Effects of guideline-based hypertension management in rural areas of Guangdong Province.

BACKGROUND: Despite the improvement in the health care industry, the rates of undetected, untreated, and uncontrolled hypertension (HTN) are still very high, especially in rural areas of China. The aim of this study was to investigate the efficacy and efficiency of a guideline-based HTN management (novel therapy) in population of rural areas of Guangdong Province. METHODS: Totally, 3113 patients with essential HTN in a rural area of Guangdong Province were enrolled and assigned to two groups, named traditional (n = 372) and novel therapeutic (n = 2741) groups, respectively. Patients in the traditional group were treated routinely, and patients in the novel group were treated in a novel model characterized by regular educational programs for hypertensive populations, close monitoring of blood pressure in combination with finely tuned antihypertensive medications, strict implementation of lifestyle modification and improving medical knowledge and skill of local medical staff efficiently. After 2 years of follow-up, primary endpoints including magnitude of systolic and diastolic blood pressures (SBP and DBP) decrease, treated and controlled rates, as well as secondary endpoints, were evaluated in both groups. RESULTS: Initially, the treated rate was significantly higher in traditional group than that of novel group (71.15% vs. 64.99%, P < 0.05), while the controlled rates were comparable and insignificant difference between baseline BP in both groups (31.07% vs. 26.88%, P > 0.05). Four variables were significantly different, namely smoking rate, daily vegetable consumption (VC), and serum levels of low-density lipoprotein-cholesterol and fasting blood glucose between these two groups. After 2 years of follow-up, decreases in SBP and DBP were more prominent in the novel group (P < 0.001). Treated and controlled rates in both groups were both increased. Nevertheless, in comparison to the traditional group, controlled rate increased more significantly in the novel group (64.31% vs. 37.85%, P < 0.001). Variables indicating lifestyle modification such as high sodium consumption, percentages of alcohol abuse, daily VC were profoundly improved in the novel group. CONCLUSIONS: The guideline-based HTN management implemented in the current study was beneficial for HTN control in rural areas of Guangdong Province.

Relationship of pulse pressure index and carotid intima-media thickness in hypertensive adults.

OBJECTIVE: To evaluate the relationship between pulse pressure index (PPI) and carotid intima-media thickness (CIMT). METHOD: Observational trial was design and 342 patients newly diagnosed as hypertension without anti-hypertensive therapy were enrolled. According to the cut-off value of CIMT, 342 participants were divided into normal (< 0.9mm) and increased CIMT groups (≥ 0.9mm). Baseline characteristics were compared, logistic regression analysis and receiver operating characteristic curve (ROC) were performed. RESULTS: Approximately 34.2% of participants (n = 117) were with CIMT ≥ 0.9 mm and participants in increased CIMT group were more elderly. Diastolic blood pressure was lower in increased CIMT group than normal group (79.3 ± 10.8 mm Hg versus 83.8 ± 9.4 mm Hg, p < 0.001), whereas pulse pressure (PP) (59.3 ± 20.2 mm Hg versus 53.6 ± 15.5 mm Hg, p = 0.004) and PPI (0.43 ± 0.09 versus 0.38 ± 0.08, p < 0.001) were significantly higher in increased CIMT group. CIMTs were 1.11 ± 0.11 mm and 0.76 ± 0.12 in increased group and normal group respectively (p < 0.001). After adjusted for the traditional risk factors, only PPI was found an independent determinant for CIMT increase, and the odd ratio was 1.644 (95% interval confidence 1.280-2.112, p < 0.001). The ROC evaluations showed that area under the curve for PP to predict CIMT increase was 0.591 ± 0.034, and PPI was 0.664 ± 0.033. PPI was more powerful than PP in discriminating CIMT increase (p = 0.006). CONCLUSION: PPI is a valuable parameter for the preliminary screening of hypertensive patients who have an increased risk of atherosclerosis.

Baseline LDL-C and Lp(a) elevations portend a high risk of coronary revascularization in patients after stent placement.

BACKGROUND AND AIM: Incidence of coronary restenosis after stent placement is high. Our study was going to investigate whether Lp(a) elevation was potential for predicting coronary restenosis and whether the effects of Lp(a) elevation on coronary restenosis were dependent on LDL-C level. METHODS AND RESULTS: Totally 832 participants eligible for stent placement were enrolled and followed up for monitoring clinical end points. Baseline characteristics were collected. According to the cut point of Lp(a), participants were divided into low Lp(a) group (Lp(a) < 30 mg/dL) and high Lp(a) group (Lp(a) ≥ 30 mg/dL). Furthermore, based on baseline LDL-C level, participants were divided into LDL-C < 1.8 mmol/L and ≥1.8 mmol/L subgroups. Clinical end points including major adverse cardiovascular events (MACE), cardiovascular death, nonfatal myocardial infarction, ischemic stroke, and coronary revascularization (CR) were compared. Patients in high Lp(a) groups more frequently presented with acute coronary syndrome and three vessel stenoses. In subgroup of LDL-C < 1.8 mmol/L, no significant differences of cardiovascular outcomes were found between low and high Lp(a) groups. While in the subgroup of LDL-C ≥ 1.8 mmol/L, incidences of MACE and CR were significantly higher in high Lp(a) group, and odds ratio for CR was 2.05. CONCLUSION: With baseline LDL-C and Lp(a) elevations, incidence of CR is significantly increased after stent placement.

Lipoprotein(a): a promising marker for residual cardiovascular risk assessment.

Atherosclerotic cardiovascular diseases (CVD) are still the leading cause of morbidity and mortality worldwide, although optimal medical therapy has been prescribed for primary and secondary preventions. Residual cardiovascular risk for some population groups is still considerably high although target low density lipoprotein-cholesterol (LDL-C) level has been achieved. During the past few decades, compelling pieces of evidence from clinical trials and meta-analyses consistently illustrate that lipoprotein(a) (Lp(a)) is a significant risk factor for atherosclerosis and CVD due to its proatherogenic and prothrombotic features. However, the lack of effective medication for Lp(a) reduction significantly hampers randomized, prospective, and controlled trials conducting. Based on previous findings, for patients with LDL-C in normal range, Lp(a) may be a useful marker for identifying and evaluating the residual cardiovascular risk, and aggressively lowering LDL-C level than current guidelines' recommendation may be reasonable for patients with particularly high Lp(a) level.