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Objective To explore the correlation of serum homocysteine(Hcy)levels and hypertrophy of left ventricle in very elderly hypertensive patients.Methods According to plasma Hcy levels,patients with essential hypertension (n=378) were divided into non H-type hypertension group (n=142) and H-type hypertension group (n=236). Height, weight, reg?ular medication, blood pressure, renal function, blood lipid profile and the concentration of plasma Hcy were recorded. Color Doppler ultrasonic equipment was used to determine the morphology and structure of left ventricle. The correlation between plasma Hcy and left ventricle remodeling was analyzed. Results The ratio of left ventricular hypertrophy was higher in H-type hypertension group than that in non H-type hypertension group(45.8%vs 24.6%,χ2=16.81,P<0.001). Patients in H-type hypertension group had higher systolic blood pressure, higher plasma level of Hcy and larger left ventricular posterior wall thickness(LVPWT), larger interventricular septal thickness (IVST) and increased left ventricular mass index (LVMI) compared to those in non H-type hypertension group(162.20 ± 14.97)vs(149.70 ± 5.06)mmHg,(19.76 ± 5.83)μmol/L vs (9.53±0.72)μmol/L,(9.77±2.35)vs(9.21±2.68)mm,(9.74±3.15)vs(8.51±2.42)mm,(118.64±39.38)vs(101.85±41.71)g/m2 respectively, all P<0.05). There was a positive correlation between LVMI and Hcy(r=0.381,P<0.001). Multivariable Lo?gistic regression analysis showed that hyperhomocysteinemia was an independent risk factor of LVMI. Conclusion High plasma Hcy level is an independent risk factor of LVMI, which works together with hypertension to promote left ventricular re?molding.
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Objective To explore the relationship between blood lipids level with creatinine clearance rate(Ccr)in patients with heart failure(HF). Methods A total of 955 patients who were diagnosed with heart failure(cardiac function NYHAⅡ~Ⅳclassification)upon discharge from the Department of Cardiology of the Second Hospital of Tianjin Medical University, between January 2010 to June 2013 were enrolled as HF group. Healthy adults (n=200) with normal cardiac function which approximately matched basic condition with HF group were selected as control group. The HF group was fur?ther divided intoⅡ,Ⅲ,Ⅳclassification according to their cardiac function(NYHA classification). HF group was also divid?ed into normal renal function group, mild renal injury group and moderate-severe renal injury group based on their Ccr. Ef?fect of gender and lipid parameters were also compared. Binary logistic regression was used to analyze factors influencing renal function in patients with HF. Results Compared with people in the control group, the levels of triacylglycerol(TG), total cholesterol(TC), low density lipoprotein cholesterol(LDL-c)and non high density lipoprotein cholesterol(non-HDL-c)in patients of HF group were increased while Ccr and high density lipoprotein cholesterol(HDL-c)were decreased. Ccr and lipids were obviously decreased in patients with HF of Ⅳclassification. TG and HDL-c were decreased in moderate-severe renal injury group. Females had a higher lipid levels than males in HF group(P<0.05 or P<0.01). Advanced age, coronary heart disease and hypertension were all risk factors for renal impairment in patients with HF by binary logistic re?gression. On the other hand, weight gain and HDL-c were the protection factors for renal function in HF patients. Conclu?sion Dyslipidemias may lead to renal insufficiency in patients with HF. It was important to control lipids and improve re?nal function in patients with HF.
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Objective To investigate the pattern of antihypertensive medication prescribing in outpatients from the Second Hospital of Tianjin Medical University, and analyze the shortcoming and deficiency compared with 2010 Chinese guidelines for the management of hypertension. Methods A total of 154 262 electronic prescribing for outpatients with hy-pertension, from January-December 2012 in a Grade 3A hospital in Tianjin, were enrolled in this retrospective survey. Data of commonly used antihypertensive medication and combination therapy in patients were analyzed. The patient data collected were divided into different groups according to age, gender, high blood pressure level and the onset of the season. Results (1)The list of the drugs commonly used for treating hypertension in outpatients were calcium antagonist (52.3%), angiotensin receptor blockers (34.0%),βblockers (25.9%), angiotensin-converting enzyme inhibitors (12.1%), fixed-dose combination (11.0%) and diuretics (1.4%).(2)The fewer combination therapy was found in outpatients than that of monotherapy (43.9%vs 56.1%). Some prescriptions were not routinely recommended by the Guideline (4.6%).(3)The combination therapy used in patients with stage 3 hypertension was higher than that of patients with stage 1or stage 2 hypertension (44.5%vs 37.7%vs 37.7%, P<0.01). The rate of combination therapy was significantly higher in cardiology department than that of other clini-cal departments (P<0.01). The combination therapy tended to be used in the elderly patients than that of non-elderly pa-tients (P<0.01). The number of prescriptions was lower in summer than that of other seasons,but the rate of combination therapy was higher in summer than that of spring, autumn and winter (P<0.01). Conclusion The prescriptions of combina-tion therapy and diuretic were inadequate in outpatients with hypertension. These findings indicate the difference between clinical prescription and the guideline for the management of hypertension.
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Objective To investigate the correlative factors affecting the plasma D-dimer level in elderly patients. Methods Five hundred and seventy-eight hospitalized elderly patients were included in this study. All participants were di-vided into normal group (＜0.4 mg/L) and elevated group (≥0.4 mg/L) according to the plasma D-dimer value,which was mea-sured by automated quantitative turbidimetric latex agglutination test. The differences in clinical indicators were compared be-tween two groups. The factors leading to the increased plasma levels of D-dimer in elderly patients were also analyzed. Results It was found that the patient age, C-reactive protein, prothrombin time, proportions of type 2 diabetes mellitus, ma-lignant tumor, bacterial pneumonia and (or) acute exacerbation of chronic bronchitis were significant higher in elevated group than those of normal group (P＜0.05), but the levels of total cholesterol and low density lipoprotein cholesterol were lower in elevated group than those of normal group (P＜0.05). There was a positive correlation between serum level of D-dimer and age, C-reactive protein (r=0.254 and 0.265, P ＜ 0.05). Binary logistic regression analysis showed that the factors affecting plasma D-dimer level of elderly patients were aging, elevated C-reactive protein level, existing of malignant tumor, type 2 dia-betes mellitus, and bacterial pneumonia and (or) acute exacerbation of chronic bronchitis. Conclusion Aging, existing of type 2 diabetes mellitus, malignant tumor, or acute inflammatory state were the important factors leading elevated plasma D-dimer levels in elderly patients.