[Reasons for not intensifying antihypertensive treatment to diabetes in some regions of China].

OBJECTIVE: To prospectively evaluate the current situation of blood pressure control in the type 2 diabetics in some regions of China. METHODS: Totally 5063 consecutive patients with hypertension were investigated. Among them 1993 with diabetes underwent baseline survey. Individualized target blood pressures were set by physicians. Four follow-up visits, in weeks 2, 4, 8, and 12 were performed to monitor the achievements of these targets and the reasons for not modifying antihypertensive treatments were analyzed when the blood pressure goals were not reached. RESULTS: The prevalence of diabetes among the hypertensive patients was 39.2%. The target blood pressure values defined by the physicians at baseline survey varied with the grade and degree of hypertension. 31.4% of the patients reached the target blood pressure goals (BP < 130/80 mm Hg) at week 12. The reasons for not intensifying antihypertensive treatment when the blood pressure targets were not achieved were manifold. The main reasons were as follows: the physicians considered that the BP value was close to the target, longer treatment and waiting for full drug effect were needed, etc. On average, 2 different antihypertensive agents were used to achieve BP target and some patients used 4-5 different drugs. The most frequent agents used were angiotensin II receptor antagonist and calcium channel blockers. The use of thiazide-type diuretics increased from the first visit to the last visit (weeks 12). CONCLUSION: The co-prevalence of hypertension and diabetes in China is high and the target blood pressure set by physician is almost 130/80 mm Hg as defined in guidelines. Only about 31.4% of patients have reached their goals 12 weeks after treatment. There are many subjective and objective reasons responsible for not intensifying antihypertensive treatment when the blood pressure targets are not achieved. Hypertension in diabetes is poorly controlled compared with that in the whole population.

Diagnostic value of magnetocardiography in patients with coronary heart disease and in-stent restenosis.

BACKGROUND: In-stent restenosis (ISR) has become one of the most challenging problems in patients with coronary heart disease. At present, using non-invasive methods to assess ISR is a hot topic. In this investigation we attempted to explore the potential of magnetocardiography (MCG) in diagnosis of in-stent restenosis. METHODS: MCG was analyzed in 52 patients with coronary artery disease for three times: before stenting, one month and 7 months after successful intracoronary stenting. RESULTS: The average classification of total maps (ACTM) and the ratio of abnormal maps (RAM) were lower in 1 month after intracoronary stenting compared with that obtained before stent planting (2.91 vs 2.52, 65.74% vs 42.80%, P < 0.01), while complex ventricular excitation index (CVEI) increased from -42.63 to -20.05 (P < 0.01). In ISR subgroup (n = 16), RAM decreased in 1 month after intracoronary stenting compared to it before stenting (68.99% vs 45.26%, P < 0.05). ACTM increased in 7 months compared to that obtained in 1 month after stenting (3.15 vs 2.51, P < 0.05). According to the ROC curve, ACTM showed its unique diagnostic value in restenosis patients. The sensitivity and specificity of ACTM were 80.0%, 69.40%, respectively. Its positive predictive value and negative predictive value were 54.6% and 88.5%, respectively. CONCLUSIONS: After successful intracoronary stenting, most parameters of MCG were improved. ACTM was of prognostic value in diagnosing ISR.

[A survey of factors influencing prognosis and control rate for patients with hypertension in mainland China].

OBJECTIVE: To observe the risk factor stratification and prevalence of target organ damage in hypertensive patients before therapy and blood pressure control rate after 4 or 12 weeks antihypertensive drug therapy. METHODS: In this prospective survey, data on cardiovascular risk factors, target organ damage and concomitant disease were collected in 26 655 hypertensive patients. Among them 26 325 and 3457 patients were recruited for antihypertensive drug therapy for 4 and 12 weeks, respectively and blood pressure control rate was determined. RESULTS: The sedentary lifestyle, smoking, high body mass index, dyslipidemia were found in 52.5%, 34.4%, 31.8%, 24.5%, and microproteinuria, left ventricular hypertrophy, coronary artery disease and diabetes in 21.0%, 23.6%, 20.1%, 26.7% hypertensive patients, respectively. The average systolic and diastolic pressures were 158 +/- 14 mm Hg and 94 +/- 11 mm Hg and 3.2%, 22.2%, 21.1% and 53.3% patients were defined as low, medium, high and very high risk patients in risk stratification to quantify prognosis. There were 77.2%, 20.4% and 2.4% systolic and diastolic, isolated systolic and isolated diastolic hypertensive patients respectively. The goal blood pressure control rate was 50.2% and 56.7% respectively after 4 and 12 weeks antihypertensive drug therapy. The control rate in patients complicated with diabetes and renal disease was significantly lower than patients without them and systolic pressure control rate was remarkably lower than diastolic pressure control rate. Majority patients required 2 or more antihypertensive drugs for effective pressure control (1.5 drug per patients in average in both 4 or 12 weeks groups). CONCLUSION: The prevalence of risk factors, target organ damage and concomitant disease were high in Chinese patients with hypertension and comprehensive interventions were indicated. To reach goal blood pressure control in patients with hypertension, follow up intensifying and drug therapy guidance are required within the context of usual medical care.

[Magnetocardiography changes in coronary artery disease patients with normal or unspecialized resting electrocardiogram].

OBJECTIVE: To investigate the magnetocardiography (MCG) changes in coronary artery disease (CAD) patients with normal or unspecific changes in resting electrocardiogram (ECG). METHODS: MCG mapping was performed by MCG-7 (MaGIC, Magiscan GmbH) installed in an unshielded room. All patients underwent ECG and coronary angiogram examinations and patients with normal or unspecified ECG changes and coronary artery narrowing > or = 70% in at least 1-vessel were defined as CAD group (n = 120). Patients with normal coronary angiogram served as control (n = 82). Four parameters: ACTM (average classification of total maps), RAM (ratio of abnormal maps), CVEI (complex ventricular excitation index) and R-max/T-max ratio, were analyzed in CAD and control groups. RESULTS: RAM (62% vs. 35%) and ACTM (2.62 +/- 0.98 vs. 2.29 +/- 0.90, P < 0.05) were significantly higher in CAD group than in control group. CVEI was found in abnormal zone (-100 - 0) in CAD group while in normal zone (0 - 100) in control group. The ratio of Rmax/Tmax in CAD group was also significantly higher in CAD group than in control group (6.41 +/- 3.29 vs. 4.10 +/- 2.00, P < 0.01). ROC curve analysis indicates that RAM, CVEI and Rmax/Tmax ratio were helpful parameters for CAD diagnosis and the diagnostic sensitivity was 67.1%, 65.9% and 64.3%; the specificity was 65.1%, 68.3% and 68.3% respectively. CONCLUSION: MCG was a useful tool for diagnosing chronic myocardium ischemia in CAD patients with normal or unspecific changes resting ECG.

[Effects of antidepressant therapy in patients with suspected "angina pectoris" and negative coronary angiogram complicating comorbid depression].

OBJECTIVE: We observed the therapeutic effectiveness and safety of different antidepressants as well as the correlation between symptomatic improvement of depression and improvement of chest pain in patients with susceptible "angina pectoris" and negative coronary angiogram complicating comorbid depression. METHODS: In this double-blinded randomized study, a total of 123 eligible patients were allocated into three groups: (1) Group F: fluoxetine 20 mg QN (n = 41); (2) Group P: Placebo 1 tablet QN (n = 40); (3) Group F + O: fluoxetine 20 mg + olanzapine 2.5 mg QN for the former 2 weeks and only fluoxetine 20 mg QN for the latter 2 weeks (n = 42). The total therapy duration was 4 weeks. HAMD, HAMA and self-evaluation table of chest pain were obtained before therapy, at the end of 1 and 2 weeks after therapy. RESULTS: Baseline HAMD and HAMA scores and self-evaluation score of chest pain were similar among 3 groups and all scores were significantly improved post various therapies in the order of group F + O > group F > group P. The rate of score decrease were seen after 1 week treatment in group F + O and after 2 week treatment in group F. There was a significant positive correlation between the rates of self-evaluation chest pain score decrease and HAMD (r = 0.867, P < 0.001) and HAMA (r = 0.854, P < 0.001) score decreases after 4 weeks therapies (P < 0.05). During the whole course of treatment, no serious adverse reaction was found in all patients. CONCLUSION: In patients with suspected "angina pectoris" and negative coronary angiogram complicating comorbid depression, the antidepressants were safe and significantly improved the symptoms of depression and anxiety and chest pain. Low dose fluoxetine plus short term olanzapine regimen was superior to fluoxetine alone regimen in terms of stronger and quicker symptom improvement.