Prevalence, trends, and factors associated with hypertensive crisis among Peruvian adults / Prevalencia, tendencias y factores asociados a la crisis hipertensiva en adultos peruanos / Prevalência, tendências e fatores associados à crise hipertensiva em adultos peruanos

There are few studies focused on the epidemiology of hypertensive crisis at the population level in resource-constrained settings. This study aimed to determine the prevalence and trends over time of hypertensive crisis, as well as the factors associated with this condition among adults. A secondary data analysis was carried out using the Peruvian Demographic and Family Health Survey (ENDES). Hypertensive crisis was defined based on the presence of systolic (≥ 180mmHg) or diastolic (≥ 110mmHg) blood pressure, regardless of previous diagnosis or medication use. The factors associated with our outcome were evaluated using multinomial logistic regression, and the trend of hypertensive crisis was evaluated using the Cochrane-Armitage test. Data from 260,167 participants were analyzed, with a mean age of 44.2 (SD: 16.9) years and 55.5% were women. Hypertension prevalence was 23% (95%CI: 22.7-23.4) and, among them, 5.7% (95%CI: 5.4-5.9) had hypertensive crisis, with an overall prevalence of 1.5% (95%CI: 1.4-1.6). From 2014 to 2022, a significant decrease in the prevalence of hypertensive crisis was observed, from 1.7% in 2014 to 1.4% in 2022 (p = 0.001). In the multivariable model, males, increasing age, living in urban areas, high body mass index, and self-reported type 2 diabetes were positively associated with hypertensive crisis, whereas higher educational level, socioeconomic status, and high altitude were inversely associated. There is a need to improve strategies for the diagnosis, treatment, and control of hypertension, especially hypertensive crisis.

Pocos estudios se han centrado en la epidemiología de la crisis hipertensiva a nivel poblacional en entornos de recursos limitados. El objetivo de este estudio fue determinar la prevalencia y tendencia, a lo largo del tiempo, de la crisis hipertensiva y los factores asociados a esta condición en adultos. Se realizó un análisis de datos secundarios utilizando la Encuesta Demográfica de Salud Familiar (ENDES) de Perú. La crisis hipertensiva se definió en función de la presencia de presión arterial sistólica (≥ 180mmHg) o diastólica (≥ 110mmHg), independientemente del diagnóstico previo o del uso de medicamentos. Los factores asociados a los resultados se evaluaron mediante regresión logística multinomial, y la tendencia a la crisis hipertensiva se estimó mediante la prueba Cochran-Armitage. Los datos de 260.167 participantes, con una media de 44,2 años (DE: 16,9) y 55,5% mujeres, fueron analizados. La prevalencia de hipertensión fue del 23% (IC95%: 22,7-23,4), de la cual el 5,7% (IC95%: 5,4-5,9) tuvo crisis hipertensiva, con una prevalencia general del 1,5% (IC95%: 1,4-1,6). En el período 2014-2022 se constató una disminución significativa en la prevalencia de crisis hipertensiva, del 1,7% en 2014 al 1,4% en 2022 (p = 0,001). En el modelo multivariable, el sexo masculino, el aumento de la edad, vivir en áreas urbanas, el alto índice de masa corporal y la diabetes autoinformada se asociaron positivamente con la crisis hipertensiva, mientras que mayor nivel educativo, nivel socioeconómico y elevada altitud estuvieron asociadas de manera inversa. Es necesario mejorar las estrategias para el diagnóstico, el tratamiento y el control de la hipertensión, especialmente de la crisis hipertensiva.

Há poucos estudos focados na epidemiologia da crise hipertensiva em nível populacional em ambientes com recursos limitados. O objetivo deste estudo foi determinar a prevalência e a tendência, ao longo do tempo, da crise hipertensiva e fatores associados a essa condição em adultos. Uma análise de dados secundários foi realizada usando a Pesquisa Demográfica de Saúde Familiar (ENDES) do Peru. Crise hipertensiva foi definida com base na presença de pressão arterial sistólica (≥ 180mmHg) ou diastólica (≥ 110mmHg), independentemente de diagnóstico prévio ou uso de medicação. Os fatores associados aos resultados foram avaliados por meio de regressão logística multinomial, e a tendência de crise hipertensiva foi avaliada pelo teste de Cochrane-Armitage. Os dados de 260.167 participantes, com média de 44,2 anos (DP: 16,9) e 55,5% mulheres, foram analisados. A prevalência de hipertensão foi de 23% (IC95%: 22,7-23,4), dentre eles, 5,7% (IC95%: 5,4-5,9) apresentaram crise hipertensiva, com prevalência geral de 1,5% (IC95%: 1,4-1,6). De 2014 a 2022, observou-se queda significativa na prevalência de crise hipertensiva, de 1,7% em 2014 para 1,4% em 2022 (p = 0,001). No modelo multivariável, sexo masculino, idade crescente, residir em área urbana, índice de massa corporal elevado e diabetes autorreferido associaram-se positivamente à crise hipertensiva, enquanto maior escolaridade, nível socioeconômico e altitude elevada associaram-se inversamente. Há necessidade de aprimorar as estratégias de diagnóstico, tratamento e controle da hipertensão arterial, especialmente da crise hipertensiva.

Earthworm Protein Protects Vascular Endothelial Function in Spontaneously Hypertensive Rats via PI3K/Akt/Nrf2 Signaling Pathway / 中国实验方剂学杂志

ObjectiveTo observe the effect of earthworm protein on the expression of phosphatidylinositol 3-kinase/protein kinase B/nuclear factor E2-related factor 2 （PI3K/Akt/Nrf2） pathway in the aorta of spontaneously hypertensive rats （SHR） and explore mechanism of earthworm protein in treating hypertensive vascular endothelial dysfunction （VED）. MethodTen 10-week-old Wistar Kyoto （WKY） rats and fifty SHR rats were selected for a week of adaptive feeding. WKY rats were selected as the normal group， and fifty SHR rats were randomized according to body weight into model， valsartan （8×10-3 g·kg-1·d-1）， and high-， medium-， and low-dose （0.2， 0.1， 0.05 g·kg-1·d-1， respectively） earthworm protein groups. The normal and model groups were administrated with equal volume of double distilled water by gavage. During the drug intervention period， the general situations of rats in each group were observed and their blood pressure was monitored at specific time points every other week before and after administration. After 8 weeks of drug intervention， enzyme-linked immunosorbent assay was employed to measure the levels of angiotensin-Ⅱ （Ang-Ⅱ） and endothelin-1 （ET-1） in the serum of rats in each group. The corresponding kits were used to determine the levels of nitric oxide （NO）， malondialdehyde （MDA）， glutathione peroxidase （GPX）， superoxide dismutase （SOD）， and ferrous ion （Fe2+）. Hematoxylin-eosin （HE） staining was employed to observe the changes in the intima of the aorta. Fluorescence quantitative polymerase chain reaction （Real-time PCR） was employed to measure the mRNA levels of PI3K， Akt， Nrf2， heme oxygenase-1 （HO-1）， and glutathione peroxidase 4 （GPX4） in the aortic tissue. Western blotting was used to determine the protein levels of p-PI3K （Tyr467/199）， PI3K， p-Akt （Ser473）， Akt， Nrf2， HO-1， and GPX4 in the thoracic aorta. ResultCompared with the normal group， the model group had decreased body mass， increased irritability， severe endothelial damage， elevated blood pressure and serum levels of Ang-Ⅱ， ET1， MDA， and Fe2+ （P<0.01）， lowered NO level （P<0.01）， and down-regulated mRNA and protein levels of p-PI3K （Tyr467/199）， PI3K， p-Akt （Ser473）， Akt， Nrf2， HO-1， and GPX4 in the aortic tissue （P<0.01）. Compared with the model group， drug intervention caused no significant change in the body mass， calmed the rats， alleviated the endothelial damage， lowered blood pressure and serum levels of Ang-Ⅱ， ET1， MDA， and Fe2+ （P<0.01）， elevated the NO level （P<0.05）， and up-regulated the mRNA and protein levels of p-PI3K （Tyr467/199）， PI3K， p-Akt （Ser473）， Akt， Nrf2， HO-1， and GPX4 （P<0.05）. ConclusionThe earthworm protein can exert antihypertensive effects by ameliorating VED in SHR. Specifically， it may regulate the PI3K/Akt/Nrf2 signaling pathway to inhibit oxidative stress and ferroptosis.

Estados hipertensivos del embarazo y complicaciones materno-perinatales en el Hospital Regional De Ciudad del Este

Introducción: Los estados hipertensivos del embarazo son un conjunto de patologías que puede producir muerte o discapacidad crónica en las madres, en los fetos y recién nacidos. Objetivo: Determinar la frecuencia de los estados hipertensivos del embarazo y las complicaciones materno-perinatales en el Hospital Regional de Ciudad del Este. Materiales y métodos: Estudio transversal descriptivo con muestreo no probabilístico. Se estudiaron a todas las mujeres embarazadas con estados hipertensivos del embarazo o asociado al mismo que tuvieron eventos obstétricos en el Hospital Regional de Ciudad del Este en los años 2018 al 2020. Los datos fueron analizados en el Software Stata 12.0. Resultados: Se estudiaron a 7056 pacientes. Se encontraron 11,9% participantes con estados hipertensivos del embarazo, 55,3% con mayor frecuencia entre los 20 a 35 años, el 71,3% tuvieron control prenatal de mala calidad, se encontraron el 42,8% con preeclampsia. El 65,2% terminaron por cesárea, 27,8% Síndrome de HELLP, el 1,4% presentaron requerimiento de terapia intensiva y 0,6% muerte materna. Con respecto a las complicaciones perinatales se encontraron bajo peso al nacer en 30,2% y muerte del 2%. Conclusión: Se registró alta frecuencia de estados hipertensivos del embarazo con alto porcentaje de complicaciones, mala calidad de control prenatal. Entre las complicaciones perinatales más frecuentes fueron el bajo peso al nacer y la más grave es la muerte.

Introduction: Hypertensive states of pregnancy are a set of pathologies that can cause death or chronic disability in mothers, fetuses and newborns. Objective: To determine the frequency of hypertensive states of pregnancy and maternal-perinatal complications at the Regional Hospital of Ciudad del Este. Materials and methods: Descriptive cross-sectional study with non-probability sampling. All pregnant women with hypertensive states of pregnancy or associated with pregnancy who had obstetric events at the Regional Hospital of Ciudad del Este in the years 2018 to 2020 were studied. The data were analyzed in Stata 12.0 software. Results: A total of 7056 patients were studied. 11.9% of participants had hypertensive states of pregnancy, and among them, 55.3% were found to be more frequent from 20 to 35 years of age, 71.3% had poor prenatal care, and 42.8% had preeclampsia. 65.2% of the participants ended up with cesarean delivery, 27.8% had HELLP syndrome, 1.4% required intensive care and 0.6% ended in maternal death. Regarding perinatal complications, low birth weight was found in 30.2%, and death at birth in 2%. Conclusion: A high frequency of hypertensive states of pregnancy with a high percentage of complications and poor quality of prenatal control was registered. One of the most common perinatal complications were low birth weight, and the most serious was death.

Perioperative hypertension

The effects of hypertension on perioperative outcomes are still unclear. No specific systolic or diastolic blood pressure measurement has been determined as the cutoff value to continue with a surgical plan or adjourn. This study is designed as a narrative review of the available scientific evidence on the perioperative management of hypertension. A search was conducted in Pubmed considering the title and abstract; 120 articles were pre-selected of which 55 papers were selected for full-text eligibility and 16 were excluded for a total of 39 articles including ACCF/AHA 2009 and ACC/AHA 2014 on perioperative cardiovascular care; 2013 ESH/ESC, 8 JNC, and the 2017 ACC/AHA/AAPA/ABC Guideline for the Prevention, detection, and management of hypertension in adults. Blood pressure values, target organ damage, and type of surgery should be considered for decision-making in the perioperative period. If surgery is elective, blood pressure fluctuations should be avoided and potential causes should be treated. A patient with mild hypertension with values below SBP 160 and DBP 110 mmHg may be managed in the ambulatory setting during the postoperative period, as long as the clinical conditions are favorable.

Los efectos de la hipertensión sobre los desenlaces durante el periodo perioperatorio aún no han quedado claramente establecidos. No se ha determinado una medición específica para la presión sistólica ni diastólica como punto de corte para continuar con el plan quirúrgico o suspenderlo. El presente estudio está diseñado a manera de revisión narrativa de la evidencia científica disponible sobre el manejo perioperatorio de la hipertensión. Se llevó a cabo una búsqueda en Pubmed, considerando el título y el resumen; se preseleccionaron 120 artículos, de los cuales se seleccionaron 55 para elegibilidad en texto completo y 16 se excluyeron, quedando un total de 39 artículos, incluyendo ACCF/AHA 2009 y ACC/AHA 2014 sobre el cuidado cardiovascular perioperatorio; 2013 ESH/ESC, 8 JNC, y la Guía del 2017 ACC/AHA/AAPA/ABC para la prevención, detección y manejo de la hipertensión en adultos. Se deben considerar los valores de la presión arterial, el daño a órgano diana y el tipo de cirugía para la toma de decisiones en el periodo perioperatorio. Si la cirugía es electiva, deben evitarse las fluctuaciones en la presión arterial y tratar activamente cualquiera de las causas potenciales. Un paciente con hipertensión leve, con valores por debajo de PAS 160 y PAD 110 mmHg puede manejarse de manera ambulatoria durante el período postoperatorio, siempre y cuando las condiciones clínicas sean favorables.

Prevalence of hypertensive phase and outcomes in patients with Ahmed valve implantation at one year of follow-up and evaluation of associated risk factors

Purpose: To evaluate the prevalence of hypertensive phase (HP) and failure in patients who underwent Ahmed Glaucoma Valve (AGV) implantation and identify the possible risk factors for both HP and failure. Methods: A cross?sectional, observational study was conducted. Medical records of patients who underwent AGV implantation and had at least 1 year of follow?up were reviewed. HP was defined as an intraocular pressure (IOP) greater than 21 mmHg between the first week and the third postoperative month not attributable to other causes. Success was defined as an IOP between 6 and 21 mmHg, with preservation of light perception and no additional glaucoma surgeries. Statistical analysis was conducted to identify possible risk factors. Results: A total of 193 eyes of 177 patients were included. HP was present in 58%; a higher preoperative IOP and younger age were associated with HP. Pseudophakic or aphakic eyes had a lower HP rate. Failure was present in 29%; neovascular glaucoma, worse basal best corrected visual acuity (BCVA), higher baseline IOP, and postoperative complications were linked to a higher likelihood of failure. No difference in the HP rate between the failure and success groups was found. Conclusion: A higher baseline IOP and younger age are associated with HP development; pseudophakia and aphakia might be protective factors. Factors for AGV failure are a worse BCVA, neovascular glaucoma, postoperative complications, and a higher baseline IOP. At 1 year, a higher number of medications were needed to achieve IOP control in the HP group

Intake of Fruits and Vegetables as Self Prescribed Weight Reducing and DASH Diets among Obese-Hypertensive Individuals Attending Irrua Specialist Teaching Hospital Irrua, Edo State, Nigeria

Background: Five servings of fruits and vegetables each day, along with relatively unprocessed whole grains or legumes with each meal, are essential for reducing the risk of obesity, hypertension and other related non communicable diseases. While being low or relatively low in calories, fruits and vegetables include a large amount of dietary fiber and a range of micronutrients, antioxidants and phytochemicals which are all essential for health. Aims: To investigate the intake of fruits and vegetables as self prescribed weight reducing and DASH (Dietary Approach to Stop Hypertension) diets among obese - hypertensive individuals attending Irrua Specialist Teaching Hospital Irrua, Edo State. Methods: A descriptive cross sectional study design was used with a sample size of 440 obese hypertensive individuals (with body mass index of = or > 30Kg/m2 and blood pressure of = or > 140/90mmHg). Questionnaires, personal interviews and anthropometric measurements were used to collect data using purposive sampling technique. Data collected were analyzed using Statistical Package for the Social Sciences (IBM SPSS) 22 Version. Results: A total of 440 respondents were used in the study and data were elicited from all of this number giving a 100% response rate. A total of 242 (55.0%) and 215 (48.9%) of the respondents consumed fruits and vegetables only one to two days per week with only 36 (8.2%) and 26 (5.9%) consuming fruits and vegetables every day. Conclusion: It can be concluded based on the key findings of this study that there is statistically significant mean difference in fruits and vegetables consumption amongst obese - hypertensive individuals attending Irrua Specialist Teaching Hospital, Edo State, Nigeria (p<0.05).

Evaluation of relationship between markers of inflammation and blood pressure in subjects attending OPD in a tertiary care center in Chennai

Background: The incidence and prevalence of hypertension have been increasing steadily in the present era. Inflammation is a proven key factor in the pathogenesis of hypertension. C-reactive protein (CRP) is a known marker of vascular inflammation leading to hypertension. High-sensitivity CRP (hs-CRP) is a sensitive marker of assessment of inflammatory changes before the rise in CRP. Aims and Objectives: The goal of this study was to decipher the stage at which inflammation starts related to changes in hypertension using CRP as well as hs-CRP. Materials and Methods: This is a cross-sectional study which included 120 individuals, who were subdivided into three groups - Normotensive: 40, pre-hypertensive: 40, and hypertensive. JNC classification was used for the categorization of blood pressure. hs-CRP was analyzed as per the principle of ELISA. Results: There was a significant difference in hs-CRP between normotensive and hypertensive. A strong association between hypertension, CRP, and hs-CRP was found. Conclusion: hs-CRP is a sensitive marker for early assessment of inflammatory components in hypertension.

Frecuencia y características de la encefalopatia hipertensiva secundaria a glomerulonefritis posinfecciosa en pacientes internados en un hospital de referencia nacional

Introducción: La glomerulonefritis aguda pos infecciosa (GNPI) puede cursar con complicaciones como la encefalopatía hipertensiva en 7-11% de los casos. Objetivo : determinar la frecuencia y características de la encefalopatía hipertensiva (EH) secundaria a GNPI en pacientes internados en el Departamento de Pediatría del Hospital Nacional en el periodo enero/2000-diciembre/2018. Materiales y Métodos : Estudio observacional, descriptivo, retrospectivo de pacientes con síndrome nefrítico (SN) con C3 disminuido y normalización a los tres meses, con hipertensión arterial (HTA) severa acompañada de manifestaciones neurológicas (cefalea, náuseas, vómitos, alteración de conciencia, convulsiones), que cedieron al regularizarse la HTA. Se estudiaron las características sociodemográficas (edad, sexo, procedencia, escolaridad de los padres, número de hijos) y clínicas (edema periférico, edema agudo de pulmón, hematuria, y manifestaciones neurológicas). Los datos fueron analizados utilizando estadística descriptiva mediante EPIINFO (CDC, Atlanta), expresando las variables cuantitativas como mediana y rango intercuartílico (RIC) y las cualitativas como frecuencia absoluta y porcentual. Resultados: 27 /160 (16,8%) pacientes, desarrollaron EH. La edad varió entre 3 a 16 años (mediana: 10 años; RIC: 5); el antecedente infeccioso más frecuente fue piodermitis (40,7%), seguido de faringitis aguda (37%). Todos los pacientes presentaron edema periférico y cefalea intensa. La duración de la HTA tuvo una mediana de 5 días (RIC: 4) y los días de internación una mediana de 7 (RIC: 6). Ningún paciente requirió diálisis ni quedó con secuelas, no se registraron óbitos. Conclusión: en pacientes con EH debe considerarse el diagnóstico de GNPI, investigando antecedentes infecciosos y valorando adecuadamente la volemia.

Introduction: Acute post-infectious glomerulonephritis (APGN) can present with complications such as hypertensive encephalopathy in 7-11% of cases. Objective: to determine the frequency and characteristics of hypertensive encephalopathy (HE) secondary to APGN in patients admitted to the Department of Pediatrics of the National Hospital from January/2000 to December/2018. Materials and Methods: This was an observational, descriptive and retrospective study of patients with nephritic syndrome (NS) with decreased C3 and normalization at three months, with severe arterial hypertension (AHT) accompanied by neurological manifestations (headache, nausea, vomiting, altered consciousness, seizures), which subsided when the AHT was controlled. Sociodemographic (age, sex, place of residence, parental education level, number of children in home) and clinical (peripheral edema, acute pulmonary edema, hematuria, and neurological manifestations) characteristics were studied. The data were analyzed using descriptive statistics through EPI INFO (CDC, Atlanta), expressing the quantitative variables as median and interquartile range (IQR) and the qualitative ones as absolute frequency and percentage. Results: 27/160 (16.8%) patients developed HE. Age ranged from 3 to 16 years (median: 10 years; IQR: 5); the most frequent infectious history was pyodermitis (40.7%), followed by acute pharyngitis (37%). All patients presented peripheral edema and severe headache. The duration of AHT had a median of 5 days (IQR: 4) and the days of hospitalization a median of 7 (IQR: 6). No patient required dialysis or was left with sequelae, no deaths were recorded. Conclusion: in patients with HE, the diagnosis of APGN should be considered, a history of infections obtained and adequately assessing fluid status.

Correlation between hypertensive retinopathy and fetal outcomes in patients with preeclampsia in a tertiary care hospital: A prospective cohort study

Purpose: To study the effect of increasing grades of hypertensive retinopathy (HTR) on neonatal outcomes among preeclamptic women and assess the various maternal risk factors for HTR. Methods: A prospective cohort study was conducted on 258 preeclamptic women. The systolic and diastolic blood pressure (SBP and DBP), liver, and renal function parameters were collected besides basic demographic details. Dilated fundus examination with the Keith–Wagner–Barker classification was used to grade HTR. Following delivery, neonatal outcomes were evaluated. Results: Of the 258 preeclamptic women recruited, 53.1% had preeclampsia (PE), and 46.9% had severe preeclampsia. With increasing grades of HTR, a significant association with low birth weight (LBW) (p = 0.012) and preterm gestational age (p = 0.002) was noted but not with the Appearance, Pulse, Grimace, Activity and Respiration (APGAR) score (p = 0.062). Also, it did not increase the risk of retinopathy of prematurity (ROP), with most babies, even those born to mothers with high grades of HTR, showing no evidence of ROP (p = 0.025). Among the maternal factors, increasing age (p = 0.016), SBP (p < 0.001), DBP (p < 0.001), serum creatinine (p = 0.035), alanine aminotransferase (p = 0.008), lower hemoglobin (Hb) (p = 0.009), lower platelet (p < 0.001), and severe PE (p < 0.001) have been found to significantly affect the grade of HTR. Conclusion: Higher grades of HTR in the preeclamptic mother are associated with preterm delivery and LBW of the neonates but neither affect the APGAR score nor pose the risk of developing ROP

El fondo de ojo, una ventana a la microvasculatura del paciente hipertenso / The fundus, a window to microvasculature in hypertensive patients

Introducción: La hipertensión arterial constituye una de las enfermedades más frecuentes en la población general. En la actualidad llega a una prevalencia global del 30 al 45 %. La microcirculación retiniana puede considerarse como una representación anatómica de las características fisiológicas y funcionales de la circulación coronaria y cerebral. Objetivos: Profundizar en la relación existente entre los niveles de presión arterial y el daño del órgano diana, específicamente a través del fondo de ojo, así como de las posibles complicaciones oftalmológicas derivadas de la hipertensión arterial, y la comparación de algunas de las clasificaciones existentes sobre los cambios oftalmológicos que esta provoca. Métodos: Se emplearon los métodos de análisis-síntesis y análisis bibliográfico y documental. Los motores de búsqueda utilizados fueron: Google y Google Académico, y las bases de datos Hinari, SciELO Cuba, Pubmed, entre otras. Conclusiones: La retinopatía hipertensiva es una de las complicaciones adversas de la hipertensión arterial aguda o crónica. Por su parte, las oclusiones venosas y la formación de macroaneurismas, constituyen otras de gran envergadura. Mientras más eficaz sea el diagnóstico y seguimiento de los pacientes hipertensos, menos recursos se necesitarán para su tratamiento, y se evitarán así las complicaciones de otros órganos diana como el cerebro y el riñón, lo que provocaría en los pacientes una mayor discapacidad.

Introduction: arterial hypertension is one the most frequent diseases in general population. Nowadays, it reaches a global prevalence of 30 to 45 %. Retinal microcirculation can be considered as an anatomical representation of the physiological and functional characteristics of the coronary and cerebral circulation. Objectives: to delve into the relationship between blood pressure levels and target organ damage, specifically through the fundus, as well as the possible ophthalmological complications derived from arterial hypertension, and the comparison of some of the existing classifications on the ophthalmological changes that it causes. Methods: analysis - synthesis and bibliographic- documentary analyses were the used methods. Google and Google Scholar as well as Hinari, SciELO Cuba, Pubmed and others databases were the search engines. Conclusions: hypertensive retinopathy is one of the adverse complications of acute or chronic arterial hypertension. On the other hand, venous occlusions and the formation of macroaneurysms constitute other serious ones to consider. The more effective the diagnosis and follow-up of hypertensive patients, the fewer resources will be needed for their treatment, thus avoiding complications in other target organs such as the brain and kidney, which would cause greater disability in patients.

Role of P Wave Duration and Tissue Doppler Imaging as Predictive Indicators for Paroxysmal Atrial Fibrillation in Hypertensive Patients

Background: Atrial fibrillation (AF) is the most prevalent chronic arrhythmia in the heart. AF accounts for one-third of rhythm disorder hospitalizations. AF increases profoundly the risk of stroke, heart failure, and death. This study used P-wave and transthoracic echocardiography with tissue Doppler imaging (TDI) to determine paroxysmal AF predictors in hypertensive individuals. Methods: This case control study was performed on 100 hypertensive adult patients. They were classified into two equal group: Group I included hypertensive patients diagnosed to have paroxysmal AF. Group II (control group) included hypertensive patients with normal sinus rhythm. All subjects were subjected to electrocardiographic and conventional and tissue Doppler Imaging measurements. Results: Pmax had significantly increased in PAF patients compared to sinus rhythm patients. PAL, PAR, PAI, LR, LI and IR had significantly increased in PAF patients compared to sinus rhythm patients. In Multivariate logistic regression analysis, Pmax, PAL, PAI, PAR, LR, LI and IR were found to be independent predictors for PAF. Therefore, Pmax, PAL PAI, PAR, LR, LI and IR were found to be significant predictors for PAF. Best cut-off values for Pmax, PAL, PAI, PAR, LR, LI and IR were: (118, 81, 61, 49.9, 34, 20 and 16 ms) with sensitivity (76, 96, 96, 88, 82, 86 and 77.5 ), specificity (84, 100, 98, 92, 78, 82 and 76) and the AUC of (0.850, 0.979, 0.987, 0.961, 0.836, 0.891 and 0.798) respectively. Conclusions: Electrocardiographic P-wave analysis and echocardiographic TDI may identify hypertension patients at risk for paroxysmal AF, since the combination of Pmax and TDI may help in predicting the development of AF in hypertensive individuals.

Effect of Vitamin A and D in Hypertensive Disorder of Pregnancy

Background: Severe preeclampsia is the main cause of maternal mortality. The correlation between vitamin D and hypertensive disorder of pregnancy is a controversial topic at present. Whether vitamin D can be used as an index to predict the risk of preeclampsia and when to supplement vitamin D in clinic has become a relatively popular research content. This study aimed to correlate vitamin A and D with hypertensive disorder of pregnancy and to reduce the risk of hypertension in pregnancy. Methods: This is a Prospective cohort study on 958 pregnant females. The patients were divided into two groups, namely, treatment group and Pregnancy Induced Hypertension (PIH) group. Liquid chromatography-tandem mass spectrometry and highperformance quid gel electrophoresis were used to find vitamin A and D in the blood of each group (HPLC). Results: There has not been a big difference in between PIH group and the placebo group (p>0.5). Preeclampsia collection and simple preeclampsia group there has been a statistical change in cesarean unit amount and impulsive transfer (p<0.05). The study further found that There is no rise in the likelihood of mild pregnancy complications, and the thing that is different would not be statistically important (p>0.05). Serum vitamin D level is less than 20 ng/ml, which is a risk factor for preeclampsia. Conclusion: The lack of vitamin A may be associated with the occurrence of hypertensive disorders during pregnancy and the progression of the disease. The lack of vitamin A may increase the risk of severe preeclampsia risk increased.

Evaluation of left atrial function and predictive value of risk stratification in patients with hypertensive disorder of pregnancy by four-dimensional automatic left atrial quantitative analysis / 中华超声影像学杂志

Objective:To investigate the change of left atrial volume and function in patients with hypertensive disorders of pregnancy (HDPs) by four-dimensional automatic left atrial quantitative analysis (4D LAQ) and analyze the predictive value of risk stratification.Methods:A total of 60 patients diagnosed with hypertensive disorder of pregnancy in Henan Provincial People′s Hospital from March to December 2021 were randomly enrolled, which were divided into gestational hypertension group (low risk group, n=30) and preeclampsia group (medium and high risk group, n=30) according to the disease development and risk stratification method reported in the literature; another 30 healthy pregnant women matched for age, gestational weeks and body mass index were selected as the control group. Left atrial anteroposterior diameter (LAd), interventricular septum thickness (IVSd), left ventricular end diastolic diameter (LVd), left ventricular ejection fraction (LVEF), left ventricular myocardial mass index (LVMI), peak early diastolic (E) and late diastolic (A) velocities of mitral inflow, and e′ values on the septal and lateral mitral annulus sides were routinely measured to calculate E/A and E/e′ values. Left atrial volume and strain parameters were obtained using 4D LAQ technique, including left atrial minimum volume (LAVmin), left atrial maximum volume (LAVmax), left atrial presystolic volume (LAVpreA), left atrial maximum volume index (LAVImax), left atrial inflation index (LAEI), left atrial stroke volume (LAEV), left atrial fraction (LAEF), longitudinal strain of left atrial reserve, conduit and systolic period (LASr, LAScd, LASct), circumferential strain of left atrial reserve, conduit and systolic period(LASr-c, LAScd-c, LASct-c). The differences among the three groups were compared. Multiple Logistics regression analysis was used to obtain the relevant indicators of risk stratification of HDPs and ROC curves were used for assessment. Results:Compared with the control group, E/e′, LAVmin, LAVpreA, LAScd, and LAScd-c increased, and LAEI, LAEF, LApEF, LASr, and LASr-c decreased in the gestational hypertension group (all P<0.05). Compared with the control group and gestational hypertension group, LAd, IVSd, LVd, LVMI, E/e′ LAVmin, LAVmax, LAVpreA, LAVImax, LAEV, LAScd, and LAScd-c increased, and LVEF, LAEF, LAEI, LApEF, LASr, and LASr-c decreased in the preeclamptic group, and the differences were statistically significant (all P<0.05). The results of multiple Logistics regression showed that LAVmax, LAScd-c and LASr were the indicators relevant to risk stratification of HDPs(β=0.344, 0.216 and -0.249, respectively, all P<0.05). ROC analysis showed when the cut-off value of left atrial strain parameter LASr was 30.5%, the AUC, sensitivity, and specificity were 0.725, 0.58, 0.90, respectively; when the cut-off value of LAVmax was 44.5 ml, the AUC, sensitivity, and specificity were 0.662, 0.80, and 0.56, respectively; and when the cut-off value of LAScd-c was -17.5%, the AUC, sensitivity, and specificity were 0.706, 0.56, and 0.78, respectively. Conclusions:Left atrial remodeling occured in pregnant women with hypertensive disorders, their reserve and conduit function were impaired, and aggravated with the progress of the disease. The four-dimensional parameters LASr, LAVmax, and LAScd-c were relevant indicators for risk stratification of HDPs. In predicting the severity of HDPs, LASr has high diagnostic value and good specificity; LAVmax and LAScd-c can be considered as supplementary parameters to predict the risk stratification of HDPs.

Efficacy of alfacalcidol on liver and kidney function，inflammatory cytokines and RAS activity in hypertensive patients with renal impairment / 中国药房

OBJECTIVE To explore the efficacy of alfacalcidol combined with conventional antihypertensive and lipid- lowering drugs on liver and kidney function， serum inflammatory cytokines and renin-angiotensin system（RAS） in hypertensive patients with renal impairment. METHODS A total of 200 hypertensive patients with renal impairment who were treated in the department of nephrology in our hospital from December 2017 to December 2020 were selected and randomly divided into control group and observation group， with 100 cases in each group. Both groups of patients were treated with conventional antihypertensive and lipid-lowering drugs for a total of 14 weeks， patients in the observation group were additionally treated with oral alfacalcidol after 2 weeks of treatment （0.25 μg each time， once a day， for a total of 12 weeks）. The levels of liver function indexes [aspartate aminotransferase （AST）， alanine aminotransferase （ALT）]， renal function indexes [blood calcium， blood phosphorus， blood urea nitrogen （BUN）， cystatin C （Cys-C）， serum creatinine （Scr）， urine microalbumin （mAlb）， β2-microglobulin （β2-MG）， urinary N- acetyl β-D-glucosaminidase （NAG）， 24 h urinary protein]， inflammatory factors [serum interleukin 6 （IL-6）， tumor necrosis factor α （TNF-α）， hypersensitive C-reactive protein （hs-CRP）] and RAS activity indexes [renin， angiotensin Ⅰ（Ang Ⅰ）， Ang Ⅱ and aldosterone] were observed in 2 groups before and after treatment， and the occurrence of adverse drug reactions was recorded during treatment. RESULTS There was no statistical significance in the levels of detection indexes between 2 groups before treatment （P＞0.05）. After treatment， the level of blood calcium in the observation group was significantly higher than before treatment （P＜0.05）， but remained at clinically normal level. Compared with before treatment， the levels of Cys-C， Scr， BUN， urine mAlb， β2-MG， NAG and 24 h urinary protein， hs-CRP， IL-6， TNF-α， renin， Ang Ⅰ， Ang Ⅱ and aldosterone were significantly decreased in the observation group after treatment （P＜0.05）. After treatment， the level of blood calcium in observation group was significantly higher than control group （P＜0.05）. Additionally， the levels of Cys-C， Scr， BUN，urine mAlb， β2-MG， NAG， 24 h urinary protein， hs-CRP， IL-6， TNF-α， renin， Ang Ⅰ， Ang Ⅱ and aldosterone were significantly lower than control group （P＜0.05）. There was no statistical significance in the incidence of adverse drug reactions between 2 groups during treatment （P＞0.05）. CONCLUSIONS Alfacalcidol combined with routine therapy of antihypertensive and lipid-lowering drugs could effectively improve liver and renal functions， inhibit inflammation and RAS activity in hypertensive patients with renal impairment， with a favorable safety.

ZHANG Zhiqiang, CHEN Wei, LIU Bo / 临床肝胆病杂志

Objective To investigate the value of spleen volume (SV) in predicting portal hypertensive gastropathy (PHG) and severe PHG in patients with liver cirrhosis. Methods A retrospective analysis was performed for the clinical data of 168 patients with liver cirrhosis who were admitted to Xiangyang No.1 People's Hospistal Affiliated to Hubei University of Medicine from January 2018 to August 2022, and with the results of gastroscopy as the gold standard, these patients were divided into non-PHG group with 115 patients and PHG group with 53 patients; the PHG group was further divided into mild PHG group with 26 patients and severe PHG group with 27 patients. All patients underwent electronic gastroscopy, abdominal magnetic resonance imaging, and serological examination to obtain related indices and parameters. The group t -test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups. A multivariate Logistic regression analysis was used to screen out the independent risk factors for PHG and severe PHG, and the receiver operating characteristic (ROC) curve was used to compare the predictive value of related indices or parameters. The area under the Roccurve is compared using Delong test. Results The univariate analysis showed that there were significant differences between the PHG group and the non-PHG group in sex, presence or absence of ascites, hemoglobin (Hb), platelet count (PLT), aspartate aminotransferase, total bilirubin, albumin (Alb), prothrombin time, international normalized ratio, Child-Pugh class, FIB-4 score, King score, Lok score, spleen diameter (SD), SV, platelet count/spleen diameter ratio (PSDR), and platelet count/spleen volume ratio (PSVR) (all P < 0.05), and there were significant differences in Hb, PLT, Alb, SD, SV, PSDR, and PSVR between the mild PHG group and the severe PHG group (all P < 0.05). The multivariate Logistic regression analysis showed that FIB-4 score (odds ratio [ OR ]=1.280, 95% confidence interval [ CI ]: 1.009-1.625, P < 0.05) and SV ( OR =1.007, 95% CI : 1.001-1.013, P < 0.05) were independent risk factors for PHG, and SV ( OR =0.990, 95% CI : 0.980-1.000, P < 0.05) was an independent influencing factor for severe PHG. The ROC curve analysis showed that in predicting PHG, SV had a larger area under the ROC curve (AUC) than FIB-4 score (0.884 vs 0.825, P < 0.05), with a sensitivity of 0.774 and a specificity of 0.870 at the optimal cut-off value of 406.82; in predicting the onset of severe PHG, SV had an AUC of 0.782, with a sensitivity of 0.593 and a specificity of 0.962 at the optimal cut-off value of 714.63. Conclusion SV has a good value in predicting the onset of PHG and severe PHG.

Intermittent heat exposure induces thoracic aorta injury in spontaneously hypertensive rats by activating the AMPK/mTOR/ULK1 pathway / 南方医科大学学报

OBJECTIVE@#To investigate the effects of different manners of heat exposure on thoracic aorta injury in spontaneously hypertensive rats (SHRs) and explore the underlying mechanism.@*METHODS@#Normal 6 to 7-week-old male SHRs were randomized into control group (cage at room temperature), intermittent heat exposure group (SHR-8 group, exposed to 32 ℃ for 8 h daily for 7 days) and SHR-24 group (with continuous exposure to 32 ℃ for 7 days). After the treatments, the pathologies of the thoracic aorta of the rats were observed with HE staining, and the expressions of Beclin1, LC3B and p62 were detected with Western blotting and immunofluorescence assay; TUNEL staining was used to observe cell apoptosis in the thoracic aorta, and the expressions of caspase-3, Bax, and Bcl-2 were detected using Western blotting. The effects of intraperitoneal injections of 3-MA (an autophagy agonist), rapamycin (an autophagy inhibitor) or compound C 30 min before intermittent heat exposure on the expressions of proteins associated with autophagy, apoptosis and the AMPK/mTOR/ULK1 pathway in the aorta were examined with immunohistochemistry.@*RESULTS@#In SHR-8 group, the rats showed incomplete aortic intima with disordered cell distribution and significantly increased expressions of Beclin1, LC3II/LC3I and Bax, lowered expressions of p62 and Bcl-2, and increased apoptotic cells in the thoracic aorta (P < 0.05). Pretreatment with 3-MA obviously inhibited the expressions of autophagy- and apoptosis-related proteins, whereas rapamycin promoted their expressions. Compared with the control group, the rats in SHR-8 group had significantly down-regulated p-mTOR and up-regulated p-AMPK and p-ULK1 expression of in the aorta; Treatment with compound C obviously lowered the expressions of p-AMPK and p-ULK1 and those of LC3B and Beclin1 as well.@*CONCLUSION@#In SHRs, intermittent heat exposure causes significant pathologies and promotes autophagy and apoptosis in the thoracic aorta possibly by activating the AMPK/mTOR/ULK1 pathway.

Involvement of Interleukin-1 β/Insulin-Like Growth Factor 1 in Ameliorating Effects of Electroacupuncture on Myocardial Fibrosis Induced by Essential Hypertension / 中国结合医学杂志

OBJECTIVE@#To investigate the effect of electroacupuncture (EA) at Neiguan (PC 6) on myocardial fibrosis in spontaneously hypertensive rats (SHRs), and to explore the contribution of interleukin-1 β (IL-1 β), insulin-like growth factor 1 (IGF-1), and transforming growth factor β 1 (TGF- β 1) to the effects.@*METHODS@#Nine 12-weeks-old Wistar Kyoto (WKY) male rats were employed as the normal group. Twenty-seven SHRs were equally randomized into SHR, SHR+EA, and SHR + sham groups. EA was applied at bilateral PC 6 once a day 30 min per day in 8 consecutive weeks. After 8-weeks EA treatment at PC 6, histopathologic changes of collagen type I (Col I), collagen type 1 (Col 1) and the levels of IGF-1, 1L-1 β, TGF- β 1, matrix metalloproteinase (MMP)-2 and MMP-9 were examined in myocardial tissure respectively.@*RESULTS@#After 8-weeks EA treatment at PC 6, the enhanced myocardial fibrosis in SHRs were characterized by the increased mean fluorescence intensity of Col I and Col 1 in myocardium tissue (P<0.01). All these abnormal alterations above in SHR + EA group was significantly lower compared with the SHR group (P<0.01). Meanwhile, the increased levels of IL-1 β, IGF-1, TGF-β 1 in serum or myocardial tissue of SHRs, diminished MMP 9 mRNA expression in SHRs were also markedly inhibited after 8 weeks of EA treatment (P<0.05 or P<0.01). Furthermore, the contents of IL-1 β, IGF-1, TGF-β 1 in myocardial tissue were positively correlated with the systolic blood pressure and hydroxyproline respectively (P<0.01).@*CONCLUSION@#EA at bilateral PC 6 could ameliorate cardiac fibrosis in SHRs, which might be mediated by regulation of 1L-1 β/IGF-1-TGF- β 1-MMP9 pathway.

Application of omics in the pathogenesis and prediction of hypertensive disorders of pregnancy: a review / 预防医学

Abstract@#Hypertensive disorders of pregnancy (HDP) are a common severe complication during pregnancy, which is characterized by complex etiology, unclear pathogenesis and lack of effective tools for early diagnosis and prediction. Recently, the development of omics technology provides new insights into the research into HDP. Based on national and international publications from 2011 to 2022, this review summarizes the application of genomics, proteomics, metabolomics, and microbiomics in the pathogenesis and prediction of HDP, so as to provide insights into the prediction, prevention and precise treatment of HDP.

Study on Compound Musk in the treatment of hypertensive cerebral hemorrhage after operation / 中国医师进修杂志

Objective:To investigate the efficacy of Compound Musk combined with nimodipine combined with minimally invasive surgery in the treatment of hypertensive cerebral hemorrhage and the effects on serum inflammation, stress and apoptosis.Methods:Prospective research methods was used. A total of 118 patients with hypertensive intracerebral hemorrhage who received treatment in the First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine from March 2017 to January 2021 were randomly divided into control group and Compound Musk group (59 cases in each group). After minimally invasive surgery, patients in the control group were treated with nimodipine on the basis of conventional treatment, while patients in the Compound Musk group were treated with compound musk on the basis of the control group. After 2 weeks, the efficacy was evaluated and the levels of serum inflammatory indexes, oxidative stress indexes and apoptosis indexes were measured.Results:The total effective rate in Compound Musk group was higher than that in control group: 98.3% (58/59) vs. 88.1% (52/59), and the difference was statistically significant ( P<0.05). After 2 weeks of treatment, serum inflammatory indexes including nuclear factor-κB (NF-κB), interleukin-1β (IL-1β), matrix metalloproteinase-3 (MMP-3), matrix metalloproteinase-9 (MMP-9); apoptosis indexes including soluble Fas receptor (sFas), soluble Fas ligand (sFAS-L); oxidative stress indexes including advanced oxidation protein products (AOPP), malondialdehyde (MDA) decreased, and some oxidative stress indexes including glutathione peroxidase (GSH-Px), catalase (CAT) increased. The levels of the above inflammatory indexes, apoptosis indexes and oxidative stress indexes in Compound Musk group were lower than those in control group, NF-κB: (18.96 ± 2.17) ng/L vs. (24.10 ± 3.23) ng/L, IL-1β: (12.88 ± 1.74) ng/L vs. (15.19 ± 1.63) ng/L, MMP-3: (5.62 ± 0.95) ng/L vs. (7.97 ± 0.86) ng/L, MMP-9: (7.07 ± 0.86) ng/L vs. (9.26 ± 1.13) ng/L, sFas: (3.24 ± 0.38) μg/L vs. (4.19 ± 0.53) μg/L, sFas-L: (209.17 ± 24.39) ng/L vs. (288.54 ± 37.61) ng/L, AOPP: (10.76 ± 1.84) μg/L vs. (13.51 ± 2.09) μg/L, MDA: (2.87 ± 0.32) μmol/L vs. (3.45 ± 0.34) μmol/L, and the differences were statistically significant ( P<0.05). Some of the above oxidative stress indexes were higher than those in control group, GSH-Px: (3 274.91 ± 376.09) U/L vs. (2 854.19 ± 325.22) U/L, CAT: (60.82 ± 7.43) U/L vs. (52.17 ± 6.48) U/L, the differences were statistically significant ( P<0.05). During treatment, there was no significant difference in the incidence of rash, diarrhea, drug-induced liver and myocardial injury between two groups ( P>0.05). Conclusions:Compound Musk has a positive effect on improving the curative effect and internal environment of patients with hypertensive intracerebral hemorrhage after minimally invasive surgery, and will not increase the occurrence of serious adverse reactions.

Clinical effect of minimally invasive catheterization based on computer 3D-Slicer software system in the treatment of hypertensive intracerebral hemorrhage / 中国医师进修杂志

Objective:To investigate the clinical effect of minimally invasive catheterization based on computer 3D-Slicer software system in the treatment of hypertensive intracerebral hemorrhage (HICH).Methods:Three hundred and fifty patients with HICH treated in People′s Hospital of Lanling County in Shandongfrom June 2019 to June 2020 were selected as the research object. According to the operation method, they were divided into 3D-Slicer group (175 cases) and CT group (175 cases). They were treated with 3D-Slicer software-assisted minimally invasive catheterization and minimally invasive soft-channel drainage under CT localization, respectively. The general conditions of the surgery, hematoma clearance rate and laboratory indexes, oxidative stress index and prognosis were compared between the two groups.Results:The intraoperative blood loss, the hospitalizationtimein the 3D-Slicer group were lower than those in the CT group: (81.42 ± 12.33) ml vs. (101.54 ± 11.71) ml, (15.67 ± 3.71) d vs. (17.22 ± 3.52) d; the success rate of one-time successful puncture to preset position in the 3D-Slicer group was higher than that in the CT group: 100.00%(175/175) vs. 81.14%(142/175), there were statistical differences ( χ 2 = 34.26, P<0.05). The hematoma clearance rate after the surgery for 1, 3 and 7d in the 3D-Slicer group were higher than those in the CT group:(87.93 ± 8.54)% vs. (66.43 ± 7.99)%, (92.48 ± 10.31)% vs. (89.52 ± 11.74)%, (96.37 ± 10.22)% vs. (94.30 ± 9.25)%, there were statistical differences( P<0.05). After the surgery for 7 d, the levels of glutathione peroxidase (GSH-Px), superoxide dismutase (SOD) and catalase (CAT) in the 3D-Slicer group were higher than those in the CT group: (121.36 ± 10.59)U/L vs. (109.14 ± 9.05) U/L, (92.80 ± 8.63) μg/L vs. (81.45 ± 9.11) μg/L, (24.64 ± 5.43) U/L vs. (20.84 ± 3.47) U/L; while the level of malondialdehyde (MDA) was lower than that in the CT group: (4.42 ± 0.57)μmol/L vs. (5.19 ± 0.51) μmol/L, there were statistical differences ( P<0.05). After the surgery for 3 months, the rate of favorable prognosis in the 3D-Slicer group was higher than that in the CT group 73.71%(129/175) vs. 62.29%(199/175), there was statistical difference ( χ2 = 5.25, P<0.05). Conclusions:Minimally invasive catheterization based on 3D-Slicer software system in the treatment of HICH can not only improve the clinical efficacy, but also shorten the hospitalization time, reduce intraoperative blood loss, and improve the prognosis.