Efectos de la calidad y cantidad de horas de sueño en pacientes con hipertensión arterial: Una revisión narrativa / Effects of the quality and quantity of sleep hours in patients with arterial hypertension: A narrative review

Introducción :La alta prevalencia de hipertensión arterial (HTA) es un problema de salud pública a nivel global. Diversas condiciones comprometen un adecuado control de esta enfermedad, siendo una de reciente interés las alteraciones del sueño. Describimos mediante una revisión narrativa los hallazgos recientes en la literatura acerca de los efectos de la calidad y cantidad de horas de sueño en pacientes hipertensos. Se seleccionaron 18 artículos que cumplieron los criterios de inclusión para esta revisión. En la presente revisión se detallarán los hallazgos encontrados en relación con las complicaciones que guardan relación con la duración y calidad del sueño en pacientes con HTA, así como factores predictores de una mala calidad del sueño en estos pacientes.

Background: High prevalence of arterial hypertension (HTN) is a global public health problem. Various conditions compromise an adequate control of this disease, being one of recent interest the sleep disturbances. We describe through a narrative review the recent findings in the literature about the effects of the quality and quantity of sleep on hypertensive patients. Eighteen articles that met the inclusion criteria were selected for this review. This review will detail the findings related to complications linked to the duration and quality of sleep in patients with HTN, as well as predictive factors of poor sleep quality in these patients.

Prevalência de hipertensão arterial sistêmica e diabetes mellitus em indivíduos com covid-19: um estudo retrospectivo de óbitos em pernambuco, brasil / Prevalence of systemic arterial hypertension and diabetes mellitus in individuals with covid-19: a retrospective study of deaths in pernambuco, brazil

Resumo Hipertensão arterial sistêmica (HAS) e diabetes mellitus (DM) são dois dos principais fatores de risco para a mortalidade por COVID-19. Descrever a prevalência e o perfil clínico-epidemiológico de óbito por COVID-19 ocorridos em Pernambuco, Brasil, entre 12 de março e 14 de maio de 2020 entre pacientes que possuíam hipertensão arterial sistêmica e/ou diabetes mellitus como doenças prévias. Estudo observacional transversal. Foram analisadas as seguintes variáveis: município de procedência, sexo, faixa etária, tempo entre o início dos sinais/sintomas e o óbito, sinais/sintomas, tipo de comorbidades e hábitos de vida. Variáveis categóricas foram descritas por meio de frequências e variáveis contínuas por meio de medidas de tendência central e de dispersão. Os testes de Mann-Whitney e Kruskal-Wallis foram utilizados. Dos 1.276 registros incluídos no estudo, 410 apresentavam HAS e/ou DM. A prevalência de HAS foi 26,5% (n=338) e de DM foi 19,7% (n=252). Dos registros, 158 (12,4%) eram de pacientes que possuíam somente HAS, 72 (5,6%) somente DM e 180 (14,1%) apresentavam HAS e DM. Dos indivíduos com HAS, 53,3% apresentavam DM e 71,4% dos diabéticos apresentam HAS. A mediana (em dias) do tempo entre o início dos sinais/sintomas e o desfecho óbito foi 8,0 (IIQ 9,0), sem diferença significativa entre os grupos de comorbidades (p=0,633), sexo (p=0,364) e faixa etária (p=0,111). Observou-se maior prevalência de DM e HAS na população masculina (DM — 61,3% eram homens e 38,9% mulheres; HAS — 53,2% eram homens e 46,8% mulheres). Os sinais/sintomas mais frequentes foram dispneia (74,1%; n=304), tosse (72,2%; n=296), febre (68,5%; n=281) e saturação de O2<95% (66,1%; n=271). Dos hipertensos, 73,3% (n=100) apresentavam outras comorbidades/fatores de risco associados, e 54,2% (n=39) dos diabéticos apresentavam outras comorbidades/fatores de risco associados. Destacaramse as cardiopatias (19,5%; n=80), obesidade (8,3%; n=34), doença respiratória prévia (7,3%; n=30) e nefropatia (7,8%; n=32). A prevalência de tabagismo foi 8,8% (n=36) e de etilismo alcançou 3,4% (n=14). O estudo mostrou que a prevalência de HAS foi superior à prevalência de DM nos indivíduos que foram a óbito por COVID-19. Em idosos, a prevalência foi superior à observada em indivíduos não idosos.

Health Promotion to Reduce Hypertension Patients' Vulnerability to Coronavirus Disease-19 (COVID-19)

Abstract Hypertension remains a prominent risk factor for cardiovascular diseases. It is not a coincidence that 23% to 30% of coronavirus disease-19 (COVID-19) confirmed cases are hypertensive patients, and the case-fatality rate of adult COVID-19 cases with hypertension was estimated at 6%. It is important that hypertensive patients be aware of their vulnerability to COVID-19, which may be achieved by a health promotion program in addition to preventive measures.

Resultados de la cicatrización con bevacizumab en la degeneración macular relacionada con la edad húmeda / Results of the cicatrization with bevacizumab in the age-related humid macular degeneration

RESUMEN Fundamento: la degeneración macular relacionada con la edad está entre las causas más comunes de pérdida visual severa e irreversible en pacientes mayores de 60 años en el mundo industrializado. Es considerado el aumento de la esperanza de vida en la población de los adultos mayores, la necesidad de un diagnóstico temprano y oportuno, es obvio para esta enfermedad que constituye un problema de salud a resolver. Objetivo: describir los resultados de la cicatrización con el uso del bevacizumab en la degeneración macular relacionada con la edad húmeda. Métodos: se realizó un estudio descriptivo, longitudinal en pacientes con el diagnóstico de degeneración macular relacionada con la edad húmeda. La población la conformaron 25 pacientes que acudieron a la consulta de retina en el periodo de octubre 2018 a abril 2019 y que cumplieron con los criterios de selección. Se les aplicó una encuesta y se estudiaron variables como: edad, sexo, antecedentes patológicos personales, número de inyecciones intravitreas colocadas a cada paciente, complicaciones post inyección y cicatrización de la lesión macular. BMMEM Resultados: según el comportamiento de los grupos de edades y el sexo, se encontró que la edad entre 60 y 69 fue de diez pacientes y el sexo femenino 15 pacientes fueron los más frecuentes. La hipertensión ocular fue la complicación que predominó. El antecedente patológico personal más frecuente fue la hipertensión arterial con cuatro pacientes. La mayor cantidad de ojos cicatrizaron con la administración de una y dos dosis del medicamento. Conclusiones: predominó el grupo de edad de 60 a 69 años y el sexo femenino. La hipertensión ocular fue la complicación más frecuente. Se constató la hipertensión arterial como el antecedente patológico personal más habitual. La cicatrización de los ojos ocurrió con la administración entre una y dos dosis.

ABSTRACT Background: the age-related macular degeneration is among the most common causes of harsh and irreversible visual loss in patient elders of 60 years in the industrialized world. Considering the increase of life expectancy and the rise in population of the senior citizens, the need of an early and opportune diagnosis, it is obvious for this disease that constitutes a health problem we have to solve. Objective: to describe the results of the cicatrization with the use of the bevacizumab in the age-related humid macular degeneration. Methods: a descriptive, longitudinal study in patients with the diagnosis of age-related humid macular degeneration was carried out. 25 patients that attended the retinal consultation in the period October, 2018 to April, 2019 and who fulfilled the criteria constituted the population of selection. They were applied an opinion poll and they studied variables were: Age, sex, pathological personal background, number of intravitreous injections placed to each patient, complications after injection and cicatrization of the macular injury. B Results: according to the age groups and the sex, it was shown that the age between 60 and 69, ten patients and the feminine sex 15 patients were the most frequent. The ocular hypertension was the complication that predominated with four patients. The greatest amount of eyes healed with the administration of one and two doses of the medication. Conclusions: the age group from 60 to 69 years and the feminine sex predominated. The ocular hypertension was the most frequent complication. It was verified high blood pressure as the most frequent pathological antecedent. The cicatrization of the eyes happened with the administration between one and two doses.

Características Clínicas da Hipertensão Arterial Resistente vs. Refratária em uma População de Hipertensos Afrodescendentes / Clinical Characteristics of Resistant vs. Refractory Hypertension in a Population of Hypertensive Afrodescendants

Resumo Fundamentos Afrodescendentes têm sido associados a uma maior gravidade da hipertensão arterial e maior incidência de complicações cardiovasculares. Características na apresentação da hipertensão resistente (HR) ou hipertensão refratária (HRf), especificamente nessa etnia, não têm sido devidamente estudadas. Objetivos O estudo compara características clínicas e epidemiológicas e prevalência de eventos cardiovasculares em afrodescendentes com diagnóstico de HR ou de HRf. Métodos: Estudo transversal realizado em ambulatório de referência para pacientes com Hipertensão Grave. O nível de significância foi de 5%. Resultados Avaliados 146 pacientes consecutivos, dos quais 68,7% eram do sexo feminino. A média de idade foi de 61,8 anos, sendo 88,4% afrodescendentes (pardos ou negros). 51% apresentavam HRf. Houve alta prevalência de fatores de risco cardiovascular: 34,2% tinham diabetes, 69,4% dislipidemia, 36,1% obesidade e 38,3% história de tabagismo. Função renal reduzida foi observada em 34,2%. Eventos cardiovasculares prévios ocorreram em 21,8% para infarto do miocárdio e em 19,9% para acidente vascular cerebral. O escore de risco de Framingham foi moderado/alto em 61%. Os pacientes com HRf eram mais jovens (média de idade de 59,38±11,69 anos versus 64,10±12,23 anos, p=0,02), tinham mais dislipidemia (83,8 versus 66,7%, p=0,021) e acidente vascular cerebral (30,4 versus 12,3%, p=0,011) quando comparados aos com HR. O uso de combinação de ACEi/BRA+CCB+Diurético, clortalidona e espironolactona também foi mais frequente em indivíduos com HRf. Conclusão Afrodescendentes com HR apresentaram alto risco cardiovascular, alta prevalência de HRf, maior frequência de dislipidemia e de acidente vascular cerebral, compatível com alta incidência de lesão a órgãos-alvo. (Arq Bras Cardiol. 2020; 115(1):31-39)

Abstract Background Afrodescendants have been associated with a greater severity of arterial hypertension and a higher incidence of cardiovascular complications. Characteristics in the presentation of resistant hypertension (RH) or refractory hypertension (RfH), specifically in this ethnic group, have not been properly studied. Objectives The study compares clinical and epidemiological characteristics and prevalence of cardiovascular events in people of African descent diagnosed with RH or RfH. Methods Cross-sectional study carried out in a referral clinic for patients with severe hypertension. The level of significance was 5%. Results 146 consecutive patients were evaluated, of which 68.7% were female. The average age was 61.8 years, with 88.4% of Afrodescendants (mixed race or black). 51% had RfH. There was a high prevalence of cardiovascular risk factors: 34.2% of subjects had diabetes, 69.4% dyslipidemia, 36.1% obesity, and 38.3% history of smoking. Reduced renal function was seen in 34.2%. Previous cardiovascular events occurred in 21.8% for myocardial infarction and in 19.9% for stroke. The Framingham's risk score was moderate/high at 61%. RfH patients were younger (mean age 59.38±11.69 years versus 64.10±12.23 years, p=0.02), had more dyslipidemia (83.8 versus 66.7%, p=0.021), and stroke (30.4 versus 12.3%, p=0.011) when compared to those with RH. The use of a combination of ACEi/ARB+CCB+Diuretic, chlortalidone and spironolactone was also more frequent in individuals with RfH. Conclusion Africandescendant people with RH had a high cardiovascular risk, a high prevalence of RfH, a higher frequency of dyslipidemia and stroke, compatible with a high incidence of injury to target organs. (Arq Bras Cardiol.2020; 115(1):31-39)

Diuretics are Similar to Losartan on Echocardiographic Target-Organ Damage in Stage I Hypertension. PREVER-Treatment Study / Diuréticos são Similares à Losartana na Avaliação Ecocardiográfica de Lesão a Órgãos-Alvo no Estágio I da Hipertensão. Estudo PREVER-Treatment

Abstract Blood pressure (BP)-lowering therapy improves left ventricular (LV) parameters of hypertensive target-organ damage in stage II hypertension, but whether there is a drug-class difference in echocardiographic parameters in stage I hypertension patients is less often studied. In the PREVER treatment study, where individuals with stage I hypertension were randomized for treatment with diuretics (chlorthalidone/amiloride) or losartan, 110 participants accepted to participate in a sub-study, where two-dimensional echocardiograms were performed at baseline and after 18 months of antihypertensive treatment. As in the general study, systolic BP reduction was similar with diuretics or with losartan. Echocardiographic parameters showed small but significant changes in both treatment groups, with a favorable LV remodeling with antihypertensive treatment for 18 months when target blood pressure was achieved either with chlorthalidone/amiloride or with losartan as the initial treatment strategy. In conclusion, even in stage I hypertension, blood pressure reduction is associated with improvement in echocardiographic parameters, either with diuretics or losartan as first-drug regimens.

Resumo A terapia de redução da pressão arterial (PA) melhora os parâmetros do ventrículo esquerdo (VE) na lesão a órgãos-alvo causada pela condição hipertensiva na hipertensão de estágio II; no entanto, se existem ou não diferenças relacionadas à classe de medicamentos nos parâmetros ecocardiográficos de pacientes com hipertensão estágio I é menos frequentemente estudado. No estudo PREVER-treatment, em que indivíduos com hipertensão estágio I foram randomizados para tratamento com diuréticos (clortalidona/amilorida) ou losartana, 110 participantes aceitaram participar de um subestudo, no qual foram realizados ecocardiogramas bidimensionais basais e após 18 meses de tratamento anti-hipertensivo. Como no estudo geral, a redução da PA sistólica foi semelhante com diuréticos ou com losartana. Os parâmetros ecocardiográficos mostraram pequenas mas significativas alterações em ambos os grupos de tratamento, com um remodelamento favorável do VE com tratamento anti-hipertensivo por 18 meses, quando a pressão arterial alvo foi atingida com clortalidona/amilorida ou com losartana como estratégia inicial de tratamento. Em conclusão, mesmo na hipertensão estágio I, a redução da pressão arterial está associada à melhora nos parâmetros ecocardiográficos tanto com o uso de diuréticos ou losartana como primeiro esquema de tratamento farmacológico.

Síndrome hepatopulmonar: revisión narrativa / Hepatopulmonary syndrome: a narrative revision

Resumen: el síndrome hepatopulmonar es una de las tres principales condiciones pulmonares en pacientes con enfermedad hepática o hipertensión portal. Esta alteración es causada por la circulación hiperdinámica, los cortocircuitos intrapulmonares y la vasodilatación pulmonar, lo que lleva a alteraciones que generan un compromiso en el intercambio gaseoso, el cual se manifiesta como hipoxemia y aumento del gradiente alveolo arterial. El diagnóstico del síndrome hepatopulmonar consiste en demostrar las alteraciones del intercambio gaseoso, por medio del análisis de los gases arteriales, y las dilataciones vasculares intrapulmonares, documentadas por ecocardiografía transtorácica contrastada con solución salina agitada, la cual es considerada el estándar de referencia. Por el impacto pronóstico del síndrome hepatopulmonar, se recomienda una tamización activa que permita un diagnóstico temprano, y referir a tiempo al paciente a un centro especializado para la valoración de trasplante hepático como único tratamiento disponible curativo. El objetivo de este artículo es proporcionar una revisión narrativa sobre el síndrome hepatopulmonar, con énfasis en la definición, diagnóstico, fisiopatogénesis y medidas terapéuticas disponibles. (AU)

Abstract: Hepatopulmonary syndrome is one of the three main pulmonary disorders affecting patients with liver disease or portal hypertension. This disease is caused by hyperdynamic circulation, intrapulmonary shunts, and pulmonary vasodilation, which leads to disturbances in gas exchange, evidenced by hypoxemia and increased alveolar-arterial gradient. Diagnosis of hepatopulmonary syndrome requires arterial blood gas analysis and documentation of intrapulmonary vascular dilation by transthoracic echocardiogram with agitated saline contrast; the gold standard for hepatopulmonary syndrome diagnosis. Due to the prognostic value of hepatopulmonary syndrome, active screening is recommended in order to achieve early diagnosis and timely patient referral to a specialized center to be evaluated as a candidate for liver transplant, as it currently is the only available curative treatment. The aim of this article is to provide a narrative review of current literature on hepatopulmonary syndrome, focusing on its definition, diagnosis, physiopathogenesis, and available therapeutic approaches. (AU)

Research updates on the correlation of hypertensive retinopathy and carotid artery lesion / 中华眼底病杂志

Hypertensive retinopathy (HR) often coexist with carotid lesions in hypertensive patients.Carotid lesions are closely associated with cardiovascular and cerebrovascular diseases,as well as end events,offering early important evidence to screening high risk patients.HR has significant value to predict target organ damage (TOD) of hypertension including carotid lesion.In addition,hypertensive retinopathy and carotid lesions-related ischemic ocular diseases will cause serious vision function damage.This article is going to summarize the value and correlation between hypertensive retinopathy and carotid lesions in terms of clinical manifestations,pathological physiological mechanism and target organ damage.

Volume calculation of rats' organs and its application in the validation of the volume relation between the abdominal cavity and the hernial sac in incisional hernias with "loss of abdominal domain" / Cálculo do volume de órgãos de ratos e sua aplicação na validação da relação de volumes entre a cavidade abdominal e o saco herniário em hérnias incisionais com "perda de domicílio"

BACKGROUND: The calculation of the volume ratio between the hernia sac and the abdominal cavity of incisional hernias is based on tomographic sections as well as the mathematical formula of the volume of the ellipsoid, which allows determining whether this is a giant hernia or there is a "loss of domain". As the images used are not exact geometric figures, the study of the volume of two solid organs of Wistar rats was performed to validate these calculations. AIM: To correlate two methods for determining the volume of the kidney and spleen of rats, comparing a direct method of observation of the volume with the mathematical calculation of this value. METHODS: The volume of left kidney, geometrically more regular, and spleen, with its peculiar shape, of ten animals was established in cubic centimeters after complete immersion in water with the aid of a beaker graduated in millimeters. These values ​​were compared with those obtained by calculating the same volume with a specific mathematical formula: V = 4/3 × π × (r1 x r2 x r3). Data were compared and statistically analyzed by Student's t test. RESULTS: Although the average volume obtained was higher through the direct method (1.13 cm3 for the left kidney and 0.71 cm3 for the spleen) than the values ​​calculated with the mathematical formula (0.81 cm3 and 0.54 cm3), there were no statistically significant differences between the values ​​found for the two organs (p>0.05). CONCLUSION: There was adequate correlation between the direct calculation of the volume of the kidney and spleen with the result of mathematical calculation of these values ​​in the animals' studies. .

RACIONAL: O cálculo da relação de volumes entre o saco herniário e a cavidade abdominal em hérnias incisionais é feito com base em cortes tomográficos e com a fórmula matemática do volume da elipsóide, permitindo determinar se a hérnia é gigante ou se há "perda de domicílio". Como as imagens utilizadas não são figuras geométricas exatas, foi realizado o estudo do volume de dois órgãos sólidos de ratos da linhagem Wistar, para validar estes cálculos. OBJETIVO: Correlacionar dois métodos para determinação do volume do rim e do baço de ratos, comparando um método direto de avaliação do volume com o cálculo matemático deste valor. MÉTODOS: O volume do rim esquerdo, geometricamente mais regular, e do baço, com seu formato peculiar, de dez animais foram estabelecidos em centímetros cúbicos após imersão total em água, com auxílio de proveta graduada em milímetros; estes valores foram comparados com os obtidos através do cálculo do mesmo volume com fórmula matemática específica: V= 4/3 x π x (r1 x r2 x r3). Os dados obtidos foram comparados e submetidos à análise estatística pelo teste t de Student. RESULTADOS: Embora o volume médio obtido tenha sido maior com o método direto, 1,13 cm3 para o rim esquerdo e 0,71 cm3 para o baço, do que os valores calculados com a fórmula matemática, 0,81 cm3 e 0,54 cm3 respectivamente, não houve significância estatística entre as diferenças dos valores encontrados para os dois órgãos (p>0,05). CONCLUSÃO: Houve correlação adequada entre o cálculo direto do volume do rim e do baço com o resultado do cálculo matemático destes valores nos animais estudados. .

Pathological changes of cardiac collagen in the elderly patients with hypertensive left ventricular hypertrophy and comparative research among hypertension, coronary heart disease and diabetes / 中国医师杂志

Objective To investigate the pathological changes of cardiac collagen in the elderly patients with hypertensive left ventricular hypertrophy(LVH)and the difference of collagen among the groups of essential hypertension(EH),diabetes (T2DM) under the condition of the same stage,providing pathological foundation of clinical treatment for curing diseases and the early heart protection.Methods A retrospective study was performed in 140 cases over 65 years old of EH and normal cases as control out of 3520 consecutive autopsied cases from 1954 to 2001 in Chinese People's Liberation Army (PLA) General Hospital.The pathological changes of collagen were studied with hematoxylin and eosion(HE) staining,Sirius Red F3B (SR)and immunohistochemistry staining.Myocardial interstital collagen deposition was observed with light microscope and polarization technique.Quantitative measurements on the myocardial collagen volume fraction (CVF),CVFS of type Ⅰ and type Ⅲ,and the rate of collagen type Ⅰ to type Ⅲ (Ⅰ/Ⅲ) were determined with videodensitometry.Results The CVF(6.32％ ± 0.92％) and CVF Ⅰ (5.93％ ± 0.94％)were increased significantly in EH LVH Ⅰ group (P ＜0.01) ; but,CVF Ⅲ (2.23％ ±0.38％) and Ⅰ/Ⅲ (2.69 ±0.42) did not change significantly in EH Ⅰ group compared with the control group; The changes in the aforementioned four items were increased significantly in EH LVH Ⅱ and EH LVH Ⅲ groups (P ＜0.01)compared with the control group.The CVF and CVF-Ⅰ were decreased significantly(P ＜ 0.01) ; but CVF-Ⅲ and Ⅰ/Ⅲ did not change significantly in DM LVH-I group compared with the EH LVH-I group; the CVF(4.23％ ± 0.69％) and CVF-Ⅰ (3.92％ ±0.40％) were decreased significantly(P ＜0.01); but CVF-Ⅲ(1.79％ ±0.21％) and Ⅰ/Ⅲ (2.20 ±0.20) did not change significantly in DM LVH-Ⅰ group compared with the EH LVH-Ⅰ group.Conclusions (1)The myocardial stiffness and the reduction of cardiac diastolic function deteriorated most with the development of LVH.(2)Under the condition of the same stage,the myocardial stiffness and the reduction of cardiac diastolic function deteriorated seriously in EH groups,diabetes patients,myocardial stiffness and the reduction of cardiac diastolic function deteriorated slightly.

A study on diffusion-weighted imaging evaluation of levamlodipine treatment in diabetic nephropathy patients accompanied with hypertension / 中国医师杂志

Objective To evaluate the effect of levamlodipine intervention in diabetic nephropathy patients which accompanied with hypertension, using the technology of diffusion-weighted imaging (DWI) of functional magnetic resonance (fMRI).Methods A controlled prospective method was taken , and fifty diabetic nephropathy ( phase III) patients which accompanied with hypertension were randomized assigned to two groups of A ( n =26) and B ( n =24).Levamlodipine (2.5 mg qd) was taken by patients of group A and amlodipine (5 mg qd) was taken by patients of group B for 24 weeks, respectively.Two groups both took angiotensinⅡreceptor blockers (ARBs) as the first line antithypertensive agents , their urinary albumin excretion rate (UAER), serum creatinine (sCr), cystatin C (Cys C) , and DWI scanning were detected before and after intervention .The levels of UAER, apparent diffusion coeffi-cient (ADC) value were compared between two groups before and after intervention .During the 24th week, two groups'adverse reac-tion to the medicines and the levels of blood pressure were recorded in each follow-up visit.Results The levels of UAER, systolic blood pressure(SBP), and diastolic blood pressure(DBP) were Significantly lower in group A after 24-week intervention compared to baseline [42.5 (25.3~91.0)μg/min vs 49.2(29.7~96.8)μg/min,(112.6 ±6.4)mmHg vs (135.3 ±7.6)mmHg, (71.4 ± 10.7)mmHg vs (80.3 ±11.6)mmHg, P 0.05).Group A had a better improvement of SBP (ΔSBP) and ADC (ΔADC) after inter-vention compared to group B ( P =0.02,0.01, respectively).The overall adverse reaction incidence was 15.4%(4/26) in group A and 41.7%(10/24)in group B, respectively (χ2 =4.27, P =0.0387).Conclusions For the diabetic nephropathy (phase III) pa-tients accompanied with hypertension , levamlodipine likely showed better effects on reducing comprehensive blood pressure and UAER , improving renal microcirculation , with less overall adverse reaction compared to amlodipine .

Study on the relationship of carotid artery atherosclerosis and helicobacter pylori infection in patients with essential hypertension / 中国医师杂志

Objective To study the correlation of carotid artery atherosclerosis (CAS) and helicobacter pylori (Hp) infection in patients with essential hypertension (EH) by observing the carotid intima-media thickness (CAIMT),helicobacter pylori (Hp)-IgG antibody,blood lipid,high sensitive C-reactive protein (hs-CRP),and homocysteine(HCY).Methods To measure CAIMT,blood lipid,serum Hp-IgG antibody,hs-CRP,and HCY were measured by color doppler ultrasound instrument,and Hp-IgG antibody by colloidal gold method.Results A total of 150 EH patients were randomly divided into CAIMT and Hp-IgG-antibody groups,and were taken statistical analysis.Results There were 89 patients with EH CAIMT ＞ 1.0 mm(59.3％) as the intimal thickening,and 67 cases of Hp-IgG antibody(+) (44.7％) for Hp infection.CAIMT thickening (73.1％) in the Hp infection group was significantly higher than that of Hp infection group (48.2％) (P ＜0.05).In the thickened CAIMT group,Hp infection (55.1％) was significantly higher than that of CAIMT non thickening (29.5％) (P ＜0.05).EH patients complicated with CAIMT thickening and Hp infection had significant correlation (r =0.179,t =2.213,P ＜0.05).In the Hp infection group,the levels of serum triglyceride (TG),total cholesterol(TC),low density lipoprotein cholesterol (LDL-C),HCY,and hs-CRP were significantly higher than those of Hp infection group (P ＜ 0.05).Serum high density lipoprotein cholesterol (HDL-C) were significantly lower than those of the Hp infection group (P ＜ 0.05).Conclusions The study proved the correlation of CAS and Hp infection in patients with EH,and promoted the development of CAS probably by influencing the blood lipid metabolism,inflammatory reaction and HCY levels.It would be one of the treatment of EH with CAS by removing or prevention of Hp infection.

Characteristics of lipid metabolism in hypertensive patients with obstructive sleep apnea-hypopnea syndrome / 中国医师杂志

Objective To explore the lipid metabolism in patients with hypertension and obstructive sleep apnea-hypopnea syndrome.Methods A total of 896 patients (655 cases of male; 241 cases of female) was recruited who were hospitalized in our department,and were classified into four groups based on the finding of polysomnography (PSG):hypertensive without obstructive sleep apnea-hypopnea syndrome (OSAS) (n =243),hypertensive with mild OSAS (n =245),hypertensive with moderate OSAS (n =195),and hypertensive with severe OSAS (n =213).Multiple indices including apnea-hypopnea index (AHI),lowest arterial oxygen saturation(lowest SaO2),body mass index (BMI),blood pressure,total cholesterol (TC),high density lipoprotein cholesterol (HDL-C),low density lipoprotein cholesterol (LDLC),triglycerides (TG),fasting blood glucose(FBG),uric acid (UA),and high-sensitivity C-reactive protein(hs-CRP) were assessed,and the relevant risk factors of lipid metabolism were analyzed.Results (1)Male patients had more opportunities to suffer OSAS than female (P ＜0.01).Compared with the group without hypertensive,patients in severe OSAS group had higher levels of AGE (48.09 ± 9.48,BMI (29.46 ±3.83),AHI[45.90(37.55,63.65)],MSpO2 (89.08 ±4.93),LSpO2 (67.36 ± 12.60),TC (4.68 ±1.00),TG[2.03(1.54,2.88)],UA (371.85 ±99.29),and hs-CRP[1.43(0.82,3.056)] (P ＜0.05),and had lower levels of HDL-C (1.09 ± 0.28).(2) Two and more than two lipids abnormal metabolic indices increased prevalence with the increase of the severity of OSAS.(3)The prevalence of high TG,high TC in AHI ≥ 15/h was significantly higher than AHI ＜ 15 group.(4) After adjustment for BMI,gender,age and other common risk factors,it confirmed that AHI was still related to lipid metabolism.AHI was an independent risk factor for abnormal lipid metabolism.Conclusions AHI was an independent risk factor for abnormal lipid metabolism.With increasing severity of OSAS,the levels TC,TG,and the category of abnormal lipid metabolism were also increased.

Clinical observation of hypertension with nephropathy treated by integrated Chinese and Western medicine / 中国基层医药

Objective To study the clinical efficacy of hypertension with nephropathy treated by integrated Chinese and Western medicine. Methods 75 patients with hypertensive nephropathy were divided into the integrated Chinese and Western medicine group (group A) and 35 cases of pure western medicine treatment group (group B) ; The change of whole blood viscosity at low shear rate(ηbL)、 whole blood viscosity at high shear rate( ηbH)、fibrino-gen( Fg)、 serum albumin(Alb)、hemoglobin(Hb)、urine prottein( Up)、blood urea nitrogen( BUN) 、creatinine( SCr)、 creatinine clearance rate( CCr)、residual renal function index ( RRFI) before treatment and after treatment were observed. Results The effective rate 31 cases(88.5% ) in group A was significantly higher than the B group 23 cases (65.7%)(x2 =3.98,P<0 05);The contents of ηbL、ηbH、BUN、Scr、CCr and RRFI in treatment group after treatment had significant difference wmpared with that before treatment(t = 2. 121,t = 223,t =2. 324,t = 2. 375,t = 2. 371 ,t =2. 265 ,t = 2. 415 ,t =2.771 ,P <0.05) ;The contents of Up、BUN、Scr、CCr、RRFI were significantly different in two groups after treatment(t =2.331 ,t = 2.378,t =2.411,t =2. 378,t =2.391 ,P <0.05). Conclusion Integrated Chinese and Western medicine for hypertensive nephropathy had good efficacy,was a safe and effective method.

Avaliação do comprometimento da função do endotélio em pacientes com hipertensão arterial pulmonar idiopática e em esquistossomóticos / Endothelial dysfunction in patients with pulmonary arterial hypertension and schistosomiasis

INTRODUÇÃO: Existem várias doenças que evoluem com hipertensão pulmonar (HP), entre elas a Hipertensão Arterial Pulmonar Idiopática (HAPI) e a Esquistossomose. Acredita-se que um dos principais fatores desencadeantes da HP esteja relacionado com a disfunção endotelial. OBJETIVOS: 1. Avaliar a disfunção endotelial de pacientes com HAPI e esquistossomóticos com e sem HAP usando os marcadores plasmáticos Endotelina-1, Selectina E, VEGF, PDGFAB e PDGF-BB; 2.Avaliar se pacientes com HAP associada à esquistossomose possuem o mesmo grau de disfunção endotelial que pacientes com esquistossomose sem HAP. METODOLOGIA: Foram formados 4 grupos distintos: Controle (n=13), HAPI (n=11), pacientes com esquistossomose e HP (ESQ+HP) (n=13) e pacientes com esquistossomose sem HP (ESQ)(n=13). Os pacientes foram submetidos a avaliação clínica (caracterizados quanto a gravidade), funcional (realizaram ecocardiograma com medida de pressão sistólica de ventrículo direito, ultrassonografia abdominal quando indicada e exames para excluir outras doenças) e laboratorial (entre eles, contagem de leucócitos, plaquetas e dosagem de BNP). A avaliação hemodinâmica foi realizada nos pacientes com HP. Para a análise da disfunção endotelial, foram coletados 40 mL de sangue de todos os indivíduos para a dosagem de Endotelina-1, Selectina E, VEGF, PDGF-AB e PDGF-BB. RESULTADOS: Observou-se que os grupos não se diferiram quanto a idade, houve um predomínio do sexo feminino e os grupos controle e ESQ apresentaram valores de PSVD menores do que os grupos com HP (controles: 23,4±4,6, ESQ: 29,5±8,5, HAPI: 79,8±26,4 e ESQ+HP: 75,2±15,3 mmHg). As medidas hemodinâmicas foram semelhantes em ambos os grupos com HAP. Quanto aos marcadores da função endotelial, o grupo controle apresentou valores séricos de PDGF-BB mais aumentados (8,9±4,8x 103 pg/mL, p<0,001) que os grupos HAPI, ESQ+HP, ESQ (3,7±2,1; 5,2±3 ; 2,4±1,7 x 103 pg/mL, respectivamente). O grupo HAPI apresentou valores mais elevados...

INTRODUCTION: There are several diseases that cause Pulmonary hypertension (PH), such as Idiopathic Pulmonary Arterial Hypertension and Schistosomiasis. The mechanisms that lead to PH are thought to be related to endothelial dysfunction. OBJECTIVES: To evaluate endothelial dysfunction, using plasma markers such as Endothelin-1(ET-1), E-Selectin, VEGF, PDGF-AB and -BB, in patients with idiopathic pulmonary arterial hypertension (IPAH) and schistosomiasis patients with or without PH; and to evaluate if schistosomiasis groups have endothelial dysfunction in the same degree. METHODOLOGY: Patients were divided in 4 different groups: Patients with IPAH (n=11), Patients with PH associated to Schistosomiasis (SchPH)(n=13), Patients with Schistosomiasis without PH (Sch)(n=13) and Controls(n=13). PAH patients were classified according to severity. All groups were submitted to echocardiography and right ventricule systolic pressure(RVSP) was measured. Abdominal ultrassonography was used to rule in or rule out schistosomiasis diagnosis. PH patients went through haemodynamics evaluation and all patients had laboratorial assessment (leucocytes and platelet count and BNP levels) Soluble adhesion molecules such as E-Selectin, VEGF, PDGF-AB, PDGF-BB e ET-1 were determined by ELISA. Leucocytes and platelet counts as well as BNP levels were also evaluated. Results: Subjects did not differ according to age and there was a higher proportion of female patients. Controls and Sch subjects had lower RVSP compared to PH groups (Sch: 23.4±4.6, controls: 29.5±8.5, IPAH: 79.8±26.4 and Sch+HP: 75.2±15.3 mmHg). Haemodynamics data did not differ in PH patients. In IPAH group, E-selectin was elevated (61.5±24,2x103pg/mL) compared to controls, Sch+HP and Sch (14.5±12.2; 23.9±15.3; 21.4±18 x103pg/mL, respectively, p=0,005). PDGF-BB was decreased in IPAH, Sch+HP, Sch (3.7±2.1; 5.2±3; 2.4±1.7x103pg/mL, respectively) compared to controls (8.9±4.8x 103 pg/mL, p<0.001). PDGF-AB was elevated...

Influence of Cirrhotic Portal Hypertension and Its Complications on Liver Transplantation / 中国普外基础与临床杂志

Objective To explore the influence of cirrhotic portal hypertension and its complications on liver transplantation. Methods The literatures of the recent years on influence of hepatic cirrhotic portal hypertension on liver transplantation were reviewed. Results Splenomegaly, hypersplenism, portal vein thrombosis, portosystemic shunt and collateral flow in cirrhotic patients will increase the difficulty of liver transplantation and lead to more postoperative complications. Appropriate handling of these conditions can achieve a higher success rate of liver transplantation. Conclusion Correct management of end-stage cirrhotic portal hypertension and its complications can expand the indications of liver transplantation and improve long-term survival rates.