Association of peripheral and central systolic blood pressure with urinary albumin-to-creatinine ratio in a community-based population in Beijing / 中华预防医学杂志

Objective@#The aim of this study was to investigate the association of both peripheral and central systolic blood pressure (pSBP and cSBP) with urinary albumin-to-creatinine ratio (UACR) in a community-based population in Beijing.@*Methods@#A total of 3 479 Chinese subjects with questionnaire, UACR, pSBP, and cSBP data available were included from an atherosclerosis cohort of Peking University First Hospital in Shijingshan District, Beijing followed up from April to July in 2014. Multivariate linear regression analyses were used to examine the effect of pSBP and cSBP on lnUACR, and further tests for interactions were performed according to associated covariates.@*Results@#Subjects were (59.0±8.6) years old, 36.2% (n=1 260) were male, 46.0% (n=1 595) had hypertension, and 20.2% (n=700) had diabetes. The pSBP and cSBP was (126.9 ± 16.4) mmHg (1 mmHg=0.133 kPa), and (136.3 ± 16.7) mmHg, respectively. P50 (P25-P75) of UACR was 6.2 (4.2-11.1) mg/g. Both pSBP and cSBP were linearly associated with lnUACR adjusted for age, sex, body mass index, smoking status, drinking status, triglyceride, HDL-C, LDL-C, fasting glucose, creatinine, history of cardiovascular disease, antihypertensive and hypoglycemic agents (every 10 mmHg increase for pSBP: β=0.12, 95%CI: 0.10-0.15, P<0.001; for cSBP: β=0.11, 95%CI: 0.09-0.14, P< 0.001). The relationships were remained in subgroups such as non-hypertension group, non-diabetes group, normal UACR group, and 3-combination group (every 10 mmHg increase for pSBP: β=0.09, 95%CI: 0.05-0.13; β=0.12, 95%CI: 0.10-0.15; β=0.07, 95%CI: 0.06-0.09; β=0.08, 95%CI: 0.05-0.12. for cSBP: β=0.07, 95%CI: 0.04-0.11; β=0.11, 95%CI: 0.08-0.13; β=0.07, 95%CI: 0.05-0.08; β=0.06, 95%CI: 0.03-0.09, all P<0.001). Furthermore, analyses for interaction found that both pSBP and cSBP were more strongly associated with lnUACR in males, current smokers and subjects with high serum creatinine level (≥87 µmol/L) when compared with females, non-current smokers and subjects with low serum creatinine level (<87 µmol/L), respectively (all P for interaction<0.05).@*Conclusion@#The results showed that both pSBP and cSBP were independently associated with UACR in this Chinese community-based population even in low risk population suggesting well-controlled both peripheral and central blood pressure may reduce urinary albumin. Males, current smokers and subjects with higher serum creatinine should pay more attention to the impacts of pSBP and cSBP on UACR.

Efficacy comparison between 5 mg perindopril arginine salt and 4 mg perindopril tert-butylamine salt for patients with mild to moderate essential hypertension / 中华心血管病杂志

<p><b>OBJECTIVE</b>To compare the efficacy and safety of 5 mg perindopril arginine salt and 4 mg perindopril tert-butylamine salt for patients with mild to moderate essential hypertension.</p><p><b>METHODS</b>The study was designed as multicenter, randomized, double-blind, active controlled trial with two parallel groups enrolling 524 participants with mild to moderate essential hypertension. After 2-week run-in period, 186 patients were enrolled and randomly treated with 5 mg perindopril arginine salt and 183 patients were enrolled and randomly treated with 4 mg perindopril tert-butylamine salt. The random sequence was generated by the I.R.I.S., and a balance was made in each center. After double-blind treatment for 8 weeks, the dose could be doubled for patients with uncontrolled BP ((SBP) ≥ 140 mmHg (1 mmHg = 0.133 kPa) or diastolic blood pressure (DBP) ≥ 90 mmHg) and patients were treated for another 4 weeks.</p><p><b>RESULTS</b>The sitting SBP was similarly decreased by (19.9 ± 17.2) mmHg in perindopril arginine group and (18.5 ± 14.7) mmHg (P = 0.000 5) in perindopril tert-butylamine group post 8 weeks treatment. Dose was doubled in 109 patients (59.9%) in perindopril arginine group and 116 patients (63.7%) in perindopril tert-butylamine group. At 12 weeks post therapy, the sitting SBP decreased by (19.8 ± 16.2) and (19.6 ± 16.3) mmHg respectively in the 2 groups. The decrease of sitting DBP was also similar in both groups (-12.0 ± 10.0) mmHg and (-11.0 ± 8.9) mmHg (P < 0.000 1), respectively. The control rate or response rate was also similar between the two groups (control rate over 8 weeks was 38.5% vs. 31.3%, 95% CI (-2.6-16.9), control rate over 12 weeks was 36.3% vs. 35.7%, 95% CI (-9.3-10.4), response rate over 8 weeks was 64.3% vs. 63.2%, 95% CI (-8.8-11.0), response rate over 12 weeks was 65.9% vs. 64.8%, 95% CI (-8.7-10.9)). Incidence of adverse events was low and similar in both therapy groups.</p><p><b>CONCLUSIONS</b>The results show that perindopril arginine salt 5 mg is as efficient as perindopril tert-butylamine 4 mg on lowering BP for patients with mild to moderate essential hypertension. Both drugs have good safety profile and are well tolerated by patients in this cohort.</p>

The clinical and echocardiography features of basal septal hypertrophy / 中华超声影像学杂志

Objective To explore the prevalence and clinical and echocardiography features of the basal septal hypertrophy(BSH).Methods Clinical and echocardiography data of 1 056 elderly population in an urban community of Beijing were analyzed.BSH was defined as the thickness of basal interventricular septum ≥1.4 cm and basal septal/mid septal ≥1.3.Data were compared between BSH and non-BSH,and the risk factors of BSH were evaluated.Results The prevalence of BSH in this population was 7.39%(95%CI:5.8%-9.0%).BSH was not associated with current cardiovascular diseases (P >0.05).Its correlates in logistic analysis included male,diabetes mellitus,small end diastolic left ventricular dimension and abnormal left ventricular diastolic function (P <0.05),with OR 0.49(0.29,0.83),1.99(1.18,3.37),2.24 (1.35,3.72),0.39(0.26,0.59),and 1.96(1.01,3.81),respectively.Conclusions BSH is common in elderly community population and not associated with cardiovascular diseases.Its risk factors included male, obesity,diabetes mellitus,small end diastolic left ventricular dimension and abnormal left ventricular diastolic function.

Relationship between high normal blood pressure and carotid artery atherosclerosis in Beijing residents / 中华心血管病杂志

<p><b>OBJECTIVE</b>To analyze the relationship between normal high blood pressure and carotid artery atherosclerosis.</p><p><b>METHODS</b>This epidemiological survey was performed in two communities of Shijingshan District of Beijing from 2007 to 2008. A total of 3 324 people were enrolled in the study and 2 895 people with carotid ultrasound survey results were analyzed. Blood lipids, blood pressure, hs-CRP, body mass index (BMI) and other cardiovascular risk factors were obtained. Carotid mean intima-media thickness (IMT) , maximum carotid IMT and carotid plaque were measured by ultrasound. A multiple logistic regression model was used to evaluate the relationship between normal high blood pressure and carotid artery atherosclerosis.</p><p><b>RESULTS</b>The carotid mean IMT, maximum IMT, incidence of carotid artery plaque increased in proportion to blood pressure level (all P < 0.01) . After adjusting for diabetes, hypercholesterolemia, hypertriglyceridemia, increased hs-CRP, smoking, sex, age, overweight and obesity, multiple logistic regression analysis showed that the OR values of carotid mean IMT and maximum IMT thickening, carotid plaque in high normal blood pressure group were 4.50 (95% CI: 1.04-19.49, P < 0.05), 1.73 (95% CI: 1.35-2.22, P < 0.01), 1.64 (95% CI:1.26-2.13, P < 0.01) compared to normal blood pressure group.</p><p><b>CONCLUSION</b>High normal blood pressure is related with higher risk of carotid artery atherosclerosis in this cohort.</p>

Correlation between anthropometric parameters and arteriosclerosis biomarker in the middle-aged and the elderly / 北京大学学报(医学版)

Objective:To investigate the correlation between anthropometric indices and arteriosclerosis detection indicators in the middle-aged and the elderly .Methods: A cross-sectional descriptive study was made of 1 626 individuals ( diabetics patients 23.37%, hypertensive subjects 39.48% and healthy individuals 37.15%), aged 45 to 90 years [mean age:(61.60 ±10.22) years)] in Shijingshan Dis-trict, Beijing.Their measurements:body mass index (BMI), waist circumference (WC), and waist to height ratio ( WHtR ) .Arterial stiffness was assessed according to brachial-ankle pulse wave velocity (baPWV), intima-media thickness (IMT), augmentation index (AI) and ankle-brachial index (ABI), which were measured by noninvasive detectors and equipment .The correlations between the various indi-cators were analyzed .Results:The percentages of the hypertensive and diabetic groups of central obesity ( male WC>85 cm, female WC >80 cm or WHtR>0.5 ) and of general obesity ( BMI>28 kg/m2 ) were significantly higher than those of the healthy group ( P0 .05 ) .There was a moderate positive correlation between the measures of abdominal obesity (WHtR and WC) and the general obesity indicators (BMI) (r=0.710 and 0.716) .In the healthy group , WC and WHtR showed positive correlation with baPWV , IMT and ABI, and negative correlation with AI 75 .BMI showed positive correlation with IMT and negative correla-tion with AI75 , and no correlation with baPWV and ABI .There was negative correlation between BMI and baPWV in the diabetic group .In the hypertension group , we found negative correlation between BMI and baPWV, maximum IMT, AI75 , and also between WC and AI 75 .The simple regression straight line of baPWV versus the anthropometric parameters showed that the regression equations were y =0 .949 +1.379 x (baPWV vs.WHtR, R2 =0.046, P<0.001) and y=1.133+0.006x (baPWV vs.WC, R2 =0.027, P<0.001), respectively.baPWV and BMI did not have a linear relationship (P =0.62). Conclusion:WHtR and WC are superior to BMI indices in predicting arteriosclerosis .Anthropometric measurements for central obesity are good predictors of cardiovascular risk .

Synergistic effect of hypertension and aging on left atrial volume and function / 中华内科杂志

Objective To assess the effect of combined hypertension (HT) and aging on left atrial (LA) size and phasic function.Methods This evaluation was based on the data from a cross-sectional study including 738 subjects with high risk for cardiovascular disease from an urban community in Beijing.Subjects were divided into 3 groups according to age (41-59,60-69 and ≥70 years) and further into HT and non-HT sub-groups.LA volume index were calculated and LA global longitudinal strain in late diastole (Sa),early diastole (Se),and total strain (Stot =Sa + Se),and strain rate in late diastole (SRa),systole (SRs),and early diastole (SRe) were measured using off-line speckle-tracking echocardiography.Results LA volume index increased significantly in HT groups with aging,whereas no changes could be viewed in non-HT subjects among all age groups.LA conduit index (Se and SRe) decreased with aging in both HT and non-HT subjects with more sever in HT subjects than in non-HT subjects in all age groups.The LA conduit index in 41-59 year-HT,and in 60-69 year-HT subjects were comparable with that in 60-69 year-non-HT subjects [Se (11.0 ±4.4)％ vs (11.6 ±4.7)％,SRe (1.0 ±0.4) s-1 vs (1.0 ±-0.3) s-1],and in ≥70 year-non-HT subjects [Se(10.1 ±4.0)％ vs (9.5 ±5.4)％,SRe (0.9 ±0.3)s-1 vs (0.8 ± 0.4) s-1],respectively.LA reservoir (Stot and SRs) and contraction (Sa and SRa) index also decreased with aging in HT but not in non-HT subjects.Conclusions Aging along does not lead to LA enlargement in subjctes,but it does when combined HT.There is synergistic effect of HT and aging on LA volume and phasic function.

Relationship of left atrial size and phasic function in hypertension / 中华超声影像学杂志

Objective To evaluate the relationship of left atrial (LA) size and phasic function in hypertension (HT).Methods Data of 589 HT patients in an urban community of Beijing was analyzed.LA global longitudinal strain in late diastole (Sa),early diastole (Se),and total strain (Stot =Sa + Se),strain rate in late diastole (SRa),systole (SRs),and early diastole (SRe) were measured using off-line speckletracking echocardiography analyzing software,and were compared among groups (normal,mild,moderate and severe enlargement) divided by LA volume index.Results LA reservoir parameters[Stot:(21.4 ± 5.8)％,(20.8±5.4)％,(19.7±4.5％),(17.8±7.4)％,P =0.012;SRs:(1.1±0.3)s-1,(1.0±0.3)s-1,(1.0 ±0.2)s-1,(0.9 ±0.3)s-1,P =0.001] and contraction parameters[Sa:(11.7±4.0)％,(11.1 ± 3.3)％,(9.9±2.6)％,(8.9±4.5)％,P＜0.001;SRa:(1.6±0.6)s-1,(1.4±0.4)s 1,(1.3±0.4)s-1,(1.1 ± 0.6)s 1,P ＜ 0.001] deteriorated from normal to severe enlarged LA groups,while conduit parameters (Se and SRe) had no difference (P ＞0.05).Conclusions LA enlargement in HT associated with deteriorated reservoir and contraction function and unaffected conduit function.

Diagnosis and treatment of pulmonary arteriovenous malformation with cryptogenic stroke caused by paradoxical embolism as the first manifestation / 中华神经科杂志

Objective To investigate the clinical and radiological features of the patients with cryptogenic stroke as the first manifestation of pulmonary arteriovenous malformation (PAVM),and to explore the mechanism and summarize the diagnostic strategy.Methods Transcmnial Doppler (TCD) bubble tests,non-contrast or contrast-enhanced transthoracic and transesophageal echocardiography,contrast-enhanced thoracic CT and pulmonary angiography were performed in 2 patients with cryptogenic stroke for the detection of right to left shunt (RLS) and the diagnosis of PAVM.Then interventional catheter embolization of PAVM and postoperative follow-up were arranged.Results TCD bubble tests in these 2 patients showed the following characteristics indicating RLS:spontaneous continuous shunt at rest,earlystage shunt appeared rapidly after injection,considerable large amount of shunt volume as a shower of microbubble,the extent of shunt volume not attenuated by Valsalva Maneuver (VM).One patient was diagnosed as PAVM,the other was PAVM plus patent foramen ovale (PFO).Both patients of PAVM were successfully treated with interventional catheter embolizations.Then TCD bubble test was repeated and showed significantly decreased amount of RLS.They remained asymptomatic during the 3-year and 1-year follow-up.Conclusions In patients with cryptogenic stroke due to suspected paradoxical embolism,TCD bubble test should be performed for screening RLS.Besides PFO,a traditional access to intracardiac shunt,PAVM should be considered as a new access to extracardiac shunt in paradoxical embolism.

Early detection of abnormal left atrial function by speckle-tracking in hypertensive patients / 中华超声影像学杂志

Objective To evaluate the feasibility of speckle-tracking echocardiography in detecting left atrial (LA) function impairment in early hypertensive (HT) patients.Methods Echocardiography was performed in 154 HT patients with LA volume index ＜28 ml/m2 and 64 age/gender-matched control subjects.LA global longitudinal strain in late diastole (Sa),systole (Ss),and total strain (Stot =Sa + Ss),strain rate in late diastole (SRa),systole (SRs),and early diastole (SRe) were measured using off-line speckle-tracking analyzing software in apical 4 chamber view.Results Both parameters reflecting LA reservoir function [Stot (23.7 ± 6.0) ％ vs (25.7 ± 5.9) ％,p =0.03 and SRs ( 1.2 ± 0.3) s- 1 vs ( 1.3 ±0.3) s-1,P =0.03]and conduit function [Ss (12.0 ± 5.1)％ vs (14.0±5.7)％,P =0.02 and SRe (1.0 ± 0.4)s- 1 vs ( 1.2 ± 0.4)s- 1,p ＜0.001 ]decreased significantly in HT group than control,while LA pump function parameters (Sa and SRa) had no differences.Ss,Stot and SRe correlated significantly with HT and HT duration.Conclusions LA phasic function are impaired in HT patients with normal LA size.Speckle tracking echocardiography is a promising tool for the early detection of LA dysfunction.

Quality control of ultrasonic measurement of carotid artery intima-media thickness / 老年心脏病学杂志（英文版）

Background To report quality control methods and baseline reproducibility data of the ultrasound measurements of carotid artery intima-media thickness in the project of Establishment of an Integrated System for Coronary Heart Disease Prevention and Treatment.Methods Standard ultrasound scanning and measuring protocols were established by the study group.All sonographers and readers were trained by the carotid ultrasound core lab and all digital ultrasound images were centrally read.Ten subjects were scanned twice (with 1 week interval) by 2 sonographers independently and images were read by a single reader to evaluate the sonographer variability.Twenty subjects' images were read twice (with 1 week interval) by a single reader to assess the reader variability and the reproducibility of IMT measured at different carotid segments.Results The intraclass correlation (ICC) of intra-and inter-sonographer and intrareader for mean IMT measurements was 0.99,0.98 and 0.97 respectively; while for max IMT,it was 0.97,0.99 and 0.95 respectively.Among different carotid segments and sites,ICC for mean IMT measurements of common carotid (CCA),carotid artery bulb (Bulb),internal carotid artery (ICA),overall near wall and overall far wall was 0.97,0.99,0.89,0.93 and 0.98 respectively.Conclusion The reproducibility of IMT measurements according to our protocol is acceptable,although better reproducibility is found when measuring the mean IMT than max IMT,CCA and Bulb IMT than ICA IMT,and far wall IMT than near wall IMT.

Location and expression of apo(a) and apoB in peripheral blood of patients with cardiovascular disease / 北京大学学报(医学版)

Objective:To explore the relationship between the severity of cardiovascular disease with the expression of apolipoprotein(a) [apo(a)] and apolipoprotein B(apoB) in peripheral blood and their location in peripheral blood cells.Methods: In this report,we selected 4 patients with angiography which indicated that three coronary arteries were narrowed and 5 control patients with normal angiography.Arterial blood was collected and analyzed for lipid parameters in plasma.The mRNA expression of apo(a) and apoB in peripheral white blood cells and platelets were determined by RT-PCR and their protein expression by western blot.Moreover,the expression and location of apo(a) and apoB in white blood cells were determined by confocal microscopy and computer 3D analysis.Results: In plasma,levels of high density lipo-protein-cholesterol(HDL-C) and apolipoprotein A-Ⅰ(apoA-Ⅰ) in cardiovascular disease(CVD) patients were significantly less than those in the control patients[(0.62?0.05) mmol/L,(0.78?0.08) mmol/L vs(0.81?0.15) mmol/L,(0.9?0.07) mmol/L,P0.05).Studies with confocal microscopy indicated that proteins of apo(a) and apoB were co-expressed by a few cells of leukocytes and the ratio of apoB/apo(a) in cardiovascular disease patients was significantly less than that in the control patients(optical density value 1.60?0.12 vs 4.40?0.35,P

Complications of pericardiocentesis and drainage for pericardial effusion / 中国介入心脏病学杂志

Objective Pericardiocentesis and drainage are the common measures for the treatment of cardiac temponade and massive pericardial effusion. In this issue, the complications of pericardiocentesis and drainage were discussed. Methods 5 in-hospital cases of cardiac temponade or massive pericardial efiusion who had complications of pericardiocentesis and drainage were reported and analyzed. Results The complications were 2 cases with neural mediated syncope, 1 case with pleural efiusion, 1 case dead of acute right ventricular dilation, and 1 case with acute pulmonary edema and effusion leaking into the subcutaneous tissue. Conclusion The importance of hemodynamic change during pericardiocentesis and drainage could not be over-emphasized, and the patients whose hemodynamic status were unstable should be monitored by bedside hemodynamic monitoring or echocardiography. Also we should pay more attention to the drainage catheter per se, which may cause the complications.

Apoptosis inducing effect of hypoxia on cultured neonatal rat cardiomyocytes / 中国介入心脏病学杂志

To test the apoptosis inducing effect of hypoxia on cardio myocytes Neonatal Wistar rat cardiomyocaytes were cultured under hypoxic condition for 2 hours,12 hours,24 hours,respectively Flow cytometery,TUNEL and morphological method were used to detect the apoptotic myocytes We found that the number of apoptotic cells of each hypoxia group was greater than that of the control group,and it increased as the time of hypoxia went longer The apoptotic cell number of the control group and the hypoxic groups of 2nd,12th and 24th h. were 9 33?0 62%,17 29?0 95%,33 59?2 09% and 76 01?4 60%( P