Effect of Health Management in Raising Awareness Rate of Disease Prevention and Treatment in Patients with Prehypertension

Objective: To analyze the effect of health management on improving the awareness rate of disease prevention and treatment in patients with prehypertension, so as to provide guidance for clinical management of patients with prehypertension. Methods: 108 patients diagnosed with prehypertension in our hospital were divided into a control group and an experimental group. The control group was not given management measures, while the experimental group was given health management. The incidence of hypertension and cognition level of hypertension knowledge were compared between the two groups after management. Results: The incidence of hypertension in the experimental group was 7.41% lower than that in the control group 29.63%. The cognitive level of hypertension in the patients (66.54 ± 1.25) was significantly higher than that in the patients without health management (41.45 ± 2.45), and P < 0.05;Conclusion: For patients with prehypertension, the implementation of health management is helpful to improve their cognition of hypertension, master related prevention knowledge, and reduce the incidence of hypertension.

Prehypertension: Underlying pathology and therapeutic options

Prehypertension(PHTN) is a global major health risk that subjects individuals to double the risk of cardiovascular disease(CVD) independent of progression to overt hypertension. Its prevalence rate varies considerably from country to country ranging between 21.9% and 52%. Many hypotheses are proposed to explain the underlying pathophysiology of PHTN. The most notable of these implicate the renin-angiotensin system(RAS) and vascular endothelium. However, other processes that involve reactive oxygen species, the inflammatory cytokines, prostglandins and C-reactive protein as well as the autonomic and central nervous systems are also suggested. Drugs affecting RAS have been shown to produce beneficial effects in prehypertensives though such was not unequivocal. On the other hand, drugs such as β-adrenoceptor blocking agents were not shown to be useful. Leading clinical guidelines suggest using dietary and lifestyle modifications as a first line interventional strategy to curb the progress of PHTN; however, other clinically respected views call for using drugs. This review provides an overview of the poten-tial pathophysiological processes associated with PHTN, abridges current intervention strategies and suggests investigating the value of using the "Polypill" in prehypertensive subjects to ascertain its potential in delaying(or preventing) CVD associated with raised blood pressure in the presence of other risk factors.

Association of resting heart rate and hypertension stages on all-cause and car- diovascular mortality among elderly Koreans： the Kangwha Cohort Study

Background Elevated resting heart rate and hypertension independently increase the risk of mortality. However, their combined ef- fect on mortality in stages of hypertension according to updated clinical guidelines among dderly population is unclear. Methods We fol- lowed a cohort of 6100 residents （2600 males and 3500 females） of Kangwha County, Korea, ranging from 55 to 99 year-olds as of March 1985, for all-cause and cardiovascular mortality for 20.8 years until December 31, 2005. Mortality data were collected through telephone calls and visits （to 1991）, and were confirmed by death record matching with the National Statistical Office （1992-2005）. Hazard ratios were calculated for all-cause and cardiovascular mortality by resting heart rate and hypertension defined by Eighth Joint National Committee crite- ria using the Cox proportional hazard model after controlling for confounding factors. Results The hazard ratios associated with resting heart rate 〉 80 beats/min were higher in hypertensive men compared with normotensives with heart rate of 61-79 beats/rain, with hazard ratios values of 1.43 （95% CI： 1.00-1.92） on all-cause mortality for prehypertension, 3.01 （95% CI： 1.07-8.28） on cardiovascular mortality for prehypertension, and 8.34 （95% CI： 2.52-28.19） for stage 2 hypertension. Increased risk （HR： 3.54, 95% CI： 1.16-9.21） was observed among those with both a resting heart rate 〉 80 beats/rain and prehypertension on cardiovascular mortality in women. Conclusions Indi- viduals with coexisting elevated resting heart rate and hypertension, even in prehypertension, have a greater risk for all-cause and cardiovas- cular mortality compared to those with elevated resting heart rate or hypertension alone. These findings suggest that elevated resting heart rate should not be regarded as a less serious risk factor in elderly hypertensive patients.

Risk factors for prehypertension in Xinjiang Uygur population

Objective To assess the risk factors for prehypertension in Xinjiang Uygur population. Methods A cross-section study was conducted in a Xinjiang Uygur population（438 males and 716 females,aged 30 to 70 years）.The fasting lipid profiles,serum glucose,insulin,and uric acid were determined.Homeostasis model assessment of insulin resistance（HOMA-IR）index was used to assess insulin resistance（IR）.Binary logistic regression analysis was performed to determine risk factors for prehypertension.Blood pressure levels ofnormotensives and prehypertensives in different body mass index（BMI）categories were compared. Results Binary logistic regression analysis performed after adjustment for gender,lipids profiles,waist-to-hip ratio,uric acid,HOMA-IR,and lifestyle（alcohol drinking and smoking）showed a significantly increasing prevalence of prehypertension with BMI.The odds ratios for prehypertension against the lowest BMI group（separated by 24 and 28）were 1.934 and 2.490（95% confidence interval：1.435-2.606 and 1.825-3.399,respectively）.Age was independently correlated to the increasing prevalence of prehypertension.HOMA-IR was not associated with prehypertensive.The mean diastolic blood pressure（DBP）was significantly increased with BMI categories in either normotensives or prehypertensives（P〈0.001）while the mean systolic blood pressure（SBP）was significantly increased with BMI only in normotensives（P〈0.001）. Conclusions In Xinjiang Uygurs,BMI and age was the risk factors for prehypertension.DBP is significantly increased with BMI.IR is not associated with prehypertension.These findings emphasize the importance of management of obesity for the control of blood pressure and other cardiovascular complications.

Body Roundness Index Is Significantly Associated with Prehypertension and Hypertension in Nonobese Chinese Subjects

Prehypertension and hypertension have been considered significant public health issues worldwide[1].Disproportionate body fat distribution(excess fat stored in the liver and visceral compartment)is a well-established risk factor for prehypertension/hypertension[2].However,the most commonly used anthropometric indicators,such as body mass index(BMI)and waist circumference(WC)。

Association between G-protein β3 subunit gene and isolated systolic blood pressure elevation of greater than 130 mmHg: A large-scale cross-sectional study in the Japanese population

AIM To investigate whether GNB3 C825 T single nucleotide polymorphism(SNP) contributes to systolic blood pressure(SBP) ≥ 130 mmH g in a large-scale cross-sectional study among the Japanese population with diastolic blood pressure(DBP) < 85 mmH g. METHODS We analyzed 11008 Japanese subjects, including 2797 cases(SBP ≥ 130 and DBP < 85 mmH g) who were not taking anti-hypertensive medication and 8211 controls(SBP < 130 and DBP < 85 mmH g), all of whom enrolled in the genome banking project of the 21 st Century COE(Center of Excellence) Program at Jichi Medical University. Subjects were divided into four groups according to gender(male and female) and age(≤ 49 years and ≥ 50 years). GNB3 gene polymorphism was determined using the TaqM an probe method. We compared the frequencies of alleles and genotypes between cases and controls by chi-squared test. The strength of the associations was estimated by odds ratios(ORs) and 95%CI by using logistic regression analysis. The ORs were adjusted for age and body mass index. RESULTS Allele and genotype distributions significantly differed between cases and controls only in males aged ≤ 49 years. Compared to the CC genotype, a significant OR was obtained in the TT genotype among males aged ≤ 49 years.CONCLUSION This study indicates that the TT genotype of the GNB3 C825 T SNP may contribute to SBP elevation of greater than 130 mmH g compared to the CC genotype in Japanese males aged ≤ 49 years.

Prevalence and Risk Factors Associated with Prehypertension among Young and Middle-Aged Health Check-Up Population in Guangzhou

Objective:To provide basic information and theories for prehypertension early intervention,a systematic analysis of the epidemic status and risk factors among young and middle-aged was carried out here.Methods:This study relied on the data bank of a health check-up population of a class a tertiary general hospital in Guangdong province in 2015.Total 9540 young and middle-aged adults were enrolled,and 733 people were included to find out the effect with lifestyle in these crowd.Principal Components Analysis(PCA)of Factor(FA)was used to identify dietary patterns.The logistic regression model was used to find the risk factors of prehypertension.Results:Among 9540 young and middle-aged cases,the incidence of prehypertension was 36.6%.Moreover,the average age,proportion of male gender,overweight,FBG(fasting blood glucose),dyslipidemia,and hyperuricemia were significantly higher in the prehypertension group than in the optimal BP group.Multivariate logistic regression analysis indicated that age,total cholesterol,triglycerides,uric acid,body mass index and HR(heart rate)were risk factors,and female was a protective factor for prehypertension.Among 733 cases,the incidence of prehypertension was 35.1%.The proportion of smoking,drinking,physical workers,moderate and severe physical activity,and the intake of meat,dietary energy were significantly higher in the prehypertension group than in the optimal BP group.Dietary patterns included“meat model”,“spice model”,“main vegeTables model”and“high protein model”.Multivariate logistic regression analysis indicated that age,drinking were risk factors for prehypertension,while dietary milk intake,dietary magnesium intake were protective factors.Conclusions:Prehypertension is highly prevalent in Guangzhou.However,education about effective lifestyle modifications as an alcohol limit,increasing the intake of dairy products,and magnesium may intervene in the development of prehypertension.But how to develop targeted interventions for such groups need to be further explored.The present study would lay the theoretical foundation and basic data for the next step.

Prehypertension, Hypertension and Associated Cardiovascular Risk Factors among Adult Congolese Urban Dwellers: Results of the Vitaraa Study

Objective: To assess the prevalence of prehypertension and hypertension, their determinants and associated cardiovascular risk factors in Congolese urban dwellers. Methods: From July 2007 to March 2008, we collected information on lifestyle habits, medical history and anthropometric data in 1292 household members of Adoula Quarter, Kinshasa, aged 20 years or more, 731 women (56.6%). We obtained measurements of BP, blood glucose, serum lipids and qualitative proteinuria. We defined blood pressure categories according to JNC7 classification and used logistic regression analyses to assess their independent determinants. We obtained age adjustment of continuous and categorical variables using GLM and Genmod procedures, respectively. Results: Prehypertension was observed in 30.3% of subjects, 34.9% of men and 26.7% of women (P = 0.0045). The prevalence of hypertension amounted to 30.9% with no difference between genders. Participants with prehypertension had average age, BMI and waist circumference intermediate between those with normal BP and hypertensive subjects. Their glucose and lipids levels were similar to those of normotensives. The prevalence of prehypertension amounted to 33% at age 20 - 29 years and decreased to 16.7% at ≥60 years whereas the prevalence of hypertension increased from 11.2% to 71.4%. The rates of diabetes mellitus were similar accross blood pressure catogo- ries whilst prevalences of overweight/obesity, abdominal adiposity, dyslipidemia and metabolic syndrome significatively increased (P = 0.05 or less). Among participants with prehypertension, 73% had two or more additional cardiovascular risk factors. In the logistic model the probability of prehypertension was higher in men (OR: 1.429;95% CI: 1.099 - 1.857) and participants with overweight/obesity (OR: 1.666;1.146 - 2.422), lower in participants aged ≥ 55 years (0.427;0.267 - 0.683) and those with high fruit intake (0.691;0.488 - 0.977). The probability of hypertension was higher in participants aged ≥ 55 years (OR: 6.988;4.561 - 10.706), overweight/obesity (2.263;1.704 - 3.004), those with high vegetables consumption (1.152;1.003 - 1.324) and faster pulse rate (1.013;1.002 - 1.025). Conclusion: Our results suggest that fruit consumption and control of over-weight are important issues for prevention of cardiovascular disease in sub-Saharan Africa where high blood pressure is the main driver of the current epidemic.

Severity of non-alcoholic fatty liver disease is a risk factor for developing hypertension from prehypertension

Background:There is little published evidence about the role of non-alcoholic fatty liver disease(NAFLD)in the progression from prehypertension to hypertension.This study was conducted to investigate the association of NAFLD and its severity with the risk of hypertension developing from prehypertension.Methods:The study cohort comprised 25,433 participants from the Kailuan study with prehypertension at baseline;those with excessive alcohol consumption and other liver diseases were excluded.NAFLD was diagnosed by ultrasonography and stratified as mild,moderate,or severe.Univariable and multivariable Cox proportional hazard regression was used to calculate the hazard ratios(HRs)and 95%confidence intervals(CIs)of incident hypertension according to the presence and 3 categories of severity of NAFLD.Results:During a median of 12.6 years of follow-up,10,638 participants progressed to hypertension from prehypertension.After adjusting for multiple risk factors,patients with prehypertension and NAFLD had a 15%higher risk of incident hypertension than those without NAFLD(HR=1.15,95%CI 1.10-1.21).Moreover,the severity of NAFLD was associated with the incidence of hypertension,which was higher in patients with more severe NAFLD(HR=1.15[95%CI 1.10-1.21]in the mild NAFLD group;HR=1.15[95%CI 1.07-1.24]in the moderate NAFLD group;and HR=1.20[95%CI 1.03-1.41]in the severe NAFLD group).Subgroup analysis indicated that age and baseline systolic blood pressure may modify this association.Conclusions:NAFLD is an independent risk factor for hypertension in patients with prehypertension.The risk of incident hypertension increases with the severity of NAFLD.

Effect of electro-acupuncture on gene expression in heart of rats with stress-induced pre-hypertension based on gene chip technology

OBJECTIVE:To explore electro-acupuncture's(EA's)effect on gene expression in heart of rats with stress-induced pre-hypertension and try to reveal its biological mechanism based on gene chip technology.METHODS:Twenty-seven Wistar male rats were randomly divided into 3 groups.The stress-induced hypertensive rat model was prepared by electric foot-shocks combined with generated noise.Molding cycle lasted for 14 days and EA intervene was applied on rats in model + EA group during model preparation.Rat Gene 2.0 Sense Target Array technology was used for the determination of gene expression profiles and the screened key genes were verified by real-time quantitative polymerase chain reaction(RT-PCR) method.RESULTS:Compared with blank control group,390 genes were changed in model group;compared with model control group,330 genes were changed in model + EA group.Significance analysis of gene function showed that the differentially expressed genes are those involved in biological process,molecular function and cellular components.RT-PCR result of the screened key genes is consistent with that of gene chip test.CONCLUTION:EA could significantly lower blood pressure of stress-induced pre-hypertension rats and affect its gene expression profile in heart.Genes that related to the contraction of vascular smooth muscle may be involved in EA's anti-hypertensive mechanism.

Combined action of C-reactive protein and lipid profiles on risk of hypertension and prehypertension in Mongolian adults in Inner Mongolia, China

Background Many studies have suggested that C-reactive protein （CRP） and blood lipids are associated with hypertension and cardiovascular disease （CVD）.However,few studies discussed the combined action of CRP and blood lipids on the risk of hypertension and prehypertension.This study aimed to investigate the combined action of CRP and lipid profiles on the risk of hypertension and prehypertension in Mongolian adults from Inner Mongolia,China.Methods The systolic and diastolic blood pressure,height,weight and waist circumference were measured and factors such as smoking,alcohol intake,family history of hypertension,etc.,were investigated and CRP,low-density lipoprotein cholesterol （LDL-C）,triglycerides （TG） were tested for 2 534 Mongolian adults aged ≥20 years.The subjects were divided into four subgroups,namely CRP 〈median and LDL-C （TG） 〈median subgroup,CRP 〈median and LDL-C （TG） 〉median subgroup,CRP 〉median and LDL-C （TG） 〈median subgroup and CRP 〉median and LDL-C （TG） 〉median subgroup.The ORs （95% C/s） of hypertension and prehypertension for the subgroups were calculated by univariate and multivariate analysis.Results The multivariate adjusted ORs （95%CIs） of hypertension/prehypertension were 1.389 （0.979-1.970）/1.1 51（0.865-1.531）,1.666 （1.159-2.394）/1.431 （1.060-1.930）,1.756 （1.242-2.484）/ 1.770 （1.321-2.372）,for CRP 〈median and LDL-C 〉median subgroup,CRP 〉median and LDL-C 〈median subgroup,and CRP 〉median and LDL-C 〉median subgroup,respectively,compared with CRP 〈median and LDL-C 〈median subgroup.Similarly,the multivariate adjusted ORs （95% CIs） of hypertension/prehypertension were 2.032 （1.394-2.963）/1.442 （1.047-1.988）,1.412 （0.960-2.079）/1.596 （1.166-2.184）,and 2.197 （1.595-3.027）/1.730 （1.321-2.266） for CRP 〈median and TG 〉median subgroup,CRP 〉median and TG 〈median subgroup,and CRP 〉median and TG 〉median subgroup,respectively,compared with CRP 〈median and TG 〈median subgroup.The risks of hypertension and prehypertension were the highest in the CRP 〉median and LDL-C （TG） 〉median subgroup among the four subgroups.Conclusions Subjects with both CRP 〉median and LDL-C （TG） 〉median had highest risks of hypertension and prehypertension among all subjects.This study appeared to indicate that the combined action of elevated CRP and elevated LDL-C （TG） further increase the risks of hypertension and prehypertension among Mongolian population.

Berberine-Promoted CXCR4 Expression Accelerates Endothelial Repair Capacity of Early Endothelial Progenitor Cells in Persons with Prehypertension

Objective： To evaluate whether the berberine treatment can improve endothelial repair capacity of early endothelial progenitor cells （EPCs） from prehypertensive subjects through increasing CXC chemokine receptor 4 （CXCR4） signaling. Methods： EPCs were isolated from prehypertensive and healthy subjects and cultured. In vivo reendothelialization capacity of EPCs from prehypertensive patients with or without in vitro berberine treatment was examined in a nude mouse model of carotid artery injury. The protein expressions of CXCR4/Janus kinase-2 （JAK-2） signaling of in vitro EPCs were detected by Western blot analysis. Results： CXCR4 signaling and alteration in migration and adhesion functions of EPCs were evaluated. Basal CXCR4 expression was significantly reduced in EPCs from prehypertensive patients compared with normal subjects （P〈0.01）. Also, the phosphorylation of JAK-2 of EPCs, a CXCR4 downstream signaling, was significantly decreased （P〈0.01）. Berberine promoted CXCR4/JAK-2 signaling expression of in vitro EPCs （P〈0.01）. Transplantation of EPCs pretreated with berberine markedly accelerated in vivo reendothelialization （P〈0.01）. The increased in vitro function and in vivo reendothelialization capacity of EPCs were inhibited by CXCR4 neutralizing antibody or pretreatment with JAK-2 inhibitor AG490, respectively （P〈0.01）. Conclusion： Berberine- modified EPCs via up-regulation of CXCR4 signaling contributes to enhanced endothelial repair capacity in prehypertension, indicating that berberine may be used as a novel potential primary prevention means against prehypertension-related atherosclerotic cardiovascular disease.

高血压前期是发生终末期肾病的独立危险因素

2014年1月AmJKidneyDis发表了南方医科大学南方医院心血管内科撰写的关于高血压前期与终末期肾病（ESRD）危险性的Meta分析（HuangY，CaiX，ZhangJ，eta1．Prehypertension and incidence of ESRD：a systematic reviewand Meta．analysis．AmJKidneyDis，2014，63：76-83）。研究对美国、日本、挪威、中国等多个国家的前瞻性队列研究进行Meta分析，最终纳入人群超过100万（其中25．6％的亚洲人群），采用95％C/的ESRD相对风险（RRs）作为主要终点，并根据血压、年龄、性别、种族和研究特征进行亚组分析。