Distribution characteristics of circulating homocysteine and folate and related factors in agriculture, stock-raising and urban populations: a cross-sectional survey.

OBJECTIVE: To investigate homocysteine (Hcy) and folate levels, prevalence of hyperhomocysteinaemia (HHcy) and folate deficiency, which are affected by lifestyles in urban, agricultural and stock-raising populations. DESIGN: This is a cross-sectional study. SETTING: Urban, agricultural and stock-raising regions in Emin, China. PARTICIPANTS: Totally 1926 subjects - 885 (45·9 %) from urban, 861 (44·7 %) from agricultural and 180 (9·4 %) from stock-raising regions - were obtained using multistage stratified random sampling. Inclusion criteria encompassed inhabitants aged ≥15 years who resided at the current address for ≥6 months and agreed to participate in the study. Surveys on health behaviour questionnaires and physical examinations were conducted and blood samples collected. RESULTS: The folate level of subjects from the stock-raising region was the lowest, followed by those from the agricultural region, and the highest in those from the urban region (3·48 v. 6·50 v. 7·12 ng/ml, P < 0·001), whereas mean Hcy showed no significant difference across regions. The OR for HHcy in stock-raising regions was 1·90 (95 % CI 1·11, 3·27) compared with the urban region after adjusting for all possible covariates. The OR for folate deficiency in stock-raising and agriculture regions was 11·51 (95 % CI 7·09, 18·67) and 1·91 (95 % CI 1·30, 2·82), respectively, compared with the urban region after adjusting for all possible covariates. CONCLUSIONS: HHcy and folate deficiency are highly prevalent in stock-raisers, which is of important reference for HHcy control in Xinjiang, with a possibility of extension to others with approximate lifestyles.

Elevated serum concentrations of lipopolysaccharide binding protein might prolong sleep stage one in middle-aged hypertensive males.

PURPOSE: Sleep architecture can be affected by alteration in circulating lipopolysaccaride and cytokines. However, still unknown are the effects of lipopolysaccaride-binding protein (LBP) on sleep architecture. Therefore, potential relationship between alteration in serum LBP concentrations and sleep architecture was analyzed. METHODS: This is a cross-sectional study. Consecutive 54 hypertensive males, aged 30-65 years. and with no obstructive sleep apnea via polysomnography, were recruited. Subjects were divided into two groups via the LBP median as hypertensives with higher and lower serum LBP (n = 27 and n = 27, respectively). Sleep architecture was assessed by polysomnography. Serum LBP, IL-1ß, IL-6, and TNF-α were measured by commercial laboratories using sandwich-type enzyme immunoassay kit. RESULTS: Hypertensive subjects with higher LBP showed significantly higher inflammatory status as assessed by IL-1ß (18.85 ± 3.71 vs 16.15 ± 4.00 ng/L, P = 0.009), IL-6 (67.64 ± 11.22 vs 58.94 ± 11.32 ng/L, P = 0.004), and TNF-α (322.27 ± 59.17 vs 283.89 ± 61.87 pg/ml, P = 0.024) than did those with lower LBP. Hypertensives with higher serum LBP also exhibited prolonged N1 % (7.63 ± 3.55 vs 4.98 ± 2.90 %, P = 0.002), the transition from wakefulness to other sleep stages or follows arousal during sleep, than did those with lower LBP. A significant positive correlation was observed between serum LBP concentrations and N1 % (r = 0.378, P = 0.005) via Spearman's correlation and remained significant even after adjusting for age, apnea-hypopnea index, and body mass index. CONCLUSION: Elevation in serum concentrations of LBP might prolong N1 % in this middle-aged hypertensive males, which needs to be confirmed further.

Recurrent gain-of-function mutation in PRKG1 causes thoracic aortic aneurysms and acute aortic dissections.

Gene mutations that lead to decreased contraction of vascular smooth-muscle cells (SMCs) can cause inherited thoracic aortic aneurysms and dissections. Exome sequencing of distant relatives affected by thoracic aortic disease and subsequent Sanger sequencing of additional probands with familial thoracic aortic disease identified the same rare variant, PRKG1 c.530G>A (p.Arg177Gln), in four families. This mutation segregated with aortic disease in these families with a combined two-point LOD score of 7.88. The majority of affected individuals presented with acute aortic dissections (63%) at relatively young ages (mean 31 years, range 17-51 years). PRKG1 encodes type I cGMP-dependent protein kinase (PKG-1), which is activated upon binding of cGMP and controls SMC relaxation. Although the p.Arg177Gln alteration disrupts binding to the high-affinity cGMP binding site within the regulatory domain, the altered PKG-1 is constitutively active even in the absence of cGMP. The increased PKG-1 activity leads to decreased phosphorylation of the myosin regulatory light chain in fibroblasts and is predicted to cause decreased contraction of vascular SMCs. Thus, identification of a gain-of-function mutation in PRKG1 as a cause of thoracic aortic disease provides further evidence that proper SMC contractile function is critical for maintaining the integrity of the thoracic aorta throughout a lifetime.

Association Between Polymorphisms of ADRBK1 Gene and Plasma Renin Activity in Hypertensive Patients: A Case-Control Study.

BACKGROUND Renin is the first step of the RAS cascade, which is a major regulator of salt-volume homeostasis. Adrenergic beta receptor kinase 1 (ADRBK1) plays important roles in regulating blood pressure via the epithelial Na+ channel (ENaC), which plays an important role in Na+ reabsorption in the renal collecting duct. The present case-control study was designed to investigate the potential relationship between polymorphisms of ADRBK1 and plasma renin activity (PRA) in hypertension. MATERIAL AND METHODS We recruited 1831 hypertensive and 422 normotensive Han Chinese subjects. Sitting PRA (ng/mL/h) was measured using radioimmunoassay method. Hypertensive patients were classified into 4 renin categories via PRA quartile. Single-nucleotide polymorphisms (SNPs) of the ADRBK1 gene (rs1894111, rs4930416, rs7127431, rs12286664, and rs3730147) were identified via TaqMan polymerase chain reaction. RESULTS Comparison of the hypertensive group and the control group showed significant differences in distribution of genotypes and alleles of rs1894111 (P<0.05). Moreover, distribution of the dominant model (CC vs. CT+TT) in rs1894111 was lower in the hypertensive group than in the control group (P<0.05). Subjects were classified into 4 subgroups based on PRA quartile; the dominant model (CC vs. CT+TT) of rs1894111 was significantly lower in the quartile 1 group (the group with the lowest PRA) than in the control group (P<0.05). Logistic regression analysis demonstrated that the dominant model (CC vs. CT+TT) of rs1894111 was significantly different in the hypertensive group (OR=1.590, 95%CI=1.022-2.474, P<0.05), particularly in the quartile 1 group (OR=1.845, 95%CI=1.119-3.042, P<0.05), but not in the quartile 4 group. CONCLUSIONS The dominant model (CC vs. CT+TT) of rs1894111 polymorphism in the ADRBK1 gene might be associated with low-renin hypertension in Han Chinese.

Relationship between surfactant proteins B and C and obstructive sleep apnea: is serum SP-B concentration a potential biomarker of obstructive sleep apnea?

BACKGROUND: Surfactant proteins B and C are mainly synthesized, secreted by alveolar type II cells, and affected by hypoxia and mechanical stretches. We hypothesized that their serum levels might be altered by intermittent hypoxia and swing of intrathoracic pressure of obstructive sleep apnea (OSA). METHODS: Consecutive 140 middle-aged males, suspicious of OSA determined by polysomnography, were studied. Surfactant proteins B and C were determined by ELISA. RESULTS: Surfactant protein B (41.39 ± 6.01 vs 44.73 ± 7.62 ng/L, p = 0.005), not C (32.60 ± 6.00 vs 32.43 ± 6.44 ng/L, p = 0.61), significantly lowered in moderate to severe OSA subjects than in non to mild OSA subjects. Severity of OSA is inversely correlated with serum surfactant protein B. Adjusting age, body mass index, and smoking history, compared to subjects with surfactant protein B (SP-B) ≥43.35 ng/L, those with SP-B <43.35 ng/L showed significantly increased 1.528-fold risk for moderate to severe OSA (p = 0.009), whereas no association between surfactant protein C and OSA was observed. Prevalence of moderate to severe OSA in lower SP-B group is higher than that in higher SP-B group (62.7 vs 38.4 %, p = 0.003). Serial and parallel tests on Epworth sleep scale (ESS) and SP-B evaluation can be complementary and prove helpful with high specificity (94.44 %) and sensitivity (84.48 %) to detect moderate to severe OSA. CONCLUSIONS: Serum surfactant protein B, rather than C, is decreased in some individuals with moderate to severe OSA, compared to non to mild OSA subjects. Serum surfactant protein B might be a potential biomarker to diagnose OSA.

What can impulse oscillometry and pulmonary function testing tell us about obstructive sleep apnea: a case-control observational study?

PURPOSE: This study aims to determine whether functional residual capacity (FRC) in obese patients with obstructive sleep apnea (OSA) decreases more than in patients without OSA because of decreased outward recoil from chest wall mass loading as well as increased lung inward recoil. METHODS: Subjects who were overweight and obese to various degrees with normal spirometric values underwent overnight polysomnography to determine the presence or absence of OSA and were labeled as cases or controls. Lung volume and respiratory mechanical properties were measured by plethysmograph and impulse oscillometry, respectively. RESULTS: A total of 76 men and 31 women were diagnosed with OSA (cases); 64 men and 33 women without OSA were confirmed as controls. Expiratory reserve volume and FRC were significantly decreased in cases compared with controls. Respiratory impedance and resistance at 5 Hz were significantly higher in cases than in controls, although reactance at low frequencies was significantly lower in cases than in controls. Reactance at 5 Hz (Xrs5) was found to be independently highly correlated with the severity of OSA as defined by the Apnea-Hypopnea Index and was significantly correlated with FRC. CONCLUSIONS: FRC is significantly decreased in overweight or obese patients with OSA compared with those without OSA, which may be attributed to an increase in lung elastic recoil. The stronger correlation between Xrs5 and OSA severity might indicate upper airway stenosis, and abnormally increased lung elastic recoil may contribute to OSA.

What do changes in concentrations of serum surfactant proteins A and D in OSA mean?

PURPOSE: Previous studies have shown that surfactant proteins are affected by oxygen concentration and mechanic stretches, although the alteration of serum surfactant proteins in individuals with obstructive sleep apnea (OSA) is still unclear. Therefore, the aim of this study is to examine whether serum concentrations of surfactant proteins A and D are altered and related to hypopnea index (HI) in OSA. METHODS: This is a cross-sectional study. Consecutive 140 males, suspicious of OSA, were studied. OSA was determined by PSG and polysomnographic data examined. Subjects with HI ≥ 10.1/h were classified as higher HI group and those with HI < 10.1/h as lower HI group. Hs-CRP, HbA1C, and FBG were determined by standard methods and Krebs von den Lungen-6 (KL-6), surfactant protein-A (SP-A), and surfactant protein-D (SP-D) by ELISA. RESULTS: OSA was diagnosed in 110 patients (78.5%). Mild, moderate, and severe OSA constitutes 26.4, 27.8, and 24.3%, respectively. Mean age was 44.6 ± 7.65 years. Subjects with higher HI had lower SP-A (139.54. ± 32.94 vs 158.2 ± 38.9 ng/L, p = 0.005) and SP-D (16.54 ± 3.67 vs 18.10 ± 3.48 ng/L, p = 0.014) compared to those with lower HI. Nocturnal HI was strongly correlated with serum levels of SP-A (r = 0.343, p = 0.012) and SP-D (r = 0.504, p < 0.001) and are inversely associated with circulating SP-A and SP-D levels, even after adjusting for age and body mass index in nonsmoking subjects. CONCLUSIONS: Circulating SP-A and SP-D levels are decreased in some individuals with higher HI in OSA, possibly reflecting severity of hypoxia in OSA.

Association of glucose transporter 4 genetic polymorphisms with obstructive sleep apnea syndrome in Han Chinese general population: a cross-section study.

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is strongly associated with the increasing prevalence of cerebrovascular events and metabolic syndrome. A growing number of studies have shown OSAS is an independent factor for insulin resistance, glucose intolerance and type2 diabetes. However, relationship of OSAS with dysglycemia is complex and still remains poorly understood. Glucose transporter 4 (GLUT4) gene is Human and rodents' main glucose transporter sensitive to insulin, and therefore confirmation of candidate gene polymorphisms and association with OSAS is needed. Aim of our study was to assess whether GLUT4 gene polymorphisms are associated with OSAS. METHODS: Patients hospitalized at People's Hospital of Xinjiang were selected from January to December 2010. A total of 568 Han subjects who possibly exist OSAS base on a history and physical examination were completed the polysomnography, 412of whom (72.5%) were diagnosed with OSAS, and 156 individuals were confirmed without OSAS (27.5%). 96 severe OSAS patients chosen from OSAS were used for DNA sequencing in functional domain. Blood samples were collected from all subjects and genotyping was performed on DNA extracted from blood cells. RESULTS: We performed GLUT4 genome sequencing, found 4 mutated sites. And finally selected three mutated sites such as rs5415, rs4517 and rs5435, according to principle of linkage disequilibrium (r2 > 0.8) and minimum gene allele frequency > 5%. All SNPs satisfied HEW (P > 0.05). Our study demonstrated a significant association of GLUT4 SNPrs5417 allele with OSAS, compared with controls (P < 0.05). Haplotype H1 (TCC) and H3 (CCC) defined as SNPrs5415, rs4517 and rs5435 are marginally associated with OSAS (P < 0.05). Frequencies of C haplotype of rs5417 in OSAS were higher than in controls. After adjustment for confounding factors, (AC + AA) genotype significantly reduces prevalence of OSAS, compared with CC genotype. Level of awake blood oxygen and lowest blood oxygen of (AA + AC) genotype was significantly superior to those of CC genotype. CONCLUSIONS: Our study demonstrates GLUT4 gene SNPrs5417 is associated with OSAS in hypertensive population. Carriers of AA + AC have less prevalence of obstructive sleep apnea syndrome than that of CC carriers.

[Association of KCNJ5 gene rs3740835(C/A) and rs2604204(A/C) polymorphism with unilateral and bilateral primary aldosteronism].

OBJECTIVE: To assess the association between polymorphisms of rs3740835(C/A) and rs2604204(A/C) in KCNJ5 gene with the susceptibility to unilateral and bilateral primary aldosteronism (PA). METHODS: A total of 1043 subjects were studied, which included 83 unilateral PA patients,142 bilateral PA patients and 818 essential hypertensive(EH) patients. The polymorphism of KCNJ5 gene at rs3740835(C/A) and rs2604204(A/C) position were analyzed with a TaqMan genotyping technique. RESULTS: Frequencies of A allele and AA+AC genotype at rs3740835(C/A) in unilateral PA group were significantly higher than EH group (P < 0.05). However, the above frequencies did not show a statistical significance between bilateral PA group and EH group (P > 0.05). No statistical difference was detected in the distribution of alleles or genotypes at rs2604204 (A/C) between unilateral PA and EH group or between bilateral PA and EH group. Haplotypic frequencies of C-A and A-A in unilateral PA group were significantly higher and lower than EH group, respectively. However, there was no statistical difference in the haplotype distribution between bilateral PA and EH groups. CONCLUSION: Rs3740835(C/A) polymorphism may be associated with unilateral PA but not with bilateral PA. rs2604204(A/C) polymorphism is not associated with either unilateral or bilateral PA. Haplotype C-A and A-A may respectively be susceptibility factor and protective factor for unilateral PA. No haplotype has been found to associate with bilateral PA.

Prevalence of primary aldosteronism in hypertensive subjects with hyperglycemia.

The aim of this study was to examine the prevalence of primary aldosteronism (PA) in hypertensive patients with hyperglycemia. Two hundred and thirty-two hypertensive patients with hyperglycemia were screened for PA. Fifty-four subjects with an aldosterone/rennin activity ratio >20 ng/dL per ng/mL/hour underwent a saline loading test. Primary aldosteronism was present in 22.4% of patients with a plasma aldosterone concentration >5 ng/dL and 11.6% of those with plasma aldosterone concentrations >10 ng/dL. There were 14.0%-23.0% patients with PA in the diabetes mellitus group, 2.3%-23.3% in the impaired glucose tolerance group, and 9.1% in the impaired fasting glucose group. Primary aldosteronism is common in hypertensive individuals with hyperglycemia.

Government-Expert Joint Intervention with Treatment Algorithm and Improved Hypertension Management and Reduced Stroke Mortality in a Primary-Care Setting.

Hypertension management is suboptimal in the primary-care setting of developing countries, where the burden of both hypertension and cardiovascular disease is huge. Therefore, we conducted a government-expert joint intervention in a resource-constrained primary setting of Emin, China, between 2014 and 2016, to improve hypertension management and reduce hypertension-related hospitalization and mortality. Primary-care providers were trained on treatment algorithm and physicians for specialized management. Public education was delivered by various ways including door-to-door screening. Program effectiveness was evaluated using screening data by comparing hypertension awareness, treatment, and control rates and by comparing hypertension-related hospitalization and total cardiovascular disease (CVD) and stroke mortality at each phase. As results, 313 primary-health providers were trained to use the algorithm and 3 physicians attended specialist training. 1/3 of locals (49490 of 133376) were screened. Compared to the early phase, hypertension awareness improved by 9.3% (58% vs. 64%), treatment by 11.4% (39% vs. 44%), and control rates by 33% (10% vs. 15%). The proportion of case/all-cause hospitalization was reduced by 35% (4.02% vs. 2.60%) for CVD and by 17% (3.72% vs. 3.10%) for stroke. The proportion of stroke/all-cause death was reduced by 46% (21.9% in 2011-2013 vs. 15.0% in 2014-2016). At the control area, the proportion of case/all-cause mortality showed no reduction. In conclusion, government-expert joint intervention with introducing treatment algorithm may improve hypertension control and decrease related hospitalization and stroke mortality in underresourced settings.

Positive Association Between Plasma Aldosterone Concentration and White Matter Lesions in Patients With Hypertension.

Background and Objective: White matter lesions (WMLs) are imaging changes in MRI of cerebral small vessel disease associated with vascular risk factors, increasing the risk of dementia, depression, and stroke. Aldosterone (ALD) or activation of mineralocorticoid receptor (MR) causes cerebrovascular injury in a mouse model. We aimed to analyze the relationship between ALD and WMLs in a population with hypertension. Methods: We conducted a retrospective review of all patients screened for causes of secondary hypertension. We enrolled 547 patients with WMLs and matched these to controls without WMLs at a 1:1 ratio. White matter lesion load was assessed by using a modified Scheltens' scale. Results: Among the analytic sample (N = 1,094) with ages ranging from 30 to 64 years, 62.2% were male. We divided plasma ALD concentration (PAC), plasma renin activity (PRA), and ALD-renin ratio (ARR) into the third tertile (Q3), second tertile (Q2), and first tertile (Q1). We also analyzed them simultaneously as continuous variables. Multivariate logistic regression analysis showed that participants in Q3 (>17.26 ng/dl) of PAC (OR 1.59, 95% CI 1.15, 2.19), Q3 (<0.80 ng/dl) of PRA (OR 2.50, 95% CI 1.81, 3.44), and Q3 (>18.59 ng/dl per ng/ml*h) of ARR (OR 2.90, 95% CI 2.10, 4.01) had a significantly higher risk of WMLs than those in Q1 (<12.48) of PAC, Q1 (>2.19) of PRA, and Q1 (<6.96) of ARR. In linear regression analysis, we separately analyzed the correlation between the modified Scheltens' scale score and log(PAC) (ß = 2.36; 95% CI 1.30, 3.41; p < 0.001), log(PRA) (ß = -1.76; 95% CI -2.09, -1.43; p < 0.001), and log(ARR) (ß = 1.86; 95% CI 1.55, 2.17; p < 0.001), which were all significantly correlated with white matter lesion load, after adjusting for confounding factors. Simple mediation analyses showed that systolic blood pressure (SBP) or diastolic blood pressure (DBP) mediated -3.83% or -2.66% of the association between PAC and white matter lesion load, respectively. In stratified analyses, there was no evidence of subgroup heterogeneity concerning the change in the risk of WMLs (p > 0.05 for interaction for all). Conclusion: Higher PAC, especially in PAC >17.26 ng/dl, increased the risk of WMLs. PAC was positively associated with white matter lesion load independent of SBP or DBP.

[Etiology analysis for hospitalized hypertensive patients: 10 years report from the department of hypertension (1999 - 2008)].

OBJECTIVE: To analyze etiology of hospitalized hypertensive patients in the department of hypertension from 1999 to 2008. METHODS: This retrospective study was performed to analyze the etiology of hospitalized hypertensive patients in department of hypertension and to show the distribution change of hypertension from 1999 to 2008. RESULTS: (1) There were 5867 (75.1%) patients with essential hypertension and 1942 (24.9%) patients with secondary hypertension (SH). (2) The prevalence rate of SH increased significantly during the 10 years (χ(2) = 387.621, P < 0.001) and was higher in 2008 than in 1999 (39.3% vs. 9.5%, P < 0.05). The prevalence of obstructive sleep apnea syndrome (OSAS) and primary aldosteronism (PA) in 2008 increased 38.3 and 1.8 times respectively than in 1999 (χ(2) = 304.025, P < 0.001; χ(2) = 42.845, P < 0.001) and other SH remained unchanged. (3) The prevalence of PA complicated with OSAS increased significantly in recent five years (χ(2) = 26.376, P < 0.001). Incidence of OSAS was 23.9% in PA patients and incidence of PA was 6.7% in OSAS patients. CONCLUSIONS: With the insights gained on hypertension mechanism and the development of new diagnostic technology, percent of diagnosed SH increased remarkably in recent years in hospitalized hypertensive patients in our department of hypertension. OSAS and PA are the leading causes of SH.

[Etiology analysis of 628 patients with refractory hypertension].

OBJECTIVE: To analyze the etiology of 628 patients with refractory hypertension and to observe the disease distribution with respect to gender and different age groups. METHODS: In this study, clinical data of 628 refractory hypertensives who hospitalized in our hospital from September 1997 to December 2005 were retrospectively analyzed. RESULTS: (1) There were 80.1% (503/628) patients with essential hypertension, 18.9% (119/628) with secondary hypertension (SH) while diagnosis was not clear in 1.0% (6/628) patients. Renovascular hypertension (33.6%) and obstructive sleep apnea syndrome (23.5%) were the major causes of SH. The highest prevalence rate of endocrine hypertension was primary aldosteronism (13.5%). (2) There were significantly more male patients than female patients with essential hypertension, SH, renal hypertension, obstructive sleep apnea syndrome, primary aldosteronism while the incidence of pheochromocytoma in female was significantly higher than that in male patients (all P < 0.05). The incidence of renovascular hypertension was similar between male and female patients. (3) SH occurred more often in young patients (33.1%) than in aged patients (13.8%, P < 0.05). CONCLUSION: Our data from this patient cohort showed that SH, especially renovascular hypertension and obstructive sleep apnea syndrome are major causes for refractory hypertension in young patients and primary aldosteronism was the commonest reason of endocrine hypertension in youth and middle-aged patients with refractory hypertension.

Excess weight loss is a vital strategy for controlling hypertension among multi-ethnic population in northwest China: A cross-sectional analysis.

Hypertension is a common global health problem including China. This study aimed to assess the prevalence and awareness of hypertension, and evaluate risk factors associated with hypertension among multi-ethnic population in northwest China using a random sampling cross-sectional data.A cross-sectional survey was conducted between 2014 and 2015 as part of a nationwide survey using stratified four-stage random sampling in Xinjiang. Hypertension was defined as mean systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) ≥140/90 mm Hg and/or taking anti-hypertensive medication. In addition, the prevalence of hypertension (SBP ≥ 130 or DBP ≥ 80 mm Hg) was also estimated according to the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) High Blood Pressure Guideline. Awareness of hypertension was based on self-report. An optimized risk score model was used to assess the risk and determine the predictive power of risk factors on hypertension.Totally 6722 subjects aged ≥18 years were enrolled and prevalence of hypertension was 24.3%, while the prevalence of hypertension based on the 2017 ACC/AHA guideline was approximately twice as high as that based on 2010 Chinese guideline (37.6%). Among individuals with hypertension, 55.5% were aware of their condition. Six potential factors were estimated to be associated with increased risk of hypertension including age, ethnicity, marital status, body mass index (BMI), waistline circumference, and comorbidity. In the analyses of calculated risk score, BMI ≥ 28.0 corresponded to the highest risk score of 23 points. The area under the receiver operation curve for the multivariable prediction model was 0.803 (95%CI: 0.789-0.813).There is a considerable prevalence of hypertension among Xinjiang adults, northwest China; awareness of hypertension is low. Excess weight loss may be a vital strategy for controlling hypertension, particularly if accompanied with other preventive measures in this region.

Decreased serum potassium may disturb sleep homeostasis in essential hypertensives.

The aim is to investigate the association between alterations in the serum potassium (K+) concentration and sleep architecture parameters in essential hypertensives. Two hundred ninety-two hypertensives undergoing polysomnography and providing blood samples were recruited. The sleep architecture was composed of sleep stages 1 (N1), 2 (N2), 3 (N3), 4 (N4) and REM. The light sleep stage (LST) was composed of N1 + N2, and the deep sleep stage (DST) was composed of N3 + N4. The potentialrelationships between electrolytes and sleep parameters were determined via univariate and multivariate analyses. The subjects were divided into two groups via the serum K+ median (3.86 mmol/L). The K+ < 3.86 mmol/L group showed significantly decreased N1 (7.10 ± 4.55% vs 8.61 ± 5.23%, p = 0.002), LST (71.48 ± 11.33% vs 75.92 ± 17.08%, p = 0.013), and periodic leg movement during sleep related to microarousals (MA) /arousal (PLMS-A) [4 (1~10) vs 8 (3~15)/night, p < 0.001] and increased REM (17.38 ± 6.43% vs 15.37 ± 6.18%, p = 0.007) compared to the K+ ≥ 3.86 mmol/L group. A subdivided analysis by gender showed that these changes were more statistically significant in men than in women. Significant positive correlations were identified between K+ and N1 (r = 0.169, p = 0.004), as well as PLMS-A (r = 0.222, p < 0.001) in subjects. Compared to women, a significantly strong correlation was identified between K+ and REM sleep in men (r = 0.158, p = 0.028 vs. r = 0.078, p = 0.442). Multiple linear regression analysis indicated that K+ is significantly associated with N1 in all subjects (p = 0.03) and with REM in men (p = 0.008), even after adjusting for confounders. Decreased K+ may disturb the homeostasis of the sleep architecture, and gender may interfere with their links in the hypertensive population.

[Analysis of etiology of the patients with hypertension from the People's Hospital of Xinjiang Uygur Autonomous Region].

OBJECTIVE: To analyze the etiology of the patients with hypertension from the People's Hospital of Xinjiang Uigur Autonomous Region, and to investigate the distribution of hypertension in gender and different ages. METHODS: From September 1997 to December 2005, the data of 4642 patients with hypertension was retrospective studied. RESULTS: (1) Of all the patients, 85.24% were essential hypertension (EH) and 14.76% were secondary hypertension (SH). Higher prevalence of sleep apnea syndrome (42.92%) and anxiety (15.04%) was found in secondary hypertension. The highest prevalence of primary aldosteronism (12.12%) was found in endocrine hypertension. (2) The male patients with hypertension were more than the female ones, and the incidence of EH, sleep apnea syndrome (SAS) and primary aldosteronism was higher in male patients than female ones, and the following was less than female: anxiety, pheochromocytoma and renovascular hypertension. (3) Among the patients with SH, 21.9% were found in youth, and 9.85% in aged. CONCLUSION: For the young, SH should be excluded, especially SAS and anxiety should be screened and differentiated. The highest prevalence of endocrine hypertension is primary aldosteronism in young and middle-aged male. The prevalence of pheochromocytoma in female is higher than that of male.

Detection of Secondary Causes and Coexisting Diseases in Hypertensive Patients: OSA and PA Are the Common Causes Associated with Hypertension.

BACKGROUND: Since the control rate of blood pressure is lower in mainland China, the aim of this study is to investigate the proportion of secondary causes and coexisting diseases of hypertension in hypertensive patients. METHODS: Data on consecutive patients with hypertension who visited the Hypertension Center. Diseases were detected using an established strict screening protocol. RESULTS: Detection rate of secondary causes and coexisting diseases of hypertension was 39.5% among 3003 hypertensive patients. Obstructive sleep apnea (OSA) was the most common, accounting for 24.7% of patients, followed by primary aldosteronism (PA) (5.8%) and PA + OSA (4.9%). Endocrine hypertension accounted for 12.1% of patients, including 10.7% of patients with PA, 1.1% with hypothyroidism, 0.1% with pheochromocytoma, 0.1% with Cushing's syndrome, and 0.1% with hyperthyroidism, respectively. Those who smoke, those who are obese, and those who have diabetes accounted for 31.3%, 27.5%, and 16.6% of total patients, respectively. There were overlapping conditions in secondary causes and coexisting diseases of hypertension. OSA was the most common in each age- and BMI-stratified group. CONCLUSION: Findings from the current study suggest an increasing frequency of secondary forms of hypertension, highlighting the burden of OSA and PA in hypertensive patients.

Does increased serum d-lactate mean subclinical hyperpermeability of intestinal barrier in middle-aged nonobese males with OSA?

Few attention has been directed to the potential effects of intermittent hypoxia experienced in obstructive sleep apnea on the integrity and permeability of intestinal barrier, particularly in adults. Therefore, we evaluated alteration in serum d-lactate concentration in middle-aged males with obstructive sleep apnea to value permeability of intestinal barrier. In this current cross-sectional study, consecutive 159 males were studied. Obstructive sleep apnea was determined by polysomnography and apnea hypopnea index ≥15 event/h was defined as obstructive sleep apnea. D-lactate, lipopolysaccharide binding protein, interleukin-1ß, interleukin-6 and tumor necrosis factor-α by ELISA method. Nonobese obstructive sleep apnea (OSA) males showed significantly higher serum d-LA than did nonobese [1374.35 (816-1735) µg/L vs 1166.43 (730-1815) µg/L, P = .018], and obese non-OSA ones [1374.35 (816-1735) µg/L vs 1188.75 (736-1557) µg/L, P = .045], whereas serum LBP levels showed no differences within groups. Serum IL-1ß was also slightly higher in nonobese OSA males, but with statistical significance, than in nonobese (19.39 ±â€Š4.67 ng/L vs 17.25 ±â€Š3.66 ng/L, P = .041), and obese non-OSA ones (19.39 ±â€Š4.67 ng/L vs 17.42 ±â€Š3.79 ng/L, P = .047), whereas other biomarkers, IL-6 and TNF-a did not show significant differences among groups. In stepwise multiple linear regression analysis, serum d-LA was independently positively associated with AHI (B = 5.577, P = .022), and ODI3 (B = 4.550, P = .024) and negatively with LSaO2 (B = -12.234, P = .019). Finally, we arrived at a conclusion that serum d-lactate was increased in nonobese middle-aged males with obstrutive sleep apnea, possibly suggesting existence of subclinical disruption of intestinal barrier, and showed significant associations with inflammatory mediators, possibly being involved in systemic inflammation of obstructive sleep apnea.

Proteomic Analyses Provide Novel Insights into Plant Growth and Ginsenoside Biosynthesis in Forest Cultivated Panax ginseng (F. Ginseng).

F. Ginseng (Panax ginseng) is planted in the forest to enhance the natural ginseng resources, which have an immense medicinal and economic value. The morphology of the cultivated plants becomes similar to that of wild growing ginseng (W. Ginseng) over the years. So far, there have been no studies highlighting the physiological or functional changes in F. Ginseng and its wild counterparts. In the present study, we used proteomic technologies (2DE and iTRAQ) coupled to mass spectrometry to compare W. Ginseng and F. Ginseng at various growth stages. Hierarchical cluster analysis based on protein abundance revealed that the protein expression profile of 25-year-old F. Ginseng was more like W. Ginseng than less 20-year-old F. Ginseng. We identified 192 differentially expressed protein spots in F. Ginseng. These protein spots increased with increase in growth years of F. Ginseng and were associated with proteins involved in energy metabolism, ginsenosides biosynthesis, and stress response. The mRNA, physiological, and metabolic analysis showed that the external morphology, protein expression profile, and ginsenoside synthesis ability of the F. Ginseng increased just like that of W. Ginseng with the increase in age. Our study represents the first characterization of the proteome of F. Ginseng during development and provides new insights into the metabolism and accumulation of ginsenosides.