Factores asociados a la adherencia al tratamiento farmacológico en pacientes con diabetes sin hipertensión arterial

Objetivo: Identificar los factores asociados a la adherencia al tratamiento farmacológico en pacientes con diabetes mellitus tipo 2 sin hipertensión arterial. Materiales y métodos: Estudio transversal y analítico en pacientes con diabetes mellitus tipo 2 sin hipertensión arterial. Se integraron el grupo con adherencia al tratamiento (n = 145) y el grupo sin adherencia al tratamiento (n = 49), determinado por la escala de adherencia a la medicación de Morisky de 4 ítems (MMAS-4). Como factores asociados, se estudiaron sexo, vida en pareja, escolaridad, ocupación, edad agrupada en decenios y tiempo de evolución de la diabetes agrupada en menos de un año, de 1 a 5 años, de 6 a 10 años y más de 10 años. El plan de análisis estadístico incluyó la prueba de ji al cuadrado. Resultados: Se identificaron el sexo (p = 0,045), la vida en pareja (p = 0,045), la edad (p = 0,001) y el tiempo de evolución de la enfermedad (p = 0,001) como factores asociados a la adherencia al tratamiento farmacológico. La escolaridad no se identificó como un factor asociado a la adherencia terapéutica en el paciente con diabetes mellitus tipo 2 (p = 0,289). A mayor edad, menor adherencia al tratamiento farmacológico en el paciente con diabetes: el punto de corte se presenta a los 60 años; después de esta edad, el porcentaje en el grupo no adherente es mayor que en el grupo con adherencia (p = 0,001). A mayor tiempo de evolución de la diabetes, menor probabilidad de adherencia; en el grupo no adherente, el porcentaje de pacientes con más de 10 años de evolución es 67,3 % y en el grupo con adherencia el porcentaje corresponde a 33,8 % (p = 0,001). Conclusiones: Se identificaron los factores asociados a la adherencia al tratamiento farmacológico en pacientes con diabetes mellitus tipo 2 sin hipertensión arterial.

Objective: To identify the factors associated with adherence to drug therapy among patients with type 2 diabetes mellitus without hypertension. Materials and methods: A cross-sectional, analytical study conducted with patients with type 2 diabetes mellitus without hypertension, divided into an adherent group (n = 145) and a non-adherent group (n = 49), determined by the 4-item Morisky Medication Adherence Scale (MMAS-4). The associated factors were sex, cohabitation, schooling, occupation, age in 10-year groups and diabetes progression time grouped in less than 1 year, from 1 to 5 years, from 6 to 10 years and more than 10 years. The statistical analysis plan included the chi-square test. Results: The factors associated with adherence to drug therapy were identified as sex (p = 0.045), cohabitation (p = 0.045), age (p = 0.001) and disease progression time (p = 0.001). Schooling was not identified as a factor associated with adherence to drug therapy among patients with type 2 diabetes mellitus (p = 0.289). The older the patient with diabetes, the lower the adherence to drug therapy; the cut-off point was 60 years of age, after which the percentage in the non-adherent group was higher than in the adherent group (p = 0.001). The longer the diabetes progression time, the lower the probability of adherence; in the non-adherent group the percentage of patients with more than 10 years of disease progression was 67.3 % and in the adherent group the percentage was 33.8 % (p = 0.001). Conclusions: The factors associated with adherence to drug therapy among patients with type 2 diabetes mellitus without hypertension were identified

Determinación del riesgo de muerte por afecciones vasculares en hipertensos de la población peruana 2021-2022

Objetivo: determinar el riesgo de muerte inmediata por eventos vasculares en hipertensos de la población peruana en el periodo 2021-2022 Metodología: estudio observacional, de casos y controles basado en datos del sistema nacional de defunciones del instituto nacional de estadística e informática del Perú entre enero de 2021 a agosto de 2022. Fueron incluidos todos los pacientes, hipertensos y no hipertensos, que fallecieron por alguna de las afecciones vasculares seleccionadas en las variables las cuales fueron, además de la presencia de hipertensión: paro cardiaco, accidente cerebrovascular isquémico y hemorrágico, choque cardiogénico, Se realizó la prueba de Chi-cuadrado de Pearson y la razón de probabilidades para la estimación del riesgo. Resultados: de 5385 muertes por infarto de miocardio, 54,80% tuvieron hipertensión arterial; de 1425 muertes por choque cardiogénico, 45,12% fueron hipertensos; de 434 fallecidos por accidente cerebrovascular isquémico, 52,76% padecieron hipertensión arterial; de los 746 fallecidos por accidente cerebrovascular hemorrágico, 56,97% fueron hipertensos; de los 4401 fallecidos por paro cardiaco, 25,61% también tuvieron hipertensión arterial. Se encontró que los hipertensos tuvieron un riesgo 7,52 veces mayor de morir por infarto agudo de miocardio, 3,39 veces por choque cardiogénico, 5,75 veces por accidente cerebrovascular isquémico, 10,27 accidente cerebrovascular hemorrágico y 1,94 veces por paro cardiaco. Conclusiones: las afecciones vasculares de mayor a menor riesgo de provocar la muerte en hipertensos son el accidente cerebrovascular, el infarto de miocardio, el accidente cerebrovascular isquémico, el choque cardiogénico y el paro cardiaco.

Objective: To determine the risk of immediate death due to vascular events in hypertensive patients in the Peruvian population in the period 2021-2022. Methodology: Observational, case-control study based on data from the national death system of the National Institute of Statistics and Informatics of Peru between January 2021 and August 2022. All patients, hypertensive and non-hypertensive, who died from any of the vascular affections selected in the variables which were, in addition to the presence of hypertension: cardiac arrest, ischemic and hemorrhagic cerebrovascular accident, cardiogenic shock. The Pearson's Chi-square test and the odds ratio were performed for the estimation of the risk. Results: Of 5385 deaths due to myocardial infarction, 54.80% had arterial hypertension; of 1425 deaths due to cardiogenic shock, 45.12% were hypertensive; of 434 deaths from ischemic stroke, 52.76% suffered arterial hypertension; of the 746 who died from hemorrhagic stroke, 56.97% were hypertensive; of the 4,401 deaths from cardiac arrest, 25.61% also had arterial hypertension. It was found that hypertensive patients had a 7.52 times higher risk of dying from acute myocardial infarction, 3.39 times from cardiogenic shock, 5.75 times from ischemic stroke, 10.27 times from hemorrhagic stroke and 1.94 times from heart attack. Conclusions: Vascular conditions from highest to lowest risk of causing death in hypertensives are cerebrovascular accident, myocardial infarction, ischemic cerebrovascular accident, cardiogenic shock and cardiac arrest.

Tasa metabólica basal y presión arterial en adultos normotensos e hipertensos de la población peruana, 2022

Objetivo: analizar la correlación y variaciones en los niveles de la tasa metabólica basal (TMB) con la presión arterial sistólica y diastólica en adultos normotensos e hipertensos de la población peruana. Metodología: se realizó un estudio observacional, analítico, retrospectivo y transversal en base a datos de la encuesta nacional demográfica y de salud-2022 (ENDES) que estuvo conformada por 18032 mujeres y 13646 hombres mayores de 18 años. Las variables fueron: sexo, TMB, presión arterial sistólica y diastólica. Se realizó la prueba chi-cuadrado, t de Student, Odds ratio crudo y ajustado por regresión logística binaria y la correlación de Spearman. Resultados: las mujeres con presión sistólica alta tuvieron una tasa TMB de 1130 mientras que en normotensas fue de 1246. Las mujeres con TMB baja tuvieron hipertensión con mayor frecuencia que las mujeres con TMB normal. En hombres, la hipertensión se presentó con mayor frecuencia en el grupo de TMB normal. En adultos hipertensos, la presión sistólica y la TMB se correlacionaron baja y negativamente, siendo más negativa en mujeres, mientras que la presión diastólica se correlacionó baja y positivamente en ambos sexos, siendo mayor en mujeres. En normotensos, la correlación entre presión sistólica y TMB fue muy baja y positiva en mujeres, mientras que en hombres fue baja y positiva mientras que la correlación entre presión diastólica y TMB fue baja y positiva en ambos sexos. Conclusiones: la TMB baja se asocia a hipertensión en mujeres, mientras que en hombres la hipertensión está asociada a una TMB normal. Asimismo, la TMB se correlaciona negativamente con la presión arterial en hipertensos y positivamente en normotensos de la población peruana.

Objective: To analyze the correlation and variations in the levels of the basal metabolic rate (BMR) with systolic and diastolic blood pressure in normotensive and hypertensive adults in the Peruvian population. Methodology: An observational, analytical, retrospective, and cross-sectional study was carried out based on data from the national demographic and health survey-2022 (ENDES), which consisted of 18,032 women and 13,646 men over 18 years of age. The variables were: sex, BMR, systolic and diastolic blood pressure. The chi-square test, Student's t test, crude Odds ratio and adjusted by binary logistic regression and Spearman correlation were applied. Results: Women with high systolic pressure had a TMB rate of 1130 while in normotensive women it was 1246. Women with low TMB had hypertension more frequently than women with normal TMB. In men, hypertension occurred more frequently in the normal TMB group. In hypertensive adults, systolic pressure and BMR were low and negatively correlated, being more negative in women, while diastolic pressure was low and positively correlated in both men and women, being higher in women. In normotensive individuals, the correlation between systolic pressure and BMR was very low and positive in women, while in men it was low and positive while the correlation between diastolic pressure and BMR was low and positive in men and women. Conclusions: Low BMR is associated with hypertension in women, while in men hypertension is associated with a normal BMR. Likewise, BMR is negatively correlated with blood pressure in hypertensives and positively in normotensives in the Peruvian population.

Efficacy and safety of acupuncture combined with antihypertensive drugs in the treatment of essential hypertension: a meta-analysis / 国际中医中药杂志

Objective:To evaluate the efficacy and safety of acupuncture combined with antihypertensive drugs in the treatment of essential hypertension through meta-analysis.Methods:RCTs about acupuncture combined with antihypertensive drugs in the treatment of essential hypertension were retrieved from CNKI, VIP, WANFANG, CBM, PubMed, Embase and Web of Science from the establishment of the databases to January 28, 2022. The risk and quality of literature publication bias were evaluated according to Cochrane 5.1.0 System Evaluation Manual, and relevant data were extracted. RevMan 5.4 software was used for meta-analysis.Results:A total of 36 RCTs involving 2 905 patients were included. Meta-analysis results showed that compared with antihypertensive drugs, acupuncture alone demonstrated advantages in reducing systolic blood pressure [ SMD=-0.70 (-1.05, -0.36), P<0.01], diastolic blood pressure [ SMD=-0.69(-1.06, -0.32), P<0.01], antihypertensive efficacy [ RR=1.11 (1.04, 1.19), P<0.01], symptomes efficacy [ RR=1.21 (1.11, 1.31), P<0.01] and comprehensive efficacy [ RR=1.35 (1.16, 1.57), P<0.01], without serious adverse reactions. Conclusion:Acupuncture alone has good clinical efficacy and safety in the treatment of essential hypertension, compared with antihypertensive drugs alone. However, researches with large samples and high quality are still needed to support the conclusion.

Study on the molecular mechanism of Linggui Zhugan Decoction in treating hypertension and obesity based on network pharmacology and molecular docking technology / 国际中医中药杂志

Objective:To explore the material basis and mechanism of Linggui Zhugan Decoction in treating hypertension and obesity by means of network pharmacology and molecular docking technique.Methods:The TCMSP was retrieved and the main active components and action targets of Linggui Zhugan Decoction were screened. The GeneCards, OMIM, TTD, DisGeNET and DrugBank databases were used to screen disease-related targets of hypertension and obesity. The Cytoscape 3.9.0 was used to draw Chinese materia medica-composition-intersection target-disease network diagram. The STRING 11.5 database was used to draw PPI network. The cytoNCA plug-in was used to screen core active components and targets. The bioenrichment analysis of GO and KEGG was carried out in the R4.1.2, and the Chinese materia medica-intersection target-path diagram was drawn, and the core active components and core targets were docked in PyMOL and AutoDockTools 1.5.7.Results:A total of 102 potentially active components and 62 intersection targets were obtained, and 8 active components and 7 core targets were screened. Enrichment analysis showed that the key targets were mainly enriched through the signaling pathways of fluid shear stress and atherosclerosis, lipid and atherosclerosis, and AGE-RAGE, which were involved in biological processes such as the response to nutritional levels and the regulation of small molecule metabolism. Molecular docking showed that there were 37 groups with addinity < -7 kcal/mol.Conclusion:The main active components of Linggui Zhugan Decoction are quercetin, kaempferol and naringenin, which may play a role in fluid shear stress and atherosclerosis pathway, lipid and atherosclerosis pathway and AGE-RAGE signal pathway through AKT1, EGFR, IL1B and other targets.

Relación entre la composición de la microbiota y la hipertensión arterial esencial. Una revisión narrativa / Relationship between microbiota composition and essential hypertension. A narrative review

La hipertensión arterial esencial es una patología de alta prevalencia a nivel mundial, y uno de los determinantes más significativos para enfermedad cardiovascular. Por otra parte, se ha generado un gran interés por la microbiota del cuerpo, y la forma en que se ve alterada por factores tanto internos como externos, ocasionando disbiosis. En la actualidad se viene estudiando el efecto de la microbiota en diferentes enfermedades, entre ellas, la relación entre la microbiota y la hipertensión. En este artículo se hizo una revisión de la literatura, entre 2010 a 2021, con el objetivo de identificar la evidencia científica que sustenta la relación entre la composición de la microbiota y la hipertensión arterial esencial. Se encontró en muchos estudios que los hipertensos tenían una diversidad menor de la microbiota, en comparación con los grupos de control sanos. En los hipertensos se encontraron principalmente bacterias del género Prevotella y en el grupo control predominaba el género Bacteroidetes. Adicionalmente, se observó una disminución de Faecalibacterium, Roseburia y Bifidobacterium en el grupo de hipertensos. Existen varias técnicas de laboratorio para el reconocimiento de la población bacteriana del intestino, tales como la secuenciación de la subunidad de ARNr 16S, la secuenciación del genoma completo y la metagenómica de la microbiota. A pesar de que los estudios realizados sobre la relación microbiota e hipertensión concluyen que existe una relación significativa entre ambas, es necesario hacer más investigaciones en diferentes grupos poblacionales

Essential arterial hypertension is a highly prevalent pathology worldwide and is one of the most significant determinants of cardiovascular disease. On the other hand, great interest has been generated in the microbiota of the body, and how it is altered by both internal and external factors, causing dysbiosis. Currently, the effect of the microbiota in different diseases is being studied, including the relationship between the microbiota and hypertension. In this article, a review of the literature was made, between 2010 and 2021, with the objective of identifying the scientific evidence that supports the relationship between the composition of the microbiota and essential arterial hypertension. It was found in many studies that individuals with high blood pressure had lower microbiota diversity compared to healthy control groups. In hypertensive patients, bacteria of the genus Prevotella were mainly found, while in the control group the genus Bacteroidetes predominated. Additionally, a decrease in Faecalibacterium, Roseburia and Bifidobacterium was observed in the hypertensive group. There are several laboratory techniques for the analysis of the intestinal bacterial population, such as 16S rRNA subunit sequencing, whole genome sequencing, and microbiota metagenomics. Despite the fact that the studies conclude that there is a significant relationship between microbiota and hypertension, it is necessary to do more research in different population groups

A Nomogram model for the early warning of essential hypertension risks based on the principles of traditional Chinese medicine syndrome elements / 数字中医药（英文）

@#[Objective] To construct a Nomogram model for the prediction of essential hypertension (EH) risks with the use of traditional Chinese medicine (TCM) syndrome elements principles in conjunction with cutting-edge biochemical detection technologies. [Methods] A case-control study was conducted, involving 301 patients with essential hypertension in the hypertensive group and 314 without in the control group. Comprehensive data, including the information on the four TCM diagnoses, general data, and blood biochemical indicators of participants in both groups, were collected separately for analysis. The differentiation principles of syndrome elements were used to discern the location and nature of hypertension. One-way analysis was carried out to screen for potential risk factors of the disease. Least absolute shrinkage and selection operator (LASSO) regression was used to identify factors that contribute significantly to the model, and eliminate possible collinearity problems. At last, multivariate logistic regression analysis was used to both screen and quantify independent risk factors essential for the prediction model. The “rms” package in the R Studio was used to construct the Nomogram model, creating line segments of varying lengths based on the contribution of each risk factor to aid in the prediction of risks of hypertension. For internal model validation, the Bootstrap program package was utilized to perform 1000 repetitions of sampling and generate calibration curves. [Results] The results of the multivariate logistic regression analysis revealed that the risk factors of EH included age, heart rate (HR), waist-to-hip ratio (WHR), uric acid (UA) levels, family medical history, sleep patterns (early awakening and light sleep), water intake, and psychological traits (depression and anger). Additionally, TCM syndrome elements such as phlegm, Yin deficiency, and Yang hyperactivity contributed to the risk of EH onset as well. TCM syndrome elements liver, spleen, and kidney were also considered the risk factors of EH. Next, the Nomogram model was constructed using the aforementioned 14 risk predictors, with an area under the curve (AUC) of 0.868 and a 95% confidence interval (CI) ranging from 0.840 to 0.895. The diagnostic sensitivity and specificity were found to be 80.7% and 85.0%, respectively. Internal validation confirmed the model’s robust predictive performance, with aconsistency index (C-index) of 0.879, underscoring the model’s strong predictive ability. [Conclusion] By integrating TCM syndrome elements, the Nomogram model has realized the objective, qualitative, and quantitative selection of early warning factors for developing EH, resulting in the creation of a more comprehensive and precise prediction model for EH risks.

Efficacy observation of pushing Qiaogong point with different intensities for treating stage Ⅰ essential hypertension / 针灸推拿医学（英文版）

Objective: To observe the clinical efficacy of pushing Qiaogong point with varying intensities for treating stage Ⅰ essential hypertension. Methods: A total of 72 patients diagnosed with stageⅠ essential hypertension were enrolled in this study. They were divided into three groups using the random number table method, including a control group, a gentle pushing group, and a heavy pushing group, with 24 patients in each group. All three groups received the same therapeutic lifestyle interventions. The control group received no additional interventions, the gentle pushing group received additional pushing Qiaogong point with gentle strength, and the heavy pushing group received additional pushing Qiaogong point with heavy strength. The treatment duration was 4 weeks, followed by a 4-week follow-up period, during which blood pressure changes were observed and analyzed in all three groups. Results: After treatment, the blood pressure levels in all three groups showed a significant decrease (P<0.05). The effective rate in the control group was 43.5％, in the gentle pushing group was 78.3％, and in the heavy pushing group was 33.3％. The reduction in blood pressure levels in the gentle pushing group was significantly superior to that in both the control group and the heavy pushing group, indicating inter-group statistical significance (P<0.01). The efficacy of the heavy pushing group was comparable to that of the control group, indicating no statistical significance (P>0.05). During the follow-up period, compared with the end of the treatment within the same group, the blood pressure levels remained stable in both the control group and the gentle pushing group, indicating no intra-group statistical significance (P>0.05). The heavy pushing group showed a significant decrease in diastolic blood pressure (DBP) and mean blood pressure (MBP) compared with the end of the treatment, indicating intra-group statistical significance (P<0.05). During the follow-up, the gentle pushing group had lower systolic blood pressure (SBP) and MBP compared with both the heavy pushing group and the control group, indicating inter-group statistical significance (P<0.01), while there was no inter-group statistical significance in comparing the DBP (P>0.05). There was no statistical significance in comparing the SBP, DBP, and MBP between the heavy pushing group and the control group (P>0.05). Conclusion: Pushing Qiaogong point with gentle strength combined with lifestyle interventions showed a higher effective rate and long-term blood pressure stability in the treatment of stage Ⅰ essential hypertension. Pushing Qiaogong point with varying intensities showed varying effects on patients with stage Ⅰ essential hypertension.

Acupuncture-moxibustion for essential hypertension: an overview of systematic reviews / 针灸推拿医学（英文版）

Objective: To propose reasonable suggestions to promote the standardization of clinical studies by reviewing the systematic reviews and meta-analyses of acupuncture-moxibustion treatment of essential hypertension (EH). Methods: Computer retrieval was conducted through Excerpta Medica Database (EMBASE), PubMed, China National Knowledge Infrastructure (CNKI), Chongqing VIP Database (CQVIP), China Biology Medicine Disc (CBM), and Wanfang Academic Journal Full-text Database (Wanfang) to collect systematic reviews and meta-analyses relevant to treating EH with acupuncture-moxibustion therapy. The time range was from the database's inception till July, 2020. The studies were screened based on the inclusion and exclusion criteria and then data-extracted. The study's quality and evidence ratings were performed by referring to the preferred reporting items for systematic review and meta-analysis (PRISMA), a measurement tool to assess systematic reviews 2 (AMSTAR 2), and the grading of recommendations, assessment, development, and evaluation (GRADE). Results: A total of 14 studies, 10 in Chinese and 4 in English, published between 2012 and 2019, were included, involving 70 outcome measures. The methodological quality was rated as critically low, the reporting was relatively complete or had certain flaws, and the evidence strength was rated as low or very low. Conclusion: Regarding the acupuncture-moxibustion treatment of EH, the methodological quality and outcome measure evidence of existing systematic reviews and meta-analyses are relatively low, and the reporting quality also expects further improvements.

Riesgo cardiometabólico en pacientes con hipertensión arterial esencial no complicada

Introducción: La evaluación del riesgo cardiometabólico en pacientes con hipertensión arterial esencial es vital y constituye un reto diagnóstico. Objetivo: Evaluar el comportamiento del riesgo cardiometabólico en pacientes con hipertensión arterial esencial no complicada. Métodos: Se realizó una investigación descriptiva y transversal en 100 pacientes hipertensos sin lesión en órgano diana a los que se les realizó historia clínica, glucemia, hemoglobina glicosilada, lipidograma y ácido úrico. Se correlacionaron con el índice de masa corporal, el tiempo de evolución de la hipertensión arterial y el riesgo cardiovascular global. Resultados: De los pacientes, el 56 % fueron hombres, el 31 % fumadores, con sobrepeso y obesidad el 83 %, el 86 % eran sedentarios, 71 % no llevaban dieta saludable y 53 % tenían más de 5 años de hipertensos. En los obesos se encuentra una relación significativa con la circunferencia abdominal (110,9 ± 8,9, p=0,000), los triglicéridos (1,8 ± 0,9, p=0,000) y al ácido úrico (374 ± 100,7, p=0,001). La edad (62,9 ± 7,8, p=0,000), la presión arterial sistólica (151,6 ± 15,6, p=0,021), la disminución del HDL (0,9 ± 0,3, p=0,000) y el ácido úrico (349, 3 ± 115,3, p=0,015) se relacionaron significativamente con el riesgo cardiovascular alto. Conclusiones: Los resultados demostraron el valor de parámetros clínicos como la edad, la circunferencia abdominal, el índice de masa corporal y la presión arterial sistólica, así como de parámetros metabólicos como los triglicéridos, el HDL y el ácido úrico en la evaluación del riesgo cardiometabólico y su relación con el riesgo cardiovascular en pacientes hipertensos.

Introduction: Cardiometabolic risk assessment in patients with essential arterial hypertension is vital and a diagnostic challenge. Objective: To evaluate the behavior of cardiometabolic risk in patients with uncomplicated essential hypertension. Methods: A descriptive, cross-sectional study was carried out in 100 hypertensive patients without target organ damage who underwent clinical history, glycemia, glycosylated hemoglobin, lipidogram and uric acid. They were correlated with body mass index, time of evolution of arterial hypertension and global cardiovascular risk. Results: Of the patients, 56% were men, 31% were smokers, 83% were overweight and obese, 86% were sedentary, 71% did not have a healthy diet and 53% had been hypertensive for more than 5 years. In the obese, a significant relationship was found with abdominal circumference (110.9 ± 8.9, p=0.000), triglycerides (1.8 ± 0.9, p=0.000) and uric acid (374 ± 100.7, p=0.001). Age (62.9 ± 7.8, p=0.000), systolic blood pressure (151.6±15.6, p=0.021), lower HDL (0.9±0.3, p=0.000) and uric acid (349, 3 ± 115.3, p=0.015) were significantly related to high cardiovascular risk. Conclusions: The results demonstrated the value of clinical parameters such as age, abdominal circumference, body mass index and systolic blood pressure, as well as metabolic parameters such as triglycerides, HDL and uric acid in the evaluation of cardiometabolic risk and its relationship with cardiovascular risk in hypertensive patients.

Effect of sports training on the rehabilitation of hypertensive patients / Efeitos de treino esportivo na reabilitação de pacientes hipertensos / Efectos de entrenamiento deportivo en la rehabilitación de pacientes hipertensos

ABSTRACT Introduction: Hypertension is one of the most common cardiovascular and cerebrovascular diseases and a major public health problem. Although, through the rational use of drugs, the blood pressure of hypertensive patients can be better controlled, a series of side effects of drugs and expensive medical expenses limit the ability of patients to comply with the demands of hypertension. Objective: To explore the effect of long-term exercise training on the rehabilitation of hypertensive patients. Methods: The patients were divided into a control group and an exercise group, and we used multiple measurements of blood pressure, a questionnaire, and registered the situation of each patient, after what results were compared and analyzed. Results: After 12 weeks of training, the subject's blood pressure has dropped significantly. The systolic blood pressure dropped by an average of 15.5mmHg compared to before the exercise prescription was implemented, diastolic blood pressure dropped by an average of 10.6mmHg. Conclusions: Continuous physical exercise in hypertensive patients has medium- and long-term effect on blood pressure control. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução: A hipertensão é uma das doenças cardiovasculares e cerebrovasculares mais comuns e um importante problema de saúde. Embora a pressão de pacientes hipertensos possa ser melhor controlada através do uso racional de medicamentos, seus efeitos colaterais e os elevados custos médicos limitam a habilidade dos pacientes de atender às demandas da hipertensão. Objetivo: Explorar o efeito a longo prazo de exercícios na reabilitação de pacientes hipertensos. Métodos: Dividiram-se os pacientes em um grupo controle e um grupo de exercícios e realizaram-se múltiplas avaliações de sua pressão sanguínea. Além disso, foi aplicado um questionário e a situação de cada paciente foi registrada. Em seguida, os resultados foram comparados e analisados. Resultados: Depois de 12 dias de treino, a pressão sanguínea dos pacientes caiu significativamente. A pressão sanguínea sistólica após a implementação dos exercícios caiu em média 15.5mmHg, e a pressão diastólica caiu em média 10.6mmHg. Conclusões: Atividade física continua em pacientes hipertensos tem efeitos de médio e longo prazo no controle da pressão sanguínea. Nível de evidência II; Estudos terapêuticos - investigação de resultados de tratamento.

RESUMEN Introducción: La hipertensión es una de las enfermedades cardiovasculares y cerebrovasculares más comunes y un importante problema de salud. Aunque la presión de pacientes hipertensos pueda ser mejor controlada a través del uso racional de medicamentos, sus efectos colaterales y los elevados costos médicos limitan la habilidad de los pacientes de atender a las demandas de la hipertensión. Objetivo: Explorar el efecto a largo plazo de ejercicios en la rehabilitación de pacientes hipertensos. Métodos: Los pacientes fueron divididos en un grupo control y un grupo de ejercicios y realizaron múltiples evaluaciones de su presión sanguínea. Además, fue aplicado un cuestionario y la situación de cada paciente fue registrada. Luego, los resultados fueron comparados y analizados. Resultados: Después de 12 días de entrenamiento, la presión sanguínea de los pacientes disminuyó significativamente. La presión sanguínea sistólica, después de la implementación de los ejercicios, descendió en promedio 15.5mmHg, y la presión diastólica descendió en promedio 10.6mmHg. Conclusiones: La actividad física continua en pacientes hipertensos tiene efectos de medio y largo plazo en el control de la presión sanguínea. Nivel de evidencia II; Estudios terapéuticos - investigación de resultados de tratamiento.

24 hour urinary sodium excretion in essential hypertension

Hypertension is a common medical condition; its prevalence increases with age. It is one of the most important risk factors for cardiovascular disease, which is the leading cause of mortality. High salt intake is associated with high blood pressure. The incidence of hypertension is higher in salt-sensitive individuals. Evidence shows that reduced sodium intake lowers blood pressure and can prevent hypertension. Urinary sodium excretion was used as measure of sodium intake, which equals urinary excretion under normal circumstances. The relationship between salt intake and renal ability to excrete sodium has suggested being a major importance for the long-term blood pressure treatment especially in essential hypertension. In the present study there was increased 24 hour sodium excretion in essential hypertensives indicating a high intake of sodium, which may be the cause for hypertension. Patients with high sodium excretion, who are salt sensitive hypertensives will respond to diuretics, when compared to others. The long term reduction in salt intake may significantly reduce the prevalence of hypertension and thereby decrease the associated morbidity and mortality.

The significance of proteinuria in essential hypertension

The prevalence of hypertension is reported to be about 29% in India. Proteinuria is often the earliest marker of hypertension mediated renal damage, occurring even before a reduction in glomerular filtration rate (GFR). It can also be used to predict risks of chronic kidney disease (CKD) progression, cardiovascular disease, and all-cause mortality in general population. Thus monitoring proteinuria is a key aspect of assessing disease progression and treatment response in a variety of kidney diseases, including hypertensive renal damage. Target organ damage is common in microalbuminuric patients. They can have high left ventricular mass, a high prevalence of retinopathy , and an increased thickness and presence of plaques in the carotid artery. It is also interpreted as a marker of early intra renal vascular dysfunction in essential hypertension. Microalbuminuria is an independent predictor of cardiovascular morbidity and mortality in patients with essential hypertension. Microalbuminuria seems to constitute a simple and accurate method to detect a hypertensive patient at a high risk for cardiovascular and probably renal damage. The present study is comprised of 50 cases of essential hypertension. Microalbuminuria and Proteinuria was estimated. 27 patients i.e. 54% had microalbuminuria. Microalbuminuria had a positive correlation with severity of Hypertension with p value of 0.047 (< 0.05). Prevalence of microalbuminuria increases with the age and duration and severity of hypertension. Microalbuminuria had a statistically significant correlation with the presence and severity of target organ damage. Screening for microalbuminuria should be performed in hypertensives to start treatment early to minimize morbidity and mortality.

Hipertensión arterial esencial: ¿cuál agente antihipertensivo elegir? / Essential hypertension: which antihypertensive agent to choose?

Resumen Introducción: La hipertensión arterial sistémica (HTA) constituye el principal factor de riesgo para morbilidad y mortalidad cardiovascular a nivel global, afecta a todas las edades, sin distinción de género y etnicidad. Su tratamiento continúa constituyendo un reto, dada la persistencia del pobre control, especialmente en países como Colombia. Objetivo: Mostrar la evidencia disponible respecto al tratamiento actualizado de la HTA y la elección certera de los agentes antihipertensivos acorde con la individualidad de cada paciente. Asimismo, consolidar y comparar el efecto hipotensor de cada agente antihipertensivo más usado. Metodología: Se realizó una búsqueda avanzada con los términos DeCS y MeSH: hipertensión, agentes antihipertensivos, hipertensión esencial y terapia combinada, en los motores de búsqueda PubMed, Clinical Key, Lilacs, Scielo. Un total de 109 artículos se seleccionaron para elaborar en la presente revisión de la literatura. Conclusiones: La individualización del manejo de la HTA lleva al reconocimiento de los distintos fenotipos, la presencia de complicaciones, el examen físico, el género y la raza como puntos fundamentales para elegir el agente antihipertensivo más adecuado que permita alcanzar las metas de control y propenda por la reducción y prevención de las complicaciones derivadas de un control no óptimo.

Abstract Introduction: Systemic arterial hypertension (HT) constitutes the main risk factor for cardiovascular morbidity and mortality at a global level, affecting all ages regardless of gender and ethnicity. Its treatment continues to be a challenge, given the persistence of poor control, especially in countries like Colombia. Objective: To show the available evidence regarding the updated treatments of HT and the correct choice of antihypertensive agents according to the individual needs of each patient. Likewise, to consolidate and compare the hypotensive effect of the most used antihypertensive agents. Methodology: An advanced search was carried out with the terms DeCS and MeSH: Hypertension, antihypertensive agents, Essential Hypertension and Combination Therapy through the search engines PubMed, Clinical Key, Lilacs, Scielo. A total of 109 articles were selected to prepare the present literature review. Conclusions: An individualized hypertension treatment plan leads to the recognition of the different phenotypes, the presence of complications, the gender, and race, which are fundamental aspects to consider when choosing the appropriate antihypertensive agents. These findings allow for the achievement of the desired blood pressure target and leads to reduction and prevention of complications derived from suboptimal control.

Clinical study on Tianma Gouteng Decoction combined with amlodipine besylate tablets in the treatment of hypertension of liver-yang hyperactivity with left ventricular hypertrophy / 国际中医中药杂志

Objective:To evaluate the clinical efficacy of Tianma Gouteng Decoction combined with amlodipine besylate tabletsin treating patients with hypertension of liver-yang hyperactivity complicated with left ventricular hypertrophy (LVH).Methods:A total of 80 patients with hypertension of liver-yang hyperactivity complicated with LVH, who met the inclusion criteria and were treated in the hospital between June 2019 and January 2021, were divided into two groups, with 40 in each group according to the random number table method. The control group was treated with amlodipine besylate tablets orally, and the observation group was treated with granules of Tianma Gouteng Decoction on the basis of the control group. Both groups were treated for 2 months. Before and after treatment, the TCM syndromes were scored and the office blood pressure was measured with sphygmomanometer, and color Doppler ultrasonic diagnostic apparatus was adopted to detect the interventricular septum thickness (IVST), left ventricular posterior wall thickness (PWT), left ventricular end diastolic diameter (LVDd) and left ventricular mass index (LVMI), and the levels of homocysteine (Hcy) and Cystatin C (Cys-C) were determined by ELISA and the level of uric acid (UA) was determined by fully automatic biochemical analyzer. The clinical efficacy was evaluated.Results:The total effective rate was 95.0% (38/40) in the observation group and that of the control group was 77.5% (31/40) ( χ2=5.17, P=0.023). After treatment, the scores of dizziness, headache, insomnia and dreaminess and vexation and forgetfulness and total score of the observation group were significantly lower than those in the control group ( t=10.06, 14.47, 15.47, 8.74, 14.50, all Ps<0.001), and the systolic blood pressure and diastolic blood pressure were significantly lower than those in the control group ( t=6.30, 8.79, P<0.001). The IVST [(9.36±1.32) mm vs. (11.23±1.07) mm, t=6.96], PWT [(8.89±1.14)mm vs. (10.03±1.02)mm, t=4.71], LVDd[(40.36±4.29) mm vs. (47.62±4.19) mm, t=7.66] and LVMI [(112.39±22.29) g/m 2vs. (148.26± 21.39) g/m 2, t=7.34] were significantly lower compared to the control group ( P<0.01). The levels of Hcy[(12.87±3.11) μmol/L vs. (19.85±3.67) μmol/L, t=9.18], UA [(276.29±19.56) μmol/L vs. (338.52±17.07) μmol/L, t=16.65] and Cys-C [(0.86±0.15) mg/L vs. (1.10±0.17) mg/L, t=6.70] were significantly lower than those in the control group ( P<0.01). Conclusion:The Tianma Gouteng Decoction can improve the clinical symptoms, control the blood pressure, relieve the left ventricular hypertrophy and improve the renal function of patients with hypertension of liver-yang hyperactivity complicated with LVH.

Expression and clinical significance of Apelin, Elabela and lipoprotein associated phospholipase A2 in patients with hypertensive heart disease / 中国医师进修杂志

Objective:To investigate the expression and clinical significance of Apelin, Elabela(ELA), lipoprotein associated phospholipase A2 (LP-PLA2) in patients with hypertensive heart disease (HHD).Methods:One hundred and eight HHD patients treated in the Fuyang District Second People′s Hospital of Hangzhou City from June 2019 to June 2021 were collected as the observation group, and 108 essential hypertension (EH) patients without HHD during the same period were collected as the control group. The clinical indicators and the levels of Apelin, ELA and LP-PLA2 were compared between the two groups. Receiver operating characteristic (ROC) curve was used to analyze the efficacy of Apelin, ELA and LP-PLA2 in predicting HHD. According to the median of Apelin, ELA and LP-PLA2, the patients were divided into high Apelin group and low Apelin group, high ELA group and low ELA group, high LP-PLA2 group and low LP-PLA2 group, with adverse cardiovascular events (MACE) as the end point. Kaplan-Meier method was used to plot the survival curve and Log-rank was used to test the difference between groups.Results:The course of EH in the observation group was longer than that in the control group: (8.74 ± 2.25) years vs. (4.72 ± 1.85) years; systolic pressure, diastolic pressure, N-terminal B-type natriuretic peptide (NT-proBNP), Apelin, ELA, LP-PLA2 were higher than those in the control group: (136.82 ± 11.47) mmHg (1 mmHg = 0.133 kPa) vs. (124.83 ± 12.72) mmHg, (82.52 ± 5.73)mmHg vs. (78.96 ± 5.95) mmHg, (3 624.35 ± 1 023.13) ng/L vs. (934.24 ± 352.53) ng/L, (5.16 ± 2.17) μg/L vs. (2.44 ± 1.97) μg/L, (182.72 ± 89.76) μg/L vs. (114.67 ± 46.22) μg/L; Apelin and left ventricular ejection fraction were lower than those in the control group: (28.75 ± 13.29) ng/L vs. (56.82 ± 19.84) ng/L, (52.16 ± 6.72)% vs. (58.63 ± 6.87)%, there were statistical differences ( P<0.05). Apelin was positively correlated with LVEF ( r = 0.530, P<0.05), while ELA and LP-PLA2 were negatively correlated with LVEF ( r = - 0.751, - 0.785, P<0.05). Apelin was negatively correlated with NT-proBNP ( r = - 0.358, P<0.05), ELA, LP-PLA2 were positively correlated with NT-proBNP ( r = 0.739 and 0.727, P<0.05). ROC curve analysis showed that the area under the curve values of Apelin, ELA and LP-PLA2 were 0.732, 0.761, 0.843. Logistic regression analysis showed that the course of EH ( OR = 1.325), Apelin ( OR = 0.563), ELA ( OR = 2.348) and LP-PLA2 ( OR = 2.573) were the risk factors of HHD ( P<0.05). Survival curve analysis showed that the incidence of MACE in the low Apelin group was higher than that in the high Apelin group, in the high ELA group was higher than that in the low ELA group, and in the high LP-PLA2 group was higher than that in the low LP-PLA2 group, there were statistical differences ( P<0.05). Conclusions:Apelin, ELA and LP-PLA2 can be used as reference indexes to predict EH complicated with HHD, and can help to judge the early prognosis of HHD patients.

Analysis of metabolic indexes and other characteristics in patients with primary aldosteronism / 中国综合临床

Objective:To analyze the changes of metabolic indexes and other characteristics in patients with primary aldosteronism (PA) and improve the understanding of PA.Methods:From January 2017 to August 2020, 91 PA patients who were clearly diagnosed and met the inclusion conditions in Tangshan workers Hospital, Hebei Medical University were selected as the observation object (PA group), and 112 patients diagnosed as essential hypertension (EH) in the same period were included as the control (EH group). A retrospective case-control study was conducted to compare the differences of blood glucose, blood lipid, homocysteine, blood potassium, creatinine, uric acid, aldosterone, renin, plasma aldosterone to renin ratio (ARR), blood pressure and waist circumference between the two groups. The measurement data of normal distribution were compared by independent sample t-test. The non normal distribution data are represented by M (Q 1, Q 3), and the rank sum test is used for inter group comparison. Comparison of counting data χ2 inspection. Logistic regression was used in multivariate analysis. Results:Univariate analysis showed that serum potassium, renin and ARR were (3.37±0.39) mmol/L, 1.61 (0.34, 7.23) ng/L and 96.85 (26.06, 506.10) in PA group and (3.91±0.59) mmol/L, 12.81 (1.90, 82.45) ng/L and 13.22 (1.06, 54.63) in EH group ( t=3.35, z=6.24, z=55.40, all P<0.001). In PA group, systolic blood pressure was (190.80±20.30) mmHg, diastolic blood pressure was (117.70±12.89) mmHg, waist circumference was (91.67±9.38) cm, and in EH group, systolic blood pressure was (177.01±12.89) mmHg, diastolic blood pressure was (101.39±9.34) mmHg, waist circumference was (86.59±9.07) cm. There were significant differences between the two groups ( t=5.88, 10.44, 3.90; all P<0.001). Multivariate logistic regression analysis showed that waist circumference (OR=1.065, 95% CI 1.007-1.118, P<0.001), systolic blood pressure (OR=1.053, 95% CI 1.034-1.077, P<0.001), diastolic blood pressure (OR=1.054, 95% CI 1.031-1.077, P<0.001), and ARR (OR=1.170, 95% CI 1.115-1.228, P<0.001) were the risk factors for PA. Conclusion:Compared with essential hypertension, PA patients have higher blood pressure, ARR and waist circumference, lower blood potassium and renin levels. Systolic blood pressure, diastolic blood pressure, ARR and waist circumference are the risk factors of PA. Strengthening the screening and treatment of PA in high-risk groups is helpful to better avoid the risk of target organ damage.

Establishment of a TreeNet algorithm-based model for early prediction of essential hypertension / 预防医学

Objective@#To create a model for early prediction of essential hypertension (EH) based on the TreeNet algorithm, so as to provide a tool for early monitoring of EH. @*Methods@#The health examination data were collected from individuals receiving health examinations in Hangzhou Haiqin Health Examination Center or Shanghai Yibao Health Management Co., Ltd from 2014 to 2016, and a predictive model for EH was created based on the TreeNet algorithm. The effectiveness of the model for early prediction of EH was evaluated using root mean square error (RMSE), mean absolute deviation (MAD), coefficient of determination (R2) and receiver operating characteristic (ROC) curve. @*Results@#A total of 12 variables were included in the model, and the highest contributing variable was body mass index (BMI), followed by BMI difference, two-year BMI difference, two-year triglyceride (TG) difference, two-year total cholesterol (TC) difference, high-density lipoprotein cholesterol (HDL-C) in 2014, TG in 2014, low-density lipoprotein cholesterol (LDL-C) in 2014, body weight in 2015, fasting blood glucose in 2015, TG in 2015, urea nitrogen difference and platelet in 2015. The highest predictive accuracy was 100.00%, and the lowest was 56.89%. The risk of EH significantly increased among individuals with BMI in 2015 of >25 kg/m2, two-year BMI difference of >0.5 kg/m2, two-year TG difference ranging from 1.3 to 3.3 mmol/L, TC in 2015 of 2.0 to 2.4 mmol/L and HDL-C in 2014 of <0.52 mmol/L. The model presented RMSE of 0.082, MAD of 0.064, R2 of 0.811, area under the ROC curve of 0.788 (95%CI: 0.741-0.815), sensitivity of 69.05% and specificity of 66.21% for prediction of EH@*Conclusion@# The TreeNet algorithm-based model is effective for early monitoring of high-risk individuals for EH.

Involvement of ET-1/eNOS in the ameliorating effect of electroacupuncture on cardiac dysfunction in rats with spontaneously hypertensive / 中国针灸

OBJECTIVE@#To observe the effect of electroacupuncture (EA) at "Neiguan" (PC 6) on cardiac function of ventriculus sinister in rats with spontaneously hypertensive (SHR), and to explore the mediation effect of endothelin-1 (ET-1)/endothelial nitric oxide synthase (eNOS).@*METHODS@#Six 12-week-old male Wistar Kyoto (WKY) rats were taken as the normal group. Eighteen 12-week-old SHR were randomly divided into a model group, an EA group and a sham EA group, 6 rats in each group. The rats in the EA group were treated with EA (disperse-dense wave, 2 Hz/15 Hz in frequency, 1 mA in current intensity) at "Neiguan" (PC 6), 30 min each time, once a day for 8 weeks. The rats in the sham EA group were treated with superficial needling at "Neiguan" (PC 6) with no electrical stimulation applied. After treatment, the left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) were tested by echocardiographic analysis. The left ventricular systolic pressure (LVSP), left ventricular end-diastolic pressure (LVEDP), heart rate (HR), the maximum rate of increase/decrease of left ventricular pressure (±dp/dtmax) were detected. The serum content of ET-1 was detected by ELISA. Western blot was used to evaluate the expression of ETAR, eNOS in myocardial tissue of left ventricular.@*RESULTS@#Compared with the normal group, LVEF, LVFS, +dp/dtmax/LVSP and -dp/dtmax/LVSP were decreased (P<0.01, P<0.05), while LVSP, LVEDP, +dp/dtmax and -dp/dtmax were increased (P<0.01) in the model group. Compared with the model group, LVEF, LVFS, +dp/dtmax/LVSP and -dp/dtmax/LVSP were increased (P<0.01, P<0.05), and LVSP and LVEDP were decreased (P<0.01) in the EA group. Compared with the normal group, the serum content of ET-1 and the expression of ETAR in myocardial tissue were increased (P<0.01), whereas expression of eNOS was decreased (P<0.01) in the model group. Compared with the model group, the serum content of ET-1 and the expression of ETAR in myocardial tissue were decreased (P<0.05), whereas expression of eNOS was increased (P<0.05) in the EA group.@*CONCLUSION@#EA intervention may alleviate hypertensive cardiac function damage by up-regulating the expression of eNOS protein in myocardial tissue, down-regulating the serum content of ET-1 and the expression of ETAR protein in myocardial tissue.

Caracterización de los pacientes con hipertensión arterial esencial y diabetes mellitus tipo 2 de la consulta externa de un servicio de medicina interna / Characterization of patients with essential arterial hypertension and type 2 diabetes mellitus from the external consultation of an internal medicine service

Caracterizar los pacientes con hipertensión arterial esencial y diabetes mellitus tipo 2 de la consulta externa. Métodos: Se realizó un estudio de único centro, transversal, en pacientes de la consulta externa de medicina interna del Hospital del Instituto Venezolano de los Seguros Sociales (IVSS) "Dr. Miguel Pérez Carreño". Resultados: Se evaluaron 120 pacientes, donde el sexo femenino fue más frecuente con 65%, provenientes en su mayoría del Distrito Capital 83.33%. Un 39,1% eran jubilados y 55% estaban en normopeso. El promedio de PAS y PAD fue de 140 ±19,6 mmHg y 84 ±15,2 mmHg respectivamente. El 47,5% tenían prescripción con BRA. La duración de las enfermedades era >10 años, el consumo de café fue el hábito más destacado con 78,33%, y la mayoría eran sedentarios con 64,16% y los últimos seis mesas el evento medico más descrito fue el mareo con 27,56%. En un 85,84% de los casos con diabetes mellitus tipo 2 no estaban controlados. El 67% de los casos con diabetes mellitus tipo 2 encuestados consideran que su enfermedad no está bajo control, y los médicos conceptuaron que el 79,17% de los pacientes no tenían adecuado control. Conclusión: Se evidencia incumplimiento de las metas de control de los pacientes con HTA y DMT2, con un mayor predominio de esta última, y la presencia de factores de riesgo como el sedentarismo en un alto porcentaje(AU)

Characterize outpatient patients with essential arterial hypertension and type 2 diabetes mellitus. Methods: A single-center, cross-sectional study was conducted in patients from the internal medicine outpatient clinic of the Hospital of the Venezuelan Institute of Social Security (IVSS) "Dr. Miguel Pérez Carreño". Results: 120 patients were evaluated, where the female sex was more frequent with 65%, coming mostly from the Capital District 83.33%. 39.1% were retired and 55% were normal weight. e mean SBP and DBP were 140 ± 19.6 mmHg and 84 ± 15.2 mmHg, respectively. 47.5% had a prescription with ARB. e duration of the diseases(AU)