Effects of Guideline-based Hypertension Management in Rural Areas of Guangdong Province

Background:Despite the improvement in the health care industry,the rates of undetected,untreated,and uncontrolled hypertension (HTN)are still very high,especially in rural areas of China.The aim of this study was to investigate the efficacy and efficiency of a guideline-based HTN management (novel therapy) in population of rural areas of Guangdong Province.Methods:Totally,3113 patients with essential HTN in a rural area of Guangdong Province were enrolled and assigned to two groups,named traditional (n =372) and novel therapeutic (n =2741) groups,respectively.Patients in the traditional group were treated routinely,and patients in the novel group were treated in a novel model characterized by regular educational programs for hypertensive populations,close monitoring of blood pressure in combination with finely tuned antihypertensive medications,strict implementation of lifestyle modification and improving medical knowledge and skill of local medical staff efficiently.After 2 years of follow-up,primary endpoints including magnitude of systolic and diastolic blood pressures (SBP and DBP) decrease,treated and controlled rates,as well as secondary endpoints,were evaluated in both groups.Results:Initially,the treated rate was significantly higher in traditional group than that of novel group (71.15％ vs.64.99％,P ＜ 0.05),while the controlled rates were comparable and insignificant difference between baseline BP in both groups (31.07％ vs.26.88％,P ＞ 0.05).Four variables were significantly different,namely smoking rate,daily vegetable consumption (VC),and serum levels of low-density lipoprotein-cholesterol and fasting blood glucose between these two groups.After 2 years of follow-up,decreases in SBP and DBP were more prominent in the novel group (P ＜ 0.001).Treated and controlled rates in both groups were both increased.Nevertheless,in comparison to the traditional group,controlled rate increased more significantly in the novel group (64.31％ vs.37.85％,P ＜ 0.001).Variables indicating lifestyle modification such as high sodium consumption,percentages of alcohol abuse,daily VC were profoundly improved in the novel group.Conclusions:The guideline-based HTN management implemented in the current study was beneficial for HTN control in rural areas of Guangdong Province.

Environmental heavy metals and cardiovascular diseases:Status and future direction

Cardiovascular disease(CVD)and environmental degradation are leading global health problems of our time.Recent studies have linked exposure to heavy metals to the risks of CVD and diabetes,particularly in populations from low-and middle-income countries,where concomitant rapid development occurs.In this review,we 1)assessed the totality,quantity,and consistency of the available epidemiological studies,linking heavy metal exposures to the risk of CVD(including stroke and coronary heart disease);2)discussed the potential biological mechanisms underlying some tantalizing observations in humans;and 3)identified gaps in our knowledge base that must be investigated in future work.An accumulating body of evidence from both experimental and obser-vational studies implicates exposure to heavy metals,in a dose-response manner,in the increased risk of CVD.The limitations of most existing studies include insufficient statistical power,lack of comprehensive assessment of exposure,and cross-sectional design.Given the widespread exposure to heavy metals,an urgent need has emerged to investigate these putative associations of environmental exposures,either independently or jointly,with incident CVD outcomes prospectively in well-characterized cohorts of diverse populations,and to determine potential strategies to prevent and control the impacts of heavy metal exposure on the cardiometabolic health outcomes of individuals and populations.

Association between Contrast Media Volume and 1-Year Clinical Outcomes in Patients Undergoing Coronary Angiography

Background： The excess volume of contrast media （CM） is a marker of a more severe coronary culprit lesion and longer intervention duration in patients undergoing cardiac procedures. However, it is unclear whether the contrast volume is directly correlated with worse clinical outcomes. The aim of this study was to investigate the association between contrast dose and the incidence of 1-year major adverse cardiac and cerebrovascular events （MACCE） and all-cause bleeding events in patients undergoing cardiac catheterization and coronary angiography （CAG）. Methods： We prospectively enrolled 10,961 consecutive patients diagnosed with coronary heart disease expecting CAG from 2012 to 2013. The study population was pursued with a follow-up duration of 1 year. The predictive value of contrast volume, divided into quartiles, for the risk of MACCE and all-cause bleeding events was assessed using logistic regression analysis. Results： The cumulative incidence of 1-year MACCE was 8.65%, which was directly associated with increasing contrast volume. In particular, MACCE was observed in 7.16%, 7.89%, 9.31%, and 11.73% of cases in the contrast volume quartile Q1 （≤100 ml）, Q2 （101-140 m）, Q3 （141-200 ml）, and Q4 （〉200 ml）, respectively （P 〈 0.001）. Moreover, the incidence of 1-year all-cause bleeding events was noted in 4.70%, 5.93%, 7.28%, and 8.21% of patients in Q1, Q2, Q3, and Q4, respectively （P 〈 0.001）. The survival analysis showed that the 1-year MACCE rate was higher in patients using greater CM volume during the CAG. CM volume used 〉140 ml was associated with the occurrence of 1-year MACCE, and the incidence was dramatically elevated in patients exceeding a contrast volume of 200 ml （P = 0.007）. Conclusion： Our data suggested that higher contrast volume was significantly correlated with an increased risk of MACCE and all-cause bleeding events in patients undergoing cardiac catheterization.