Chinese Hypertension Research Articles

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

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

Cardiovascular outcomes of β-blocker-calcium channel blocker initial dual therapy vs. other initial dual therapies in Chinese patients with hypertension: A real-world retrospective study.

This retrospective study compared cardiovascular (CV) outcomes between initial β-blocker (BB)+calcium channel blocker (CCB) dual therapy ("B+C") and other initial dual therapies in Chinese newly diagnosed hypertensive patients. In this study, all patients in a regional electronic database with newly diagnosed hypertension from January 01, 2012 to December 31, 2016 who received any initial optimal dual therapy recommended by the Chinese hypertension guideline were included. 1:2 propensity score matching (PSM) was used to balance baseline characteristics between patients receiving B+C and patients receiving other initial dual therapies ("Others"). The primary outcome was major adverse cardiovascular events (MACE) that occurred from January 01, 2012 to December 31, 2017, consisting of non-fatal stroke, non-fatal myocardial infarction (MI), non-fatal chronic heart failure (CHF), and all-cause death. Cox proportional hazard models were used to compare these CV outcomes in the 2 matched cohorts. After the PSM, 6227 patients receiving B+C and 12454 patients receiving Others were included. Compared to patients receiving Others, patients receiving B+C had a significantly lower risk of MACE (hazard ratio [HR] 0.85; 95% confidential interval [CI] 0.78-0.92; p<.001), non-fatal stroke (HR 0.89; 95% CI 0.81-0.98; p=.018) and non-fatal CHF (HR 0.74; 95% CI 0.63-0.86; p<.0001). Additionally, differences in risks of non-fatal MI and all-cause death between the 2 treatment cohorts were not statistically significant. In conclusion, BB+CCB initial dual therapy was associated with a lower risk of MACE, stroke, and CHF than other optimal initial dual therapies recommended by the Chinese hypertension guideline in Chinese newly diagnosed hypertensive patients.

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.

Association Between Hypertension and New-Onset Non-Alcoholic Fatty Liver Disease in Chinese Non-Obese People: A Longitudinal Cohort Study.

Quantification of the relationship between hypertension and non-alcoholic fatty liver disease (NAFLD) risk is limited and controversial. This study aimed to investigate the relationship between hypertension and NAFLD in non-obese Chinese and to use different methods to demonstrate that hypertension is an independent risk factor for NAFLD. On 16,153 nonobese individuals, a retrospective cohort study was conducted in China to examine the impact of hypertension on incident NAFLD. We compared five methods: multivariable Cox proportional-hazards regression, propensity score-matched (PSM) analysis, propensity score adjustment method (considering the propensity score as a covariate in a multivariable Cox proportional-hazard regression), and two propensity score-based weighted methods-The first one estimated the hypertension effect in the overall study population-inverse probability of treatment weights (IPTW), the other in the hypertensive population-standardized mortality ratio (SMR) weights. We also used a genetic matching (GenMatch) algorithm to match the participants for sensitive analysis. Between 2010 and 2014, 16,153 participants met our inclusion criteria, including 2427 (15.03%) with hypertension. A total of 2321 (14.37%) participants developed NAFLD during the median follow-up of 2.98 years. The crude hazard ratio (HR) between hypertension and incident NAFLD was 2.05 (95% confidence interval (CI): 1.87, 2.25). The adjusted HR depended on the different methods, ranging from 1.09 (95% CI: 0.77, 1.23) for the PSM method to 2.24 (95% CI: 2.05, 2.44) for the SMR weighted analysis. Hypertensive participants with high propensity scores had a higher risk of developing NAFLD in the future. Excluding participants with propensity scores <8% yielded comparable hazard ratios with a narrower range, from 1.04 to 1.80. After adjusting for the confounding variables, the relationship also existed in the GenMatch cohort as a sensitivity analysis (HR=1.06, 95% CI 1.01-1.13). Hypertension is a significant cause of NAFLD in Chinese adults in non-obese Chinese adults, with the hazard ratio ranging from 1.09 to 2.24.

Analysis of prescription status of antihypertensive drugs in Chinese patients with hypertension based on real-world study

Background Globally, the prevalence of hypertension and the accompanying burden of cardiovascular disease are increasing. Through drug utilization research, we can understand the prescription status of hypertension patients and promote rational drug use. The purpose of this retrospective study was to describe the current prescription pattern of antihypertensive drugs in Chinese patients and determine the compliance level of treatment guidelines. Materials and methods Around 11.1 million patients who received a prescription for antihypertensive therapy between January 2021 to December 2021 were obtained from a database of Hangzhou Kang Sheng Health Consulting CO., Ltd. Results The mean age of hypertensive patients was 54.75 ± 12.98 years. About 6.7 million (60.30%) were males. About 46.07% of patients had comorbidities. The most common classes of antihypertensive medications used were calcium channel blockers (CCBs) and angiotensin II receptor blockers (ARBs). Around 78.33% of participants were on monotherapy. Diuretics + ARBs and Diuretics + CCBs + ARBs were the most commonly prescribed pattern in two-drug combination therapy and three-drug combination therapy, respectively. Conclusions CCBs and ARBs were the two most frequently prescribed for patients with hypertension. The prescription pattern of antihypertensive medications in the study largely complied with recommended Chinese hypertension guidelines. Key messages Cardiovascular disease is the most common complication of hypertension. Calcium channel blockers (CCBs) and angiotensin II receptor blockers (ARBs) are the two most commonly used drugs for hypertension patients in China. The proportion of combination prescription pattern in Chinese hypertensive patients is low.

Hypertriglyceridemic waist phenotype is associated with left ventricular hypertrophy in Chinese hypertension patients

Left ventricular hypertrophy (LVH), the most common target organ damage in patients with hypertension, is closely related to excessive visceral adipose tissue (VAT) accumulation in the body. The hypertriglyceridemic waist (HTHW) phenotype can act as a surrogate marker of excessive VAT. However, the relationship between the HTHW phenotype and LVH in patients with hypertension remains unknown. The present study aimed to investigate whether the HTHW phenotype is associated with LVH, using echocardiography in a cross-sectional study involving 4470 middle-aged and older Chinese patients with hypertension. Logistic regression analysis revealed that patients with the HTHW phenotype were 1.52-fold more likely to experience LVH than those with normal triglyceride levels and normal waist circumference. This association was independent of age, sex, and other potentially confounding factors. In the stratified analysis, a stronger correlation was found among women, people of at least 70years of age, and people with hyperuricemia. These results suggest that distinguishing the HTHW phenotype in patients with hypertension could serve as a simple and effective screening strategy for identifying people with a higher risk of developing LVH.

PS-BPC05-3: THE RELATIONSHIP BETWEEN THE WEIGHT-ADJUSTED-WAIST INDEX AND LEFT VENTRICULAR HYPERTROPHY IN CHINESE HYPERTENSION ADULTS

Abstract Background: Left ventricular hypertrophy (LVH) is a major cardiac complication of hypertension. weight-adjusted-waist index (WWI) is a new obesity index that has been found to be positively associated with cardiovascular disease mortality. We aimed to investigate the relationship between the weight-adjusted-waist index and left ventricular hypertrophy in Chinese hypertension adults. Methods: The study is a community-based cross-sectional study that included 4715 patients with hypertension and integrated clinical and echocardiographic data. LVH was diagnosed by transthoracic echocardiography in these patients based on a criterion of left ventricular mass index (LVMI) over 49.2 g/m2.7 in men and 46.7 g/m2.7 in women. The independent association between the WWI quartiles and LVH prevalence was analyzed by logistic regression models. Results: The prevalence of LVH in the first quartile of WWI (Q1:less than 10.16), second (Q2:10.16∼10.67), the third (Q3:10.68∼11.19), and the highest quartile (Q4:greater or equal to11.20) was 34.1%, 38.4%, 42.4%, 51.5%, respectively. Logistic regression analysis suggested that the WWI was independently correlated with the risk of LVH with adjustment of confounding factors, and increased across the quartile of WWI. Compared to the first quartile of WWI (Q1), the odds ratios (ORs) and their 95% confidence intervals (CIs) for LVH in the increasing quartiles (Q2-Q4) were 1.33(1.08–1.63), 1.50 (1.19–1.89) and 2.28(1.74–2.99), respectively. In stratified analyses, the relationship between WWI and LVH risk persisted. Conclusions: The WWI may be an independent risk factor of LVH in Chinese hypertension adults.

Comparison of the Three Most Commonly Used Metabolic Syndrome Definitions in the Chinese Population: A Prospective Study.

Metabolic syndrome (MetS) is associated with cardiovascular risk, and there are various definitions, but which is most predictive of future cardiovascular disease (CVD) in the Chinese population is still unclear. MetS was defined with the revised ATP III (Third Adult Treatment Panel Report), International Diabetes Federation (IDF), and the Joint Committee for Developing Chinese Guidelines (JCDCG) definitions. Cox regression was used to estimate the hazard risk of cardiovascular disease among 20,888 participants using the Chinese Hypertension Survey (CHS) data. Sensitivity, specificity, and receiver operating characteristic (ROC) curve distance were used to test the ability of three MetS criteria to identify CVD. During an average follow-up of 4.89 years of 20,888 participants, 925 CVD events occurred (stroke, 560; coronary heart disease, 275; and other cardiovascular events, 119). The revised ATP III criteria identified the most individuals with MetS and had the highest prevalence of MetS. In addition, MetS was associated with a high risk of CVD in both men and women, according to three criteria. The highest diagnostic specificity was for IDF in men and JCDCG in women. The revised ATP III criteria had the highest sensitivity and shortest ROC curve distance in both men and women. Although the MetS definitions, including the revised ATP III, IDF, and JCDCG, are all related to the increased risks of CVD, overall, the revised ATP III performs best and is the most recommended for the Chinese population.

Association of triglyceride–glucose index and its 6-year change with risk of hypertension: A prospective cohort study

Background and aimWe aimed to investigate the association of triglyceride–glucose (TyG) index and its dynamic change with risk of hypertension in rural Chinese and, further, to explore whether the TyG index mediates the obesity-related hypertension. Methods and resultsA prospective cohort study, including 10,309 subjects without hypertension at baseline, was conducted in 2007–2008 and followed up in 2013–2014. TyG index was calculated as Ln[fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. Logistic regression model was used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs). Mediation analysis was performed to examine the contribution of the TyG index to the association of obesity-hypertension incidence. During a median follow-up of 6 years, 2073 subjects developed hypertension. In multivariate logistic model adjusted for age, sex, alcohol drinking, smoking, physical activity and education, monthly income, family history of hypertension, TC, and HDL-C, the risk of hypertension was 1.14 (1.07–1.22) for per-SD increase in TyG. After additional controlling for obesity, this association was nonsignificant (1.06, 0.99–1.13) and (1.05, 0.99–1.13) for BMI and WC, respectively. Increasing trends were found for hypertension incidence as the TyG change increased, with or without adjustment for obesity (all Ptrend < 0.05). With per-SD increment in TyG change, the risks of hypertension incidence were 1.14 (1.07–1.22) for absolute TyG change, and 1.15 (1.08–1.22) for relative TyG change in multivariate logistic model; the results were significant after further adjustment for BMI or WC, respectively. The TyG index partially mediated the obesity-incident hypertension association: 6.84% for BMI and 6.68% for WC, respectively. ConclusionsElevated TyG index and its dynamic change were positively associated with risk of incident hypertension in rural Chinese population, and the TyG index may play a partially mediating role in obesity-related incident hypertension.

Nomogram based on clinical features at a single outpatient visit to predict masked hypertension and masked uncontrolled hypertension: A study of diagnostic accuracy

Patients with masked hypertension (MH) and masked uncontrolled hypertension (MUCH) are easily overlooked, and both cause target organ damage. We propose a prediction model for MH and MUCH patients based on clinical features at a single outpatient visit. Data collection was planned before the index test and reference standard were after. Thus, we retrospectively collect analyzed 804 subjects who underwent ambulatory blood pressure monitoring (ABPM) at Renmin Hospital of Wuhan University. These patients were divided into normotension/controlled hypertension group (n = 121), MH/MUCH (n = 347), and sustained hypertension (SH)/sustained uncontrolled hypertension group (SUCH) (n = 302) for baseline characteristic analysis. Models were constructed by logistic regression, a nomogram was visualized, and internal validation by bootstrapping. All groups were performed according to the definition proposed by the Chinese Hypertension Association. Compared with normotension/controlled hypertension, patients with MH/MUCH had higher office blood pressure (BP) and were more likely to have poor liver and kidney function, metabolic disorder and myocardial damage. By analysis, [office systolic blood pressure (OSBP)] (P = .004) and [office diastolic blood pressure (ODBP)] (P = .007) were independent predictors of MH and MUCH. By logistic regression backward stepping method, office BP, body mass index (BMI), total cholesterol (Tch), high-density lipoprotein cholesterol (HDL-C), and left ventricular mass index are contained in this model [area under curve (AUC) = 0.755] and its mean absolute error is 0.015. Therefore, the prediction model established by the clinical characteristics or relevant data obtained from a single outpatient clinic can accurately predict MH and MUCH.

Effect of a Multicomponent Intervention Delivered on a Web-Based Platform on Hypertension Control

The prevalence of hypertension is high and still increasing across the world, while the control rate remains low in many countries. Emerging technology, such as telemedicine, may offer additional support to change the unsatisfactory situation. To establish a multicomponent intervention delivered on a web-based telemedicine platform and oriented with the Chinese hypertension management guidelines and to evaluate the effect of the intervention on blood pressure (BP) control for patients with hypertension. This cluster randomized clinical trial of a hypertension management program was conducted at 66 community health centers in China from October 1, 2018, to May 31, 2020, with a 12-month follow-up. Patients with hypertension were blinded to randomization and were randomized to either the intervention group or control group. Hypertension was diagnosed at mean systolic BP (SBP) and diastolic BP (DBP) readings higher than 140 and 90 mm Hg or with use of antihypertensive medication. Evaluation of the intervention effect was based on the principle of modified intention to treat. Multicomponent intervention was delivered on a web-based platform and consisted of a primary prevention program for cardiovascular disease and standardized management for hypertension. The primary outcome was the change in BP control rate (SBP and DBP levels <140 and 90 mm Hg, or <130 and 80 mm Hg for patients with diabetes) from baseline to the 12-month follow-up among patients with hypertension in the intervention and control groups. A total of 4118 patients (mean [SD] age, 61.6 [9.4] years; 2265 women [55.0%]) were included in the analysis, with 2985 in the intervention group and 1133 in the control group. The BP control rate at baseline was 22.8% in the intervention group and 22.5% in the control group. After 12 months of the intervention, the BP control rate for the intervention group compared with the control group was significantly higher (47.4% vs 30.2%; odds ratio, 1.18; 95% CI, 1.13-1.24; P < .001). The intervention effect on SBP level was -10.1 mm Hg (95% CI, -11.7 to -8.5 mm Hg; P < .001) and on DBP level was -1.8 mm Hg (95% CI, -2.8 to -0.8 mm Hg; P < .001). Results of this trial showed that a multicomponent intervention delivered on a web-based platform improved BP control rate and lowered BP level more than usual care alone. Such a telemedicine program may provide a new, effective way to treat patients with hypertension in the community and may generate public health benefits across diverse populations. Chinese Clinical Trial Registry Identifier: ChiCTR1800017791.

Clinical decision support system for hypertension medication based on knowledge graph

BackgroundHigh prevalence of hypertension and complicated medication knowledge have presented challenges to hypertension clinicians and general practitioners. Clinical decision support systems (CDSSs) are developed to aid clinicians in decision making. Current clinical knowledge is stored in fixed templates, which are not intuitive for clinicians and limit the knowledge reusability. Knowledge graphs (KGs) store knowledge in a way that is not only intuitive to humans but also processable by computers directly. However, existing medical KGs such as UMLS and CMeKG are general purpose and thus lack enough knowledge to enable hypertension medication. MethodsWe first construct a KG specific to hypertension medication according to the Chinese hypertension guideline and then develop the corresponding CDSS to implement hypertension medication and knowledge management. Current advances in knowledge graph representation and modelling are researched and applied in the complex medical knowledge representation. Traditional knowledge representation and KG representation are innovatively combined in the storage of the KG to enable convenient knowledge management and easy application by the CDSS. Along a predefined reasoning path in the KG, the CDSS finally accomplishes the hypertension medication by applying knowledge stored in the KG. 124 health records of a hypertension Chief Physician from Beijing Anzhen Hospital, Capital Medical University, are collected to evaluate the system metrics on the single drug recommendation task. Results and conclusionThe proposed CDSS has functions of medication knowledge graph management and hypertension medication decision support. With elaborate design on knowledge representation, knowledge management is intuitive and convenient. By virtue of the KG, medication recommendations are highly visualized and explainable. Experiments on 124 health records with 90% guideline compliance collected from hospitals in single class recommendation task achieve 91%, 83% and 77% on recall, hit@3 and MRR metrics respectively, which demonstrates the quality of the KG and effectiveness of the system.

The relationship between the weight-adjusted-waist index and left ventricular hypertrophy in Chinese hypertension adults.

Left ventricular hypertrophy (LVH) is a major cardiac complication of hypertension. Weight-adjusted-waist index (WWI) is a new obesity index that has been found to be positively associated with cardiovascular disease mortality. We aimed to investigate the relationship between the WWI and LVH in Chinese hypertension adults. The study is a community-based cross-sectional study that included 4715 patients with hypertension and integrated clinical and echocardiographic data. LVH was diagnosed by transthoracic echocardiography in these patients based on a criterion of left ventricular mass index (LVMI) over 49.2 g/m2.7 in men and 46.7 g/m2.7 in women. The independent association between the WWI quartiles and LVH prevalence was analyzed by logistic regression models. The prevalence of LVH in the first quartile of WWI (Q1: <10.16), second (Q2: 10.16 ~ 10.67), the third (Q3: 10.68~11.19), and the highest quartile (Q4: ≥11.20) was 34.1%, 38.4%, 42.4%, 51.5%, respectively. Logistic regression analysis suggested that the WWI was independently correlated with LVH with adjustment of confounding factors, and increased across the quartile of WWI. Compared to the first quartile of WWI (Q1), the odds ratios (ORs) and their 95% confidence intervals (CIs) for LVH in the increasing quartiles (Q2-Q4) were 1.33(1.08-1.63), 1.50 (1.19-1.89) and 2.28(1.74-2.99), respectively. In stratified analyses, the relationship between WWI and LVH risk persisted. The WWI may be an independent determinant of LVH in Chinese hypertension adults.

Selexipag-based triple combination therapy improves prognosis in Chinese pulmonary arterial hypertension patients.

AimSelexipag is an oral selective prostacyclin receptor agonist approved for treatment of patients with pulmonary arterial hypertension (PAH). In the present study, we aim to assess the safety and efficacy of selexipag in triple combination therapy with endothelial receptor antagonists (ERAs) and PDE5is for Chinese PAH patients.Methods and resultsA single center retrospective study was performed on group 1 PAH patients (n = 68) initiating triple combination therapy with selexipag from 1 February 2020 to 31 August 2021 in Qilu Hospital of Shandong University (Shandong, China). Adolescents, children, and PAH patients with unrepaired congenital heart disease were excluded. The French pulmonary hypertension network (FPHN) non-invasive risk assessment, echocardiogram parameters, and clinical data, including tolerability, safety, and death/hospitalization events associated with PAH, were collected. Of the 68 patients, 31 (45.6%) patients had tolerable side effects while only a single patient discontinued selexipag due to severe diarrhea. In the analysis of the efficacy set of 62 patients, the median selexipag treatment time from selexipag initiation to last risk assessment was 27 (21, 33) weeks. Compared to baseline parameters, the percentage of WHO FC III/IV decreased from 77.4% (48) to 24.2% (15) (p = 0.000), median 6-min walk distance (6MWD) increased 82 m [from 398 (318, 450) to 480 (420, 506) m; p = 0.000], and NT-proBNP levels decreased from 1,216 (329, 2,159) to 455 (134, 1,678) pg/mL (p = 0.007). Patients who improved to three low-risk criteria increased from 9.7 to 38.7%. Right ventricular diameter (RV) diameter also decreased and was accompanied by an improved tricuspid annular plane systolic excursion (TAPSE). Patients transitioning from subcutaneous treprostinil to selexipag continued to show improvements in WHO FC, 6MWD (404 ± 94 vs. 383 ± 127 m) and NT-proBNP levels (2,319 ± 2,448 vs. 2,987 ± 3,770 pg/mL). Finally, the 1-year event free survival rate was 96.7% for patients initiating the triple combination therapy within 3 years of PAH diagnosis.ConclusionTriple combination therapy with selexipag was safe and effective in Chinese PAH patients, which was confirmed by acceptable tolerability, and improved exercise capacity, right heart function, risk assessment, and prognosis.

Threshold effect of plasma total homocysteine levels on cognitive function among hypertensive patients in China: A cross-sectional study

BackgroundIncreased plasma total homocysteine (tHcy) is an influencing factor of cognitive impairment in the general population. However, studies on the relationship between the risk of cognitive impairment and plasma tHcy levels in patients with hypertension are limited. This study aimed to explore the association between plasma tHcy levels and cognitive function assessed by MMSE scores among hypertensive patients in China.MethodsA total of 9,527 subjects from the Chinese Hypertension Registry Study participated in this study. Plasma tHcy levels were quantified by high-performance liquid chromatography using a fluorescence detector. Cognitive assessment was performed using the Mini-Mental State Examination (MMSE). Linear regression models, two piecewise linear regression models, and smoothing curve fitting were applied to determine the relationship between plasma tHcy levels and cognitive function.ResultsThis analysis included 9,527 Chinese hypertensive adults. Based on the results of linear regression models, a negative relationship was identified between plasma tHcy levels and MMSE scores [beta coefficient (β) per standard deviation (SD) increase: −0.26, 95% confidence interval (CI) −0.35, −0.16, P &amp;lt; 0.001]. The fully adjusted smooth curve fitting presented a nonlinear between plasma tHcy levels and MMSE scores. The threshold effect analysis showed that the inflection point of tHcy was about 27.1 μmol/L. The effect size [β (95% CI)] per SD increase in plasma tHcy concentrations on MMSE scores was −0.93 (−1.24, −0.6) on the left side and −0.07 (−0.24, 0.10) on the right side of the inflection point (P-value for log-likelihood ratio (LLR) test was &amp;lt;0.001). Moreover, subgroup analyses revealed that sex could influence the negative association between plasma tHcy levels and MMSE scores up to a specific threshold (P-value for interaction &amp;lt;0.001). Linear regression models indicated that there was an enhanced inverse association between tHcy levels and MMSE scores in female patients with tHcy concentrations less than 26.9 μmol/L compared to male patients with tHcy concentrations less than 32.0 μmol/L.ConclusionsPlasma tHcy levels had a threshold effect on MMSE scores among hypertensive patients in China. Increased plasma tHcy levels were independently inversely associated with cognitive decline among hypertensive patients with tHcy concentrations &amp;lt;27.1 μmol/L.

Prevalence, awareness, treatment, and control rates of hypertension in patients hospitalized with atrial fibrillation in China: Findings from the CCC-AF project.

BackgroundThe status of hypertension in patients with atrial fibrillation (AF) remains unknown in China.MethodsThis study used data from patients hospitalized with AF recruited by the Improving Care for Cardiovascular Disease in China-AF (CCC-AF) project from 236 hospitals enrolled by geographic-economic level in China from 2015 to 2019. The prevalence, awareness, treatment, and control rates of hypertension in patients hospitalized with AF were estimated. Multivariable logistic regression was used to analyze the factors associated with uncontrolled hypertension.ResultsAmong 60,390 patients hospitalized with AF, the prevalence of hypertension according to the 2018 Chinese hypertension guidelines was 66.1%. The awareness, treatment, and control rates of hypertension were 80.3, 55.8, and 39.9%, respectively. Among patients treated for hypertension, the treatment control rate was 46.2%. These rates varied according to patient clinical characteristics and geographic regions. The young (18–44 and 45–54 years old), rural insurance, alcohol drinking, history of heart failure, valvular AF, first diagnosed AF, and permanent AF, were associated with uncontrolled hypertension. Under the 2017 American College of Cardiology/American Heart Association (ACC/AHA) hypertension guidelines, the prevalence of hypertension was 79.3%, and the control and treatment control rates dropped to 16.7 and 21.2%, respectively.ConclusionHypertension is common in patients hospitalized with AF in China. Although most patients were aware of their hypertensive status, the treatment and control rates of hypertension were still low. The management of hypertension in patients with AF needs to be further improved.

Association of marital status with cognitive function in Chinese hypertensive patients: a cross-sectional study

PurposeThe aim of this study was to evaluate the association of marital status with cognitive function and to examine the potential effect modifiers in Chinese hypertensive populations.MethodsA total of 9,525 adult Chinese hypertensive patients were enrolled in this cross-sectional study. Cognitive function, as the dependent variable in our study, was assessed by the Chinese version of the Mini‐Mental State Examination (MMSE). We adjusted for potential confounding factors in multiple linear regression models to examine the relationship of marital status with cognitive function. In addition, we divided the population according to sex to explore whether there were sex-specific differences.ResultsAmong the 9,525 study participants, the mean (SD) age for men was 63.5 (10.3) years, and the mean MMSE score was 24.9 ± 5.0, whereas for women, the mean (SD) age was 63.8 (9.3) years, and the mean MMSE score was 19.4 ± 6.4. Unmarried persons had lower scores on the MMSE and lower subscores in each of the cognitive domains. A stronger correlation between marital status and a lower MMSE score was statistically significant in men (unmarried men: β = -1.55; 95% CI: -1.89, -1.21) but not women (unmarried women: β = -0.22; 95% CI: -0.56, 0.12; p interaction = 0.006). Compared to men who were widowed or divorced, never married men were more likely to have lower MMSE scores (β = -2.30, 95% CI -3.10,—1.50; p < 0.001).ConclusionsOur study demonstrated that being unmarried is an extremely important but neglected social risk factor for cognitive function. Sex was a strong effect modifier: being unmarried was correlated with a higher risk of cognitive decline than being married in Chinese hypertensive men, especially among older men, but this correlation was not observed among women. Moreover, never married men showed poorer cognitive function than those who were divorced or widowed.

Chinese Visceral Adiposity Index Is More Closely Associated With Hypertension and Prehypertension Than Traditional Adiposity Indices in Chinese Population: Results From the REACTION Study.

PurposeThe optimal adiposity index that is strongly associated with hypertension or prehypertension remains inconclusive in Chinese population. This study aimed to investigate the relationship between Chinese visceral adiposity index (CVAI) and hypertension and prehypertension, as well as to compare the discriminative power of CVAI, visceral adiposity index (VAI), body mass index (BMI), waist circumference (WC), waist to height ratio (WHtR), low-density lipoprotein cholesterol (LDL-C), and waist-to-hip ratio (WHR) with hypertension and prehypertension in Chinese general population.Patients and MethodsA total of 34732 participants from REACTION study were recruited. Multiple logistic regression analyses were performed to detect the association between adiposity indices (CVAI, VAI, BMI, WC, WHtR, WHR, LDL-C) and hypertension and prehypertension.ResultsMultivariate logistic regression analysis showed that compared with other obesity indices, CVAI remained significantly associated with hypertension and prehypertension (Hypertension: odds ratio (OR) 3.475, 95% confidence interval (CI) 3.158-3.824, p<0.001 in total subjects; OR 2.762, 95% CI 2.369–3.221, p<0.001 in men; OR 3.935, 95% CI 3.465–4.469, p<0.001 in women, Prehypertension: OR 2.747, 95% CI 2.460-3.068, p<0.001 in total subjects; OR 2.605, 95% CI 2.176–3.119, p<0.001 in men; OR 2.854, 95% CI 2.465–3.304, p<0.001 in women).In a stratified analysis, CVAI was significantly associated with hypertension and prehypertension at any level of blood glucose, age or estimated glomerular filtration rate(eGFR).ConclusionCVAI is significantly associated with hypertension and prehypertension. CVAI shows the superior discriminative ability for hypertension and prehypertension compared with VAI, BMI, WC, WHtR, WHR and LDL-C in Chinese general population.

Clinical Features of Acute Coronary Syndrome in Patients with Coronary Heart Disease and Its Correlation with Tumour Necrosis Factor in Cardiology.

Tumour necrosis factor (TNF) levels are higher in patients who have experienced an acute ischemic stroke. Greater levels of TNF may not be linked to an increased risk of recurrent coronary events in the stable phase after myocardial ischemia (MI). Coronary atheroma is connected to endothelial and smooth muscle cells, as well as macrophages that emit the multifunctional cytokine tumour necrosis factor (TNF). Transplanted tumours become more vulnerable when TNF-α was first recognized to have a function in hemorrhagic necrosis. TNF-α has been demonstrated to induce heart failure, pulmonary edoema, and cardiomyopathy in people with advanced heart failure when it is elevated in the bloodstream. It has been postulated that prolonged overexpression of TNF-α after ischemia may contribute to poor cardiac outcomes by increasing TNF-α when the myocardium undergoes both temporary ischemia and reperfusion. A rise in TNF levels has been seen after a myocardial infarction, but it is unclear if these higher levels, found months after the initial event, are associated with an increased risk of subsequent heart attacks. We looked at TNF levels in the blood of 270 patients with coronary heart disease in the Chinese Hypertension League's Cholesterol and Recurrent Events (CARE) experiment to see if this notion held true. Recurrent coronary syndrome and coronary mortality were monitored prospectively in the participants. The min max imbalance normalization can be used to assess a patient's baseline characteristics, including hormone and cholesterol test results. Type 2 stimulant connection to aggregate the TNF-signaling qualities and fuzzy techniques was applied. There may now be enough preliminary evidence from the crucial bundle neural network analysis to identify the risk of coronary heart disease associated with TNF pregeneration studies. The tests were assessed using a variety of methods and performance metrics in a Matlab environment.

Plasma Lipidomic Subclasses and Risk of Hypertension in Middle-Aged and Elderly Chinese.

The online version contains supplementary material available at 10.1007/s43657-022-00057-y.