Hypertensive cardiac hypertrophy is a major pathological consequence of chronic hypertension, leading to heart failure and increased cardiovascular morbidity. Emerging evidence highlights the critical role of neuroinflammation in the development and progression of hypertensive cardiac hypertrophy. This review provides a comprehensive overview of the interplay between neuroinflammation and hypertensive cardiac hypertrophy, focusing on the roles of the sympathetic nervous system (SNS), immune activation, and central nervous system (CNS) dysregulation. We also explore the molecular mechanisms underlying neuroinflammation-induced cardiac remodeling and discuss potential therapeutic strategies targeting neuroinflammatory pathways. By integrating recent preclinical and clinical findings, this review aims to shed light on novel approaches to prevent or reverse hypertensive cardiac hypertrophy through modulation of neuroinflammation.

Hypertensive cardiac hypertrophy (HCH) is a compensatory response to chronic pressure overload, ultimately progressing to heart failure if left unmanaged. Emerging evidence highlights the critical role of mitochondrial dysfunction in HCH pathogenesis, with impaired mitophagy-a selective autophagic process that removes damaged mitochondria-contributing to cardiomyocyte death, oxidative stress, and fibrosis. Protective mitophagy eliminates damaged mitochondria, averting reactive oxygen species (ROS)/calcium overload in HCH. Conversely, its dysregulation-either insufficient clearance or excessive removal-exacerbates mitochondrial dysfunction, driving pathological hypertrophy, fibrosis, and bioenergetic crisis. This dual nature presents a therapeutic paradox demanding contextual modulation. This review comprehensively examines the molecular mechanisms underlying mitophagy dysregulation in HCH, focusing on key pathways such as PINK1/Parkin, BNIP3/NIX, and FUNDC1. We also discuss the interplay between mitophagy and other cellular processes, including mitochondrial biogenesis, inflammasome activation, and metabolic remodeling. Furthermore, we explore potential therapeutic strategies targeting mitophagy to ameliorate HCH, including pharmacological agents, lifestyle interventions, and gene therapy approaches. Understanding the dual role of mitophagy in HCH-both protective and detrimental-may pave the way for novel precision medicine strategies in cardiovascular disease.

Objective:To explore the effect of obesity on obstructive sleep apnea (OSA) combined with hypertension and the associated risks, to clarify the value of different obesity assessment indicators (body mass index [BMI], neck circumference [NC], waist circumference [WC], body fat percentage [BF%], and visceral adiposity index [VAI]) in predicting hypertension risk in OSA patients, and to provide regional evidence for hypertension risk stratification of OSA patients in Southwest China. Methods:A total of 299 OSA patients were enrolled at the Sleep Medicine Center, West China Fourth Hospital, Sichuan University in 2024. The participants were divided into a simple OSA group (179 cases) and a group of those with OSA combined with hypertension (120 cases) according to their hypertension diagnosis. Logistic regression was performed to assess the risk association between obesity indicators and OSA combined with hypertension. Receiver operating characteristic (ROC) curves were plotted to evaluate the predictive performance of each indicator, and age stratification (≤ 45 years or > 45 years) was performed to analyze risk differences. Results:Significant differences were observed between the two groups (the OSA combined with hypertension group and the OSA-only group) in terms of age (the proportion of middle-aged and older adults, 65.0% and 38.5%, respectively), educational attainment (high school or below, 37.5% and 22.9%, respectively), and family history of hypertension (60.0% and 33.0%, respectively) (P < 0.01). All obesity indicators were positively correlated with the risk of OSA combined with hypertension, with progressively increasing risk observed across higher indicator categories. VAI exhibited the most pronounced risk gradient: the risk for participants with VAI ≥ P75 was 45.96 times that for those with VAI < P25 (odds ratio [OR] = 45.96, 95% CI: 15.46-136.59), and the risk for participants with VAI between P50 and P75 was 8.06 times that for those with VAI < P25 (OR = 8.06, 95% CI: 2.86-22.73). VAI demonstrated the best predictive performance (area under the curve [AUC] = 0.856; 95% CI: 0.819-0.893), outperforming traditional indicators (AUCBMI = 0.821, 95% CI: 0.782-0.860; AUCWC = 0.799, 95% CI: 0.760-0.838). The hypertension risk associated with each obesity indicator in the middle-aged and older adult group was higher than that in the younger group. Conclusion:Obesity is a key risk factor for OSA combined with hypertension. VAI demonstrates the best predictive performance for the risk of OSA combined with hypertension and can be used as a priority indicator for hypertension screening in OSA patients in Southwest China. Age and obesity indicators exhibit a cumulative risk effect, which highlights the need to strengthen obesity management in middle-aged and older populations with OSA.

Objective:To investigate the effect of obstructive sleep apnea syndrome (OSAS) on nocturnal ambulatory blood pressure monitoring results in older adults without cardiovascular or cerebrovascular diseases, and to identify factors causing fluctuations in nocturnal blood pressure in older adults with OSAS. Methods:A total of 169 older adult OSAS patients with no history of cardiovascular or cerebrovascular diseases were enrolled. According to their severity of OSAS, the participants were divided into 4 groups, including a normal OSAS group, a mild OSAS group, a moderate OSAS group, and a severe OSAS group. The baseline characteristics of the 4 groups were compared to identify differences. The relationship between polysomnography parameters and nocturnal ambulatory blood pressure monitoring results and the factors causing nocturnal blood pressure fluctuations in older adults with OSAS were further analyzed. Results:The nocturnal blood pressure fluctuation (NBPF) index of the normal OSAS group, the mild OSAS group, the moderate OSAS group, and the severe OSAS group were 1.89 ± 1.58, 3.35 ± 5.40, 3.90 ± 6.40, and 16.60 ± 27.70, respectively, indicating that the NBPF index gradually increased with the increasing severity of OSAS (P < 0.05). According to findings from the partial correlation analysis, the NBPF index was positively correlated with apnea-hypopnea index (AHI), micro-awakening index (MAI), percentage of cumulative time with oxygen saturation under 90% in the total sleep time (TS90%), oxygen desaturation index (ODI), and the longest apnea time (LAT) (P < 0.05), and negatively correlated with the lowest oxygen saturation (LSpO2) and sleep quality index (SQI) (P < 0.05). The mean nocturnal systolic and diastolic blood pressures were positively correlated with AHI, ODI, and TS90% (P < 0.05). A multi-factor regression analysis showed that every time ODI increased by 1 unit, the NBPF index increased by 0.26 units (β = 0.26; 95% CI, 0.03-0.50; P = 0.030), and every time TS90% increased by 1 unit, the NBPF index increased by 26.78 units (β = 26.78; 95% CI, 2.47-51.08; P = 0.031). Conclusion:In older adult OSAS patients without cardiovascular or cerebrovascular disease, fluctuations in blood pressure at night become more pronounced with increasing disease severity. ODI and TS90% are important factors that affect nocturnal blood pressure fluctuations.

OBJECTIVE:To evaluate the clinical efficacy and safety of Yangxue Qingnao Pills (YXQNP) combined with amlodipine in treating patients with grade 1 hypertension. METHODS:This is a multicenter, randomized, double-blind, and placebo-controlled study. Adult patients with grade 1 hypertension of blood deficiency and Gan (Liver)-yang hyperactivity syndrome were randomly divided into the treatment or the control groups at a 1:1 ratio. The treatment group received YXQNP and amlodipine besylate, while the control group received YXQNP's placebo and amlodipine besylate. The treatment duration lasted for 180 days. Outcomes assessed included changes in blood pressure, Chinese medicine (CM) syndrome scores, symptoms and target organ functions before and after treatment in both groups. Additionally, adverse events, such as nausea, vomiting, rash, itching, and diarrhea, were recorded in both groups. RESULTS:A total of 662 subjects were enrolled, of whom 608 (91.8%) completed the trial (306 in the treatment and 302 in the control groups). After 180 days of treatment, the standard deviations and coefficients of variation of systolic and diastolic blood pressure levels were lower in the treatment group compared with the control group. The improvement rates of dizziness, headache, insomnia, and waist soreness were significantly higher in the treatment group compared with the control group (P<0.05). After 30 days of treatment, the overall therapeutic effects on CM clinical syndromes were significantly increased in the treatment group as compared with the control group (P<0.05). After 180 days of treatment, brachial-ankle pulse wave velocity, ankle brachial index and albumin-to-creatinine ratio were improved in both groups, with no statistically significant differences (P>0.05). No serious treatment-related adverse events occurred during the study period. CONCLUSIONS:Combination therapy of YXQNP with amlodipine significantly improved symptoms such as dizziness and headache, reduced blood pressure variability, and showed a trend toward lowering urinary microalbumin in hypertensive patients. These findings suggest that this regimen has good clinical efficacy and safety. (Registration No. ChiCTR1900022470).

The consensus guidelines of the Geriatric Society of Chinese Medical Association on the management of atrial fibrillation (AF) in the elderly was first published in 2011 and updated in 2016, with endorsement by Chinese Society of Geriatric Health Medicine. Since then, many important studies regarding the screening and treatment in the elderly population have been reported, necessitating this updated expert consensus guideline. The writing committee members comprehensively reviewed updated evidence pertaining to elderly patients with AF, and formulated this 2024 update. The highlighted issues focused on the following: screening for AF, geriatric comprehensive assessment, use of the Atrial fibrillation Better Care (ABC) pathway for the elderly patients, and special clinical settings related to elderly patients with AF. New recommendations addressing smart technology facilitated AF screening, ABC pathway based management, and optimal anticoagulation were developed, with a focus on the elderly.

2022中国老龄化研究报告显示,2020年我国65岁以上老龄人口达到1.91亿,占总人口比重为13.5％,全球每4个老年人中就有1个中国人.预计2057年中国65岁以上人口达4.25亿人的峰值,占总人口比重32.9％～37.6％.2033年老龄化人口占比将＞20％,达到超级老龄化社会,随后老龄化人口占比持续快速升高,2060年将达到35％.随着老龄化人口增加,心血管病危险也随之增加.弗莱明翰危险评分系统或者欧洲心血管手术危险因素评分系统显示,老龄化是最强的心血管危险因素.美国研究数据显示,65岁以上老年人群心血管病相关死亡率＞80％,80岁以上高龄老年男性心血管病发病率为79％,女性为85％.在80岁以上高龄老年患者中,20％发生心肌梗死和30％发生心肌梗死相关死亡.我国研究显示,血脂异常与合并心肌梗死的高龄心血管病患者死亡密切相关[1].流行病学研究表明,在中年到第7个十年中,血清TC和LDL-C随着年龄增长而增加的趋势尤为明显.但是在老年人中,血清TC水平则趋于稳定甚至下降.

氢是化学元素周期表中的第一个元素,化学符号"H",是惟一由几种同位素组成的物质元素.自然界中存在的 H同位素有氕、氘、氚,氕是自然界中含量最丰富的氢同位素(丰度达99.98％),氕原子核只有一个质子,不含中子,是构造最简单的原子.两个氢原子组成氢分子即氢气(H2).H2在潜水医学领域研究和应用已有80多年,它是一种安全的潜水使用气体,目前还没有发现对人体的不利作用.

The most recent primary cardiovascular disease (CVD) prevention clinical guidelines used in Europe, Italy, the USA, China, and South Korea differ in aspects of their approach to CVD risk assessment and reduction. Low dose aspirin use is recommended in certain high-risk patients by most but not all the countries. Assessment of traditional risk factors and which prediction models are commonly used differ between countries. The assessments and tools may not, however, identify all patients at high risk but without manifest CVD. The use of coronary artery calcium (CAC) score to guide decisions regarding primary prevention aspirin therapy is recommended only by the US primary prevention guidelines and the 2021 European Society of Cardiology guidelines. A more consistent and comprehensive global approach to CVD risk estimation in individual patients could help to personalize primary CVD prevention. Wider detection of subclinical atherosclerosis, together with structured assessment and effective mitigation of bleeding risk, may appropriately target patients likely to gain net benefit from low dose aspirin therapy.

老年患者区别于非老年患者的重要特点是多种疾病共存.老年人因器官衰老、生理功能减退而易患多种慢性病,2008年世界卫生组织正式将共病(multimorbidity)定义为共存于同一患者体内病理不同、不互相依赖的2种或2种以上的慢性病[1].伴随着全球老龄化的快速进程,共病的患病率随增龄而增加,已成为威胁老年人群生存与健康的重要隐患,是目前全球医疗关注的热点之一,也是当前老年医学面临的重大课题之一.老年共病患者的科学管理涉及到患者生存质量和健康预期寿命的提高,因此美国老年医学会(2012年,2019年)和中国老年保健医学研究会(2018年)曾先后发表过相关指南和专家共识,推动了老年共病患者的科学管理进程[2-4].现结合老年共病患者的特点及笔者临床诊治的经验,提出老年共病患者的管理模式,涉及到评估-决策-实施3个部分.

目前,心血管疾病仍然是全球最主要的死因,2017年已造成全球约1780万人死亡[1].该病最常见的死因是缺血性心脏病.冠状动脉粥样硬化性心脏病(冠心病)是缺血性心脏病的主要类型.因其病程动态特性带来各异的临床表现,可被归类为急性冠状动脉综合征(acute coronary syndrome,ACS)或慢性冠状动脉综合征(chronic coronary synd-rome,CCS).据估计,中国冠心病的患病人数已达1100万,且患病率和死亡率仍处上升阶段[2].CCS是老年冠心病患者的主要表现类型,患者人数多、病程长、预后差,导致生活质量下降,疾病负担与经济负担沉重;尤其是高危CCS患者,病死率和总死亡率高,尽管目前标准的预防和治疗策略,使患者生存期得以延长,但残留心血管风险仍然较高.

The present study aimed to investigate the effects of the overexpression of sarco/endoplasmic reticulum Ca2+-ATPase (SERCA2a) on endoplasmic reticulum (ER) stress (ERS)-associated inflammation in neonatal rat cardiomyocytes (NRCMs) induced by tunicamycin (TM) or hypoxia/reoxygenation (H/R). The optimal multiplicity of infection (MOI) was 2 pfu/cell. Neonatal Sprague-Dawley rat cardiomyocytes cultured in vitro were infected with adenoviral vectors carrying SERCA2a or enhanced green fluorescent protein genes, the latter used as a control. At 48 h following gene transfer, the NRCMs were treated with TM (10 mu g/ml) or subjected to H/R to induce ERS. The results of electrophoretic mobility shift assay (EMSA) revealed that overexpression of SERCA2a attenuated the upregulation of nuclear factor (NF)-kappa B and activator protein-1 (AP-1) DNA-binding activities induced by TM or H/R. Western blot analysis and semi-quantitative RT-PCR revealed that the overexpression of SERCA2a attenuated the activation of the inositol-requiring 1 alpha (IRE1 alpha) signaling pathway and ERS-associated apoptosis induced by TM. The overexpression of SERCA2a also decreased the level of phospho-p65 (Ser536) in the nucleus, as assessed by western blot analysis. However, the overexpression of SERCA2a induced the further nuclear translocation of NF-kappa B p65 and higher levels of tumor necrosis factor (TNF)-alpha transcripts in the NRCMs, indicating the occurrence of the ER overload response (EOR). Therefore, the overexpression of SERCA2a has a 'double-edged sword' effect on ERS-associated inflammation. On the one hand, it attenuates ERS and the activation of the IRE1 alpha signaling pathway induced by TM, resulting in the attenuation of the upregulation of NF-kappa B and AP-1 DNA-binding activities in the nucleus, and on the other hand, it induces EOR, leading to the further nuclear translocation of NF-kappa B and the transcription of TNF-alpha. The preceding EOR may precondition the NRCMs against subsequent ERS induced by TM. Further studies using adult rat cardiomyocytes are required to prevent the interference of EOR. The findings of the present study may enhance the current understanding of the role of SERCA2a in cardiomyocytes.

Influenza and pneumonia can be prevented by vaccination, but they remain major causes of morbidity and mortality in age-related diseases. In most areas of China, the rates of influenza and pneumococcal vaccination are relatively low and public awareness of vaccination remains insufficient. Thus, it is essential to recommend influenza and Streptococcus pneumoniae vaccination to elderly people in clinical practice. Based on recently published studies and related documents issued by several vaccination authorities, such as the World Health Organization, the National Health and Wellness Committee, the Chinese Center for Disease Control and Prevention, the US Centers for Disease Control and Prevention, and the US Advisory Committee on Immunization Practices, we propose official recommendations for influenza and S pneumoniae vaccination in elderly people in China.

Background Obesity is a disease characterized by much fat accumulation and abnormal distribution, which was related to cardiovascular diseases, diabetes mellitus (DM) and muscular skeletal diseases. The aim of this study was to evaluate the usefulness of appendicular skeletal muscle mass to total body fat ratio (ASM/TBF) in screening for the risk of obesity in elderly people. Methods A prospective study was carried out with 446 participants (non-obese elderly people with body mass index (BMI) < 28 kg/m 2 ) who underwent baseline and an average around 2.2-year follow-up health check-up examinations. Results The mean age at baseline was 63.6 years. The incidence of new obesity was 5.4% during follow-up. Linear regression demonstrated that baseline ASM/TBFs were negatively correlated with follow-up BMIs in both men and women ( β = − 1.147 (− 1.463—-0.831) for men and − 4.727 (− 5.761—-3.692) for women). The cut-off points of baseline ASM/TBF in elderly people for obesity were 1.24 in men and 0.90 in women which were identified by Classification and Regression Tree (CART). Logistic regression showed that both men and women with decreased ASM/TBF had higher risks of obesity over the follow-up period ( Relative Risk ( RRs ) = 5.664 (1.879–17.074) for men and 34.856 (3.930–309.153) for women). Conclusions Elderly people with a low ASM/TBF had a higher risk of new obesity, which suggested that ASM/TBF should be considered in obesity management in the elderly.

This study aimed to explore the prevalence and the in-hospital mortality of hyponatremia in older inpatients who were diagnosed and treated at a single center. Nearly a quarter of older inpatients presented with hyponatremia, which was most frequently associated with common primary diseases such as respiratory diseases, tumors, cardiovascular diseases, central nervous system diseases, and orthopedic diseases. Patients were most likely to use drugs such as PPIs, loop diuretics, potassium-preserving diuretics, ACEIs/ARBs, thiazide diuretics and NSAIDs, which were often associated with hyponatremia. The in-hospital mortality rate among patients with hyponatremia was 11.7%, and this rate increased with the severity of the disorder. Early mobilisation on the day of/after surgery should be added as a new formal hip fracture standard of care in keeping with best international practice. This study aimed to explore the incidence, clinical features, etiology, and mortality of hyponatremia in older inpatients and thus provide preliminary data for an epidemiological study. Hospitalized older patients diagnosed with hyponatremia at the First Medical Center of PLA General Hospital during January 2013–December 2016 were stratified by serum sodium concentrations into mild (130– < 135 mmol/L), moderate (125– < 130 mmol/L) and severe hyponatremia groups (< 125 mmol/L). Etiologies, medication histories, hospitalization times, and outcomes were analyzed. During the indicated period, 4364 older patients with hyponatremia were hospitalized, including 2934 men and 1430 women with an average age of 84.6 ± 3.5 years (range 80–104 years). The prevalence of hyponatremia was 24.7%. An analysis of common primary diseases identified respiratory diseases as the most frequent (25.0%), followed by tumors (23.1%), cardiovascular diseases (19.9%), central nervous system diseases (8.9%), and orthopedic diseases (6.1%). PPIs (59.7%), loop diuretics (57.4%), potassium-preserving diuretics (29.5%), ACEIs/ARBs (20.0%), thiazide diuretics (12.5%), and NSAIDs (12.4%) were the drugs most commonly associated with hyponatremia. The in-hospital mortality rate was 11.7%. Aggravated hyponatremia led to a prolonged hospitalization time. Moreover, when compared with mild hyponatremia, moderate and severe hyponatremia were associated with significant increases in in-hospital mortality (ORs 1.89 and 2.66, respectively; 95% CIs 1.54–2.33 and 2.06–3.43, respectively; P < 0.01). Hyponatremia is a common complication in hospitalized older patients and is caused mainly by respiratory diseases, tumors, and cardiovascular diseases. Given the correlation between the degree of hyponatremia and prognosis, the early and accurate identification and treatment of this condition can reduce the associated morbidity and mortality.

目前,我国已成为世界上老年人口数量最多的国家,而且老龄化的速度也已成为世界上最快的国家之一.截至2019年底,我国已成为世界上唯一的老年人口数量超过2亿的国家,全国60岁及以上老年人口的数量约为2.54亿,占全国总人口的18.1％.我国人口老龄化的这一严峻挑战,也为老年医学的发展带来巨大的机遇. 1 老年医学面I临严峻挑战 1.1我国老年人的整体健康状况不容乐观我国患有各种慢性病的老年人数量超过1.8亿,患有一种及以上慢性病的老年人比例高达75％,因各类慢性病而呈失能、半失能状态的老年人数量约为4 000万.老年人失能的主要原因是慢性病,如心脑血管疾病、恶性肿瘤、呼吸系统疾病、代谢性疾病、骨关节疾病等.目前,我国人均预期寿命为77岁,但健康预期寿命仅为68.7岁,说明老年人的患病时间早,带病时间长,生活质量还不够高.

2019年ESC发布了《2019 ESC慢性冠状动脉综合征诊治指南》[1].摒弃了以往稳定性冠心病的概念,明确提出慢性冠状动脉综合征(choronic coronary syndrome,CCS)的概念.由于CCS是老年冠心病患者的主要表现形式,因此了解《2019 ESC慢性冠状动脉综合征诊治指南》更新的概念内涵和诊治原则对于老年医学专科医师十分重要.

自2014年国家启动了住院医师规范化培训试点后,于2016年又开展了专科医师规范化培训专科目录的研究.基于此,本研究将美国、英国、加拿大、日本与中国相关的专业和专科目录设置情况进行对比,并与我国住院医师规范化培训专业目录设置进行异同分析,旨在为推动我国毕业后医学教育进程,逐步完善住专一体化培训提供有益的参考.

2018年,几项阿司匹林一级预防研究的阴性结果公布后,阿司匹林一级预防的必要性引起业内专家的关注和争议.2019年1月5日,来自心血管与消化领域的9位专家齐聚北京,召开了关于阿司匹林一级预防进展的报告会.会议由李小鹰、赵冬、施仲伟教授共同主持,郭艺芳、张存泰、刘宏斌、阴大伟、史旭波、郑松柏、宋志强教授先后报道了各自专题文献检索的结果,结合现有循证证据和我国国情,对阿司匹林一级预防面临的问题进行了深入讨论.