Hypertension In Chinese Population Research Articles

Association of the metabolic score for insulin resistance with cardiovascular diseases, cardiovascular and all-cause mortality in Chinese hypertensive population.

Little is known about the relationship between the metabolic score for insulin resistance (METS-IR) and the prognosis of hypertensive patients in China. To investigate the association between the novel non-insulin-based METS-IR index and the cardiovascular composite endpoints and all-cause mortality in Chinese hypertensive participants. This cohort study used data from the China H-Type Hypertension Project, a long-term prospective cohort consisting of 14234 hypertensive patients in southern China, with a baseline from March to August 2018. The median follow-up period for participants was 3.94 years, as of 2022. The data analysis period is from July 2023 to September 2023. METS-IR index of participants in the Chinese H-type hypertension project. The calculation formula for METS-IR is (Ln (2 × FPG) +TG) × BMI/Ln (HDL-C). Cardiovascular events and cardiovascular, all-cause mortality were identified by linking the cohort database with the health care system through October, 2023. A total of 14220 participants were included in this study. The prevalence rates of cardiovascular disease (CVD), cardiovascular death, and all-cause death were 2.59% (369/14220), 2.79% (397/14220), and 5.66% (805/14220), respectively. After adjusting for confounding factors in the multivariate logistic regression analysis models, the METS-IR index was significantly positively correlated with CVD, and cardiovascular, all-cause mortality, whether as a categorical or continuous variable. Layered analysis showed that the METS-IR index of hypertensive participants in different subgroups was positively correlated with the endpoint event. This large, prospective cohort study demonstrated that the METS-IR index, a new IR evaluation index, were independently associated with a higher risk of the cardiovascular composite endpoint and all-cause mortality among Chinese hypertensive population. Importantly, our finding provides an independent indicator for evaluating the prognosis of hypertensive patients.

Triglyceride-glucose index change and chronic kidney disease progression in a Chinese hypertensive population.

The impact of triglyceride-glucose (TyG) index variations on chronic kidney disease (CKD) progression remains unexplored. To investigate the effects of the TyG index and its dynamic changes on CKD progression. This prospective cohort study included data from 8,418 hypertensive participants. The exposure variable in this study was defined as the difference between the TyG index at the last visit from that at baseline. The study's outcome variable was the progression of CKD, defined as follows: for subjects with an estimated glomerular filtration rate (eGFR) ≥60 mL/min, a ≥30% decrease in eGFR with a final follow-up value <60 mL/min; for those with an eGFR <60 mL/min, a ≥50% decrease in eGFR; or terminal renal failure requiring dialysis. During a median follow-up period of 48 months, 1077 patients were diagnosed with CKD progression. In the fully adjusted Model 3, patients with a change in the TyG index <0 exhibited a significantly decreased 13% risk of CKD progression (HR: 0.87, 95% CI: 0.76-0.98) compared to those with a change in the TyG index≥0 group. Subgroup analyses showed that changes in the TyG index significantly increased the risk of CKD progression only in patients with diastolic blood pressure (DBP) <90mmHg. In the path analysis, baseline TyG was associated with follow-up eGFR (the standard regression coefficient was 1.26 [95% CI, 0.45-2.06]). Our findings suggest that TyG variability may serve as a useful tool for identifying individuals at risk of CKD progression, particularly hypertensive patients with normal DBP levels.

High serum uric acid is a risk factor for arterial stiffness in a Chinese hypertensive population: a cohort study.

The prospective cohort study was to explore the association between serum uric acid (SUA) and arterial stiffness in a Chinese hypertensive population. A total of 7444 participants with hypertension who completed two or more measurements of brachial-ankle pulse wave velocity (baPWV) and baseline SUA detection were followed-up in the Kailuan Study from 2010 to 2020. A restricted cubic spline curve was used to verify whether there was a linear association between baseline SUA and arterial stiffness. A Cox proportional hazard regression model was used to explore the association of between baseline SUA and the incidence of arterial stiffness. Our results showed that the restricted cubic spline curve revealed a linear relationship between baseline SUA and arterial stiffness in total participants (p < 0.001). After follow-up 4.6 ± 2.8 years, Kaplan-Meier survival curves indicated that the risk of arterial stiffness was increased in the high level of baseline SUA (Log-rank p = 0.0002). After adjusting for potential confounding factors, the HR (95% CI) for risk of stiffness was 1.33 (1.17-1.52, p < 0.001) in the highest SUA group. Hierarchical analysis showed that the HRs (95% CI) for risk of arterial stiffness were 1.45 (1.25-1.69), 1.38 (1.19-1.60), 1.41 (1.21-1.64), and 1.35 (1.15-1.58) in the highest SUA group of males, <65 years old, not taking antihypertensive drugs, and failure to achieve the control targets of blood pressure respectively (p < 0.001). These results reveal that high SUA is a risk factor for arterial stiffness in the Chinese hypertensive population.

The association between passive smoking and sleep quality in a Chinese hypertensive population: A cross-sectional study.

This study evaluates the association between passive smoking, specifically secondhand smoke (SHS) and thirdhand smoke (THS) exposure, and sleep quality in a hypertensive population. We enrolled 1427 eligible hypertensive patients from a 2022 national cross-sectional survey in China. Data on tobacco smoke exposure and sleep were collected via questionnaires. Multiple logistic regression and linear regression were employed to assess the relationship between passive smoking and sleep quality characteristics, as well as the correlation between passive smoking exposure characteristics and sleep quality. Among 589 hypertensive patients with no tobacco smoke exposure, 679 exposed to SHS, and 159 exposed to THS, SHS exposure was associated with a higher risk of poor sleep quality, even after adjusting for potential confounding factors (β=0.10; 95% CI: 0.32-0.95). No significant relationship was observed between THS exposure and sleep quality. SHS exposure was associated with various sleep quality characteristics, including shorter sleep duration (AOR=1.71; 95% CI: 1.06-2.76) and increased frequency of 1-2 sleep disturbances per week (AOR=1.68; 95% CI: 1.25-2.26). Individuals exposed to SHS were more likely to experience poorer subjective sleep quality (AOR=1.53; 95% CI: 1.07-2.21) and have sleep efficiency <65% (AOR=1.82; 95% CI: 1.22-2.71). Exposure to passive smoking at home, in the community, in public places, exposure to passive smoking with family and friends, and increased frequency of exposure, were all associated with a higher risk of poor sleep quality. Our study suggests that SHS exposure in hypertensive populations is associated with poor sleep quality and various characteristics of sleep quality. No significant association was found between THS exposure and sleep quality. These findings underscore the need to enhance tobacco control efforts in China, particularly for individuals with chronic diseases, to safeguard public health.

Impaired kidney function and the risk of all-cause mortality and cardiovascular disease among Chinese hypertensive adults: Using three different equations to estimate the glomerular filtration rate

ObjectivesWe aimed to seek accurate assessments of the glomerular filtration rate (GFR) in a Chinese hypertensive population to identify individuals at high risk for chronic kidney disease (CKD) progression. Then, the risk of cardiovascular disease (CVD) and all-cause death due to kidney injury were further investigated under appropriate GFR-estimation equations. MethodsIn this prospective follow-up cohort study of 10,171 hypertensive patients, we compared the discrimination power of a trio of GFR-estimation equations using Harrell's C-index, measuring the model fit by calculating the Akaike information criterion. Univariate and multivariable logistic regression analyses were respectively used to calculate the hazard ratio (HR) and 95% confidence interval [CI] values for CKD progression. In addition, we also assessed the risk of CVD and all-cause death with impaired renal function using multivariable-adjusted Cox regression models. ResultsThe Modification of Diet in Renal Disease (MDRD) equation showed the highest C-index range for the predicted probability of CKD progression in the fully adjusted model. During MDRD analysis, a low eGFR (60–89 mL/min/1.73m2 or < 60 mL/min/1.73m2) was an independent risk factor for CVD, especially stroke (1.28 [95% CI, 1.05–1.55] and 1.89 [95% CI, 1.08–3.31]), as well as all-cause mortality (1.28 [95% CI, 1.09–1.50] and 1.68 [95% CI, 1.01–2.78]). ConclusionsThe MDRD equation seems to be more suitable for screening CKD progression in Chinese hypertensive populations, targeting potential risk factors for effective prevention to reduce renal impairment so as to further limit CVD morbidity and mortality.

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.

Health-related quality of life among cancer survivors: pre-existing chronic conditions are to be given priority.

This study aimed to describe the health-related quality of life (HRQoL) of cancer survivors in China by the five-level EuroQol-5-dimension (EQ-5D-5L) questionnaire and to explore the impact of the comorbidity of pre-existing chronic conditions on HRQoL in cancer survivors. Data on cancer survivors were obtained from two cross-sectional surveys conducted in Shandong Province, China. The data of the Chinese general population, the Chinese diabetes population, the Chinese hypertension population, and the Chinese urban population from the published studies were used as the controls. The χ2 test was conducted to compare the incidence of five-dimensional problems between the study and control populations. The non-parametric Mann-Whitney U test and Kruskal-Wallis test were performed to examine the differences in EQ-5D-5L utility scores. Besides, the Tobit regression model was used to examine the variables influencing the EQ-5D-5L utility score. One thousand fifty-one adult cancer survivors were included. Cancer survivors had significantly lower EQ-5D-5L utility scores (Z = - 15.939, P < 0.001) and EQ-VAS scores (Z = - 11.156, P < 0.001) than the general adult population. The average EQ-5D-5L utility score of hypertensive cancer survivors was lower than that of the hypertensive population (Z = - 1.610, P = 0.107), but the difference was not statistically significant. Compared to the general population, the HRQoL of cancer survivors was extremely poor in all dimensions of the EQ-5D-5L. Pre-existing chronic conditions had significant antecedent effects on the HRQoL of cancer survivors. Therefore, more attention should be paid to chronic diseases, and effective interventions should be adopted based on this.

Triglyceride-glucose index is associated with a higher risk of stroke in a hypertensive population

BackgroundThis study aimed to evaluate the association of triglyceride-glucose (TyG) index, an insulin resistance surrogate biomarker, with first stroke in a hypertensive population and to explore potential influencing factors.MethodsThis study, a cohort study among a rural Chinese hypertensive population, utilized data from the China Stroke Primary Prevention Trial (CSPPT). The TyG index was calculated as ln [fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2]. Multivariate analysis using Cox proportional hazards models was conducted.ResultsA total of 7569 hypertensive patients were included in this study. When TyG index was assessed as quartiles, compared with the reference group (Quartile 1), the hazard ratio of stroke was 1.04 in Quartile 2, 1.43 in Quartile 3, and 1.45 in Quartile 4, with a significant trend test (P = 0.013). When Quartiles 3 and 4 were combined (≥ 8.8), the hazard ratio was 1.41 compared with combined Quartiles 1 and 2 (< 8.8). Similar findings were observed for the association of TyG index with ischemic stroke. Further, a joint effect of baseline TyG index and age on first stroke was found. Using the group with TyG < 8.8 and age < 60 years as a reference, the highest hazard ratio of stroke was found in the group with a higher TyG index and aged 60 or greater (HR: 2.15, 95% CI 1.50, 3.07, P < 0.001).ConclusionsIn a hypertensive population, baseline TyG index was associated with a significantly higher risk of first stroke. In addition, age was a significant effect modifier for this association.

Association between serum cholinesterase and the prevalence of atrial fibrillation in Chinese hypertensive population: a cross-sectional study

BackgroundAtrial fibrillation (AF) is a very common arrhythmia with significant incidence rate and mortality. Several studies have shown a notable correlation between non-alcoholic fatty liver disease (NAFLD) and AF. It has been observed that serum cholinesterase (SChE) levels are elevated in individuals with fatty liver. However, the relationship between the SChE index and AF is still unclear. Therefore, the purpose of this study is to explore the association between the SChE index and the prevalence of AF in patients with hypertension.MethodWe collected cross-sectional data from January 2018 to April 2021 based on a retrospective study of cardiovascular disease. A total of 748 patients with hypertension were included, of whom 165 had AF. We used logistic regression models to test the relationship between SChE and the prevalence of AF in hypertensive patients.ResultIn hypertensive patients, the SChE index was significantly associated with AF (OR = 0.723, P < 0.001). After adjusting for potential confounding factors, this correlation was still significant (OR = 0.778, P < 0.001). The stability of the model was verified by adjusting the variable type of SChE. The data were further stratified according to whether the patient had fatty liver. In the stratified data, the correlation between SChE and atrial fibrillation was still significant (P < 0.05).ConclusionOur study showed that SChE was significantly negatively correlated with the occurrence of AF in patients with hypertension. And this correlation was not affected by whether the patient had fatty liver.

Associations of PM2.5 composition and green space with metabolic syndrome in a Chinese essential hypertensive population

BackgroundMetabolic syndrome (MetS) has emerged as a significant global public health concern. While environmental factors, including PM2.5, have been identified as important risk factors for MetS in the general population, limited studies have investigated their impact on individuals with essential hypertension. Therefore, our study aims to explore the relationship between PM2.5 composition, green space, and their combined effects on MetS among a Chinese essential hypertensive population. MethodA total of 20,131 participants diagnosed with essential hypertension from 10 provinces in China were included in this study. Individual level exposure to various environmental factors (including PM2.5, PM2.5 composition, green space and temperature) were evaluated using spatiotemporal models based on satellites data. Participants were defined as MetS according to the definition issued by the International Diabetes Federation. Generalized additive mixed models were used to analyze the individual air pollutants, green space and their interaction on MetS. ResultThe prevalence of MetS in this population was 44.33%. The adjusted odd ratio (OR) of MetS, with each one unit increase in SO42−, BC and NO3− were 1.077 (1.049, 1.106), 1.126 (1.077, 1.177) and 0.977 (0.958, 0.996) respectively. Additionally, each unit increase of the Normalized Difference Vegetation Index (NDVI) was associated with a decreased risk of MetS (OR: 0.988, 95% CI: 0.984–0.993). In particular, green space was found to mitigate the adverse impacts of PM2.5 on MetS (OR: 0.988, 95% CI: 0.984–0.993). ConclusionOur results suggested that there was a positive association between PM2.5 and its composition (SO42−, BC) with MetS in the essential hypertensive population, while green space might play a protective role. Moreover, green space could effectively weaken the positive relationship between air pollutants and MetS, especially in males and participants younger than 60 years old.

Prevalence and prognosis of atrial fibrillation in a hypertensive population: A prospective cohort study.

Identifying risk factors for atrial fibrillation (AF) and evaluating their impact are essential to avoid the occurrence of adverse events. However, few studies to date have explored the prevalence, risk factors, and prognosis of AF in hypertensive patients. The objective of this study was to investigate the epidemiology of AF in a hypertensive population and determine the relationship between AF and all-cause mortality. At baseline, a total of 8541 Chinese patients with hypertension were enrolled from the Northeast Rural Cardiovascular Health Study. A logistic regression model was established to assess the relationship between blood pressure and AF, and Kaplan-Meier survival curve analysis and multivariate Cox regression were used to explore the relationship between AF and all-cause mortality. Meanwhile, subgroup analyses illustrated the robustness of results. This study found that the overall prevalence rate of AF was 1.4% in its Chinese hypertensive population. After adjusting for the confounding factors, every standard deviation increase in diastolic blood pressure (DBP) was associated with a 37% increase in the prevalence of AF (95% confidence interval: 1.152-1.627, p<.001). Compared to hypertensive patients without AF, those with AF had an increased risk of all-cause mortality (hazard ratio=1.866, 95% confidence interval: 1.117-3.115, p=.017) in the adjusted model. The results show that the burden of AF is quite large in rural-dwelling Chinese hypertensive patients. Focusing on the control of DBP to prevent the occurrence of AF can be helpful. Meanwhile, AF increases risk of all-cause mortality in hypertensive patients. Our results indicated a huge burden of AF. Considering that most of the risk factors of AF were unmodifiable in hypertensive individuals and given their high risk of mortality, long-term interventions, including AF education, timely screening, and widespread use of anticoagulant drugs, should be emphasized in hypertensive populations.

Ascending aorta dilatation reduces the influence of elevated pulse pressure on left ventricular hypertrophy: findings from a Chinese elderly hypertensive population.

To determine the role of ascending aorta dilatation in the relationship between pulse pressure (PP) and left ventricular (LV) hypertrophy. A total of 1556 Chinese elderly hypertensive patients were retrospectively studied. Transthoracic echocardiography was used to obtain the aortic and cardiac structure measurements. In addition, brachial blood pressure was measured, and total arterial compliance, systemic vascular resistance, arterial elastance, and end-systolic LV elastance were calculated. The participants were divided into four groups according to the status of ascending aortic diameter and PP. LV mass index increased in succession in the four groups, i.e., the group with the normal aorta and lower PP, with the normal aorta and higher PP, with aortic dilatation and lower PP, and with aortic dilatation and higher PP (P trend < 0.001). Total arterial compliance-1, arterial elastance, and end-systolic LV elastance were slightly higher in the individuals with normal aorta compared to those with aortic dilatation, regardless of PP being lower or higher (P < 0.01). Compared to the group with the normal aorta and lower PP, individuals with aortic dilatation had a significantly increased multivariable adjusted risk of LV hypertrophy, and higher PP further exacerbated this risk [aortic dilatation with lower PP (OR = 1.75, 95% CI: 1.01-3.04) and aortic dilatation with higher PP (OR = 3.42, 95% CI: 2.03-5.77)]. In the relation between PP and LV mass index (β = 0.095, P < 0.001), -41.3% of the total effect was attributable to mediation by ascending aortic diameter (P < 0.0001). In Chinese elderly patients with hypertension, ascending aorta dilatation could reduce the influence of elevated PP on LV hypertrophy.

PS-C09-9: AMBULATORY BLOOD PRESSURE CHARACTERISTICS IN CHINESE OBESE HYPERTENSIVE PATIENTS: A POPULATION-BASED AMBULATORY BLOOD PRESSURE MONITORING COHORT STUDY

Background: Ambulatory blood pressure monitoring (ABPM) is increasingly recommended for clinical practice, but more knowledge about the characteristics of Chinese obese hypertensive patients ABPM remains to further explore. This study aimed to assess the features in Chinese obese and hypertensive patients from multi-regions ambulatory blood pressure database in China. Methods: In this cohort, 35,367 hypertensive patients who were eligible for this study including 19,380 men (54.8%) and 15,987 women (45.2%) aged from 19 to 99 were recruited. ABPM characteristics were defined according to European guidelines. Overweight was defined as BMI 18.5 kg/m2 or greater, and obesity BMI 25 kg/m2 or greater. Hypertension was defined as elevated mean ambulatory BP (135/85 mmHg greater in day-time, 120/70 mmHg greater in night-time, 130/80 mmHg greater over 24-h). There are four kinds of blood pressure circadian rhythm, dippers, non-dippers, reverse dippers and extreme dippers. Results: Based on the ABPM recordings, 70.5% of participants had 24-h hypertension, 26.1% had dippers rhythm. 2.6% of participants had normal weight, 51.0% were overweight, 38.2% were obesity, and 8.2% were in severe obesity state. Considering blood pressure circadian rhythm, 48% non-dippers rhythm, 23.6% reverse dippers rhythm and 2.3% extreme dippers rhythm. Among participants who were obesity and severe obesity, 48% and 45.1% of patients were non-dippers. Severe obesity patients had higher 24-h blood pressures, especially in independent nocturnal hypertension. The prevalence of reverse dippers rhythm hypertension increased with age and the obesity degree. A positive association between blood pressure level and variability was observed, and within-person and between-person SD and CV were of similar magnitude. Conclusions: In Chinese obese hypertensive population, circadian rhythm blood pressure variation is an underappreciated problem on the population level. Therefore, the ambulatory blood pressure monitoring in obese hypertensive population needs to be expanded.

Association of METS-IR with incident hypertension in non-overweight adults based on a cohort study in Northeastern China.

Insulin resistance (IR) plays an important role in the progression of hypertension (HTN); therefore, early identification of IR is clinically important for preventing HTN. Our study aims to explore the relationship between the metabolic score for IR (METS-IR) and HTN in Chinese population who maintained non-overweight. A total of 4678 adults who underwent annual health check-up in our institution from 2010 to 2017, did not have HTN at the first check-up and maintained non-overweight at follow-up were selected as subjects. The baseline METS-IR was calculated and the outcome was incident HTN. Cox proportional hazards regression models were used to evaluate hazards ratios of HTN for METS-IR. Additionally, sensitive analyses and stratification analyses were used to deeply verify the relationship of METS-IR with HTN. The dose-response association between METS-IR and HTN risk was investigated using restricted the cubic spline analysis fitted for the Cox proportional hazards model. Compared with the first quartiles of METS-IR, the risk of incident HTN was increased by 58% [hazard ratio (HR) 1.58, 95% confidence interval (CI) 1.12-2.22] and 96% (HR 1.96, 95% CI 1.40-2.76) in the Q3 group and the Q4 group, respectively. The results remained consistent when analyses were restricted to people without abnormal high-density lipoprotein cholesterol, triglyceride or fasting plasma glucose level at baseline. A linear dose-response relationship between METS-IR and HTN risk was identified (HR 1.08, 95% CI 1.04-1.12). The risk of incident HTN was associated with elevated METS-IR levels in non-overweight individuals. METS-IR could help predict the risk of HTN in non-overweight individuals.

Online prediction model for primary aldosteronism in patients with hypertension in Chinese population: A two-center retrospective study.

BackgroundThe prevalence of primary aldosteronism (PA) varies from 5% to 20% in patients with hypertension but is largely underdiagnosed. Expanding screening for PA to all patients with hypertension to improve diagnostic efficiency is needed. A novel and portable prediction tool that can expand screening for PA is highly desirable.MethodsClinical characteristics and laboratory data of 1,314 patients with hypertension were collected for modeling and randomly divided into a training cohort (919 of 1,314, 70%) and an internal validation cohort (395 of 1,314, 30%). Additionally, an external dataset (n = 285) was used for model validation. Machine learning algorithms were applied to develop a discriminant model. Sensitivity, specificity, and accuracy were used to evaluate the performance of the model.ResultsSeven independent risk factors for predicting PA were identified, including age, sex, hypokalemia, serum sodium, serum sodium-to-potassium ratio, anion gap, and alkaline urine. The prediction model showed sufficient predictive accuracy, with area under the curve (AUC) values of 0.839 (95% CI: 0.81–0.87), 0.814 (95% CI: 0.77–0.86), and 0.839 (95% CI: 0.79–0.89) in the training set, internal validation, and external validation set, respectively. The calibration curves exhibited good agreement between the predictive risk of the model and the actual risk. An online prediction model was developed to make the model more portable to use.ConclusionThe online prediction model we constructed using conventional clinical characteristics and laboratory tests is portable and reliable. This allowed it to be widely used not only in the hospital but also in community health service centers and may help to improve the diagnostic efficiency of PA.

Comparing effect of definition of diurnal periods by diary, fixed periods, and actigraphy on ambulatory blood pressure parameters in a Chinese population.

Background:Reliable measurement of daytime and night-time blood pressure (BP), and degree of BP dipping during sleep during ambulatory blood pressure monitoring (ABPM) requires an accurate definition of sleep time (diurnal definition). However, superiority of any diurnal definition on ABPM remains unclear. The present study compared mean daytime and night-time SBP and DBP using different methods for diurnal definition: patient's diary, wide-defined and narrow-defined fixed periods, and actigraphy, in a Chinese population with diagnosed essential hypertension. We hypothesize that BP values from actigraphy are different from BP obtained by other methods and associated with end-organ damage (i.e. impaired renal function, proteinuria, left ventricular hypertrophy).Methods:From April 2017 to October 2019, 203 Chinese patients diagnosed with hypertension were recruited prospectively from Lek Yuen Clinic and 179 completed a 48-h ABPM study, wearing a validated actigraph and completed a sleep diary. Presence of end-organ damage was retrieved from the computerized clinical management system. The differences in the mean BP values provided by different diurnal definition were compared using paired t tests and Bland–Altman plots. The prevalence of elevated BP, dipping status categories, overall percentage agreement and the Kappa statistic were calculated by pairwise comparisons between different diurnal definitions. The reproducibility was also estimated and logistic regression was used to examine the relationship between BP values from different diurnal definitions and end-organ damage.Results:Mean daytime and night-time BP values were similar regardless of the definition used (mean difference <2 mmHg). Kappa statistics and overall percentage agreement found excellent agreement between different definitions to diagnose elevated daytime BP (Kappa ranged from 0.80 to 0.91) and night-time BP (Kappa ranged from 0.74 to 0.89). Good agreement to diagnose nondipping was also detected (Kappa ranged from 0.65 to 0.78). Furthermore, ABPM values were most reproducible when diurnal periods were defined by patient's diary (intra-class correlation coefficient = 0.82–0.93). Daytime and night-time BP values obtained using different diurnal definitions did not differ in their association to end-organ damage.Conclusion:Differing definitions of diurnal periods provide similar mean BP values among a Chinese hypertensive population and have good agreement for diagnosis of elevated BP and dipping status. In individual patients, clinicians should be aware that different definitions of diurnal periods can lead to a 3–5 mmHg difference in patient's BP values and may affect the diagnosis of elevated BP in patients with BP close to diagnostic thresholds. The current study supports using the patient's diary to define diurnal periods, which provided the best reproducibility.

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.

Novel Insights on Establishing Machine Learning-Based Stroke Prediction Models Among Hypertensive Adults.

BackgroundStroke is a major global health burden, and risk prediction is essential for the primary prevention of stroke. However, uncertainty remains about the optimal prediction model for analyzing stroke risk. In this study, we aim to determine the most effective stroke prediction method in a Chinese hypertensive population using machine learning and establish a general methodological pipeline for future analysis.MethodsThe training set included 70% of data (n = 14,491) from the China Stroke Primary Prevention Trial (CSPPT). Internal validation was processed with the rest 30% of CSPPT data (n = 6,211), and external validation was conducted using a nested case–control (NCC) dataset (n = 2,568). The primary outcome was the first stroke. Four received analysis methods were processed and compared: logistic regression (LR), stepwise logistic regression (SLR), extreme gradient boosting (XGBoost), and random forest (RF). Population characteristic data with inclusion and exclusion of laboratory variables were separately analyzed. Accuracy, sensitivity, specificity, kappa, and area under receiver operating characteristic curves (AUCs) were used to make model assessments with AUCs the top concern. Data balancing techniques, including random under-sampling (RUS) and synthetic minority over-sampling technique (SMOTE), were applied to process this unbalanced training set.ResultsThe best model performance was observed in RUS-applied RF model with laboratory variables. Compared with null models (sensitivity = 0, specificity = 100, and mean AUCs = 0.643), data balancing techniques improved overall performance with RUS, demonstrating a more satisfactory effect in the current study (RUS: sensitivity = 63.9; specificity = 53.7; and mean AUCs = 0.624. Adding laboratory variables improved the performance of analysis methods. All results were reconfirmed in validation sets. The top 10 important variables were determined by the analysis method with the best performance.ConclusionAmong the tested methods, the most effective stroke prediction model in targeted population is RUS-applied RF. From the insights, the current study revealed, we provided general frameworks for building machine learning-based prediction models.

Investigating the inverse association between glycaemia and abdominal aortic dilatation in a large Chinese hypertensive population: a cross-sectional study.

BackgroundThere is epidemiological evidence that diabetes has a protective effect on the occurrence and development of abdominal aortic aneurysms (AAAs). However, information on the role of glucose level on abdominal aortic diameter is limited. This study sought to assess the relationship between fasting plasma glucose (FPG) and infra-renal aortic diameter in a Chinese hypertensive population.MethodsThe prospective participants comprised candidates from 2 large population-based studies on the clinical presentation and management of hypertension in China. In total, 18,034 hypertensive participants (6,942 male and 11,092 females, with a mean age of 64.72±7.41 years) were included in the study. The maximal diameter of the infra-renal aorta was measured by ultrasound scanning. Multivariate linear regression analyses were conducted to assess the specific association between FPG and abdominal aortic diameter. The interaction terms between the baseline covariables and the aortic diameter were used to determine if a variable affected the association between FPG and abdominal aortic diameter.ResultsOf these, 22 cases of AAA were identified, and the prevalence of diabetes was lower in those with AAA than those without. A significant negative association was also found between FPG and aortic diameter in both sexes. A dose-dependent decrease in the prevalence of diabetes across quartiles of aortic diameter was also observed, with an estimated odds ratio (OR) of 0.60 (95% CI: 0.50–0.72) for men and 0.72 (95% CI: 0.63–0.82) for women for the top quartiles compared to the bottom quartiles. Cigarette smoking only interacted with the association between FPG level and aortic diameter in women. The association did not differ with other subgroups.ConclusionsOur findings indicate that glycaemia may plays a protective role in the early stage of aortic dilatation in both sexes in a Chinese hypertensive population. Prospective studies need to be conducted to confirm our findings and explore the mechanism underlying this association in different populations.

Association of lncRNA PVT1 Gene Polymorphisms with the Risk of Essential Hypertension in Chinese Population

Vascular dysfunction and hyperlipidemia are essential risk factors contributing to essential hypertension (EH). The plasmacytoma variant translocation 1 (PVT1) is involved in modulating angiogenesis in tumor tissues and plays an important role in fat differentiation in the progress of obesity. Therefore, we selected two tagSNPs of PVT1 (rs10956390 and rs80177647) to investigate whether they are contributing to the risk of hypertension in Chinese patients. In total, 524 adult patients with EH and 439 matched healthy controls were enrolled for two central of China. Results. PVT1 rs10956390 and rs80177647 polymorphisms were genotyped by using TaqMan assay. PVT1 rs10956390 TT genotype was associated with a decreased risk of EH (OR = 0.561, 95% CI = 0.372-0.846, P = 0.006), while rs80177647 TA genotype was associated with an increased risk (OR = 2.236, 95% CI = 1.515-3.301, P < 0.001). Rs10956390 T allele was associated with lower triglyceride levels in the plasma both from healthy and EH donors. What is more, there is an association between rs10956390 polymorphism and HDL-C level, as well as LDL-C. Conclusion. PVT1 rs10956390 and rs80177647 polymorphisms may contribute to the risk of EH in Chinese population by regulating blood lipid levels.