Association of stage 1 hypertension defined by the 2017 ACC/AHA guideline with cardiovascular events and mortality in Chinese adults / 中华医学杂志(英文版)

BACKGROUND@#The 2017 American College of Cardiology/American Heart Association (ACC/AHA) blood pressure (BP) guideline lowered the threshold defining hypertension to 130/80 mmHg. However, how stage 1 hypertension defined using this guideline is associated with cardiovascular events in Chinese adults remains unclear. This study assessed the association between stage 1 hypertension defined by the 2017 ACC/AHA guideline and clinical outcomes in the Chinese population.@*METHODS@#Participants with stage 1 hypertension ( n = 69,509) or normal BP ( n = 34,142) were followed in this study from 2006/2007 to 2020. Stage 1 hypertension was defined as a systolic blood pressure of 130-139 mmHg or a diastolic blood pressure of 80-89 mmHg. None were taking antihypertensive medication or had a history of myocardial infarction (MI), stroke, or cancer at baseline. The primary outcome was a composite of MI, stroke, and all-cause mortality. The secondary outcomes were individual components of the primary outcome. Cox proportional hazards models were used for the analysis.@*RESULTS@#During a median follow-up of 11.09 years, we observed 10,479 events (MI, n = 995; stroke, n = 3408; all-cause mortality, n = 7094). After multivariable adjustment, the hazard ratios for stage 1 hypertension vs. normal BP were 1.20 (95% confidence interval [CI], 1.13-1.25) for primary outcome, 1.24 (95% CI, 1.05-1.46) for MI, 1.45 (95% CI, 1.33-1.59) for stroke, and 1.11 (95% CI, 1.04-1.17) for all-cause mortality. The hazard ratios for participants with stage 1 hypertension who were prescribed antihypertensive medications compared with those without antihypertensive treatment during the follow-up was 0.90 (95% CI, 0.85-0.96).@*CONCLUSIONS@#Using the new definition, Chinese adults with untreated stage 1 hypertension are at higher risk for MI, stroke, and all-cause mortality. This finding may help to validate the new BP classification system in China.

Correlation analysis between body mass index and clinical characteristics of rheumatoid arthritis / 北京大学学报(医学版)

OBJECTIVE@#To analyze the clinical features of overweight and obese rheumatoid arthritis (RA)patients, and the relationship between body mass index (BMI) and disease characteristics.@*METHODS@#The demographic data, extra-articular manifestations, comorbidities, and disease activity of RA patients admitted to the Rheumatology and Immunology Department of Peking University Third Hospital from January 2015 to December 2020 were collected, and the above characteristics of overweight and obese RA patients were retrospectively analyzed. According to the WHO, BMI≥30 kg/m2 referred to obese individuals, 25≤BMI < 30 kg/m2 referred to overweight individuals, 18.5≤BMI < 25 kg/m2 referred to normal individuals, BMI < 18.5 kg/m2 referred to reduced body mass individuals. t test was used for the quantitative data in accordance with normal distribution. Wilcoxon rank sum test was used for the quantitative data of non-normal distribution. The qualitative data were analyzed by chi square test. But while 1≤theoretical frequency < 5, Chi square test of corrected four grid table was used. And Fisher exact probability method was used when theoretical frequency < 1. Analyzing whether overweight or obesity was associated with comorbidities using Logistic regression adjusted confounding factors.@*RESULTS@#A total of 481 RA patients were included in this study, with an average BMI value of (23.28±3.75) kg/m2.Of the patients, 31 cases (6.5%) were with BMI < 18.5 kg/m2, 309 cases (64.2%) with 18.5≤ BMI < 25 kg/m2, amounting to 340 cases (70.7%). There were 119 overweight individuals (25≤ BMI < 30 kg/m2, 24.7%) and 22 obese individuals (BMI≥30 kg/m2, 4.6%), totaling 141 (29.3%).The proportion of the overweight and obese RA patients suffering from hypertension (57.4% vs. 39.1%, P < 0.001), diabetes (25.5% vs. 15.0%, P=0.006), hyperlipidemia (22.7% vs. 10.9%, P=0.001), fatty liver (28.4% vs. 7.4%, P < 0.001), osteoarthritis (39.0% vs. 29.4%, P=0.040) was significantly higher, and the proportion of the patients with osteoporosis(59.6% vs. 70.9%, P=0.016) and anemia (36.2% vs. 55.6%, P < 0.001) was significantly lower. However, there was no difference between the two groups in coronary heart disease (5.7% vs. 7.6%, P=0.442), cerebrovascular disease (6.4% vs. 8.8%, P=0.372) and peripheral atherosclerosis (9.2% vs. 7.6%, P=0.565).The median C-reactive protein (CRP, 1.52 mg/dL vs. 2.35 mg/dL, P=0.008), median erythrocyte sedimentation rate (ESR, 34.0 mm/h vs. 50.0 mm/h, P=0.003), pain visual simulation score (VAS) (3.66±3.08 vs. 4.40±2.85, P=0.011), and 28 joint disease activity scores (DAS-28, 5.05±1.60 vs. 5.45±1.52, P=0.010) in the overweight and obese RA group were all lower than those in the normal and reduced weight groups. Multivariate regression analysis showed that overweight and obesity was an independent risk factor for hypertension, diabetes, hyperlipidemia and fatty liver, and had protective effects on osteoporosis and anemia.@*CONCLUSION@#In RA patients, RA disease activity is lower in overweight and obesity patients. Overweight and obesity is associated with hypertension, diabetes and hyperlipidemia, but not with cardiovascular and cerebrovascular diseases.

Clinical characteristics and prognostic analysis of female patients with Stanford type B aortic dissection / 中华心血管病杂志

Objective: To explore the clinical characteristics and prognostic factors of female patients with Stanford type B aortic dissection. Methods: This is a single-centre retrospective study. Consecutive patients diagnosed with Stanford type B aortic dissection in General Hospital of Northern Theater Command from June 2002 to August 2021 were enrolled, and grouped based on sex. According to the general clinical conditions and complications of aortic dissection tear, patients were treated with thoracic endovascular aortic repair, surgery, or optimal medication. The clinical characteristics and aortic imaging data of the patients at different stages were collected, adverse events including all-cause deaths, stroke, and occurrence of aortic-related adverse events were obtained during hospitalization and within 30 days and at 1 and 5 years after discharge. According to the time of death, death was classified as in-hospital death, out-of-hospital death, and in-hospital death was divided into preoperative death, intraoperative death and postoperative death. According to the cause of death, death was classified as aortic death, cardiac death and other causes of death. Aortic-related adverse events within 30 days after discharge included new paraplegia, post-luminal repair syndrome, and aortic death; long-term (≥1 year after discharge) aortic-related adverse events included aortic death, recurrent aortic dissection, endoleak and distal ulcer events. The clinical characteristics, short-term and long-term prognosis was compared between the groups. Logistic regression analysis was used to explore the association between different clinical factors and all-cause mortality within 30 days in female and male groups separately. Results: A total of 1 094 patients with Stanford type B aortic dissection were enrolled, mean age was (53.9±12.1) years, and 861 (78.7%) were male and 233 (21.3%) were female. (1) Clinical characteristics: compared with male patients, female patients were featured with older average age, higher proportion of aged≥60 years old, back pain, anemia, optimal medication treatment, and higher cholesterol level; while lower proportion of smoking and drinking history, body mass index, calcium antagonists use, creatine kinase level, and white blood cell count (all P<0.05). However, there was no significant difference in dissection tear and clinical stage, history of coronary heart disease, diabetes, hypertension, and cerebrovascular disease between female and male patients (all P>0.05). (2) Follow-up result: compared with male patients, female patients had a higher rate of 30-day death [6.9% (16/233) vs. 3.8% (33/861), P=0.047], in-hospital death (5.6% (13/233) vs. 2.7% (23/861), P=0.027), preoperative death (3.9% (9/233) vs. 1.5% (12/861), P=0.023) and aorta death (6.0% (14/233) vs. 3.1% (27/861), P=0.041). The 1-year and 5-year follow-up results demonstrated that there were no significant differences in death, cerebrovascular disease, and aorta-related adverse events between the two groups (all P>0.05). (3) Prognostic factors: the results of the univariate logistic regression analysis showed that body mass index>24 kg/m2 (HR=1.087, 95%CI 1.029-1.149, P=0.013), history of anemia (HR=2.987, 95%CI 1.054-8.468, P=0.032), hypertension (HR=1.094, 95%CI 1.047-1.143, P=0.040) and troponin-T>0.05 μg/L (HR=5.818, 95%CI 1.611-21.018, P=0.003)were associated with an increased risk of all-cause mortality within 30 days in female patients. Conclusions: Female patients with Stanford type B aortic dissection have specific clinical characteristics, such as older age at presentation, higher rates of anemia and combined back pain, and higher total cholesterol levels. The risk of death within 1 month is higher in female patients than in male patients, which may be associated with body mass index, hypertension, anemia and troponin-T, but the long-term prognosis for both female and male patients is comparable.

Risk factors related to coronary artery occlusion in female patients with ischemic angina pectoris / 中华心血管病杂志

Objective: To analyze the risk factors of coronary artery occlusion in female patients with ischemic angina pectoris. Methods: Clinical data of 1 600 patients (666 females and 934 males) who underwent coronary angiography from January 2013 to December 2015 due to angina pectoris in 6 major coronary intervention centers in China were retrospectively analyzed. The clinical characteristics were compared between the female and male groups, and between the non-obstructive coronary artery disease (INOCA) and ischemic obstructive coronary artery disease (IOCA) subgroups of female subjects with angina pectoris. The risk factors related to the degree of coronary artery occlusion in female patients were analyzed. Results: In the enrolled patients who underwent coronary angiography for angina pectoris, female group was older than the male group, and the proportion of patients with hypertension, diabetes and ischemia accompanied by IOCA was significantly higher than that of the male group (P<0.05). Univariate analysis showed that age≥65 years, hypertension, diabetes, and typical angina symptoms were associated with an increased risk of IOCA in female patients with angina pectoris. Multivariate regression analysis showed that age≥65 years old (OR=1.784, 95%CI: 1.146-2.776, P=0.010), hypertension (OR=1.782, 95%CI: 1.201-2.644, P=0.004) and typical angina symptoms (OR=1.642, 95%CI: 1.127-2.393, P=0.010) were independent risk factors for female patients with angina pectoris diagnosed as IOCA. The correlation analysis between the number of risk factors and the type of coronary artery disease obstruction showed that the incidence of INOCA decreased significantly with the increase of the number of risk factors, from 45.5% to 14.2%. The incidence of IOCA increased significantly with the number of risk factors, from 54.5% to 85.8% (P for trend<0.001). Conclusion: The incidence of INOCA in female patients with angina pectoris suspected of coronary heart disease is higher than that of male. The incidence of IOCA increased significantly, and the incidence of INOCA decreased significantly in proportion to the increase of the number of combined risk factors.

Summary of the 2022 Report on Cardiovascular Health and Diseases in China / 中华医学杂志(英文版)

Recent decades have seen the remarkable development of China in medical accessibility and quality index, and the application of a number of new advanced cardiovascular technologies benefits more patients. However, according to the Annual Report on Cardiovascular Health and Diseases in China published in this article, which was organized and summarized by National Center for Cardiovascular Diseases, there is still a huge population living with risk factors of cardiovascular diseases (CVD), and the morbidity and mortality of CVD are increasing. It is estimated that there are around 330 million patients suffering from CVD currently, including 245 million of hypertension, 13 million of stroke, 45.3 million of peripheral artery disease, 11.39 million of coronary heart disease (CHD), 8.9 million of heart failure, 5 million of pulmonary heart disease, 4.87 million of atrial fibrillation, 2.5 million of rheumatic heart disease, and 2 million of congenital heart disease. Tobacco use, diet and nutrition factors, physical activity, overweight and obesity, and psychological factors are what affect cardiovascular health, while hypertension, dyslipidemia, diabetes, chronic kidney disease, metabolic syndrome, and air pollution are the risk factors for CVD. In this article, in addition to risk factors for CVD, we also report the epidemiological trends of CVD, including CHD, cerebrovascular disease, arrhythmias, valvular heart disease, congenital heart disease, cardiomyopathy, heart failure, pulmonary vascular disease and venous thromboembolism, and aortic and peripheral artery diseases, as well as the basic research and medical device development in CVD. In a word, China has entered a new stage of transforming from high-speed development focusing on scale growth to high-quality development emphasizing on strategic and key technological development to curb the trend of increasing incidence and mortality of CVD.

Associations Between Insulin Resistance Indexes and Hyperuricemia in Hypertensive Population / 中国医学科学院学报

Objective To explore the relationship between insulin resistance (IR) indexes and hyperuricemia (HUA) among the people with hypertension. Methods From July to August in 2018,hypertension screening was carried out in Wuyuan county,Jiangxi province,and the data were collected through questionnaire survey,physical measurement,and biochemical test.Logistic regression was performed to analyze the relationship between HUA and IR indexes including metabolic score for IR (METS-IR),triglyceride-glucose (TyG) index,TyG-body mass index (BMI),TyG-waist circumference (WC),visceral adiposity index (VAI),triglyceride (TG)/high-density lipoprotein cholesterol (HDL-C),and lipid accumulation product (LAP).The penalty spline method was used for the curve fitting between IR indexes and HUA.The area under the receiver operating characteristic curve (AUC) was employed to reveal the correlation between each index and HUA. Results The 14 220 hypertension patients included 6 713 males and 7 507 females,with the average age of (63.8±9.4) years old,the average uric acid level of (418.9±120.6) mmol/L,and the HUA detection rate of 44.4%.The HUA group had higher proportions of males,current drinking,current smoking,diabetes,and using antihypertensive drugs,older age,higher diastolic blood pressure,WC,BMI,homocysteine,total cholesterol,TG,low-density lipoprotein cholesterol,blood urea nitrogen,creatinine,aspartate aminotransferase,alanine aminotransferase,total protein,albumin,total bilirubin,direct bilirubin, METS-IR, TyG, TyG-BMI, TyG-WC, VAI, TG/HDL-C, and LAP, and lower systolic blood pressure and HDL-C than the normal uric acid group (all P<0.05).Multivariate Logistic regression showed that METS-IR (OR=1.049,95%CI=1.038-1.060, P<0.001), TyG (OR=1.639,95%CI=1.496-1.797, P<0.001), TyG-BMI (OR=1.008,95%CI=1.006-1.010, P<0.001), TyG-WC (OR=1.003,95%CI=1.002-1.004, P<0.001), lnVAI (OR=1.850, 95%CI=1.735-1.973, P<0.001), ln(TG/HDL-C) (OR=1.862,95%CI=1.692-2.048, P<0.001),and lnLAP (OR=1.503,95%CI=1.401-1.613,P<0.001) were associated with the risk of HUA.Curve fitting indicated that METS-IR,TyG,TYG-BMI,TYG-WC,lnVAI,ln(TG/HDL-C),and lnLAP were positively correlated with HUA (all P<0.001),and the AUC of TyG index was higher than that of other IR indexes (all P<0.05). Conclusion Increased IR indexes,especially TyG,were associated with the risk of HUA among people with hypertension.

Serum lipoprotein-associated phospholipase A2 level is positively correlated with the recurrence risk of acute ischemic cerebral infarction in hypertensive patients / 南方医科大学学报

OBJECTIVE@#To explore the relationship between serum lipoprotein-associated phospholipase A2 (Lp-PLA2) level and the risk of acute ischemic stroke (AIS) recurrence in hypertensive patients.@*METHODS@#This retrospective case-control study was conducted among 211 hypertensive patients with AIS treated in Foshan First People's Hospital, including 35 patients with recurrence of AIS during the 1-year follow-up as confirmed by head CT/MR. In the overall patients, 60 had grade 1 hypertension (including 5 recurrent cases), 76 had grade 2 hypertension (with 11 recurrent cases), and 75 had grade 3 hypertension (with 19 recurrent cases). Univariate analysis, multivariate logistic regression analysis, trend analysis, and smooth curve fitting analysis were performed to explore the correlation between serum Lp-PLA2 level within 24 h after admission and the risk of AIS recurrence. The predictive efficacy of serum Lp-PLA2 level for AIS recurrence in different hypertension grades was evaluated using ROC curve analysis.@*RESULTS@#Serum Lp-PLA2 level, age, NIHSS score at admission, mRS scores at 7 days, homocysteine level and smoking status differed significantly between patients with and without AIS recurrence (P < 0.05). After adjustment for confounding factors, multivariate regression analysis showed that the highest tertile of Lp-PLA2 level was associated with a 4.13-fold increase of AIS recurrence risk compared with the lowest tertile (OR=5.13, 95% CI: 1.35-19.40), and each 1 ng/mL increase of Lp-PLA2 level was associated with a 1% increase of AIS recurrence risk (OR= 1.01, 95% CI: 1.01-1.02). Serum Lp-PLA2 level was shown to positively correlate with AIS recurrence risk, and in patients with grade 3 hypertension, its areas under the ROC curve for predicting AIS recurrence was 0.869 with a specificity of 0.893 and a sensitivity of 0.737.@*CONCLUSION@#Serum Lp-PLA2 concentration is an independent risk factor and potentially an effective predictor for AIS recurrence in patients with grade 3 hypertension.

Research progress in the association of peri-implant diseases and metabolic syndrome / 中华口腔医学杂志

Peri-implant disease, an important group of diseases that cause implant failure, are associated with metabolic abnormality. Metabolic syndrome (MetS) is a common metabolic disorder comprising abdominal obesity, hyperglycemia, systemic hypertension and atherogenic dyslipidemia. Previous studies had reported that MetS and its diversified clinical manifestations might be associated with peri-implant diseases, but the relationship and underlying mechanisms were unclear. This review aims to explore the relationship between MetS and peri-implant disease, in order to provide beneficial reference for the prevention and treatment of peri-implant disease in patients with MetS.

Correlation between left atrial strain and left ventricular diastolic function in hypertensive patients / 中南大学学报(医学版)

OBJECTIVES@#Early detection of asymptomatic diastolic dysfunction is essential to prevent the development of heart failure in hypertensive patients. Current studies suggest that left atrial strain contributes to the evaluation of left ventricular diastolic function, but there are fewer studies on the correlation between left atrial strain and diastolic function in hypertensive patients. In this study, we applied a two-dimensional speckle tracking technique to evaluate the changes in left atrial strain in hypertensive patients, and to investigate the relationship between left atrial strain and left ventricular diastolic function.@*METHODS@#A total of 82 hypertensive patients who were visited the Department of Cardiology at the Third Xiangya Hospital of Central South University from July 2021 to January 2022, were enrolled for this study, and 59 healthy subjects served as a control group. According to the number of left ventricular diastolic function indexes recommended by the 2016 American Society of Echocardiography Diastolic Function Guidelines (mitral annular e´ velocity: Septal e´<7 cm/s, lateral e´<10 cm/s, E/e´ ratio>14, left atrial volume index>34 mL/m2, peak tricuspid regurgitation velocity>2.8 m/s), the hypertensive patients were divided into 3 groups: Group Ⅰ (0 index, n=36 ), Group Ⅱ (1 index, n=39), and Group Ⅲ (2 indexes, n=7). Two-dimensional speckle tracking technique was used to measure left atrial reservoir strain (LASr), conduit strain, and contraction strain, and to analyze the correlation between left atrial strain and left ventricular diastolic function in hypertensive patients.@*RESULTS@#The LASr, left atrial conduit strain (LAScd), and LASr/(E/septal e´) of the hypertension group were lower than those of the control group, and E/LASr was higher than that of the control group. There was no significant difference in left atrium volume index between the 2 groups (P>0.05). Compared with Group Ⅰ, LASr, LAScd, and LASr/(E/septal e´) were decreased in Group Ⅱ and Group Ⅲ, LASr/(E/septal e´) was also decreased in Group Ⅲ compared with Group Ⅱ (all P<0.05). Compared with Group Ⅰ, E/LASr was increased in Group Ⅲ. LASr was positively correlated with septal e´, lateral e´, E, and E/A, and negatively correlated with E/septal e´.@*CONCLUSIONS@#The changes of left atrial function in patients with early hypertension are earlier than those of left atrial structure. Left atrial strain and its combination with conventional ultrasonographic indices [LASr/(E/septal e´)] of diastolic function are potentially useful in assessing left ventricular diastolic function in hypertensive patients.

Expression of LRG-1 in mice with hypertensive renal damage and its significance / 中南大学学报(医学版)

OBJECTIVES@#Long-term elevated blood pressure may lead to kidney damage, yet the pathogenesis of hypertensive kidney damage is still unclear. This study aims to explore the role and significance of leucine-rich alpha-2-glycoprotein-1 (LRG-1) in hypertensive renal damage through detecting the levels of LRG-1 in the serum and kidney of mice with hypertensive renal damage and its relationship with related indexes.@*METHODS@#C57BL/6 mice were used in this study and randomly divided into a control group, an angiotensin II (Ang II) group, and an Ang II+irbesartan group. The control group was gavaged with physiological saline. The Ang II group was pumped subcutaneously at a rate of 1.5 mg/(kg·d) for 28 days to establish the hypertensive renal damage model in mice, and then gavaged with equivalent physiological saline. The Ang II+irbesartan group used the same method to establish the hypertensive renal damage model, and then was gavaged with irbesartan. Immunohistochemistry and Western blotting were used to detect the expression of LRG-1 and fibrosis-related indicators (collagen I and fibronectin) in renal tissues. ELISA was used to evaluate the level of serum LRG-1 and inflammatory cytokines in mice. The urinary protein-creatinine ratio and renal function were determined, and correlation analysis was conducted.@*RESULTS@#Compared with the control group, the levels of serum LRG-1, the expression of LRG-1 protein, collagen I, and fibronectin in kidney in the Ang II group were increased (all P<0.01). After treating with irbesartan, renal damage of hypertensive mice was alleviated, while the levels of LRG-1 in serum and kidney were decreased, and the expression of collagen I and fibronectin was down-regulated (all P<0.01). Correlation analysis showed that the level of serum LRG-1 was positively correlated with urinary protein-creatinine ratio, blood urea nitrogen, and blood creatinine level in hypertensive kidney damage mice. Serum level of LRG-1 was also positively correlated with serum inflammatory factors including TNF-α, IL-1β, and IL-6.@*CONCLUSIONS@#Hypertensive renal damage mice display elevated expression of LRG-1 in serum and kidney, and irbesartan can reduce the expression of LRG-1 while alleviating renal damage. The level of serum LRG-1 is positively correlated with the degree of hypertensive renal damage, suggesting that it may participate in the occurrence and development of hypertensive renal damage.

Outcome of surgical repair for aortic coarctation with coexisting descending aortic aneurysm in adult patients / 中华心血管病杂志

Objective: To evaluate the efficacy of surgical treatment of aortic coarctation combined with descending aortic aneurysm in adult patients. Methods: This is a retrospective cohort study. Adult patients with aortic coarctation who were hospitalized in Beijing Anzhen Hospital from January 2015 to April 2019 were enrolled. The aortic coarctation was diagnosed by aortic CT angiography, and the included patients were divided into the combined descending aortic aneurysm group and the uncomplicated descending aortic aneurysm group based on descending aortic diameter. General clinical data and surgery-related data were collected from the included patients, and death and complications were recorded at 30 days after surgery, and upper limb systolic blood pressure was measured in all patients at discharge. Patients were followed up after discharge by outpatient visit or telephone call for their survival and the occurrence of repeat interventions and adverse events, which included death, cerebrovascular events, transient ischemic attack, myocardial infarction, hypertension, postoperative restenosis, and other cardiovascular-related interventions. Results: A total of 107 patients with aortic coarctation aged (34.1±15.2) years were included, and 68 (63.6%) were males. There were 16 cases in the combined descending aortic aneurysm group and 91 cases in the uncomplicated descending aortic aneurysm group. In the combined descending aortic aneurysm group, 6 cases (6/16) underwent artificial vessel bypass, 4 cases (4/16) underwent thoracic aortic artificial vessel replacement, 4 cases (4/16) underwent aortic arch replacement+elephant trunk procedure, and 2 cases (2/16) underwent thoracic endovascular aneurysm repair. There was no statistically significant difference between the two groups in the choice of surgical approach (all P>0.05). In the combined descending aortic aneurysm group at 30 days after surgery, one case underwent re-thoracotomy surgery, one case developed incomplete paraplegia of the lower extremity, and one case died; and the differences in the incidence of endpoint events at 30 days after surgery were similar between the two groups (P>0.05). Systolic blood pressure in the upper extremity at discharge was significantly lower in both groups compared with the preoperative period (in the combined descending aortic aneurysm group: (127.3±16.3) mmHg vs. (140.9±16.3) mmHg, P=0.030, 1 mmHg=0.133 kPa; in the uncomplicated descending aortic aneurysm group: (120.7±13.2) mmHg vs. (151.8±26.3) mmHg, P=0.001). The follow-up time was 3.5 (3.1, 4.4) years. There were no new deaths in the combined descending aortic aneurysm group, no transient ischemic attack, myocardial infarction or re-thoracotomy surgery, and one patient (1/15) suffered cerebral infarction and 10 patients (10/15) were diagnosed with hypertension. The differences in the occurrence of endpoint events during postoperative follow-up were similar between the two groups (P>0.05). Conclusion: In experienced centers, long-term prognosis of patients with aortic coarctation combined with descending aortic aneurysm is satisfactory post surgical intervention.

Clinical characteristics and prognosis of 12 cases of lupus nephritis complicated with thrombotic microangiopathy / 中国当代儿科杂志

OBJECTIVES@#To investigate the clinical characteristics, pathological features, treatment regimen, and prognosis of children with lupus nephritis (LN) and thrombotic microangiopathy (TMA), as well as the treatment outcome of these children and the clinical and pathological differences between LN children with TMA and those without TMA.@*METHODS@#A retrospective analysis was conducted on 12 children with LN and TMA (TMA group) who were admitted to the Department of Nephrology, Children's Hospital of Nanjing Medical University, from December 2010 to December 2021. Twenty-four LN children without TMA who underwent renal biopsy during the same period were included as the non-TMA group. The two groups were compared in terms of clinical manifestations, laboratory examination results, and pathological results.@*RESULTS@#Among the 12 children with TMA, 8 (67%) had hypertension and 3 (25%) progressed to stage 5 chronic kidney disease. Compared with the non-TMA group, the TMA group had more severe tubulointerstitial damage, a higher Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score at onset, and higher cholesterol levels (P<0.05). There were no significant differences between the two groups in the percentage of crescent bodies and the levels of hemoglobin and platelets (P>0.05).@*CONCLUSIONS@#There is a higher proportion of individuals with hypertension among the children with LN and TMA, as well as more severe tubulointerstitial damage. These children have a higher SLEDAI score and a higher cholesterol level.

Comparação de desfechos clínicos e correlação entre funcionalidade e tempo de ventilação mecânica de pacientes em uti / Comparison of clinical outcomes and correlation between functionality and time of mechanical ventilation in icu patients / Comparación de los resultados clínicos y correlación entre la funcionalidad y el tiempo de ventilación mecánica de los pacientes en uti

O objetivo deste estudo foi comparar os desfechos clínicos dos pacientes em suporte ventilatório invasivo por período curto e prolongado e correlacionar funcionalidade e tempo de ventilação mecânica (VM). Estudo documental retrospectivo, realizado na UTI neurocirúrgica de um hospital escola. Dos prontuários clínicos foram coletados: idade, sexo, hipótese diagnóstica de internação, tempo de internação e de VM em dias, o desfecho sucesso ou falha da extubação e o nível de funcionalidade. Os prontuários foram divididos em grupo um (GI): pacientes em VM por até três dias e grupo dois (GII): pacientes em VM por mais de três dias. Foram analisados 210 prontuários, 73% dos pacientes permaneceram menos de três dias em VM. A idade média de GI foi 51,8±15,5 anos e GII 48,7±16,3 anos (p=0,20), prevalência do sexo masculino em GI (59%) e GII (68%). O acidente vascular cerebral foi o diagnóstico mais prevalente no GI (18%) e o tumor cerebral no GII (21%) e hipertensão arterial, a comorbidade mais prevalente em GI (28%) e GII (25%). O GII permaneceu maior tempo (p<0,0001) em VM e internação na UTI que o GI e percentual de sucesso no desmame/extubação menor (p=0,01) que o GI. Não houve correlação significativa entre funcionalidade e tempo de VM em GI e GII (p>0,05). Os pacientes em suporte ventilatório invasivo por período prolongado evoluíram com maior permanência em VM, maior tempo de internação na UTI e menor taxa de sucesso no desmame/extubação. O tempo de permanência em suporte ventilatório invasivo não interferiu na funcionalidade desses pacientes.

The aim of this study was to compare the clinical outcomes of patients on short- and long-term invasive ventilatory support and to correlate functionality and duration of mechanical ventilation (MV). Retrospective documental study, carried out in the neurosurgical ICU of a teaching hospital. The following were collected from the clinical records: age, gender, diagnostic hypothesis of hospitalization, length of hospital stay and MV in days, the outcome of success or failure of extubation and the level of functionality. The medical records were divided into group one (GI): patients on MV for up to three days and group two (GII): patients on MV for more than three days. A total of 210 medical records were analyzed, 73% of the patients remained on MV for less than three days. The mean age of GI was 51.8±15.5 years and GII 48.7±16.3 years (p=0.20), male prevalence in GI (59%) and GII (68%). Stroke was the most prevalent diagnosis in GI (18%) and brain tumor in GII (21%) and hypertension was the most prevalent comorbidity in GI (28%) and GII (25%). GII remained longer (p<0.0001) in MV and ICU admission than GI and the percentage of success in weaning/extubation was lower (p=0.01) than GI. There was no significant correlation between functionality and time on MV in GI and GII (p>0.05). Patients on invasive ventilatory support for a long period evolved with longer MV stays, longer ICU stays and lower weaning/extubation success rates. The length of stay on invasive ventilatory support did not interfere with the functionality of these patients.

El objetivo de este estudio fue comparar los resultados clínicos de los pacientes con soporte ventilatorio invasivo a corto y largo plazo y correlacionar la funcionalidad y el tiempo de ventilación mecánica (VM). Se trata de un estudio documental retrospectivo, realizado en la UCI neuroquirúrgica de un hospital universitario. Se recogieron los siguientes datos de las historias clínicas: edad, sexo, hipótesis diagnóstica, duración de la estancia y tiempo de VM en días, el resultado éxito o fracaso de la extubación y el nivel de funcionalidad. Las historias clínicas se dividieron en el grupo uno (GI): pacientes bajo VM hasta tres días y el grupo dos (GII): pacientes bajo VM durante más de tres días. Se analizaron 210 historias clínicas, el 73% de los pacientes permanecieron menos de tres días con VM. La edad media de GI fue de 51,8±15,5 años y la de GII de 48,7±16,3 años (p=0,20), con prevalencia masculina en GI (59%) y GII (68%). El ictus fue el diagnóstico más prevalente en GI (18%) y el tumor cerebral en GII (21%) y la hipertensión, la comorbilidad más prevalente en GI (28%) y GII (25%). El GII permaneció más tiempo (p<0,0001) en la VM y la estancia en la UCI que el GI y el porcentaje de éxito en el destete/extubación fue menor (p=0,01) que el GI. No hubo correlación significativa entre la funcionalidad y el tiempo de VM en GI y GII (p>0,05). Los pacientes con soporte ventilatorio invasivo a largo plazo evolucionaron con una mayor estancia en la VM, una mayor estancia en la UCI y una menor tasa de éxito de destete/extubación. La duración de la estancia con soporte ventilatorio invasivo no interfirió en la funcionalidad de estos pacientes.

Rastreamento clínico e nutricional de gestantes de alto risco na estratégia de saúde da família de Santa Quitéria - CE / Clinical and nutritional screening of high-risk pregnant women in the family health strategy of Santa Quitéria - CE / Cribado clínico y nutricional de las embarazadas de alto riesgo en la estrategia de salud familiar de Santa Quitéria - CE

Considera-se gestação de alto risco quando a mulher apresenta comorbidade materna e/ou condição sociobiológica que levam as chances de ocorrer alguma intercorrência na evolução natural da gravidez, como hipertensão arterial, diabetes, anemia, alcoolismo e obesidade. É de grande importância o acompanhamento pré-natal com uma equipe de assistência capaz de identificar os problemas antes mesmo que possam ser agravados. O objetivo deste estudo foi rastrear o perfil clínico e nutricional de mulheres com gestação de alto risco na Estratégia de Saúde da Família de Santa Quitéria- CE. Trata-se de um estudo descritivo, com abordagem quantitativa realizado com 33 gestantes. Para a coleta de dados foi utilizado o cartão da gestante e prontuário, o estado nutricional foi avaliado através do peso pré- gestacional contido no cartão e peso atual através da balança. Para análise estatística, foram usados frequências, percentuais, médias e desvio padrão, verificadas por meio dos testes de Kolmogorov-Smirnov e Levene. Para a comparação de médias entre duas categorias, utilizou-se o teste t de Student para amostras independentes. Os resultados mostraram que a maioria tinha o ensino médio como nível de escolaridade, renda igual ou menor que um salário mínimo, multíparas com um ou mais abortos. Em relação às características do estado clínico patológico, as condições mais prevalentes nas gestantes do presente estudo foram hipertensão arterial sistêmica, pré-eclâmpsia, seguidos de DMG e eritoblastose. Excesso de peso antes e durante a gravidez com ganho ponderal de peso adequado. O que demonstra a necessidade de estratégias para a saúde da mulher. É apropriado acionar sinal de alerta no acompanhamento da saúde da mulher também antes da gestação e não somente no pré-natal para que transcorra bem durante e após o parto. PALAVRAS-CHAVE: Estado nutricional; Gestação de alto risco; Assistência Pré-Natal.

High-risk pregnancy is considered when the woman presents maternal comorbidity and/or sociobiological condition that increase the chances of some complication occurring in the natural evolution of pregnancy, such as arterial hypertension, diabetes, anemia, alcoholism, and obesity; It is of great importance the prenatal follow-up with an assistance team capable of identifying the problems even before they can be aggravated; The objective of this study was to track the clinical and nutritional profile of women with high-risk pregnancy in the Family Health Strategy of Santa Quitéria-CE; This is a descriptive study with a quantitative approach carried out with 33 pregnant women; For data collection the pregnant woman's card and medical records were used, the nutritional status was evaluated through the pre-gestational weight contained in the card and current weight through the scale; For statistical analysis, frequencies, percentages, means and standard deviation were used, verified by means of the Kolmogorov-Smirnov and Levene tests;For comparison of means between two categories, Student's t test for independent samples was used; The results showed that most had high school education, income equal to or less than one minimum wage, multiparous women with one or more abortions; Regarding the characteristics of the pathological medical condition, the most prevalent conditions in the pregnant women of the present study were hypertension, pre- eclampsia, followed by GDM and erythoblastosis; Overweight before and during pregnancy with adequate weight gain; This demonstrates the need for women's health strategies; It is appropriate to trigger warning signals in the monitoring of women's health also before pregnancy and not only in the prenatal period so that it goes well during and after delivery;

Se considera embarazo de alto riesgo cuando la mujer presenta comorbilidad materna y/o condición socio-biológica que conlleva las posibilidades de aparición de alguna complicación en la evolución natural del embarazo, como son la hipertensión, la diabetes, la anemia, el alcoholismo y la obesidad. Es de gran importancia el seguimiento prenatal con un equipo de asistencia capaz de identificar los problemas incluso antes de que puedan agravarse. El objetivo de este estudio fue rastrear el perfil clínico y nutricional de las mujeres con embarazo de alto riesgo en la Estrategia de Salud Familiar de Santa Quitéria-CE. Se trata de un estudio descriptivo con un enfoque cuantitativo realizado con 33 mujeres embarazadas. Para la recopilación de datos se utilizó el cartón de la gestante y el prontuario, el estado nutricional se evaluó a través del peso pregestacional contenido en el cartón y el peso actual a través de la balanza. Para el análisis estadístico se utilizaron frecuencias, porcentajes, medias y desviación estándar, verificados mediante las pruebas de Kolmogorov-Smirnov y Levene. Para la comparación de medias entre dos categorías, se utilizó la prueba t de Student para muestras independientes. Los resultados mostraron que la mayoría tenía estudios secundarios, ingresos iguales o inferiores a un salario mínimo, mujeres multíparas con uno o más abortos. En cuanto a las características del estado clínico patológico, las condiciones más prevalentes en las embarazadas del presente estudio fueron la hipertensión arterial sistémica, la preeclampsia, seguidas de la DMG y la eritoblastosis. Exceso de peso antes y durante el embarazo con un aumento de peso adecuado. Lo que demuestra la necesidad de estrategias de salud para las mujeres. Es conveniente activar la señal de alarma en el seguimiento de la salud de las mujeres también antes del embarazo y no sólo en la atención prenatal para que funcione bien durante y después del parto.

Prescription of statins according to the ASCVD estimator at Pablo Arturo Suarez Hospital, March 2021 to February 2022 / Prescripción de estatinas según el estimador ASCVD en el Hospital Pablo Arturo Suárez, marzo 2021 a febrero 2022

Worldwide, the leading cause of death is cardiovascular disease. The study details the prescription of statins at the Pablo Arturo Suarez Hospital in Ecuador between March 2021 and February 2022 following the ASCVD risk scale of the American College of Cardiology and the American Heart Association. There are 563 people in this cross-sectional and retrospective study: 70% women, 30% men, 93.30% mestizos, 48.10% diabetics, 62.30% hypertensives, and 18.70% smokers. 26.10% of all patients received statins, with simvastatin being the most common (96.60%). The mean cardiovascular risk in the general population was 15.52 ± 14.51%, 44.99% of subjects had a risk lower than 7.50%, and 29% had a risk higher than 20%, with a statistically significant difference (p<0.001) according to sex. The study determined that 58.60% of the population received a statin or an inadequate dosage.

A nivel mundial, la principal causa de muerte es la enfermedad cardiovascular. El estudio detalla la prescripción de estatinas en el Hospital Pablo Arturo Suárez de Ecuador entre marzo de 2021 y febrero de 2022, siguiendo la escala de riesgo ASCVD del Colegio Americano de Cardiología y la Asociación Americana del Corazón. Son 563 personas en este estudio transversal y retrospectivo: 70% mujeres, 30% hombres, 93.30% mestizos, 48.10% diabéticos, 62.30% hipertensos y 18.70% fumadores. El 26.10% de los pacientes recibía estatinas, siendo la simvastatina la más frecuente (96.60%). El riesgo cardiovascular medio en la población general fue de 15.52 ± 14.51%, el 44.99% de los sujetos tenía un riesgo inferior al 7.50%, y el 29% tenía un riesgo superior al 20%, con una diferencia estadísticamente significativa (p<0.001) según el sexo. El estudio determinó que el 58.60% de la población recibía una estatina o una dosis inadecuada.

Mortality from chronic kidney disease secondary to hypertension in Brazil: a study of the "Global Burden of Disease" / Mortalidade por doença renal crônica secundária à hipertensão no Brasil: um estudo do "Global Burden of Disease" / Mortalidad por enfermedad renal crónica secundaria a hipertensión en Brasil: un estudio de la "Global Burden of Disease"

Background and Objectives: Chronic kidney disease (CKD) is one of the main complications resulting from arterial hypertension, and a recent increase in the incidence and prevalence of the disease has been reported, which can lead to an increase in mortality and complications resulting from the disease. Thus, the objective of study is to describe the variations in mortality from CKD secondary to arterial hypertension, in Brazil, between the years 1990 to 2019. Methods: Epidemiological study, with a quantitative approach and descriptive character, which analyzed data from the "Global Burden of Disease Study" (GBD) tool. Results: In all of Brazil's federative units, the estimate of deaths from CKD secondary to hypertension increased, with the Southeast region having the highest estimates. The States of Rio de Janeiro, Rio Grande do Sul, and Paraíba lead with the highest mortality rates. Regarding sex, in all years, higher rates were observed in males, however, over the years, this difference has been reduced. The age group of ≥70 years was the most affected, standing out with the highest death rates. Conclusion: the burden of CKD in Brazil has increased in the last 30 years; among the regions of the country, the Southeast recorded the highest estimates of deaths in all the years analyzed, being mainly higher among men.(AU)

Justificativa e objetivos: A doença renal crônica (DRC) é uma das principais complicações decorrentes da hipertensão arterial. Nos últimos anos, tem sido relatado um aumento na incidência e prevalência da doença, o que pode levar ao aumento da mortalidade e das complicações decorrentes da doença. Assim, o objetivo deste estudo foi descrever as variações da mortalidade por DRC secundária à hipertensão arterial no Brasil entre 1990 e 2019. Métodos: Trata-se de um estudo epidemiológico, de abordagem quantitativa e caráter descritivo, que analisou dados da ferramenta Global Burden of Disease Study (GBD). Resultados: Em todas as unidades da federação, a estimativa de mortes por DRC secundária à hipertensão apresentou aumento, a região Sudeste apresentando as maiores estimativas. Os estados do Rio de Janeiro, Rio Grande do Sul e Paraíba lideram as pesquisas com as maiores taxas de mortalidade. No que diz respeito ao sexo, em todos os anos foram observadas maiores taxas de DRC em indivíduos do sexo masculino; contudo, nota-se que tem ocorrido uma redução dessa diferença. A faixa etária de ≥70 anos foi a mais acometida, destacando-se com as maiores taxas de mortes. Conclusão: a carga de DRC no Brasil aumentou nos últimos 30 anos. Entre as regiões do país, o Sudeste registrou as maiores estimativas de mortes em todos os anos analisados, principalmente de homens.(AU)

Justificación y objetivos: La enfermedad renal crónica (ERC) es una de las principales complicaciones derivadas de la hipertensión arterial, y en los últimos años se ha reportado un aumento en la incidencia y prevalencia de la enfermedad, lo que puede conducir a un aumento de la mortalidad y de las complicaciones derivadas de esta, por lo tanto, el objetivo del estudio es describir las variaciones en la mortalidad por ERC secundaria a la hipertensión arterial en Brasil entre los años 1990 a 2019. Métodos: Estudio epidemiológico, con enfoque cuantitativo y carácter descriptivo, que analizó datos de la herramienta Global Burden of Disease Study (GBD). Resultados: En todas las unidades de la federación, aumentó la estimación de muertes por ERC secundaria a la hipertensión arterial, con la región Sudeste presentando las estimaciones más altas. Los estados de Rio de Janeiro, Rio Grande do Sul y Paraíba lideran con las tasas de mortalidad más altas. Con respecto al sexo, en todos los años se observaron mayores tasas en los varones, sin embargo, con el paso de los años, esta diferencia se ha ido reduciendo. El grupo de edad de ≥70 años fue el más afectado, destacándose con las tasas de mortalidad más altas. Conclusión: la carga de ERC en Brasil ha aumentado en los últimos 30 años; de las regiones del país, el Sudeste registró las mayores estimaciones de muertes en todos los años registrados entre los analizados, siendo principalmente mayor entre los hombres.(AU)

Hipertensão arterial sistêmica autorrelatada em pacientes atendidos no curso de Odontologia da Unigranrio e sua relação com parâmetros periodontais e CPOD / Self-reported systemic arterial hypertension in patients treated at Unigranrio's Dentistry course and its relationship with periodontal parameters and DMFT

Objetivo: Avaliar a frequência de hipertensão arterial sistêmica e sua associação com parâmetros periodontais e do índice de dentes cariados, perdidos, obturados (CPOD) em indivíduos atendidos na clínica do Curso de Odontologia da Unigranrio. Materiais e métodos: Noventa e cinco indivíduos de ambos os sexos foram incluídos no estudo entre março e maio de 2021. Os participantes responderam a questionários anamnésicos, tiveram sua pressão arterial sistêmica aferida e foram examinados para obtenção do índice CPOD e de parâmetros periodontais. Resultados: A frequência de hipertensão arterial sistêmica na população estudada foi 23,15%. Em pacientes com periodontite, essa prevalência foi 27%, e, em pacientes com gengivite, 19%. Pacientes com periodontite tiveram médias superiores de pressão arterial sistólica (PAS) e diastólica (PAD) comparado ao grupo com gengivite (p<0,0001). Foram identificadas correlações significativas positivas entre PAS e bolsas periodontais moderadas (rho=0,356) e profundas (rho=0,342), perda de inserção avançada (rho=0,538), CPOD (rho=0,365) e quantidade de dentes ausentes (rho=0,477), p < 0,001. A PAD apresentou correlações significativas (p < 0,001) positivas com bolsas periodontais moderadas (rho=0,331) e profundas (rho=0,283), perda de inserção avançada (rho=0,465), CPOD (rho=0,361) e dentes ausentes (rho=0,348). Conclusões: A frequência de hipertensão arterial sistêmica autorrelatada é relativamente alta na população estudada e, em especialmente, dentre as pessoas com periodontite. Pressão arterial sistólica e diastólica são correlacionadas positivamente com parâmetros periodontais indicadores de severidade de doença, assim como piores escores do CPOD.

Aim: The study evaluated the prevalence of systemic arterial hypertension and its association with periodontal parameters and decayed-missing-filled teeth (DMFT) index in individuals treated in a Dental School clinic. Material and methods: Ninety-five individuals of both genders were included in the study in the period between March and May 2021. All participants answered anamnestic questionaries, had their systemic blood pressure measured, and were examined to obtain the DMFT and periodontal parameters. Results: The prevalence of systemic arterial hypertension in the study population was 23.15%. In periodontitis individuals, that prevalence was 27%, and, in gingivitis patients, 19%. Patients with periodontitis have higher mean systolic (SBP) and diastolic (DBP) blood pressure compared with gingivitis individuals (p<0.0001). Significant positive correlations were found between SBP and moderate (rho=0.356) and deep (rho=0.342) periodontal pockets, severe attachment loss (rho=0.538), DMFT (rho=0.365), and amount of missing teeth (rho=0.477), p ? 0.001. The DBP showed significant (p?0.001) positive correlations with moderate (rho=0.331) and (rho=0.283) deep periodontal pockets, severe attachment loss (rho=0.465), DMFT (rho=0.361), and missing teeth (rho=0.348). Conclusions: The prevalence of systemic arterial hypertension is relatively high in the study population and, in particular, among individuals with periodontitis. Systolic and diastolic blood pressure are positively correlated with periodontal parameters that indicate the severity of disease, as well as with worse DMFT scores.

Use of Diuretics is Associated with Higher Risk of Sarcopenia in Older Adults with Hypertension

Abstract Background: Sarcopenia is a disease that involves skeletal muscle mass loss and is highly prevalent in the older adult population. Moreover, the incidence of sarcopenia is increased in patients with hypertension. Objectives: The study aimed to evaluate the association between the classes of the drugs used for arterial hypertension treatment and the presence or absence of sarcopenia. Methods: 129 older adults with hypertension were evaluated by the researchers who registered the participants medication for arterial hypertension treatment. Sarcopenia level was measured by anthropometric parameters, muscular strength, and functional capacity. The data were analyzed by one-way ANOVA followed by post-hoc test and Fisher's exact test; statistical significance was set at 0.05. Results: Age was not different between women with different levels of sarcopenia, but significant differences were observed between men with absent sarcopenia (66.8±4.2 years) and men with probable sarcopenia (77.0±10.2 years). Individuals with absent sarcopenia showed higher handgrip strength (men: 33.8±7.4, women: 23.2±4.6 Kgf) in comparison with those with sarcopenia (men with probable sarcopenia: 9.5±3.3 Kgf, women with probable, confirmed, and severe sarcopenia: 11.7±2.5, 12.2±3.0, 11.8±1.8 Kgf, respectively). The analysis showed an association between the type of medication and degree of sarcopenia; diuretics were significantly associated with probable sarcopenia, and angiotensin II receptor blockers (alone or in combination with diuretics) was associated with absence of sarcopenia. Conclusion: In conclusion, handgrip strength was a good method to diagnose sarcopenia, and diuretics were associated with increased risk of sarcopenia in older adults with hypertension.