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.

Pulmonary arterial hypertension confirmed by right heart catheterization following COVID-19 pneumonia: A case report and review of literature

BACKGROUND Pulmonary arterial hypertension(PAH)is a disease of the arterioles resulting in an increased resistance in pulmonary circulation with associated high pressures in the pulmonary arteries,causing irreversible remodeling of the pulmonary arterial walls.Coronavirus disease 2019(COVID-19)has been associated with development of new onset PAH in the literature leading to symptoms of dyspnea,cough and fatigue that persist in spite of resolution of acute COVID-19 infection.However,the majority of these cases of COVID related PAH were diagnosed using echocardiographic data or via right heart catheterization in mechanically ventilated patients.CASE SUMMARY Our case is the first reported case of COVID related PAH diagnosed by right heart catheterization in a non-mechanically ventilated patient.Right heart catheterization has been the gold standard for diagnosis of pulmonary hypertension.Our patient had right heart catheterization four months after her initial COVID-19 infection due to persistent dyspnea.CONCLUSION This revealed new onset PAH that developed following her infection with COVID-19,an emerging sequela of the infection.

EFFECTIVE INVERSION OF LEFT HEART REMODELING BY PHENYLALANINE IN ESSENTIAL HYPERTENSION

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

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.

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

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.

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.

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.

先心病肺高压术后肺高压危象的预防及护理

本文通过对５０例１４岁以下先天性心脏病合并中、重度肺高压的病人围术期的临床观察和护理。并对其中９例术后出现肺高压危象的病人作了回顾性分析，作者认为术前进行呼吸、咳嗽训练、间歇吸氧、口服克甫定等降低肺动脉压药物。术后给予连续监测和降低肺动脉压、稳定循环系统，合理制定和调整呼吸机参数，正确实施机械通气，适当过度通气，减少对呼吸道的刺激，防治呼吸道感染等护理措施对预防肺高压危象出现有重要意义。

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.

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.

BIOCHEMICAL AND BIOPHYSICAL CHARACTERISTICS OF MITOCHONDRIA IN THE HYPERTROPHIC HEARTS FROM HYPERTENSIVE RATS

A comparative study of the biochemical and biophysical characteristics of myocardial mitochondria was conducted in 16-weeks-old male stroke-prone spontaneously hypertensive rats （SHRsp） and normotensive Wistar-Kyoto control rats （WKY） （n = 6-12）. Cardiac and ventricular weights of SHRsp were significantly higher than those of the WKY group. The average amounts of mitochondria （Mit） and sarcoplasmic reticulum （SR） proteins isolated from the ventricle of SHRsp were 37% and 25% greater, respectively, when compared with those of WKY. Mit cytochrome c oxidase activities （μmol / min / mg） were 4.63 ± 0.71 for SHRsp and 5.55 ± 0.50 for WKY myocardium （x± s）, so that the activity of the former was significantly reduced by 17% （P<0.01）. Mit Ca2- , Mg2-TPase activity （μmol / min / mg） of SHRsp was 24% lower than that of WKY myocardium （P<0.01）. The fluorescence polarization of myocardial Mit membrane labelled with DPH （1, 6-diphenyl-1, 3, 5-hexatriene） in hypertensive rats was not different from that in con

THE EFFECT OF ISOPTIN SR ON BLOOD PRESSURE,HEART FUNCTION AND HYPERTROPHY OF LEFT VENTRICLEOF HYPERTENSIVE PATIENTS

Isoptin SR was used in 65 essential hypertensive patients.240mg Isoptin SR(German Knoll Pharmaceutical company) Per day was used in group A(35 cases)for 6 weeks,and in guoup B(30 cases)for 24 weeks,BP in group a and B decreased obviously in the first and second week after treament.

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.