Sustained Hypertension Research Articles

Abstract P187: The Associations of White Coat and Masked Hypertension With Cardiovascular Disease and Mortality in the Jackson Heart Study

Introduction: The 2017 American College of Cardiology/American Heart Association (ACC/AHA) blood pressure (BP) guideline uses lower clinic and out-of-clinic BP thresholds to define hypertension compared to previous US guidelines. Using these thresholds, we determined the associations between white coat hypertension (WCH) and masked hypertension with cardiovascular disease (CVD) events and mortality. Methods: We included 993 African Americans participating in the Jackson Heart Study who had clinic BP measured during their baseline study visit between 2000 and 2004 and underwent ambulatory blood pressure monitoring (ABPM). We defined normotension, WCH/white coat effect (WCE), masked/masked uncontrolled hypertension, and sustained hypertension using clinic BP and mean awake BP on ABPM (Table). CVD events (i.e., coronary heart disease and stroke; n=107), and all-cause mortality (n=185) were adjudicated from baseline through December 2014 and December 2016, respectively. Results: The mean age of participants was 59 years and 68% were female. Among those not taking antihypertensive medication, 38% had normotension, 27% had WCH, 33% had masked hypertension, and 31% had sustained hypertension. WCH, masked hypertension, and sustained hypertension were each associated with an increased risk for CVD and mortality compared to normotension (Table). Among those taking antihypertensive medication, 26% had controlled normotension, 25% had a WCE, 45% had masked uncontrolled hypertension, and 39% had treated sustained hypertension. Masked uncontrolled hypertension was associated with a higher risk for CVD and a lower risk for mortality compared to controlled normotension. WCE was not associated with CVD events or all-cause mortality. Conclusions: According to the ACC/AHA BP guideline, WCH and masked hypertension are common among African American adults. ABPM could have an important role in guiding antihypertensive medication initiation and intensification to reduce CVD and mortality risk among African Americans.

Abstract MP65: Maternal Vascular Lesions in the Placenta May Identify Women Susceptible to Masked Hypertension a Decade After Pregnancy

Introduction: Women with placentally mediated pregnancy complications such as preeclampsia have excess hypertension and cardiovascular disease later in life, but the underlying pathophysiology linking these conditions is unknown. Hypothesis: We considered that histological examination of the placenta may reveal maternal vascular impairments that identify a group susceptible to blood pressure (BP) elevations a decade after delivery, including elevations that may only be detectable using out of office BP measurement. Method: Women with a singleton live birth at Magee-Womens Hospital (Pittsburgh, PA) during 2008-2009 were enrolled 8-10 years after delivery (n=248). Pregnancy features and placental pathology were abstracted from medical records. Women with placental vasculopathy (several related lesions arising from impaired remodeling of maternal myometrial and decidual arteries, n=24) or infarcts (n=32) were compared to women with neither lesion (n=192). Clinic BP was measured three times by trained research staff using a standard protocol and a validated home BP device. Women were trained to measure their BP twice daily for 7 days using the same device mentioned above. Subsequently, time and date stamped BP measures were downloaded (mean 12.2 measures ± 4.5). BP status (elevated, stage 1, stage 2) was identified using the 2018 ACC/AHA guidelines for clinic and home BP measures. Sustained normotensive, white coat, masked, and sustained hypertension status were classified. Results: Women were, on average, 37 years of age at measurement. In analysis controlled for age and race (p-value < 0.05) those with placental vasculopathy had higher mean diastolic BP in clinic and at home (80.5 ± 13.3 mmHg, 79.9 ± 10.4, respectively) than women without vascular lesions in the placenta (75.4 ± 9.8 mmHg and 74.3 ±8.6, respectively). In addition, women with placental vasculopathy had a higher prevalence of masked hypertension (higher elevated BP status measured at home vs. in clinic; 37.5% vs. 14.1%) that persisted after accounting for maternal age and race (adjusted OR 4.7, 95% confidence interval 1.6, 13.8). Vasculopathy associations were similar after excluding women with preeclampsia (n=42), the pregnancy complication most strongly associated with placental vascular pathology. There were modest, non-significant associations between placental infarcts and all measures of maternal blood pressure. Conclusions: Irrespective of prior preecclampsia, women with placental evidence of vasculopathy have excess hypertension and particularly masked hypertension in the decade after pregnancy. Our results emphasize the value of out of office blood pressure measurement, and indicate that placental vasculopathy may be pathophysiologically related to development of hypertension before age 50.

Ambulatory Blood Pressure Monitoring: Profiles in Chronic Kidney Disease Patients and Utility in Management.

Optimal control of blood pressure (BP) may reduce the risk of progression of CKD. Misclassification of hypertension (HTN) and status of control may result in suboptimal management. Clinic or home BP may overestimate or underestimate status of control compared with ambulatory BP monitoring (ABPM), which is considered the gold standard. The latter relates not only to the superiority of ABPM concerning outcome prognosis but also to its ability to accurately diagnose white coat and masked HTN, which is critical in assuring adequate BP control. However, ABPM has not gained widespread use in practice because of limited third-party reimbursement and a paucity of high quality randomized controlled intervention studies evaluating its use. Herein, we review HTN phenotypes that have been identified in patients with CKD, and the potential value of ABPM in this high-risk population.

Microglial Cells Impact Gut Microbiota and Gut Pathology in Angiotensin II-Induced Hypertension.

Increased microglial activation and neuroinflammation within autonomic brain regions have been implicated in sustained hypertension, and their inhibition by minocycline-an anti-inflammatory antibiotic-produces beneficial effects. These observations led us to propose a dysfunctional brain-gut communication hypothesis for hypertension. However, it has been difficult to reconcile whether an anti-inflammatory or antimicrobial action is the primary beneficial effect of minocycline in hypertension. Accordingly, we utilized chemically modified tetracycline-3 (CMT-3)-a derivative of tetracycline that has potent anti-inflammatory activity-to address this question. Test the hypothesis that central administration of CMT-3 would inhibit microglial activation, attenuate neuroinflammation, alter selective gut microbial communities, protect the gut wall from developing hypertension-associated pathology, and attenuate hypertension. Rats were implanted with radiotelemetry devices for recording mean arterial pressure. Ang II (angiotensin II) was infused subcutaneously using osmotic mini-pumps to induce hypertension. Another osmotic mini-pump was surgically implanted to infuse CMT-3 intracerebroventricularly. Intracerebroventricular CMT- 3 infusion was also investigated in SHR (spontaneously hypertensive rats). Physiological, pathological, immunohistological parameters, and fecal microbiota were analyzed. Intracerebroventricular CMT-3 significantly inhibited Ang II-induced increases in number of microglia, their activation, and proinflammatory cytokines in the paraventricular nucleus of hypothalamus. Further, intracerebroventricular CMT-3 attenuated increased mean arterial pressure, normalized sympathetic activity, and left ventricular hypertrophy in Ang II rats, as well as in the SHR. Finally, CMT-3 beneficially restored certain gut microbial communities altered by Ang II and attenuated pathological alterations in gut wall. These observations demonstrate that inhibition of microglial activation alone was sufficient to induce significant antihypertensive effects. This was associated with unique changes in gut microbial communities and profound attenuation of gut pathology. They suggest, for the first time, a link between microglia and certain microbial communities that may have implications for treatment of hypertension.

What is the optimal cut-off threshold in self-home blood pressure measurement?: A cohort study according to STROBE statement.

Two aspects arise concerning the use of self-measured blood pressure monitoring to diagnose white-coat hypertension (WCH): the presence of target organ damage (TOD) and the normal cut-off threshold. This study aims to evaluate the cardiovascular risk of WCH according to different self-measured blood pressure normal cut-off thresholds and the influence of TOD at baseline.In all, 678 patients were followed for 6.2 years; 223 normotensive patients, 271 patients with sustained hypertension (HT), and 184 with WCH. TOD was defined as: left ventricular hypertrophy according to ECG, albuminuria, or low estimated glomerular filtration rate. The risk for different cutting points of self-measured blood pressure (<135/85 mm Hg, <130/85 mm Hg, and <130/80 mm Hg) has been determined.The patients with HT experienced an increase in cardiovascular risk and death higher than the normotensive patients (odds ratio [OR] 7.9, 95% confidence interval [CI] 3.8–16.2 for sustained HT; and OR 3.5, 95% CI 1.6–7.4 for WCH). This was observed for all the cut-off thresholds analyzed. In white-coat hypertensive patients (cut-off <135/85 mm Hg) with TOD, the risk was higher than in normotensive patients (OR 4.5; 95% CI 1.9–10.6). Using a self-monitoring blood pressure cut-off threshold of <130/80 mm Hg without TOD at baseline, the WCH cases exhibited no differences in risk to the normotensive patients (OR 2.0, 95% CI 0.5–7.7).The decisions being taken for patients with WCH based on the presence of TOD and a self-administered home monitoring blood pressure measurement cut-off point probably lower than the one that is currently recommended.

Hypertension in Children and Adolescents.

Hypertension is a growing problem in children and adolescents, with primary hypertension becoming the most common etiology. In addition to demonstrating that high blood pressure in children and young adults is likely to remain elevated into adulthood, this review (1) addresses important aspects of measuring blood pressure in children and adolescents, (2) defines elevated blood pressure and hypertension in this age group, (3) describes the initial evaluation and workup of abnormally high blood pressure, and (4) introduces treatment strategies for youth with sustained hypertension.

High Normal Blood Pressure and Left Ventricular Hypertrophy Echocardiographic Findings From the PAMELA Population.

Cross-sectional and longitudinal data analysis of the PAMELA (Pressioni Monitorate E Loro Associazioni) population was performed to assess the association between prehypertension and left ventricular hypertrophy (LVH) at entry and the risk of new-onset LVH associated to this condition in the subset of participants with normal LV mass index (LVMI). A total of untreated 1397 participants with measurable echocardiographic parameters at baseline were considered in the cross-sectional analysis. The longitudinal analysis included 880 participants without LVH at baseline and with measurable LVMI at follow-up examination performed 10 years later. At entry, after adjustment for major confounders LVH prevalence rates (LVM/body surface area) showed a significant, progressive increase from the normotensive (2.1%), to prehypertension (6.7%), and hypertension group (18.3%). The incidence of LVH increased progressively from the normotensive to prehypertension and hypertension group (9.0%, 23.2%, and 36.5%, respectively). The risk of new LVH was significantly greater in prehypertension who progressed to sustained hypertension (odds ratio, 4.21; CI, 1.64-10.83; P=0.003) than in those with persistent prehypertension (odds ratio, 1.89; CI, 0.77-5.11; P=0.21) compared with persistent normotensive participants after adjustment for age, sex, baseline LVMI, obesity, glucose, creatinine, total cholesterol and the use of antihypertensive drugs at follow-up. Further adjustments for changes in body mass index, metabolic variables, and creatinine during the follow-up did not modify the strength of association between prehypertension and new-onset LVH. Our findings offer a new piece of evidence on the association of prehypertension with LVH and support the view that preventive actions for this condition affecting a large fraction of the general population should be intensified.

Resistant Hypertension: Diagnosis and Management.

Resistant hypertension is defined as high blood pressure requiring 3 or more medications for adequate control or controlled blood pressure requiring 4 or more medications. Considering the growing prevalence of hypertension and the strong link with cardiovascular disease, it is vital to understand the causes and treatment of resistant hypertension. This review article starts with an overview of the prevalence and little-known pathophysiology of resistant hypertension. Afterward, we discuss the evaluation and management of suspected secondary resistant hypertension in 2 broad categories: pseudoresistant hypertension and true resistant hypertension. Strategies for the identification and management of pseudoresistant hypertension are addressed. In addition, causes of true resistant hypertension, such as obstructive sleep apnea, primary aldosteronism, and renal artery stenosis, are examined along with their respective treatments. Finally, treatment of resistant hypertension is reviewed including pharmacologic treatments and novel procedural interventions for resistant hypertension. Overall, the review hopes to provide practitioners with a cohesive approach for the diagnosis and treatment of resistant hypertension.

Peri-operative, intravenous clindamycin may improve the resolution rate of hypertension after Roux-en-Y gastric bypass in morbidly obese patients.

Recent studies have suggested that potential aberrant alterations in the gastrointestinal microbiome contribute to the development of cardiovascular disease, specifically hypertension. Bariatric surgery produces significant sustained weight loss and hypertension resolution likely through multiple mechanisms which includes beneficial changes in the gut microbiome. We hypothesized that the type of prophylactic antibiotic given for bariatric surgery could impact the resolution rate of hypertension by altering the post-operative gastrointestinal microflora. A retrospective analysis of adult bariatric patients who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between 2012 and 2016 was conducted. The standard antibiotic prophylaxis was cefazolin, or clindamycin in patients with a penicillin allergy. Univariate analyses were performed comparing the differing peri-operative antibiotic treatments with resolution of hypertension at 2-week (± 1week), 6-week (± 2weeks), 3-month (± 2weeks), 6-month (± 6weeks), and 1-year (± 2months) follow-up appointments. The criterion for resolution of hypertension was no longer requiring medication at time of follow-up. In total, 123 RYGB and 88 SG patients were included. No significant differences were found between cefazolin and clindamycin regarding hypertension resolution rates after SG. However, patients who underwent RYGB and received clindamycin had a significantly higher rate of hypertension resolution compared to cefazolin. This effect started at 2weeks post-operatively (52.4% vs. 23.5% respectively, p = 0.008) and persisted up to the 1-year (57.9% vs. 44.0% respectively, p = 0.05). Prophylactic peri-operative, intravenous clindamycin was associated with significantly increased resolution of post-operative hypertension compared to cefazolin. This finding was not observed in SG patients. Future studies are needed to confirm the mechanism of action for this novel finding is due to the differing modifications of the gastrointestinal microflora after RYGB resulting from the specific peri-operative antibiotic administered.

Pheochromocytoma and paraganglioma-an update on diagnosis, evaluation, and management.

Pheochromocytomas and paragangliomas (PPGLs) generally grouped together are rare catecholamine-secreting endocrine tumors. Symptoms of catecholamine excess are non-specific and therefore a high index of suspicion in children with sustained hypertension, family history of endocrine tumors, or features of syndromes associated with PPGLs leads to a timely diagnosis and treatment. Freemetanephrines in theplasma or 24-h urine are the preferred tests to establish catecholamine excess. Considerations for false-positive conditions improve diagnostic yield and accuracy. Functional imaging, targeting either specific cell membrane transporters or vesicular catecholamine transport systems, is indicated for incidental lesions suspicious for PPGLs with inconclusive biochemical testing, assessment of regional extension or multifocality, and exclusion of metastases. Surgery is the mainstay of treatment for PPGLs. Preoperatively, sequential use of alpha adrenergic receptor blockade and volume expansion followed by beta blockade is mandatory to reduce intraoperative intravascular instability and blood pressure fluctuation due to tumor manipulation. Since genetic mutations have been reported in tumor susceptibility genes in nearly 50% of patients with PPGLs, genetic counselling and testing should be considered in all patients with a confirmed tumor.

Prevalence of Masked and White-Coat Hypertension in Pre-Hypertensive and Stage 1 Hypertensive patients with the use of TeleMRPA.

BackgroundThe diagnosis of arterial hypertension based on measurements of blood pressure in the office has low accuracy.ObjectiveTo evaluate the prevalence of masked hypertension (MH) and white-coat hypertension through home blood pressure monitoring (HBPM) in pre-hypertensive and stage 1 hypertensive patients.MethodRetrospective study, of which sample consisted of individuals with BP ≥ 120/80 mmHg and < 160/100 mmHg at the medical office without the use of antihypertensive medication and who underwent exams on the HBPM platform by telemedicine (TeleMRPA) between May 2017 and September 2018. The four-day MRPA protocol was used, with 24 measurements, using automated, validated, calibrated equipment with a memory function.ResultsThe sample consisted of 1,273 participants, of which 739 (58.1%) were women. The mean age was 52.4 ± 14.9 years, mean body mass index (BMI) 28.4 ± 5.1 kg/m2. The casual BP was higher than the HBPM in 7.6 mmHg for systolic blood pressure (SBP) and 5.2 mmHg for diastolic blood pressure (DBP), both with statistical significance (p < 0.001). There were 558 (43.8%) normotensive individuals; 291 (22.9%) with sustained hypertension; 145 (11.4%) with MH and 279 (21.9%) with white-coat hypertension (WCH), with a diagnostic error by casual BP in the total sample in 424 (33.3%) patients. In stage 1 hypertensive individuals, the prevalence of WCH was 48.9%; in prehypertensive patients, the prevalence of MH was 20.6%.ConclusionMH and WCH have a high prevalence rate in the adult population; however, in prehypertensive or stage 1 hypertensive patients, the prevalence is higher. Out-of-office BP measurements in these subgroups should be performed whenever possible to prevent misdiagnosis.

Pheochromocytoma

Objective: Pheochromocytomas are catecholamine-producing neuroendocrine tumors arising from chromaffin cells of the adrenal medulla or extra-adrenal paraganglia. There is no large-scale study in Taiwan at present. Our retrospective analysis was focused on clinical characteristics of Taiwanese patients with pheochromocytoma. Method: We retrospectively reviewed 48 patients who were pathologically proved as pheochromocytoma at the Kaohsiung Veterans General Hospital between Jan. 1990 and Jan. 2014. Parameters including patient and tumor characteristics, clinical presentation, treatment and long-term followup results were collected from the medical records. Metastasis was confirmed by pathologic proof using surgical removal or percutaneous biopsy. Result: Thirty-one patients (64.5%) had adrenal and 17 (35.4%) had extra-adrenal pheochromocytoma. The locations of extra-adrenal pheochromocytoma included the retroperitoneum in 6 patients (35%), head and neck in 4 (23%), scrotum in 2 (12%), urinary bladder in 2 patients (12%), multiple organs in 2 (12%), and mediastinum in 1 (6%). The most common symptom was sustained hypertension (52%). Five patients were diagnosed as malignant pheochromocytoma due to pathologically proved metastasis. Conclusion: Pheochromocytomas are rare neuro-endocrine tumors with a highly variable clinical presentation. Prompt surgical removal of pheochromocytoma ensures a better prognosis. Radical surgical removal of tumor with vigorous control of blood pressure is the mainstay to improve symptoms and survival for malignant pheochromocytoma. Multi-center and large-scale studies were warranted and Lifelong followup is strongly recommended for all patients with pheochromocytoma.

Successful Surgical Repair of Scimitar Syndrome in a 38-Year-Old Adult

Scimitar syndrome is an infrequent congenital malformation. It is a partial anomalous pulmonary venous drainage of the right lung into the inferior vena cava. Up to 25% of cases are associated with other heart diseases. The incidence in adults is reported to be 0.5-0.7%; classically, the adult form does not have pulmonary arterial hypertension, and may be unnoticed and asymptomatic for many years. It often presents after the second decade of life with nonspecific symptoms. Without surgical repair, clinical worsening, increased pulmonary pressure and sustained pulmonary arterial hypertension ultimately occur, when the syndrome is associated with other congenital heart diseases. We present the case of a 38-year-old woman diagnosed with scimitar syndrome associated with a large superior sinus venosus atrial septal defect, who underwent successful surgical repair using a lateral pericardial tunnel technique to redirect right pulmonary venous flow to the left atrium through a left atriotomy. This repair has shown good medium-term results. Possible complications such as tunnel thrombosis and stenosis will need to be explored in future assessments, and follow up must be lifelong.

Efficacy of trabeculectomy in acute angle-closure glaucoma patients with sustained intraocular hypertension

Objective To evaluate the efficacy of trabeculectomy in primary acute angle-closure glaucoma patients with sustained intraocular hypertension. Methods The data of 82 eyes of 79 patients of primary acute angle-closure glaucoma from Mar. 2016 to Oct. 2017 were analyzed retrospectively. The patients were divided into two groups: the observation group, 41 eyes of 40 patients, with IOP ≥40 mmHg and lasted for more than 3 days after conventional treatment and the control group, 41 eyes of 39 patients, with IOP<40 mmHg. The two groups were treated with trabeculectomy. The follow up time was 3 months. The surgical efficacy and postoperative complications were compared and analysed. Results The improved, unchanged and decreased rate of visual acuity in observation group at 3 months postoperatively were 78.05%, 17.07% and 4.88%, the difference were not statistically significant between the two groups (Z=1.620, P=0.110). The postoperative IOP of the two groups significantly decreased (P<0.05). The incidence of intraocular hypertension of observation group was higher significantly than control group at early stage after operation(χ2=4.100, P=0.042). The differences of IOP between the two groups was not statistically significant at 3 months postoperatively(t=1.309, P=0.194). Postopertive complication rate of observation group was 36.6%, and the control group was 7.3%.The difference between the two groups was statistically significant(χ2=10.250 P=0.001). Conclusion Trabeculectomy is safe and effective for primary acute angle-closure glaucoma patients with sustained intraocular hypertension, the complications should be treated actively. Key words: Glaucoma, angle-closure, acute, primary; Intraocular hypertension, sustained; Trabeculectomy

Low-dose combination therapy to control sustained ambulatory hypertension-Basic principles and future directions.

Low-dose combination therapy to control sustained ambulatory hypertension-Basic principles and future directions.

Prognostic role of masked and white-coat hypertension: 10-Year mortality in treated elderly hypertensives.

White-coat uncontrolled hypertension (WUCH) and masked uncontrolled hypertension (MUCH) are common in the elderly. The prognostic role of these hypertension phenotypes is not completely defined in this subpopulation. Our aim is to evaluate the long-term prognostic role of WUCH and MUCH in treated elderly hypertensives. Observational study conducted on 120 consecutive treated elderly hypertensives. Patients were assessed on a first clinical visit in 2006. Subsequently, such patients or their relatives have been recalled after 10 years to evaluate the survival rates. Main inclusion criteria at baseline: age ≥ 65 years, a previous diagnosis of essential hypertension, a valid 24-h ambulatory blood pressure monitoring (ABPM). All participants received anti-hypertensive drugs during the 10-year period and we considered 10-year mortality for the analysis. General characteristics at baseline: mean age was 71.2 ± 5.3 years; females were 53.3%; 15.1% of patients had sustained controlled hypertension (SCH), 35.8% had WUCH, 10.8% had MUCH and 38.3% had sustained uncontrolled hypertension (SUCH). Thirty-two patients (26.7%) died during the 10-year period. Deceased patients were older, had lower treatment intensity, HDLc levels and eGFR than survivors. After adjusting for these covariates, MUCH (HR 12.30, p < 0.001) and SUCH (HR 4.84, p = 0.007) were associated with higher risk of death, compared to SCH, while no relationship emerged with WUCH (HR 1.58, p = 0.455). In our real-life study on treated elderly hypertensives, MUCH was associated with higher risk of death, compared to SCH and SUCH, while WUCH was not. ABPM is a key tool to improve management and therefore prognosis in this subpopulation.

When Office Blood Pressure Is Not Enough: The Case of Masked Hypertension.

An increasing attention has been devoted in the last two decades to masked hypertension (MH), a condition characterized by the fact that classification of a normal blood pressure (BP) status by office measurements is not confirmed by home and/or ambulatory BP monitoring (ABPM). MH definition (i.e., normal office BP, but high out-of-office BP) should be restricted to untreated subjects (true MH) whereas masked uncontrolled hypertension (MUCH) reserved to treated patients previously classified as hypertensives, presenting normal office BP and high ABPM or home values. Both MH and MUCH are associated with metabolic alterations, comorbidities, and hypertension-mediated organ damage (HMOD). Furthermore, the risk of cardiovascular events related to these conditions has been shown to be close or greater than that of sustained hypertension. This review discusses available evidence about MH and MUCH by focusing on its prevalence, clinical correlates, association with HMOD, prognostic significance, and their therapeutic implications.

Hydralazine Versus Nifedipine For Acute Hypertensive Emergency In Pregnancy: A Randomized Controlled Trial

(Am J Obstet Gynecol. 2017;217:687.e1–687.e6) Hypertensive disorders of pregnancy can contribute to maternal and fetal mortality and morbidity. Timely antihypertensive therapy is recommended to lower severe hypertension in preeclamptic women during pregnancy. Intravenous hydralazine, intravenous labetalol, and oral nifedipine are commonly used to control the blood pressure (BP) in such women, but there is a paucity of evidence regarding the best option for the acute control of BP in the setting of severe sustained hypertension. This double-blind, randomized, controlled trial was conducted to determine the efficacy of 2 commonly used agents—intravenous hydralazine and oral nifedipine—for controlling acute severe hypertension in pregnant women with preeclampsia.

Clinical Implications

Clinical Implications

Correlation between the glucose level and the development of acute pancreatitis.

ObjectiveTo investigate the correlation between the level of glucose in serum and the development of acute pancreatitis (AP).MethodsData of 153 AP cases were collected, in which there were 130 patients with mild AP (MAP), 4 with moderate-severe AP (MSAP) and 19 with severe AP (SAP). At the time of admission, following indexes of patients were recorded: glucose, APACHE II score, TNF-α and C-reaction protein (CRP).ResultsAt the time of admission, the levels of glucose in serum and APACHE II scores in the MSAP and SAP groups were significantly higher than those in the MAP group, but after treatment, the level of glucose in serum was recovered in 95.8% of the patients in the MAP group, while this digit in the SAP group remained to be 68.4%; in the SAP group, the levels of TNF-α and CRP in patients with sustained hypertension were significantly higher than those with non-persistent hypertension; in terms of the length of stay in hospital, the SAP group was shorter than that in the non-treatment group, and the difference had statistical significance (p < 0.05). Moreover, we found that the level of glucose in serum was positively correlated with the APACHE II scores, TNF-α and CRP.ConclusionGlucose level in serum can be used as one of the indicators for evaluating the severity and development of AP in clinical practice.