2019 Chinese guideline for the management of hypertension in the elderly

Table of contents Preamble 1 Introduction 1.1 Class of recommendations and level of evidences 1.2 Definition and categories of hypertension in the elderly 1.3 Current status of epidemiology of hypertension in the elderly 1.4 The characteristics of hypertension in the elderly.

Sex difference in the prevalence of metabolic syndrome and its relationship to BMI and age

Objective:To investigate the prevalence of metabolic syndrome (MetS) in primary aldosteronism(PA) patients with different genders and relationship between body mass index(BMI), age and MetS. Methods:This study included 168 PA patients who were hospitalized in hypertension treatment center of Xinjiang Uygur Autonomous Region People' Hospital, including 94 male patients and 74 female patients and the backgrounds and biochemical parameters of two groups were compared. Based on this, the relationship between BMI, age and MetS were also analyzed. Results:The prevalence of MetS was significantly higher in male patients with PA than female patients with PA(83.0% vs 58.1%,P<0.001). Compared to PA patients without MetS, PA patients with MetS had a higher level of BMI and greater prevalence of obesity (P<0.05). According to the BMI stratification analysis, we found the prevalence of MetS was higher in obese groups than non-obese groups (P<0.05). Moreover, the obese male patients with PA had higher prevalence of every component of MetS and prevalence of MetS with 5 metabolic factors compared to the non-obese group (P<0.05);while the obese female patients with PA only had higher prevalence of abdominal obesity compared to the non-obese group (P<0.001). Among the patients classified by age, the both prevalence of MetS was higher in male than female, and there was no male:female ratio inverted in patients with PA after menopause. Conclusions:The prevalence of MetS in male patients with PA was higher than female patients with PA. In addition, the obese groups had the higher prevalence of MetS than non-obese groups.

Screening of biomarkers for the diagnosis and prognosis of adrenocortical carcinoma based on bioinformatics analysis

Objective:To explore the gene biomarkers related to the diagnosis and prognosis of adrenocortical carcinoma(ACC)by bioinformatics.Methods:GEPIA online analysis tool was used to screen differentially expressed genes for sequencing data from patients with ACC and normal adrenal cortex.The overall survival rate and disease-free survival method were used to conduct batch survival analysis on differentially expressed genes,and the top 100 genes with HR values calculated by the two methods were obtained respectively.The intersection method is used to obtain core genes that play a key role in both overall survival and disease-free survival.GEPIA online analysis tool was used again to explore the relationship between the above-mentioned survival-related genes and the pathological stage of ACC.Use UALCAN online analysis tool to verify the survival-related genes again and draw the Kaplan-Meier survival curve.Finally,GSE33371 chip dataset of the GEO database was used to evaluate the diagnostic value of the above-mentioned survival-related genes.Results:514 differentially expressed genes were obtained by limma method.Batch analysis of differential genes was performed to obtain the top 100 genes most related to overall survival and disease-free survival,of which 13 genes were closely related to overall survival and disease-free survival.9 hub genes including TP73,SNHG1,PDE6D,GPC2,SUV39H2,HELLS,CLK2,COPS7B and CEP164 were finally obtained by exploring the relationship between their expression levels and pathological stage and resurvival analysis.At the same time,the results of ROC analysis suggest that the above hub genes have high diagnostic value for patients with adrenocortical carcinoma.Conclusion:By using GEPIA,UALCAN and the gene chip retrieved from GEO database,combined with the bioinformatics method,we analyzed and verified the new biomarkers that can be used to evaluate the prognosis of patients with ACC and to differential diagnosis of ACC,and provided the theoretical support of bioinformatics for exploring the occurrence,development of molecular mechanism and potential target of treatment of ACC.

A nomogram of 5-year risk of type 2 diabetes in Chinese population

Objective:The aim of this study was to analyze the risk factors of type 2 diabetes in 5 years in Chinese population,and to construct the prediction model of nomogram and verify its validity.Methods:The physical examination and follow-up data of the participants who received physical examination at 32 sites in 11 cities in China from 2010 to 2016 were collected from the Dryad digital repository database.Randomly divided into modeling group(n=22936)and validation group(n=9830).In the modeling group,the independent risk factors were determined by single factor and multi factor analysis based on Cox regression model,and the nomogram prediction model was constructed by R software.The accuracy and performance of the model were evaluated by AUC value,C-index and calibration curve.Results:The multivariate regression model suggested that fasting blood glucose,triglyceride,smoking history and drinking history were independent risk predictors of 5-year risk of type 2 diabetes in Chinese population.In the modeling group,AUC was 0.776(95%CI:0.699-0.849),and C-index was 0.783(95%CI:0.706-0.856).Similarly,in the validation group,the AUC value was 0.743(95%CI:0.665-0.824),and the C-index was 0.764(95%CI:0.667-0.846),suggesting that the model had a good discrimination ability.The 5-year adjusted risk curve of type 2 diabetes in Chinese population suggests a good consistency between the predicted value and the actual value.Conclusion:The nomogram model can predict the 5-year risk of type 2 diabetes in Chinese population intuitively and accurately.

Folate level and prevalence of folate deficiency in population from agriculture and stock-raising regions and its correlation with hypertension

Objective:To compare the plasma folate level,prevalence of folate deficiency and the related influencing factors of hypertension in Xinjiang agricultural and pastoral areas.Methods:We enrolled 1926 study subjects with 447 hypertensive and non-hypertensive 1479 ones aged≥15 years old using multi-stage stratified sampling in Emin Xinjiang between January and December 2014,conducted the health behavior questionnaire and physical examination,and collected blood samples.The plasma folate level were measured by chemiluminescence method.Results:(1)There were significant differences(P<0.05)in age,gender,ethnic composition,marital status,education level,smoking consumption,drinking data,overweight and obesity and hyperhomocysteinemia(HHcy)between hypertension group and non hypertension group.(2)The folate deficiency rate of hypertension group was higher than that of non hypertension group(P=0.003);the folate deficiency rate of systolic and diastolic hypertension was the highest(P=0.008);the folate level of hypertension with HHcy was the lowest(P<0.001)and the folate deficiency rate was the highest(P=0.023).(3)Partial correlation analysis showed that folate was negatively correlated with systolic blood pressure and pulse pressure(P<0.05).(4)Multivariate logistic regression analysis showed that age 45-59(OR=3.78,95%CI:2.45-5.82),age≥60(OR=6.87,95%CI:4.35-5.10.87),male gender(OR=6.96,95%CI:3.86-12.54),Kazakhs(OR=2.12,95%CI:1.52-2.96),Mongolian(OR=2.38,95%CI:1.25-4.53),smoking(OR=4.21,95%CI:2.05-8.63),drinking(OR=6.36,36%CI:3.00-13.48),overweight and obesity(OR=2.11,95%CI:1.58-2.81),and folate deficiency(OR=1.72,95%CI:1.05-2.80)were the related factors of hypertension.Conclusions:The prevalence of folate deficiency in the population with hypertension in Xinjiang is higher than that in the non hypertension group,and the highest prevalence of folate deficiency is in hypertension with HHcy.Therefore,folate supplementation in the prevention of hypertension may be helpful,especially for the elderly,men and Kazakhs,and at the same time,healthy life style has an important reference value for reducing the level of hypertension and preventing and controlling cardiovascular diseases.

Consensus of Chinese Specialists on Diagnosis and Treatment of Resistant Hypertension

INTRODUCTION Resistant hypertension has become a challenge in the treatment of hypertension.As the population continues to age and obesity,sleep apnea hypopnea syndrome,and chronic kidney disease increase in incidence,resistant hypertension has become an increasingly common issue in clinical practice.Failure to control blood pressure can impair target organs such as the heart,brain,and kidney,facilitating the occurrence of clinical cardiovascular events.

Genetic variants of rs1275988 and rs2586886 in TWIK-related acidsensitive K^+ channel-1 gene may be potential risk factors for obese patients with obstructive sleep apnea

Background: The pathogenesis of obstructive sleep apnea (OSA) remains not fully understood. This study aimed to explore the mechanism of OSA by assessing the association between the human tandem of P domains in a weak inwardly rectifying K^+ channel (TWIK)-related acid-sensitive K^+ channel-1 (TASK-1) gene and OSA. Methods: A total of 164 patients with severe OSA and 171 patients without OSA were recruited from the Center for Hypertension of People’s Hospital of Xinjiang Uygur Autonomous Region (China) from April to December in 2016. Two single nucleotide polymorphisms (rs1275988 and rs2586886) in the TASK-1 gene were selected and genotyped using a kompetitive allele specific polymerase chain reaction genotyping system. Clinical-pathological characteristics and genotype data were compared between the severe and non-OSA groups to explore the association between TASK-1 gene polymorphism and severe OSA. Results: There were no significant differences in genotype distribution, allele frequency, and the recessive and dominant model of the two selected single nucleotide polymorphisms (rs1275988 and rs2586886) between the severe and non-OSA groups in the total population (P < 0.05). However, for patients with a body mass index (BMI)≥28 kg/m2, the distribution of genotypes and alleles, and the recessive model (GG + GA vs. AA) exhibited significant differences between the severe and non-OSA group (for genotypes: P = 0.014 and P = 0.026;for alleles: P = 0.006 and P = 0.011;for the recessive model: P = 0.005 and P = 0.009, respectively). The simple logistic regression analysis revealed that the GG genotype was a risk factor for OSA. The odds ratio (OR) and 95% confidence intervals (CI) were 4.902 (1.582–15.186, P = 0.006) for rs1275988 and 4.420 (1.422–13.734, P = 0.010) for rs2586886, respectively. In multivariate logistic regression analysis, the combination of GG genotypes of rs1275988 with BMI ≥28 kg/m^2 increased the risk of severe OSA (OR = 8.916, 95% CI 4.506–17.645, P < 0.001). Conclusion: Both the GG genotype of rs1275988 and GG genotype of rs2586886 in the TASK-1 gene may play as potential risk factors in obese patients with OSA.