Air Pollutants and Mortality Risk in Patients with Aortic Dissection: Evidence from a Clinical Cohort, Single-Cell Sequencing, and Proteomics.

We aimed to evaluate the association between air pollutants and mortality risk in patients with acute aortic dissection (AAD) in a longitudinal cohort and to explore the potential mechanisms of adverse prognosis induced by fine particulate matter (PM2.5). Air pollutants data, including PM2.5, PM10.0, nitrogen dioxide (NO2), carbon monoxide (CO), sulfur dioxide (SO2), and ozone (O3), were collected from official monitoring stations, and multivariable Cox regression models were applied. Single-cell sequencing and proteomics of aortic tissue were conducted to explore the potential mechanisms. In total, 1,267 patients with AAD were included. Exposure to higher concentrations of air pollutants was independently associated with an increased mortality risk. The high-PM2.5 group carried approximately 2 times increased mortality risk. There were linear associations of PM10, NO2, CO, and SO2 exposures with long-term mortality risk. Single-cell sequencing revealed an increase in mast cells in aortic tissue in the high-PM2.5 exposure group. Enrichment analysis of the differentially expressed genes identified the inflammatory response as one of the main pathways, with IL-17 and TNF signaling pathways being among the top pathways. Analysis of proteomics also identified these pathways. This study suggests that exposure to higher PM2.5, PM10, NO2, CO, and SO2 are associated with increased mortality risk in patients with AAD. PM2.5-related activation and degranulation of mast cells may be involved in this process.

Abnormal adiposity indices are associated with an increased risk of diabetes in a non-obese Asian population.

OBJECTIVES: The aim of this study was to evaluate the association between adiposity indices and the risk of incident diabetes and to compare their predictive ability in non-obese healthy individuals. STUDY DESIGN: Population-based cohort study. METHODS: Data were taken from the NAGALA research study, which enrolled Japanese adults aged 18-79 years. Cox regression was used to evaluate the association between adiposity indices (including waist circumference [WC], waist-to-height ratio [WHtR], lipid accumulation product index [LAP], body roundness index [BRI], visceral adiposity index [VAI] and Chinese visceral adiposity index [CVAI]) and diabetes risk. The performance of the indices for predicting diabetes was explored using area under the receiver operating characteristic curve (AUC). A Chinese community-based population was used for validation. RESULTS: A total of 12,940 healthy Japanese individuals with normal body mass index and glycaemic levels were included and were followed up for a median of 6 years. Multivariable Cox models revealed a positive and significant association between all indices and incident diabetes, with the hazard ratios for the highest quartile of the indices ranging from 1.89 to 2.90 (all P-values < 0.01). A non-linear association between WC, BRI and VAI and a linear association between WHtR, LAP and CVAI and diabetes risk were observed. CVAI, VAI and LAP had comparable ability in predicting diabetes, with the highest AUC being 0.733 for CVAI. Data from 10,830 Chinese individuals confirmed these results. CONCLUSIONS: Adiposity indices are associated with incident diabetes in healthy non-obese individuals. Participants in the highest quartile of WC, WHtR, LAP, BRI, VAI and CVAI had an increased risk of developing diabetes.

Visceral fat and its dynamic change are associated with renal damage: Evidence from two cohorts.

BACKGROUND AND AIMS: To evaluate the association of Chinese visceral adiposity index (CVAI) and its dynamic trends with risk of renal damage, and to compare its prediction performance with that of other obesity indices. METHODS AND RESULTS: A community-based population with 23 905 participants from Shantou city was included in the cross-sectional analysis. A total of 9,778 individuals from two separated cohort were included in the longitudinal portion. Five patterns of CVAI change were predefined (low-stable, decreasing, moderate, increasing, and persistent-high). Logistic and Cox regressions were used to evaluate the association between CVAI and renal damage. We explored potential mechanisms using the mediating effect method, and the prediction performance was determined by receiver operating characteristic curve analysis. Results from both cross-sectional and longitudinal data revealed a positive and linear association between CVAI and risk of renal damage. Pooled analysis of the two cohorts showed that per unit increase in Z score of CVAI induced 18% increased risk of renal damage (P = .008). Longitudinal trends of CVAI were also associated with renal damage, and the moderate, increasing, and persistent-high patterns showing a higher risk. Blood pressure and glucose had a mediating effect on renal damage induced by CVAI. Among several obesity indices, CVAI was the optimal for predicting renal damage. CONCLUSION: A higher level of immediate CVAI and longitudinal increasing and persistent-high patterns of CVAI were independently associated with increased risk of renal damage. Monitoring immediate level and long-term trend of CVAI may contribute to the prevention of renal damage.

Poor sleep quality is negatively associated with low cognitive performance in general population independent of self-reported sleep disordered breathing.

BACKGROUND: Sleep disordered breathing (SDB) plays a significant role in both sleep quality and cognition and whether it has an impact on the relationship between above two factors remains to be clear. The study aimed to explore the association between sleep quality and cognitive performance in general population by considering influence of sleep disordered breathing (SDB). METHODS: In this cross-sectional study, we enrolled subjects aged ≥ 18 years using a multi-stage random sampling method. Cognitive status was assessed using Mini Mental State Examination (MMSE) questionnaire, sleep quality using Pittsburgh Sleep Quality Index (PSQI) and SDB was assessed using No-SAS scale, respectively. Multi-variable logistic regression was applied to examine the association of sleep quality and cognitive performance. Subgroup analyses were performed in different age groups, and in those with and without SDB. RESULTS: Finally, 30,872 participants aged 47.5 ± 13.8 years with 53.5% women were enrolled, of whom 32.4% had poor sleep quality and 18.6% had low cognitive performance. Compared with good sleepers, subjects with poor sleep quality exhibited significantly higher presence of low cognitive performance (23.7% vs 16.2%, P < 0.001). Poor sleepers revealed 1.26 (95%CI: 1.16,1.36), 1.26 (1.08,1.46) and 1.25 (1.14,1.37) fold odds for low cognitive performance in general population and in subjects with and without self-reported SDB respectively. Stratified by age and SDB, the association was observed in young and middle-aged group without SDB (OR = 1.44, 95%CI: 1.30,1.59) and in the elderly group with SDB (OR = 1.30, 95%CI: 1.07,1.58). CONCLUSIONS: Sleep quality is in a negative association with cognitive performance in general population independent of SDB, implying improvement of sleep disturbances is a potential objective of intervention strategies for cognitive protection at population level.

Association of Hypertension with Mild Cognitive Impairment in Population from Less-Developed Areas of Multiethnic Northwest China.

BACKGROUND: Relationship between hypertension and mild cognitive impairment (MCI) remains undetermined in population from less-developed regions. We aimed to explore whether hypertension is associated with MCI in this specific population. METHODS: In this cross-sectional study, we enrolled subjects aged ≥18 years using multistage random sampling from Emin, China, in 2019. Participants underwent questionnaires and data collection including mini-mental state examination (MMSE) and blood pressure measurement. RESULTS: Finally, 31,329 subjects were included, with 11,270 hypertensives. Compared with normotensive subjects, hypertensives were characterized by significantly older age (55.19 ± 12.25 vs. 43.26 ± 12.71), more men (52.5% vs. 42.9%), low education attainment (≤primary education: 42.4% vs. 26.3%), more abdominal obesity (39.7% vs. 19.1%), poor sleep quality (39.1% vs. 28.7%), and chronic kidney disease (6.6% vs. 3.4%, p for all <0.001). Prevalence of MCI in hypertensives was significantly higher than that of normotensive subjects (24.3% vs. 15.6%, p < 0.001). Multivariate logistic regression analysis showed in a fully adjusted model that the odds for MCI were significantly increased in hypertensives than in normotensive population (OR = 1.19, 95% CI: 1.09, 1.30, p < 0.001) and independent of all the parameters studied including age, education level, and stroke. In the age-stratified regression model, presence of hypertension significantly increased the odds of MCI by 1.17-fold (95% CI: 1.03, 1.33, p = 0.020) and by 1.22-fold (95% CI: 1.04, 1.44, p = 0.016) in middle-aged and elderly population. Sensitivity analysis of excluding those with stroke history showed that hypertension was still a risk factor for MCI in total, middle-aged, and elderly population. CONCLUSION: Hypertension is in independent negative association with MCI in middle-aged and elderly population from underdeveloped regions.

A systematic review and meta-analysis of effects of spironolactone on blood pressure, glucose, lipids, renal function, fibrosis and inflammation in patients with hypertension and diabetes.

PURPOSE: Hypertension commonly co-exists with diabetes mellitus (DM), and both are closely related to adverse health outcomes. The activation of aldosterone and mineralocorticoid receptor (MR) may play important roles in this process. Therefore, we aim to evaluate the efficacy of MR antagonists on cardiovascular risk factors, including blood pressure (BP), glucose, lipids, renal function, fibrosis and inflammatory and its safety in patients with both hypertension and DM. METHODS: We searched PubMed, Embase, Web of Science and Cochrane databases for clinical trials published until December 31, 2019. Studies comparing the effect of spironolactone to placebo in patients with hypertension and DM were included. Mean difference with 95% confidence intervals was used to report outcomes. RESULTS: Eleven randomised placebo-controlled trials with 640 participants were finally included with mean follow-up of 5 months. Compared to placebo, spironolactone significantly reduced office systolic (-6.57, 95%CI: -9.21, -3.93) and diastolic BP (-2.63, 95%CI: -4.25, -1.02) as well as ambulatory BP; increased glycosylated haemoglobin by 0.3 but no clear effect on fasting glucose. Spironolactone induced a significantly reduction of urinary albumin but increased serum creatinine (7.60, 95%CI: 4.94, 10.27) and decreased glomerular filtration rate (-4.28, 95%CI: -6.38, -2.18). Markers of fibrosis and inflammation, including NIIINP, PICP, hs-CRP and TNF-α were also decreased after spironolactone therapy. For lipid metabolism, there was no significant difference between groups. Spironolactone mildly increased serum potassium (0.30, 95%CI: 0.23, 0.37). 2.5% subjects treated with spironolactone experienced mild to moderate hyperkalaemia and received medication or dietary advice and another 1.6% developed severe hyperkalaemia and withdrawn from the studies. CONCLUSION: Spironolactone reduced BP and urinary albumin, improve fibrosis and inflammation, whereas slightly increases the glycosylated haemoglobin and serum creatinine in patients with hypertension and diabetes. Long-term RCTs to assess the effects of spironolactone on cardiovascular events in this population are warranted.

Prevalence of primary aldosteronism in patients with concomitant hypertension and obstructive sleep apnea, baseline data of a cohort.

Obstructive sleep apnea (OSA) and primary aldosteronism (PA) often coexist in hypertension, whereas whether hypertensive patients with OSA should be screened for PA is controversial and whether gender, age, obesity and OSA severity should be considered is unexplored. We explored cross-sectionally prevalence and associated factors of PA in co-existent hypertension and OSA by considering gender, age, obesity and OSA severity. OSA was defined as AHI ≥5 events/h. PA diagnosis was defined, based on the 2016 Endocrine Society Guideline. We included 3306 patients with hypertension (2564 with OSA). PA prevalence was significantly higher in hypertensives with OSA than in those without OSA (13.2 vs 10.0%, P = 0.018). In gender-specific analysis, PA prevalence was significantly higher in hypertensive men with OSA, compared to non-OSA ones (13.8 vs 7.7%, P = 0.001). In further analysis, PA prevalence was significantly higher in hypertensive men with OSA aged <45 years (12.7 vs 7.0%), 45-59 years (16.6 vs 8.5%), and with overweight and obesity (14.1 vs 7.1%) than did their counterparts (P < 0.05). For OSA severity, men participants showed increased PA prevalence from non to moderate OSA and a decrease in the severe OSA group (7.7 vs 12.9 vs 15.1 vs 13.7%, P = 0.008). Young and middle age, moderate-severe OSA, weight, and blood pressure showed a positive independent association with PA presence in logistic regression. In conclusion, PA is prevalent in co-existent hypertension and OSA, indicating the need for PA screening. Studies are needed for women, older and lean population due to the smaller samples in this study.

The relationship between obstructive sleep apnea and risk of renal impairment in patients with hypertension, a longitudinal study.

OBJECTIVE: Association of obstructive sleep apnea (OSA) with renal damage is undetermined, especially in the population with hypertension, a high-risk group for chronic kidney disease. Therefore, we aimed to explore whether OSA is an independent risk factor for renal impairment in patients with hypertension, by considering the effects of gender, age, obesity and OSA severity. METHODS: The longitudinal observational study included patients with hypertension and suspected OSA without renal damage at baseline who visited Hypertension Center between January 2011 and December 2018, and followed up till renal outcomes, death, loss to follow-up, or May 31, 2022, using annual health check-ups, hospital readmission or out-patient visits. Main renal outcome was chronic kidney disease (CKD), defined as estimated glomerular filtration rate <60 ml/min per 1.73 m2 and/or positive proteinuria. Cox proportional hazard models were used to evaluate the association, and repeated after propensity score matching. Sensitivity analysis were performed by excluding those with primary aldosteronism. RESULTS: 7961 patients with hypertension were included with 5022 ones with OSA, and 82% were followed up. During median follow-up of 3.42 years, 1486 patients developed CKD. Per 1000 person-year incidence of CKD was 56.72 in OSA group. In Cox regression analysis, OSA and severe OSA group respectively showed 1.21 (95% CI: 1.08-1.35) and 1.27 (95% CI: 1.09-1.47) fold risk for CKD in total, compared with non-OSA group. Overall results remained consistent in propensity score matching and sensitivity analysis. CONCLUSION: OSA is independently associated with higher risk of chronic kidney disease in hypertension.

Lower 24-h urinary potassium excretion is associated with higher prevalent depression and anxiety status in general population.

BACKGROUND: Uncertainty remains about the association of potassium (K) intake with depression and anxiety status. We explored their relationship using 24-h urinary K, reflecting K intake, in general population. METHODS: We collected 24-h urine and performed self-rating depression and anxiety scales (SDS, SAS) cross-sectionally in adults selected by random sampling in China. SDS and SAS standard score ≥50 defined depression and anxiety status. Participants were divided into three groups (T1, T2, and T3) by 24-h urinary K tertile. Odds ratios (OR) and 95% confidence intervals were calculated. Sensitivity analysis was performed by excluding anti-hypertensive agent takers. RESULTS: 546 participants comprised current analytical sample. First, T1 and T2 groups showed higher SDS scores (40.0 vs 40.0 vs 36.0, p = .001), prevalence (19.8 vs 15.9 vs 7.1%, p = .002), whereas increased adjusted odds for depression status only in T1 group (OR = 2.71, p = .017), compared with T3 group. Second, T1 and T2 groups showed higher SAS scores (38.0 vs 40 vs 35.0, p < .001) and prevalence (14.8 vs 21.4 vs 8.8%, p = .003), whereas increased adjusted odds for anxiety status only in T2 group (OR = 2.07, p = .042), compared with T3 groups. Third, T1 and T2 groups showed higher prevalence (10.4% vs 11.5% vs 2.7%, p = .004) and adjusted odds (OR = 3.71, p = .013; OR = 3.66, p = .014) for co-existent anxiety and depression status, compared with T3 group. Most results remained consistent in sensitivity analysis. CONCLUSIONS: Lower K intake is implicated in presence of anxiety and depression status in general population; this may provide basis for programs to increase K intake and prevent disease.

Chinese Visceral Adiposity Index Is Associated With Incident Renal Damage in Patients With Hypertension and Abnormal Glucose Metabolism: A Longitudinal Study.

Objective: To evaluate the association between Chinese visceral adiposity index (CVAI) and incident renal damage and compared its predictive power with that of other visceral obesity indices in patients with hypertension and abnormal glucose metabolism (AGM). Methods: This retrospective cohort consecutively included patients with hypertension and AGM who did not have renal damage at baseline. Renal damage was defined using the estimated glomerular filtration rate (eGFR) and urine protein. Multivariable Cox regression analysis was used to evaluate the association between CVAI and incident renal damage. Restricted cubic splines were used to determine the shape of the association. The predictive power of the CVAI was examined and directly compared with other indices, including the VAI, body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR), using the area under the receiver operating characteristic curve (AUC) and C-index. Results: In total, 2,033 patients with hypertension and AGM were included. During a median follow-up of 2.6 years, the incidence of renal damage was 31.5, 48.9, 56.8, and 67.5/1,000 person-years across the quartiles of CVAI. Compared with the first quartile, the risk of renal damage was higher in the second (hazard ratio (HR) = 1.36 [95% CI: 0.93-1.97]), third (HR = 1.57 [95% CI: 1.09-2.27]), and fourth (HR = 1.65 [95% CI: 1.11-2.44]) quartiles (p for trend = 0.011). A linear dose-response association was observed. Sensitivity and subgroup analyses confirmed the robustness and consistency of the results. In terms of predictive power, the CVAI had the highest AUC and C-index values. Conclusions: CVAI is positively associated with renal damage risk in a linear dose-response pattern and has the best performance in predicting incident renal damage in patients with hypertension and AGM. The CVAI may serve as a reliable indicator for identifying patients at a high risk of renal damage.

Higher plasma renin activity is associated with increased kidney damage risk in patients with hypertension and glucose metabolic disorders.

The impact of renin on kidney remain unclear among hypertensives with glucose metabolic disorders (GMD). We aimed to evaluate the association between plasma renin activity (PRA) and kidney damage in hypertensive patients with GMD. Overall, 2033 inpatients with hypertension and GMD free of chronic kidney disease (CKD) at baseline were included. CKD was defined using estimated glomerular filtration rate (eGFR) and urine protein. PRA was treated as continuous variable, and also dichotomized as high (≥0.65) or low (< 0.65) groups. The association of PRA with incident CKD was evaluated using multivariable Cox model controlling for antihypertensive medications and baseline aldosterone, and traditional parameters. Subgroup and interaction analyses were performed to evaluate heterogeneity. During a median follow-up of 31 months, 291 participants developed CKD. The incidence was higher in high-renin group than that in low-renin group (54.6 vs 36.6/1000 person-years). Significant association was observed between PRA and incident CKD, and the association was mainly driven by an increased risk for proteinuria. Each standard deviation increment in log-transformed PRA was associated with 16.7% increased risk of proteinuria (hazard ratio = 1.167, P = .03); compared with low-renin group, there was 78.4% increased risk for high-renin group (hazard ratio = 1.784, P = .001). Nonlinear associations were observed between PRA and kidney damage. Higher PRA is associated with greater risk of incident kidney damage, especially for positive proteinuria, in patients with coexistence of hypertension and diabetes, independent of aldosterone. In this patient population with high risk for kidney damage, PRA may serve as an important predictor.

Development and Validation of a Prediction Model for 5-Year Risk of Kidney Dysfunction in Patients with Hypertension and Glucose Metabolism Disorder.

PURPOSE: Patients with hypertension and glucose metabolism disorder (GMD) are at high risk of developing kidney dysfunction (KD). Therefore, we aimed to develop a nomogram for predicting individuals' 5-year risk of KD in hypertensives with GMD. PATIENTS AND METHODS: In total, 1961 hypertensives with GMD were consecutively included. Baseline data were extracted from medical electronic system, and follow-up data were obtained using annual health check-ups or hospital readmission. KD was defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73m2. Subjects were randomly divided into training and validation sets with a ratio of 7 to 3. Least absolute shrinkage and selection operator method was used to identify potential predictors. Cox proportional hazard model was applied to build a nomogram for predicting KD risk. The discriminative ability, calibration and usefulness of the model were evaluated. The prediction model was verified by internal validation. RESULTS: During the follow-up of 5351 person-years with a median follow-up of 32 (range: 3-91) months, 130 patients developed KD. Age, sex, ethnicity, hemoglobin A1c, uric acid, and baseline eGFR were identified as significant predictors for incident KD and used for establishing nomogram. The prediction model displayed good discrimination with C-index of 0.770 (95% CI: 0.712-0.828) and 0.763 (95% CI: 0.704-0.823) in training and validation sets, respectively. Calibration curve indicated good agreement between the predicted and actual probabilities. The decision curve analysis demonstrated that the model was clinically useful. CONCLUSION: The prediction nomogram, including six common easy-to-obtain factors, shows good performance for predicting 5-year risk of KD in hypertensives with GMD. This quantitative tool could help clinicians, and even primary care providers, recognize potential KD patients early and make strategy for prevention and management.

Higher Plasma Aldosterone Concentrations Are Associated With Elevated Risk of Aortic Dissection and Aneurysm: a Case-Control Study.

BACKGROUND: Animal models demonstrate circulating aldosterone leads to aortic dissection and aneurysm, whereas data from humans are lacking. Therefore, we aimed to examine the associations of plasma aldosterone concentrations (PAC) with aortic dissection and aneurysm. METHODS: We identified patients with aortic dissection and aneurysm with assessed PAC before disease onset from hospital-based electronic database and set as case group. Simultaneously, age and gender-matched cohort with PAC measurement whereas without aortic dissection and aneurysm were selected as control group using ratio of 1:4. Multi-variable logistic regression analysis was used to assess the relationship of PAC with aortic dissection and aneurysm. RESULTS: Totally, 133 cases and 531 controls (all hypertensive) were enrolled between 2004 and 2021, with 77.9% men, mean age of 55.5 years and PAC of 13.9 ng/dL. Case group showed significantly higher PAC(14.51 versus 13.65 ng/dL, P=0.012) than did control group. In logistic regression analysis, higher PAC exhibited 1.68-fold higher odds (95% CI, 1.14-2.48, P=0.008) for presence of aortic dissection and aneurysm, significant in adjusted model (odds ratio, 1.69 [95% CI, 1.11-2.57], P=0.015). In stratified analysis, the association between the two was observed in women of all ages and in men with coronary artery disease. Sensitivity analysis by excluding those under interfering agents at PAC measurement and those with primary aldosteronism did not change the relationship of the two. CONCLUSIONS: Higher PAC is associated with the increased odd for aortic dissection and aneurysm in patients with hypertension, even in the absence of primary aldosteronism, implying that PAC might be a target for prevention.

Diurnal cortisol features with cardiovascular disease in hypertensive patients: a cohort study.

Objective: The hypothalamic-pituitary-adrenal (HPA) axis may be associated with cardiovascular disease (CVD) and the effects of diurnal cortisol features on future CVD remain unclear among patients with hypertension. This study aimed to evaluate the association between diurnal cortisol features and CVD in patients with hypertension. Design and methods: Participants with cortisol rhythm test at baseline in Urumqi Research on Sleep Apnea and Hypertension (UROSAH) in 2011-2013 were enrolled and followed up till 2021. Incident events included coronary heart disease, stroke, and heart failure. Cox proportional hazards model was used to evaluate the relationship between diurnal cortisol features and incident CVD. Sex-specific and sensitivity analyses were also performed. Results: In total, 2305 hypertensive participants comprised the current analytical sample. During a median follow-up of 7.2 years and 16374.9 person-years, there were 242 incident CVD cases. Multivariable Cox regression showed that steep diurnal cortisol slope (DCS) was significantly associated with decreased CVD risk (per s.d., hazard ratio (HR) = 0.86, 95% CI: 0.77-0.96, P = 0.011). Midnight cortisol was positively associated with an increased CVD risk (per s.d., HR = 1.24, 95% CI: 1.08-1.42, P = 0.002). Comparable results were observed in the sensitivity analyses. Neither midnight cortisol nor DCS was associated with incident CVD in the female subgroup. Conclusions: Flatter DCS and higher midnight cortisol levels are associated with an increased risk of CVD in patients with hypertension, especially in men. The detection of diurnal cortisol rhythm may help identify patients with hypertension at high risk of CVD.

Development and Validation of a Prognostic Model to Predict High-Risk Patients for Coronary Heart Disease in Snorers With Uncontrolled Hypertension.

Purpose: Snoring or obstructive sleep apnea, with or without uncontrolled hypertension, is common and significantly increases the risk of coronary heart disease (CHD). The aim of this study was to develop and validate a prognostic model to predict and identify high-risk patients for CHD among snorers with uncontrolled hypertension. Methods: Records from 1,822 snorers with uncontrolled hypertension were randomly divided into a training set (n = 1,275, 70%) and validation set (n = 547, 30%). Predictors for CHD were extracted to construct a nomogram model based on multivariate Cox regression analysis. We performed a single-split verification and 1,000 bootstraps resampling internal validation to assess the discrimination and consistency of the prediction model using area under the receiver operating characteristic curve (AUC) and calibration plots. Based on the linear predictors, a risk classifier for CHD could be set. Results: Age, waist circumference (WC), and high- and low-density lipoprotein cholesterol (HDL-C and LDL-C) were extracted as the predictors to generate this nomogram model. The C-index was 0.720 (95% confidence interval 0.663-0.777) in the derivation cohort and 0.703 (0.630-0.776) in the validation cohort. The AUC was 0.757 (0.626-0.887), 0.739 (0.647-0.831), and 0.732 (0.665-0.799) in the training set and 0.689 (0.542-0.837), 0.701 (0.606-0.796), and 0.712 (0.615-0.808) in the validation set at 3, 5, and 8 years, respectively. The calibration plots showed acceptable consistency between the probability of CHD-free survival and the observed CHD-free survival in the training and validation sets. A total of more than 134 points in the nomogram can be used in the identification of high-risk patients for CHD among snorers with uncontrolled hypertension. Conclusion: We developed a CHD risk prediction model in snorers with uncontrolled hypertension, which includes age, WC, HDL-C, and LDL-C, and can help clinicians with early and quick identification of patients with a high risk for CHD.

Higher plasma aldosterone is associated with increased risk of cardiovascular events in hypertensive patients with suspected OSA: UROSAH data.

Objective: To evaluate the association of plasma aldosterone concentration (PAC) with incident cardiovascular disease (CVD) and all-cause mortality in hypertensive patients with suspected obstructive sleep apnea (OSA) and calculate the optimal cut-off value of PAC for this specific population. Patients and methods: Participants with PAC at baseline in UROSAH in 2011-2013 were enrolled and followed up till 2021. Composite outcome included CVD and all-cause mortality. Cox proportional hazards model was used to evaluate the relationship between PAC and the composite outcome. Time-dependent ROC curve was used to determine the optimal cut-off value of PAC. Besides, we conducted subgroup analyses and sensitivity analyses. Results: 3173 hypertensive participants aged 18-84 years comprised analytical sample. During a median follow-up of 7.3 years and 22640 person-years, 69 deaths and 343 cases of incident CVD occurred. The incidence of composite outcome was increased with elevation in tertile of PAC. Compared with the first tertile, the risk of CVD and all-cause death was higher in third tertile (HR=1.81, 95%CI: 1.39-2.35, P<0.001). Time-dependent ROC curve showed optimal threshold for PAC was 12.5ng/dl. Whether renin was suppressed or not (≤0.5 or >0.5ng/ml per h), elevated PAC was associated with an increased risk of CVD. Our results remained stable and consistent in sensitivity analyses. Conclusion: Higher PAC was associated with increased risk of CVD and all-cause mortality in hypertensives with suspected OSA, even in the absence of primary aldosteronism (PA). Hypertensives with PAC≥12.5ng/dl showed a significantly increased risk of CVD, indicating that special attention and treatment were required in this specific population.

Elevated body mass index increases the risk of cardiovascular events in hypertensive patients accompanied with obstructive sleep apnea: A cohort study.

BACKGROUND: Effects of body mass index (BMI) on cardiovascular events are inconsistent. We aimed to investigate the association of BMI with cardiovascular events in hypertensives with obstructive sleep apnea (OSA). METHODS: Hypertensives with OSA diagnosed with polysomnography between 2011 and 2013 in UROSAH cohort were followed up till Jan 2021. Outcomes were non-fatal cardiovascular events and cardiac death. Cox regression was used to estimate the relationship of continuous and categorical BMI with total and specific outcomes. Sensitivity analyses were performed by excluding those on OSA treatment or underweight patients. Stratified analyses were conducted by parameters including sex and age. RESULTS: 2239 hypertensives with OSA were included with 405 normal weight (BMI<25 kg/m2), 1164 overweight (25-29.9 kg/m2) and 670 obesity (≥30 kg/m2). 206 non-fatal cardiovascular events and 18 cardiac death were recorded during 6.6 years follow-up. Compared with normal weight group, overweight (HR=1.53, 95%CI: 1.01-2.32, P = 0.047) and obesity groups (1.85, 1.19-2.86, P = 0.006) showed increased risk for cardiovascular events, significant in obesity group and marginal in overweight group in fully-adjusted model. In specific events, obesity showed significantly elevated HR for non-fatal cardiovascular events (1.64, 1.04-2.60, P = 0.035). Continuous BMI showed significantly increased HR for total and specific events in all models. Sensitivity analysis yielded consistent results. In stratification analysis, stronger association between obesity and cardiovascular events was observed in the young (HR=5.97, P interaction=0.030). CONCLUSIONS: BMI is in positive association with cardiovascular events in hypertensives with OSA, emphasizing importance of maintaining healthy BMI for prevention of adverse events in this population, on the basis of guideline-recommended treatment.

Higher aldosterone is associated with increased renal impairment risk in patients with hypertension and abnormal glucose metabolism: a longitudinal study.

OBJECTIVE: The aim of this study was to evaluate the association between plasma aldosterone concentration (PAC) and renal impairment in patients with both hypertension and abnormal glucose metabolism (AGM). METHODS: The longitudinal observational study included 2033 hypertensive individuals with AGM who did not have chronic kidney disease (CKD) at baseline. CKD was defined as estimated glomerular filtration rate (eGFR) less than 60 ml/min per 1.73 m2 and/or positive proteinuria. Directed acyclic graphs and LASSO regression analyses were applied to identify adjusted sets. Cox proportional hazard models and linear regression were used to evaluate the association of PAC with CKD and its components including decreased renal function (DRF) and proteinuria. Mediation analysis was used to examine the role of blood pressure (BP) in the association between the two. RESULTS: During total follow-up of 5951 person-years with a median follow-up of 31 months, 291 participants developed CKD. The incidence of CKD was increased with the elevation in tertile PAC. Multivariable Cox model showed that PAC was positively associated with increased CKD risk (hazard ratio = 1.76 for natural log-transformed PAC, P < 0.001), and with increased risk of DRF and proteinuria. SBP mediated 7.5-17.9% of the association between PAC and renal impairment. Overall results remained consistent and significant in sensitivity analysis by excluding those with suspicious primary aldosteronism, too short follow-up time and mineralocorticoid receptor antagonists use. CONCLUSION: Higher PAC was associated with increased CKD risk in patients with hypertension and AGM, even in the absence of suspicious primary aldosteronism. The results indicate PAC may serve as a potential therapeutic target in this population.

24-hour urinary potassium excretion is negatively associated with self-reported sleep quality in the general population, independently of sleep-disordered breathing.

STUDY OBJECTIVES: To investigate the association of 24-hour urinary potassium excretion with self-reported sleep quality in the general population. METHODS: In this cross-sectional study, a population of patients aged 18 years or older was randomly selected from Xinjiang, China in 2019, 24-hour urine samples collected, and Pittsburgh Sleep Quality Index (PSQI) questionnaires assessed. Participants were divided into 2 groups (upper and lower median of 24-hour urinary potassium excretion). Poor sleep quality was defined as PSQI global score ≥ 6. Associations between 24-hour urinary potassium excretion and [24.8 mmol/L] sleep quality were assessed by multiple logistic regression analysis in total participants and those stratified by sex. RESULTS: In total, 24-hour urine samples were collected from 1,147 participants, of whom data for those with complete urine samples and PSQI data were analyzed (n = 727; mean age = 48.7 years; percentage of women = 62%). Compared with the upper median group for 24-hour urinary potassium excretion, the lower median group showed a significantly higher PSQI global score (6 vs 5, P = .011), and prevalence of poor sleep quality (51.7% vs 42.2%, P = .011). In a fully-adjusted model of multivariate logistic regression, the lower median group showed 1.50-fold increased odds for presence of poor sleep quality (95% confidence interval: 1.01-2.24, P = .045). Sex-specific analyses translated these results to women, but not to men. CONCLUSIONS: These results suggest that low potassium intake, indicated by lower potassium excretion, is associated with poor sleep quality in the general population, especially among women. Therefore, additional research is necessary to clarify the effect of increasing potassium intake to improve sleep quality. CITATION: Li M, Heizhati M, Wang L, et al. 24-hour urinary potassium excretion is negatively associated with self-reported sleep quality in the general population, independently of sleep-disordered breathing. J Clin Sleep Med. 2022;18(11):2589-2596.

Association of objective and subjective parameters of obstructive sleep apnea with plasma aldosterone concentration in 2,066 hypertensive and 25,368 general population.

Study objectives: Obstructive sleep apnea (OSA) severity has been suggested in aldosterone elevation in resistant hypertension, whereas it is undetermined in the rest population. We explored the association of OSA parameters with plasma aldosterone concentration (PAC) in participants with and without hypertension. Methods: We enrolled clinically hypertensive patients with polysomnography and PAC data under no interfering agents, compared (log) PAC, and assessed the linearity of log PAC by tertiles (T1/2/3) of sleep parameters and their association using linear regression by gender and age. We enrolled participants with and without hypertension who had No-SAS scale and PAC data from the community and duplicated the observations from clinical setting considering age, gender, and presence of hypertension. Results: Of the 2,066 clinical patients with hypertension (1,546 with OSA), men participants (n=1,412), log apnea-hypopnea index (p=0.043), apnea index (AI, p=0.010), and lowest oxygen saturation (LSaO2, p=0.013) showed significant linearity with log PAC. Log AI (B=0.04, 95%CI: 0.01,0.07, p=0.022) and log LSaO2 (B=-0.39, 95%CI: -0.78,-0.01, p=0.044) showed significant positive and negative linear associations with log PAC in regression. In community dwellers, 6,417 participants with untreated hypertension (2,642 with OSA) and 18,951 normotensive participants (3,000 with OSA) were included. Of the men participants with and without hypertension, the OSA group showed significantly higher (log) PAC than did their counterparts, and log No-SAS score showed positive association with log PAC (hypertension: B=0.072, 95%CI: 0.002,0.142, p=0.043; normotension: B=0.103, 95%CI: 0.067,0.139, p<0.001) in linear regression analysis, which were consistent in all age groups. Conclusions: OSA parameters were positively associated with PAC in normotensive and hypertensive participants, indicating that OSA may increase circulating aldosterone, especially in men.