Hypertension, Arterial Stiffness, and Clinical Outcomes: A Cohort Study of Chinese Community-Based Population.

[Figure: see text].

Predictive Value of Cumulative Blood Pressure for All-Cause Mortality and Cardiovascular Events.

The predictive value of cumulative blood pressure (BP) on all-cause mortality and cardiovascular and cerebrovascular events (CCE) has hardly been studied. In this prospective cohort study including 52,385 participants from the Kailuan Group who attended three medical examinations and without CCE, the impact of cumulative systolic BP (cumSBP) and cumulative diastolic BP (cumDBP) on all-cause mortality and CCEs was investigated. For the study population, the mean (standard deviation) age was 48.82 (11.77) years of which 40,141 (76.6%) were male. The follow-up for all-cause mortality and CCEs was 3.96 (0.48) and 2.98 (0.41) years, respectively. Multivariate Cox proportional hazards regression analysis showed that for every 10 mm Hg·year increase in cumSBP and 5 mm Hg·year increase in cumDBP, the hazard ratio for all-cause mortality were 1.013 (1.006, 1.021) and 1.012 (1.006, 1.018); for CCEs, 1.018 (1.010, 1.027) and 1.017 (1.010, 1.024); for stroke, 1.021 (1.011, 1.031) and 1.018 (1.010, 1.026); and for MI, 1.013 (0.996, 1.030) and 1.015 (1.000, 1.029). Using natural spline function analysis, cumSBP and cumDBP showed a J-curve relationship with CCEs; and a U-curve relationship with stroke (ischemic stroke and hemorrhagic stroke). Therefore, increases in cumSBP and cumDBP were predictive for all-cause mortality, CCEs, and stroke.

[Study on the effects of different risk stratifications in patients with diabetes mellitus: a clinical endpoint event].

OBJECTIVE: To estimate the relationship between the risk stratification of patients with diabetes and their clinical endpoint events. METHODS: In this cohort study, we prospectively followed 8302 individuals under the following situations:contents of fasting plasma glucose ≥ 7.0 mmol/L, being diagnosed as diabetes or having used hypoglycemic drugs from Kailuan study in which 101 510 employees (81 110 males, 20 400 females, who were being employed and those retired from the company were included) from the Kailuan Company, were screened. During the 38 - 53 (48.01 ± 3.14) months of follow-up period, a new heart or cerebrovascular events were ascertained every six months. The impacts of different risk stratification in diabetic population on the incidence rates of cardiovascular and cerebrovascular events were estimated. RESULTS: Using the definitions of "people with ischemic cardiovascular disease incidence of 10-year risk assessment methods" developed by the Chinese Academy of Medical Sciences, Institute of Cardiovascular Disease, the study cohort was divided into four groups, namely, very low-risk, low risk, medium risk and high risk. (1) Along with the increasing risk of the disease, the incidence rates of total cardiovascular and cerebrovascular events, myocardial infarction, stroke, cardiovascular death and all-cause death rate also gradually increased and the differences were statistically significant (P < 0.01). However, the difference on incidence rate of sudden death was not significantly different (P > 0.05). (2) Compared to the very low-risk group, the age and sex adjusted relative risk for cardiovascular and cerebrovascular events were 1.42 (95%CI: 1.02 - 1.96, P < 0.05), 2.26 (95%CI: 1.67 - 3.04, P < 0.01) for those with medium and high risk groups, respectively. CONCLUSION: In diabetic patients, those risk factors as age, hypertension, body mass index, total cholesterol and smoking having been used on ischemic cardiovascular disease, could also be used to predict the occurrence of cardiovascular events. Along with the increasing risk factors, the risk of cardiovascular events incidence also increased.

[Impact of patient compliance on the outcomes in hypertensive patients receiving hydrochlorothiazide based combination therapy with spironolactone or captopril].

OBJECTIVE: To explore the impact of patient compliance on the long-term outcomes in hypertensive patients receiving hydrochlorothiazide (HCTZ) based combination therapy with spironolactone or captopril. METHODS: A total of 853 patients with mild to moderate hypertension were recruited and randomly divided into HCTZ group (HCTZ 12.5 mg q.d), spironolactone group (HCTZ 12.5 mg q.d and spironolactone 20 mg q.d), and captopril group (HCTZ 12.5 mg q.d and captopril 25 mg bid) after 2-week placebo washout period and 6-week loading period for HCTZ. Since the efficacy of combination therapy was proven to be better than monotherapy 1 year after therapy beginning, patients in HCTZ group were randomly assigned to spironolactone group or captopril group. The patients were followed up for 4 years. Patients were divided to compliance (n = 424) or non-compliance group (n = 429) according test drug taking questionnaire. During the follow-up time, the blood pressure and the outcomes were recorded monthly, and blood biochemical parameters were determined once a year. RESULTS: At the end of follow up, incidence of cardio-cerebral vascular events was significantly lower in compliance group (2 fatal, 8 non-fatal) than that in noncompliance group (7 fatal, 21 non-fatal, P < 0.05). Systolic blood pressure [-(19.4 +/- 20.6) mm Hg, 1 mm Hg = 0.133 kPa] and diastolic blood pressure [-(10.7 +/- 13.5) mm Hg] were significantly reduced compared values at baseline and noncompliance group (all P < 0.001) while the reduction did not reach statistically significance in noncompliance group [-(7.3 +/- 18.2) mm Hg and -(3.5 +/- 10.2) mm Hg, all P > 0.05 vs. baseline]. The serum BUN, Cr and UA levels in the compliance group were significantly higher and the serum K(+), CHO, LDL-C level were significantly lower than baseline values. The serum BUN, UA levels in the compliance group were significantly higher while the serum K(+), cholesterol levels were significantly lower than those in the noncompliance group (all P < 0.05). CONCLUSIONS: This study indicates that patient compliance could affect the long-term outcome and antihypertensive efficacy in hypertensive patients receiving HCTZ based combination therapy with spironolactone or captopril.