ObjectiveTo investigate the prevalence and risk factors of hypertension in urban and rural residents in Chengdu. MethodsA cluster random sampling survey was carried out from February to October in 2010. A total of 2 011 residents aged 35-70 years in four communities of Chengdu (two communities in urban area, two in rural area) were investigated for the incidence of hypertension. Analysis was performed using SPSS 18.0 software. ResultsThe standardized prevalence of hypertension was 31.30% among residents aged 35-70 years, which was much higher in urban than that in rural:39.03% vs. 24.90% (P < 0.05). The results of multivariate logistic regression analysis showed that, age, waist, heart rate, fasting blood glucose and education level were the major risk factors of hypertension for male; while age, waist, heart rate, fasting blood glucose, triglyceride and uric acid were the major risk factors for female. ConclusionThe prevalence of hypertension in urban is higher than that in rural in Chengdu. Prevention and intervention should be performed more for whom have increased waist circumfluence, abnormal levels of fasting glucose, and increased heart rate.
Objective To systematically evaluate the effectiveness and safety of calcium channel blockers (CCBs) and angiotensin-converting enzyme inhibitors (ACEIs) used alone v.s. used in combination on the reversion of left ventricular hypertrophy (LVH) in Chinese essential hypertension (EH) patients. Methods The following databases were searched, including, Cochrane Library (Issue 7, 2011), PubMed (1980 to 2011), EMbase (1990 to 2011), CBM (1978 to 2011), CNKI (1994 to 2011), VIP (1989 to 2011), and WanFang Data (1998 to 2011). The studies were screened, and the quality was evaluated according to predefined inclusion and exclusion criteria, and then Meta-analysis was conducted by using RevMan 5.1 software. Results A total of 10 studies involving 859 patients were included. The results of Meta-analysis showed that the CCBs plus ACEIs group (the combination group) was superior to the CCBs group in improving EH patients’ systolic pressure (SBP) (MD= –6.49, 95%CI –10.55 to –2.43), diastolic pressure (DBP) (MD= –4.48, 95%CI –6.76 to –2.21), left ventricular mass index (LVMI) (MD= –5.31, 95%CI –8.43 to –2.19), interventricular septal thickness (IVST) (MD= –1.33, 95%CI –2.00 to –0.66) and left ventricular posterior wall thickness (LVPWT) (MD= –0.87, 95%CI –1.41 to –0.33). In addition, compared with the ACEIs group, the combination group was greatly superior in decreasing LVMI (MD= –11.54, 95%CI –15.06 to –8.01), IVST (MD= –0.76, 95%CI –1.25 to –0.27) and LVPWT (MD= –0.80, 95%CI –1.01 to –0.59). But clinical effectiveness was similar between the combination group and the CCBs group or the ACEIs group in aspects of the left ventricular end diastolic diameter (LVEDD), fraction shortening (FS) and ejection fractions (EF) (Pgt;0.05). Conclusion The combination therapy of CCBs with ACEIs is superior to either the CCBs or the ACEIsmonothrepy in regression of left ventricular hypertrophy. Because of the low methodological quality and small sample, this conclusion needs to be proved by more high-quality, large-scale and multicenter randomized controlled trials in the future.
ObjectiveTo systematically review the efficacy and safety of sacubitri valsartan in the treatment of hypertension. MethodsPubMed, ClinicalTrials.gov, CNKI, WanFang Data and CBM databases were electronically searched to collect randomized controlled trials (RCTs) of sacubitril valsartan in the treatment of hypertension from inception to August 31, 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using RevMan 5.3 and Stata 13.0 software. ResultsA total of 11 RCTs involving 3 564 patients were included. Meta-analysis showed that compared with control group, sitting systolic blood pressure (MD=−6.85, 95%CI −9.94 to −3.76, P<0.01) and sitting diastolic blood pressure (MD=−3.70, 95%CI −5.61 to −1.79, P<0.01) significantly decreased in the experimental group, and the difference was statistically significant. The results of subgroup analysis did not show significant changes. At the same time, the incidence of adverse reactions with sacubitril valsartan was low, and no fatal adverse events were observed. ConclusionCurrent evidence shows that sacubitril valsartan in the treatment of hypertension has definite efficacy and fewer adverse reactions. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
Perioperative management of 58 hypertensive patients suffering from surgical disease is reported. We emphasize that before operation the blood pressure should be adequately controlled, and heart function promoted. It is safer that the diastolic pressure is controlled under 14 kPa before operation. During operation we strictly observe the change of the blood pressure and manage it in time. Analgesic and antihypertensive agents are used after operation.
ObjectiveTo investigate the significance of using the term "high-normal blood pressure" and its intervention in the early stage. MethodsIn 1992 and 2007, we performed two similar investigations focusing on cardiovascular risk factors in 711 people in Chengdu city. Since 114 individuals were diagnosed with hypertension, 597 people without hypertension were eligible and divided into two groups:the normal-pressure[<120/80 mm Hg (1 mm Hg=0.133 kPa)] group and the high-normal blood pressure (systolic blood pressure 120-139 mm Hg and/or diastolic blood pressure 80-89 mm Hg) group. Data in the two investigations were compared to explore the relationship among high-normal blood pressure, cardiovascular disease (CVD) and hypertension. ResultsThe high-normal blood pressure group had a higher level of CVD risk factors both in 1992 and 2007, and the 15-year cumulative incidence of hypertension in the high-normal blood pressure group was higher than that of normal-pressure group (91.2% vs. 22.2%, P<0.001). After adjusting for serum lipid, body weight and other CVD risk factors, high-normal blood pressure could predict the progression into hypertension[HR=5.354, 95% CI (4.094, 7.002), P=0.001]. There was no statistics difference in CVD prevalence in the two groups in 1992, but in 2007 the prevalence of CVD tended to be higher in the high-normal blood pressure group (6.6% vs. 3.1%, P=0.052). ConclusionHigh-normal blood pressure is a special stage of blood pressure with high level of CVD risk factors and high potential to progress into hypertension. The term should be emphasized and intervention should be done in the early stage for high-normal blood pressure people to prevent from hypertension and CVD.
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.
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 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 investigate on the antihypertensive therapy for hypertension patients in Wuhou District communities in Chengdu city and assess whether they have complied with the hypertension treatment guidelines. MethodsIn a survey of 1 539 community people, we selected 337 hypertensive patients who had detailed high blood pressure medication records. ResultsThe main characteristics of community hypertension treatment included higher proportions of single-drug therapy (70.3%), and traditional compound preparation (13.9%). Calcium channel blockers (CCB) and beta blockers were most commonly used in the dual step-down scheme (39.7%), while CCB, angiotensin converting enzyme inhibitors and beta blockers were mostly used in step-down triple combination. The control rate was 46.7% after antihypertensive drug treatment in the community. ConclusionIt is necessary to carry out hypertension education, strengthen the training of doctors at the basic level with hypertension prevention and control guidelines to improve the rates of treatment and control of hypertension.
ObjectiveTo explore the effect of non-pharmaceutical therapy in patient with hypertension in Chengdu. MethodsFrom October 2010 to October 2011, a total of 33 general practitioners from 14 community health-care centers in Chengdu were trained by 2009 "Hypertension Guideline" of China for grass-root; each practitioner was required to manage 25 hypertensive patients during one year, based on standardized project. We evaluated the effect of non-pharmaceutical therapy before and after project and the antihypertensive effects from different therapy. ResultsBy the end of 2011, a total of 632 hypertensive patients[aged from 36 to 79 with an average of 65.72±8.55; 263 males with the mean age of (66.41±9.10) years old, 369 females with the mean age of (65.22±8.10) years old], who were eligible for criteria with complete data had been managed for one year. The non-pharmaceutical management includes quitting smoke, limiting alcohol, limiting salt diet, reducing weight and increasing regular physical activity. At the beginning of this project, the acceptance rate of such management were 75.96%, 71.43%, 99.01%, 73.28%, and 85.00%, respectively. After one year of such non-pharmaceutical management, the proportion of patient, who suffered from smoking, alcohol drinking, excess salty diet, overweight and obesity, and lack of physical exercise, decreased from 8.54%, 5.54%, 16.00%, 55.06%, and 23.73% to 3.80%, 1.42%, 2.69%, 34.43%, and 11.39%, respectively with statistical difference (P<0.001). Overweight and obesity is the main risk factor related to lifestyle. During one year management, Systolic blood pressure decreased by 25.81, 23.71, and 27.78 mm Hg (1 mm Hg=0.133 kPa) in the patients with non-pharmaceutical therapy, pharmaceutical therapy, and both, respectively; diastolic blood pressure decreased by 10.23, 3.99, and 10.46 mm Hg, respectively, in the three groups with statistical difference (P<0.05). ConclusionThrough the hypertension management, strengthening the cognition of non-pharmaceutical therapy for general practitioner can reduce both high blood pressure risk and cardiovascular risk significantly and comprehensively.