Arterial hypertension and electrocardiographic diagnosis of left ventricular hypertension in the group of geriatric patients with coronary heart disease living in the far north

As a result of research, high prevalence of arterial hypertension has been identified in the group of patients with coronary heart disease aged 60 and older. Most often, occurring form of arterial hypertension among geriatric patients is isolated systolic arterial hypertension (ISAH). The comparison of two ethnic groups of the population has showed higher levels of systolic and diastolic blood pressure (SBP and DBP) in the group of patients of non-indigenous nationality, rather than Yakut patients. Correlation was recorded in the group of non-indigenous patients as they age. Significant increase in the level of SBP was identified in the group of senile and long-livers than in the elderly. Detection of ECG signs of LVH showed the lowest specificity of Cornell voltage criterion comparing to Sokolow-Lyon criterion with its more often occurrence. ECG-signs of left ventricle hypertrophy are significantly more often established by Sokolow-Lyon criterion for men, Cornell voltage—for women. Correlation has been found between the presence of LVH and combination of Cornell voltage criterion with both Gubner-Ungerleider and Sokolow-Lyon criteria.

Clinical characteristics of Danshen Ligustrazine injection in the treatment of coronary heart disease with hypertension-A real world study

Objective:To explore the characteristics and rules of Danshen Ligustrazine Injection in the treatment of coronary heart disease with hypertension.Methods:From the information systems of 12 tertiary tier-one hospitals across the country,we extracted the medical data of the application of Danshen Ligustrazine Injection in the treatment of patients with coronary heart disease and hypertension.After normalization,the model was established by Apriori algorithm,and the association rules were analyzed by Clementine 12.0 software.Results:Most of the 1928 patients were between 75 and 90 years old(54.26%).There were more males than females,most with type 2 diabetes,cerebral infarction,etc.Each dose was more than 10 mL(52.78%).Aspirin enteric-coated tablets(67.63%),L-carnitine injection(58.77%),and atorvastatin calcium capsules(50.93%)were often used in combination with safflower yellow pigment(22.20%),Shexiang Baoxin Pill(16.55%),Suxiao Jiuxin Pill(15.09%);the most commonly used combination of western medicine was anticoagulant thrombolytic and antiplatelet drugs(85.84%),and the type of Chinese medicine was Huoxuehuayu(72.98%);The most common combination of two western medicines was L-carnitine injection+aspirin enteric-coated tablets,with a support of 41.9%;The most common combination of two Chinese and western medicines is western medicine·anti-anginal medicine+western medicine·anticoagulant thrombolytic and antiplatelet drugs with a support of 67.6%.Conclusion:Danshen Ligustrazine injection is mainly used in elderly patients with coronary heart disease and hypertension,with many comorbidities.The dosage standard needs to be optimized.The combination of drugs and guidelines should coordinate with each other,which provide clues for clinical diagnosis and treatment and optimization of medication.

Therapeutic Effect of Nifedipine Combined with Enalapril on Elderly Patients with Coronary Heart Disease Complicated with Hypertension

The objective of this study was to analyze the efficacy of combined drug therapy for elderly patients with coronary heart disease and hypertension.66 elderly patients with coronary heart disease and hypertension were enrolled from December 2016 to November 2017.They were randomly divided into two groups,33 patients in each group.Patients in the experimental group received nifedipine.In combination with enalapril,patients enrolled in the control group received nifedipine monotherapy.Compared with the control group,the total effective rate,serum nitric oxide(NO)after treatment,C-reactive protein(CRP)after treatment,homocysteine(HCY)after treatment,and blood pressure after treatment were significantly improved(P<0.05).There were no significant differences in serum NO,pre-treatment CRP,pre-treatment HCY,pre-treatment blood pressure,and adverse reactions during treatment between the two groups(P>0.05).The elderly patients with coronary heart disease and hypertension are treated with nifedipine and enalapril.

Correlation between serum Hcy content and coronary atherosclerosis severity in patients with H-type hypertension and coronary heart disease

Objective:To analyze the correlation between serum Hcy content and coronary atherosclerosis severity in patients with H-type hypertension and coronary heart disease. Methods: 48 patients with H-type hypertension and coronary heart disease were selected as observation group, and 57 patients with normal hypertension and coronary heart disease were selected as control group. Echocardiography was used to determine coronary lesion parameters, enzyme-linked immunosorbent assay (ELISA) was used to determine serum levels of homocysteine (Hcy) and coronary heart disease-related indexes, and the correlation between Hcy levels and coronary heart disease was further analyzed. Results:Serum Hcy level of observation group was higher than that of control group (P<0.05), absolute GLPSS value and E/A value under echocardiography were less than those of control group while E-DT and E/e value were higher than those of control group (P<0.05);serum adiponectin (APN) level was lower than that of control group while P-selectin, asymmetric dimethylarginine (ADMA), oxidized high-density lipoprotein (OX-HDL), MMP-2, MMP-9, lipoprotein-associated phospholipase A2 (Lp-PLA2) and Resistin levels were higher than those of control group (P<0.05);Hcy was negatively correlated with absolute GLPSS value, E/A value and APN level, and was positively correlated with E-DT value, E/e value as well as P-selectin, ADMA, OX-HDL, MMP-2, MMP-9, Lp-PLA2 and Resistin levels (P<0.05). Conclusions:There is direct correlation between serum Hcy levels and the severity of coronary heart disease in patients with H-type hypertension and coronary heart disease, it can be a reliable way to early screen for coronary heart disease and evaluate the illness, and it is also a new target of coronary heart disease intervention.

Effects of telmisartan combined with nifedipine controlled release tablet on inflammatory factors, vascular endothelial function and left ventricular function in patients with coronary heart disease with mild to moderate hypertension

Objective: To investigate the effect of telmisartan combined with Nifedipine Controlled Release Tablet on inflammatory factors, vascular endothelial function and left ventricular function in patients with coronary heart disease with mild to moderate hypertension. Methods:A total of 92 cases of patients with coronary heart disease with mild to moderate hypertension were selected as the object of observation, according to the random data table, they were divided into the control group (n=46) and observation group (n=46), and patients in the control group were treated with Nifedipine Controlled Release Table therapy, on this basis, the observation group patients were given telmisartan treatment, two groups were treated for 6 months. The levels of the blood pressure, inflammatory factors, vascular endothelial function and left ventricular function compared between the two groups before and after treatment. Results: There were no significant differences in the levels of SBP, DBP, hs-CRP, TNF-α, NO, ET-1, LVEF, LVEDD and LVESD in the two groups before treatment. After treatment, two groups of SBP, DBP, hs-CRP, TNF-α, ET-1, LVEDD and LVESD levels were significantly lower than those in the same group before treatment, and after treatment, the levels of SBP, DBP, hs-CRP, TNF-α, ET-1 and LVESD in the observation group were significantly lower than those in the control group, while there were no significant difference in the level of LVEDD between the two groups after treatment;Compared with level in the group before treatment, the levels of NO and LVEF in the two groups were significantly increased, and the observation group [(82.13±19.01) μmol/L, (52.83±7.45)%] was significantly higher than the control group ((67.37±13.08) μmol/L, (49.47±6.96)%)Conclusion: Telmisartan combined with Nifedipine Controlled Release Table in treating coronary heart disease with mild to moderate hypertension, can effectively control blood pressure, reduce the inflammatory stress, improve vascular endothelial function and left ventricular function of patients, has an important clinical value.

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.

Combined effects of hypertension and angiotensin Ⅱ on the risk of coronary heart disease:a population-based prospective cohort study among Inner Mongolians in China

Objective To investigate the combined effects of hypertension and angiotensinⅡon the risk of coronary heart disease(CHD)on the basis of a 10-year prospective study in an Inner Mongolian population of China.Methods Based on a cross-sectional survey,a prospective cohort study was conducted from June 2003 to July 2012 among 2,530 Mongolian people.

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.

High adiponectin levels fail to protect against the risk of hypertension and,in women,against coronary disease:involvement in autoimmunity?

AIM:To investigate whether serum adiponectin protects against cardiometabolic risk in a population sample with prevailing metabolic syndrome.METHODS:Middle-aged adults representative of a general population with baseline circulating adiponectin measurements(n=1224)were analyzed prospectively at a mean of 3.8 years’follow-up,using continuous values or sex-specific tertiles.Total adiponectin was assayed by an ELISA kit.Type-2 diabetes was identified by criteria of the American Diabetes Association.Hypertension was defined as a blood pressure≥140 mmHg and/or≥90 mmHg and/or use of antihypertensive medication.Outcomes were predicted using Cox proportional hazards regression analysis in models that were controlled for potential confounders.RESULTS:In models of multiple linear regression,sex hormone-binding globulin,fasting insulin(inverse)and,in men,age were significant independent covariates of serum adiponectin which further tended in women to be positively associated with serum creatinine.Cox regression analyses for incident coronary heart disease(CHD),adjusted for sex,age,non-HDL cholesterol,waist circumference and C-reactive protein,revealed significant inverse association with adiponectin tertiles in men but not women(HR=0.66;95%CI:0.32-1.38 for highest tertile).Cox regression for type-2 diabetes in a similar model(wherein glucose replaced non-HDL cholesterol),adiponectin tertiles appeared to protect in each gender.HR for incident hypertension roughly displayed unity in each of the adiponectin tertiles(P-trend=0.67).CONCLUSION:High adiponectin levels failed to protect against the development of hypertension and,in women,against CHD,presumably paralleling impairment in renal function as well.Involvement of adiponectin in autoimmune complex with loss of antioxidative-antiatherogenic properties may be underlying.

The Correlation between Free Triiodothyronine, Free Thyroxine and Hypertension in Depression Patients with Hypothyroidism and Its Clinical Guiding Value

Background: Cardiovascular diseases, such as hypertension and coronary heart disease, are often accompanied by thyroid and mental diseases, the harm of which poses great threats to patients’ health. Objective: To explore the correlation between free triiodothyronine (FT3), free thyroxine (FT4) and hypertension in depression patients with hypothyroidism and its clinical guiding value. Methods: A total of 548 patients diagnosed with hypothyroidism in Wuxue First People’s Hospital of Hubei Province from January 2018 to September 2022 were enrolled. According to whether complicated with depression, they were divided into hypothyroidism without depression group (group A) and hypothyroidism with depression group (group B). The gender, age, comorbidities (such as depression, hypertension, diabetes, dyslipidemia, acute myocardial infarction), FT3, FT4, and thyroid stimulating hormone (TSH) levels were recorded. Spearman rank correlation was used to analyze hypertensive patients with hypothyroidism. Multivariate binary Logistic regression was used to analyze the influencing factors of hypertension in patients with hypothyroidism. Results: The TSH level, the number of hypertension, coronary heart disease and hyperlipidemia in group B were statistically significantly higher than those in group A (P 3 level in group B was statistically significantly lower than that in group A (P s = 0.092), coronary heart disease (rs = 0.000), hyperlipidemia (rs = 0.000), diabetes (rs = 0.000), and age (rs = 0.000), and negatively correlated with FT3 (rs = 0.000) (P 3 and FT4 were the influencing factors of hypertension. The risk of hypertension in patients with coronary heart disease and hyperlipidemia significantly increased by 3.425 and 1.761 times (P 3, the risk of hypertension increased (P 4, the risk of hypertension significantly increased (P 3 and FT4 are the influencing factors of hypertension. The lower the FT3 level, the higher the FT4 level, the higher the risk of hypertension. FT3 and FT4 may be potential biomarkers of depression in hypertensive patients. Thyroid function assessment is recommended in patients with hypertension.

Herbal medicine prescribing patterns from contemporary famous old TCM doctors for treating coronary heart disease: an analysis based on data mining

To analyze the herbal medicine prescribing patterns of contemporary famous old traditional Chinese medicine doctors in treating coronary heart disease,based on data mining technology,so as to provide useful insights into the clinical practice.Methods:Databases,including Medline(January 1966 to December 2019),Wanfang(January 1982 to December 2019),VIP Database(January 1989 to December 2019),CNKI(January 1979 to December 2019),CBMdisc(January 1978 to December 2019),and Classic Case Collection from Contemporary Famous Old Traditional Chinese Medicine Doctors were searched,and 224 eligible studies involving 416 patients were entered into the case study database after data processing.Frequency analysis and association rule analysis were used to investigate the prescribing patterns of contemporary famous old traditional Chinese medicine doctors in treating coronary heart disease.Results:In total 290 kinds of Chinese herbal drugs and 19 core drugs were used in the cases studied.The most commonly used categories were“Qi-Tonifying Drugs”,“Blood-Activating Drugs”,and“Phlegm-Eliminating Drugs”.The association rule analysis identified 14 commonly used herbal pairs,19 three-drug combinations,and 1 four-drug combination.Conclusion:Contemporary famous old traditional Chinese medicine doctors considered warming heart yang as an extremely important approach to treat coronary heart disease based on Zhang Zhongjing’s treatment for chest painful obstruction caused by“Inactivity of Chest Yang”(blockade of phlegm turbidity).Both symptoms and root causes were addressed in the formulas prescribed by these doctors.“Tonifying Qi,Nourishing Yin,Activating Blood,and Eliminating Phlegm”were the most commonly used therapeutic methods for patients with coronary heart disease.

Prevalence, risk factors, and survival associated with pulmonary hypertension and heart failure among patients with underlying coronary artery disease: a national prospective, multicenter registry study in China

Background: Coronary artery disease (CAD) is the commonest cause of heart failure (HF), whereas pulmonary hypertension (PH) has not been established or reported in this patient population. Therefore, we assessed the prevalence, risk factors, and survival in CAD-associated HF (CAD-HF) complicated with PH.Methods: Symptomatic CAD-HF patients were continuously enrolled in this prospective, multicenter registry study. Echocardiography, coronary arteriography, left and right heart catheterization (RHC), and other baseline clinical data were recorded. Patients were followed up and their survival was recorded.Results: One hundred and eighty-two CAD-HF patients were enrolled, including 142 with HF with a preserved ejection fraction (heart failure with preserved ejection fraction [HFpEF];left ventricular ejection fraction [LVEF] ≥50%) and 40 with a reduced ejection fraction (heart failure with reduced ejection fraction [HFrEF];LVEF < 50%). PH was diagnosed with RHC in 77.5% of patients. Patients with PH showed worse hemodynamic parameters and higher mortality. HFrEF-PH patients had worse survival than HFpEF-PH patients. CAD-HF patients with an enlarged left ventricular end-diastolic diameter and reduced hemoglobin were at higher risk of PH. Nitrate treatment reduced the risk of PH. Elevated creatinine and mean pulmonary arterial pressure (mPAP), diastolic pressure gradient (DPG) ≥7 mmHg, and previous myocardial infarction (MI) entailed a higher risk of mortality in CAD-HF patients with PH.Conclusions: PH is common in CAD-HF and worsens the hemodynamics and survival in these patients. Left ventricle enlargement and anemia increase the risk of PH in CAD-HF. Patients may benefit from nitrate medications. Renal impairment, elevated mPAP, DPG ≥7 mmHg, and previous MI are strong predictors of mortality in CAD-HF-PH patients.Trial Registration: ClinicalTrials.gov, NCT02164526.

The link between dietary nutrients intake and cardiovascular diseases in cold regions

Background:The cold winter weather in northern China influences the dietary habits of its residents,contributing to a heightened risk of cardiovascular disorders,such as hypertension and coronary heart disease.Key factors include low vegetable consumption and high salt and fat intakes.This study aims to investigate the relationships between northern dietary nutrient intake in northern China and cardiovascular disorders during the winter season.Methods:A food frequency questionnaire tailored to the actual eating habits in northern China was designed.Retrospective data from 955 Chinese adults were collected from November to March between 2014 to 2023.Logistic regression was employed to analyze the relationship between dietary nutrients and cardiovascular diseases,with model performance assessed using receiver operating characteristic(ROC)curves.Results:Adjusted for gender,age,and body mass index(BMI),an inverse association was observed between vitamin A(OR=0.706,95%CI:0.550,0.907),nicotinic acid(OR=0.584,95%CI:0.447,0.762),phosphorus(OR=0.777,95%CI:0.608,0.994),selenium(OR=0.719,95%CI:0.560,0.923),zinc(OR=0.683,95%CI:0.531,0.880),methionine(OR=0.730,95%CI:0.569,0.936),arginine(OR=0.753,95%CI:0.588,0.964),lysine(OR=0.706,95%CI:0.550,0.907),aspartic acid(OR=0.730,95%CI:0.569,0.936)and hypertension.Additionally,a negative association was found between niacin(OR=0.752,95%CI:0.597,0.946)and coronary heart disease.Conversely,a positive association was identified between iodine and hypertension(OR=1.305,95%CI:1.020,1.669)and coronary heart disease(OR=1.301,95%CI:1.037,1.634).Conclusion:Our study suggests that maintaining a balanced dietary intake of vitamin A,niacin,phosphorus,selenium,zinc,methionine,arginine,lysine,and aspartic acid can be beneficial in preventing hypertension.Adequate niacin intake is associated with a lower risk of coronary heart disease.However,excessive iodine intake may contribute to hypertension and coronary heart disease.

Resting heart rate control and prognosis in coronary artery disease patients with hypertension previously treated with bisoprolol:a subgroup analysis of the BISO-CAD study

Background:Resting heart rate(RHR)is considered as a strong predictor of total mortality and hospitalization due to heart failure in hypertension patients.Bisoprolol fumarate,a second-generation beta-adrenoreceptor blockers(β-blocker)is commonly prescribed drug to manage hypertension.The present study was to retrospectively evaluate changes in the average RHR and its association with cardiovascular outcomes in bisoprolol-treated coronary artery disease(CAD)patients from the CAD treated with bisoprolol(BISO-CAD)study who had comorbid hypertension.Methods::We performed ad-hoc analysis for hypertension sub-group of the BISO-CAD study(n=866),which was a phase IV,multination,multi-center,single-arm,observational study carried out from October 2011 to July 2015 across China,South Korea,and Vietnam.Multivariate regression analysis was used to identify factors associated with incidence of composite cardiac clinical outcome(CCCO),the results were presented as adjusted odds ratio(OR)along with 95%confidence interval(CI)and adjusted P value.Results::A total of 681 patients(mean age:64.77±10.33 years)with hypertension from BISO-CAD study were included in the analysis.Bisoprolol improved CCCOs in CAD patients with comorbid hypertension,with RHR<65 and<70 beats/min compared with RHR≥65 and≥75 beats/min,respectively,in the efficacy analysis(EA)set.In addition,it lowered RHR in both intent-to-treat(ITT)and EA groups after 6,12,and 18 months of treatment.Further,RHR 70 to 74 beats/min resulted in significantly higher risk of CCCOs EA set of patients(adjusted OR:4.34;95%CI:1.19-15.89;P=0.03).Also,events of hospitalization due to acute coronary syndrome were higher when RHR 69 to 74 beats/min compared to RHR<69 beats/min in ITT patients.Conclusion::Bisoprolol can effectively reduce RHR in Asian CAD patients with comorbid hypertension and hence,improve CCCO without affecting their blood pressure.

基于三酰甘油葡萄糖指数联合血管弹性指标的绝经后女性高血压患者冠心病发生风险模型开发研究

背景绝经后女性高血压患者是冠心病易发人群,其冠心病患病率与死亡率较绝经前显著升高。本研究在团队前期研究基础上进一步联合糖脂代谢、血管弹性等相关指标诊断绝经后女性高血压患者发生冠心病,以期为临床识别绝经后女性高血压患者的冠心病风险提供新思路。目的探讨三酰甘油葡萄糖(TyG)指数、踝肱指数(ABI)、臂踝脉搏波传导速度(baPWV)、脉压指数(PPI)、动脉硬化指数(AI)联合与绝经后女性高血压患者发生冠心病的相关性及预测价值,构建绝经后女性高血压患者冠心病发生风险的预测模型。方法本研究选取2019—2022年就诊于中日友好医院中西医结合心内科的首次行冠状动脉造影检查的绝经后女性高血压患者,根据冠状动脉造影结果分为冠心病组与非冠心病组。收集患者入院时的TyG指数、ABI、baPWV、PPI、AI等临床资料,采用多因素Logistic回归分析构建绝经后女性高血压患者冠心病发生风险预测模型,并绘制列线图实现模型可视化。采用受试者工作特征(ROC)曲线、校准曲线、临床决策曲线分析(DCA)评价诊断效能。结果本研究共纳入首次行冠状动脉造影的绝经后女性高血压患者300例,其中非冠心病组141例、冠心病组159例。多因素Logistic回归分析结果显示,ABI、baPWV、TyG指数、PPI、AI是绝经后女性高血压患者发生冠心病的影响因素(P<0.05),并根据预测方程绘制列线图。ROC曲线分析结果显示,ABI、baPWV、TyG指数、PPI、AI和联合预测模型预测绝经后女性高血压患者发生冠心病的ROC曲线下面积(AUC)分别为0.662、0.687、0.659、0.700、0.612、0.808(P<0.001),预测模型预测绝经后女性高血压患者冠心病发生风险的灵敏度为0.7806,特异度为0.7410。校准曲线显示预测结果与实际结果具有较好的一致性。DCA曲线表明列线图具有较好的临床实用价值。结论ABI、baPWV、TyG指数、PPI、AI是绝经后女性高血压患者发生冠心病的影响因素,新开发模型可对冠心病风险进行有效预警。

Management of chronic heart failure in the older population

Chronic heart failure （CHF） is the leading cause of hospitalization for those over the age of 65 and represents a significant clinical and economic burden. About half of hospital re-admissions are related to co-morbidities, polypharmacy and disabilities associated with CHF. Moreover, CHF also has an enormous cost in terms of poor prognosis with an average one year mortality of 33%–35%. While more than half of patients with CHF are over 75 years, most clinical trials have included younger patients with a mean age of 61 years. Inadequate data makes treatment decisions challenging for the providers. Older CHF patients are more often female, have less cardiovascular diseases and associated risk factors, but higher rates of non-cardiovascular conditions and diastolic dysfunction. The prevalence of CHF with reduced ejection fraction, ischemic heart disease, and its risk factors declines with age, whereas the prevalence of non-cardiac co-morbidities, such as chronic renal failure, dementia, anemia and malignancy increases with age. Diabetes and hypertension are among the strongest risk factors as predictors of CHF particularly among women with coronary heart disease. This review paper will focus on the specific consideration for CHF assessment in the older population. Management strategies will be reviewed, including non-pharmacologic, pharmacologic, quality care indicators, quality improvement in care transition and lastly, end-of-life issues. Palliative care should be an integral part of an interdiscipli-nary team approach for a comprehensive care plan over the whole disease trajectory. In addition, frailty contributes valuable prognostic in-sight incremental to existing risk models and assists clinicians in defining optimal care pathways for their patients.

Differences in coronary microvascular lesions in coronary heart disease and hypertension:an autopsy study of elderly patients

Background In the case of hypertension, lesions in the microvessels of the target organs precede and deteriorate futher after arteriosclerosis in the small arteries. Thus coronary microvascular lesion (CML) was considered the crucial factor contributing to damage to the target organs. The purpose of this study is to observe the characteristics and differences of CML in autopsies of elderly patients with essential hypertension (EHT), coronary heart disease (CHD), or EHT with CHD, given the same degree of left ventricular wall thickness (LVWT).Methods A retrospective study was performed on 246 cases of patients over 60 years old with EHT, CHD, or EHT with CHD, and on 26 cases without cardiovascular disease as controls , out of a total of 3195 consecutive autopsied cases. The arterioles (with diameter 10 -60 μm) and the capillaries in the cardiac muscle layer were examined by haematoxylin and eosin staining, elastic van Gieson staining, and CD31 immunohistochemistry. To quantify CML severity, measurements were taken of arteriole density (AD), the ratio of wall-to-lumen area of arteriole (RWL), and capillary density (CD), using light microscopy and computer image analysis. Based on LVWT, the cases were divided into four degrees, from Ⅰ to Ⅳ. The EHT, CHD, and EHT with CHD groups all rated LVWT Ⅰ -Ⅳ, and the control group rated LVWT Ⅰ. SAS software was used for statistical analysis.Results With the aggravation of LVWT, both AD and RWL increased while CD decreased significantly in the EHT group (P<0. 05 -0. 0001); there were similar but more severe changes in the EHT with CHD group (P<0. 001 -0. 0001); and AD increased (P <0.001) while RWL and CD did not change significantly in the CHD group.Conclusion Comparing EHT with CHD patients, there are similar patterns of change to AD, but different patterns of change to RWL and CD. CML is much more severe in EHT patients with CHD. We conclude that CML is one of the main causes of decreased coronary flow reserve and myocardial damage in both EHT patients and EHT patients with CHD.

Clinical Study on Effect of Garlicin in Stabilizing the Carotid Artery Atherosclerotic Plaque in Patients with Primary Hypertension and Coronary Artery Disease

Objective： To investigate the effect of garlicin in treating carotid artery atherosclerotic plaque （OAAP） in patients with primary hypertension and coronary heart disease （PHT-OHD）. Methods： Seventynine patients with PHT-OHD were randomly divided into the treated group （39 patients） treated with garlicin and fosinopril and the control group （40 patients） treated with fosinopril alone. The change of OAAP was evaluated by high frequency ultrasonic examination every six months, and the changes of intercellular adhesion molecule-1 （IOAM-1） and high sensitive O-reactive protein （hs-ORP） were measured by ELISA, with the observation proceeding for 52 weeks totally. Results： By the end of the experiment, the number of complex plaques, Orouse integrals, intima-media thickness, serum IOAM-1 and hs-ORP were significantly lower in the treated group than those in the control group with significant difference （P〈0.05）. Conclusion： Garlicin could stabilize CAAP to a certain extent and shows a definite vascular protective effect in patients with PHT-CHD.

Prevalence and clinical characteristics of atrial fibrillation in hospitalized patients with coronary artery disease and hypertension: a cross-sectional study from 2008 to 2018

Background: The clinical characteristics of patients with the comorbidities of hypertension and coronary artery disease (HT-CAD) and atrial fibrillation (AF) are largely unknown. This study aimed to investigate the prevalence of AF in patients with HT-CAD and clinical characteristics of patients with both HT-CAD and AF. Methods: This cross-sectional study was conducted in Chinese People’s Liberation Army General Hospital in Beijing, China, and included 20,747 inpatients with HT-CAD with or without AF from August 2008 to July 2018. We examined the overall prevalence, clinical characteristics, comorbidity profiles, treatment patterns, and blood pressure (BP) control of patients with both HT-CAD and AF. Multivariate logistic regression was used to investigate the associations of cardiovascular risk factors with AF in patients with HT-CAD. Results: The overall prevalence of AF in patients with HT-CAD was 4.87% (1011/20,747), and this increased with age;to be specific, the prevalence in women and men increased from 0.78% (2/255) and 1.02% (26/2561) at the age of <50 years to 8.73% (193/2210) and 10.28 % (298/2900) at the age of ≥70 years, respectively. HT-CAD patients who had AF had a higher prevalence of cardiovascular-related comorbidities than those without AF. Multivariate logistic regression showed that age, gender (male), body mass index, heart failure, and chronic kidney disease were independently associated with the risk of AF in patients with HT-CAD. For those with both HT-CAD and AF, 73.49% (743/1011) had a CHA 2 DS 2 -VASc score of ≥4, and only about half of them had the BP controlled at <140/90 mmHg, which indicated a high risk of thromboembolism and stroke. The use of oral anticoagulation increased during the study period (10.00% [20/200] in 2008 to 2011 vs. 30.06% [159/529] in 2015 to 2018, P < 0.01), but remained at a relatively low level. Conclusions: AF is highly prevalent among patients with HT-CAD. Patients with both HT-CAD and AF have a higher prevalence of cardiovascular-related comorbidities, lower BP control rate, and lower use of oral anticoagulation.

Mobile and wireless technologies applying on sphygmomanometer and pulsimeter for patients with pacemaker implementation and other cardiovascular complications

Continuously monitoring pulse is very important for the pacemaker patients., and the continuously observing blood pressure is also a matter of concern for those who have hypertension, coronary heart disease, or other cardiovascular diseases, for example cardiac arrhythmia and hypertension. What we expect is not only to eliminate arrhythmia, also to treat patients as a whole of body. Therefore, how to keeping monitoring blood pressure and pulses rise to a very important issue. This research edits a wrist-able sphygmomanometer and pulsimeter combining with cell phone, to achieve wireless, continuous, and real-time observation, early detects any accident occurring from the patients with pacemaker implementation or with other cardiovascular