Causal associations between gastroesophageal reflux disease and essential hypertension: A bidirectional Mendelian randomization study

BACKGROUND Clinical studies have reported that patients with gastroesophageal reflux disease(GERD)have a higher prevalence of hypertension.AIM To performed a bidirectional Mendelian randomization(MR)analysis to investi-gate the causal link between GERD and essential hypertension.METHODS Eligible single nucleotide polymorphisms(SNPs)were selected,and weighted median,inverse variance weighted(IVW)as well as MR egger(MR-Egger)re-gression were used to examine the potential causal association between GERD and hypertension.The MR-Pleiotropy RESidual Sum and Outlier analysis was used to detect and attempt to reduce horizontal pleiotropy by removing outliers SNPs.The MR-Egger intercept test,Cochran’s Q test and“leave-one-out”sen-sitivity analysis were performed to evaluate the horizontal pleiotropy,heterogen-eities,and stability of single instrumental variable.RESULTS IVW analysis exhibited an increased risk of hypertension(OR=1.46,95%CI:1.33-1.59,P=2.14E-16)in GERD patients.And the same result was obtained in replication practice(OR=1.002,95%CI:1.0008-1.003,P=0.000498).Meanwhile,the IVW analysis showed an increased risk of systolic blood pressure(β=0.78,95%CI:0.11-1.44,P=0.021)and hypertensive heart disease(OR=1.68,95%CI:1.36-2.08,P=0.0000016)in GERD patients.Moreover,we found an decreased risk of Barrett's esophagus(OR=0.91,95%CI:0.83-0.99,P=0.043)in essential hypertension patients.CONCLUSION We found that GERD would increase the risk of essential hypertension,which provided a novel prevent and therapeutic perspectives of essential hypertension.

Pannexin-1 hemi-channels mediate pyroptosis on peripheral blood monocytes in patients with essential hypertension via regulating NLRP3/Caspase-1 pathway

Objective:To explore the role of NLRP3/Caspase-1-mediated pyroptosis on peripheral blood monocytes in patients with essential hypertension(EH),and its regulation by pannexin-1(Panx-1)hemi-channels.Methods:The peripheral blood of EH patients and healthy subjects was collected,peripheral plasma of the two groups was subsequently separated,and IL-1βcontent in peripheral plasma was further measured by ELISA.In the meantime,the monocytes from peripheral blood were sorted by immunomagnetic beads,and mRNA and protein expression of Panx-1,NLRP3 inflammasome related molecules(NLRP3,ASC,Caspase-1),downstream effector IL-1β,and pyroptosis-related protein GSDMD,were analyzed by RT-qPCR and Western blot,respectively.Subsequently,human primary monocytes in two group were cultured in vitro.Immunofluorescence assay was performed to detect the expression and location of Panx-1 on monocytes.Finally,the cultured monocytes from EH patients were exposed to NLRP3 inflammasome activator lipopolysaccharide(LPS),and also to LPS pretreated with Panx-1 hemi-channel inhibitor probenecid or specific Panx-1 siRNA,followed by collection of the cell culture supernatant and monocytes.The cell viability of each group was detected by CCK-8 assay,IL-1βcontent in the culture supernatant was analyzed by ELISA,and the expression of target proteins on monocytes was determined by Western blot assay.Results:Compared with healthy subjects,EH patients showed higher IL-1βcontent in peripheral plasma,and increased expression in both mRNA and protein levels for Panx-1,NLRP3 inflammasome related molecules,IL-1βand GSDMD on peripheral monocytes.Furthermore,Panx-1 protein in EH patients was significantly higher than that in healthy subjects and localized on monocyte membrane as evidenced by immunofluorescence assay.In the cultured human primary monocytes from EH patients,the cell viability in each group showed no significant difference.LPS stimulation can induce NLRP3-dependent pyroptosis,by showing an increase in IL-1βcontent in cell culture supernatant and protein expressions of NLRP3 inflammasome related molecules and GSDMD on monocytes,by LPS exposure.However,the above stimulating effect of LPS could be counteracted by pretreatment with probenecid or Panx-1 siRNA.Conclusion:The NLRP3/Caspase-1-mediated pyroptosis is activated on peripheral blood monocytes in patients with EH,and this activation could be regulated by Panx-1 hemi-channels.

Relationship of Toll-Like Receptors 2 and 4 Gene Polymorphisms with Essential Hypertension in Chinese Han Population

Objective: There are numerous studies suggesting that genetic polymor-phisms of inflammation factors Toll-like receptors 2 and 4 (TLR2, TLR4) might play a role in the pathophysiological process of hypertension. In this study, we evaluated the association in a sample of members of the Chinese Han population. Method: We selected four single nucleotide polymor-phisms (SNP) of TLR2 (rs3804099, rs3804100, rs7656411) and TLR4 (rs1927906) genes, and measured the distributions of genotypic and allelic frequencies in 1063 participants, including 391 essential hypertension pa-tients and 672 controls. Result: No significant differences in the genotypic and allelic frequencies of the four SNPs were detected between cases and controls. However, three haplotypes, CCG, TTG and TTT of TLR2, were significantly associated with a decrease in the risk of essential hyperten-sion (OR: 0.512, 95% CI: 0.397 - 0.660, P P = 0.0038;OR: 0.797, 95% CI: 0.667 - 0.952, P = 0.0122, respectively). Inversely, the risk of essential hypertension increased sig-nificantly in patients with the CTG, TCG or TCT haplotypes (OR: 2.924, 95% CI: 2.157 - 3.963, P P P Conclusion: Our study suggested that haplotypes (CCG, TTG, TTT, CTG, TCG and TCT) of TLR2 might have profound effects on the development of essential hypertension in the Chinese Han population.

Exploring the therapeutic effects of Cortex Lycii on essential hypertension

Background:Essential hypertension affects over a billion people worldwide.Despite the absence of a definitive cure,current treatments primarily aim to manage blood pressure levels.There is a compelling need for antihypertensive medications that offer high effectiveness,low toxicity,and minimal side effects.Objective:This study seeks to investigate the antihypertensive properties of Cortex Lycii by employing network pharmacology and validating the findings through molecular docking.Methods:We utilized various platforms and databases related to traditional Chinese medicine to identify the active compounds within Cortex Lycii.Targets associated with hypertension were gathered from well-established disease-related resources.Shared targets were delineated using the EVenn.Subsequently,we conducted GO and KEGG analyses through the DAVID platform and visualized the resultant network with Cytoscape.Molecular docking was carried out using Autodock Vina and PyMOL.Results:Our investigation revealed ten active compounds in Cortex Lycii that demonstrated correlation with 82 essential hypertension-associated targets.These shared targets were categorized into four distinct clusters,each with unique functions.Fourteen hub targets were singled out based on predefined selection criteria.GO analysis unveiled the participation of shared targets in various biological processes linked to hypertension.KEGG analysis identified ten significant signaling pathways associated with hypertension development.Molecular docking analysis provided confirmation of the interaction between the selected hub targets and the active compounds.Conclusion:Cortex Lycii,a traditional Chinese herb with a long history of use,exerts its antihypertensive effects through a combination of active compounds,involvement of multiple targets,regulation of various biological processes,and modulation of key signaling pathways.

Association of the Apolipoprotein B Gene Polymorphisms With Essential Hypertension in Northern Chinese Han Population

Objective To study the association of the apolipoprotein B gene polymorphisms with essential hypertension in Northern Chinese Han population. Methods XbaI and EcoRl polymorphisms of the apolipoprotein B （APOB） gene were genotyped by polymerase chain reaction （PCR） and restriction fragment-length polymorphism （RFLP） method in 503 unrelated hypertensive patients and 490 healthy controls recruited from international collaborative study of cardiovascular disease in Asia （InterAsia）. Results The difference in the genotypic distributions could be neglected across the groups. The prevalence of X＋ allele in healthy controls （4.8%） was less frequent in Chinese, and there was no significant difference in the frequency of the X＋ allele between cases （5.7%） and controls （P=0.38）. The observed E- allele frequencies were closely similar among groups （5.9% in cases vs 5.0% in controls, P=0.39）. Logitstic regression analyses revealed that the lack of association still persisted after adjustment of other environmental factors. Haplotype analysis showed that X-E＋ was most frequent and no haplotype could significantly contribute to essential hypertension. Conclusion The APOB gene XbaI and EcoRI polymorphisms are not associated with essential hypertension in the Northern Chinese Han population. Future studies on single nucleotide polymorphisms in larger samples are needed to further investigate the possible contribution of the APOB gene to essential hypertension.

Polymorphisms of Renin-angiotensin System in Essential Hypertension in Chinese Tibetans

Objective To evaluate the potential implications of the genetic variability of angiotensin converting enzyme, angiotensinogen and angiotensin II type 1 receptor gene for essential hypertension in Tibetan. Methods A case-control study was conducted in 173 hypertensive individuals and 193 individuals with normal blood pressure. Multiple logistic regression analyses were used to estimate the risks of developing hypertension for different genotypes, and haplotype analyses of the angiotensinogen gene were used to determine the association between two-locus angiotensinogen gene polymorphisms and hypertension. Results As to the risk to high blood pressure and high systolic pressure, women with MM genotype were 7.7 (95% CI: 1.3-20.5) and 8.7 (95% CI: 1.8-20.1) times higher than those with TT genotype after adjustment for age and body mass index. Haplotype frequencies for M235T and G-6A were significantly different between hypertensive individuals and controls, which indicated an association of angiotensinogen gene haplotypes with hypertension, and a significant association of 235T/-6A haplotype with hypotensive effect. Conclusion Our results suggest that angiotensinogen gene 235MM is a predictor for hypertension development in Tibetan women but not in men, and may exert its hypertensive effect on linkage disequilibrum with a possible function locus of G-6A.

Association between essential hypertension and polymorphisms of beta 1 adrenergic receptor gene G1165C (Gly389Arg) in Chinese Mongolian population

BACKGROUND： The prevalences of hypertension, cerebrovascular diseases, etc. are higher in Mongolian population because of the influence of various factors including genetics, geography, diet, etc. Therefore, it is helpful to develop researches on the genetics of various diseases including hypertension in Mongolian population. OBJECTIVE： To analyze the association between the polymorphism of beta1 adrenergic receptor （β1-AR） gene G1165C （Arg389Gly）, an important candidate gene for various diseases of cardiovascular system, and essential hypertension in Mongolian population. DESIGN ： A cross-sectional study SETTINGS： Department of Neurology, the First Affiliated Hospital of Inner Mongolia Medical College; Wulate Houqi Red Cross Society. PARTICIPANTS： The survey was carried out from February 2003 to March 2005. Totally 239 Mongolian residents, whose blood relations of 3 generations were all Mongolians, were selected from Wulate Houqi, Inner Mongolia, and they were all informed with the survey and detected items. Based on the diagnostic standard of hypertension set by WHO in 1999, the subjects were divided into two groups according to the level blood pressure： ① Normal blood pressure group （n=117）： systolic blood pressure （SBP） 〈 140 mm Hg （1 mm Hg =0.133 kPa）, diastolic blood pressure （DBP） 〈 90 mm Hg, and those having histories of cerebrovascular disease, heart disease, diseases of liver, kidney and tiroides, and diabetes mellitus were excluded. ② Essential hypertension group （n=122）： including 51 patients with simple high SBP. All the enrolled subjects had no blood relationship with each other, and had no history of miscegenation. METHODS ： The body height, body mass, waist circumference and blood lipids were measured routinely, and their habits of smoking and drinking were also investigated. Penpheral venous blood （5 mL） was drawn, the genome DNA was extracted, and the polymorphisms of the β1-AR Gl165C （Gly389Arg） genotype were detected with the Sequenom system. Polymerase chain reaction （PCR） experiment and SNP detection were performed in Huada Gene Laboratory of Bejing, then the univariate analysis of variance was applied in the sample comparison among groups, and the chi-square test was used to compare the genotypes and allele frequencies. The odd ratio （OR） and 95% confidence interval （CO were calculated. MAIN OUTCOME MEASURES： The distributions of β1-AR Gl165C （Gly389Arg） genotypes and alleles were observed. RESULTS： A11 the 239 subjects were involved in the analysis of results, and no one missed, ①Comparison of β1-AR G1165C （Gly389Arg） genotypes and allele distnbutions： In Mongolian population, the frequencies of CC and GG＋GC genotypes at β1-AR G1165C （Gly389Arg） site in the essential hypertension group （72%, 28%） were not significantly different from those in the normal blood pressure group （67%, 33%） （xz=0.841, P=-0.359; OR 0.773, 95%Cl： 0.445-1.342）; The frequencies of C and G alleles also had no significant differences between the essential hypertension group （85%, 15%） and the normal blood pressure group （82%, 18%） （x^2=1.136, P=-0.287; OR： 0.769, 95%Cl： 0.747-1.248）. ②The frequencies of CC and GG＋GC genotypes at β1-AR G1165C （Gly389Arg） site had no significant differences between the patients with simple high SBP （71%, 29%） and the normal blood pressure group （x^2=0.250, P=-0.617; OR： 0.833, 95%C/： 0.408-1.703）; The frequencies of C and G alleles were not significantly different between the patients with simple high SBP （86%, 14%） and the normal blood pressure group （x^2=0.670, P=-0.413; OR 0.766, 95%Cl： 0.404-1.453）. CONCLUSION： In Mongolian population, the distributions of the genotypes and alleles of β1-AR Gl165C （Gly389Arg） have no obvious differences between the subjects with normal blood pressure and the patients with essential hypertension （including simple SBP increase）, which suggests that G1165C （Glu389Asp） site of β1-AR gene may be not a genetic mark of essential hypertension and simple high SBP in Mongolian population.

EFFECTIVE INVERSION OF LEFT HEART REMODELING BY PHENYLALANINE IN ESSENTIAL HYPERTENSION

Objective The aim is to ascertain whether phenylalanine (Phe) can inverse the left heart"remodeling" in patients with essential hypertension. Methods The changes of echocardiographic variables werecompared aler 3,6 and 9 months of observation between the Phe intervention group (Phe 1g/d+amiloride complex1 tablet/d, 20 cases) and control group (placebo 1g/d+amiloride complex 1 tablet/d, 20 cases) with eitherinterventricular septum and (or) post- wall thickness≥12mm, and were carried on further to compare incross- over trial. Results (1) Phe improved elfectively the left heart and systolic dyslunction; while theimprovement, also shown in control group due to the concurrent use of diuretic antihypertensive drug-amiloridecomplex, was much less evident than that in Phe group. (2) The disturbed left heart structure and systolic functionwere improved prominently while placebo was crossed over to Phe, and the improvement decreased afer Phe wascrrossed over to placebo. (3) The changes almost attained to its peak level after 6 months and not improved furtherat 9 months. (4) The differences seen between above 2 groops could not be eoplained by their diverse drops of bloodpressure. Conclusion Phe does exert an indopendent inverse effect on cardiac "remodeling", which mightimplicate an important clinical oplication upon the prevention and control of essential hypertension and itscomplications.

Association of Connexin Gene Polymorphism with Essential Hypertension in Kazak and Han Chinese in Xinjiang,China

Essential hypertension（EH） is affected by both genetic and environmental factors.The polymorphism of connexin（Cx） genes is found associated with the development of hypertension.However,the association of the polymorphism of Cxs with EH has not been investigated.This study aimed to investigate the association of the polymorphism of connexin（Cx） genes Cx37,Cx40,and Cx43 with EH in Kazak and Han Chinese in Xinjiang,China.Polymerase chain reaction-restriction fragment length polymorphism（PCR-RFLP） method and matrix-assisted laser desorption ionization time-of-flight mass spectrometry（MALDI-TOF-MS） were used to analyze the polymorphism of Cx genes in Kazak and Han EH patients as well as their normotensive controls.The results showed that there were no significant differences in the frequencies of different three genotypes（A/A,A/G,and G/G） and A and G alleles of Cx40 rs35594137 and rs11552588 between EH patients and normotensive controls.However,in Kazak EH patients,the frequencies of three genotypes（A/A,A/G,and G/G） of Cx37 rs1630310 were 24.8%,47.2% and 28.0%,respectively,which were significantly different from those in Han EH patients.In Han EH patients,the frequencies of the three genotypes（C/C,C/G and G/G） of Cx43 rs1925223 were 6.4%,35.6% and 58.0%,respectively.Frequencies of the other four genotypes had no statistical differences among Kazak and Han EH patients and their normotensive controls.These results suggest polymorphisms of Cx37 rs1630310 and Cx43 rs1925223 genes may be associated with the pathogenesis of EH.Carrying Cx37 rs1630310-A or Cx43 rs1925223-G genotypes may protect against the development of EH.

Determinants of Blood Pressure Variability in Individuals with Essential Hypertension: A Survey-Based Study

Background: Blood pressure variability (BPV) in hypertensive patients is implicated as a remarkable feature leading to additional cardiovascular complications. The aim of the study was to identify the determinants influencing BPV among patients with essential hypertension seen at the Cardiology department of the faculty of medicine, University of Alexandria, Egypt. Methods: This was a descriptive cross-sectional hospital-based study conducted from August 2019 to November 2019. All the eligible patients were made to fill out a standard questionnaire to obtain family and personal clinical history and undergo routine physical examination, laboratory tests and 24-hour ambulatory blood pressure monitoring. BPV was summarized as the standard deviation (SD) of all-day systolic and diastolic BP in both normal patients (with SD 11) and abnormal patients (with SD ≥ 11). Results: Out of a total of 114 patients, 18 (15.8%) non-hypertensive patients were included in the control group and the remaining 96 (84.3%) were classified based on the degree of hypertension. BPV in all these patients was found to be significantly related to the male gender, a mild or moderate degree of hypertension, high prevalence of non-dipping, diabetes, use of beta-blockers as antihypertensive medication, heart rate variability, BMI, and increased day-time variability. Conclusion: Variability in blood pressure influenced by different intrinsic and extrinsic factors plays an important role in the management of hypertension. In order to reduce the burden of disease and for a better quality of life for hypertensive patients, it is important that physicians start considering lowering BPV in addition to reducing physiological BP levels.

Comparison of Arrhythmias among Different Left Ventricular Geometric Patterns in Essential Hypertension

The differences of arrhythmias among distinct left ventricular geometric patterns in the patients with essential hypertension were studied. 179 patients with essential hypertension received 24 h dynamic ECG recording, ambulatory blood pressure monitoring, echocardiography examination, etc. According to the examinations, left ventricular geometric patterns and arrhythmias were identified. The comparison of morbidity of arrhythmias between the left ventricular remodeling group and the normal geometric pattern group was performed. The multiple stepwise regression analysis was carried out to identify the independent determinants of arrhythmias. After these predictors were controlled or adjusted, the severity of arrhythmias among different left ventricular geometric patterns was compared. It was found that the morbidity of atrial arrhythmia, ventricular arrhythmia and complex ventricular arrhythmias in the left ventricular remodeling group was significantly higher than in the normal geometric pattern group respectively. There were many independent factors influencing on arrhythmias in essential hypertension. Of all these factors, some indices of left ventricular anatomic structure, grade of hypertension, left atrial inner dimension, E/A, diastolic blood pressure load value at night and day average heart rate and so on were very important. After the above mentioned factors were adjusted, the differences of the orders of arrhythmias between partial geometric patterns were reserved, which resulted from the differences of the geometric patterns. Many factors contributed to arrhythmias of essential hypertension, such as grade of hypertension, LVMI, LA, PWT and so on. The severity of arrhythmias was different in different left ventricular geometric patterns.

Ultrasonic evaluation of the relationship between left ventricular hypertrophy or left ventricular geometry and endothelial function in patients with essential hypertension

Objective： To assess the relationship between left ventricular hypertrophy （LVH） or left ventricular geometry （LVG） and endothelial function in patients with essential hypertension （EH）. Methods： Seventy-six patients and 30 normal subjects were first examined by echocardiography. Brachial artery dilatation induced by reactive hyperemia （DIRH） or nitroglycerin （DING） was detected using high-resolution ultrasonography. Results： DIRH was lower in patients with hypertension than in the controls, and the decrease in DIRH was greater in the patients with LVH than that in patients without LVH （4.36±2.54% vs 8.56 ± 1.87 %; P 〈 0.0001）. There were no significant differences in age, serum concentrations of total cholesterol, triglycerides or sugar, blood pressure and the brachial artery dilatation induced by nitroglycerin between the two groups （P 〉 0.05）. While there was no significant difference in DIRH between the patients with normal left ventricular geometry or cardiac remodeling, the patients showing either eccentric or concentric left ventricular hypertrophy had lower DIRH than the patients with normal left ventricular geometry or cardiac remodeling. The DIRH was the lowest in patients with concentric hypertrophy. Although bivariate analysis showed that the left ventricular mass index （LVMI） correlated well with the brachial artery dilatation induced by reactive hyperemia, diastolic blood pressure and mean blood pressure （r=-0.61, P 〈 0.0001; r=0.27, P 〈 0.05; r=0.31, P 〈 0.05, respectively）, a multivariate stepwise regression demonstrated that LVMI correlated only with the brachial artery dilatation induced by reactive hyperemia. Conclusion： Left ventricular hypertrophy was related to endothelial dysfunction in essential hypertension. The endothelial dysfunction might be basic and important in the progression of left ventricular hypertrophy.

The Efficacy of Banxia Baizhu Tianma Decoction(半夏白术天麻汤)Combined with Xuefu Zhuyu Decoction(血府逐瘀汤)for Essential Hypertension and the Effects on Endothelial Function:A Systematic Review and Meta-analysis

Objective:Banxia Baizhu Tianma Decoction(半夏白术天麻汤,BBTD)combined with Xuefu Zhuyu Decoction(血府逐瘀汤,XFZYD)is widely used to treat essential hypertension in China,but its efficacy remains largely unexplored.We systemically summarized relevant evidence from randomized controlled trials(RCTs)to assess the therapeutic efficacy of BBTD+XFZYD.Methods:This review retrieved 6 databases like Pubmed,Cochrane Library,Embase,CNKI,et al.RCTs of BBTD+XFZYD plus conventional Western drugs(experimental group)and conventional Western drugs alone(control group)for hypertension was collected from the database establishment to August 5,2020.And the outcomes included clinical total effective rate,systolic blood pressure(SBP),diastolic blood pressure(DBP),nitric oxide(NO)and endothelin-1(ET-1).All studies’risk of bias were assessed by the Cochrane Collaboration tool 5.1.0.The data was statistically analyzed by RevMan5.3 Software.Results:Six studies with 608 participants were identified.About duration of treatment,4 studies were 1 month,2 studies were 2 months.The quality presented a high risk of bias.The experimental group showed that clinical total effective rate of the 1-month and 2-month was higher(P<0.00001),the systolic pressure was significantly lower(P<0.05),the NO increased(P<0.00001),and the ET-1 decreased(P<0.00001)compared with the conventional Western drugs used alone.However,DBP was significantly lower(P<0.05)at 2 months of treatment.Conclusion:BBTD+XFZYD plus conventional Western drugs might reduce blood pressure,improve clinical efficacy,repair endothelial function,but still need high-quality RCTs to better assess the outcomes.

The Contrast Study on Serum Collagen Metabolism between Essential Hypertension and Normal Control

Objectives To investigate serum concentration of procollagen type Icarboxyterminal peptide (PⅠP), type Ⅲ aminopeptide (PⅢP) and type Icollagen telopeptide (ICTP) in essential hypertension (EH). Methods Serum levels of PⅠP, PⅢP and ICTP in 42 EH patients and 30 healthy control were measured by radioimmunoassays. Results In EH patients, serum concentration of PⅠP, PⅢP was significantly higher than that in 30 healthy control. Although EH patients did tend to exhibit a higher serum ICTP concentration than normal control subjects, the difference was not statistically significant. EH patients with left ventricular hypertrophy exhibited higher values of PⅠP (P < 0. 05) and lower values of ICTP (P < 0. 05) than EH patients without left ventricular hypertrophy. No significant difference was noted between the serum PⅢP of the EH patients with and without left ventricular hypertrophy (P > 0.05 ). Conclusions The results suggest that PⅠP and PⅢP are sensitive serum markers of myocardial collagen synthesis. Myocardial fibrosis may be due to the excessive synthesis and insufficient degradation of collagen. PⅠP, PⅢP and ICTP may be indirect markers of myocardial fibrosis.

Correlation Factor Analysis of Retinal Microvascular Changes in Patients With Essential Hypertension

Objectives To investigate correlation between retinal microvascular signs and essential hypertension classification. Methods The retinal microvascular signs in patients with essential hypertension were assessed with the indirect biomicroscopy lens, the direct and the indirect ophthalmoscopes were used to determine the hypertensive retinopathy grades and retinal arteriosclerosis grades. The rank correlation analysis was used to analysis the correlation these grades with the risk factors concerned with hypertension. Results Of 72 cases with essential hypertension, 28 cases complicated with coronary disease, 20 cases diabetes, 41 cases stroke, 17 cases renal malfunction. Varying extent retinal arterioscleroses were found in 71 cases, 1 case with retinal hemorrhage, 2 cases with retina edema, 4 cases with retinal hard exudation, 5 cases with retinal hemorrhage complicated by hard exudation, 2 cases with retinal hemorrhage complicated by hard exudation and cotton wool spot, 1 case with retinal hemorrhage complicated by hard exudation and microaneurysms, 1 case with retinal edema and hard exudation, 1 case with retinal microaneurysms, 1 case with branch retinal vein occlusion. The rank correlation analysis showed that either hypertensive retinopathy grades or retinal arteriosclerosis grades were correlated with risk factor lamination of hypertension （r=0.25 or 0.31, P 〈0.05）, other correlation factors included age and blood high density lipoprotein concerned about hypertensive retinopathy grades or retinal arteriosclerosis grades, but other parameters, namely systolic or diastolic pressure, total cholesterol, triglyceride, low density lipoprotein cholesterol, fasting blood glucose, blood urea nitrogen and blood creatinine were not confirmed in this correlation analysis （P 〉 0.05）. Conclusions Either hypertensive retinopathy grade or retinal arteriosclerosis grade is close with the hypertension risk factor lamination, suggesting that the fundus examination of patients with hypertension plays a important part in predicting the incidence of cardiovascular events.

Resistive Cerebral Blood Flow as a Potential Marker of Subclinical Brain Damage in Essential Hypertension

Introduction: Subclinical brain damage in essential hypertension is more prevalent than cardiovascular or renal impairment;nevertheless, screening for nervous system involvement is difficult due to the low accessibility and high costs of these techniques. Objective: To assess the frequency of silent target organ damage in a cohort of asymptomatic hypertensive patients and to evaluate the potential usefulness of carotid ultrasonographic (US) variables as predictors of subclinical brain damage. Patients and Methods: Thirty four neurologically asymptomatic subjects (mean age 59 years) with essential hypertension were included. Target organ damage was evaluated: degree of hypertensive retinopathy, heart, kidney and brain. Structural and hemodynamical carotid Doppler US parameters were also investigated. Results: The brain was the most frequently affected target organ (70.6%), followed by the heart (67.9%) and kidney (58.6%). Carotid US parameters showed no association of intima media thickness with brain MRI results;nevertheless, decreased diastolic flow velocity and increased resistive index pointed to a resistive carotid flow pattern in patients with classical brain MRI lesions and predicted subclinical lesions with a sensitivity of 70% and 74% and a specificity of 72% and 80% respectively. Conclusions: This study supports previous findings that place the brain as the most frequently affected target organ in essential hypertensive patients and sheds more light on the potential usefulness of carotid structure and hemodynamics as imaging biomarkers of subclinical brain lesions.

Effects of a Graded Brisk Walking Test with Different Intensity Levels on Elderly Patients with Essential Hypertension:A Prospective Study in Shanghai,China

Background:This study aimed to clarify the effects of a Graded Brisk Walking Test(GBWT)program on blood pressure(BP)control in elderly patients with essential hypertension and to determine its appropriate degree of intensity for elderly people.Methods:In total,421 out of 620 participants were randomly sampled from a community health center in Shanghai,China.Among them,200 and 221 patients were assigned to the intervened and control groups,respectively.They were all treated with the GBWT program for 8 weeks,16 weeks,and 24 weeks.Results:Based on ANOVA,there was no significant time main effect,condition main effect,or time by condition interaction both in heart rate and body mass index indicators(P>0.05).There were significant condition main effects,time by condition interaction,or time main effects in blood pressure(F=21.875,33.457,65.342,respectively;All P<0.05).After the intervention,significant differences in systolic blood pressure(SBP)and diastolic blood pressure(DBP)values were also observed in the two groups(P<0.05);the average values of the baseline and second phases of the intervention group were significantly lower than those of the control group(P<0.05).Significant differences in blood pressure values after the first two phases were also observed when compared with those before the intervention.Similarly,a significant difference in the first phase and second phase was also found between the BP group and intervention group.However,after the third phase(24 weeks,high-intensity exercise),no significant differences existed both in SBP and DBP groups compared with those before the intervention(P=0.07).Conclusion:GBWT is an effective exercise prescription to mitigate the essential hypertension in elderly Chinese patients,and the intensity,walking distance,and target number of steps can be adjusted according to the age of the patients.

Efficacy of scraping therapy on blood pressure and sleep quality in stage Ⅰ and Ⅱ essential hypertension: A systematic review and meta-analysis

Background Scraping therapy is widely used in treating stage I and II essential hypertension in China.However,there has been no systematic evaluation of the efficacy of scraping therapy on blood pressure and sleep quality in stage I and II essential hypertension.Search strategy Seven electronic databases(PubMed,Scopus,Cochrane Library,Web of Science,EBSCO,China National Knowledge Infrastructure and Wanfang Data electronic databases)were searched from inception to December 2022.Based on the principle of combining subject words with text words,the search strategy was constructed around search terms for“scraping therapy,”“scraping,”“Guasha,”“Gua sha,”“hypertension,”and“high blood pressure”during the database searches.Inclusion criteria Randomized controlled trials(RCTs)were included if they recruited patients with stage I and II essential hypertension and included a scraping therapy intervention.The intervention group received antihypertensive drugs and scraping therapy,while the control group only took antihypertensive drugs.Data extraction and analysis Review Manager 5.4.0 and STATA 15.1 were used to enter all the relevant outcome variables to conduct the meta-analysis.The quality of the selected RCTs was assessed using the PEDro scale.The sensitivity analysis was carried out by iteratively excluding individual studies and repeating the analysis to determine the stability of the findings and identify any studies with greater influence on the outcome.Subgroup analysis was performed to find the source of heterogeneity.Funnel plots were used to evaluate the publication bias of included studies.Results Nine RCTs including 765 participants were selected.Meta-analysis showed that scraping therapy combined with medication had an advantage over the use of medication alone in lowering systolic blood pressure(mean difference[MD]=?5.09,95%confidence interval[CI]=?6.50 to?3.67,P<0.001)and diastolic blood pressure(MD=?2.66,95%CI=?3.17 to?2.14,P<0.001).Subgroup analysis showed that scraping therapy improved sleep quality in middle-aged patients with hypertension,but the efficacy was better in elderly patients(MD=?7.91,95%CI=?8.65 to?7.16,P<0.001)than in middle-aged patients(MD=?2.67,95%CI=?4.12 to?1.21,P=0.0003).Conclusion The available evidence indicates that scraping therapy has significant effects on patients with stage I and II hypertension,and it improves sleep quality for elderly patients with hypertension better than for middle-aged ones.Scraping therapy can be an adjunctive treatment for stage I and II essential hypertension.However,further high-quality studies are needed to verify its effectiveness and the best therapeutic strategies.

Tibetan patients with essential hypertension caused by underlying oxi dative metabolism dysfunction and depressed nitric oxide synthesis

To assess the role of oxidative metabolism and nitric oxide synthesis for elucid a ting their pathophysiological mechanisms in a Tibetan patient with essential hyp ertension Methods The serum levels of total superoxide dismutase (T SOD), malondialdehyde (MDA), total antioxidant capacity (T AOC), nitric oxide (NO) and nitric oxide synthase (NOS) were assayed in sixty native Tibetans (thirty hypertensive patients and t hirty healthy volunteers as control) Results The levels of T SOD, T AOC, NO and NOS were significantly lower in the patien t group than in the control group ( P <0 01); MDA was significantly higher in the patient group than in the control group ( P <0 01) The level of MDA ha d a strong negative correlation with T SOD, T AOC, NO and NOS ( r =-0 82, -0 76, -0 79, -0 73, respectively, P <0 001 for all) Conclusion Tibetan patients with essential hypertension (EH) may have underlying oxidative metabolism dysfunction and depressed NO synthesis, both responsible for the hype rtensive process

Association of WNK1 exon 1 polymorphisms with essential hypertension in Hani and Yi minorities of China

The association of polymorphisms in exon 1 of the WNK1 gene with essential hypertension in the minority groups of Hani and Yi of China was investigated in the case-control study.The sequence of 1257 bp containing the WNK1 gene exon 1 was determined in 1307 individuals（649 essential hypertension subjects and 658 controls）to identify SNPs in Hani and Yi minority groups.Four of eleven previously known SNPs （rs3168640,rs11885,rs11554421 and rs34880640）were identified.The SNP analysis indicated that SNPs rs11885 and rs11554421 were significantly associated with hypertension in both Hani and Yi populations,and rs34880640 was significantly associated with hypertension in Hani but not in Yi population,adjusted for covariates.Haplotype analysis indicated that the haplotype H1 significantly decreased the risk of hypertension in both populations.These results suggested that WNK1 polymorphisms were involved in the predisposition of essential hypertension in Hani and Yi populations and its effects showed a clear population specificity.This finding supported the importance of population specificity in determining the genetic factors associated with diseases and thus disease treatment.