Objective To systematically investigate the association and dose-response relationship between the metabolic score for insulin resistance(METS-IR)and the risk of hypertension,using data from a prospective cohort study of Chinese adults.Methods A total of 4 866 adults without hypertension at baseline were enrolled from the 2009 China Health and Nutrition Survey(CHNS)and followed up for 6 years to observe new-onset hypertension.Multivariable logistic regression,restricted cubic spline analysis,and subgroup analyses were employed to comprehensively evaluate the relationship between METS-IR and hypertension risk.Results During follow-up,1 256 participants developed hypertension.Multivariable logistic regression analysis showed that METS-IR was an independent risk factor for hypertension.As a continuous variable,METS-IR showed a positive correlation with hypertension risk(OR=1.03,95％CI:1.02-1.05,P＜0.001).In quartile analyses,compared with the lowest quartile,the highest quartile of METS-IR was associated with increased hypertension risk(OR=1.73,95％CI:1.37-2.18,P＜0.001).Restricted cubic spline analysis confirmed a linear correlation between METS-IR and hypertension risk(Pnonlinear=0.388).Subgroup analyses indicated no significant interaction effects of sex,smoking,alcohol consumption,region,body mass index,or age on this association(all P＞0.05).Conclusion METS-IR serves as an independent risk factor for hypertension,with elevated levels demonstrating a positive correlation with hypertension risk.
BACKGROUND:Whether mean arterial pressure (MAP) and pulse pressure (PP), two indicators of cerebral perfusion, could guide the selection of anti-hypertensive strategies after acute ischaemic stroke remains uncertain. Our study was to explore the impact of early anti-hypertensive intervention on adverse clinical outcomes following ischaemic stroke stratified by the levels of MAP and PP based on the China Antihypertensive Trial in Acute Ischemic Stroke (CATIS). METHODS:The trial randomised 4071 acute ischaemic stroke patients with elevated systolic blood pressure (SBP) to receive anti-hypertensive treatment (targeting a 10%-25% reduction in SBP during the 24 hours postrandomisation, reaching a BP level <140/90 mm Hg in 7 days, further keeping these levels throughout hospitalisation) or discontinue anti-hypertensive treatment during hospitalisation. The primary outcome was death or major disability at 14 days or hospital discharge. Study outcomes were analysed by comparing the BP-lowering intervention group and control group, stratified by tertiles of MAP or PP levels. RESULTS:No significant difference was observed in the primary outcome between the intervention and control groups across all MAP (p=0.69 for homogeneity) and PP (p=0.78 for homogeneity) categories. The corresponding odds ratios (95% CIs) were 1.08 (0.85-1.36), 0.92 (0.74-1.15) and 1.00 (0.81-1.25) for participants with low, intermediate, and high MAP and were 0.99 (0.79-1.25), 1.06 (0.84-1.34) and 0.95 (0.77-1.18) for participants in PP subgroups, respectively. Furthermore, early anti-hypertensive intervention was not associated with secondary outcomes (including neurological deterioration, recurrent stroke, vascular events and all-cause mortality) by MAP and PP (all p>0.05). CONCLUSIONS:Early anti-hypertensive therapy neither decreased nor increased the odds of major disability, mortality, recurrent stroke or vascular events in patients with acute ischaemic stroke regardless of different MAP and PP levels. TRIAL REGISTRATION NUMBER:ClinicalTrials.gov identifier: NCT01840072.
BACKGROUND:High blood pressure (BP) is a major risk factor for cardiovascular disease (CVD) events. The ideal cardiovascular health metrics (ICVHMs) have beneficial effects on the cardiovascular system. The present study examined the association between ICVHMs and the risk of hypertension-related CVD in hypertensive patients across different BP ranges. METHODS:Analyses included 31,427 adults from the National Health and Nutrition Examination Survey 2005-2018. The BP target was < 130/80 mm Hg and ICVHMs were defined based on the 2022 American Heart Association Presidential Advisory. Fatal major adverse cardiovascular events (MACE) were the primary outcomes. Cox proportional hazards models were used to calculate the HR and 95% CI for MACE mortality. RESULTS:Among 31,427 participants, hypertensive patients with ≥ 5 ICVHMs did not appear significantly additional risk of MACE mortality compared to participants without hypertension (BP at target: HR, 1.09; 95% CI, 0.72-1.64; BP above target: HR, 0.98; 95% CI, 0.69-1.39). Compared to patients with 0-1 ICVHMs, experiencing ≥ 5 ICVHMs was associated with a lower MACE mortality risk (BP at target: HR, 0.60; 95% CI, 0.36-0.98; BP above target: HR, 0.43; 95% CI, 0.30-0.62). Among hypertensive patients, each increase in the number of ICVHMs was associated with a lower risk of MACE mortality (BP at target: HR, 0.86; 95% CI, 0.76-0.97; BP above target: HR, 0.84; 95% CI, 0.78-0.91), even in patients with high-risk factors for CVD. CONCLUSIONS:Compared to participants without hypertension, hypertensive patients with fewer ICVHMs, regardless of whether their blood pressure is well-controlled, face a significantly higher risk of MACE mortality.
BACKGROUND:The main goal of this study was to conduct a meta-analysis and systematic review to examine the correlation between metabolic syndrome (MetS) and hyperuricemia. METHODS:All studies available in PubMed, Cochrane Library, Embase, and Web of Science were obtained within the retrieval timeframe ending on 9 December 2023. Utilizing the Agency for Healthcare Research and Quality (AHRQ) and the Newcastle-Ottawa Scale (NOS), the included studies underwent quality appraisal, and Stata v14 software was employed for the subsequent data analysis. RESULTS:A total of 40 studies, covering 214,091 patients, were selected based on specified inclusion and exclusion criteria. The analysis revealed a substantial association between MetS and hyperuricemia (odds ratio (OR) = 2.25, 95% confidence interval (CI) 1.19-4.26, P < 0.001). The metabolically abnormal overweight/obese group (MUHOWO) exhibited a heightened risk of hyperuricemia (OR = 3.54, 95% CI 2.66-4.71, P = 0.002). Additionally, hyperuricemia increased the likelihood of developing MetS (OR = 2.13, 95% CI 1.63-2.79, P < 0.001). Stratified by gender, hyperuricemia elevated the risk of MetS in both men (OR = 1.92, 95% CI 1.43-2.58, P < 0.001) and women (OR = 2.13, 95% CI 1.62-2.8, P < 0.001). CONCLUSIONS:This meta-analysis and systematic review robustly affirm a significant bidirectional association between MetS and hyperuricemia. The increased risk observed, especially in MUHOWO and across gender lines, underscores the clinical relevance. Addressing MetS emerges as crucial in preventing and managing hyperuricemia, and vice versa. These findings offer valuable insights, urging further research into underlying mechanisms for more targeted interventions and personalized treatments in clinical practice.
BACKGROUND:The objective of our case-control study was to evaluate the determinants of childhood cardio-vagal baroreflex failure and exaggerated orthostatic pressor response, which are risk factors for subsequent hypertension. METHODS:Four groups of children were matched for sex and age: 12 with congenital central hypoventilation syndrome (autonomic nervous system dysfunction), 12 with chronic kidney disease (frequently abnormal blood pressure [BP]), 12 with sickle cell disease (frequently abnormal orthostatic BP), and 24 control children (preterm birth with normal BP). The children underwent tonometry evaluation (aortic systolic BP) and continuous BP and ECG measurements in supine and standing positions, allowing ambulatory BP monitoring and the computation of heart rate variability indices, baroreflex sensitivity (BRS), and orthostatic systolic BP response. RESULTS:Supine and standing BRS correlated significantly with aortic systolic BP (ρ = -0.34, ρ = -0.52, respectively), daytime systolic BP (ρ = -0.33, ρ = -0.54, respectively), low frequencies power in similar body positions (supine: ρ = 0.68, standing: ρ = 0.65), and high frequencies (HF) power (ρ = 0.78, ρ = 0.76, respectively). Orthostatic BP response correlated significantly with standing BRS (ρ = -0.38) and standing HFnu (ρ = -0.46). In multivariate analyses, only supine and standing HF power remained independently associated with the respective BRS, while standing HFnu and standing BRS were independently associated with the orthostatic pressor response. CONCLUSIONS:Defective parasympathetic modulation's detrimental effect on baroreflex sensitivity and the orthostatic pressor response in childhood is evident, regardless of the underlying pathology.
INTRODUCTION:Evidence on left ventricular (LV) mechanics, assessed by speckle tracking echocardiography (STE), in children and adolescents with elevated blood pressure (BP)/hypertension is scanty. AIM:The aim of the present meta-analysis was to provide an updated information on LV systolic function phenotyped by global longitudinal strain (GLS) and LV ejection fraction (LVEF) in the setting of pediatric hypertension. METHODS:Systematic searches were conducted across bibliographic databases (Pub-Med, OVID, EMBASE, and Cochrane Library) to identify eligible studies from inception up to 30 November 2024. Studies reporting data on LV mechanics in pediatric hypertension and controls were included. The statistical difference of the echocardiographic variables of interest between groups such as LVEF and GLS was calculated by standardized mean difference (SMD) with 95% confidence interval (CI) using random-effects models. RESULTS:Eight studies including 719 individuals with elevated BP/hypertension and 1,653 age-matched healthy controls were considered for the analysis. Pooled average LVEF values were 72.4 ± 1.6% in the healthy control group and 72.5 ± 1.8% in the elevated BP/hypertensive group (SMD: 0.08 ± 0.15, CI: -0.21/0.36, P = 0.60); the corresponding values of GLS were -19.6 ± 1.1% and 18.5 ± 0.9% (SMD: -0.96 ± 0.25, CI: -1.46/-0.47, P < 0.0001). A parallel impairment of global circumferential strain emerged from pooled data of three studies (SMD: -0.96 ± 0.25, CI: -1.46/-0.47, P < 0.0001). CONCLUSIONS:Our data suggest that LVEF is unable to detect early alterations in systolic function in pediatric hypertension, and the implementation of STE may be highly useful in unmasking systolic dysfunction in this setting.
Objective To assess the current situation of risk factor exposure and control among middle-aged and elderly people at high risk of atherosclerotic cardiovascular disease(ASCVD)in the community and provide a basis for optimizing prevention and control strategies.Methods A cross-sectional survey was conducted.The middle-aged and elderly people(aged 40 years and above)with a confirmed diagnosis of ASCVD or a Prediction for ASCVD Risk in China(China-PAR)score of high-risk in Jinshui District,Zhengzhou City were enrolled.The exposure and control of risk factors for cardiovascular diseases were analyzed.Results A total of 4 357 residents at high risk of cardiovascular disease were enrolled,and the top three cardiovascular risk factors were hypertension(75.44％,3 287 cases),diabetes mellitus(49.00％,2 135 cases),and hyperlipidemia(47.05％,2 050 cases).The prevalence of the"three highs"was higher in women.The treatment rates of patients with hypertension,diabetes mellitus and hyperlipidemia were 59.96％(1 971/3 287),51.48％(1 099/2 135),and 40.39％(828/2 050),respectively,and the control rates were 59.23％(1 947/3 287),42.81％(914/2 135)and 24.15％(533/2 050),respectively.Risk factor aggregation was significant(60.45％with≥2 risk factors).Among diabetic patients,those with"three highs"had the lowest control rate.Among patients with hyperlipidemia,with the increase of co-morbidities,the lipid-lowering treatment rate increased,while the control rate decreased.Compared with ASCVD residents,among those with a high-risk China-PAR score,the antihypertensive treatment rate of hypertensive patients was lower(55.02％vs.73.18％,x2=88.789,P＜0.001),the anti-diabetic treatment rate of diabetic patients was lower(48.12％vs.62.78％,x2=31.873,P＜0.001),and the lipid-lowering treatment rate of patients with hyperlipidemia was lower(36.35％vs.50.97％,x2=35.833,P＜0.001),while the lipid control rate of patients with hyperlipidemia was higher(28.79％vs.11.99％,x2=21.218,P＜0.001).Conclusions The high-risk population of cardiovascular diseases in the community shows the characteristics of"two highs and two lows"(high prevalence of cardiovascular risk factors and aggregation of multiple risk factors;low treatment rate and low control rate),and there are gender and population differences in risk factor exposure and control,so it is urgent to optimize the comprehensive management of cardiovascular risk factors in the community,and implement precise prevention and control for different populations.There is an urgent need to further optimize the comprehensive management of cardiovascular risk factors in the community and to implement precise prevention and control for different populations.
Objective To investigate the current comorbidity situation of hypertension,diabetes,and dyslipidemia and infulencing factors in adults of Fujian province,and to provide a scientific basis for"co-management of the three diseases".Methods Based on the Fujian Province data from the"China Residents Cardiovascular Disease and Risk Factors Surveillance Project(2020)",a multi-stage stratified random sampling method was used to select 9 666 residents aged≥18 years as the survey subjects.Data were collected through questionnaires(demographics,lifestyle and behaviors,disease history,and medication history),physical examinations(height,weight,body fat,waist circumference,blood pressure),and laboratory tests(fasting blood glucose,total cholesterol,triglycerides,high density lipoprotein cholesterol,low density lipoprotein cholesterol).Chi-square or trend chi-square tests were used to analyze the differences in comorbidities among people with different characteristics,and multivariate unordered multinomial logistic regression analysis was applied to identify influencing factors of comorbidity status of hypertension,diabetes,and dyslipidemia.Results The age-standardized prevalences of hypertension,diabetes,and dyslipidemia were 34.6％,7.3％,and 31.7％,respectively.Among the comorbidity patterns of two and three diseases,the prevalence of hypertension combined with dyslipidemia was the highest(standardized prevalence was 12.7％).The standardized prevalences of three diseases and hypertension combined with diabetes were 2.9％and 2.0％,respectively.The prevalence of diabetes combined with dyslipidemia was the lowest(the standardized prevalence was 1.3％).Multinomial logistic regression analysis showed that male(ORs were 2.173,2.496 and 2.049,respectively),age(compared with the 18-44 years old group,the ORs for the 45-59 years old group were 2.217,3.723 and 4.780,and for the≥60 years old group were 4.773,10.720 and 23.311,respectively),married/remarried/cohabiting(compared with unmarried,ORs were 1.504,2.175 and 2.967,respectively),divorced/widowed/separated(compared with unmarried,ORs were 1.757,2.625 and 3.458,respectively),central obesity(ORs were 1.457,2.061 and 3.109,respectively),overweight or obese(compared with normal body mass index,ORs for overweight were 1.803,2.643 and 3.454;ORs for obese were 3.043,5.048 and 6.752,respectively),and insufficient physical activity(ORs were 1.114,1.154,and 1.356,respectively)were all positively associated with the comorbidity of 1,2 and 3 diseases(P＜0.05).In addition,current alcohol drinkers had a higher risk of developing the"three highs",with an OR of 1.465(P＜0.05).Conclusions The comorbidity of hypertension,diabetes,and dyslipidemia is common among adults in Fujian Province.It is necessary to strengthen the"co-management of three diseases"in key populations such as male,middle-aged and elderly,married or cohabiting individuals,and those with other marital statuses(divorced,widowed,separated,etc.),as well as those who are overweight,obese,and physically inactive.The multimorbidity management approach should be applied to improve management outcomes.
Objective To investigate the relationship between orthostatic hypotension and major cardiovascular dis-eases,including heart failure,coronary heart disease(CHD),and stroke.Methods The literature on the relation-ship between orthostatic hypotension and major cardiovascular diseases was systematically searched using databases such as PubMed,Web of Science,Cochrane Library,CNKI(China National Knowledge Infrastructure),VIP data-base,and Wanfang Data Knowledge Service Platform from inception up to November 30,2023.A meta-analysis was conducted using hazard ratios(HR)value as statistics.Results Six prospective studies were included in this meta-analysis.The follow-up time was 3 to 26 years.The quality scores of included literature were all ≥4,indicating a high-quality level.The meta-analysis results showed that orthostatic hypotension increased the risk of heart failure(HR=1.37,95％CI:1.24-1.52),CHD(HR=1.47,95％CI:1.04-2.07),and stroke(HR=1.60,95％CI:1.32-1.93).Subgroup analysis showed that follow-up duration was a cause of heterogeneity in the analysis for CHD.Sensitivity analysis showed that in the analysis for heart failure and stroke,the results were generally robust,while in the analysis for CHD,the result was not robust.The funnel plot for orthostatic hypotension in relation to heart failure,CHD,and stroke showed asymmetry,indicating the presence of publication bias.After correction using the trim-and-fill method,the funnel plot exhibited symmetry.Conclusions Orthostatic hypotension is po-tentially associated with heart failure,CHD and stroke.However,the sensitivity analysis regarding the relationship between CHD and orthostatic hypotension indicates that the results is unstable,and further research is needed.
Objective To investigate the association between hypoxia parameters and vascular endothelial dysfunction in patients with hypertension combined with obstructive sleep apnea-hypopnea syndrome(OSAHS)of different severity.Methods A cross-sectional study was conducted.A total of 629 hypertensive patients,aged(39.21±8.87)years,who visited the Hypertension Department of TEDA International Cardiovascular Hospital from April 2020 to July 2023 or Tianjin Kanghui Hospital from December 2023 to September 2024,were included.Male patients accounted for 77.6％(488/629)and female patients accounted for 22.4％(141/629).The patients underwent portable sleep monitoring and were categorized into 4 groups based on the apnea-hypopnea index(AHI):essential hypertension without OSAHS group(AHI＜5 events/hour,n=205),hypertension with mild OSAHS group(AHI 5 to＜15 events/hour,n=227),hypertension with moderate OSAHS group(AHI 15 to＜30 events/hour,n=1 12),and hypertension with severe OSAHS group(AHI≥30 events/hour,n=85).Vascular endothelial function was assessed via brachial artery flow-mediated dilation(FMD).Multivariate linear regression analysis was used to assess the correlation between hypoxia parameters and endothelial dysfunction.Receiver operating characteristic(ROC)curve analysis was used to preliminarily evaluate the diagnostic performance of the time spent below oxygen saturation of 90％(TS90％)on severe endothelial dysfunction in hypertensive patients with severe OSAHS.Results FMD in the hypertension with mild,moderate,and severe OSAHS group was(4.38±2.25)％,(4.20±1.96)％,and(3.95±2.04)％,respectively,which was lower than that in the essential hypertension group[(5.56±2.66)％](F=15.465,P＜0.001).Multivariate linear regression analysis showed that,after adjusting for estimated glomerular filtration rate(eGFR),uric acid,and other factors,TS90％had an independent impact on FMD in the hypertension with severe OSAHS group(B=-0.008,P=0.006).In the hypertension with severe OSAHS group,the area under the ROC curve(AUC)for TS90％diagnosing severe endothelial dysfunction was 0.692(95％CI:0.579 to 0.806;P＜0.001).The optimal cut-off value was 30.25 minutes,with a sensitivity of 80.43％and a specificity of 56.41％.Conclusion In hypertensive patients with severe OSAHS,TS90％is an independent influencing factor for endothelial dysfunction.
Objective To analyze the composition and characteristics of ocular surface microbiota in patients with essential hypertension based on high-throughput sequencing of 16S rDNA,and provide new ideas for the prevention and treatment of hypertension related eye diseases.Methods Sixty patients with essential hypertension who visited the outpatient department of Zigong First People's Hospital from July 2022 to December 2022 were selected as the hypertension group(HTN group),and 30 healthy volunteers from the same period were selected as the control group(Ctrl group).High-throughput sequencing technology was used to detect the V3-V4 variable regions of the 16S rDNA gene in ocular surface bacteria,and the differences between the two groups were compared.Results A total of 6 544 987 valid sequences and 3 748 operational taxonomic units(OTUs)were obtained through sequencing,including 1 296 OTUs unique to the HTN group and 476 OTUs unique to the Ctrl group.Diversity analysis showed that the abundance-based coverage estimator(ACE)index[494.03(356.68,888.36)vs 385.86(333.99,502.88),Z=-2.019,P=0.043]and Chao1 index[387.50(260.00,558.10)vs 343.15(256.45,413.55),Z=-2.009,P=0.045]of the HTN group were higher than those of the Ctrl group,and βdiversity analysis revealed distinct microbial community structures between the two groups(P＜0.05).The analysis of relative abundance of microbiota showed that the abundance of actinobacteria[0.203(0.123,0.319)vs 0.117(0.058,0.181),Z=-2.441,P=0.015]and corynebacterium[0.123(0.051,0.230)vs 0.034(0.017,0.100),Z=-2.822,P=0.004]in the HTN group was significantly higher than that in the Ctrl group.Characteristic bacterial linear discriminant analysis showed that compared with the Ctrl group,the abundance of actinobacteria,actinobacteria,corynebacteriales,and corynebacteriaceae in the HTN group increased.Functional analysis revealed that 14 pathways enriched in the HTN group,including nicotinate and nicotinamide metabolism,arachidonic acid metabolism,and riboflavin metabolism.Conclusion The ocular surface microbiota of hypertensive patients has changed significantly in diversity,relative abundance and characteristic fungi compared with healthy individuals.
To explore the correlation between life’s essential 8 (LE8) score developed by the American Heart Association and the inter-arm systolic blood pressure difference (IASBPD). A cross-sectional study was conducted with a total of 47,671 subjects. The association between LE8 score and IASBPD was analyzed using generalized linear models. The impact of LE8 score on IASBPD was analyzed using logistic regression models. The dose–effect relationship between LE8 score and IASBPD was assessed by a restricted cubic spline regression model. Stratified analysis was conducted for patients of different ages and genders, as well as for patients with and without tumors, and with and without coronary heart disease. IASBPD³10 mmHg was detected in 5,411 subjects (11.35%). After adjusting for confounders, a 10-point increase in LE8 score was associated with a decrease in IASBPD: 0.31 mmHg overall, 0.27 mmHg in males, 0.30 mmHg in females, 0.27 mmHg in the young and middle-aged group, and 0.26 mmHg in the elderly (all P < .01). Compared to the low cardiovascular health (CVH) group (LE8 score was 0–49), the risk of abnormal IASBPD was reduced by 24% (odds ratio [OR] = 0.76, 95% confidence interval [CI]: 0.71–0.81, P < .01) in the medium CVH group (LE8 score was 50–79) and by 65% (OR = 0.35, 95% CI: 0.29–0.43, P < .01) in the high CVH group (LE8 score was 80–100). Each standard deviation increase in LE8 score lowered the risk by 21% (OR = 0.79, 95% CI: 0.76–0.81, P < .01). Restricted cubic spline plot showed a significant nonlinear negative correlation between LE8 score IASBPD (P < .01). Significant interactions were found with gender and age (both P < .01). In stratified analysis high CVH reduced IASBPD risk by 72% (OR = 0.28, 95% CI: 0.20–0.38) in females, 43% (OR = 0.57, 95% CI: 0.44–0.74) in males, 63% (OR = 0.37, 95% CI: 0.30–0.46) in young and middle-aged group, and 53% (OR = 0.47, 95% CI: 0.29–0.76) in the elderly. Higher LE8 scores are associated with lower IASBPD, and this inverse relationship is more pronounced among females and individuals in the middle-aged and young adults.
Objective To evaluate the relationship between essential hypertension and the risk of colorectal tumor through a meta-analysis.Methods Chinese and English literatures about the relationship between essential hypertension and colorectal tumor published so far were searched in China National Knowledge Infrastructure(CNKI),Wanfang Database,VIP Database,Chinese Medical Journal Database,PubMed,Web of Science,The Cochrane Library and Embase Database.Information extraction and quality evaluation were carried out on the included documents,statistical analysis was carried out by using RevMan 5.3 software,forest map was drawn,and sensitivity and publication bias were detected.Results Six articles including 5 530 369 participants were finally included.Meta-analysis showed that the risk of colorectal tumor in patients with essential hypertension increased(OR=1.71,95％CI 1.65-1.77,P＜0.001).The results of sensitivity analysis showed that the results were stable,and the publication bias analysis showed that there was no significant publication bias.Conclusion There is a correlation between essential hypertension and colorectal tumor.
Objective To clarify the relationships between legume intake and the risk of major cardiovascular events and all-cause mortality.Methods In this study,the data was from the Prospective Urban and Rural Epidemiology China(PURE-China)cohort study,which enrolled adults aged 35-70 years in 115 urban and rural areas in 12 provinces in China from 2005 to 2009 and followed them up every three years.The follow-up deadline for this analysis was August 10th,2019.Legume intake was obtained through a validated food frequency questionnaire during face-to-face interviews,and was divided into four groups:＜10.0,10.0-＜72.4,72.4-＜214.7,≥214.7 g/d.The Cox frailty models were used to analyze the associations between legume intake and the risk of major cardiovascular events and all-cause mortality.Restricted cubic splines(RCS)analyses were used to examine the non-linear associations between legumes intake and the risks of major cardiovascular events and all-cause mortality.Results A total of 41 357 subjects were included in the analysis,and the median daily intake of legumes was 72.4(29.5,134.3)g/d.During 11.9(9.5,12.6)years of median follow-up,a total of 3 175 major cardiovascular events and 1 827 all-cause deaths were recorded.Legume intake was associated with the risk of major cardiovascular events(Pnon-linear＜0.001).In the multivariable-adjusted model,compared with individuals who consumed legumes of＜10.0 g/d,individuals who consumed legumes of 72.4-＜214.7 g/d had a 17.0％lower risk of major cardiovascular events(HR=0.83,95％CI 0.73-0.93,P=0.002)and 24.0％lower risk of all-cause mortality(HR=0.76,95％CI 0.66-0.89,P=0.001).Stratified analysis showed that in the elderly population,compared with the reference population,legume intake ranging from 72.4 to＜214.7 g/d was associated with a 34.0％reduction in the risk of major cardiovascular events(HR=0.66,95％CI 0.50-0.86,P=0.002).Among people with hypertension,compared with the reference population,legume intake ranging from 72.4 to＜214.7 g/d was associated with an 18.0％reduction in the risk of major cardiovascular events(HR=0.82,95％CI 0.71-0.95,P=0.008)and a 30.0％reduction in the risk of all-cause mortality(HR=0.70,95％CI 0.57-0.86,P=0.001).In the western region,compared with the reference population,the risk of major cardiovascular events reduced by 26.0％in the individuals with legumes intake of 72.4-＜214.7 g/d(HR=0.74,95％CI 0.59-0.93,P=0.008).In the eastern population,compared with the reference population,the risk of all-cause mortality reduced by 29.0％in the individuals with legumes intake of 72.4-＜214.7 g/d(HR=0.71,95％CI0.57-0.89,P=0.002).Conclusions There is a non-linear association between legumes intake and the risk of major cardiovascular events in the Chinese population.In the general population,elderly and hypertensive population,moderate legume intake(72.4-＜214.7 g/d)is associated with lower risks of major cardiovascular events and all-cause mortality.
Objective To analyze the risk factors of carotid atherosclerosis in physical examination population at different blood pressure levels.Methods A total of 6 912 subjects were retrospectively selected in people who underwent a physical examination and carotid artery color ultrasound examination at the medical examination center of The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University from January 2020 to December 2023.The subjects were divided into carotid atherosclerosis group(n=2 629)and normal carotid artery group(n=4 283)according to the results of carotid artery ultrasound.Logistic regression was used to analyze the contributing risk factors of carotid atherosclerosis in people with different blood pressure.Results The detection rate of carotid atherosclerosis in the subjects was 38.04％(2 629/6 912).The detection rates of carotid atherosclerosis in the normal blood pressure group,the high-normal blood pressure group,and the hypertension group were 25.16％(425/1 689),35.45％(1 076/3 035),and 51.55％(1 128/2 188)respectively.Multivariate logistic regression analysis showed that male(OR=2.091,95％CI 1.791-2.442),age(compared with ≤40 years,OR=3.945,95％CI 3.166-4.916 for 40-50 years,OR=9.000,95％CI 7.265-11.149 for＞50-60 years,OR=17.973,95％CI 13.964-23.134 for＞60-70 years,OR=41.994,95％CI 30.243-58.312 for＞70 years),hypertension(OR=1.416,95％CI 1.210-1.658),increased fasting blood glucose(compared with＜6.1 mmol/L,OR=1.278,95％CI 1.050-1.555 for 6.1-＜7.0 mmol/L,OR=1.523,95％CI 1.279-1.814 for ≥7.0 mmol/L),increased low-density lipoprotein cholesterol(LDL-C)(OR=1.640,95％CI 1.459-1.844),white blood cell count(OR=1.047,95％CI 1.009-1.086),and platelet count(OR=1.001,95％CI 1.000-1.002)were independent risk factors for carotid atherosclerosis(all P＜0.05).In people with normal blood pressure,male,age,fasting blood glucose ≥ 7.0 mmol/L,increased LDL-C,and monocyte count were independent risk factors for carotid atherosclerosis(all P＜0.05).In people with high-normal blood pressure,male,age,increased fasting blood glucose,and increased LDL-C were independent risk factors for carotid atherosclerosis(all P＜0.05).In hypertensive people,age,fasting blood glucose ≥7.0 mmol/L,increased LDL-C,neutrophils,and creatinine were independent risk factors for carotid atherosclerosis(all P＜0.05).Conclusions Age,increased fasting blood glucose and increased LDL-C are common risk factors for carotid atherosclerosis in people with different blood pressures.Besides these factors,male and monocyte count are independent risk factors for carotid atherosclerosis in people with normal blood pressure,male is independent risk factor for carotid atherosclerosis in people with high-normal blood pressure,and neutrophils and creatinine are independent risk factors for carotid atherosclerosis in people with hypertension.
Objective To explore the potential differences of the association between cardiovascular health(CVH)scores,which was evaluated by the life's essential 8(LE8)metrics,and the incidence of cardiovascular disease(CVD)across different genders and age groups.Methods A prospective cohort study was conducted.The Kailuan study population who participated in the 2006 health examination was selected as the research subjects.After excluding those with incomplete LE8 data or a prior history of CVD at the time of the 2006 health examination,92 230 individuals were included in the analysis.The revised CVH scores,which encompassed eight key metrics-dietary status,physical activity,nicotine exposure,sleep duration,body mass index(BMI),lipids,blood glucose,and blood pressure-were categorized into three groups:low CVH,moderate CVH,and high CVH.Kaplan-Meier method was used to calculate the cumulative incidence of CVD of these CVH subgroups,and Log-rank test was used to compare the difference of the cumulative incidence of CVD among groups.To evaluate the independent association between CVH scores and CVD,a multifactorial Cox regression analysis was performed.Additionally,stratified analyses by sex and age were conducted to investigate potential interactions.Results Among 92 230 participants from the Kailuan community,79.37％were male.Over an average follow-up period of(14.36±3.71)years,11 377 cases of CVD were identified.Multifactor Cox regression analysis showed that after adjusting for confounding factors such as alcohol consumption,education level,marital status,income level,family history of CVD,and triglyceride levels,in subjects＜45 years of age,each standard deviation increase in CVH score was associated with a 48％reduction in the risk of CVD among women(HR=0.52,95％CI 0.46-0.60,P＜0.001),and a 40％reduction in the risk of CVD among men(HR=0.60,95％CI 0.57-0.64,P＜0.001);in subjects＞65 years of age,each standard deviation increase in CVH score was associated with a 29％reduction in CVD risk among women(HR=0.71,95％CI0.64-0.80,P＜0.001),and a 18％reduction risk in CVD risk among men(HR=0.82,95％CI 0.79-0.86,P＜0.001).Conclusion The inverse relationship between CVH scores,as evaluated by the LE8 framework,and the risk of CVD is notably stronger among women and younger demographic groups.
Objective To develop an interpretable machine learning model to predict all-cause mortality risk in patients with hypertension and heart failure with preserved ejection fraction(HFpEF).Methods A prospective cohort of 847 patients diagnosed with hypertension and HFpEF from 3 tertiary hospitals in Shanxi Province between April 2014 and March 2019 was followed until April 1,2022.All-cause mortality was used as the outcome event.The cohort was randomly divided into training(70％)and testing(30％)sets.The training set was used to construct prediction models,and the testing set was used for performance evaluation.Predictors were selected using the least absolute shrinkage and selection operator(LASSO)-Cox regression.Six machine learning models,including extreme gradient boosting(XGBoost),logistic regression,random forest(RF),decision tree(DT),support vector machine(SVM),and multilayer perceptron(MLP),were developed to predict the 3-year all-cause mortality risk.Model performance was evaluated using receiver operating characteristic(ROC)curves,calibration curves,and clinical decision curves.The Shapley additive explanations(SHAP)framework was applied to the simplified optimal model interpret,and restricted cubic spline models were used to explore the nonlinear relationships between key predictors and all-cause mortality.Results After a median follow-up of 4.25(P25,P75 2.86,6.17)years,224 patients(26.4％)experienced all-cause mortality.Using the LASSO-Cox regression,17 predictors were identified from patients'clinical characteristics,including vital signs,laboratory tests,and imaging results.The RF model achieved the best performance,with an area under the ROC curve(AUC)of 0.823(95％CI:0.693-0.950),accuracy of 84.0％,sensitivity of 82.3％,specificity of 83.0％,and an F1 score of 0.810.Calibration and clinical decision curves confirmed the RF model's good calibration and clinical applicability.SHAP feature importance analysis revealed that age,estimated glomerular filtration rate(eGFR),systolic blood pressure,and body mass index(BMI)were the top 4 factors influencing all-cause mortality in patients with hypertension and HFpEF.Further restricted cubic spline analysis indicated that age＞72 years,eGFR＜72.9 mL/(min·1.73 m2),systolic blood pressure＞136 mmHg,and BMI＞26.6 kg/m2 were associated with increased all-cause mortality risk.To enhance the clinical applicability of risk warning thresholds,clinically practical thresholds were selected for Cox regression analysis.The results showed that systolic blood pressure＞135 mmHg(HR=1.362,95％CI:1.020-1.819)and eGFR＜70 mL/(min·1.73 m2)(HR=1.519,95％CI:1.135-2.034)were both significantly associated with an increased risk of all-cause mortality.Conclusions The RF-based prediction model can effectively estimate 3-year all-cause mortality risk in patients with hypertension and HFpEF after discharge.SHAP-based interpretability analysis can provide clear insights for clinical decision-making.
Objective To investigate the correlation between systemic immune inflammation index(SII)and carotid plaque in middle-aged patients with essential hypertension(EH).Methods A total of 4 782 middle-aged patients with EH who received carotid ultrasound examination at the Health Management Center of the First Affiliated Hospital of Anhui Medical University between January and December 2023 were selected and divided into the non-plaque group(n=3 570)and the plaque group(n=1 212)according to the results of carotid ultrasound.The general clinical and laboratory information was collated and subsequently compared between the two groups.Furthermore,the plaque detection rate and plaque characteristics(including plaque acoustic characteristics and the number and sites of occurrence)were analysed according to the SII tertile groups.Multivariate logistic regressions were used to analyse the impact of SII on carotid plaque in middle-aged patients with EH.Subgroup analyses were conducted with interaction effects investigating.Results The SII level in the plaque group was significantly higher than that in the non-plaque group(459.99±164.19 vs 389.47±140.99,t=-13.372,P＜0.001).The SII level was significantly higher in patients with homogeneous hypoechoic or inhomogeneous echo plaques than in patients with homogeneous strong echo or isoechoic plaques(495.64±169.61 vs 428.43±152.57,t=-7.262,P＜0.001).Furthermore,the SII level was significantly elevated in cases of bilateral or multiple plaques compared to cases of unilateral single ones(500.24±189.13 vs 425.18±129.50,t=-7.936,P＜0.001).The SII tertile grouping analysis demonstrated a gradual increase in the carotid plaque detection rate from the low to high tertile group(16.8％vs 23.7％vs 35.5％,x2=152.043,P＜0.001).Among patients with plaques,the proportion of homogeneous strong or isoechoic plaques exhibited a gradual decline from the first to the third tertile group of SII(70.4％,52.9％,and 45.0％,respectively),while the proportion of homogeneous hypoechoic or inhomogeneous plaques exhibited a gradual increase(29.6％,47.1％,and 55.0％,respectively),and the difference was statistically significant(x2=47.166,P＜0.001).In addition,the proportion of unilateral single plaques gradually decreased(62.9％,59.8％,and 45.1％,respectively),while the proportion of bilateral or multiple plaques gradually increased(37.1％,40.2％,and 54.9％,respectively),with a statistically significant difference(x2=31.430,P＜0.001).After adjusting for confounding variables,multivariate logistic regression analyses demonstrated that for every one standard deviation(150.36)increase in the SII,the odds ratio(95％confidence interval)[OR(95％CI)]for the presence of carotid plaques was 1.533(1.428-1.645).In comparison to the first tertile of SII,the risk of carotid plaque presence significantly increased in the second and third tertiles(P for trend＜0.001),with ORs(95％CI)of 1.361(1.131-1.638)and 2.538(2.122-3.035),respectively.Further subgroup analyses revealed that the significant association between SII and carotid plaques remained consistent across multiple subgroups,and interaction tests did not yield meaningful results(all P＞0.05).Conclusion Elevated SII level is an influencing factor for carotid plaque in middle-aged patients with EH,and is correlated with the number and stability of plaque.
Objective To evaluate arterial elasticity in children with essential hypertension by measuring carotid-femoral pulse wave velocity(cfPWV)and brachial-ankle pulse wave velocity(baPWV),and to explore the related influencing factors.Methods One hundred and sixty-six children diagnosed as essential hypertension in Children's Hospital Affiliated to Capital Institute of Pediatrics from April 2021 to April 2022 were selected as hypertension group,and according to the blood pressure levels,they were divided into hypertension grade 1 group(138 cases)and hypertension grade 2 group(28 cases).Thirty children with normal blood pressure who underwent physical exami-nation in the hospital during the same period were selected as control group.The general clinical and biochemical in-dicators were recorded.The cfPWV was measured by SphygmoCor cardiovascular function detector,and the baPWV was measured by Omron arteriosclerosis detector.The influencing factors of cfPWV and baPWV in children with es-sential hypertension were identified by univariate and multivariate linear regression analysis.Results The cfPWV and baPWV of children in hypertension grade 2 group were significantly higher than those of children in hypertension grade 1 group and the control group[cfPWV:5.8(5.3,6.6)vs 5.5(5.0,6.1)vs 5.1(4.5,5.4)m/s,H=16.609,P＜0.001;baPWV:1 073.8(972.1,1 174.0)vs 964.0(886.0,1 073.3)vs 907.8(862.4,980.6)cm/s,H=22.054,P＜0.001].Multifactor linear regression analysis showed that body mass index(BMI),systolic blood pressure(SBP)and diastolic blood pressure(DBP)were independent influencing factors of cfPWV(P＜0.05),and age,SBP and DBP were independent influencing factors of baPWV(P＜0.05).Conclusions The cfPWV and baPWV of children with essential hypertension were significantly increased,suggesting that their arterial elasticity decreased.Age,BMI,SBP and DBP may be independent risk factors for decreased arterial elasticity in children with essential hypertension.
Objective To explore the effects of aerobic treadmill exercise on blood pressure and intestinal flora of spontaneously hypertensive rats(SHR).Methods Twelve male 8-week-old SHR were randomly divided into SHR group and SHR exercise group,with 6 in each group,and 6 male Wistar Kyoto(WKY)rats of the same age were set as the normal blood pressure control group.Rats in the normal blood pressure control group and SHR group were placed on a stationary treadmill for 60 min/day,5 days/week,while the rats in the SHR exercise group under-went continuous 8 weeks of treadmill exercise(speed 18-20 m/min,treadmill slope 0°,60 min/day,5 days/week).Systolic and diastolic blood pressure of the rat tail artery were measured on the day before the experiment and at week 2,4,6 and 8 of the experiment.Fecal samples were collected from rats in each group 8 weeks after the experiment for 16S rDNA high-throughput sequencing to analyze the composition and diversity of intestinal flora.Results Compared with the SHR group,the systolic blood pressure and diastolic blood pressure of the SHR exer-cise group rats significantly decreased at week 8(P＜0.05).There was no significant difference in a diversity be-tween SHR and SHR exercise group(P＞0.05),and the flora structure in SHR exercise group was more similar to that of the normal blood pressure control group.Compared with the SHR group,in the SHR exercise group,at the phylum level,the relative abundance of Elusimicrobia increased(P＜0.05),and the relative abundance of Spiro-chaetes decreased(P＜0.05);and at the genus level,the relative abundance of beneficial bacterial genera such as Elusimicrobium and Ruminococcaceae UCG-009 increased(P＜0.05).The genera Elusimicrobium,Marvinbryan-tia,Negativibacillus,Ruminococcus_1 and Dubosiella,which were negatively correlated with systolic blood pres-sure,were significantly increased(P＜0.05),and ASF356,which was positively correlated with systolic blood pressure,showed a significant decrease after treadmill exercise intervention(P＜0.05).Conclusion Treadmill exercise can reshape the composition of intestinal flora in SHR rats,enrich the beneficial genera and reduce the harmful bacterial abundance in the intestinal tract,restore intestinal microecological balance,thus exerting antihy-pertensive effects.
