Evaluation and treatment of refractory hypertension / 中国实用内科杂志

Resistant hypertension(RH) is a type of hypertension that causes progression of cardiovascular and cerebrovascular diseases. Clear diagnosis and effective treatment are essential. The article provides a detailed summary of the definition, etiology, diagnosis and treatment of RH. The treatment of RH should emphasize individualization, and it is necessary to carefully discern the cause and distinguish from secondary hypertension. Ambulatory blood pressure monitoring and home blood pressure measurement are important diagnostic tools. A combination of multiple drugs(including diuretics) that are reasonable, optimal, and of tolerable doses is the key to controlling blood pressure.

Analysis of Inflammatory Factors and Related Factors in Population With Overweight Combining Abdominal Obesity and High-normal Blood Pressure / 中国循环杂志

Objective: To explore the changes of inflammatory factors and related factors in the population with overweight combining abdominal obesity and high-normal blood pressure (BP). Method: Our research included in 2 groups: Group A: n=189 subjects with high-normal BP, overweight and abdominal obesity, their BMI ≥ 24 kg/m2, waist circumference (WC) ≥ 90 cm in male, WC ≥ 85 cm in female, SBP(120-139) mmHg or DBP (80-89) mmHg; Group B, n=87 healthy subjects with matched age, BMI < 24 kg/m2, BP < 120/80 mmHg as normal control. Blood lipids and other biochemical parameters were examined; serum levels of intercellular adhesion molecule-1 (ICMA1), monocyte chemoattractant protein-1 (MCP1), chemokines-1 (CXCL-1), CXCL-2 and oxidized low density lipoprotein (oxLDL) were measured by ELISA. Results: Compared with Group B, Group A had increased TG, fasting blood glucose and non-HDL-C, all P<0.05; elevated serum levels of ICMA1 and MCP1, both P<0.05. Correlation analysis indicated that in Group A, ICMA1 was positively related to BMI, SBP, LDL-C and negatively related to age, which had gender difference; MCP1 was positively related to WC, SBP, LDL-C, non-HDL-C and negatively related to HDL-C, which also had gender difference; oxLDL was positively related to SBP, LDL-C; no evidence showed that CXCL-1 and CXCL-2 were related to obesity, BP and metabolic parameters; in Group B, no evidence showed that inflammatory factors were related to the other parameters. Linear regression analysis for inflammatory parameters found that after excluding other factors, in Group A, ICMA1 was positively related to BMI (t=2.901, P=0.005); in male gender, MCP1 was positively related to SBP (t=5.076, P=0.000), negatively related to DBP (t=-3.369, P=0.001). oxLDL was positively related to age (t=2.168, P=0.032) and LDL-C (t=2.146, P=0.034); CXCL-1 was negatively related to HDL-C (t=-2.013, P=0.047). Conclusion: The subjects with overweight abdominal obesity and high-normal BP were usually having abnormal metabolism of glucose and lipids, elevated serum levels of inflammatory parameters, blood levels of inflammatory factors were increasing with elevated BMI and SBP accordingly which implied the association with critical range of BP.

Effect of aliskiren on arterial stiffness, compared with ramipril in patients with mild to moderate essential hypertension / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Aliskiren is a novel blood pressure-lowering agent acting as an oral direct renin inhibitor. The aim of this study was to assess the effect of aliskiren on arterial stiffness, compared with that of ramipril in mild to moderate essential hypertensive patients.</p><p><b>METHODS</b>Following a two week placebo run-in period, patients with a mean sitting diastolic blood pressure (ms-DBP) ≥ 95 and < 110 mmHg (1 mmHg = 0.133 kPa), and a mean sitting systolic blood pressure (ms-SBP) < 180 mmHg were randomly allocated to treatment with aliskiren (150 mg/d, n = 20) or ramipril (5 mg/d, n = 20) for eight weeks. Blood pressure, plasma renin activity, and the brachial-ankle pulse wave velocity (ba-PWV) were measured before and after eight weeks of treatment.</p><p><b>RESULTS</b>Eight weeks of treatment significantly decreased systolic blood pressure and diastolic blood pressure in both the aliskiren group and ramipril group. The hypotensive effect did not differ between the two groups. Plasma renin activity decreased after aliskiren treatment and increased after ramipril treatment. There was no significant difference in baseline ba-PWV between the aliskiren and ramipril groups (P = 0.892). The ba-PWV was significantly reduced in both the aliskiren group (1535 (1405 - 1666) vs. 1464 (1360 - 1506) cm/s) (P < 0.01) and the ramipril group (1544 (1433 - 1673) vs. 1447 (1327 - 1549) cm/s) (P < 0.01). No statistically significant difference was found in the decline of ba-PWV between the two groups (P = 0.766).</p><p><b>CONCLUSIONS</b>The current study revealed that aliskiren (150 mg/d) could ameliorate arterial stiffness and its effect was similar to ramipril (5 mg/d) in mild to moderate hypertensive patients, indicating that in addition to lowering blood pressure, aliskiren had beneficial effect on vascular protection.</p>

Status of glucose metabolism in Chinese essential hypertensive patients / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate glucose metabolism status and its relationship with blood pressure, obesity, renal function and cardio-cerebral vascular events in Chinese essential hypertensive patients.</p><p><b>METHODS</b>Essential hypertensive patients without diabetic history were enrolled in this cross-sectional survey. All patients filled in questionnaires and received physical examination and laboratory tests. Oral glucose tolerance test (OGTT, fasting and 2 hours glucose level after drinking the 75 g glucose solution) was performed in patients who signed the informed consent.</p><p><b>RESULTS</b>(1) The control rate of systolic BP was lower in patients with dysglycemia than in patients without dysglycemia (41.0% vs. 46.4%, P = 0.000). (2) The albuminuria detection rate and the abnormal rate of estimated glumerular filtration rate (eGFR) increased significantly with the deterioration of glucose metabolism. (3) Multifactor-analysis showed that abnormal waist circumference, decreased eGFR and presence of albuminuria were independent risk factors for abnormal glucose metabolism. Cardiovascular events was significantly higher in patients with abnormal glucose metabolism than patients with normal glucose metabolism.</p><p><b>CONCLUSION</b>Abnormal glucose metabolism is common in Chinese essential hypertensive patients. When complicated with abnormal glucose metabolism, essential hypertensive patients had poor blood pressure control rate and were related to higher cardiovascular risk.</p>

Catestatin could ameliorate proliferating changes of target organs in spontaneously hypertensive rats / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Catestatin, a chromogranin A-derived peptide, is a potent antagonist of nicotine-evoked catecholamine release. We know that catecholamine plays an important role in cardiovascular remodeling induced by hypertension, therefore we hypothesized that catestatin would affect target-organ structure during hypertension.</p><p><b>METHODS</b>Twelve spontaneously hypertensive rats (SHRs) were randomized to SHR control group and catestatin group, the normal control group was comprised of six healthy Wistar-Kyoto rats of the same age. Tail-cuff blood pressure and pulse rate were obtained at weeks 1, 4 and 8. At the end of the eight-week period, the heart, abdominal aorta and left kidney were excised and weighed, VG staining was done and the intima-media thickness of vessels and the collagen volume fraction were assessed by an image acquisition and analysis system. The proliferating cell nuclear antigen (PCNA) was observed by immunohistochemistry, and real time reverse transcription-polymerase chain reaction (RT-PCR) was used to detect the mRNA levels of proliferative genes including cyclin A, ki67 and PCNA in the abdominal aorta.</p><p><b>RESULTS</b>All the parameters in SHR observed in the present study increased significantly compared to Wistar Kyoto rats (P < 0.01). With intervention with catestatin, the systolic blood pressure decreased slightly but it was not significantly different from the SHR control, the cardiac mass index and left ventricular mass index both decreased significant ly, the collagen volume fraction decreased by nearly 30% in the heart, by 25% in vessels and by 10% in the kidney, and the intima-media thickness and expression of proliferative genes, including cyclin A, ki67 and PCNA, in the abdominal aorta also decreased significant ly.</p><p><b>CONCLUSIONS</b>The present study indicated that catestatin could ameliorate proliferating changes of heart, kidney and vessels during hypertension, especially to the deposition of interstitial collagen. Blood pressure was not the main factor to mediate this effect, which suggested that catestatin could become a novel protective factor for hypertensive target organs.</p>

Erythrocytic or serum hydrogen sulfide association with hypertension development in untreated essential hypertension / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Endogenous hydrogen sulfide (H(2)S) plays an important role in hypertension. The aim of this study was to investigate the role of erythrocyte and serum H(2)S in patients with untreated essential hypertension.</p><p><b>METHODS</b>We recruited 62 patients (age 22 - 74 years) with untreated prehypertension or hypertension, and 64 normotensive subjects (age 18 - 64 years). We assessed the 3-mercaptopyruvate sulphurtransferase (MPST) protein expression in erythrocytes and measured the H(2)S production from erythrocytes and serum H(2)S levels, then analyzed the association of erythrocytic or serum H(2)S content and blood pressure or cardiovascular risk factors (e.g., age, body mass index (BMI) and dyslipidemia). A stepwise regression analysis was used to evaluate the possible relationship of erythrocytic H(2)S in hypertension.</p><p><b>RESULTS</b>In hypertensive patients, erythrocyte H(2)S production ((111.04 ± 29.20) nmol/min per 10(8) erythrocytes) was higher than that in controls ((78.85 ± 19.38) nmol/min per 10(8) erythrocytes), and serum H(2)S was also higher. The erythrocytic H(2)S production was associated with increased systolic blood pressure (sBP), diastolic blood pressure (dBP), age, BMI, level of C-reactive protein (CRP), as well as triglycerides (TG) and high density lipoprotein cholesterol (HDL-C). Serum H(2)S was not associated with age or CRP. Stepwise regression analysis showed that erythrocytic H(2)S production was correlated with sBP, TG, HDL-C, low density lipoprotein cholesterol (LDL-C) and blood urea nitrogen (BUN) and serum H(2)S was correlated with dBP and TG. Results of receiver-operating characteristic curve analysis suggested that erythrocytic H(2)S production was a more sensitive predictor of hypertension development than serum H(2)S.</p><p><b>CONCLUSION</b>Erythrocytic or serum H(2)S production is sensitive predictor of hypertension.</p>

Effects of angiotensin II receptor antagonist olmesartan on renal hemodynamic variables and vascular structural properties in streptozotocin-induced diabetic rats / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Diabetic nephropathy is a major cause of renal failure in diabetes mellitus (DM). It has been known that renin-angiotensin system (RAS) blockers have a renal protective effect. This study aimed to investigate whether treatment with angiotensin II receptor blocker, olmesartan, could modify renal hemodynamic variables and vascular structural properties, then attenuate renal injury in streptozotocin (STZ)-induced DM rats.</p><p><b>METHODS</b>DM was induced in male Wistar rats by intraperitoneal administration of STZ. The rats were then randomized to a DM group and an olmesartan treatment (OLM + DM) group. The normal group (non-DM) were administered only citrate buffer. At the end of the 14th week, blood glucose, kidney weight/body weight and urinary protein-to-creatinine ratio were determined. Further, the flow-pressure and pressure-glomerular filtration rate (GFR) relationships were determined for maximally vasodilated, perfused kidneys. From the relationship, 3 indices of vascular structural properties were estimated: slope of flow-pressure (minimal renal vascular resistance, reflecting overall luminal dimensions of preglomerular and postglomerular vasculature), slope of pressure-GFR (glomerular filtration capacity against pressure) and threshold pressure for beginning filtration at pressure-GFR (preglomerular to postglomerular vascular resistance ratio). Kidneys were then perfusion fixed for histological analysis. The renal histopathology was observed by light microscopy.</p><p><b>RESULTS</b>The body weight of DM rats was lower than that of non-DM rats. Blood glucose, kidney weight/body weight, urinary protein-to-creatinine ratio were significantly greater in DM rats than in non-DM rats. The parameters such as kidney weight/body weight, urinary protein-to-creatinine ratio in OLM + DM rats had dramatically decreased compared with those in DM rats. However, the treatment with olmesartan had no effect on blood glucose levels. The slope of flow-pressure relationship was greater in DM rats than that in non-DM rats (P < 0.05). But the slope of the pressure-GFR relationship was lower in DM rats than that in non-DM rats (P < 0.05) with the x-intercept of the line similar between the two groups. The slope of the flow-pressure relationship was decreased in DM rats group treated with olmesartan (P < 0.05). Moreover, olmesartan significantly increased the slope of the pressure-GFR relationship in DM rats (P < 0.05). The x-intercept of the pressure-GFR relationship reduced following olmesartan in DM rats.</p><p><b>CONCLUSIONS</b>Treatment with olmesartan reduced urinary protein-to-creatinine ratio independent of blood glucose and increased average renal vessel lumen diameter in the perfused kidneys of STZ-induced DM rats, predominantly in preglomerular vessels, and then improved renal excretory capability. These findings were consistent with remodeling of the preglomerular vasculature in our hisological measurements.</p>

Effect of xinkeshu tablet on heart rate variability in patients with coronary heart disease / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To evaluate the effect of Xinkeshu Tablet (XKS) on heart rate variability (HRV) in patients with coronary heart disease (CHD).</p><p><b>METHODS</b>Sixty patients with their diagnosis of CHD confirmed by coronary angiography were randomized into two groups equally. Besides the conventional treatment for CHD, XKS and Metoprolol were given respectively to patients in the treated group and the control group for 8 weeks. Symptoms and 24 h dynamic ECG were observed before and after treatment.</p><p><b>RESULTS</b>Episode of angina pectoris decreased obviously in both groups after treatment, from 8.8 +/- 3.2 times per week (the same hereafter) to 4.4 +/- 2.1 in the treated group (P<0.05), and from 8.4 +/- 3.1 to 3.9 +/- 2.0 in the control group (P <0.05). HRV analysis showed that after treatment the average heart rate lowered from 85.44 +/- 2.89 beat/min to 77.32 +/- 2.17 beat/min in the treated group and from 83.80 +/- 4.30 beat/min to 76.70 +/- 2.93 beat/min in the control group (both P < 0.05), showing no significant difference in extent of lowering between groups (P > 0.05). The time-domain indexes elevated in both groups, showing no statistical difference between groups (P >0.05). As for the frequency-domain indexes, low frequency (LF), high frequency (HF) and total power raised, while LF/HF and very low frequency lowered in both groups, but the changes were more significant in the treated group (P <0.05).</p><p><b>CONCLUSION</b>XKS could improve HRV in patients of CHD and reduce the episode of angina pectoris in them.</p>

Association between coronary artery stenosis and peripheral artery function in normotensive and hypertensive patients with coronary artery disease / 中华心血管病杂志

<p><b>OBJECTIVE</b>To observe the relationship between the parameters of artery elasticity and coronary artery stenosis in normotensive and hypertensive patients with coronary artery disease (CAD).</p><p><b>METHODS</b>Systemic vascular compliance (SVC), systemic vascular resistance (SVR), brachial artery compliance (BAC) and brachial artery resistance (BAR) were measured by Dynapulse 200M (Pulse Metric, Inc., USA) in 88 hypertensive and 41 normotensive patients with chest pain before coronary artery angiography.</p><p><b>RESULTS</b>(1) The prevalence rate of severe coronary disease (> or = 2 coronary branches) was higher in hypertensives than in normotensives (64.7% vs. 27.1%, P < 0.05); (2) the peripheral artery buffering function was significantly lower in hypertensives than in normotensives [SVC: (0.85 +/- 0.10) ml/mm Hg (1 mm Hg = 0.133 kPa) vs. (1.17 +/- 0.11) ml/mm Hg; BAC: (0.047 +/- 0.011) ml/mm Hg vs. (0.063 +/- 0.010) ml/mm Hg, all P < 0.05]; (3) Lower arterial elasticity was associated with severe coronary artery stenosis.</p><p><b>CONCLUSION</b>The non-invasive obtained artery elasticity is associated with the degree of coronary artery stenosis in hypertensive patients with CAD.</p>

Plasma hydrogen sulfide and homocysteine levels in hypertensive patients with different blood pressure levels and complications / 中华心血管病杂志

<p><b>OBJECTIVE</b>The present study was designed to observe the plasma concentrations of hydrogen sulfide (H(2)S) and homocysteine (HCY) in hypertensive patients with different blood pressure levels and complications.</p><p><b>METHODS</b>A total of 165 outpatients with essential hypertension were involved in this study (84 males, 81 females, mean age 59.81 +/- 10.60 years old). There were 28 new-onset untreated, 137 ever-treated patients. Among ever-treated patients, blood pressure was normal in 38, grade 1 hypertension in 43, grade 2 and 3 hypertension in 56 patients. Thirty-two patients were accompanied with coronary heart disease (CAD), and 42 patients were accompanied with stroke. A total of 32 age- and sex-matched healthy controls (18 males) were also recruited. Plasma H(2)S and HCY concentrations were determined in all patients and controls.</p><p><b>RESULTS</b>(1) Plasma H(2)S levels were significantly lower (P < 0.05) and HCY levels were significantly higher (P < 0.01) in ever-treated hypertensive patients compared with controls. (2) Plasma HCY levels were significantly higher in patients with hypertension history > 6 months and complicated with CAD compared to patients without CAD. (3) Plasma H(2)S concentrations in patients with stroke history > 5 years were significantly lower than that in patients without stroke (P < 0.01). Plasma HCY concentrations were increased in proportion to stroke history. (4) In ever-treated hypertensive patients, plasma H(2)S concentrations in patients with grade 2 and 3 hypertension were significantly lower (P < 0.05) and HCY levels significantly higher (P < 0.01) than that in patients with well-controlled blood pressure.</p><p><b>CONCLUSION</b>Hyperhomocysteinemia and the novel signaling gasotransmitter H(2)S might play important roles in the pathogenesis and development of hypertension.</p>

Therapeutic efficacy of valsartan and valsartan/HCTZ in mild to moderate hypertensive patients / 中华心血管病杂志

<p><b>OBJECTIVE</b>To assess the efficacy and safety of valsartan/hydrochlorothiazide (HCTZ) 80/12.5 mg once daily (o.d.) in Chinese patients with mild to moderate essential hypertension who was not adequately controlled by valsartan 80 mg o.d. monotherapy.</p><p><b>METHODS</b>In this multi-center, double-blind, randomized, active controlled, parallel group trial, 1051 out of 1175 Chinese patients with mild to moderate essential hypertension [DBP >or= 95 mm Hg and < 110 mm Hg (1 mm Hg = 0.133 kPa)] completed single-blind run-in period (valsartan 80 mg o.d. therapy for 4 weeks) after 2 week's wash-out period. At the end of the single-blind run-in period, those patients with DBP >or= 95 mm Hg (n = 864) were randomized in 1:1 ratio to Valsartan and Valsartan 80 mg (n = 429)/HCTZ80/12.5 mg (n = 435) treatment o.d. for 8 weeks. Safety and efficacy was assessed every 4 weeks during double blind phase.</p><p><b>RESULTS</b>At the end of study, valsartan/HCTZ 80/12.5 mg combination treatment further reduced systolic (-3.5 mm Hg) and diastolic (-2.2 mm Hg) pressures and increased the rate of patients reaching goal BP level (53.9% vs. 40.9%) compared to valsartan 80 mg o.d. monotherapy. Incidence of side effects was similar between the combination therapy and monotherapy groups (8.9% vs. 5.1%, P > 0.05).</p><p><b>CONCLUSION</b>Efficacy of Valsartan 80 mg/HCTZ 12.5 mg compound was superior to valsartan 80 mg on BP reduction and goal BP control rate in Chinese patients with mild to moderate essential hypertension. The combination of Valsartan 80 mg/hydrochlorothiazide (HCTZ) 12.5 mg provides a suitable treatment for Chinese patients who are not adequately controlled by valsartan 80 mg o.d. monotherapy.</p>

Retrospective survey on clinical characteristics and therapy management for hospitalized patients with essential hypertension in Beijing / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the clinical characteristics and therapy conditions in hospitalized patients with essential hypertension in Beijing.</p><p><b>METHODS</b>Patients with essential hypertension hospitalized in 20 Beijing hospitals in recent 2 years were included in this epidemiologic retrospective survey. Data on age, blood pressure level, risk factors and complicated diseases, antihypertensive medication and heart structural and functional characteristics measured by echocardiography were collected.</p><p><b>RESULTS</b>Total 5106 hospitalized patients (mean age 63.78 years) with essential hypertension were recorded. Mean blood pressure was 145.97/84.23 mm Hg (1 mm Hg = 0.133 kPa). Among them, 75.5% complicated with at least one risk factor, 30% suffered from heart failure. The atria enlargement and left ventricular diastolic dysfunction were the two most common echocardiographic pathological changes. Left ventricular hypertrophy is positively correlated with blood pressure. Logistic regression analysis showed that increased systolic blood pressure, diastolic blood pressure and plasma creatinine, old age and decreased HDL-cholesterol were risk factors of left ventricular hypertrophy. Only 32.1% patients achieved the goal blood pressure level (<140/90 mm Hg) and 38.1% patients were treated with monotherapy. The most commonly used antihypertensive drugs were calcium channel blockers and diuretics.</p><p><b>CONCLUSIONS</b>It is of importance to strictly follow the therapy guidelines on hypertension treatment and use combined drug therapy to increase the rate of patients reaching goal blood pressure level and reduce hypertensive complications.</p>

Comparison Between Two Criteria for Diagnosing Metabolic Syndrome in Hypertension Patients / 中华高血压杂志

Objective To compare the prevalence rate of metabolic syndrome(MS)using the criteria of Chi- nese Diabetes Society(CDS)or International Diabetes Federation(IDF)in hypertension patients in China.Methods The prevalence of MS in hypertension patients(n=17861)in China and its relations with age,gender and levels of blood pressure were studied.Results 1)the prevalence of MS in hypertension patients was 42.2 % or 46.3 %,ac- cording to the definition of CDS or of IDF.The diagnostic rate of the definition of IDF was higher(P80 years group,the diagnostic rate by IDF definition was slightly but significantly higher in all ages groups(P0.05),on contrary,the female prevalence was increased while the male prevalence decreased by IDF. The prevalence of MS increased with levels of blood pressure by both definition.4)The prevalence rate was in- creased with the elevation of BP,compare with CDS criteria the diagnostic rate of MS was slightly higher by IDF cri- teria in all levels of BP.Conclusion Compared with the definition of CDS,the diagnostic rate of MS by the defini- tion of IDF was higher in hypertension patients,addressing more aggressively control global risk factors.

Effects of intracoronary autologous bone marrow mononuclear cells transplantation in patients with anterior myocardial infarction / 中华心血管病杂志

<p><b>OBJECTIVES</b>To investigate the efficacy of intracoronary transfer of autologous bone marrow mononuclear cells (ABMMNCs) to patients with myocardial infarction (MI) on left ventricular function and myocardial perfusion.</p><p><b>METHODS</b>Thirty-five patients with MI (> 4 weeks) were enrolled in this prospective, open-labeled study (20 patients in cell transplantation group; 15 patients in control group). All patients were treated by standard drug therapy and percutaneous coronary intervention (PCI). Baseline and 3 months follow-up evaluations included complete clinical and laboratory examinations, six minutes walk test, echocardiography, Dual-isotope simultaneous acquisition single photon emission computed tomography (DISA-SPECT) and cardiac magnetic resonance imaging (MRI).</p><p><b>RESULTS</b>Baseline parameters were similar between the two groups. NYHA classification and six minutes walk test at 3 months follow-up were also similar between the two groups. However, left ventricular ejection fraction (LVEF) determined by echocardiography and DISA-SPECT was significantly higher; regional wall motion measured by echocardiography and cardiac MRI, myocardial viability and myocardial perfusion in the infarct zone assessed by DISA-SPECT were all significantly improved than before transplantation and than that in control group at 3 months follow-up.</p><p><b>CONCLUSIONS</b>Our results indicate that intracoronary transplantation of ABMMNCs could improve the left ventricular systolic function and beneficially affect myocardial perfusion up to 3 months post transplantation in patients with myocardial infarction.</p>

Tyrosine kinase dependent lectin-like oxidized LDL receptor-1 upregulation by thrombin and factor Xa in vascular smooth muscle cells / 中华心血管病杂志

<p><b>OBJECTIVE</b>Thrombin and factor Xa are key players in the process of arterial thrombi formation and lectin-like oxidized low density lipoprotein receptor-1 (LOX-1) is a cell surface endocytosis receptor for atherogenic oxidized LDL (ox-LDL). Here we investigate whether thrombin and factor Xa can induce LOX-1 protein expressions in cell-associated forms and soluble forms in cultured bovine aortic smooth muscle cells (BSMCs).</p><p><b>METHODS</b>BSMCs were treated with thrombin or factor Xa in the presence or absence of AG1478, an epidermal growth factor (EGF) receptor-associated tyrosine kinase inhibitor. Total cell lysates and concentrated culture medium were then analyzed by Western blot using a mouse anti-LOX-1 monoclonal antibody.</p><p><b>RESULTS</b>LOX-1 protein levels in cell lysates and culture medium were significantly increased by thrombin and factor Xa in a concentration- and time-dependent manner. Upregulation of LOX-1 protein expressions in cell lysates and concentrated culture medium was observed at concentrations above 2.0 and 3.0 U/ml of thrombin and 50 and 100 nmol/L of factor Xa, respectively. Increased LOX-1 protein expressions in cell lysates and cell culture medium were detectable as early as 4 h and peaked at 12 h after treatment with thrombin or factor Xa. LOX-1 expression induced by thrombin and factor Xa could be blocked by pretreatment with AG1478.</p><p><b>CONCLUSIONS</b>Thrombin and factor Xa can act as LOX-1 inducers via tyrosine kinase activation.</p>

Association between microalbuminuria and arterial stiffness in hypertensive and diabetic patients / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the relationship between microalbuminuria and arterial compliance in hypertensive and diabetes patients.</p><p><b>METHODS</b>A total of 200 patients with essential hypertension and/or diabetes were studied. Albumin/creatinine ratio (ACR) was determined. Carotid to femoral Pulse Wave Velocity (PWV), C(1) and C(2) were measured by a Complier Colson device and DO-2020, respectively.</p><p><b>RESULT</b>(1) C(1) and C(2) were lower and PWV higher in high ACR group than in normal ACR group (P < 0.01). (2) In patients younger than 60 years, C(1) was lower and PWV higher in high ACR group than that in normal ACR group (P < 0.01). In patients older than 60 years, C(1), C(2) were lower in high ACR group than in normal ACR group.</p><p><b>CONCLUSION</b>The results indicated that compliance of large and small vessels in hypertensive and diabetic patients decreased with increasing ACR.</p>

The control rate of irbesartan/hydrochlorothiazide combination regimen in the treatment of Chinese patients with mild to moderate hypertension / 中华心血管病杂志

<p><b>OBJECTIVES</b>To analyse the control rate of irbesartan/hydrochlorothiazide (HCTZ) combination tablets (COAPROVEL) in the treatment of patients with mild to moderate primary hypertension.</p><p><b>METHODS</b>In this multi-center, open, single therapy trial, the enrolled patients aged 18-75 were treated with irbesartan/HCTZ combination tablets for 8 weeks. The initial dose comprised one tablet of irbesartan (150 mg)/HCTZ (12.5 mg) once a day during the first 2 weeks. If diastolic blood pressure was greater than 85 mm Hg at the end of the second or fourth weeks, irbesartan (300 mg)/HCTZ (12.5 mg) once a day or irbesartan (300 mg)/HCTZ (25 mg) once a day were added respectively.</p><p><b>RESULTS</b>In 968 patients with mild to moderate hypertension enrolled, 920 patients were followed up for 8 weeks. (1) After 1 week of treatment, irbesartan/HCTZ combination tablets lowered systolic blood pressure by 11.87 mm Hg and diastolic blood pressure by 8.54 mm Hg (P < 0.01). After 8 weeks of treatment, the corresponding decreases were 21.97 mm Hg and 16.08 mm Hg, respectively (P < 0.01). (2) After 2, 4 and 8 weeks of treatment, 526, 703 and 769 patients reached blood pressure target (diastolic blood pressure less than 85 mm Hg). The control rates were 57.17%, 76.41% and 83.59%, respectively. (3) Among the 920 patients who completed the trial, 637 patients took irbesartan (150 mg)/HCTZ (12.5mg) once a day (69.24%), 211 patients took irbesartan (300 mg)/HCTZ (12.5 mg) once a day (22.93%), and 72 patients took irbesartan (300 mg)/HCTZ (25 mg) once a day (7.82%). (4) In the intention-to-treat analysis, no adverse reaction was observed in 903 patients (93.29% of the patients enrolled).</p><p><b>CONCLUSIONS</b>When irbesartan/HCTZ combination regimen are used in the treatment of patients with mild to moderate primary hypertension, the proportion of patients reaching blood pressure target is high and adverse reactions are rare.</p>

Relationship between HLA-DQA1 polymorphism and genetic susceptibility to idiopathic dilated cardiomyopathy / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Autoimmune mechanisms are likely to participate in the pathogenesis of subgroup of idiopathic dilated cardiomyopathy (IDC), and components of the major histocompatibility complex may serve as markers for the propensity to develop immune-mediated myocardial damage. Human leukocyte antigen (HLA) class II genes, especially highly polymorphic HLA-DQ genes, play an important role in the activation of immune responses, and thus control the predisposition for or protect from IDC. This study was conducted to investigate the HLA-DQA1 allele polymorphisms in IDC patients and to explore the underlying immunological mechanism and the hereditary susceptibility to IDC.</p><p><b>METHODS</b>The polymerase chain reaction sequence-specific primers (PCR-SSP) technique was used to analyze the polymorphisms in the second exon of DQA1 in three groups: 72 IDC patients diagnosed according to the criteria of World Health Organization (IDC group); 100 end-stage heart failure patients suffering from a disease of known etiology (HF group); and 100 healthy subjects enrolled for the study during a routine health survey (control group). Patients in the IDC group were stratified according to ejection fraction (EF). Those with EF values were higher than 35% were placed into subgroup 1; subgroup 2 included patients with an EF value of 15% - 35%; and subgroup 3 consisted of those whose EF values less than 15%.</p><p><b>RESULTS</b>The frequency of HLA-DQA1 *0501 alleles was significantly higher in the IDC group (0.39) than that in the HF group (0.12) and the control group (0.09) (both P < 0.05). Further analysis of the three IDC subgroups showed a higher frequency of DQA1 *0501 among patients with lower EF values (both P < 0.05, compared with subgroups 1 and 2). The frequency of DQA1 *0201 was higher in the control group than that in the IDC group (P < 0.05).</p><p><b>CONCLUSIONS</b>The HLA-DQA1 *0501 allele confers susceptibility to IDC, while the DQA1 *0201 allele confers protection against it, which indicates that genetic background involved in IDC and heart failure is different. HLA-DQA1 genes are involved in the regulation of specific immune responses by auto- or foreign anti-myocardium antibody.</p>

Association between angiotensin converting enzyme gene, chymase gene and regression of left ventricular hypertrophy in patients treated with angiotensin converting enzyme inhibitors / 中华流行病学杂志

<p><b>OBJECTIVE</b>To investigate the association between insertion/deletion (I/D) polymorphism of the angiotensin converting enzyme (ACE) gene and the A/B polymorphism of the chymase (CMA) gene with regression of left ventricular hypertrophy (LVH) in patients with essential hypertension and left ventricular hypertrophy. The study subjects had been participants in along-term trial of therapy with an ACE inhibitor.</p><p><b>METHODS</b>Follow-up data of 157 patients with essential hypertension and left ventricular hypertrophy were collected. DNA fragments of ACE gene and CMA gene were amplified by PCR and analysed by RFLP. LVDd, IVST and LVPWT were measured by Ultrasonic Cardiogram (UCG).</p><p><b>RESULTS</b>(1) When long-term treatment with Benazepril was carried out, the blood pressure was markedly decreased and the heart rate was maintained steadily. (2) Regression of left ventricular hypertrophy was improved. (3) The magnitudes of regression of LVM and LVMI during therapy were greater in the DD group than in the II and ID group. No significant differences of other indices were found in the different genotype groups of ACE. (4) No significant differences of all indices were found in the different genotype groups of CMA. (5) No interaction appeared between the genotypes of the ACE and the genotypes of the CMA.</p><p><b>CONCLUSION</b>Hypertensive patients with DD genotype were more likely to have regression of left ventricular hypertrophy when treated with ACE inhibitors than patients with other ACE genotypes. No evidence was found to support an association between CMA genotype and regression of LVH in those patients.</p>

Carotid remodeling of hypertensive subjects and polymorphism of the angiotensin-converting enzyme gene / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>This study was designed to investigate the relationships between changes in the structure and function of carotid arteries and angiotensin converting enzyme (ACE) gene polymorphism in Chinese hypertensive subjects.</p><p><b>METHODS</b>Multiplex polymerase chain reaction amplification was used to evaluate the ACE gene insertion/deletion (I/D) polymorphism. High-resolution B-mode ultrasound examinations were performed to detect parameters of carotid artery remodeling.</p><p><b>RESULTS</b>Intima-media thickness (IMT) was significantly different among the DD, ID and II genotypes of ACE (DD > ID > II, P < 0.05). Carotid internal diameter, distensibility and stiffness were similar among the DD, ID and II genotypes of ACE (P > 0.05) in hypertensive subjects. The frequency of the DD gene and D allele of ACE were higher in patients with thickening carotid than in patients with normal carotid (70.4% vs 24.1%, and 79.5% vs 40.5%, respectively, P < 0.001). In multiple stepwise regression analysis, independent risk factors for increased carotid IMT in hypertensive subjects were ACE genotypes (P < 0.001), age (P < 0.001) and carotid internal diameter (P = 0.032). Moreover, triglycerides and total cholesterol were higher in patients with the DD genotype than in those with the II genotype (P < 0.05).</p><p><b>CONCLUSIONS</b>The I/D polymorphism of the ACE gene was related to IMT, but not to internal diameter, distensibility and stiffness of the carotid in Chinese hypertensive subjects. ACE gene polymorphism was a main risk factor for increased carotid IMT. These results may imply that there is a link between lipid metabolism and ACE genotype polymorphism in Chinese hypertensive subjects.</p>