ABSTRACT
Objective:To investigate the development of hypertension specialty and chronic disease management of county-level hospitals in China, for reference in improving the standardized chronic disease management level of hypertension in the counties.Methods:From September to November 2020, a questionnaire survey on 597 county-level hospitals in 24 provinces was conducted on a voluntary basis. The survey covered such areas as the setup of hypertension specialty, team building of professionals and the management regulations of chronic hypertension of the hospital. The survey data were analyzed by descriptive statistics.Results:Among the 597 county-level hospitals, 54(13.5%) hospitals had independent hypertension departments, 147(24.6%) had hypertension clinics, and 143(24.0%) hospitals had hypertension beds. 431(72.2%) hospitals had hypertension diagnosis and treatment process in outpatient clinics, 454(76.0%) hospitals had hypertension diagnosis and treatment process in wards, and 535(89.6%) hospitals had graded diagnosis and treatment process of hypertension. 473(79.2%) hospitals had established county medical alliance as the lead unit, including 167 compact medical alliances. 97.7% of the hospitals were equipped with basic hypertension risk stratification screening items, and 63.8% could carry out primary screening of secondary hypertension.Conclusions:The pattern of chronic diseases management of hypertension in county-level medical institutions has basically taken shape, but there is still room for improvement. In the future, we should focus on the construction of professional teams of hypertension, the standardized management of diagnosis and treatment of hypertension, and a smoother path of tiered medical service, so as to increase the health management level of hypertension in China.
ABSTRACT
Objective To survey the status of aspirin application asautiplatelet therapy for secondary prevention of coronary artery disease (CAD) in Beijing communities.Methods A cross-sectional survey on status of aspirin use was conducted among 60 communities in Beijing from September 2014 to January 2015.Items of survey included the duration of aspirin application,aspirin dosage,application time,reasons for interruption and reasons for non-application.Results Total 61 000 questionnaires were delivered and 56 969 valid ones were retrieved with a recovery of 93.39％.The aspirin application rate was 78.22％ (15 105/19 311)among patients with diagnosed CAD,while that was 81.42％ (1 319/1 620) among patients with self-reported CAD (x2=9.06,P＜0.01).There was no effect of early cardiovascular disease family history on aspirin application among patients with diagnosed CAD (P =0.77).Among the patients with diagnosed CAD,the reasons of no aspirin application were:rejection with unknown reasons,worry about stomach side effects,clopidogrel application,not suitable subjectsand other antiplatelet drugs application.Conclusions The proportion of aspirin application is relatively high among coronary artery disease patients in Beijing communities.The results of survey provide the direction of patient education in the future.
ABSTRACT
Objective: To analyze plasma levels of catestatin (CST) in patients with different blood pressure (BP) and metabolic status. Methods: Our research included in 3 groups: Control group,n=60 subjects with normal BP from physical examination in our hospital; 131 patients with essential hypertension (EH) were divided into 2 groups: Isolated EH group,n=90 and MS (metabolic syndrome) group,n=41. Plasma levels of CST, norepinephrine (NE) were examined, the ratio of CST/NE was calculated, and those indexes were compared among different groups. Results: Compared with Control group, plasma levels of CST and the ratios of CST/NE were decreased in Isolated EH and MS groups,P Conclusion: Plasma levels of CST and the ratio of CST/NE were obviously decreased in EH patients, CST was even lower in MS patients which implied that CST might be involved in the development of EH and MS.
ABSTRACT
Objective To evaluate the efficacy of Nebivolol on patients with mild or moderate essential hypertension(EH) using different methods of ambulatory blood pressure monitoring.Methods Forty-seven patients with mild or moderate EH were enrolled as our subjects after a 2-week administration of placebo.They were administrated Nebivolol (5 mg) once daily for 12 weeks.All the patients completed ambulatory blood pressure monitoring before and after taking Nebivolol for 12 weeks.The overall and individual methods were used to calculate the trough-to-peak ratio (T/P ratio) and smooth index (SI).Results (1) For all of 42 patients treated with Nebivolol (5 mg) for 12 weeks,the systolic blood pressure(SBP),diastolic blood pressure(DBP) of the whole-day,daytime and nighttime after treatment were decreased compared to before treatment (the whole day:(144.1 ± 9.8),(124.4 ± 10.4) mmHg vs.(93.2 ± 6.3),(79.2 ± 7.2) mmHg;daytime:(148.9 ± 9.7),(128.3 ± 10.5) mmHg vs.(96.8 ±6.1),(82.2 ±7.5) mmHg;nighttime:(133.9 ± 11.9),(115.9 ± 12.0) mmHg vs.(85.7 ± 8.0),(72.5 ± 7.5) mmHg),and there was significant difference (t =8.06,8.74,8.00,8.82,5.75,and 6.57 respectively; P ＜ 0.01).T/P ratios of SBP/DBP calculated by overall method were 78.4％ (17.4/22.2) and 61.2％ (9.0/14.7),but it were (79.3 ±0.4) ％ and (58.5 ±0.5) ％ by individual calculation method.(2) Among 30 patients with better effect,the SBP,DBP of the whole-day,daytime and nighttime after treatment were decreased compared to before treatment (the whole day:(143.4 ± 9.1),(127.5 ±10.7) mmHgvs.(92.6 ±6.2),(81.6±7.6) mmHg;daytime:(147.8 ±9.1),(131.0 ±10.5)mmHg vs.(95.8 ± 6.4),(84.1 ± 7.5) mmHg; nighttime:(134.7 ± 11.6),(119.6 ± 13.2) mmHg vs.(86.2 ± 7.4),(75.2 ± 8.5) mmHg),and there was significant difference(t =11.18,12.77,11.14,12.85,7.37,and 8.74 respectively,P ＜0.01).T/P ratios of SBP/DBP were 78.9％ (18.3/23.2),75.3％ (11.6/15.4) and SIof SBP/DBP were 7.4(19.5/2.6),7.1 (14.2/2.0) calculated by overall method,but T/P ratios of SBP/DBPwere (78.4 ± 0.4) ％,(74.6 ± 0.4) ％ and SI were (1.35 ± 0.73),(1.34 ± 0.54) calculated by individualmethod.Conclusion Nebivolol (5 mg once daily) can significantly reduce ambulatory blood pressure.Overall calculation method is better than individual method in terms of assessing the time of durative action and smooth effect by trough peak ratio and smooth index.
ABSTRACT
Objective To investigate blood pressure control the glucose metabolism,cardiovascular risk factors of patients who were regularly followed up at professional hypertension clinics in China.Methods A cross-sectional survey was conducted in 32 004 patients from 127 professional hypertension clinics across China.The questionnaires included case history and related treatment physical examination and laboratory biochemical tests were also taken at the same time.Results The mean blood pressure of overall population was (151 ± 13)/(92 ± 10) mm Hg(1 mm Hg =0.133 kPa).Totally 3424 patients (10.7％) had never taken any anti-hypertension medicine.Among patients treated with anti-hypertension drugs,19 818 were of mono-therapy (69.3％) and 8762 were of combination therapy.The most frequently used drug was reninangiotensin system inhibitor,followed by calcium-channel blocker.Fixed compound preparations accounted for 15.6％.The overall blood pressure control rate (＜ 140/90 mm Hg) was 26.8％,among them,27.7％,30.0％,25.4％ and 21.3％ patients were complicated with coronary heart disease,diabetes mellitus,kidney diseases and cerebral stroke respectively.About 70.3％ hypertensive patients had abnormal glucose metabolism whose mean glycosylated hemoglobin (GHbA1 c) was 7.84％,which was significantly higher than 7.0％,the target value defined by ADA.Even among them,20.2％ patients have never received any anti-diabetic drugs.Low-risk and medium-risk patients accounted for 16.0％.Totally 48.0％ patients were classified in high-risk group and 36.0％ in very high risk group.About half of all patients had different target organ dysfunction.About 49.0％ patients had associated comorbidities.Conclusions Co-existence of hypertension and abnormal glucose metabolism is common in Chinese population.Among these patients,target organ dysfunction and comorbidities are prevalent,but blood pressure is only effectively controlled in less than 30％ patients.Low proportion of combination therapy is one of the reasons for unsatisfied control of blood pressure.It indicates that effective management of hypertension is urgent.
ABSTRACT
Objective To investigate the association between albuminuria incidence and blood pressure (BP) level or body weight index (BMI) in patients with essential hypertension from five regions in China. Methods A total of 5021 non-diabetic patients with clearly diagnosed essential hypertension were enrolled in our study. The participants came from five cities in China.Urinary albumin/creatinine ratio was measured in these patients for two times. The associations of albuminuria with BP level and BMI were analyzed. Results (1)There was no significant difference of albuminuria incidence between ＜60-year-old and ≥60-year-old patients. The longer the hypertension exited, the higher the albuminuria incidence was. (2) The albuminuria incidence was associated with blood pressure level significantly. The urinary protein excretion increased with the level of blood pressure. The albuminuria incidences in patients with normal BP, upper range of normal BP, Ⅰ , Ⅱ or Ⅲ stage hypertension were 26.3%, 27.3%, 28.7%, 31.5% and 40.3% respectively. (3) The albuminuria incidence was significantly different in patients with uncontrolled BP (≥ 140/90 mm Hg) compared with those with well controlled BP (＜ 140/90 mm Hg) (27.1% vs 30.2%, P＜0.05 ). (4) The albuminuria incidence was higher in obese patients compared with those with normal BMI at same BP level, but the difference was not statistically significant. (5) Patients with albuminuria had more cardiocerebral or renal events as compared to those without proteinuria. Conclusions The albuminuria incidence of non-diabetic hypertensive patients from 5 cities in China is 28.8%, of which the microalbuminuria incidence is 18.6% and the clinical albuminuria incidence is 10.2%. Uncontrolled BP is an important risk factor of proteinuria.
ABSTRACT
In this study, the effects of blood glucose and blood pressure on the compliance of large and small arteries were investigated. The results showed that arterial compliances of both large and small arteries were decreased in patients with diabetes mellitus. In non-diabetic patients with well controlled blood pressure, the compliance of small arteries was markedly improved. These results suggested that both blood glucose and blood pressure affected arterial compliance.
ABSTRACT
Objective To investigate the relationship between serum of type Ⅲ collagen and arterial compliance in hypertensive patients.Methods One hundred fifty-eight in-patients of hypertension were enrolled.All subjects underwent laboratory measurements including serum PⅢNP,blood-lipid,glucose and high sensitivity C-reactive protein.Carotid to femoral pulse wave velocity(PWVcf),C1 and C2 were measured by a Complior Colson device and DO-2020.Results(1)PWVcf positively correlated with serum PⅢNP(P
ABSTRACT
Objectives To compare the effects of losartan and atenolol on fibrinolytic system and plasma von willebrand factor (vWF) in patients with essential hypertension. Methods Sixty patients with mild to moderate essential hypertension were randomized to receive lostartan(50 mg/d, n=30) or atenolol(50 mg/d, n=30) for 8 weeks. If the goal blood pressure(
ABSTRACT
Objective To study the regulation of VSMC proliferation by NO/PKG via modulating intracellular Ca~(2+)/calcineurin(CaN) signaling pathway.Methods Primary VSMCs from rat aorta were used as the experimental model.CaN protein and its activity were assayed using immunoblotting and free inorganic phosphate content analysis respectively.Growth and viability of cells were determined by MTT assay and acridine orange and ethidium bromide staining.Results The addition of SNAP and Sp-8-pCPT-cGMPS decrease absorbance of cells stimulated by phenylephrine(PE),whereas the addition of Rp-8-pCPT-cGMPS increases it.In SMCs p retreated with Ver,absorbance of cells stimulated by PE decreased and was further inhibited by the additional treatment of SNAP and Sp-8-pCPT-cGMPS.In SMCs pretreated with CsA,absorbance of cells stimulated by PE decrease,but it can not be further altered by the additional treatment of SNAP,Sp-8-pCPT-cGMPS and Rp-8-pCPT-cGMPS.Moreover,expression and activities of CaN induced by PE is inhibited by SNAP and Sp-8-pCPT-cGMPS.Conclusion NO/PKG inhibits the proliferation of vascular SMCs without decreasing cell survival rate,which is mediated via intracellular Ca~(2+)/CaN signaling pathway.
ABSTRACT
Objective To investigate the changes in plasma levels of angiotensin Ⅱ, endothelin-1 and blood pressure fluctuation during light-dark alterative period in sinoaortic denervated (SAD) rats. Methods Seventy-two male Sprague-Dawley rats underwent SAD or sham operation at the age of 12 weeks. Twenty-four-hour blood pressure and blood pressure variability (BPV) were measured in conscious, unrestrained rats 4 weeks after operation. Rats were housed in a 12 h light/12 h dark cycle (LD 12:12) for at least 10 days, then the blood samples were taken every 4 h. The plasma levels of angiotensin Ⅱ and endothelin-1 were assayed by radioimmunoassay (RIA). Results No significant difference in SBP or DBP between SAD and sham-operated rats was found. Compared with sham-operated rats, SAD rats had greater SBPV and DBPV over 24 hours (SBPV: 13.8?4.2 vs control: 6.4?1.1, DBPV:11.5?3.1 vs control: 5.3?0.8 mm Hg, all P
ABSTRACT
Objective Calcineurin-NFAT pathway in the regulation of VSMCs proliferation induced by catecholamines.Methods Primary VSMCs from rat aorta were used as the experimental model.Proliferation of VSMCs was measured by MTT assay and cell count.Calcineurin protein and its activity were assayed with immunoblotting and free inorganic phosphate content analysis respectively.Localization of NFATc1 was detected by immunofluorescence staining.Results Phenylephrine(PE,an ?1-adrenoceptor agonist) increased VSMCs proliferation.Prazosin(an ?1-adrenoceptor antagonist),cyclosporin A(CsA,an inhibitor of calcineurin) and chelerythrine(an inhibitor of PKC) decreased PE-induced absorbance and cell number.Timolol(?-adrenoceptor antagonist) has no effect on absorbance and cell number induced by PE.Additional treatment with CsA further inhibited PE-induced absorbance and cell number compared with the chelerythrine pretreatment group.CsA and chelerythrine alone had no significant effect on either absorbance or cell number.CsA decresed PE-induced alcineurin level and its activity.NFATc1 was translocated from cytoplasm to nucleus upon treatment with PE.This translocation was reversed by CsA.Conclusion CsA partially inhibits PE-induced VSMCs proliferation via inhibiting calcineurin activity and NFATc1 nuclear translocation.Calcineurin-NFATc1 pathway is involved in hyperplastic growth of VSMCs induced by catecholamines.
ABSTRACT
Objective To investigate the vascular compliance markers (C1 and C2) and pulse wave velocity in relative with other physiological indexes in a cohort of young normotensive people in Beijing. Methods Two hundred and seventy normotensive volunteers (112 men and 158 women aged 16 to 30 years) were invovled,completed questionnaires of demographic information. Large (C1) and small (C2) arterial compliance were derived from arterial pulse wave contour analysis. Pulse wave velocity(carotid-femoral PWV and carotid-radial PWV)was determined by Complior SP. Results In both male and female C1 correlated positively with height and weight,and negatively with systolic(SBP),mean arterial blood pressure(MAP),pulse pressure(PP),and heart rate(HR),in which PP showed the best correlation with C1;C2 was inversely related with SBP,diastolic blood pressure(DBP),MAP and HR,in which SBP showed the best correlation with C2;cfPWV correlated positively with DBP and age,crPWV correlated positively with age,DBP,height and weight. Conclusion Blood pressure,heart rate were the important influential factors of large and small arterial compliance in both males and females,while diastolic blood pressure was determinant for pulse wave velocity.
ABSTRACT
Objective To evaluate the effects of Xin-ke-shu and Betaloc on arterial elasticity of coronary heart disease(CHD).Methods According to the results from coronary angiography,50 patients who were taking long-term treatment of coronary artery obstructions were enrolled and divided into two groups in equal number at random.They were divided into Xin-ke-shu group(n=25)and Betaloc group(n=25).The Xin-ke-shu group received Xin-ke-shu(12/d)individually and the Betaloc group received Betaloc(50mg/d)for eight weeks.Patient's heart rate was measured by the doctor.Brachial blood pressure was measured by standardized mercury cuff sphygmomanometer.Automatic pulse wave velocity(PWV)measurement system and Complior Colson device and DO-2020 were applied to examine the carotid-radial artery PWV(PWVcr)and the large arterial elastic indexes(C1 and C2)respectively.Results After eight weeks of treatment.All patient's heart rate showed significant decrease.The Betaloc group,after excluded the betaloc effect,showed significant decrease of blood pressure.The Xin-ke-shu group showed significant increase of C1 and C2,and PWVcr slowed down obviously.Conclusion Xin-ke-shu improves the small and large arterial elasticity,and attenuates the wave reflex amplitude.
ABSTRACT
Objective To test the hypothese that metabolic syndrome is closely associated with inflammation, we compare the difference of inflammatory factors and von Willebrand factor between essential hypertensives and hypertensive patients with metabolic syndrome. Methods According to the new definition of metabolic syndrome by IDF 2005, one hundred thirty eight consecutive hospitalized essential hypertensives were catelogorized into EH+MS group, n=99 and EH alone group, n=39. Biochemistry assay, white blood cell (WBC) counts, serum high sensitive C reactive protein (hsCRP) and plasma von Willebrand factor (vWF) were measured. The relationship between hsCRP, vWF and MS were analysed. Results Waist circumference, body mass index, triglyceride, low density lipoprotein cholesterol (LDL-C), WBC, serum hsCRP and plasma vWF were increased(P
ABSTRACT
Objective: To dicuss the regulation of expression of cGMP-dependent protein kinase I_? (PKG I_?) by calcineurin (CaN) in vascular smooth musle cells (VSMCs) proliferation. Methods: Cultured wistar rat aortic VSMCs were used as an experimental model. CaN was inhibited by its special inhibitor cyclosporin A (CsA). Phenylephrine (PE) was given to stimulate VSMCs to proliferate. All of cultured cells were divided into four groups:control group, 0.5 mg/L CsA group, 5 mg/L CsA group and 5 mg/L CsA+10 ?mol/L PE group. The mRNA and protein expressions were assayed by RT-PCR, immunocytochemistry and Western blot analysis. Results: The OD ratio of PKG I_? mRNA expression in 0.5 mg/L CsA group resembled that in the control group while that in 5 mg/L CsA group was significantly higher than that in the control group (P
ABSTRACT
Objective:To study the relationship between G protein ? 3 subunit ( GNB3 )C825T variant and plasma renin angiotensin system(RAS) activity in Chinese essential hypertensive patients. Methods: Case control method was used. For 408 essential hypertensive patients who were enrolled in the trial groups, we chose 140 normotensives as control group 1 and 61 health persons with hypertensive familial history as control group 2, respectively. PCR-RFLP method was used to measure the C/T polymorphism. The results were observed by agarose gel eletrophoresis. Results: The frequencies of 825T allele were 45.6% to 56.4% in the three groups. Neither GNB3 genotype distribution nor the frequency of T allele was associated with essential hypertension. But patients with TT genotype had higher aldosterone level and lower angiotensin converting enzyme (ACE) activity than patients with CC genotype. Conclusion:In Chinese, patients with TT genotype had higher aldosterone level and lower angiotensin converting enzyme (ACE) activity.
ABSTRACT
0.05). And HRV indexes of low-frequency(LF), high-frequency (HF) and total power (TP) were increased obviously, while the low-to high-frequency ratio (LF/HF), very-low-frequency (VLF) were remarkably lower(P
ABSTRACT
Objective:To compare the difference of microalbuminuria (MAU) and von Willebrand factor (vWF) between essential hypertensives and hypertensive patients with metabolic syndrome (MS), and to explore the association of these factors with MS. Methods: According to the new definition of MS by International Diabetes Federation (IDF) for 2005, 133 consecutive essential hypertensives were divi-ded into two groups: hypertensive patients with metabolic syndrome (EH-MS group, n=97), and essential hypertensives (EH group, n=36). Biochemistry assay, plasma vWF, 24 hours urine albumin excretion (UAE) and morning urine albumin/creatinine ratio (ACR) were measured. The association of MAU and vWF with MS was analysed. Results: Waist circumference, body mass index, triglyceride (TG), low density lipoprotein cholesterol (LDL-C), plasma vWF and UAE were increased(P0.05, respectively). Logistic regression showed HDL-C, TG, LDL-C,vWF and UAE were associated with the deve-lopment of MS in hypertensive patients (standardized coefficients: -0.825, 0.63, 0.339, 0.331, 0.371,P
ABSTRACT
<p><b>OBJECTIVE</b>To determine the association of cigarette smoking and coronary artery diseases (CAD).</p><p><b>METHODS</b>A case-control study involving 355 people classified as CAD or without CAD was performed. But people treated with diuretic, aspirin, lipid-lowering agents, heparin or those with renal, hepatic diseases were excluded. Gender, age, body mass index, plasma glucose under fasting, total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, fibrinogen, cigarette smoking consumption grade (0: no smoking, 1: less or equal 100 cigarette year, 2: one hundred cigarette year < cigarette index </=200 cigarettes year, 3: greater than 200 cigarette year), CAD family history, essential hypertension and CAD severity were analyzed.</p><p><b>RESULTS</b>In multiple logistic regression, age, gender, fasting plasma glucose, fibrinogen and cigarette smoking showed significant independent association with CAD. Compared with non-smoker, the odds ratio (OR) of CAD of grade 3-cigarette smoking was 3.519 (95% CI: 1.538 - 8.053, P = 0.003). However with grade 1 cigarette smoking group, no significant independent association was found with CAD (OR = 0.948, P = 0.959). With more than grade 2 [grade 2 + 3, compared with less than grade 2 (0 + 1)] and grade 3 [compared with less than grade 3 (0 + 1 + 2)] cigarette smoking, ORs of CAD were 2.094 (P = 0.027), 3.463 (P = 0.002) respectively. Three hundred fifty-five people were divided into 3 groups: control, stable angina (SA) and unstable angina (UA) groups. In multinomial logistic regression, when comparing with UA, parameter estimate of cigarette smoking degree in the SA group were beta = -0.220, s(x) = 0.138, P = 0.112, OR = 0.803 respectively.</p><p><b>CONCLUSIONS</b>Cigarette smoking was a significant independent risk factor for CAD. With more cigarettes smoked, a higher odds ratio of CAD was seen. Gender, age, fibrinogen and plasma glucose during fasting were also independent factors significantly associated with CAD. No significant independent association between cigarette smoking and unstable angina was found.</p>