H-type Hypertension Research Articles

Association between serum calcium levels and first stroke: A community-based nested case-control study.

BackgroundEvidence from epidemiologic studies has been limited and inconsistent regarding the role of serum calcium in stroke incidence risk. We aimed to evaluate the association between serum albumin-corrected calcium and the risk of the first stroke in the Chinese community-dwelling population.MethodsThe study sample population was drawn from the “H-type Hypertension and Stroke Prevention and Control Project.” Using a nested case-control study, a total of 1,255 first-stroke cases and 1,255 controls matched for age, sex, and village were included in the final data analysis. We measured the serum calcium by inductively coupled plasma mass spectrometry and assessed the associations between serum albumin-corrected calcium and first stroke using conditional logistic regression.ResultsThe overall mean (SD) serum albumin-corrected calcium was 8.9 (0.6) mg/dl. Compared with the middle tertile (8.7–9.1 mg/dl), the multivariate-adjusted odds ratios (95% CIs) of first total stroke associated with the lowest tertile and the highest tertile of serum albumin-corrected calcium were 1.37 (1.10, 1.70) and 1.30 (1.04, 1.62), respectively. Similar trends were observed for the first ischemic stroke. Consistently, restricted cubic spline showed a U-shaped association between serum albumin-corrected calcium and risk of total stroke and ischemic stroke. However, serum albumin-corrected calcium had no significant effect on first hemorrhagic stroke. No significant effect modification was observed in the subgroup analysis.ConclusionsOur results suggested a U-shaped association between serum calcium and first stroke; both low and high serum calcium levels were associated with an increased risk of the first stroke in the Chinese population.

Individual and joint effects of borderline ankle-brachial index and high plasma total homocysteine on all-cause death in hypertensive adults.

BACKGROUNDThe cardiovascular hazards of total homocysteine (tHcy) are long known. In addition, despite the acknowledgment on the importance of low ankle-brachial index (ABI) (< 0.9), borderline ABI (0.91-0.99) was once commonly overlooked. This study aims to explore the independent and joint effect of tHcy level and borderline ABI on all-cause death in hypertensive population.METHODSThis study included 10,538 participants from China H-type Hypertension Registry Study. ABI was described into two groups: normal ABI (1.00-1.40) and borderline ABI. tHcy level was also divided into two groups: < 15.02 and ≥ 15.02 μmo/L. Four groups were analyzed, using COX proportional hazard regression model, separately and pairwise to observe the independent and joint effect on all-cause death.RESULTSA total of 126 (1.2%) deaths were observed in the 1.7 years follow-up time. Borderline ABI has a higher predicted risk of death than normal ABI (HR = 1.87, 95%CI: 1.17-3.00) after adjusting for potential covariates. Compare with tHcy level < 15.02 μmo/L (low tHcy), those with tHcy ≥ 15.02 μmo/L (high tHcy) had higher risk to event outcome (HR = 1.99, 95% CI: 1.30-3.05). According to the cumulative hazard curve, group with borderline ABI and high tHcy level has significantly higher altitude and larger increasing rate over follow-up period compare to other groups. Among those with borderline ABI, participants with high tHcy had higher death risk than those with low tHcy, nevertheless, no significant different between borderline and normal ABI among those with low tHcy levels.CONCLUSIONSBorderline ABI and tHcy level both have independent predictive value on all-cause death. The combined group of borderline ABI and high tHcy has highest risk factor of outcomes, which suggested the mutual additive value of borderline ABI and tHcy. More attention should be given to the importance of borderline ABI in hypertensive population, especially with elevated tHcy level.

Association between body fat percentage and H-type hypertension in postmenopausal women

BackgroundPrevious studies have explored the relationship between body fat percentage (BFP) and hypertension or homocysteine. However, evidence on the constancy of the association remains inconclusive in postmenopausal women. The aim of this study was to investigate the association between BFP and H-type hypertension in postmenopausal women.MethodsThis cross-sectional study included 1,597 eligible female patients with hypertension. Homocysteine levels ≥10 mmol/L were defined as H-type hypertension. BFP was calculated by measuring patients' physical parameters. Subjects were divided into 4 groups according to quartiles of BFP (Q1: 33.4% or lower, Q2: 33.4–36.1%, Q3: 36.1–39.1%, Q4: >39.1%). We used restricted cubic spline regression models and logistic regression analysis to assess the relationship between BFP and H-type hypertension. Additional subgroup analysis was performed for this study.ResultsAmong 1,597 hypertensive patients, 955 (59.8%) participants had H-type hypertension. There were significant differences between the two groups in age, BMI, educational background, marital status, exercise status, drinking history, WC, TG, LDL, Scr, BUN, and eGFR (P < 0.05). The prevalence of H-type hypertension in the Q1 to Q4 groups was 24.9, 25.1, 24.9, and 25.1%, respectively. After adjusting for relevant factors, we found that the risk of H-type hypertension in the Q4 group had a significantly higher than the Q1 group (OR = 3.2, 95% CI: 1.3–7.5).ConclusionBFP was positively associated with the risk of H-type hypertension in postmenopausal women. Postmenopausal women should control body fat to prevent hypertension.

Prediction of H-type Hypertension Based on Pulse Wave MFCC Features Using Mixed Attention Mechanism

PurposeH-type hypertension increases the risks of stroke and cardiovascular disease, posing a great threat to human health. Pulse diagnosis in traditional Chinese medicine (TCM) combined with deep learning can independently predict suspected H-type hypertension patients by analyzing their pulse physiological activities. However, the traditional time-domain feature extraction has a higher noise and baseline drift, affecting the classification accuracy. In this article, we propose an effective prediction on frequency-domain pulse wave features.MethodsFirst, we filter time-domain pulse waves via removal of high-frequency noises and baseline shift. Second, Hilbert–Huang Transform is explored to transform time-domain pulse wave into frequency-domain waveform characterized by Mel-frequency cepstral coefficients. Finally, an improved BiLSTM model, combined with mixed attention mechanism is built to be applied for prediction of H-type hypertension.ResultsWith 337 clinical cases from the Longhua Hospital affiliated to Shanghai University of TCM and Hospital of Integrated Traditional Chinese and Western Medicine, the threefold cross-validation results show that sensitivity, specificity, accuracy, F1-score and AUC reaches 93.48%, 95.27%, 97.48%, 90.77% and 0.9676, respectively. In addition, we calculate the feature importance both in time-domain and frequency-domain according to purity of nodes in Random Forest and study the correlation between features and classification.ConclusionThe proposed model achieves better generalization performance than the classical traditional ûmodels, and has a good reference value for TCM clinical auxiliary diagnosis.

Correlation between Serum Homocysteine Level and Cystatin C Elevation in Patients with H-type Hypertension

[Objective] To investigate the correlation between serum levels of homocysteine (Hcy) and cystatin C (CysC), a sensitive marker of renal function, in patients with H-type hypertension. [Methods] A total of 857 patients with essential hypertension without moderate to severe renal impairment (estimated glomerular filtration rate ≥ 60 ml/(min-1.73 m2) by Modification of Diet in Renal Disease equation) visited the Seventh Affiliated Hospital of Sun Yat-sen University from May 2018 to May 2020 were selected as the research subjects. The observation group (n = 635) consisted of patients with H-type hypertension (essential hypertension with Hcy ≥ 10 mmol/l) and the control group (n = 222) consisted of patients with non-H-type hypertension (essential hypertension with Hcy &lt; 10 mmol/l). Multivariate logistic regression analysis, curve fitting, and threshold analysis were used to evaluate the correlation between elevated CysC and serum Hcy levels. [Results]CysC in observation group was significantly higher than that in control group (0.96 ± 0.160 vs 0.84 ± 0.13 mmol/l; p &lt; 0.001). Multivariate logistic regression analysis, curve fitting, and threshold analysis showed that there was a significant difference in the risk of CysC elevation between Hcy levels at 10-25 mmol/L and Hcy levels below 10 mmol/L; there was no significant difference in the risk of CysC elevation between Hcy levels above 25 mmol/L and Hcy levels below 10 mmol/L. The inflection point of Hcy was 15.23 mmol/L, and when Hcy was &lt; 15.23 mmol/L, the probability of CysC elevation increased by 27\% for each 1 mmol/L increase in Hcy (OR 1.27, 95\% Cl: 1.12, 1.44; P = 0.0002). When Hcy was &gt; 15.23 mmol/l, the probability of CysC elevation was reduced by 4\% for each 1 mmol/l increase in Hcy (OR 0.96, 95\% Cl: 0.92, 1.01; P = 0.1085). [Conclusions] The risk of CysC in patients with H-type hypertension is higher than that in patients with non-H-type hypertension when Hcy is between 10-25 mmol/L; and the probability of cystatin C elevation is the highest when Hcy is at 15.23 mmol/L.

Sex Modified the Association between Sleep Duration and worse Cognitive Performance in Chinese Hypertensive Population: Insight from the China H-Type Hypertension Registry Study.

Objectives Cognitive decline could be seen as the sign of preclinical phase of dementia, which was found to be sex differentiated. Previous studies had discovered that there might be some link between abnormal sleep duration and cognitive performance. Additionally, hypertension was found to be one of the important risk factors for cognitive decline and abnormal sleep duration was also a significant risk factor for hypertension. Therefore, the purpose of this study was to investigate sex differences in the association of sleep duration with cognitive performance and to further explore potential effect modifiers that may exist. Methods Data analyzed in this study was from the China H-type Hypertension Registry Study. Sleep duration was assessed with a sleep questionnaire and categorized as <5 hours, 5-8 hours, and ≥8 hours. Cognitive performance was evaluated with the Mini-Mental State Examination (MMSE). Result A total of 9527 subjects were included. The average age was 63.7 ± 9.8 years. Linear regression analyses showed that the association between long sleep duration (≥8 h) and MMSE score adjusting for pertinent covariables was stronger in female (β = −0.95, 95% CI: -1.23 to -0.68, P < 0.001) than in male (β = −0.29, 95% CI: -0.53 to -0.06, P = 0.013). Furthermore, there was a significant interaction between sleep duration and age on cognitive performance only in female. Conclusion In summary, this study found that long sleep duration (≥8 h) was associated with poorer cognitive performance. Furthermore, this association was more pronounced in female than in male, especially in older female.

Association between MTHFR gene polymorphism and primary hypertension in children

To study the distribution characteristics of methylenetetrahydrofolate reductase (MTHFR) C677T gene polymorphism in children with primary hypertension, and to explore the association between MTHFR C677T gene polymorphism and H-type hypertension in children. A total of 121 children with primary hypertension who were hospitalized in the department of cardiovascular medicine from January to July 2021, newly diagnosed, and untreated were retrospectively selected as the subjects. The children were divided into three groups: CC genotype (19 children), CT genotype (51 children), and TT genotype (51 children). According to the serum homocysteine (Hcy) level, they were divided two groups: H-type hypertension (47 children) and simple hypertension (74 children). The medical data were compared between the groups. The association between MTHFR C677T gene polymorphism and H-type hypertension was evaluated. The mutation frequency of T allele in children with primary hypertension was significantly higher than that in healthy adults in Beijing and Chinese Han adults (P<0.001). The serum Hcy level in the TT genotype group was significantly higher than that in the CC and CT genotype groups (P<0.001). The serum Hcy level in the H-type hypertension group was significantly higher than that in the simple hypertension group (P<0.001), and MTHFR C677T was mostly TT genotype, which was associated with the risk of H-type hypertension (OR=12.71, P<0.001). There was no significant difference in the incidence rate of target organ damage between the H-type hypertension and simple hypertension groups (P>0.05). However, multiple organ involvement was observed in the H-type hypertension group at diagnosis, accounting for 11% (5/47). The mutation rate of MTHFR C677T T allele in children with primary hypertension is high and associated with the serum Hcy level. TT genotype is an independent risk factor for H-type hypertension in children, and it may be related to the severity of early target organ damage.

Analysis of the Correlation between the Distribution of MTHFR Gene and the Severity and Renal Function of Elderly Patients with H-Type Hypertension.

In order to investigate the correlation between the distribution of methylenetetrahydrofolate reductase (MTHFR, MR) C677T gene and the severity of disease and renal function in elderly patients with H-type hypertension, a total of 170 patients with H-type hypertension admitted to our hospital from September 2020 to February 2021 and 173 elderly patients with non-H-type hypertension during the same period are selected as the research objects and are respectively included in the observation group and control group. Baseline data and distribution of MR C677T genotype are compared between the two groups, influencing factors of H-type hypertension are analyzed by logistic regression analysis, and differences and correlation of homocysteine (Hcy) and estimated glomerular filtration rate (eGFR) levels in different MR C677T genotypes are compared. The influence of MR C677T genotype on the severity and renal function of patients with H-type hypertension is further analyzed. There are many influencing factors for H-type hypertension, including advanced age, high-sodium diet, and MR TT genotype. Patients with hypertension with these risk factors should be monitored. H-type hypertension has a high frequency of carrying TT genotype and T allele, and the TT genotype in H-type hypertension will affect the Hcy and eGFR levels. Therefore, Hcy level of H-type hypertension patients with TT genotype should be actively controlled to help control the disease and reduce kidney damage. MR TT genotype can be used as a reference index in the early screening of H-type hypertension.

Association between methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism and H-type hypertension: A systematic review and meta-analysis.

The polymorphism of methylenetetrahydrofolate reductase (MTHFR) gene C677T has been linked to H-type hypertension. But the conclusion remained controversial. To elucidate this issue, we performed a comprehensive meta-analysis to analyze the MTHFR C677T polymorphism and H-type hypertension. The English and Chinese databases were systematically searched to identify relevant studies until November 2020. RevMan 5.3 and Stata 12.0 software were used for meta-analysis. The odds ratio (ORs) and 95% confidence intervals (95% CIs) were used to assess the relationship between the MTHFR C677T polymorphism and H-type hypertension. A total of 14 studies involving 1769 cases and 1443 controls were included. The meta-analysis results showed the association between MTHFR C677T polymorphism and H-type hypertension with the homozygous codominant model (OR=3.30, 95% CI=1.94-5.60), heterozygous codominant model (OR=2.34, 95% CI=1.53-3.58), dominant model (OR=1.79, 95% CI=1.33-2.41), recessive model (OR=2.70, 95% CI=1.73-4.21),and the allelic model (OR=1.82, 95% CI=1.41-2.35). All p-values were less than 0.05. Therefore, MTHFR C677T polymorphism has a positive correlation with the risk of H-type hypertension. Among them, TT mutation has the greatest impact on the activity of this enzyme, which causes Hcy to rise and leads to H-type hypertension. In summary, our results provide sufficient data to support the hypothesis that the MTHFR C677T polymorphism is related to H-type hypertension susceptibility.

Association of MTHFR Polymorphisms with H-Type Hypertension: A Systemic Review and Network Meta-Analysis of Diagnostic Test Accuracy

Purpose An association between MTHFR polymorphisms and H-type hypertension (H-HTN) has been investigated by epidemiological studies, but results have been inconsistent. Thus, a systematic assessment of the association was performed based on a literature review and pooled analysis, to provide stronger evidence on the effects of single nucleotide polymorphisms on H-HTN risk. Methods Three investigators independently retrieved relevant studies in PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), Wanfang Database, and China Biomedical Literature Database (CBM). A fixed or random effects model was selected to calculate pooled odds ratio (OR) and 95% confidence intervals (CIs). A network meta-analysis of diagnostic test and Thakkinstian's algorithm were used to select the most appropriate genetic model, along with false-positive report probability (FPRP) for noteworthy associations. All data were processed using Stata 15.0 and Meta-Disc. Results A total of 14 studies involving 1759 cases and 1581 controls for MTHFR were included in our meta-analysis. In a direct meta-analysis, we found that MTHFR C667T rs1801133 significantly increased the risk of H-HTN susceptibility except for an overdominant model. However, MTHFR A1298C rs1801131 polymorphism had no significant correlation with H-HTN risk. Besides, MTHFR C667T rs1801133 is a potential diagnostic biomarker for estimating H-HTN risk. The results indicated that the dominant model was an optimal diagnosis model for excluding diseases, which could reduce a missed diagnosis rate and further improve the accuracy of disease diagnosis. Conclusion The present result suggests that MTHFR C667T rs1801133 polymorphism is associated with H-HTN risk and may act as a promising predictive biomarker for H-HTN risk. However, further well-designed studies are warranted to confirm these results.

Explore the Role of the rs1801133-PPARG Pathway in the H-type Hypertension.

Both rs1801133 mutation on Methylenetetrahydrofolate reductase (MTHFR) gene and transcription factor peroxisome proliferator-activated gamma (PPARG) have been associated with plasma homocysteine (Hcy) levels and hypertension. However, their role in H-type hypertension remains unclear. In this study, we first tested the association between rs1801133 genotypes and Hcy level in H-type hypertension using clinical profiles collected from 203 patients before and after the treatment using enalapril maleate and folic acid tablets (EMFAT). Then, we constructed a literature-based pathway analysis to explore the role of the rs1801133-PPARG signaling pathway in H-type hypertension and its treatment. Although presented similar blood pressure, the patients with TT genotype of rs1801133 were much younger (p value <0.05) and significantly higher in Hcy levels (x2 = 6.11 and p < 0.005) than that in the CC and CT genotype groups. Pathway analysis showed that T-allele of rs1801133 could inhibit the expression of PPARG through the downregulation of folate levels and upregulation of Hcy levels, which increased the risk of hypertension and hyperhomocysteinemia. Treatment using EMFAT led to similarly decreased Hcy levels for all patients with different genotypes (x2 = 86.00; p < 0.36), which may occur partially through the activation of PPARG. Moreover, even after treatment, the patients with TT genotype still presented significantly higher Hcy levels (x2 = 7.87 and p < 0.001). Our results supported that rs1801133 mutation could play a role in H-type hypertension, which might be partially through the downregulation of PPARG. Moreover, PPARG might also be involved in treating H-type hypertension using EMFAT.

Prediction of H-type hypertension based on pulse-taking and inquiry diagnosis

H-type hypertension increases the morbidity of stroke and cardiovascular diseases, posing a great threat to human health. The existing diagnosis of H-type hypertension detects patients’ plasma homocysteine content, which is inefficient and leaves wounds. The pulse-taking diagnosis of traditional Chinese medicine (TCM) can implement the non-invasive auxiliary diagnosis of H-type hypertension by the physiological activities of patient’s pulse wave combined with the clinical inquiry information. Therefore, we propose a combined model of pulse-taking and inquiry diagnosis, which includes a pulse-taking model based on CNN-BiLSTM and an inquiry diagnosis model based on the integrated Cluster-RFs. We search the optimal weights for the heterogeneous integrated model dynamically by using Grid Search to classify H-type hypertension. The datasets are the collection of 364 cases H-type hypertension from Longhua Hospital affiliated to Shanghai University of Chinese Medicine and Hospital of Integrated Traditional Chinese and Western Medicine concerning pulse-taking and inquiry diagnosis. The evaluation indicator of classification of H-type hypertension, i.e. Sensitivity, Specificity, Accuracy, F1-score, AUC, is 82.31%, 73.75%, 79.34%, 85.92%, 87.78% respectively, is higher than that of the other typical machine learning models on pulse-taking or inquiry diagnosis. In addition, this article also studies the correlation between pulse-taking or inquiry diagnosis and its attributes, and analyzes the feature importance ranking on pulse-taking and inquiry diagnosis, which aids clinicians seek the occurrence mechanisms of H-type hypertension, and find the reasonable measurements for timely prevention and treatment.

Combination of hyperhomocysteinemia and hypertension in patients with atherosclerosis of brachiocephalic arteries: the frequency, clinical and laboratory correlates

Combination of hypertension (HTN) and hyperhomocysteinemia &gt; 10 mсmol/l is frequently called H-type hypertension. It is associated with an increased risk of vascular events including stroke.Objective. To estimate the frequency and clinical and laboratory correlates of combination of hyperhomocysteinemia and HTN in a cohort of patients with atherosclerosis of brachiocephalic arteries (BCA).Design and methods. We recruited out-patients with confirmed atherosclerosis of BCA based on the ultrasound duplex scans. History were registered. Complete blood count, biochemical analysis (lipids, creatinine, homocysteine and C-reactive protein) and urine analysis were performed.Results. Data from 93 patients were analyzed. The frequency of combination of hyperhomocysteinemia and HTN among patients with atherosclerosis of BCA was 95%. The level of homocysteine was higher in males than in females (p = 0,001). Correlation analysis showed a direct weak association between the level of homocysteinemia and the number of white blood cells, red blood cells, monocytes, level of creatinine in the blood and microalbuminuria (p &lt; 0,05). Linear regression analysis showed that male gender along with microalbuminuria were independent predictors of the homocysteine level in these patients.Conclusions. A combination of hyperhomocysteinemia and HTN is common among patients with the atherosclerosis of BCA. Stroke prevention measures in patients with HTN and atherosclerosis of BCA should include assessment of homocysteine level and prescription of B vitamins if needed.

High Estimated Glomerular Filtration Rate Is Associated With Worse Cognitive Performance in the Hypertensive Population: Results From the China H-Type Hypertension Registry Study.

BackgroundIncreasing studies have focused on the predictive value of high estimated glomerular filtration rate (eGFR) on cardiovascular diseases and mortality; however, the association between high eGFR with cognitive function is still not established. Thus, this study aimed to determine the co-relationship between high eGFR and cognitive performance in the hypertensive population.MethodsWe conducted a baseline cross-sectional study using data from the China H-type Hypertension Registry study. Mini-Mental State Examination (MMSE) assessment was performed to evaluate the cognitive function scale, and serum creatinine was collected to estimate eGFR level. Different MMSE cutoff values were applied in participants with the various educational background to define dementia: <24 in participants with secondary school and above education setting, <20 in those with primary school, and <17 in illiterate participants.ResultsA total of 9,527 hypertensive adults with mean age 63.7 ± 9.8 years and 67% female gender were analyzed. The eGFR cutoff value of 71.52 ml/min/1.73 m2 was found after adjusting for potential covariates in a threshold effect analysis. The MMSE increased significantly with the increment of eGFR (β, 0.27; 95% CI: 0.12–0.41) in participants with eGFR < 71.52 ml/min/1.73 m2 and decreased (β, −0.28; 95% CI: −0.39 to −0.17) in participants with eGFR ≥ 71.52 ml/min/1.73 m2. Individuals with eGFR ≥ 85 ml/min/1.73 m2 have an elevated risk of cognitive impairment than those with eGFR of 65–75 ml/min/1.73 m2. Subgroup analysis showed that a greater reduction degree of MMSE was observed in female individuals and those who had body mass index (BMI) ≥ 24 kg/m2 among participants with eGFR ≥ 71.52 ml/min/1.73 m2.ConclusionOur findings observed an inverted U-shaped relationship between eGFR and cognitive function. Both the low and high levels of eGFR were independently associated with worse cognitive assessment in the hypertensive population.

Positive Association between the Triglyceride-Glucose Index and Hyperuricemia in Chinese Adults with Hypertension: An Insight from the China H-Type Hypertension Registry Study.

Background Previous studies have revealed the triglyceride-glucose (TyG) index is closely related to hyperuricemia in the general population. However, this relationship in hypertensive patients has not been reported. The aims of this study are to investigate the relationship of the TyG index and hyperuricemia in adult Chinese hypertension. Methods The China H-type Hypertension Registration (an observational, noninterventional, and real-world study) was conducted from March 01, 2018, to August 31, 2018, in 16 communities in Wuyuan of China. The TyG index was calculated from fasting triglycerides (mg/dL) and fasting glucose (mg/dL)/2. Hyperuricemia was categorized by uric acid concentration ≥420 μmol/L (7 mg/dL). Results Overall average TyG index of 13,060 adults with hypertension was 8.87; age was 63.81 years. The TyG index was positively correlated with serum uric acid by multiple linear regression analyses (β = 38.03; 95% CI: 34.55 to 41.51). Coincidentally, logistic analyses also demonstrated the TyG index had a positive correlation with hyperuricemia (OR = 2.04; 95% CI: 1.87 to 2.24). Strong linear associations of the TyG index with serum uric acid and hyperuricemia were confirmed by restricted cubic spline analysis. Compared with subjects in the lowest quartile (7.13 to 8.44) of the TyG index, subjects in the 2nd–4th quartiles had 1.25 (95% CI: 1.10 to 1.41), 1.63 (95% CI: 1.43 to 1.86), and 2.79 (95% CI: 2.41 to 3.24) times greater incident risk of developing hyperuricemia. The TyG index had significant correlations between male patients and hyperuricemia (OR = 2.01) by subgroup analysis. Conclusion Positive associations were found between the TyG index and serum uric acid and between the TyG index and hyperuricemia in adults with hypertension. This trial was registered at clinicaltrials.gov as ChiCTR1800017274.

Plasma 25-hydroxyvitamin D3 concentrations and incident risk of ischemic stroke in rural Chinese adults: New insight on ceiling effect

ObjectiveThe aim of this study was to investigate the relationship between 25-hydroxyvitamin D3 (25[OH]D3) and ischemic stroke and its potential modifying factors in rural Chinese adults. MethodsThis nested case-control study was drawn from the H-type Hypertension and Stroke Prevention and Control Project, a community-based, prospective, observational study. Plasma 25(OH)D3 was measured by liquid chromatography with tandem quadrupole mass spectrometry. All stroke records came from the Chinese Center for Disease Control and Prevention. Multiple logistic regression models were used to evaluate the association between 25(OH)D3 and risk of ischemic stroke. ResultsWe included 1079 participants with ischemic stroke and 1079 matched controls. Due to a non-linear relationship, the analyses were stratified by 25(OH)D3. For those with 25(OH)D3 < 20 ng/mL, there was a 15% reduction in the risk of ischemic stroke for each SD increment in 25(OH)D3 (odds ratio, 0.85; 95% confidence interval, 0.73–0.99). Compared with the lowest-tertile group, the risk of ischemic stroke decreased by 39% (odds ratio, 0.61; 95% confidence interval, 0.41–0.89) in the highest-tertile group. Furthermore, two effect modifiers were identified: diabetes and homocysteine level. Although participants with 25(OH)D3 ≥ 20 ng/mL had the lowest risk of ischemic stroke overall, there was no dose-response association within that range. ConclusionsAn inverse dose-response association between 25(OH)D3 and incident risk of ischemic stroke in rural Chinese adults was only observed in those with 25(OH)D3 < 20 ng/mL, along with two effect modifiers. Higher levels of 25(OH)D3 did not confer additional benefit.

Association Between Lipid Accumulation Product and Cognitive Function in Hypertensive Patients With Normal Weight: Insight From the China H-type Hypertension Registry Study.

BackgroundHypertension is a major cardiovascular risk factor for cognitive impairment. Lipid accumulation product (LAP), an index that represents fat overaccumulation in the body, has been shown to be associated with cardiovascular disease. Nevertheless, the relationship between LAP and cognitive function in hypertensive patients with normal weight has been infrequently studied.ObjectiveThis study aimed to assess the relationship between LAP and cognitive function in hypertensive patients with normal weight.MethodsThis study included 5,542 Chinese hypertensive patients with normal weight. Cognitive function was evaluated using the Mini-Mental State Examination (MMSE). The relationship between LAP and MMSE scores was evaluated using multiple linear regression.ResultsThe mean age of the participants was 64.8 ± 9.3 years, and 2,700 were men (48.7%). The mean MMSE score was 24.5 ± 5.1 in men and 19.2 ± 6.5 in women. The mean LAP was 26.2 ± 25.5 in men and 42.5 ± 34 in women. Log10-LAP showed a significant positive association with MMSE score (men: β = 0.69, 95% CI 0.14–1.24, p = 0.015; women: β = 1.03, 95% CI 0.16–1.90, p = 0.020). When LAP was divided into 3 groups according to tertiles, participants in the third LAP tertile had higher MMSE scores for both men (p for trend = 0.04) and women (p for trend = 0.015).ConclusionLAP showed an independent positive association with MMSE in Chinese hypertensive patients with normal weight.

Relationship Between the Triglyceride Glucose Index and the Risk of First Stroke in Elderly Hypertensive Patients.

BackgroundSeveral recent studies have shown the relationship between the triglyceride glucose (TyG) index and the risk of stroke in the general population and in a few patient cohorts; however, the role of the TyG index on stroke risk in elderly hypertensive patients has not been determined. Thus, we aimed to investigate the association of the TyG index with first stroke and first ischemic stroke in elderly individuals with hypertension.MethodsWe included 8487 elderly subjects with hypertension from the China H-type Hypertension Registry Study for the current analysis. The TyG index was calculated as ln (fasting triglyceride [mg/dL] × fasting glucose [mg/dL]/2). Outcomes were the first stroke and first ischemic stroke.ResultsDuring a median follow-up of 1.72 years, the first stroke was diagnosed in 82 patients (0.97%), and the first ischemic stroke was diagnosed in 48 patients (0.57%). Multivariable Cox proportional hazards models revealed that the TyG index was positively associated with the risk of first stroke (per 1-unit increment; HR: 1.72; 95% CI: 1.07, 2.76) and first ischemic stroke (HR: 2.31; 95% CI: 1.32, 4.05). When the TyG index was assessed as quartiles, significantly higher risks of first stroke (HR: 1.90; 95% CI: 1.04, 3.45) and first ischemic stroke (HR: 2.45; 95% CI: 1.16, 5.20) were found in participants in quartile 4 compared with those in quartiles 1–3.ConclusionThe TyG index is potentially useful in the early identification of elderly hypertensive patients at high risk of experiencing a first stroke.

Effects of individualized administration of folic acid on prothrombotic state and vascular endothelial function with H-type hypertension: A double-blinded, randomized clinical cohort study.

Background:Hypertension and hyperhomocysteinemia (HHcy) have long been associated with adverse cardiovascular and cerebrovascular health outcomes. This study evaluated the effect of individualized administration of folic acid (FA) on homocysteine (Hcy) levels, prothrombotic state, and blood pressure (BP) in patients with H-type hypertension (combination of HHcy and hypertension).Methods:In this double-blinded, randomized clinical cohort study, 126 patients with H-type hypertension who were treated at our hospital were randomly divided into treatment and control groups (n = 55 each). The control group was treated with oral levamlodipine besylate tablets 2.5 mg and placebo, once a day (in the morning). The treatment group was first treated with oral levamlodipine besylate 2.5 mg and FA tablets 0.8 mg, once a day (in the morning), for 12 weeks. Then, in a second 12-week phase, the FA dose was adjusted using the methylene tetrahydrofolate reductase C677 polymorphism genotype. The levels of Hcy and coagulation factors, prothrombotic state parameters, BP, and adverse drug reactions were compared between the 2 groups.Results:Pretreatment general patient characteristics, including Hcy levels, were similar between the 2 groups (P > .05). BP and prothrombotic status did not differ before and after the first phase of treatment (P > .05). However, Hcy and endothelin-1 (ET-1) levels decreased, while nitric oxide levels increased significantly in the intervention group (P < .05). In the second phase, after 3 months’ treatment with an FA dose adjusted according to methylene tetrahydrofolate reductase C677T genotype, the Hcy and ET-1/NO levels were significantly decreased in the intervention group and were lower than those after the first treatment phase and lower than in the control group (P < .01). BP, D-dimer levels, and fibrinogen scores were significantly lower after the second treatment phase (P < .01). There was no significant difference in the incidence of adverse drug reactions between the 2 groups (P > .05).Conclusions:Individualized administration of FA tablets can effectively reduce BP, and Hcy and coagulation factor levels, and significantly improve prothrombotic status in patients with H-type hypertension.

Relationship Between the Lipid Accumulation Product Index and Arterial Stiffness in the Chinese Population With Hypertension: A Report From the China H-Type Hypertension Registry Study.

BackgroundLipid accumulation product (LAP) index, as a new index to predict cardiovascular disease (CVD), has attracted the attention of many researchers. The relation of the LAP index with brachial-ankle pulse wave velocity (baPWV) has been evaluated in several previous studies and yielded inconsistent results. This study aimed to investigate the association between the LAP index and arterial stiffness in the Chinese population with hypertension.MethodsWe conducted a cross-sectional analysis in 4,926 Chinese population with hypertension (aged 64.42 ± 9.44 years). The LAP index was developed from population-based frequency plots of adult waist circumferences and circulating triglyceride concentrations according to men and women. Arterial stiffness was determined by measuring baPWV.ResultsThe multivariate linear regression analyses showed that the LAP index was independently and positively associated with baPWV [beta coefficients (β), 24.10 cm/s; 95% CI: 5.72, 42.49 cm/s]. Consistently, the multivariate logistic regression analyses showed a positive association between the LAP index risk of elevated baPWV (>75th percentile) [odds ratio (OR), 1.19; 95% CI 1.01, 1.41]. A restricted cubic spline showed that a significant linear association existed between the LAP index and baPWV. In different subgroups of diastolic blood pressure (DBP), there is interaction between the LAP index and baPWV (DBP <90, 90–99, ≥100 mm Hg; p-interaction = 0.006).ConclusionLAP is significantly positively associated with baPWV and elevated baPWV in Chinese hypertensive adults and especially among participants with DBP ≤ 99 mm Hg.