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.

Real-time Three-dimensional Echocardiographic Assessment of Left Ventricular Remodeling Index in Patients with Hypertensive Heart Disease and Coronary Artery Disease

Left ventricular remodeling index （LVRI） was assessed in patients with hypertensive heart disease （HHD） and coronary artery disease （CAD） by real-time three-dimensional echocardiography （RT3DE）. RT3DE data of 18 patients with HHD, 20 patients with CAD and 22 normal controis （NC） were acquired. Left ventricular end-diastolic volume （EDV） and left ventricular end-diastolic epicardial volume （EDVepi） were detected by RT3DE and two-dimensional echocardiography Simpson biplane method （2DE）. LVRI （left ventricular mass/EDV） was calculated and compared. The results showed that LVRI measurements detected by RT3DE and 2DE showed significant differences inter-groups （P〈0.01）. There was no significant difference in NC group （P〉0.05）, but significant difference in HHD and CAD intra-group （P〈0.05）. There was good positive correlations between LVRI detected by RT3DE and 2DE in NC and HHD groups （t=0.69, P〈0.01; r=0.68, P〈0.01）, but no significant correlation in CAD group （r=0.30, P〉0.05）. It was concluded that LVRI derived from RT3DE as a new index for evaluating left ventricular remodeling can provide more superiority to LVRI derived from 2DE.

Status,outcome,and related factors of postpartum hypertension in the Shanghai community

BACKGROUND Postpartum hypertension poses a considerable health risk.Despite research on gestational hypertension,comprehensive studies focusing on postpartum hypertension in communities are limited.Understanding its prevalence and associated risk factors is crucial for effective prevention and management.AIM To provide insights for postpartum hypertension’s prevention and management.METHODS In total,3297 women who gave birth between June 2021 and December 2022 in Xuhui District,Shanghai were selected.Blood pressure was measured thrice within one month post-delivery during home visits.Eighty-six women with hypertension were followed up for four months to analyze hypertension persistence and its related risk factors.A predictive model for persistent postpartum hypertension was established and verified using the Nomo diagram model.RESULTS Hypertension prevalence 1 month post-delivery was 2.61%(86/3297).Among the 86 pregnant women,32(37.21%)had persistent hypertension at four months post-delivery.Multivariate logistic regression analysis revealed that older age[odds ratio(OR)=1.212;95%confidence interval(CI):1.065–1.380]and higher pre-pregnancy body mass index(BMI)(OR=1.188;95%CI:1.006–1.404)were associated with hypertension(OR=10.781;95%CI:1.006–1.404)during pregnancy.A 95%CI of 1.243–93.480 is a risk factor for persistent postpartum hypertension.The Nomograph model accurately predicted the risk of persistent postpartum hypertension,demonstrating high precision.CONCLUSION In Xuhui,older age,higher pre-pregnancy BMI,and gestational hypertension are risk factors for persistent postpartum hypertension.Our prediction model can identify high-risk individuals,thereby improving patient quality of life.

Animal models of pulmonary hypertension due to left heart disease

Pulmonary hypertension due to left heart disease(PH-LHD) is regarded as the most prevalent form of pulmonary hypertension(PH). Indeed, PH is an independent risk factor and predicts adverse prognosis for patients with left heart disease(LHD). Clinically, there are no drugs or treatments that directly address PH-LHD, and treatment of LHD alone will not also ameliorate PH. To target the underlying physiopathological alterations of PH-LHD and to develop novel therapeutic approaches for this population, animal models that simulate the pathophysiology of PH-LHD are required. There are several available models for PH-LHD that have been successfully employed in rodents or large animals by artificially provoking an elevated pressure load on the left heart, which by transduction elicits an escalated pressure in pulmonary artery. In addition, metabolic derangement combined with aortic banding or vascular endothelial growth factor receptor antagonist is also currently applied to reproduce the phenotype of PH-LHD. As of today, none of the animal models exactly recapitulates the condition of patients with PH-LHD. Nevertheless, the selection of an appropriate animal model is essential in basic and translational studies of PH-LHD. Therefore, this review will summarize the characteristics of each PH-LHD animal model and discuss the advantages and limitations of the different models.

Assessment of Reversibility in Pulmonary Hypertension Related to Congenital Heart Disease by Using Biomarkers and Clinical Features

Background:Reversibility of pulmonary hypertension(PH)is closely related to the treatment options for and prognosis of children with congenital heart disease.Objective:We combined patient-specific clinical features including diagnosis,age and echocardiographic results,and biomarkers of pulmonary vascular dysfunction to explore the noninvasive methods that can be used to accurately evaluate the reversibility of pulmonary hypertension in congenital heart disease(PH-CHD).Methods:Based on the preoperative systolic pulmonary arterial pressure(sPAP),70 CHD patients were divided into normal,PH-CHD suspected,and confirmed groups.Additionally,biomarkers of circulating endothelial cells(CECs),endothelin-1(ET-1),and endothelial nitric oxide synthase(eNOS)were detected.Patients were categorized into reversible(RPH)and irreversible(IRPH)groups according to the sPAP 6 months after surgery.Risk stratification was performed according to the clinical features and biomarkers.Results:CECs and ET-1 levels in the confirmed group were significantly higher.eNOS was higher in the confirmed and suspected groups than that in the normal group.CECs in the IRPH group were significantly higher compared to the RPH group.No such intergroup differences were observed with respect to ET-1 and eNOS levels.The ROC curve showed that the risk stratification was of high diagnostic value to evaluate reversibility.Conclusion:The CECs,eNOS,and ET-1 were closely related with PH-CHD.CECs and risk stratification have high practical value in assessing the reversibility of PH-CHD.

Study on Features of Insulin Resistance in Patients with Coronary Heart Disease

Objective Researching the features of insulin resistance in patients with coronary heart disease (CHD) . Methods The study included 20 healthy subjects (control group), 53 CHD patients without (Group A) and 24 with essential hypertension (Group B) . Oral glucose tolerance test was administered to all subjects. Venous blood samples were taken during fasting and at 30, 60, 120 and 180 min after the glucose load (100g). All samples were assayed for glucose, insulin and C - peptide. Results The glucose, insulin, and C - peptide curves were at a hierarchy of Group B > Group A > the control group. Insulin - sensitivity - index was at an inverse hierarchy (-4. 31±0.55, -4. 05±0.47, - 3. 82±0. 42, respectively) . The ratio of the area under the C - peptide to the insulin was at a hierarchy of control group (3. 84±0. 81)> Group A (2. 84±0. 93)> Group B (2.26±0. 67), P < 0. 01) . As to insulin and C - peptide releasing types, most subjects of the control group had common type, while the predominant response type was pure - high in Group A, delayed - and delayed - high in Group B. Conclusions There are insulin resistance, insulin - C - peptide separation and changes of insulin and C - peptide releasing types in CHD patients. Insulin resistance is more severe when with hypertension. The hyperinsulinemia in CHD might be due to the over - secretion of insulin, also due to slow clearance in the patients accompanied by hypertension.

Preliminary study of abnormal increase of postexercise systolic blood pressure in the diagnosis of coronary artery disease

Objectives This study sought to evaluate the diagnostic value of abnormal increase of postexercise systolic blood pressure (SBP) for detecting coronary artery disease (CAD) in patients with or without hypertension. Methods Treadmill exercise testing (TET) was conducted in 88 patients (40 CAD patients, 48 control subjects) with or without hypertension, each of whom underwent selective coronary angiography (CAG). The abnormal increase of postexercise SBP was defined as 10mmHg higher than earlier periods during the recovery phase (6 minutes) of exercise testing. Results The abnormal increase of postexercise SBP had higher sensitivity, specificity, and accuracy for detecting CAD than those of ST - segment depression in patients with or without hypertension. Its accuracy increased with the severity of CAD while decreased in patients with hypertension, and the increase value of SBP had a positive correlation with the extent of coronary artery lesion. The combination of ST - segment depression and abnormal increase of postexercise SBP diagnosed CAD most accurately in patients with hypertension. Conclusions Abnormal increase of postexercise SBP may be a useful index for diagnosing CAD.

Treatment of patients with bosentan in postoperation of congenital heart disease with pulmonary arterial hypertension:a double-blind,randomized controlled trial

Objective Endothelin is a key role in the pathogenic of pulmonary arterial hypertension. High concentrations of endothelin 1 have been recorded in plasma and lungs of patients with pulmonary artery hypertension associated with congenital heart disease,and the concentrations of endothelin-1 was correlated with severity degree

Global,regional,and national burden of hypertensive heart disease among older adults in 204 countries and territories between 1990 and 2019:a trend analysis

Background:Hypertensive heart disease(HHD)poses a public health challenge,but data on its burden and trends among older adults are scarce.This study aimed to identify trends in the burden of HHD among older adults between 1990 and 2019 at the global,regional,and national levels.Methods:Using the Global Burden of Diseases study 2019 data,we assessed HHD prevalence,death,and disability-adjusted life-year(DALY)rates for individuals aged 60-89 years at the global,regional,and national levels and estimated their average annual percentage changes(AAPCs)between 1990 and 2019 using joinpoint regression analysis.Results:In 2019,there were 14.35 million HHD prevalent cases,0.85 million deaths,and 14.56 million DALYs in older adults.Between 1990 and 2019,the prevalence of HHD increased globally{AAPC,0.38(95%confidence interval[CI],0.36,0.41)}with decreases observed in mortality(AAPC,-0.83[95%CI,-0.99,-0.66])and the DALY rate(AAPC,-1.03[95%CI,-1.19,-0.87]).This overall global trend pattern was essentially maintained for sex,age group,and sociodemographic index(SDI)quintile except for non-significant changes in the prevalence of HHD in those aged 70-74 years and in the middle SDI quintile.Notably,males had a higher HHD prevalence rate.However,HHD-related mortality and the DALY rate were higher in females.The middle SDI quintile experienced the largest decreases in mortality and the DALY rate,with a non-significant decline in prevalence between 1990 and 2019.There were significant discrepancies in the HHD burden and its trends across regions and countries.Conclusions:In the past three decades,there has been an overall increasing trend in the prevalence of HHD among older adults worldwide despite decreasing trends in mortality and the DALY rate.Better management of hypertension,and prevention and control of HHD are needed in older adults.

Changing profiles of cardiovascular disease and risk factors in China:a secondary analysis for the Global Burden of Disease Study 2019

Background:Understanding the changing profiles of cardiovascular disease(CVD)and modifiable risk factors is essential for CVD prevention and control.We aimed to report the comprehensive trends in CVD and risk factors in China from 1990 to 2019.Methods:Data on the incidence,death,and disability-adjusted life years(DALYs)of total CVD and its 11 subtypes for China were obtained from the Global Burden of Disease Study 2019.The CVD burden attributable to 12 risk factors was also retrieved.A secondary analysis was conducted to summarize the leading causes of CVD burden and attributable risk factors.Results:From 1990 to 2019,the number of CVD incidence,death,and DALYs considerably increased by 132.8%,89.1%,and 52.6%,respectively.Stroke,ischemic heart disease,and hypertensive heart disease accounted for over 95.0%of CVD deaths in 2019 and remained the top three causes during the past 30 years.Between 1990 and 2019,the age-standardized rate of stroke decreased significantly(percentage of decreased incidence:-9.3%;death:-39.8%;DALYs:-41.6%),while the rate of ischemic heart disease increased(percentage of increased incidence:11.5%;death:17.6%;DALYs:2.2%).High systolic blood pressure,unhealthy diet,tobacco,and air pollution continued to be the major contributors to CVD deaths and DALYs(attributing to over 70%of the CVD burden),and the high body mass index(BMI)-associated CVD burden had the largest increase between 1990 and 2019.Conclusions:The significant increases in the number of CVD incident cases,deaths,and DALYs suggest that the CVD burden is still a concern.Intensified strategies and policies are needed to maintain promising progress in stroke and to reduce the escalating burden of ischemic heart disease.The CVD burden attributable to risk factors has not yet made adequate achievements;even worse,high BMI has contributed to the increasing CVD burden.

Proximal Iliac Artery Stenosis in Allograft Renal Transplant, a Diagnostic beyond Echo-Doppler, Treatment Approach

Background: Transplant Renal Artery Stenosis (TRAS) is a well-known vascular complication after a kidney transplant. It is associated with premature renal failure, uncontrolled hypertension, and allograft loss. However, Proximal Iliac Artery Stenosis to a Kidney Transplant (Prox-TRAS) is an uncommon cause of vascular graft complication leading to acute renal failure and refractory hypertension with a less incidence around and only a few cases reports have been described in the medical literature. Methods: We reviewed the medical record of kidney transplant recipients of the General Hospital of Ciudad Real, Spain, from March 2008 to March 2019. We identified all cases (260) with the diagnosis of renal vascular hypertension by imaging studies. Of those 260 renal vascular stenoses, five (5) were diagnosed with proximal iliac artery stenosis through Angio-CT and arteriography. We performed an analysis of clinical parameters and evolution. Results: Prox-TRAS was diagnosed in 5 of the 260 patients who presented acute or progressive allograft dysfunction with refractory hypertension, with an incidence rate of 1.4%. In 4 of them (1.1%), we had to resort to another imaging test, angio-CT, arteriography, as the echo-doppler was unable to identify the abnormalities. Hypertension was a constant finding along with impaired renal function (100%);with respect to Prox-TRAS, its onset was later (12 - 60 months) after transplantation. An increase in TA (140 ± 10 and 80.7 ± 7 to 160 ± 18 and 85 ± 7 mmHg, p-0.009) was observed. There was an increase in the use of hypotensive drugs (2.1 ± 1.1 and 4.3 ± 1, p-0.003). Similarly, in all cases, a worsening of basal creatinine from 0.9 to 0.1 ± to 1.2 ± (P × 0.004) was also observed. Prox-TRAS was a cause of the increase in both creatinine and TA (140 ± 10 and 80.7 ± 7 to 160 ± 18 and 85 ± 7 mmHg, P 0.009). All cases were treated by Percutaneous transluminal angioplasty with stent placement, N= 5. In the follow-up, improvement was obtained from the claudication clinic as well as renal function and blood pressure, CRB (from 2.7 ± 1.4 to 1.8 ± 0.4 mg/dL, P-0.02) and TA (160 ± 18/85 ± 7mmHg at 138 ± 7/82 ± 9, p 0.018). Kidney function, blood pressure remained unchanged during follow-up (130 ± 36 months). Conclusion: Through these cases review, we propose highlighting the importance of extending imaging studies to the iliac artery of the kidney graft in case of high suspected renal vascular hypertension;showing the role and safety of angioplasty as a reasonable and effective treatment in the identified cases. We assessed the possibility of the limited role of Duplex Sonography (DS) regarding clinical and angiographic. PTA is the appropriate initial treatment of Prox-TRAS, with low morbidity and mortality rates, achieving improvement of graft function and amelioration of hypertension.

Regulatory T cells and cardiovascular diseases

Inflammation is a major underlying mechanism in the progression of numerous cardiovascular diseases(CVDs).Regulatory T cells(Tregs)are typical immune regulatory cells with recognized immunosuppressive properties.Despite the immunosuppressive properties,researchers have acknowledged the significance of Tregs in maintaining tissue homeostasis and facilitating repair/regeneration.Previous studies unveiled the heterogeneity of Tregs in the heart and aorta,which expanded in CVDs with unique transcriptional phenotypes and reparative/regenerative function.This review briefly summarizes the functional principles of Tregs,also including the synergistic effect of Tregs and other immune cells in CVDs.We discriminate the roles and therapeutic potential of Tregs in CVDs such as atherosclerosis,hypertension,abdominal arterial aneurysm,pulmonary arterial hypertension,Kawasaki disease,myocarditis,myocardial infarction,and heart failure.Tregs not only exert anti-inflammatory effects but also actively promote myocardial regeneration and vascular repair,maintaining the stability of the local microenvironment.Given that the specific mechanism of Tregs functioning in CVDs remains unclear,we reviewed previous clinical and basic studies and the latest findings on the function and mechanism of Tregs in CVDs.

Correlation between Diastolic Function and Mass and Geometry of Left Ventricle in Essential Hypertension

Object Diastolic function' s assessment is vital in order to produce information relevant to patients' functional class, management and prognosis. We sought to investigate diastolic dysfunction in essential hypertension (EH) with or without coronary heart disease (CAD) using color M - mode Doppler echocardiography and to study the relation between diastolic dysfunction and left ventricular mass index (LVMI) and geometry of LV, and to demonstrate partly the cause of increased cardiovascular risk of an echocardiographic pattern of LV geometry. Methods36 normal subjects (Group Ⅰ) and 107 patients with essential hypertension (Group II) were studied using color M - mode Doppler echocardiography. Four different LV anatomic adaptation to hypertension were i-dentified by categorizing patients according to values of end - diastolic relative wall thickness (RWT) and LVMI. We measured the rate of propagation of peak early filling flow velocity (Vp), time delay (TD) of the peak early filling flow velocity from mitral tips to the apex and Vp/E. Results The geometry of LV was classified into four types according to the LVMI and RWT. The normal limits of LVMI and RWT were obtained from the upper limits of the 95 % confidence interval from mean of LVMI and RWT in healthy control group respectively, which were 115.2 g/m2 and 0. 44. The definition of each type was as follows: Type I (normal group): LVMI≤115. 2 g/m2 and RWT≤ 0.44; Type Ⅱ (concentric remodeling): LVMI≤ 115. 2 g/m2 and RWT > 0. 44; Type III (eccentric hypertrophy): LVMI> 115.2 g/m2 and RWT≤0.44; Type Ⅳ (concentric hypertrophy): LVMI> 115.2 g/m2 and RWT>0.44. Most parameters of diastolic function in each geometry type differed significantly from those in the control group, but the difference among each geometry type was not significant. When compared with type Ⅰ, there was a tendency that TD was longer and Vp/E smaller in Type Ⅱ, Ⅲ and Ⅳ groups. The correlation between LVMI and Vp and TD had statistical significance ( P < 0. 01); the correlation coefficients were-0.21 and 0.29, respectively. Conclusions There is diastolic dysfunction in different LV geometry in patients with essential hypertension, even in patients with LV normal geometry there is diastolic dysfunction. LVMI has negative correlation to Vp, and positive correlation to TD. It may indicate that the greater the LVMI is, the worse the LV diastolic function.

Surgical Treatment of 144 Children with Ventricular Septal Defect and Severe Pulmonary Hypertension

Objective To report the result of surgical treatment for 144 children with ventricular septal defect and severe pulmonary hypertension. Method The diagnosis had been confirmed by cardiac catheter before the operation, Pp/Ps (0. 81±0.09) and Rp (9.41 ±5.37 ) wood. Ventricular septal prothesis was performed under cardiopulmonary bypass. Transthoracic intracardiac monitoring line inserted into pulmonary artery in 117 cases. Results Fourteen cases died of the 144 postoperatively, with mortality of 9.12% . Preoperative Pp/Ps≥0. 8 and Rp≥10 wood made the mortality higher than that of others ( P < 0. 05 ) . 32 persons had post - operative SpPA > 50 mmHg among the survivors and among the children with preoperative Pp/Ps ≥0. 8 and Rp≥10 wood the mortality was 28. 6 % being higher than that among those with Pp/Ps≥0. 8 and Rp < 10 wood. Conclusion The higher the preoperative Pp/Ps and Rp are, the higher the surgical mortality is. The prevention and treatment of postoperative pulmonary hypertension crisis should be given more attention. The placement of transthoracic intracardiac monitoring lines plays an important role in the prevention and treatment of the complications occurring postoperationally in children with pulmonary hypertension.

STATUS AND CONTROL POLICY OF MAIN CHRONIC DISEASES IN COMMUNITY HEALTH MANAGEMENT BASES IN SHANGHAI AND GUANGDONG

Objective To investigate the current conditions of the main chronic diseases and to make the control policy in community health management base in China. MethodsThe questionnaire consisting of prevalence, awareness rate, management rate, behavior correct rate, control rate, and medicine obey was used to survey the chronic disease condition in 2009. A total of 809 736 residents were randomly selected from Shanghai and Guangdong, China. ResultsThe hypertension prevalence was 17.81%. From sex analysis, the female has higher rate than male in hypertension prevalence, understand rate, management rate, behavior correct rate, control rate, and medicine obey rate. From age analysis, the prevalence, understand rate, management rate, control rate, and medicine obey were increasing along with the age, but behavior correct rate was not in this condition. The diabetes prevalence was 6.92%. To compare with Shanghai and Guangzhou in 5 aspects, the prevalence of chronic diseases was alike. Except lower behavior correct rate in Shanghai, management rate, behavior correct rate, control rate, and medicine obey rate were higher in Shanghai. ConclusionThe government must take main principle in chronic disease control. Base construction of community health management and increase management level of chronic diseases should be enhanced and practitioner's knowledge of chronic disease management should also be enhanced.

Characteristics of biochemical markers in patients with pulmonary hypertension related to left heart disease

Objective To investigate the differences of biochemical markers between the patients with pulmonary hypertension related to left heart disease(PH-LHD)and LHD;to explore the sensitive biomarkers which may predict PH in LHD patients.Methods A total of 355 LHD patients admitted to our hospital from 2014-01 to

Congestive heart failure and sepsis:a retrospective study of hospitalization outcomes from a rural hospital in Southwest Missouri

Background:Sepsis is the leading cause of death in hospitalized patients and significant effort has been made to facilitate early diagnosis and management.However,aggressive treatment can have negative effects,especially in patients with unstable volume status,such as those with congestive heart failure.Methods:We used electronic medical records to perform a retrospective study looking at hospital outcomes in patients from Southwest Missouri who were admitted with sepsis and had a comorbid diagnosis of hypertensive heart failure.Our primary outcome was in-hospital mortality.Results:We studied a total of 184 patients with the diagnosis of hypertensive heart failure with sepsis,and 348 patients with the diagnosis of sepsis that served as the baseline group.There was a total of 37(20%)deaths in the hypertensive heart failure group and a total of 94(27%)deaths in the baseline group.Conclusion:Our study showed no significant difference between the baseline group and those with hypertensive heart disease with heart failure.