H-type Hypertension Research Articles

Saturation Effects of Plasma Homocysteine on Chronic Kidney Disease in Chinese Adults With H-type Hypertension: A Cross-sectional Study

Data on the association between homocysteine (Hcy) and the risk of chronic kidney disease (CKD) in patients with H-type hypertension were limited. This study aimed to examine the relation of Hcy with the prevalence of CKD and estimated glomerular filtration rate (eGFR) among Chinese adults with H-type hypertension. A total of 12,873 Chinese adults with H-type hypertension aged 27-75years were enrolled in the final analysis. Hcy concentrations were divided into 11 groups at 2μmol/L interval. The outcome was CKD, defined as eGFR <60mL/min/1.73m2. The prevalence of CKD was 7.58%, and the mean Hcy was 17.58±10.96μmol/L. The smoothing curve indicated that with the increase of Hcy, the prevalence of CKD increases first and then flattens, eGFR decreases first and then flattens, which supports theL-shaped association of Hcy with the prevalence of CKD and eGFR. Moreover, we further found the inflection point of Hcy was 22μmol/L. OR (95% CI) of risk of CKD was 1.31 (1.28, 1.35) on the left side of an inflection point and 1.00 (0.99, 1.01) on the right of an inflection point, β (95% CI) of eGFR was -1.58 (-1.65, -1.50) on the left side of an inflection point and 0.00 (-0.03, 0.03) on the right of an inflection point, respectively. Similar results were found in various subgroups. Our study suggested saturation effects of Hcy on the prevalence of CKD and eGFR among Chinese patients with H-type hypertension.

Positive association between triglyceride glucose index and arterial stiffness in hypertensive patients: the China H-type Hypertension Registry Study

BackgroundData are limited on whether TyG index is an independent predictor of arterial stiffness in hypertensive patients. The purpose of this study was to assess the association between the TyG index and arterial stiffness, and examined whether there were effect modifiers, in hypertensive patients.MethodsThis study included 4718 hypertensive adults, a subset of the China H-type Hypertension Registry Study. The TyG index was calculated as ln[fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. Arterial stiffness was determined by measuring brachial-ankle pulse wave velocity (baPWV).ResultsThe overall mean TyG index was 8.84. Multivariate linear regression analyses showed that TyG index was independently and positively associated with baPWV (β, 1.02; 95% confidence interval [CI] 0.83, 1.20). Consistently, Multiple logistic analyses showed a positive association between TyG index risk of elevated baPWV (> 75th percentile) (odds ratio [OR], 2.12; 95% CI 1.80, 2.50). Analyses using restricted cubic spline confirmed that the associations of TyG index with baPWV and elevated baPWV were linear. Subgroup analyses showed that stronger associations between TyG index and baPWV were detected in men (all P for interaction < 0.05).ConclusionTyG index was independently and positively associated with baPWV and elevated baPWV among hypertensive patients, especially in men. The data suggest that TyG index may serve as a simple and effective tool for arterial stiffness risk assessment in daily clinical practice.

Evaluation of H-type hypertension prevalence and its influence on the risk of increased carotid intima-media thickness among a high-risk stroke population in Hainan Province, China.

H-type hypertension, defined as a combination of hypertension and hyperhomocysteinemia (Hhcy), is associated with atherosclerosis and, therefore, increased stroke risk. However, the role of hypertension and Hhcy in high-risk stroke populations has not been studied. The present study investigated the prevalence of H-type hypertension in a high-risk stroke population of Hainan Province, China and to assess possible joint effects between hypertension and Hhcy for increased carotid intima-media thickness (CIMT). In this community-based cross-sectional study, 959 high-risk stroke subjects (age, 65.8 ± 10.8 years; 46.6% men) were recruited from Hainan Province, China. The demographic and clinical characteristics were collected, and blood samples were obtained. Analysis of variance or chi-square tests were performed to compare variates among groups based on both homocysteine levels and blood pressure status. The associations of hypertension and Hhcy with increased CIMT were evaluated through logistic regression. The prevalence of H-type hypertension was 34.8% in this population, with a higher ratio of H-type hypertension in men than in women. Compared with the normotension and normal homocysteine subgroup, the risk of increased CIMT was significantly higher in the subgroup with hypertension and Hhcy (odds ratio [OR] = 2.639; 95% confidence interval [CI], 1.690–4.091) after adjusting for age and sex. Increased CIMT was affected by an additive synergetic interaction between Hhcy and hypertension (synergy index = 1.105). It emphasized the clinical importance of anti-hypertension and lowering Hhcy in the high-risk stroke population.

H-Type Hypertension Is a Risk Factor for Cerebral Small-Vessel Disease.

Background The correlation between H-type hypertension and cerebral small-vessel diseases (CSVD) remains uncertain. Objective The present study was designed to explore the possible relationship between H-type hypertension and CSVD spectrum and total burden. Method We included 329 patients in the present study and divided them into four groups: the H-type hypertension group, isolated hypertension group, isolated hyperhomocysteinemia (HHcy) group, and control group. Clinical variables of interest and the MR examination sequences were obtained. We counted the presence of each CSVD feature and rated the total burden of CSVD on an ordinal scale from 0 to 4 according to a recent described score rule. Result The results showed that H-type hypertension was associated with the presence of cerebral microbleeds (CMBs), and the severity of white-matter hyperintensities (WMHs) and peripheral vascular space (PVS). CSVD total burden was significantly related to age (OR: 1.059, 95% CI: 1.037–1.082), systolic pressure (OR: 1.122, 95% CI: 1.007–1.136), triglycerides (OR: 1.386, 95% CI: 1.037–1.854), isolated HHcy (OR: 4.154, 95% CI 1.836–9.401), and H-type hypertension (OR: 5.028, 95% CI: 2.323–10.883). Also, we further observed hypertension and HHcy had a synergistic effect on CSVD total burden (OR: 2.776, 95% CI: 1.564–4.927). Conclusion H-type hypertension was associated with CSVD total burden and CSVD spectrum, which deserves further prevention measures. Furthermore, hypertension and HHcy had a synergistic effect on CSVD total burden.

Effect of Banxia Baizhu Tianma Tang for H-type hypertension: A protocol for a systematic review.

H-type hypertension is a kind of cardiovascular disease that threatens human life and health seriously. Banxia Baizhu Tianma Tang (BBTT) has been used widely for H-type hypertension while its effective evidence is not clear. Hence, we provide a systematic review protocol to evaluate the efficacy and safety of BBTT in the treatment of H-type hypertension. Nine databases including Cochrane Library, PubMed, EMBASE, WOS, Medline, CNKI, WangFang, CBM, and VIP will be searched from their inception to October 2019. All randomized controlled trials (RCTs) of BBTT for H-type hypertension will be included. The language is limited to Chinese and English. The primary outcome measure will be the major adverse cardiac and cerebral events (MACCE). The entire process will include study selection, data extraction, assessment of bias risk, data synthesis. Data analysis will be performed using RevMan V.5.3.5 (The Cochrane Collaboration, Oxford, UK). This study will evaluate the efficacy and safety of BBTT in the treatment of H-type hypertension from several aspects, including MACCE, blood pressure (BP), blood lipids, inflammation indicators and homocysteine (Hcy). This systematic review will provide evidence for determining whether or not BBTT is an effective and safe intervention for H-type hypertension. PROSPERO CRD 42019131491.

Abstract TP184: High-Density Lipoprotein Cholesterol Levels Inversely Associated With First Ischemic Stroke in a Chinese Hypertensive Population

Background and Purpose: Lipid levels are established risk factors for ischemic heart disease, but uncertainty persists about the relevance of lipids for first ischemic stroke (IS). The goal of this study was to evaluate whether lipid profiles are risk factors for first IS in a Chinese hypertensive population. Methods: Our study population was selected from 300,000 individuals registered from 2016-2018 in the Lianyungang and Rongcheng “H-type hypertension prevention and control public service project”. Hypertensive patients with stroke data from the Chinese centers for disease control and prevention (CDC, 2013-2018) who had complete records (physical exam, questionnaire, and biological samples) were selected as cases. We used a nested case-control study design and matched 3615 ischemic stroke cases with an equal number of controls (hypertensive patients without stroke) for age±1 years, sex, and village. The crude and adjusted risks of first ischemic stroke were estimated by ORs and 95% CIs using conditional logistic regression, with or without adjustment for pertinent covariates. Results: Participants with first IS had higher blood pressure, body mass index, fasting glucose, triglycerides, and low-density lipoprotein cholesterol. High-density lipoprotein cholesterol (HDL-C) was significantly and inversely associated with IS risk (OR, 0.71; 95% CI: 0.61-0.82). When HDL was assessed as quartiles, the lowest quartile was used as reference, a significantly lower risk for IS was found in the highest quartile (HDL-C ≥ 1.8mmol/L: OR, 0.70; 95% CI: 0.59-0.82). There was a significant positive association between TG and the risk of IS (per SD increment; OR, 1.13; 95% CI, 1.07-1.20). Consistently, a significantly higher risk of first IS was found in quartile 4 (≥1.8 mmol/L: OR, 1.41; 95% CI, 1.20-1.65) compared with those in quartile 1 (&lt;0.9 mmol/L). Conclusions: HDL-C levels inversely associated with first IS. These results differ from existing evidence from western populations, highlighting potential differences in Chinese populations. These differences can be attributed to multiple factors, including genetics, diet and lifestyle and call for further study to investigate potential explanatory mechanisms.

Higher concentration of serum C-terminal cross-linking telopeptide of type I collagen is positively related with inflammatory factors in postmenopausal women with H-type hypertension and osteoporosis.

ObjectiveTo investigate the changes of inflammatory factors and bone metabolism markers in postmenopausal women with H‐type hypertension and to assess the relationship between them.MethodsPostmenopausal women who were diagnosed with osteoporosis were selected as observation objects. Participants were divided into three groups: only osteoporosis group (osteoporosis group), hypertension combined with osteoporosis group (hypertension group), and H‐type hypertension combined with osteoporosis group (H‐type hypertension group). The changes in bone mineral density and bone metabolic markers (osteocalcin [OC], procollagen type I N‐terminal propeptide (PINP), and C‐terminal cross‐linking telopeptide of type I collagen [CTX]) and inflammatory factors (interleukin‐6 [IL‐6] and tumor necrosis factor‐α [TNF‐α]) were compared among three groups.ResultsIn the hypertension group and the H‐type hypertension group, the bone mineral density of the lumbar spine (0.647 ± 0.038 vs 0.638 ± 0.034 vs 0.668 ± 0.047, P < 0.05) and the femoral neck (0.567 ± 0.047 vs 0.552 ± 0.053 vs 0.618 ± 0.059, P < 0.05) was significantly lower than that in the osteoporosis group. The concentrations of CTX (266.61 ± 64.65 vs 293.09 ± 72.34 vs 235.48 ± 62.85, P < 0.05), IL‐6 (44.36 ± 6.45 vs 48.05 ± 8.04 vs 39.06 ± 7.95, P < 0.05) and TNF‐α (30.53 ± 6.28 vs 34.52 ± 7.15 vs 28.66 ± 6.19, P < 0.01) in the hypertension group and in the H‐type hypertension group were significantly higher than those in the osteoporosis group. The concentrations of OC (30.59 ± 6.43 vs 27.10 ± 6.51, P < 0.05) and PINP (36.36 ± 6.16 vs 33.16 ± 6.77, P < 0.05) in the H‐type hypertension group were increased dramatically. The concentration of CTX was positively correlated with the concentration of IL‐6 (r = 0.587, P < 0.01) and TNF‐α (r = 0.474, P < 0.01) and negatively related with the concentration of OC (r = −0.591, P < 0.01) and PINP (r = −0.646, P < 0.01) and the bone mineral density of the lumbar spine (r = −0.470, P < 0.01) and the femoral neck (r = −0.509, P < 0.01).ConclusionHigher concentration of serum CTX is found in postmenopausal women with H‐type hypertension, which is positively correlated with inflammatory factors. Besides, H‐type hypertension could further enhance the activity of osteoclasts and increase the expressions of inflammatory factors, resulting in the aggravation of osteoporosis.

Sex differences in risk factors for stroke in patients with hypertension and hyperhomocysteinemia

Data on the sex-specific differences in risk of stroke among patients with H-type hypertension are limited. We aimed to analyze interactions between sex and other risk factors on stroke, including the sex-methylenetetrahydrofolate reductase (MTHFR) interaction. A retrospective analysis of baseline data from 2040 patients with hypertension and hyperhomocysteinemia (HHcy) included demographic characteristics, biomarkers, history of chronic diseases and lifestyle factors. Polymerase chain reaction-restriction fragment length polymorphism method was used to investigate the C677T polymorphism of MTHFR gene. We examined independent effects and interactions between sex and stratified factors on the risk of stroke by logistic regression model. A total of 1412 patients suffered stroke, and the prevalence of stroke was 70.65% in men and 66.53% in women. Both men and women had independent risk factors for stroke, including diabetes mellitus, atrial fibrillation, smoking, increased level of systolic blood pressure (SBP) and plasma total homocysteine (tHcy), as well as the decreased level of high-density lipoprotein cholesterol. Diastolic blood pressure (DBP) -specific risk of stroke was unique to men. Interactions between sex and other risk factors on stroke risk were statistically significant: age, fasting plasma glucose (FPG), SBP, DBP, triglycerides (TG) and tHcy. Furthermore, tHcy interacted with age, SBP and DBP in men, and age, SBP, DBP, FPG, and TG in women to modulate the risk of stroke. Although TT genotype did not have an independent effect on stroke, it could interact with sex and FPG, TG and SBP to increase stroke. In conclusion, sex-specific differences are useful to stratify the risk of stroke and assist clinicians in the decision to select a reasonable therapeutic option for high-risk patients.

Predictive value of obesity measurement index for H-type hypertension

Objective By investigating the obesity of the adult population in Hunan, we explored the relationship between body mass index (BMI) [including waist circumference (WC), waist-to-hip ratio (WHR), waist-to-body ratio (WHtR) and H-type hypertension] in predicting H-type hypertension. Methods A multi-stage random sampling method was used to conduct a questionnaire survey, physical examination and laboratory testing on 4 012 adults >30 years old in 6 districts of Hunan Province. The receiver operator characteristic (ROC) curve was used to evaluate the predictive effects of BMI, WC, WHR and WHtR on H-type hypertension. Results ROC curve analysis indicated that the area under curve (AUC) of the evaluation of H-type hypertension of WC, WHtR, WHR and BMI in men were: 0.637, 0.640, 0.601, 0.639, of which the largest were combination of WC+ BMI and WHtR+ BMI, both being 0.647. In women, the AUC of individual indexes WC, WHtR, WHR and BMI for evaluating H-type hypertension were 0.660, 0.670, 0.660 and 0.604 respectively. The combination of WHtR and WHR had the largest AUC, which was 0.675. The WC for evaluating H-type hypertension in youth people had the largest AUC(0.732); the WC+ BMI, WHR+ BMI for evaluating H-type hypertension in middle-aged people had the largest AUC, all being 0.687; the WC predicted the largest AUC of H-type hypertension in elderly people (0.590). Conclusions WC, WHtR, WHR and BMI are important predictors of H-type hypertension. The optimal indicators for different genders and ages are different, and the combined indicators are better than the individual indicators. Key words: Hyperhomocysteinemia; Hypertension; Obesity; Body weights and measures

Correlations of plasma homocysteine with cerebral white matter lesion severity and cognitive impairment in elderly patients with hypertension

Objective To investigate the correlations of plasma homocysteine(Hcy)levels with cerebral white matter lesion(WML)severity and cognitive impairment in elderly hypertension patients. Methods A retrospective case-control study was conducted.Ninty-eight elderly patients with hypertension were enrolled.Based on the presence or absence of hyperhomocysteinemia(hypertension with plasma Hcy levels ≥10 μmol/L was defined as H-type hypertension), patients were divided into two groups: a control group(n=48)and an H-type hypertension group(n=50). The degree of WML was rated by the Fazekas scale using magnetic resonance imaging(MRI)analysis.Neuropsychological examinations including mini-mental state examination(MMSE)and Montreal cognitive assessment(MoCA)were taken to assess cognitive function.The degree of WML and cognitive impairment were compared between the two groups.Correlations of plasma Hcy levels with the degree of WML and cognitive impairment were analyzed. Results Compared with the control group, scores of the Fazekas scale(3.2±1.0 vs.2.5±1.0, P<0.05)and deep white matter hyperintensity on MRI(1.7±0.8 vs.1.3±0.7, P<0.05)increased, and scores of MMSE(24.9±3.3 vs.27.7±1.8, P<0.05)and MoCA(18.6±3.9 vs.25.0±3.0, P<0.05)decreased in the H-type hypertension group.Plasma Hcy levels were positively correlated with the degree of WML(r=0.430, P<0.01)and negatively correlated with cognitive function(r=-0.406 in MMSE and-0.663 in MoCA, P<0.01). Multivariate logistic regression showed that Hcy, fasting blood-glucose, deep WML, low-density lipoprotein cholesterolin, age and systolic pressure were influencing factors for cognitive impairment(P<0.01). Conclusions WML and cognitive function are worse in elderly H-type hypertension patients than in hypertension patients with normal Hcy levels.WML and cognitive impairment are aggravated with increased plasma Hcy levels.The plasma Hcy level may be an effective clinical indicator of cognitive function in elderly people with hypertension. Key words: Hypertension; Cysteine; Leukoencephalopathies; Cognitive disorders

GW29-e0314 Effects of sex differences on the risk of stroke in H-type hypertension patients

GW29-e0314 Effects of sex differences on the risk of stroke in H-type hypertension patients

A6373 Prevalence and risk factors of H-type hypertension in Qinghai-Tibet plateau

A6373 Prevalence and risk factors of H-type hypertension in Qinghai-Tibet plateau

Association of H-Type Hypertension with Stroke Severity and Prognosis

Background. The correlation between H-type hypertension and acute ischemic stroke remains uncertain. Objective. The present study was designed to explore the possible relationship between H-type hypertension and severity and prognosis of acute ischemic stroke. Method. We included 372 patients with acute ischemic stroke and divided them into four groups: H-type hypertension group, simple hypertension group, simple hyperhomocysteinemia (HHcy) group, and the control group. NIHSS score was measured at both admission and two weeks later. mRS score, stroke recurrence, cardiovascular event, or all-cause mortality was recorded at 3-month and 1-year follow-up. Result. The results showed that the NIHSS score on admission in the H-type hypertension group (6.32 ± 5.91) was significantly higher than that in the control group (3.97 ± 3.59) (P < 0.05), while there was no obvious association between H-type hypertension and NIHSS score after 2-week treatment (P = 0.106). Endpoint events incidence in H-type hypertension group was the highest; however, in the cox regression model of multiple factor analysis, H-type hypertension was not an independent risk factor. Conclusion. H-type hypertension may result in early functional deterioration and higher incidence rate of endpoint events but not act as an independent risk factor.

Mecobalamin and early functional outcomes of ischemic stroke patients with H-type hypertension.

To analyze the effect of mecobalamin on the early-functional outcomes of patients with ischemic stroke and H-type hypertension. From October of 2014 to October of 2016, 224 cases of ischemic stroke and H-type hypertension were selected. The patients were randomly divided into treatment control groups, with 112 patients in each group. The control group was treated with the conventional therapy. The observation group was treated with 500 µg of mecobalamin three times a day in addition to the conventional therapy. We compared serum homocysteine (Hcy), hs-CRP levels, carotid plaques, and NIHSS scores between the two groups on the 2nd day and at 4 weeks, 8 weeks, 3 months, and 6 months. After 4 weeks, 8 weeks, 3 months and 6 months, the difference of serum Hcy level between the two groups was statistically significant (t = 4.049, 3.896, 6.052, 6.159, respectively. All P <0.05). After the treatment, at 4 weeks, 8 weeks, 3 months and 6 months, the levels of hs-CRP in the treatment group were significantly lower than those in the control group (t = 37.249, 28.376, 26.454, 20.522, respectively. All P <0.01). After 3 months and 6 months, the carotid artery plaques were significantly reduced in the treatment group compared to those in the control group (t = 2.309 and 2.434. All P <0.05). After 3 months and 6 months, the NIHSS score was significantly higher in the treatment group compared to those in the control group (t = 2.455 and 2.193. All P <0.05). Mecobalamin can reduce the level of plasma homocysteine, then lead to reductions of levels of plasma inflammatory factors and volume of carotid artery plaques, resulting in more significant functional recovery.

Research progress of traditional Chinese medicine for the H-hype hypertension

Hypertension with high serum Homocysteine (Hcy) significantly increases the incidence of cardiovascular and cerebrovascular events, which is defined as H-Type Hypertension by Chinese scholars. Plenty of researches have confirmed that high prevalence of H-Type Hypertension in Chinese population is now the big public problem in China. Traditional Chinese Medicine(TCM)treatment shows the advantages in integral regulation, less side effect, and anti-Hcy effect in hypertension. This paper discussed the prevalence, TCM syndrome and TCM treatment progress in H-Type Hypertension to provide some ideas and references for the intervention of H-Type Hypertension by TCM. Key words: Hypertension; Medicine-pharmacologic literature (TCM); Review

Association between homocysteine and conventional predisposing factors on risk of stroke in patients with hypertension

Previous studies have focused mostly on independent effects of the stroke risk factors, whereas little attention has been paid to interactions between individual factors which may be important for stroke prevention. We collected data related to the patients’ demographic characteristics, history of chronic diseases and lifestyle factors in 2258 patients with primary hypertension. Logistic regression models based on odds ratio (OR) with their associated 95% confidence interval (CI) were used to estimate an independent effect of homocysteine (Hcy) on the risk of stroke but also include the interactions between Hcy and other risk factors. Hcy was associated with an increased OR of the risk of stroke in both hypertension patients (OR, 1.027; 95% CI, 1.016–1.038; P < 0.001) and H-type hypertension patients (OR, 1.026; 95% CI, 1.014–1.037; P < 0.001), after adjustment for potential confounding factors. Among the hypertension participants, three tests of interactions between Hcy and other risk factors were statistically significant: sex, systolic blood pressure and diastolic blood pressure. In conclusion, complexities of the interactions of Hcy stratified by sex and blood pressure need to be considered in predicting overall risk and selecting certain treatments for stroke prevention.

Contribution of non-traditional lipid profiles to reduced glomerular filtration rate in H-type hypertension population of rural China

Background: Despite current interest in the unfavourable impact of non-traditional lipid profiles on cardiovascular disease, information regarding its relations to reduced glomerular filtration rate (GFR) in H-type hypertension population has not been systemically elucidated.Methods: Analyses were based upon a cross-sectional study of 3259 participants with H-type hypertension who underwent assessment of biochemical, anthropometric and blood pressure values. Reduced GFR was considered if meeting estimated GFR <60 ml/min/1.73 m2.Results: A stepwise multivariate regression analysis indicated that non-traditional lipid parameters remained as independent determinants of estimated GFR (all p < .001). In multivariable models, we observed a 50%, 51%, 31%, and 24% higher risk for decreased GFR with each SD increment in TC/HDL-C, TG/HDL-C, LDL-C/HDL-C ratios and non-HDL-C levels, respectively. The highest quartile of TC/HDL-C, TG/HDL-C and LDL-C/HDL-C ratios carried reduced GFR odds (confidence intervals) of 5.50 (2.50 to 12.09), 6.63 (2.58 to 17.05) and 2.22 (1.15 to 4.29), respectively.Conclusions: The relative independent contribution of non-traditional lipid profiles, as indexed by TC/HDL-C, TG/HDL-C, LDL-C/HDL-C ratios and non-HDL-C, towards reduced GFR putting research evidence at the very heart of lipoprotein-mediated renal injury set a vital example for applying a clinical and public health recommendation for reducing the burden of chronic kidney disease.KEY MESSAGESNon-traditional lipid profiles has been linked with the occurrence of cardiovascular disease, but none of the studies that address the effect of non-traditional lipid profiles on reduced GFR risk in H-type hypertension population has been specifically established.A greater emphasis of this study resided in the intrinsic value of TC/HDL-C, TG/HDL-C, LDL-C/HDL-C ratios and non-HDL-C that integrate atherogenic and anti-atherogenic lipid molecules to predict the risk of reduced GFR among H-type hypertension population and provide insight into the pathophysiology of subsequent cardio-cerebrovascular outcomes.In a large Chinese H-type hypertension adults, the relative independent contribution of non-traditional lipid profiles, as indexed by TC/HDL-C, TG/HDL-C, LDL-C/HDL-C ratios and non-HDL-C, towards reduced GFR putting research evidence at the very heart of lipoprotein-mediated renal injury set a vital example for applying a clinical and public health recommendation for reducing the burden of CKD.

Association between H-type Hypertension and Asymptomatic Extracranial Artery Stenosis

Asymptomatic extracranial artery stenosis (ECAS) is a well-known risk factor for stroke and H-type hypertension, which is defined as hypertension with hyperhomocysteinemia, is associated with cardio-cerebrovascular diseases. However, the impact of H-type hypertension on ECAS is mostly unknown. We designed this study to investigate the association between H-type hypertension and prevalence of ECAS. We included 2330 participants in this study and classified them into four groups: the control group without hypertension or hyperhomocysteinemia, isolated hypertension group, isolated hyperhomocysteinemia group and H-type hypertension group. We measured the baseline plasma total homocysteine levels and assessed ECAS by carotid duplex sonography twice at baseline and during follow up. We used a Cox regression model to analyse the association between H-type hypertension and ECAS. At baseline, 608 subjects suffered from H-type hypertension. Within two years of follow-up, asymptomatic ECAS occurred in 250 (10.73%) participants. After adjusting for relevant risk factors, we found H-type hypertension to be an independent risk factor for asymptomatic ECAS (relative risk (RR) 3.16, 95% confidence interval (95% CI) 2.00–5.00). Our findings provide direct evidence for the importance of H-type hypertension in the occurrence of ECAS and as a potential therapeutic target for carotid atherosclerosis.

Impact of hyperhomocysteinemia on insulin resistance in patients with H-type hypertension

ABSTRACTBackground: Hypertension (HT) and hyperhomocysteinemia (HHcy) had been considered influential factors of insulin resistance. H-type HT occurred as HHcy associated with HT. The impact of HHcy on insulin resistance in H-type HT patients remains to be estimated. The interacted effects of HHcy and HT on insulin resistance are still unclear. Methods: A total of 790 patients were recruited and classified into four groups according to their blood pressure and plasma Hcy level, i.e., control group (C group), HHcy group (HHcy subjects without HT), HT group (HT subjects without HHcy), and H group (subjects with H-type HT). The relationship between HHcy and insulin resistance, as estimated using the HOMA-IR, was analyzed and related to blood pressure. Results: HOMA-IR values were significantly higher in the HHcy group than the C group (2.97 (2.23–4.01) versus 2.54 (1.87–3.58), P ＜ 0.01). H-type HT patients showed more severe insulin resistance than those who only got HT (3.58 (2.59–4.85) versus 2.96 (1.90–3.49)，P ＜ 0.01). Moreover, HOMA-IR values were positively correlated with Hcy levels (r = 0.26, P ＜ 0.01). After correcting for possible risking factors, a linear regression relationship between insulin resistance and HHcy was found (β = 0.158, P ＜ 0.01). HHcy was interacted with HT on the exacerbation of insulin resistance in H-type HT patients (β = 0.501, P ＜ 0.01). Conclusions: HHcy obviously exacerbate insulin resistance, especially in H-type HT patients. HHcy and HT have a multiplicative effect on metabolic dysfunction, which may help to interpret why these patients are suffering a high risk of cardiovascular disease and stroke.

Research progress of risk factors and nursing care of H-type hypertension

This article mainly reviewed the H-type hypertension in following aspects: the concept, prevalence, associated risk factors and its nursing. In order to improve the medical staffs' cognition of H-type hypertension, so as to provide a theoretical basis for effective prevention and control of the onset and development of H-type hypertension. Key words: Nursing care; H-type hypertension; Disease risk; Prevalence; Risk factors