An index of open-access hypertension content relevant to primary care
Relationship of Red Blood Cell Distribution Width with Polysomnography Parameters in Patients with Hypertension and Sleep Apnea Hypopnea Syndrome
http://123.57.154.95:8088/zgqkyx/CN/10.12114/j.issn.1007-9572.2021.00.523
LIU Guixin，CHENG Wenli*，YU Jing，MA Huijuan
Beijing Anzhen Hospital，Capital Medical University，Beijing 100029，China
*Corresponding author：CHENG Wenli，Chief physician；E-mail：chengwenli2000@163.com
Abstract：Background There is a controversy about the relationship of inflammatory factors with upper airway obstruction.Polysomnography serves as a “gold standard” in support of the diagnosis of obstructive sleep apnea syndrome （OSAS），it is not suitable for repeated monitoring due to complex operation，time-consuming and high cost.Objective To explore the relationship of red blood cell distribution width（RDW-CV） with polysomnography parameters and its influencing factors by retrospectively analyzing relevant data of hypertensive patients with OSAS.Methods Participants（n=287） were hypertensive patients discharged from Beijing Anzhen Hospital，Capital Medical University during 2017 to 2019 were collected at admission.High sensitivity C-reactive protein（hs-CRP），RDW-CV，oxygen desaturation index，lowest and mean oxygen saturation，apnea-hypopnea index（AHI），24 hSBP and 24 hDBP were detected during hospitalization.Those who were found with OSAS were stratified into mild，moderate and severe（number of apneas 5-15，16-30 and >30 times/h） subgroups by AHI level.Results At baseline，there were 62 patients without OSAS and 225 with OSAS，including 50 mild cases，78 moderate cases and 97 severe cases.Patients with OSAS had greater mean age，BMI，24 hSBP，RDW-CV and hs-CRP，as well as higher cardiovascular disease prevalence than those without（P<0.05）.The RDW-CV value in patients with OSAS was positively correlated with age，BMI，24 hSBP，oxygen desaturation index，AHI and hs-CRP，and negatively correlated with the lowest and mean oxygen saturation（P<0.05）.Multivariate Logistic regression analysis showed that age，AHI and hs-CRP were associated with RDW-CV（P<0.05）.Conclusion RDW-CV may be related to polysomnography parameters in patients with hypertension and OSAS，indicating that it could be used as an easily monitored parameter.
Analysis of the Current Situation of Frequent Visits and Influencing Factors of Hypertension Patients in Yuetan Community
http://123.57.154.95:8088/zgqkyx/CN/10.12114/j.issn.1007-9572.2021.00.502
JI Yan，DING Jing*，CHEN Xue，LIU Meixing
Yuetan Community Health Center，Fuxing Hospital，Capital Medical University，Beijing 100045，China
*Corresponding author：DING Jing，Chief physician；E-mail：xiaoxiaodingj@ccmu.edu.cn
Abstract：Background Frequent visits not only causes unreasonable application of community medical resources，but also increases the workload of general practitioners.Objective To understand the current situation of frequent visits to patients with hypertension in Beijing Yuetan Community and to analyze related influencing factors.Methods 434 hypertensive patients with complete outpatient visit records in Yuetan Community Health Center，Fuxing Hospital，Capital Medical University from July 2017 to June 2018 were retrospectively selected as the research object and their basic information（gender，age，marital status，occupational status，education level，whether to contract a family doctor service agreement），disease atatus（body mass index，combination with other chronic diseases），status of visits（number of simple consultations，types of oral hypotensive drugs，times of blood pressure measurement）were analyzed.Results 434 patients with hypertension paying a total of 9 910 visits，among them，there were 160 patients（36.9%）in the frequent visits group（the annual visiting times >24），with a total of 5 694 visits（57.5%）；274 patients（73.1%）in the routine visits group（the annual visiting times ≤24），with a total of 4 216 visits（42.5%）.There were statistically significant differences in age composition，proportion of contracted family doctor services，body mass index，proportion of patients with coronary heart disease and stroke between the two groups（P<0.05）.Multivariate Logistic regression analysis showed that the contracted family doctor services〔OR=2.467，95%CI（1.536，3.964）〕 and combination with stroke〔OR=2.702，95%CI（0.449，1.106）〕 were risk factors for frequent visits.Conclusion Frequent attenders in hypertension patients occupy a large amount of community medical resources，contracted family doctor services and combination with stroke are the are the risk factors of frequent visits.We should enhance the importance of frequent visits，screen and interven unnecessary medical visits，so as to help play better role of general practitioners and make full use of community medical resources.
Correlation between Ambulatory Arterial Stiffness Index and Severity of Heart Failure with Preserved Ejection Fraction in Patients with Hypertension
http://123.57.154.95:8088/zgqkyx/CN/10.12114/j.issn.1007-9572.2021.00.429
ZHU Mingna1，ZHANG Lihua1*，JIANG Youxu2，MA Xiaoying1，XIONG Haiyan1，LI Yuan1，ZHU Lina3，HUANG Xin1
1.Cardiovascular Department，the Second Affiliated Hospital of Zhengzhou University，Zhengzhou 450002，China
2.Cardiovascular Department，Beijing Anzhen Hospital，Capital Medical University，Beijing 100029，China
3.Cardiovascular Department，Henan Provincial Chest Hospital，Zhengzhou 450003，China
*Corresponding author：ZHANG Lihua，Professor，Chief physician；E-mail：zlhxp126.com
Abstract：Background The major pathophysiological mechanism of heart failure with preserved ejection fraction（HFpEF）refers to ventricular diastolic dysfunction caused by ventricular remodeling.Ambulatory arterial stiffness index（AASI）refers to a common clinical indicator，which is closely related to both arteriosclerosis and left ventricular remodeling.But less researches on AASI and HFpEF has appeared yet.Objective To examine the changes of AASI in patients with hypertension and HFpEF，and explore the correlation of AASI with cardiac functional and ventricular structural indices.Methods 210 patients with hypertension〔including 112 with HFpEF（63 with NYHA class Ⅱ-Ⅲ and 49 with NYHA class Ⅲ-Ⅳ）and 98 without〕 who were admitted into the Cardiovascular Department，the Second Affiliated Hospital of Zhengzhou University from 2018 to 2019 were enrolled.Gender，age，admission systolic and diastolic blood pressures，and heart rate and medication history（use of ACEIs/ARBs，calcium channel blockers，digoxin，mineralocorticoid receptor antagonists，diuretic），serum indices〔serum creatinine（Scr），serum urea nitrogen（SUN），alanine aminotransferase，aspartate aminotransferase，total cholesterol，triglyceride，high- and low-density lipoprotein〕in the fasting venous blood sample taken after admission，and NT-proBNP and cardiac functional and structural indices，such as echocardiography measured left ventricular ejection fraction（LVEF），left ventricular end-diastolic diameter（LVDd），interventricular septal thickness，left ventricular posterior wall thickness，left atrial diameter，and calculated left ventricular mass，left ventricular mass index（LVMI）and AASI were recorded.Pearson correlation analysis was used to explore the correlation of AASI with cardiac function and ventricular structure indices.Results Hypertensive patients with HFpEF had greater average age，higher average levels of Scr，SUN，NT-proBNP，LVMI，LVDd and AASI，as well as higher rate of using diuretics，but had lower average level of LVEF compared with those without（P<0.05）.Hypertensive patients with HFpEF of NYHA class Ⅰ-Ⅱ had lower average levels of NT-proBNP，LVDd，LVMI and AASI，and higher average level of LVEF than those of NYHA class Ⅲ-Ⅳ（P<0.05）.AASI was positively correlated with NT-proBNP（r=0.434，P<0.001），LVDd（r=0.470，P<0.001）and LVMI（r=0.417，P<0.001），and negatively correlated with LVEF（r=-0.410，P<0.001）in patients with HFpEF and hypertension.Conclusion The AASI was higher，and was related to the changes of cardiac function and the degree of ventricular remodeling in hypertension patients with HFpEF，which may be caused by HFpEF.
Association of Carotid Intima-media Thickening and Hypertension with New-onset Cardio-cerebrovascular Disease
http://123.57.154.95:8088/zgqkyx/CN/10.12114/j.issn.1007-9572.2021.00.555
ZHANG Ying1，DU Xin2*，LI Jie1，MA Lin1，ZHANG Shuhua1，WU Shouling2
1.North China University of Science and Technology Affiliated Hospital，Tangshan 063000，China
2.Kailuan General Hospital Affiliated to North China University of Science and Technology，Tangshan 063000，China
*Corresponding author：DU Xin，Associate chief physician；E-mail：552444475@qq.com
Abstract：Background Either carotid intima-media thickening（CIMT） or hypertension is closely related to the occurrence of cardio-cerebrovascular disease（CVD），yet large-scale studies exploring the combination of the two in relation to cardio-cerebrovascular disease are rare.Objective To investigate the association of new-onset CVD with the combination of CIMT thickening and hypertension.Methods In this prospective cohort study，5 440 middle-aged and elderly people（≥ 40 years old） who participated in the health examination of Kailuan Group from July 2006 to January 2017 and carotid ultrasound in 2010 were randomly selected.The content of epidemiological investigation，anthropometric indices，biochemical indices and the definition of living habits were described in the previous study of our group.Participants were grouped according to CIMT thickening and hypertension prevalence：group 1：normal CIMT（CIMT<1.0 mm） without hypertension；group 2：CIMT thickening without hypertension；group 3：normal CIMT（CIMT<1.0 mm） with hypertension；group 4：CIMT thickening with hypertension.The follow-up started since the completion of 2010 physical examination，and ended on 2017-12-31 with CVD（including stroke and myocardial infarction） as the endpoint event.The CVD cumulative incidence curves of the four groups were plotted by Kaplan-Meier method，and were compared by the Log-Rank test.Multivariate Cox regression analysis was used to explore the association of CIMT thickening and hypertension with new-onset CVD.Results The mean follow-up period was（6.84±0.89） years.The cumulative incidence of CVD for groups 1，2，3，and 4 was 1.28%，2.96%，5.73% and 8.37%，respectively，with a statistically significant difference（χ2=96.10，P<0.001）.Multivariate Cox regression analysis showed that compared with group 1，the HR（95%CI） for new-onset CVD in groups 2，3 and 4 was 1.15（0.55，2.37），3.34（2.15，5.19） and 3.16（1.91，5.12），respectively.Sex-based analysis showed that compared to men in group 1，the HR（95%CI） for new-onset CVD in those in groups 2，3 and 4 was 1.35（0.62，2.94），3.46（2.04，5.89） and 3.29（1.84，5.90），respectively.Compared to women in group 1，the HR（95%CI） for new-onset CVD in those in groups 3，4 was 2.53（1.13，5.65） and 2.67（0.98，7.31），respectively.After eliminating the interference of antihypertensive drugs，the HR value of group 4 was significantly higher than that of group 3（P<0.05）.After excluding individuals taking lipid-lowering drugs，multivariate Cox regression analysis showed that compared with group 1，the HR（95%CI） of new-onset CVD in group 4 was 3.36（2.02，5.59）.After excluding those taking antihypertensive drugs，the HR（95%CI） of new-onset CVD in group 4 was 3.19（1.19，5.71） compared to group 1in the multivariate Cox regression.And after excluding those taking hypoglycemic drugs，the HR（95%CI） of new-onset CVD in group 4 was 3.59（2.06，6.25） compared to group 1showed by multivariate Cox regression analysis.Conclusion CIMT thickening with hypertension may be strongly associated with new-onset CVD，which can provide help for clinical prevention of CVD.
Serum Uric Acid Level and Mild Cognitive Impairment in Patients with H-type Hypertension
http://123.57.154.95:8088/zgqkyx/CN/10.12114/j.issn.1007-9572.2021.00.554
LI Qian1，ZHAO Jianhua1*，PENG Xue1，MENG Lifang1，LIU Hao1，WANG Jin1，LIU Junli1，ZHAO Panpan1，WANG Fan1，LI Shaomin2
1.Department of Neurology，First Affiliated Hospital of Xinxiang Medical University/Henan Key Laboratory of Neurorestoratology/Henan Joint International Research Laboratory of Neurorestoratology for Senile Dementia，Xinxiang 453100，China
2.Ann Romney Center for Neurologic Diseases，Brigham and Women's Hospital，Harvard Medical School，Boston 02115，United States
*Corresponding author：ZHAO Jianhua，Associate chief physician，Associate professor；E-mail：051092@xxmu.edu.cn
Abstract：Background H-type hypertension easily brings about the decline of cognitive，whose incidence in China is increasing with years.Elevated serum uric acid（SUA） levels in patients with H-type hypertension may be related to mild cognitive impairment（MCI）.Objective The present study aimed at investigating the correlation between SUA level and MCI in patients with H-type hypertension to find early identification indicators of cognitive decline caused by H-type hypertension.Methods Eighty-nine patients with H-type hypertension and 40 health examinees were selected from the First Affiliated Hospital of Xinxiang Medical University from January 2019 to September 2020.Clinical data of the participants were collected，including gender，age，years of education，height，weight，and body mass index，history of smoking，drinking，coronary heart disease，hyperlipidemia，and diabetes，systolic blood pressure（SBP），diastolic blood pressure（DBP），homocysteine（Hcy），SUA.The Mini-Mental State Examination（MMSE） and the Chinese version of the Montreal Cognitive Assessment（MoCA） were used to assess cognitive function in hypertension patients，and by the assessment results，the patients were divided into H-type hypertension with MCI subgroup（n=47），and H-type hypertension with normal cognitive function subgroup（n=42）.Multivariate Logistic regression analysis was carried out to identify the factors associated with H-type hypertension with MCI.The correlation between SUA level and MoCA score in H-type hypertension patients was analyzed by Pearson correlation analysis.Results Compared to health examinees，H-type hypertension patients with MCI had lower mean height，and higher mean levels of SBP，DBP and Hcy（P<0.05），those with normal cognitive function had higher mean levels of SBP，DBP，Hcy and SUA（P<0.05）.In addition，H-type hypertension patients with normal cognitive function had higher mean SUA level than those with MCI（P<0.05）.Multivariate Logistic regression analysis found that elevated SUA was associated with decreased risk of MCI，while elevated SBP was associated with increased risk of MCI in H-type hypertension（P<0.05）.The level of SUA had a positive correlation with the MoCA score in patients with H-type hypertension（r=0.279，P=0.008）.Conclusion SUA level may be related to MCI in patients with H-type hypertension，and may contribute to a decreased risk of MCI.
Adherence to WeChat Interventions and Associated Factors among Middle-aged and Elderly People with Prehypertension and Hypertension in the Community
http://123.57.154.95:8088/zgqkyx/CN/10.12114/j.issn.1007-9572.2021.00.239
LUO Yang1，LI Xiaowen1，LIN Aihua1，2*
1.Department of Medical Statistics，School of Public Health，Sun Yat-sen University，Guangzhou 510080，China
2.School of Health Sciences，Guangzhou Xinhua University，Guangzhou 510520，China
*Corresponding author：LIN Aihua，Associate professor，Master supervisor；E-mail：linaihua@mail.sysu.edu.cn
Abstract：Background The development of science and technology and the popularity of smart phones have made WeChat a potential tool for community-based hypertension management. Objective To study the adherence to WeChat interventions and associated factors in middle-aged and elderly people with prehypertension and hypertension in the community. Methods From November 2018 to May 2019，we delivered a six-month WeChat-based tiered interventions（first three-month health education，then three-month health behavior promotion） to middle-aged and elderly people with prehypertension and hypertension selected using convenient sampling method from Baiyun Subdistrict，Guangzhou's Yuexiu District. A descriptive analysis of the adherence to the interventions was performed. Logistic regression analysis was used to identify the associated factors of adherence to the interventions. Results A total of 209 cases were enrolled，and 167（79.9%）of them completed the study，including 81 with good intervention adherence，and 86（51.5%）with poor adherence. Multivariate Logistic regression analysis found that education level，current marital status，comorbidities，and drinking status were influencing factors of adherence to WeChat interventions in middle-aged and elderly people with prehypertension and hypertension in the community（P<0.05）. Conclusion The adherence to WeChat-based interventions in these people may be associated with multiple factors，and needs to be improved. To do this，priority during the intervention delivery shall be given to individuals having a low level of education，spouse，at least one comorbidity，or drinking.
Association of Plasma Renin Activity and Early Renal Damage in Essential Hypertensive Patients
http://123.57.154.95:8088/zgqkyx/CN/10.12114/j.issn.1007-9572.2021.01.202
LI Yu1，WU Ting2，ZHAO Xin2，LI Nanfang2*
1. No.2 Department of Comprehensive Internal Medicine，the First Affiliated Hospital of Xinjiang Medical University，Urumqi 830054，China
2. Department of Hypertension，People's Hospital of Xinjiang Uygur Autonomous Region，Urumqi 830001，China
*Corresponding author：LI Nanfang，Professor，Chief physician；E-mail：lnanfang2016@sina.com
Abstract：Background Kidney injury is one of the most common target organ damages in essential hypertension. Early detection and intervention will possibly reverse or even eliminate underlying renal damage. Previous studies have shown that plasma renin activity（PRA）plays an important role in appropriate treatment and prognosis evaluation of essential hypertensive patients，but it is unclear whether PRA can predict early hypertensive renal damage. Objective To investigate the relationship of PRA with early renal damage in essential hypertensive patients. Methods A total of 1 614 Han Chinese inpatients with essential hypertension were recruited between January 2007 and October 2014 from Department of Hypertension，People's Hospital of Xinjiang Uygur Autonomous Region. Data including gender，age，BMI，course of hypertension，blood pressure，fasting blood glucose，blood lipid，plasma aldosterone（PAC），and renal function indicators（urea nitrogen，creatinine，Cyst C，24-hour urine protein，24-hour urine microalbuminuria）were compared between sitting PRA quartiles 〔low renin（Q1，<0.44 μg?L-1?h-1），medium renin 1（Q2，0.44-1.07 μg?L-1?h-1），medium renin 2（Q3，1.08 -2.36 μg?L-1?h-1）and high renin（Q4，>2.36 μg?L-1?h-1）〕. Multivariate Logistic regression was used to explore factors associated with early hypertensive renal function damage. Results Q1 group had lower male proportion，and lower levels of mean DBP，PRA and TG，and greater mean age and ARR ratio than other groups（P<0.05）. This group also showed lower levels of mean PAC，TC and LDL-C and longer mean course of hypertension than Q3 and Q4 groups（P<0.05）. Q2 group had greater mean age and longer mean course of hypertension as well as lower mean level of PRA than Q3 group（P<0.05）. Q2 group had lower male proportion，and lower mean DBP，greater mean age and longer mean course of hypertension，lower mean PRA and PAC，and higher mean ARR ratio than Q4 group（P<0.05）. Q3 group had lower male proportion，and lower mean DBP，PRA and PAC as well as greater mean age than Q4 group（P<0.05）. Q1 group had lower mean level of creatinine than Q2 and Q3 groups（P<0.05）. Q1 group showed lower mean levels of creatinine and Cyst C than Q4 group，so did Q3 group（P<0.05）. Multivariate Logistic regression analysis showed that gender，course of hypertension，BMI，SBP，DBP and PRA level were associated with early renal damage（P<0.05）. Conclusion In Xinjiang Han Chinese people with essential hypertension，female，overweight，longer course of hypertension，higher blood pressure and higher PRA were risk factors for early renal damage.
General Practitioners Should Understand the Subtype of Essential Hypertension "Longitudinal Hypertension"
http://123.57.154.95:8088/zgqkyx/CN/10.12114/j.issn.1007-9572.2021.00.444
NIE Liantao1，RUAN Bingxin2，ZHANG Fangfang1，JING Yan1，HUANG Juxiang1，YAN Qiongwen1，ZHOU Yuhan1，LI Shifeng1，LI Zhongjian1*
1.Department of Electrocardiography，the Second Affiliated Hospital of Zhengzhou University，Zhengzhou 450014，China
2.Department of Electrocardiography，Nanning First People's Hospital，Nanning 530022，China
*Corresponding author：LI Zhongjian，Professor，Chief technologist；E-mail：lizhongjian56@126.com
NIE Liantao and RUAN Bingxin are co-first authors
Abstract：In clinical work and daily life，target organ damage caused by blood pressure ≥140/90 mm Hg（1 mm Hg=0.133 kPa） usually attracts attention，but target organ damage caused by blood pressure <140/90 mm Hg will often be ignored.Therefore，in order to improve the innovative concept and research orientation of hypertension，the research team proposed "longitudinal hypertension".This article found that the transverse hypertension emphasizes the “quantity” change caused by blood pressure ≥140/90 mm Hg，while the “longitudinal hypertension” emphasizes both "quantity" change and "quality" change of each individual through the introdution of the concept，diagnostic criteria and advantages of "longitudinal hypertension"，similarities and differences between “longitudinal hypertension” and transverse hypertension.Therefore，as primary health caregivers，general practitioners should understand and master the essence，concept，diagnosis and treatment methods of "longitudinal hypertension".At the same time，the research team also hopes to discuss and improve the existence and application value of "longitudinal hypertension" with colleagues.
Relationship between Blood Pressure Level and Renin-aldosterone System Activity in Patients with Essential Hypertension：a Meta-analysis
http://123.57.154.95:8088/zgqkyx/CN/10.12114/j.issn.1007-9572.2021.00.422
YUAN Bo1，MA Qing 2，LI Wenfei3，LI Zhipeng2*
1.Department of General Practice，West China Hospital，Sichuan University，Chengdu 610041，China
2.International Medical Center，West China Hospital，Sichuan University，Chengdu 610041，China
3.West China College of Medicine，Sichuan University，Chengdu 610041，China
*Corresponding author：LI Zhipeng，Associate professor；E-mail：13568985243@163.com
Abstract：Background Increased aldosterone is an important risk factor for cardiac hypertrophy，heart failure and renal impairment，leading to more serious damage to the target organs of hypertension such as heart and kidney.Except for primary aldosteronism（PA），clinical evidence shows that plasma rennin activity and aldosterone are elevated in some patients with essential hypertension.However，there are few studies on the correlation between blood pressure level and plasma renin activity and aldosterone levels in patients with essential hypertension，and the conclusions are also inconsistent.Objective To investigate the relationship between blood pressure and renin-aldosterone system activity，and the potential pathophysiological mechanism of hyperaldosteronemia in essential hypertension patients，to provide a theoretical basis for early treatment of essential hypertension and delaying the development of related target organ damages.Methods The databases of PubMed，Embase，CNKI，CQVIP and Wanfang Data Knowledge Service Platform were searched from inception to January 2020 to identify articles about the relationship between blood pressure and renin-aldosterone system activity in patients with essential hypertension.Two researchers independently screened the literature based on the inclusion and exclusion criteria，extracted the data，and evaluated the quality using the Newcastle-Ottawa Scale.RevMan 5.2 was used to conduct meta-analysis.Results A total of 16 articles with Chinese essential hypertensive individuals（n=1 885）compared to healthy controls（n=1 438）as the participants were included.All scored above 5 points on the Newcastle-Ottawa Scale.The results of meta-analysis showed that plasma renin activity〔MD=0.40，95%CI（0.04，0.76）〕in essential hypertensive individuals was significantly higher〔MD=60.03，95%CI（22.28，97.79）〕than that of controls in general（P<0.05）.But the supine and standing values of plasma renin activity 〔MD=-1.27，95%CI（-1.37，-1.16）；MD=-1.67，95%CI（-1.88，-1.46）〕were lower in essential hypertensive individuals（P<0.05）.Essential hypertensive individuals had higher plasma aldosterone level than the controls 〔MD=60.03，95%CI（22.28，97.79）〕on the whole.They also showed higher supine and standing plasma aldosterone levels〔MD=0.07，95%CI（0.06，0.09）；MD=0.22，95%CI（0.05，0.39）〕（P<0.05）.Conclusion （1）Plasma renin activity and aldosterone levels in patients with essential hypertension were different from those with normal blood pressure.The supine and standing values of plasma renin activity were decreased，and supine and standing values of plasma aldosterone were elevated in essential hypertensive patients.（2）In some patients with essential hypertension，the changes of plasma renin and aldosterone are inconsistent，suggesting that elevated aldosterone may be not renin-dependent in essential hypertension，and mineralocorticoid receptor antagonists should be chosen for antihypertension.
Advances in Impact of Internet Remote Management on Treatment Adherence in Hypertensive Patients in the Community
http://123.57.154.95:8088/zgqkyx/CN/10.12114/j.issn.1007-9572.2020.00.022
YANG Rong，LIAO Xiaoyang*，LI Zhichao
International Hospital，West China Hospital，Sichuan University，Chengdu 610041，China
*Corresponding author：LIAO Xiaoyang，Chief physician；E-mail：625880796@qq.com
Abstract：Hypertension is one of the most serious chronic diseases that endanger human health seriously. It has a high morbidity and mortality but low control rate worldwide，especially in less developed countries and regions. Effective hypertension management is the key to improving treatment compliance and influencing blood pressure control rate. Along with the development of the Internet，the traditional patterns of hypertension treatment compliance based on doctors' management have been changed. This paper discusses the research progress of Internet remote management on the hypertension treatment adherence at home and abroad，and concludes that the Internet remote management of blood pressure treatment adherence has lots of advantages in health education，economy，doctor-patient communication and follow-up，but disadvantages and shortcomings like use difficulties，inaccurate data，limited research evidence，and lack of guarantee of safety and reliability also exist. It is expected that the Internet remote management of blood pressure could be better applied on community management of hypertension treatment compliance.
Hypertension and Diabetes Incidence in Community-dwelling Han and Uygur Chinese People with Obstructive Sleep Apnea：a 7-year Telephone Follow-up Study
http://123.57.154.95:8088/zgqkyx/CN/10.12114/j.issn.1007-9572.2021.01.004
JIANG Xuelong1，CHEN Dongmei1，WANG Qin1，ZHANG Qinglong1，LI Jianping1，SHI Juan1，LI Min1，HE Zhongming1*，HAN Fang2，CHEN Yan1
1.Department of Respiratory and Critical Care Medicine，Karamay Central Hospital of Xinjiang，Karamay 834000，China
2.Department of Respiratory and Critical Care Medicine，Peking University People's Hospital，Beijing 100000，China
*Corresponding author：HE Zhongming，Chief physician；E-mail：zhongming_he@sina.com
JIANG Xuelong and CHEN Dongmei are co-first authors
Abstract：Background Obstructive sleep apnea（OSA） is highly prevalent，which has become a serious disease affecting public health. There are little data comparing the incidence of hypertension and diabetes in Uygur and Han people with OSA，which we assume to be different. Objective To perform a comparative analysis of the incidence of hypertension and diabetes in Han and Uygur people with OSA. Methods This prospective study was conducted from October 2010 to October 2017. Participants（n=1 331） were Han and Uygur Chinese snorers aged more than 35 years with no hypertension and diabetes prior to the study who were selected from Tianshan Community，Karamay. All of them received an annual telephone follow-up in each of the seven years，for investigating the incidence of hypertension and/or diabetes，and the results of ambulatory blood pressure monitoring and oral glucose tolerance test performed when having clinical manifestations of hypertension and diabetes. The primary endpoint was diabetes and/or hypertension. General demographics，and parameters of portable home sleep test（apnea-hypopnea index，hypopnea index，lowest oxygen saturation，and mean oxygen saturation during sleep，and the number of 4% desaturations） were collected. The incidence of hypertension and/or diabetes was compared by OSA（assessed by the portable home sleep test） in all participants，in Han people，and Uygur people，and by OSA and ethnic group in participants. Results All cases were included for final analysis 〔including 532（42.4%） men and 724（57.6%） women with a mean age of（58±13） years〕 except for 75 missed cases. 820 cases（470 Han and 350 Uygur people） were diagnosed with OSA，and 436（164 Han and 272 Uygur people） without. By the end of the follow-up，compared with those without OSA，participants with OSA had higher incidence of hypertension （P<0.05）. Uygur people with OSA had higher incidence of hypertension than those without（P<0.05）. The incidence of diabetes differed significantly between participants with and without OSA（P<0.05）. But the difference in the incidence of diabetes was not significant between Han people with and without OSA，Uygur people with and without OSA，and Han and Uygur people with OSA（P>0.05）. Conclusion Both Han and Uygur people with OSA were more likely to suffer from hypertension. OSA may be an independent risk factor for hypertension and diabetes. Han people with OSA were more prone to hypertension than Uygur counterparts，so early and aggressive intervention is needed.
The Influence and Combined Effect of Arteriosclerosis and Essential Hypertension on the Pathogenesis of Cardiovascular and Cerebrovascular Diseases：a 8-year Follow-up Study
http://123.57.154.95:8088/zgqkyx/CN/10.12114/j.issn.1007-9572.2021.01.204
MA Yihan1，2，LI Xingyu1，3，HAN Xu 1，2，LIU Qian1，2，LI Guo4，WU Shouling2，WU Yuntao2*
1.Graduate School of North China University of Technology，Tangshan 063000，China
2.Cardiovascular Department，Kailuan General Hospital，Tangshan 063000，China
3.Department of Gastroenterology，North China University of Technology Affiliated Hospital，Tangshan 063000，China
4.Cardiovascular Department，Luanzhou People's Hospital，Tangshan 063700，China
*Corresponding author：WU Yuntao，Chief physician，Master supervisor；E-mail：Wyt0086@163.com
Abstract：Background Either arterial stiffness or essential hypertension has been sufficiently proved to be a major risk for cardio-cerebrovascular disease，but combined association of them with cardio-cerebrovascular disease has been rarely reported. Objective To further explore the relationship of arterial stiffness or essential hypertension with cardio-cerebrovascular disease in Chinese population in a large prospective community-based cohort study，and examine whether the former two have a combined association with the latter. Methods Participants（n=33 820）were selected from individuals attending the four annual follow-up visits（2010—2011，2012—2013，2014—2015，2016—2017）of Kailuan study and had brachial-ankle pulse wave velocity（baPWV）measurement（without any cardio-cerebral vascular events prior to the measurement）and ABI<0.9. Age，gender，systolic blood pressure（SBP），diastolic blood pressure（DBP），baPWV，heart rate，body mass index（BMI），fasting blood glucose（FBG），total cholesterol（TC），triglyceride（TG），low-density lipoprotein cholesterol（LDL-C），high-density lipoprotein cholesterol（HDL-C），uric acid（UA），smoking，drinking，physical exercise，education level，diabetes，and the use of antihypertensive drugs and hypoglycemic drugs were collected. The study was completed until December 31，2017，with the occurrence of a cardiovascular or cerebrovascular event as the endpoint event. Arterial stiffness was defined as baPWV > 1 400 cm/s. By the prevalence of arterial stiffness and essential hypertension during the follow-up period，participants were categorized into group 1（having no essential hypertension and arterial stiffness），group 2（having no essential hypertension but arterial stiffness），group 3（having essential hypertension and arterial stiffness），and group 4（having essential hypertension but no arterial stiffness）. Multivariate Cox regression analysis was used to further investigate the association of arterial stiffness or essential hypertension with cardio-cerebrovascular disease，and the strength of combined association of the former two with the latter. Results The average follow-up years was（3.34±2.38）. The incidence density of cardio-cerebrovascular disease was 51.67 per 10 000 person-year. The cumulative incidence of cardio-cerebrovascular disease in groups 1-4 was 0.28%，1.94%，1.75%，4.70%，respectively. Four groups had statistically significant differences in male proportion，mean age，baPWV，BMI，FBG，TC，TG，LDL-C，HDL-C，SBP，DBP，heart rate，BMI，FBG，TC，TG，LDL-C，UA，smoking，drinking，physical exercise，diabetes，prevalence of taking antihypertensive drugs，prevalence of taking hypoglycemic drugs，and cumulative incidence of cardio-cerebrovascular disease（P<0.05）. Multivariate Cox regression analysis showed that prevalence of arterial stiffness 〔HR=2.60，95%CI（1.88，3.61）〕，baPWV-SD〔HR=1.22，95%CI（1.12，1.33）〕，prevalence of essential hypertension〔HR=2.05，95%CI（1.59，2.64）〕 and SBP-SD〔HR=1.26，95%CI（1.14，1.38）〕 were the associated with cardio-cerebrovascular disease（P<0.05）. Compared with group G1，the HR of cardio-cerebral vascular events in groups 2-4 was 3.33〔95%CI（2.08，5.33）〕，2.81〔95%CI（1.57，5.03）〕and 5.98〔95%CI（3.79，9.43）〕，respectively. The results suggested there was no interact effect between arterial stiffness and essential hypertension on cardio-cerebrovascular disease（P=0.789）. No result was changed after repeating the above analysis after excluding the population taking antihypertensive medications. Conclusion Our study found that both arterial stiffness and essential hypertension increased the risk of cardio-cerebrovascular disease，and they had a combined association with cardio-cerebrovascular disease.
Methods of Obtaining Epidemiological Data of Hypertensive Elderly People in an Isolated Natural Village：a Comparative Analysis
http://123.57.154.95:8088/zgqkyx/CN/10.12114/j.issn.1007-9572.2021.01.305
HOU Xuliang1，FENG Yong'en2，YIN Tianlu3，CHEN Wei4，XU Shaohua1，FENG Lijie1，LIU Yahua4，SUN Xin5*，SHEN Hong1*
1.Department of Emergency，the First Medical Center of PLA General Hospital，Beijing 100853，China
2.Menjiazhuang Xidibei Clinic，Hengshui 053200，China
3.Affiliated Hospital of Hebei Engineering University，Handan 056000，China
4.Department of Emergency，the Third Medical Center of PLA General Hospital，Beijing 100853，China
5.School of Computer Science & Technology，Beijing Institute of Technology，Beijing 100081，China
*Corresponding authors：SHEN Hong，Chief physician，Professor，Doctoral supervisor；E-mail：shenhong@em120.com
SUN Xin，Associate professor，Master supervisor；E-mail：sunxin@bit.edu.cn
Abstract：Background In China，imperfections in the early detection，real-time monitoring and effective control of chronic diseases make it impossible to accurately obtain the epidemiological characteristics of hypertension and other chronic diseases，negatively influencing chronic disease management and residents' health. Artificial intelligence（AI）technologies significantly improve health records management. Exploring methods that can accurately obtain epidemiological characteristics is conducive to the management of chronic diseases. Objective To compare the reliability of three methods used for accurately obtaining epidemiological data of hypertensive elderly people in an isolated natural village，providing a reference for bettering the prevention and treatment of hypertension in primary care. Methods This study was conducted in an isolated natural village with a population of 2 603 as of June 2019 in Menjiazhuang Township，Jizhou District，Hengshui City，Hebei Province. For obtaining the epidemiological data of hypertension in villagers aged over 65 years，three methods were used，with different numbers of participants. The first method was by searching the data stored in the local health information management system，the number of villagers aged over 65 years was determined〔n=516，accounting for 20.76% of the total villagers registered by the village physician since January 2016 （n=2 485，accounting for 95.47% of the total village residents）〕，and the number of diagnosed hypertensive cases registered was also collected，then the hypertension prevalence was estimated. The second method was by use of a household survey（consisting of completing a blood pressure questionnaire and blood pressure measurement） conducted between June and July 2019，the number of respondents was determined as 416〔accounting for 80.62% of the total surveyed villagers aged over 65 years（n=516）〕，and the hypertension prevalence，awareness level，treatment rate and control rate of hypertension in the respondents were obtained according to the survey results. And the third method was searching the health management data in an AI-assisted diagnosis and treatment system，which has been used since December 2017，and had stored 9 856 visits of 2 460 villagers as of June 2019，including 337 villagers aged over 65 years. By analyzing the healthcare-seeking data of older villagers，the hypertension prevalence，awareness level，treatment rate and control rate of hypertension were obtained. The merits and limitations of these three methods were compared. Results No significant differences were found in the mean age and sex ratio across the three participant groups（P>0.05）. According to the statistics of hypertension registration，the prevalence of hypertension was 43.80%（226/516）. According to the household survey，the prevalence of hypertension was 75.24%（313/416）；260 cases had a history of definite hypertension，and 53 were newly found with hypertension；the awareness rate of hypertension was 83.07%（260/313）；238 received anti-hypertensive medication treatment in the past two weeks，with a treatment rate of 76.04%（238/313）；74 had a blood pressure reading of<140/90 mm Hg（1 mm Hg=0.133 kPa），with a hypertension control rate of 23.64%（74/313）. According to the analysis of the data in the AI-assisted diagnosis and treatment system，the hypertension prevalence was 52.23%（176/337）；172 had a hypertension history；the awareness rate of hypertension was 97.73%（172/176）；168 received anti-hypertensive medication treatment in the past two weeks，with a treatment rate of 96.45%（168/176）；118 had blood pressure measurement records，and 32 of them had a blood pressure reading of<140/90 mm Hg，with a hypertension control rate of 27.12%（32/118）. Conclusion The use of AI-assisted diagnosis and treatment system and household surveys can both better obtain the prevalence rate，awareness rate，treatment rate and other epidemiological characteristics of hypertension. In particular，using the AI-assisted diagnosis and treatment system can obtain data more comprehensively and dynamically，which facilitates the collection of epidemiological data and chronic disease management.
Predictive Value of Lp-PLA2 Concentration and AASI Level for Left Ventricular Function in Patients with Essential Hypertension
http://123.57.154.95:8088/zgqkyx/CN/10.12114/j.issn.1007-9572.2021.01.209
XIN Caifeng1，ZHANG Qiang1*，YANG Lihong2，SUN Caihong1，YAO Fang1，LIU Fangfang1，FEI Sijie1
1.Cardiovascular Department，the Second Affiliated Hospital of Zhengzhou University，Zhengzhou 450014，China
2.Henan Provincial People's Hospital，Zhengzhou 450003，China
*Corresponding author：ZHANG Qiang，Chief physician；E-mail：zq3397@163.com
Abstract：Background Essential hypertension is supposed to be independently associated with increased risk of multiple cardio-cerebrovascular diseases，and increased arterial stiffness in essential hypertension is associated with increased cardiovascular morbidity and mortality. However，there is a lack of adequate indicators to evaluate the cardiac function of essential hypertension patients. Objective To investigate the predictive value of lipoprotein-associated phospholipase A2（Lp-PLA2）concentration and ambulatory arterial stiffness index（AASI）on left ventricular function in patients with essential hypertension. Methods A total of 216 inpatients（including 122 with essential hypertension and 94 without）were selected from Cardiovascular Department the Second Affiliated Hospital of Zhengzhou University in 2020. Data were collected，including general information（gender，age，body weight，BMI，history of smoking，drinking，diabetes，and dyslipidemia），and biomarkers〔serum uric acid（SUA），creatinine，fasting plasma glucose，glycosylated hemoglobin，triglyceride，high-density lipoprotein cholesterol，low-density lipoprotein cholesterol，C-reactive protein，NT-proBNP，Lp-PLA2，AASI，and left ventricular ejection fraction（LVEF）〕. The concentrations of Lp-PLA2 and AASI were compared between LVEF≥50% and<50% subgroups to explore the association of them with LVEF，and between NT-proBNP≥514 ng/L and <514 ng/L subgroups（stratified by the median value NT-proBNP）to explore the association of them with NT-proBNP. Multivariate Logistic regression was used to explore risk factors of LVEF，NT-proBNP and hypertension. ROC analysis was conducted to assess the predictive value of Lp-PLA2 and AASI for heart failure. Results Patients with and without essential hypertension showed significant differences in mean age，and SUA，Lp-PLA2，AASI，SBP，NT-proBNP and LVEF（P<0.05）. Linear regression analysis indicated that LVEF was negatively correlated with Lp-PLA2（r=-0.437，P=0.036），and AASI（r=-0.580，P=0.001），but NT-ProBNP was positively correlated with Lp-PLA2（r=0.309，P=0.038）and AASI（r=0.519，P=0.041）in patients with essential hypertension. However，in those without essential hypertension，LVEF showed no linear correlation with Lp-PLA2（r=0.027，P=0.601）and AASI（r=0.019，P=0.372），and NT-ProBNP also showed no linear correlation with Lp-PLA2（r=0.033，P=0.460），and AASI（r=0.058，P=0.703）. Multivariate Logistic regression analysis revealed that hypertension history，Lp-PLA2 and AASI were associated with LVEF（P<0.05），Lp-PLA2 and AASI were associated with NT-proBNP，and Lp-PLA2，smoking history and AASI were associated with essential hypertension（P<0.05）. The AUC of Lp-PLA2 concentration in predicting heart failure in essential hypertension was 0.637 〔95%CI（0.48，0.80）〕，with the optimal cutoff value of 115.77 μg/L（sensitivity：64%；specificity：70%）. The AUC AASI in predicting heart failure in essential hypertension was 0.861 〔95%CI（0.750，0.973）〕，with the optimal cutoff value of 0.535（sensitivity：82%；specificity：85%）. Conclusion Essential hypertension may be associated with poorer cardiac function. Lp-PLA2 or AASI may be an effective independent predictor for left ventricular function in essential hypertension.