[Procedural success rate and short-term outcomes of percutaneous interventional therapy for severe subclavian artery stenosis in 152 patients].

OBJECTIVE: To evaluate the safety and efficacy of percutaneous transluminal angioplasty (PTA, with or without stents) for the treatment of patients with subclavian artery stenosis. METHODS: Using the brachial (n = 25), radial (n = 3), femoral (n = 96), or combined (n = 28) approach, PTA was performed in consecutive 152 [bilateral n = 27, unilateral n = 125, 88 male, aged 17 approximately 82 (58 +/- 16) years old] subclavian artery stenosis patients with 179 lesions. Stenosis was caused by atheroma in 114 of 152 patients (75%) and by aortoarteritis in the other patients (25%). The indications for intervention were arm claudication in 130 of 152 patients (85.5%), subclavian steal in 138 of 152 patients (90.8%), blue finger syndrome in 2 of 152 patients (1.3%), coronary steal syndrome in 2 of 162 patients (1.3%), or anticipated coronary artery bypass grafting using the internal mammary artery in 10 asymptomatic patients (6.6%). All patients were followed up for at least 9 months after procedure. RESULTS: PTA was succeeded in 142 of 152 patients (93.4%) and procedural success rate was 100% in 133 stenotic lesions (diameter reduction 70% approximately 99%) and 78.2% in total occlusive lesions (36/46). Stents were deployed in 145 of 169 lesions. In the 142 patients successfully treated with PTA, the percent diameter stenosis was reduced from (90 +/- 8)% to (6 +/- 8)%, and lesions diameter improved from (1.0 +/- 0.9) mm to (7.0 +/- 0.5) mm (all P values < 0.001). No severe procedure related complications were observed. During 9 months follow-up in these 142 patients with successful PTA, sustained clinical improvement was seen in 135 patients and restenosis occurred in 7 patients with aortoarteritis (n = 4) and atheroma (n = 3). CONCLUSIONS: Percutaneous transluminal angioplasty is effective and safe for the treatment of subclavian artery stenosis.

[Role of endothelin-1 and its receptors on hypertrophy or proliferation of cultured cardial cells].

OBJECTIVE: To investigate the role of endothelin-1 and its receptors on hypertrophy or proliferation of cultured cardial cells. METHODS: Cardiomyocytes and cardiac fibroblasts were isolated by trypsin digestion method, DNA and protein synthesis were measured by 3H-dexyribonucleotidethymine (3H-TdR) and 3H-Leucine (3H-Leu) incorporation, while protein content was measured by Bradford method. Atrial natriuretic peptide (ANP) mRNA expression of cardiomyocyte was measured by reverse transcripted-polymerase chain reaction. Selective endothelin (ET) receptor subtype antagonists BQ123 and BQ788 were used to block ET(A) receptors (ET(A)R) and ET(B)R respectively and to observe the effects of the two receptors during cardiac hypertrophy. RESULTS: ET-1 significantly increased the 3H-TdR and 3H-Leu incorporation rate of cardiomyocytes and cardiac fibroblasts in a dose-dependent manner and increased protein content. Furthermore, ET-1 promoted the ANP mRNA expression of cardiomyocyte. ET(A)R antagonist remarkably blocked these effects, while ET(B)R antagonist had no obvious effect. CONCLUSIONS: ET-1 can induce the hypertrophy for cardiomyocytes and the proliferation for cardiac fibroblasts. These effects are mediated by ET(A)R.

[Study on polymorphic Hind III restriction site of the Y chromosome and essential hypertension in Tangshan district].

OBJECTIVE: Since males are at higher risk of cardiovascular diseases than females, the aim of the study was to examine whether there is an association between BP and a polymorphic Hind III biallelic marker in nonrecombining region of Y chromosome in essential hypertension in Tangshan district in China. METHODS: In the study, 225 patients with essential hypertension and 187 healthy people were enrolled into this study as control group. DNA was extracted from white blood cell. Segments of polymorphic Hind III restriction site of the Y chromosome were amplified from DNA by polymerase chain reaction (PCR). PCR products were restricted with 10 U of Hind III for a night at 37 degrees C. The digested products were subjected to electrophoresis in 3% agarose gels, and stained with ethidium bromide. RESULTS: We amplified 178 controls (95.2%) and 216 essential hypertensive patients (96.0%) successfully. Hind III(-) genotype was found in 45.8% of the men in essential hypertension and in 32.0% of the men in the controlled group. The Hind III(-) genotype was significantly higher than that in the controls (chi2 = 7.782, P = 0.007). However, the Hind III(+) genotype was lower in SBP (133.16 mm Hg +/- 21.60 mm Hg vs. 143.58 mm Hg +/- 24.16 mm Hg, P < 0.001), DBP (82.82 mm Hg +/- 11.72 mm Hg vs. 86.82 mm Hg +/- 12.65 mm Hg, P = 0.001), pulse pressure (50.34 mm Hg +/- 14.31 mm Hg vs. 56.76 mm Hg +/- 14.20 mm Hg, P < 0.001) and mean arterial pressure (99.59 mm Hg +/- 14.19 mm Hg vs. 105.74 mm Hg +/- 15.31 mm Hg, P < 0.001) than the Hind III(-) genotype. CONCLUSION: Polymorphic Hind III restriction site of the Y chromosome seemed to be associated with essential hypertension in Tangshan district in China.

[Polymorphic Hind III restriction site of the Y chromosome and essential hypertension in Chinese Han People].

OBJECTIVE: To examine whether there is an association essential hypertension pressure and a polymorphic Hind III biallelic marker in the non-recombining region of Y chromosome in Chinese Han people. METHODS: Peripheral blood samples were collected from 402 males with essential hypertension pressure and 455 age- and body height-matched healthy males as control group. Genomic DNA was extracted from the white blood cells. Segments of polymorphic Hind III restriction site of the Y chromosome were amplified from the genomic DNA by polymerase chain reaction (PCR). The PCR products were restricted with 10 U of Hind III overnight at 37 degrees C. The digested products were subjected to electrophoresis in 3% agarose gels, and stained with ethidium bromide. RESULTS: The Hind III (+) genotype was found in 58.5% of the men with essential hypertension (235/402), significantly lower than that in the healthy men (64.4%, 302/455, P = 0.02). The systolic blood pressure of the men with Hind III (+) genotype was 133.8 mm Hg +/- 25.2 mm Hg, significantly lower than that of the Hind III (-) genotype (138.0 mm Hg +/- 27.0 mm Hg, P < 0.05), and the diastolic blood pressure (DBP) of the men with Hind III (+) genotype was 83.5 mm Hg +/- 13.3 mm Hg, significantly lower than that of the men with Hind III (-) genotype (85.9 mm Hg +/- 14.4 mm Hg, P = 0.01), and the mean arterial pressure of the men with Hind III (+) genotype was 100.2 mm Hg +/- 16.5 mm Hg, significantly lower than that of the of the men with Hind III (+) genotype was (103.3 mm Hg +/- 17.6 mm Hg, P = 0.01). CONCLUSION: Polymorphic Hind III restriction site of the Y chromosome is associated with essential hypertension in Chinese Han people.

[MMP-9 gene -1562C/T polymorphism in aortic dissection in Chinese hypertensive patients].

OBJECTIVE: To investigate the association of matrix metalloproteinase 9 (MMP-9) gene -1562C/T polymorphism with the pathogenesis and site involved range of aortic dissection in Chinese population. METHODS: 142 hypertensive patients with aortic dissection and 130 hypertensive patients without aortic dissection were enrolled. Genomic DNAs were extracted from peripheral blood leucocytes. MMP-9 gene -1562C/T polymorphism was determined with PCR-RFLP. MMP-9 gene -1562C/T genotype and allele frequency were compared between hypertensive patients with aortic dissection and without. In addition, associations of MMP-9 gene -1562C/T polymorphism with clinical aspects were analyzed in hypertensive patients with aortic dissection. RESULTS: There was a significant difference in the T allele frequency of the C-1562T MMP-9 polymorphism between the two groups, with more T allele (17.6%) observed in hypertensive patients with aortic dissection as compared with these without (11.2%) (P = 0.033). The genotype distribution for the MMP-9 -1562C/T polymorphism in hypertensive patients with aortic dissection (-1562CC: 69.0%; -1562 CT: 26.8%; -1562TT: 4.2%) and those without (-1562CC: 79.2%; -1562CT: 19.2%; -1562TT: 1.6%; P = 0.118) showed no remarkable difference, but hypertensive patients with aortic dissection possessing T allele showed a higher odds ratio for involving ascending aorta (OR = 2.063, 95% CI = 0.998 - 4.264, P = 0.049) as compared with those without T allele. CONCLUSIONS: The T variant of MMP-9 gene -1562C/T polymorphism was significantly associated with aortic dissection in hypertensive patients and may represent an important genetic component contributing to aortic dissection susceptibility. Furthermore, hypertensive patients with aortic dissection possessing MMP-9 gene -1562T allele are more prone to involvement of ascending aorta.

[Correlativity between the polymorphisms of aldosterone synthase gene, Hind III restriction site on Y chromosome and essential hypertension].

OBJECTIVE: To investigate the relationship of associating the polymorphisms of CYP11B2 -344C/T and Hind III restriction site on Y chromosome with essential hypertension. METHODS: This study enrolled 654 patients with essential hypertension and 386 healthy subjects as control group. The genomic DNA was extracted from blood leukocytes. The DNA segments of CYP11B2 and Y chromosome were amplified from genomic DNA by polymerase chain reaction (PCR). The PCR products were digested with Hae III or Hind III at 37 degrees centigrade respectively. The digested products were subjected to agarose gel electrophoresis and stain with ethidium bromide. RESULTS: (1)The Hind III (-) genotype was found at 42.0% for patients with essential hypertension and 32.9% for control. The Hind III (-) genotype frequency of hypertension patient was significantly higher than that of the control (P was 0.03). The Hind III (+) genotype had a lower SBP and DBP than the Hind III (-) genotype (P was 0.01, P was 0.03). (2)With combining CC or CT genotype with Hind III (-) genotype, the relative risk suffering from hypertension was 1.998 fold high (P was 0.01). CONCLUSION: The polymorphism of Hind III restriction site on Y chromosome is associated with essential hypertension, and when combined with polymorphism of CYP11B2 -344C/T, may have a united role to increase the risk of suffering from hypertension disease.

Associations between CYP11B2 gene polymorphisms and the response to angiotensin-converting enzyme inhibitors.

OBJECTIVE: Our objective was to investigate the association between the -344C/T or A6547G polymorphism of the aldosterone synthase gene and the blood pressure response to angiotensin-converting enzyme inhibitors in a hypertensive cohort. METHODS: After a 2-week single-blind placebo run-in period, either benazepril or imidapril was administered for 6 weeks to 509 patients with mild to moderate essential hypertension. Polymerase chain reaction combined with restriction enzyme digestion was used to detect the 2 polymorphisms. The achieved changes in systolic and diastolic blood pressure were analyzed for their association with genotypes at the aldosterone synthase gene loci. RESULTS: Regarding the -344C/T polymorphism, we observed the CC genotype in 53 patients (10.4%), the CT genotype in 204 (40.1%), and the TT genotype in 252 (49.5%). After 6 weeks of treatment, the reductions in diastolic blood pressure were significantly greater in patients carrying the TT or CT genotype compared with those carrying the CC genotype (9.1+/-7.0 mm Hg or 8.9+/-7.0 mm Hg versus 5.1+/-7.3 mm Hg, respectively; P=.001, ANOVA). Regarding the A6547G polymorphism, we observed the AA genotype in 19 patients (3.7%), the AG genotype in 184 (36.2%), and the GG genotype in 306 (60.1%). There were no significant differences in the blood pressure reductions after treatment among the 3 genotype groups, and there was no interaction between it and the -344C/T polymorphism. Stepwise multiple regression analysis showed that the significant predictors of diastolic blood pressure reduction at 6 weeks were baseline diastolic blood pressure (P<.001), -344C/T genotype (P=.007), and sex (P=.033). CONCLUSIONS: The -344C/T variant, but not the A6547G variant, of the aldosterone synthase gene may be a determinant of the blood pressure response to angiotensin-converting enzyme inhibitors in hypertensive patients.

[The effects of angiotensin II receptor blockers in hypertensive patients complicating hyperuricaemia].

OBJECTIVE: To study the effects of angiotensin II receptor blockers (ARB), losartan and irbesartan, on blood pressure and serum uric acid (SUA) level in mild to moderate essential hypertensive patients complicating hyperuricaemia. METHODS: A total of 351 eligible patients were recruited in this multi-center, randomized, double-blind parallel clinical trial. After 1 week screening and a 2 week single-blinded placebo wash-out period, patients were randomly assigned to receive losartan 50 mg (n=76) or irbesartan 150 mg (n=175) once daily for 4 weeks, followed by a double-dose for another 4 weeks in patients whose seated DBP were >or=90 mm Hg or SBP>or=140 mm Hg at the end of 4 weeks. The SUA concentration and blood pressure were measured at baseline, 4 and 8 weeks post therapy. RESULTS: Three hundred and twenty-five patients completed the study (162 in the losartan group and 163 in the irbesartan group). Both groups were well matched for baseline clinical characteristics and demographics. SUA was significant reduced in losartan group (430.93 micromol/L vs 372.35 micromol/L, P<0.0001), but not in Irbesartan group (430.46 micromol/L vs 420.67 micromol/L, P>0.05) 8 weeks post therapy compared to baseline level. Blood pressure was significantly and equally reduced in both groups after 8 weeks treatment compared to baseline level (P<0.0001). CONCLUSION: Losartan is an optimum choice of medication for patients with mild-to-moderate hypertension complicating hyperuricemia.

[The AGT genotype affects the antihypertensive effects of benazepril].

OBJECTIVE: To investigate the association between M235T variant of angiotensinogen (AGT) gene and the blood pressure response to benazepril in a hypertensive cohort. METHODS: Benazepril (10-20 mg/day) was administered for 6 weeks to 251 essential hypertensives. Polymerase chain reaction (PCR) combined with restriction enzyme digestion was used to detect the polymorphism and the patients were classified as MM, MT or TT genotype. The changes in systolic and diastolic blood pressure (SBP and DBP) were analyzed for association with genotypes at the AGT gene locus. RESULTS: The MM genotype was observed in 23 patients (9.2%), the MT genotype in 104 patients (41.4%) and the TT genotype in 124 patients (49.4%). There was no association between these polymorphisms and the blood pressure responses in the total 251 patients. But based on the analysis stratified by age, the association between these polymorphism and the DBP responses was found in the old patients (> or = 60 years old) subgroup, the reduction in DBP was significantly greater in patients carrying the MM compared to MT or TT genotypes (14.8 +/- 4.8 mm Hg vs. 7.9 +/- 7.7 mm Hg or 9.8 +/- 6.4 mm Hg respectively; ANOVA, P = 0.034). CONCLUSION: The M235T polymorphism of the AGT gene was shown to influence the responses to benazepril in old hypertensive patients (> or = 60 years old). Thus, specific genotypes might predict the response to specific antihypertensive treatment.

[The comparison of the effect of enalapril and indapamide on the peripheral blood pressure and central blood pressure through pulse wave analysis].

OBJECTIVES: The purpose of this study was to evaluate the effects of the angiotensin-converting enzyme (ACE) inhibitor enalapril and diuretic indapamide on the peripheral blood pressure and the central blood pressure in Chinese patients with essential hypertension. METHODS: This study was a double blind, randomized study. Informed consent were given by all patients. After 2 weeks of placebo run-in period, 105 patients with mild or moderate essential hypertension were randomized to receive either enalapril (10 mg per day) or indapamide (2.5 mg per day) for 8 weeks. Radial pulse wave recordings were performed in all the patients before the active treatments were given and at the end of the study. Only those patients who have finished 8 weeks of active treatment in both groups were included into the final analysis. RESULTS: One hundred one patients (51 in enalapril group and 50 in indapamide group) completed the study. No significant difference (all P values > 0.05) was found in baseline data between the two groups. After 8 weeks of treatment, all the parameters of pulse wave (except heart rates in both groups and augmentation index in indapamide group) decreased significantly. Comparison of the 2 groups showed that there were no significant differences (all P values > 0.05) in all the parameters of pulse wave except that the central systolic blood pressure, augmentation and augmentation index were significantly lower in enalapril group than in indapamide group. In enalapril group, the reduced values of systolic blood pressure and pulse pressure in central aorta were significantly larger than those in brachial artery. However, the difference was not observed in indapamide group. CONCLUSIONS: Enalapril and indapamide are both similarly effective in reducing peripheral arterial blood pressure. Moreover, enalapril is more effective in reducing central systolic pressure and augmentation index than indapamide. The difference is probably due to the reduction of wave reflection caused by enalapril.

[Effects of renal artery stenting on renal function of patients with ischaemic nephropathy].

OBJECTIVES: To evaluate the effects of stent revascularization on renal function of patients with atherosclerotic renal artery stenosis with renal insufficiency. METHODS: Percutaneous transluminal renal angioplasty with stent (PTRAS) was performed on 27 consecutive patients with severe atherosclerotic renal artery stenosis for preservation of renal function, and follow-up was conducted for 6 approximately 48 months. RESULTS: Technically PTRAS was successfully performed in all 27 patients. The creatinine value was 155 micromol/L +/- 31 micromol/L before operation, and increased to 189 micromol/L +/- 38 micromol/L (P < 0.001), then decreased to 145 micrommol/L +/- 22 micrommol/L, 143 micromol/L +/- 22 micromol/L, 143 micromol/L +/- 24 micromol/L, and 139 micromol/L +/- 10 micromol/L, 6, 12, 24, and 36 months after the PTRAS respectively (all P < 0.05). The severe complications related to the procedure mainly included 7 cases of acute renal failure, 4 cases being reversible. One case died of cardiac infarction with underlying coronary heart disease 9 months after and 1 case died heart failure due to valvular disease of heart 25 months after. CONCLUSION: Renal artery stent revascularization is effective for preservation of renal function in patients with ischaemic nephropathy effect on. However, complications related to the procedure frequently occurred. The long-term efficacy is to be investigated further.

[The effect long-term administration of a selective beta1 blocker bisoprolol on glucose metabolism in patients with essential hypertensive and type 2 diabetes mellitus].

OBJECTIVE: To investigate the effects of bisoprolol on glucose metabolism and blood pressure in essential hypertensive patients with type 2 diabetes mellitus. METHODS: A total of 92 hypertensive patients with type 2 diabetes on stable antidiabetic therapy with HbAlc less than 7% were recruited. In a randomized, open trial the patients were treated for 12 weeks with bisoprolol or captopril following a 1-week placebo run-in period, the main parameters measured were HbA1c, fasting blood glucose and 2-hour postprandial glucose following a standard dinner as well as systolic and diastolic blood pressure. RESULTS: There were no differences in HbA1 [(6.0 +/- 0.8)% vs (6.2 +/- 0.8)%, P > 0.05], fasting glucose [(7.0 +/- 1.8) mmol/L vs (7.0 +/- 1.9) mmol/L, P > 0.05], 2-hour postprandial blood glucose [(10.7 +/- 2.5) mmol/L vs (11.2 +/- 3.4) mmol/L, P > 0.05], systolic blood pressure [(147.3 +/- 9.7) mm Hg (1 mm Hg = 0.133 kPa) vs (146.2 +/- 8.3) mm Hg, P > 0.05] and diastolic blood pressure (88.3 +/- 8.9 mm Hg vs 87.8 +/- 7.9 mm Hg, P > 0.05) between the bisoprolol and captopril group before treatment. After administration of bisoprolol or captopril, there were still no differences between these two groups in HbA1c [(5.7 +/- 0.9)% vs (5.7 +/- 1.1)%, P > 0.05], fasting blood glucose [(6.8 +/- 1.6) mmol/L vs (6.4 +/- 2.1) mmol/L, P > 0.05], 2-hour postprandial glucose [(10.0 +/- 2.9) mmol/L vs (10.2 +/- +/- 2.9)mmol/L, P > 0.05], systolic blood pressure [(124.8 +/- 10.6) mm Hg vs (126.6 +/- 7.8) mm Hg, P > 0.05] and diastolic blood pressure [(74.5 +/- 7.7) mm Hg vs (77.6 +/- 7.6) mm Hg, P = 0.05]. CONCLUSIONS: Based on these results, bisoprolol appears to be a beta1-selective blocker possessing a satisfactory antihypertensive effect without any adverse effects on glucose metabolism and is therefore a choice for treating hypertensive patients with type 2 diabetes mellitus.

[Assisting protective effect of Yiyuan oral solution on mice from irradiation injury].

OBJECTIVE: To study the protective effect of Yiyuan oral solution against radiation injury in mice. METHODS: Yiyuan oral solution was administered in mice at 10.00, 3.33 and 1.67 ml/kg for 30 days. The mice were then exposed to (60)Co-gamma irradiation at 3 Gy once and the effect of the irradiation on the WBC, bone marrow polychromatic erythrocytes (PEC) micronuclei and serum hemolysin antibody against sheep red cells. RESULTS AND CONCLUSION: Yiyuan oral solution at 10 ml/kg significantly increased WBC counts, decreased bone marrow PEC micronucleus rate and enhanced serum hemolysin antibody in mice, suggesting the protective effect of this preparation against radiation injury.

[Clinical results of stent revascularization as treatment for renal artery stenosis during 6 months of follow-up].

OBJECTIVES: To evaluate the safety and midterm efficacy of stent revascularization as treatment for renal artery stenosis. METHODS: Percutaneous transluminal renal angioplasty with stent (PTRA) was performed because of poorly controlled hypertension or preservation of renal function in 150 consecutive patients with severe renal artery stenosis, caused by atheroma (96 patients), arteritis (44 patients) and fibromuscular dysplasia (10 patients). All of them subsequently underwent 6-month clinical follow-up to observe the effect of the procedure on renal function, blood pressure control, number of antihypertensive medications. RESULT: Angiographic success was obtained in 148 (98.7%) of 150 patients after PTRA. At 6 months, both systolic and diastolic blood pressures significantly decreased (from 169.6 to 142.7 mm Hg and from 97.3 to 83.3 mm Hg, respectively; P < 0.001), and less antihypertensive medication was taken (from 2.7 to 1.9). The blood pressure became normal without taking any antihypertensive medications in 48 of 150 patients (32.0%), and the blood pressure control was more facile in 78 patients (52.0%), however, there were no improvement in 22 patients (16.0%). Creatinine level decreased in 34 patients (22.7%), remained stable in 112 patients (74.6%), and increased in 4 (2.7%). There was no statistical significance. No deaths occurred during 6-months follow-up. CONCLUSIONS: Renal artery stent revascularization had a beneficial effect on blood pressure control and a nondeleterious effect on renal function during 6-months follow-up. The long-term efficacy should be investigated. The procedure is safe in usual.

[Fasting plasma insulin and insulin sensitivity in the offspring of parents with a family hypertensive history].

OBJECTIVE: To investigate the plasma insulin levels and insulin sensitivity in the offspring of parents with family hypertensive history in Tibetan population. METHODS: Tibetan hypertensive pedigrees and normotensive pedigrees based on a door-to-door cross section study performed from 1997 to 1998 in stable communities in the ruban district of Lhasa city were set up, 47 offsprings from hypertensive pedigrees (group I) and 21 offsprings from normotensive pedigrees (group II) were enrolled into this study. Plasma insulin levels using by radioimmunoassay and insulin sensitivity with the formulae insulin sensitivity = 1/(fasting plasma glucose x fasting plasma insulin) were compared between two groups. RESULTS: There were no statistically significant differences in fasting blood glucose levels between group I and group II. But fasting plasma insulin level was 10.20 +/- 6.95 m IU/L in group I and 6.56 +/- 2.81 m IU/L in group II, respectively, and there were statistically significant differences between these two groups. The insulin sensitivity index in group I was significantly lower than that in group II (0.036 +/- 0.024 and 0.046 +/- 0.022, respectively). CONCLUSION: Offspring of Tibetan hypertensive pedigrees were observed to be hyperinsulinemia and reduced insulin sensitivity. These metabolic abnormalities may be associated with hypertension and dyslipidemia in adulthood.