking prevalence decreased from 25.2% in 2011 to 21.1% in 2018. The incidence of physician-provided smoking cessation advice reached a peak of 60.3% in 2015, decreasing to 54.8% in 2018. Visitors to primary care facilities reported the highest rate of advice reception. While patients receiving advice exhibited a higher smoking prevalence, instrumental variable regression and subgroup analyses found no significant correlation between advice receipt and successful cessation. We observed a substantial smoking prevalence among older hypertensive Chinese individuals and limited effectiveness of existing cessation programs. This underscores the necessity for augmenting primary care and devising a comprehensive health policy for more successful smoking cessation interventions, particularly considering China's rapidly aging population.

Gut microbiome profile of Chinese hypertension patients with and without type 2 diabetes mellitus

BackgroundThe coexistence of hypertension and type 2 diabetes mellitus (T2DM) may largely increase the risk for cardiovascular disease. However, there is no clear consensus on the association between hypertension and the risk of diabetes. Gut microbiota plays important roles in the development of hypertension and T2DM, but whether there is difference between hypertension patients with or without T2DM has not been explored yet.MethodsWe recruited 101 hypertension patients in this study (72 patients without T2DM named HT group and 29 patients with T2DM named HT-T2DM group). Their blood samples were collected for testing clinical characteristics and fecal samples were tested for bacterial DNA using 16 S ribosomal RNA gene sequencing targeting the V3 and V4 region. The data of 40 samples were downloaded from project PRJNA815750 as health control (HC group) in this study. The community composition and structure of the microbiome, taxonomic difference, co-occurrence network and functional enrichment were analyzed by alpha/beta diversity, LEfSe, Fruchterman Reingold’s algorithm and PICRUSt2 functional analysis, respectively.ResultsAlpha and beta diversity analysis showed significant differences in microbial community richness and composition among the three groups. The HC group had a significantly higher Simpson index and a distinct microbiota community compared to the HT and HT-T2DM groups, as demonstrated by significant differences in unweighted and weighted UniFrac distances. The LEfSe analysis identified specific taxa that had significantly different abundance among the groups, such as Bacteroides uniformis, Blautia wexlerae, Alistipes putredinis, and Prevotella stercorea in the HC group, Prevotella copri and Phascolarctobacterium faecium in the HT group, and Klebsiella pneumoniae in the HT-T2DM group. Co-occurrence network analysis indicates that Prevotella copri, Mediterraneibacter gnavus, Alistipes onderdonkii and some unidentified species act as key nodes in the network. Differentially functional pathway identified by PICRUSt2 were concentrated in nutrition and energy metabolism, as well as the biosynthesis of other secondary metabolites.ConclusionsOur study found significant differences in microbial community richness, composition, and function among the healthy controls, hypertension patients with and without T2DM. Some specific taxa may explain this difference and serve as potential therapeutic targets for hypertension, T2DM, and their coexistence.

Prevalence of hypertension among type 2 diabetes mellitus patients in China: a systematic review and meta-analysis.

This study aimed to estimate the prevalence of hypertension in Chinese patients with type 2 diabetes mellitus (T2DM) using the results of a regional study. The studies were reviewed using PubMed, EMBASE, Web of Science, the Cochrane Library, China National Knowledge Infrastructure, China Biology Medicine, Wan Fang Data and Chinese Science Citation Database. After screening articles and data extraction, Stata V.16 was used for statistical analysis. This study was registered in the Prospective Register Systematic Reviews (CRD42020170649). A total of 2126 articles were identified, and nine papers were finally included. Random-effects modelling showed that the pooled prevalence of hypertension among Chinese patients with T2DM was 54% (95% CI 47 to 61%). Subgroup analysis showed that the prevalence in men (59.8%; 95% CI 49.0 to 70.7%) was higher than that in women (40.2%; 95% CI 29.3 to 59.2%). The prevalence in North China was higher than that in East China. The prevalence in institution-based settings (56%; 95% CI 48 to 64%) was higher than that in community-based settings (51%; 95% CI 34 to 69%). Appropriate preventive measures should be undertaken, such as health education, to control and reduce the risk of hypertension in diabetic patients and reduce the burden of cardiovascular disease.

Evaluation of the structural development potential of receptors based on SARS-CoV-2 infection

Since 2019, the coronavirus has posed a huge threat to human health and the environment. Many scholars have since started studying the coronavirus and its branches, including SARS-CoV-2. SARS-CoV-2 is a positive stranded RNA virus composed of four main proteins and several auxiliary proteins that encapsulate genetic material. It mainly mediates virus invasion through the binding of S protein to host cell receptors, determining the tissue and host preference of the virus. ACE2 is a receptor required for SARS-CoV-2 to enter cells, which is consistent with the epidemiological risk of severe diseases observed in Chinese cardiovascular disease and hypertension patients. This article will explore the potential development of SARS-CoV-2 receptor ACE2 in terms of structure.

Effectiveness of China-PAR and Framingham risk score in assessment of 10-year cardiovascular disease risk in Chinese hypertensive patients

ObjectivesEstimating the total risk of cardiovascular disease (CVD) using risk prediction models represents a huge improvement in identifying and treating each of the risk factors. The objective of this study was to evaluate the effectiveness of the China-PAR (Prediction of atherosclerotic CVD risk in China) and Framingham risk score (FRS) in predicting the 10-year risk of CVD in Chinese hypertensive patients. The results of the study can be used to design health promotion strategies. Study designA large cohort study was used to assess the validity of models by comparing model predictions with actual incidence rates. MethodsIn total, 10,498 hypertensive patients aged 30–70 years in Jiangsu Province, China, participated in the baseline survey that took place between January and December 2010 and were followed up to May 2020. China-PAR and FRS were used to calculate the predicted 10-year risk of CVD. The 10-year observed incidence of new cardiovascular events was adjusted by the Kaplan–Meier method. The ratio of the predicted risk to the actual incidence was calculated to evaluate the effectiveness of the model. The discrimination Harrell's C statistics and calibration Chi-square value were used to evaluate the predictive reliability of the models. ResultsOf the 10,498 participants, 4411 (42.02%) were male. During the mean follow-up of 8.30 ± 1.45 years, a total of 693 new cardiovascular events occurred. Both models overestimated the risk of morbidity to varying degrees, and the FRS overestimated to a greater extent. After adjustment for covariates, the results of Cox proportional hazards regression showed that the risk of CVD in the high-risk group was higher than in low-risk group. The degree of discrimination in both models was approximately 0.6, which showed that discrimination was not ideal in the models. In addition, Chi-square calibrations of the two models were <20 in males, which showed that calibration of the models was better for men than women. ConclusionsThe China-PAR and FRS models overestimated the risk of CVD for participants in this study. In addition, the degree of discrimination was not ideal, and both models performed better in males than in females in terms of calibration. The results of this study suggest that a more suitable risk prediction model should be established according to the characteristics of the hypertensive population in Jiangsu Province.

Control status of ambulatory blood pressure and its relationship with arterial stiffness in the China nationwide registry of treated hypertensive patients: the REACTION-ABP study.

The control rate of ambulatory blood pressure (BP) is unclear in Chinese hypertensive patients, and whether it would be associated with the ambulatory arterial stiffness indices is also unknown. From June 2018 until December 2022, 4408 treated hypertensive patients (52.8% men, average age 58.2 years) from 77 hospitals in China were registered. Ambulatory BPs were measured with validated monitors and analyzed with a web-based standardized Shuoyun system ( www.shuoyun.com.cn ). The BP control rate was the highest in the office (65.7%), moderate in the daytime (45.0%), low in the morning (34.1%), and the lowest in the nighttime (27.6%, P < 0.001). Only 21.0% had their 24 h BP perfectly controlled. The stepwise regression analyses identified that the factors associated with an imperfect 24 h BP control included male sex, smoking and drinking habits, a higher body mass index, serum total cholesterol and triglycerides, and the use of several specific types of antihypertensive drugs. After adjustment for the above-mentioned factors, the 24 h pulse pressure (PP) and its components, the elastic and stiffening PPs, were all significantly associated with an uncontrolled office and ambulatory BP status with the standardized odds ratios ranging from 1.09 to 4.68 (P < 0.05). The ambulatory arterial stiffness index (AASI) was only associated with an uncontrolled nighttime and 24 h BP status. In conclusion, the control rates of 24 h ambulatory BP, especially that in the nighttime and morning time windows, were low in Chinese hypertensive patients, which might be associated with arterial stiffness in addition to other common risk factors.

ASSOCIATION BETWEEN BMI AND AMBULATORY BLOOD PRESSURE CHARACTERISTICS: EVIDENCE FROM POPULATION-BASED AMBULATORY BLOOD PRESSURE MONITORING COHORT

Objective: The aim of our study was to investigate the association between BMI and Chinese hypertensive patients’ ambulatory blood pressure characteristics. Design and method: According to the inclusion criteria and exclusion criteria, recruiting participants for analysis. Overweight was defined as BMI = &gt; 18.5 kg/m2, and obesity as BMI = &gt; 25 kg/m2. ABPM characteristics were defined according to European guidelines. Hypertension was defined as elevated mean ambulatory BP (&gt;135/85 mmHg in day-time, &gt;120/70 mmHg in the night-time, &gt;130/80 mmHg over 24-h). There are four kinds of blood pressure circadian rhythm, dippers, non-dippers, reverse dippers, and extreme dippers. The effects of BMI on ambulatory blood pressure characteristics were analyzed using between-group analysis of variance and logistic regression analysis. Results: In our cohort, 35367 hypertensive patients who were eligible for this study were analyzed finally, including 19380 men (54.8%) and 15987 women (45.2%) aged from 19 to 99 (mean age 58.86 years). The mean 24hBP of the study subjects was 126.41±16.00/78.79±11.62 mmHg. The different BMI groups showed that ambulatory BP increased with BMI, and the obese group had the highest increase in BP, HR, and systolic BP (P &lt; 0.05). Blood pressure variability and systolic load tended to increase with BMI, while the nocturnal blood pressure drop rate tended to decrease. When analyzing the type of hypertension among the participants, the prevalence of MBPS and morning hypertension increased significantly with the elevated BMI (P &lt; 0.05), and the highest prevalence of MBPS was found in the obese group. Logistic regression analysis revealed that the increased risks of MBPS and morning hypertension were the highest in the obese group, corresponding to a 2.1-fold (P &lt; 0.05) and 1.6-fold (P &lt; 0.05) increase in risk, respectively, with no change in trend after adjustment. Conclusions: BMI may affect the characteristics of hypertensive patients’ ambulatory blood pressure. The blood pressure variability and 24h SBP tended to increase with BMI, and the incidence of MBPS was highest in the obese group.

Relationship Between Plasma Aldosterone Concentrations and Non-Alcoholic Fatty Liver Disease Diagnosis in Patients with Hypertension: A Retrospective Cohort Study.

To investigate the association between plasma aldosterone concentration (PAC) and non-alcoholic fatty liver disease (NAFLD) diagnosis in Chinese hypertensive patients. We conducted a retrospective study of all patients diagnosed with hypertension between January 1, 2010, and December 31, 2021. We included 3713 hypertensive patients based on the criteria for inclusion and exclusion. PAC measurement was performed using a radioimmunoassay. NAFLD was diagnosed using abdominal ultrasonography. Cox regression analysis was used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for univariable and multivariable models. A generalized additive model was used to identify nonlinear relationships between PAC and NAFLD diagnosis. A total of 3713 participants were included in the analysis. Over a median follow-up of 30 months, 1572 hypertensive individuals developed new-onset NAFLD. When PAC was used as a continuous variable, the risk of NAFLD increased by 1.04 and 1.24-fold for each 1 ng/dL and 5 ng/dL increase in PAC, respectively. When PAC was considered a categorical variable, the HR for tertile 3 was 1.71 (95% CI, 1.47-1.98, P < 0.001) compared to tertile 1. Overall, there was a J-shaped relationship between PAC and new-onset NAFLD. By fitting a two-piecewise linear regression model and using a recursive algorithm, we identified a PAC inflection point at 13 ng/dL (log-likelihood ratio test, P = 0.005). In adjusted model 3, for PAC ≥ 13 ng/dL, a 5 ng/dL increase in PAC was associated with a 30% increase in the risk of new-onset NAFLD (95% CI, 1.25-1.35, P < 0.001). The study revealed a non-linear relationship between elevated PAC levels and the incidence of NAFLD in hypertensive patients. Notably, the risk of new-onset NAFLD was significantly increased when PAC levels were ≥13 ng/dL. Larger, prospective studies are necessary to confirm these findings.

THE INFLUENCES OF ACHIEVED BLOOD PRESSURE ON CARDIOVASCULAR OUTCOMES IN HYPERTENSIVE PATIENTS WITH DIFFERENT LEFT VENTRICULAR GEOMETRIC PATTERN: A PROSPECTIVE COHORT STUDY IN CHINA

Objective: Intensive antihypertensive therapy might bring additional benefits for hypertensive patients with high risks of cardiovascular diseases. The left ventricular(LV) geometric patterns could reasonably stratify cardiovascular risks in hypertensive patients, which might facilitate the selection of individuals who were more suitable for intensive antihypertensive therapy. Design and method: This investigation is a community-based, multi-center, prospective cohort study to investigate the geographical profile of cardiovascular disease risk across China. In total, 7680 hypertensive patients were recruited. Firstly, we divided all individuals into four subgroups, including normal geometry(NG), concentric remolding(CR), eccentric hypertrophy(EH) and concentric hypertrophy(CH) based on the diagnostic thresholds recommended by the EACVI/ASE and EMINCA study respectively, respectively. Secondly, we defined the primary endpoint as composite endpoints including the stroke, hospitalization for heart failure and coronary artery disease. We exhibited the hazard ratios of patients with different achieved systolic blood pressure (achieved SBP&gt;140mmHg, 130&lt;SBP&lt; = 140mmHg, and SBP&lt; = 130mmHg) after receiving anti-hypertensive therapy from general practitioners in the NG, CR, EH and CH subgroups based on the diagnostic thresholds of echocardiographic measurements from EMINCA study and EACVI/ASE guideline respectively. Results: We firstly validated that the diagnostic thresholds based on EMINCA study could preferably stratify cardiovascular risks for Chinese hypertensive patients considering the racial differences (Figure 1). And we demonstrated the additional benefits from intensive antihypertensive therapy featured by a SBP target lower than 130mmHg only occurred in the patients with CH regardless of according to the diagnostic thresholds from EMINCA study and EACVI/ASE guidelines (Figure 2). Intriguingly, we found the unexpected negative correlation between achieved SBP and occurrence of the primary endpoint in the patients with CR, exhibited by higher cardiovascular risks of patients with a achieved SBP below 130mmHg (Figure 2), which might be due to that CR patients were positively associated with extracardiac organ damage and might be more susceptible to the hypotension and organ hypoperfusion. Conclusions: The patients with CH might profit additionally from intensive anti-hypertensive therapy, but it needs to be more cautious in the patients with CR.