Dry eye rate and its relationship with disease stage in patients with primary hypertension:a cross-sectional study in Vietnam

AIM:To determine the dry eye(DE)rate and its relationship with disease stage in patients with primary hypertension.METHODS:A cross-sectional study included 432 patients with primary hypertension(with an equal number of patients in each group:144 in stage Ⅰ,Ⅱ,and Ⅲ hypertension)and 144 healthy subjects as a control group.The Ocular Surface Disease Index(OSDI)and Schirmer Ⅰ test without anesthetics were conducted on all 576 subjects.Subjects with OSDI scores<13 and Schirmer Ⅰ values equal to or under 10 mm were diagnosed with DE.RESULTS:The ratio of DE in hypertension patients was higher than in the control group(41.7%versus 18.8%;P<0.001).The proportion of patients with DE increased gradually according to the hypertension stage:27.1% in stage Ⅰ,40.3% in stage Ⅱ,and 57.6% in stage Ⅲ,P<0.001.Age,duration of hypertension,plasma urea,creatinine,and high-sensitivity C-reactive protein(CRP-hs)levels in hypertension patients with DE were higher than those without DE,P<0.001.Advanced age,a long duration of hypertension,diabetes mellitus,elevated plasma creatinine,and CRP-hs levels were independent factors associated with DE in primary hypertension patients,P<0.001.CONCLUSION:DE is a common disorder associated with advanced age,a long duration of hypertension,diabetes mellitus,elevated plasma CRP-hs,and creatinine levels in patients with primary hypertension.

Relevant detection indicator of prethrombotic state in patients with primary hypertension

BACKGROUND Hypertension is a common chronic disease that affects many people worldwide.Only a few reports related to the exploration of relevant indicators of the prethrombotic state in patients with primary hypertension(PH)in clinical settings were available.AIM To detect prethrombotic state-related indicators in patients with PH and analyze their differences in different patient populations to provide a laboratory basis for the clinical prevention and control of hypertensive thrombotic diseases.METHODS The general data of patients with PH who attended the Department of Cardiovascular Medicine,The First Affiliated Hospital of Jiangxi Medical College,from January 2022 to December 2022 were collected retrospectively.The patients were divided into three groups of 40 patients each according to the Grade of PH:Grade 1,Grade 2,and Grade 3 hypertension experimental group.The baseline data of 40 volunteers,who underwent physical examination in our hospital but were not diagnosed with PH during the same period,were included in the control group.The relevant indicators of prethrombotic state of the participants were compared,and mainly included inflammation-related indicators,hemorheology-related indicators,and coagulation function related indicators.The relationship between the aforementioned indicators and the progression of PH was analyzed.RESULTS No significant differences were observed in age,sex,diabetes mellitus,smoking history,drinking history,body mass index,New York Heart Association functional classification,or the course of hypertension among the four groups(P>0.05).The expressions of high-sensitivity C-reactive protein(hs-CRP),thrombomodulin(TM),hematocrit(Hct),erythrocyte sedimentation rate(ESR),P-selectin on platelet surface(CD62P),and fibrinogen(FIB)in the control group were<Grade 1 hypertension group<Grade 2 hypertension group<Grade 3 hypertension group,and the expressions of platelet(PLT),activated partial thromboplastin time(APTT),prothrombin(PT),and plasma thrombin time(TT)in the control group was>Grade 1 hypertension group>Grade 2 hypertension group>Grade 3 hypertension group,and the difference was statistically significant(P<0.05).The results of the multivariate logistic regression model showed that the expression of hs-CRP,TM,Hct,ESR,CD62P,PLT,APTT,PT,TT,and FIB in the included participants was related to the progression of PH.Among these,high expression of hs-CRP,TM,Hct,ESR,CD62P,APTT,PT,and TT,and low expression of PLT and FIB were risk factors for PH(OR>1,P<0.05).The results of the receiver operating characteristic curve analysis showed that the area under the curve of hs-CRP,TM,ESR,CD62P,APTT,PT,TT,and FIB for the prediction of PH were>0.80,and the prediction value was ideal.Linear correlation analysis with bivariate Spearman showed that hs-CRP,TM,Hct,ESR,CD62P,APTT,PT,and TT were positively correlated with each other(r>0,P<0.05);PLT and FIB were negatively correlated with hs-CRP,TM,Hct,ESR,CD62P,APTT,PT,and TT(r<0,P<0.05);and PLT and FIB were positively correlated(r>0,P<0.05).Linear correlation analysis using bivariate Spearman showed that hs-CRP,TM,Hct,ESR,CD62P,and FIB were positively correlated with each other(r>0,P<0.05),whereas PLT,APTT,PT,and TT were negatively correlated with hs-CRP,TM,Hct,ESR,CD62P,and FIB(r<0,P<0.05).There was a positive correlation between PLT,APTT,PT,and TT(r>0,P<0.05).CONCLUSION The relevant indicators of the prethrombotic state in patients with PH,such as hs-CRP,TM,Hct,ESR,CD62P,PLT,APTT,PT,TT,and FIB,showed differences.High expression of hs-CRP,TM,Hct,ESR,CD62P,and FIB,and low expression of PLT,APTT,PT,and TT are the keys to the occurrence,progression,and thrombotic state of PH.Based on the above serum indicators’expression in patients,targeted interventions can be administered to patients with abnormal expression levels to control the progression of their disease and reduce the risk of developing a prethrombotic state.

Primary hypertension in a postoperative paraganglioma patient:A case report

BACKGROUND Primary hypertension is a common clinical disease.Pheochromocytoma and paraganglioma is a rare cause of secondary hypertension.The diagnosis of the latter is still difficult,and the relationship between the two is not clear.The successful diagnosis of this case confirmed that standardized etiological investigation of secondary hypertension is necessary,contributes to the accurate diagnosis of rare diseases,and is conducive to the formulation or optimization of treatment plans.It shows an example of the coexistence of primary hypertension and secondary hypertension.CASE SUMMARY The patient was a 54-year-old male and was hospitalized with high blood pressure for 4 years.The patient’s blood pressure was measured at 150/100 mmHg during physical examination 4 years ago and had no paroxysmal or persistent elevated blood pressure,no typical triad of headache,palpitation,and sweating,without postural hypotension.After taking nifedipine sustained release tablets intermittently,the blood pressure did not meet the standard.Physical examination revealed blood pressure of 180/120 mmHg.There was no abnormality in cardiopulmonary and abdominal examination.The results of blood and/or urinary catecholamines/metanephrine and normetanephrine before and after operation were normal.Fundus examination revealed retinal arteriosclerosis in both eyes.There was a history of paraganglioma diagnosed by pathology after retroperitoneal tumor resection,a family history of hypertension,and a history of passive smoking.The clinical diagnosis was subclinical paraganglioma,primary hypertension,and hypertensive fundus lesions.The patient’s blood pressure was regulated,blood lipid was reduced,and anti-inflammatory,and symptomatic support were given.After treatment,the blood pressure was stable and up to standard without discomfort symptoms.CONCLUSION Subclinical paraganglioma and primary hypertension can coexist.The holistic thinking in clinical practice is helpful to the early diagnosis of rare diseases.

Monitoring the changes in plasm C-reactive protein,fibrinogen and blood white cell in patients with primary hypertension combined with acute cerebral infarction

BACKGROUND： Inflammatory reaction and the increased level of its accompanying active protein play an important role in the occurrence and development of cerebral infarction. C-reactive protein, fibrinogen and white blood cell, as the monitoring index of inflammatory reaction, are very important in the occurrence and development of acute cerebral infarction. OBJECTIVE： To make a comparison between patients with primary hypertension accompanied with acute cerebral infarction and with simple primary hypertension by observing the changes in plasma C-reactive protein and fibrinogen levels as well as white blood cell and differential counts and analyzing their significances. DESIGN ： Controlled observation SETTING ： Ward Building for VIP, Shenzhen Hospital, Peking University. PARTICIPANTS： Totally 133 patients with primary hypertension were selected from Ward Building for VIP, Shenzhen Hospital, Peking University during September 2003 to September 2005, The diagnostic criteria were based on the hypertension diagnosis criteria formulated by the 7^th World Health Organization-International Society of Hypertension Guidelines （WHO-ISH） in 1998. The informed consents were obtained from all the participants. The involved patients were assigned into two groups： primary hypertension group, in which, there were 65 patients with primary hypertension （ degree 2）, including 42 males and 23 females, with mean age of （61 ±14）years and mean blood pressure of （162.7±6.8）/（94.2±8.4） mm Hg （1 mm Hg =0.133 kPa）, and primary hypertension combined with cerebral infarction group, in which, there were 68 patients with primary hypertension combined with cerebral infarction （ meeting the diagnostic criteria formulated in the 4^th National Cerebrovascular Diseases Meeting in 1995 and diagnosed by skull CT or MRI to exclude the patients with lacunar infarction）, including 42 males and 26 females, with mean age of （56±15） years and mean blood pressure of （176.4±9.2）/（96.3±9.7） mm Hg. METHODS： Plasm C-reactive protein and fibrinogen levels, and white blood cell and differential counts of patients in the two groups were examined 24 hours after stroke. The above indexes were re-examined in the primary hypertension combined with cerebral infarction group 72 hours after stroke. White blood cell and differential counts were performed with laser method （East Asia FE-95001 RAM-1, Japan）. The level of C-reactive protein was measured with turbidimetry （BNII Automatic Systems For Analysis, USA）. The level of fibrinogen was measured with algorithm method when prothrombin time was normal and with Clauss method when prothrombin time was abnormal （ACL Automatic Coagulation Analyzer, USA）. MAIN OUTCOME MEASURES： The plasm C-reactive protein and flbrinogen levels, and white blood cell and differential counts 24 hours after stroke in two groups and 72 hours after stroke in primary hypertension combined with cerebral infarction group. RESULTS： All the 133 involved patients participated in the result analysis. The plasm C-reactive protein and fibrinogen levels, and white blood cell and neutrophil counts in patients with primary hypertension were all within the normal range. The plasm C-reactive protein and fibrinogen levels, and white blood cell and neu- trophil counts in patients with primary hypertension combined with cerebral infarction were significantly higher than those in patients with primary hypertension 24 hours after stroke and 72 hours after stroke respectively[24 hours after stroke：（32.12±11.76） mg/L vs. （5.02±3.21 ） mg/L;（4.64±0.75） g/L vs. （3.12±0.49） g/L; （9.32±81）×10^9 L^- 1 vs. （5.78±1.32）×10^9L^- 1 （7.85±2.38）×10^9 L^- 1 vs.（3.49±1.28）×10^9 L^-1,t =7.094, 5.759,4.106,5.491, respectively,all P〈 0.01; 72 hours after stroke： （47.62±18.43） mg/L vs. （32.12±11.76） mg/L; （5.08±0.82） g/L vs. （4.64±0.75） g/L, t =2.864,2.220, respectively, both P 〈 0.05]. CONCLUSION： The increase in fibrinogen level and white blood cell count are the important index in monitoring primary hypertension combined with acute cerebral infarction. The increase in plasm C-reactive protein and fibrinogen levels 72 hours after stroke indicates that plasma C-reactive protein and fibrinogen are very important in the development of disease.

Effect of auricular plaster for primary hypertension in older people:A meta-analysis

BACKGROUND Hypertension is a critical public health problem globally.Antihypertensive drugs can create an extra burden on hypertension patients'self-regulation leading to an imbalance of blood supply and demand.This study aimed to evaluate the effect of auricular plaster therapy combined with western medicine to treat primary hypertension in older people.AIM To carry out a systematic review and meta-analysis for the effect of auricular plaster in elderly hypertension patients.METHODS Multiple databases like PubMed,EMBASE,Cochrane Library,Chinese Biomedical Literature on Disc,China National Knowledge Infrastructure,Wan Fang and Chinese Science and Technology Periodical Database were used to search for the relevant studies and full-text articles involved in the evaluation of auricular plaster combined with western medicine and western medicine alone for primary hypertension in older people.All included articles were quality assessed and the data analysis was conducted with the Review Manager(5.4).Forest plots,sensitivity analysis and funnel plots were also performed on the included articles.RESULTS In this analysis,fourteen(14)relevant studies were included.The Meta-analysis showed a significant difference in the effective ratio(OR=3.62;95%CI,2.46 to 5.33;P<0.00001),diastolic blood pressure change(5.68 mmHg;95%CI,3.49 to 7.87;P<0.00001),systolic blood pressure change(MD=8.78 mmHg;95%CI,5.04 to 12.53;P<0.00001)and symptom score(MD=3.20;95%CI,1.23 to 5.18;P=0.001)between auricular plaster combined with western medicine group and western medicine alone group.One bias was detected as selection bias and another two in reporting bias.Sensitivity analysis fulfilled the stability of the results.CONCLUSION Our study suggested that auricular plaster combined with western medicine improved primary hypertension better than western medicine alone.Limited by the quality of included studies,further studies should be performed to confirm our findings.

Songling Xuemaikang Capsule(松龄血脉康胶嚢)for Primary Hypertension: A Systematic Review of Randomized Controlled Trials

Objective： To evaluate the effectiveness and safety of Songling Xuemaikang Capsule （松龄血脉康胶囊, SXC） for the treatment of primary hypertension. Methods： An extensive search including Cochrane Library, PubMed, Cochrane Central Register of Controlled Trials （CENTRAL）, Chinese Biomedical Literature Database （CBM）, Chinese National Knowledge Infrastructure （CNKI）, Chinese Scientific Journal Database （VIP）, KoreaMed, Japanese database, and online clinical trial registry websites was performed up to February 2013. Randomized controlled trials （RCTs） regarding SXC for the treatment of primary hypertension were searched without no language restrictions. The quality of each trial was assessed according to the Cochrane Reviewers＇ Handbook 5.0, and RevMan 5.0 provided by the Cochrane Collaboration. Result： A total of 17 RCTs involving 1,778 patients were included. Meta-analysis showed that there was no significant difference between SXC and antihypertensive agents on systolic blood pressure [mean difference （MD）： --0.10 [-4.83, 4.63]; P=0.97] and diastolic blood pressure （MD： 1.00 [-1.16, 3.16]; P=0.36）, but SXC combined with antihypertensive drugs was more effective in lowering systolic blood pressure （MD： -6.17 [-7.86, -4.49]; P〈0.00001） and diastolic blood pressure （MD： -7.24 [-8.62, -5.85]; P〈0.00001） compared with the antihypertensive drugs alone. Conclusions： SXC used alone or combined with antihypertensive drugs appear to be an effective treatment for lowering elevated blood pressure and improving symptoms in patients with primary hypertension. However, the conclusion cannot be drawn definitely due to the poor quality of the included studies. There is still an urgent need for well-designed, long-term studies to address the benefits of SXC for treating primary hypertension.

Efficacy of Getong Tongluo Capsule(葛酮通络胶嚢)for Convalescent-Phase of Ischemic Stroke and Primary Hypertension:A Multicenter,Randomized,Double-Blind,Controlled Trial

Objective:To evaluate whether the efficacy of Getong Tongluo Capsule(葛酮通络胶囊,GTC,consisted of total flavone of Radix Puerariae)on improving patients'quality of life and lowering blood pressure are superior to the extract of Ginkgo biloba(EGB)for patients with convalescent-phase ischemic stroke and primary hypertension.Methods:This randomized,positive-drug-and placebo-controlled,double-blind trial was conducted from September 2015 to October 2017.Totally 477 eligible patients from 18 hospitals in China were randomly assigned in a 2:1:1 ratio to the following interventions,twice a day for 12 weeks:(1)GTC 250 mg plus EGB-matching placebo 40 mg(237 cases,GTC group),(2)EGB 40 mg plus GTC-matching placebo 250 mg(120 cases,EGB group)or(3)GTC-matching placebo 250 mg plus EGB-matching placebo 40 mg(120 cases,placebo group).Moreover,all patients were orally administered aspirin enteric-coated tablets 100 mg,once a day fo r 12 weeks.The primary outcome was the Barthel Index(Bl).The secondary outcomes included the control rate of blood pressure and National Institutes of Health Stroke Scale(NIHSS)scores.The incidence and severity of adverse events(AEs)were calculated and assessed.Results:The Bl relative independence rates,the clinical recovery rates of NIHSS,and the total effective rates of NIHSS in the GTC and EGB groups were significantly higher than the placebo group at 12 weeks after treatment(P<0.05),and no statistical significance was found between the GTC and EGB groups(P>0.05).The control rate of blood pressure in the GTC group was significantly higher than the EGB and placebo groups at 12,18 and 24 weeks after treatment(P<0.01).There were no statistically significant differences in the incidences of AEs,adverse drug reactions,or serious AEs among the 3 groups(P>0.05).Conclusion:GTC exhibited significant efficacy in improving patients'quality of life as well as neurological function and controlling hypertension.

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.

Plasma Hemoglobin Was Decreased in Elderly With Primary Hypertension and/or Type 2 Diabetes Complicated With End-stage Renal Disease

Objectives To study the change in plasma hemoglobin concentration in elderly patients with primary hypertension and/or type 2 diabetes complicated with end-stage renal disease （ESRD） determined by estimated glomerular filtration rate. Methods Two hundred and thirty cases of Chinese patients aged 60 years or older with primary hypertension and/or type 2 diabetes complicated with chronic kidney disease were enrolled in the study. Patients with chronic kidney disease were divided into ESRD group with estimated glomemlar filtration rate less than 15 mL . min^-1.1.73 m^-2 （7.80 ± 3. 14 mL. min^-1 . 1.73 m^-2） and non-ESRD group with estimated glomerular filtration rate 15 mL.min^-1 . 1.73 m^-2（29. 76 ± 12. 90 mL.min^-1 . 1.73 m^-2） or higher. The plasma hemoglobin concentration was compared between the above two groups retrospectively. Results There was significant decrease in plasma hemoglobin concentration in ESRD group compared with non-ESRD group （74.4 ± 22. 5 g/L vs 100. 8 ± 23.0 g/L, P 〈 0. 05 ）. After stratification by sex, there was also significant decrease in plasma hemoglobin concentration both in male and female of ESRD groups compared with their respective non-ESRD groups（77. 2±22. 0 g/L vs 104. 9 ±20. 7 g/L; 69. 7 ±22. 8 g/L vs 96.4± 24.8 g/L, P 〈 0. 05, respectively）. Plasma hemoglobin concentration was positively related to estimated glomerular filtration rate significantly in patients with ESRD （ P 〈 0. 05 ）. Conclusions Plasma hemoglobin concentration is decreased significantly, and is positively related to estimated glomerular filtration rate significantly in elderly patients with primary hypertension and/or type 2 diabetes complicated with ESRD determined by estimated glomerular filtration rate.

Microalbuminuria in White and Black Hypertensive Nondiabetic Brazilian Patients

Microalbuminuria (MAU) is a predictor of cardiovascular mortality in patients with diabetes mellitus (DM) and hypertension (HTN) and also in an unselected population. The American Diabetes Association (ADA) and the National Kidney Foundation (NKF) define MAU as an albumin/creatinine ratio (ACR) between 30 and 300 μg/mg in both men and women. Aim: To evaluate the possible relationship among MAU, HTN and gender and ethnicity in Brazilian nondiabetic primary hypertensive patients. Design: Population-based study. Participants: Ninety-eight men and women, seventy-two black and twenty-six white nondiabetic primary hypertensive patients aged 20 years or older were selected. Forty healthy individuals, paired according to age, gender, and ethnics were used as controls. Methods: Early-morning midstream urine was used. Urinary albumin was spectrophotometrically measured with Coomassie Brillant Blue G-250. Creatinine was determined by a method based on Jaffe’s reaction. ACR (μg albumin/mg creatinine) was calculated. Data are expressed as medians. Results: ACR level was significantly higher in 98 hypertensive patients (38.00) than in 40 control individuals (23.00) (P < 0.001). ACR level was significantly higher in 48 hypertensive male (46.00) than in 50 hypertensive female (34.00) (P = 0.008). No significant effect of ethnicity on ACR levels between 26 hypertensive Whites (35.50) and 72 hypertensive Blacks (38.00) was observed (P = 0.978). Conclusions: The ACR level, significantly higher in hypertensive patients than in control individuals, supports data from the literature. To our knowledge, this is the first study demonstrating that the ACR level is significantly higher in men than in women. The lack of an ethnicity effect supports what was already asserted, namely, that in Brazil, at an individual level, color, as determined by physical evaluation, is a poor predictor of genomic African ancestry, as estimated by molecular markers.

辰时针刺对原发性高血压患者的降压效应

Objective:To observe the anti-hypertensive effect of time acupuncture on primary hypertension so as to provide the therapeutic regimen for the treatment of primary hypertension.Methods:A total of 120 patients with primary hypertension were randomized into a western medication group and an acupuncture-medication group,60 cases in each one.In the western medication group,levoamlodipine maleate tablets were prescribed for oral administration.In the acupuncture-medication group,on the base of the treatment as the western medication group,time acupuncture was combined in the period of a day from 7:00 a.m.to 9:00 a.m.The duration of treatment was 4 weeks in the two groups.Before and after treatment,blood pressure,serum endothelin(ET)and nitrious oxide(NO)were measured successively and the clinical therapeutic effect was evaluated.Results:(1)Blood pressure:the systolic and diastolic pressure after treatment were all lower than that before treatment in the two groups,indicating statistical differences(all P<0.05),After treatment,the systolic and diastolic pressure in the acupuncture-medication group were lower than that of the western medication group,indicating significant differences(both P<0.05).(2)ET and NO:after treatment,ET in the acupuncture-medication group was lower than the western medication group and NO was higher than the western medication group,indicating statistical differences(both P<0.05).(3)Clinical therapeutic effect:the total effective effect of anti-hypertension was 89%in the acupuncture-medication group,higher than 63%in the western medication group,indicating statistical difference(P<0.05).Conclusion:The combined treatment of western medication and time acupuncture(7:00 am to 9:00 am)achieves better effect on primary hypertension as compared with simple western medication and its anti-hypertensive effect is probably related to the decrease of ET and the increase of NO.