ObjectiveTo explore the prevalence and risk factors of hypertension in Anyue County from June 2011 to June 2013. MethodsUsing stratfied random cluster sampling method, 5 391 people over 15 years of age were selected from 3 residential areas and 3 natural villages to finish a questionnaire and blood pressure measurement. ResultsThe total prevalence rate of hypertension in Anyue County was 18.77%. The prevalence rates of hypertension in urban areas and rural areas were 21.75% and 16.20%, and the difference was significant (χ2=27.120, P<0.001). In both urban and rural areas, the prevalence rate of hypertension increased with age (χ2=475.634, P<0.001; χ2=394.026, P<0.001). The percentages of awareness, treatment and control in Anyue County were 31.30%, 24.41%, and 9.09%. The percentages of awareness, treatment and control in urban areas were 40.15%, 33.70%, and 11.23% and were 20.68%, 13.65%, and 6.61% in rural areas. There were significant differences in the percentages of awareness, treatment and control between urban and rural areas (χ2=44.475, P<0.001; χ2=54.861, P<0.001; χ2=8.202, P=0.004). The logistic regression analysis showed that age (OR=1.061, P<0.001), diabetes (OR=1.550, P<0.001), hyperlipemia (OR=2.372, P<0.001) and smoking (OR=1.335, P<0.001) were the risk factors for hypertension; and it showed that high level of education was a protective factor for hypertension (OR=0.755, P<0.001). ConclusionBecause of high prevalence and low percentages of awareness, treatment and control in Anyue County, the prevention and control situation of hypertension are grim. We should focus on the control of smoking, blood lipid and blood glucose.
Exercise prescription is an effective tool for the prevention and control of hypertension, diabetes and dyslipidemia. However, a full set of exercise prescription is difficult to be implemented in China's primary medical institutions and community public health service centers. Therefore, under the support of the theoretical system of exercise prescription and the standard development norms, this clinical pathway of exercise prescription is developed according to the characteristics of national physical fitness and the status quo of primary healthcare institutions in China, aiming at simplifying the process of exercise prescription development, reducing the professional threshold, empowering primary healthcare, and providing a scientific and feasible solution for the promotion of exercise prescription in primary healthcare institutions.
Objective To analyze the risk factors of hypertension combined with cerebral hemorrhage. Methods From May 2015 to October 2016, 92 hypertension patients with cerebral hemorrhage (group A) were enrolled; simultaneously, 110 hypertension patients without cerebral hemorrhage (group B) were included. We analyzed retrospectively the clinical data of two groups and the risk factors of hypertension complicated with cerebral hemorrhage. Results The results of univariate analysis showed that the ratios of patients in group A with the following indexes, >65 years old, body mass index >30 kg/m2, >7-year smoking history, triglyceride level >1.7 mmol/L, cholesterol level >5.72 mmol/L, high density lipoprotein level >0.9 mmol/L, and bad medication compiance, were much more higher than those in group B (P<0.05). The rusults of multivariate analysis showed that smoking history, diabetes mellitus history, hypertension history, triglycerides level, cholesterol level, bad medication compliance were the risk factors of hypertension combined with cerebral hemorrhage (P<0.05). Conclusions The risk factors of hypertension combined with cerebral hemorrhage include smoking history, diabetes mellitus history, hypertension history, triglyceride level, cholesterol level, and medication compliance. We shoud pay more attention to these factors in clinical practice.
ObjectiveTo explore and compare the therapeutic effects of neuro-endoscopic and craniotomic hematoma evacuation for hypertensive hematomas in the basal ganglia region. MethodsEighty-six patients with hypertensive hematomas in the basal ganglia regions treated between January 2010 and September 2014 were divided into neuro-endoscopy and craniotomy groups randomly with 43 in each. Hematoma was removed directly under neuro-endoscope in the endoscopic group, while it was removed under the operating microscope in the craniotomy group. The average operation bleeding amount, residual hematoma after operation, hematoma evacuation rate, the changes of National Institutes of Health Stroke Scale (NIHSS) and Barthel index (BI) scores before operation, 1 and 3 months after operation were compared between the two groups. All data were analyzed statistically. ResultsThe average amount of operation bleeding was (127±26) mL, postoperative residual hematoma was (6±4) mL, and the hematoma clearance rate was (86±9)% in the neuro-endoscopy group, while those three numbers in the craniotomy group were respectively (184±41) mL, (11±6) mL, and (72±8)%, with all significant differences (P < 0.05). The NIHSS and BI scores were not significantly different between the two groups before surgery (P > 0.05). Seven days, one month and three months after surgery, the NIHSS score was significantly lower, and the BI score was significantly higher in the neuro-endoscopy group than the craniotomy group (P < 0.05). ConclusionNeuro-endoscopic surgery for hypertensive hematomas in basal ganglia region is proved to have such advantages as mini-invasion, direct-vision, complete clearance and good neural function recovery after surgery, which is a new approach in this field.
Chronic kidney disease (CKD) and hypertension are very common chronic diseases. Active and standardized treatment of hypertension in patients with CKD can not only delay the progress of renal disease, but also reduce the risk of cardiovascular events. In recent years, although the guidelines for hypertension have put forward detailed suggestions for the management of hypertension in CKD patients, there are differences in the recommendation of blood pressure target value for CKD patients. Combined with the latest guidelines, this review interprets the blood pressure measurement methods, diagnostic criteria, antihypertensive targets and drug therapy in patients with CKD.
Objective To observe the effects of valsartan/ hydrochlorothiazide and valsartan on left ventricular thickness and the left ventricular diastolic function in patients with essential hypertension and left ventricular hypertrophy and impaired left ventricular diastolic function. Methods 56 patients of essential hypertension with left ventricular hypertrophy and impaired left ventricular diastolic function were randomized into two randomized double-blind groups, valsartan/hydrochlorothiazide (HCTZ) 80/12.5 mg o.d were gave to A group and valsartan 80 mg o.d were gave to B group. The dosage would be doubled in patients whose SDBP ≥ 12 kPa or SSBP ≥ 18.7 kPa after 4 weeks. Treatment lasted for 6 months. Result At the end of 6 months, valsartan/ hydrochlorothiazide and valsartan significantly reduced BP from baseline (Plt;0.01), there was significant difference in reducing BP between the two groups (Plt;0.05). Indexes of left ventricular diastolic function (IVST, LVPWT, LVMI) significantly decreased (Plt;0.01). LVEF increased significantly (Plt;0.01). There was significant difference in IVST, LVPWT, LVMI and LVEF between two groups (Plt;0.05). Conclusion Valsartan/ hydrochlorothiazide (HCTZ) can not only decrease blood pressure effectively, but also can significantly improve left ventricular hypertrophy and left ventricular diastolic function.
ObjectiveTo analyze the causal relationship between obstructive sleep apnea (OSA) with its typical symptoms (daytime sleepiness and snoring) and cardiovascular diseases (hypertension, coronary heart disease, myocardial infarction, heart failure) by using Mendelian randomization. MethodsWe used the instrumental variables (IV) in the FINNGen database and the UK Biobank to perform two-sample Mendelian randomization (TSMR) analysis. The results of random-effects inverse variance weighting method (IVW) were the main results. MR-Egger method was used for pleiotropic analysis and sensitivity analysis was performed by the leave-one-out method to verify the reliability of the data. ResultsOSA could lead to hypertension (IVW β=0.043, 95%CI 0.012 to 0.074, P=0.006) and heart failure (IVW β=0.234, 95%CI 0.015 to 0.452, P=0.036). Daytime sleepiness also had a pathogenic effect on heart failure (IVW β=1.139, 95%CI 0.271 to 2.006, P=0.010). There was no causal association between OSA and CHD or MI, snoring and the four CVDs. There was no causal association between daytime sleepiness and hypertension, CHD or MI.ConclusionOSA and daytime sleepiness have pathogenic effects on hypertension and heart failure, with heart failure being the most affected.
ObjectiveTo evaluate the effect of different doses of dexmedetomidine on hemodynamics during endotracheal extubation of laparoscopic cholecystectomy in patients with hypertension. MethodsA total of 120 hypertension patients ready to undergo laparoscopic cholecystectomy under general anesthesia between December 2013 and December 2014 were chosen to be our study subjects. They were randomly divided into 4 groups with 30 patients in each:saline control group (group C), low-dose dexmedetomidine hydrochloride injection group (group D1), moderate-dose dexmedetomidine hydrochloride injection group (group D2), and high-dose dexmedetomidine hydrochloride injection group (group D3). The anesthesia methods and drugs were kept the same in each group, and 20 mL of saline, 0.25, 0.50, 1.00 μg/kg dexmedetomidine (diluted to 20 mL with saline) were given to group C, D1, D2, and D3 respectively 15 minutes before the end of surgery. Time of drug administration was set to 15 minutes. We observed and recorded each patient's mean arterial pressure (MAP) and heart rate (HR) in 5 particular moments:the time point before administration (T1), immediately after administration (T2), extubation after administration (T3), one minute after extubation (T4), and 5 minutes after extubation (T5). Surgery time, recovery time, extubation time and the number of adverse reactions were also detected. ResultsCompared at with, MAP and HR increased significantly at the times points of T3, T4, T5 compared with T1 and T2 in Group C and group D1 (P<0.05), while the correspondent difference was not statistically significant in group D2 and D3 (P>0.05). Compared with group C, MAP and HR decrease were not significantly at the time points of T3, T4, T5 in group D1 (P>0.05). However, MAP and HR decrease at times points of T3, T4, T5 in group D2 and D3 were significantly different from group C and D1 (P<0.05). After extubation, there were two cases of dysphoria in group C and two cases of somnolence in group D3, but there were no cases of dysphoria, nausea or shiver in group D1, D2, D3. ConclusionIntravenously injecting moderate dose of dexmedetomidine 15 minutes before the end of surgery can effectively reduce patients' cardiovascular stress response during laparoscopic cholecystectomy extubation for patients with hypertension, and we suggest a dose of 0.5 μg/kg of dexmedetomidine.
The management of middle-aged and youth hypertension has become a challenge in clinical practice. The hypertension group of the Chinese Society of Cardiology published the expert consensus on the management of hypertension in young and middle-aged Chinese population in 2019. This paper interprets the key contents of the consensus and provides references for management of young and middle-aged hypertension.
Objective To formulate an evidence-based treatment plan for a patient with ischemic stroke accompanied by hypertension and atrial fibrillation. Methods We searched The Cochrane Library (Issue 4, 2006), SUMsearch (January 1980 to December 2006) and PubMed (January 1980 to December 2006) to identify randomized controlled trials (RCTs), systematic reviews (SRs) and meta-analyses about the efficacy and safety of anticoagulant therapy for ischemic stroke coupled with atrial fibrillation, and blood pressure lowering therapy for ischemic stroke coupled with hypertension. We evaluated the validity, reliability and feasibility of each study to identify the current best evidence. Results Four guidelines, 3 SRs and 6 RCTs were included. The evidence showed that low-intensity anticoagulant therapy was safe and effective for this patient, and that rapid blood pressure lowering therapy was not suitable for acute ischemic stroke. According to the current evidence, as well as the patient’s clinical condition and preference, low-intensity warfarin was given with a target INR (international normalized ratio) of 2.0. During convalescence, he was given oral fosinopril and indapamide. His symptoms were relieved after two weeks of treatment, and follow-up at one month indicated that this plan was suitable for the patient. Conclusions Anticoagulant therapy is still preferred for acute ischemic stroke accompanied by hypertension and atrial fibrillation. The current evidence suggests that warfarin is superior to other anticoagulants. The target INR should be adjusted individually, especially in old patients. The maintenance of a low INR level, if necessary, could maximise utility and minimise the risk of hemorrhage. Aspirin is recommended when anticoagulants cannot be tolerated. Intensive blood pressure lowering therapy is not reasonable for patients with acute ischemic stroke. Antihypertensive drugs like ACEI and low-dose diuretics may be chosen during convalescence.