Systemic Vasculitis:An Important and Underestimated Cause of Malignant Hypertension

Objectives:Malignant hypertension(MHT)is defi ned as severe hypertension accompanied by ischemic failure of one or more organs.The aims of this study were to evaluate the current clinical and etiologic profi les of MHT.Methods:As a retrospective study,we selected all patients admitted to our center from January 2013 to December 2016.Seventy patients with MHT were included.Results:The average age of the patients was 40 years,and more than half of the patients were male(78.57%).There were 24 patients with essential hypertension,accounting for 34.29%of the patients,and 46 with secondary hypertension,accounting for 65.71%of the patients.For secondary MHT,systemic vasculitis(25.57%)was the most common cause,followed by severe obstructive sleep apnea syndrome(15.71%),primary renal parenchymal hypertension(11.43%),primary aldosteronism(7.14%),and Cushing syndrome(1.43%)and nutcracker phenomenon(1.43%).Twenty patients with systemic vasculitis were characterized by severe hypertension accompanied by damage to two or more target organs of differing severity.The levels of white blood cells,hypersensitive C-reactive protein,serum creatinine,and 24-hour urinary protein were above their normal range.Conclusion:Systemic vasculitis may be one of the main causes of MHT,and has been underestimated in the past.In future clinical work,clinicians need to pay more attention to patients with systemic vasculitis.

Folate level and prevalence of folate deficiency in population from agriculture and stock-raising regions and its correlation with hypertension

Objective:To compare the plasma folate level,prevalence of folate deficiency and the related influencing factors of hypertension in Xinjiang agricultural and pastoral areas.Methods:We enrolled 1926 study subjects with 447 hypertensive and non-hypertensive 1479 ones aged≥15 years old using multi-stage stratified sampling in Emin Xinjiang between January and December 2014,conducted the health behavior questionnaire and physical examination,and collected blood samples.The plasma folate level were measured by chemiluminescence method.Results:(1)There were significant differences(P<0.05)in age,gender,ethnic composition,marital status,education level,smoking consumption,drinking data,overweight and obesity and hyperhomocysteinemia(HHcy)between hypertension group and non hypertension group.(2)The folate deficiency rate of hypertension group was higher than that of non hypertension group(P=0.003);the folate deficiency rate of systolic and diastolic hypertension was the highest(P=0.008);the folate level of hypertension with HHcy was the lowest(P<0.001)and the folate deficiency rate was the highest(P=0.023).(3)Partial correlation analysis showed that folate was negatively correlated with systolic blood pressure and pulse pressure(P<0.05).(4)Multivariate logistic regression analysis showed that age 45-59(OR=3.78,95%CI:2.45-5.82),age≥60(OR=6.87,95%CI:4.35-5.10.87),male gender(OR=6.96,95%CI:3.86-12.54),Kazakhs(OR=2.12,95%CI:1.52-2.96),Mongolian(OR=2.38,95%CI:1.25-4.53),smoking(OR=4.21,95%CI:2.05-8.63),drinking(OR=6.36,36%CI:3.00-13.48),overweight and obesity(OR=2.11,95%CI:1.58-2.81),and folate deficiency(OR=1.72,95%CI:1.05-2.80)were the related factors of hypertension.Conclusions:The prevalence of folate deficiency in the population with hypertension in Xinjiang is higher than that in the non hypertension group,and the highest prevalence of folate deficiency is in hypertension with HHcy.Therefore,folate supplementation in the prevention of hypertension may be helpful,especially for the elderly,men and Kazakhs,and at the same time,healthy life style has an important reference value for reducing the level of hypertension and preventing and controlling cardiovascular diseases.

Sex difference in the prevalence of metabolic syndrome and its relationship to BMI and age

Objective:To investigate the prevalence of metabolic syndrome (MetS) in primary aldosteronism(PA) patients with different genders and relationship between body mass index(BMI), age and MetS. Methods:This study included 168 PA patients who were hospitalized in hypertension treatment center of Xinjiang Uygur Autonomous Region People' Hospital, including 94 male patients and 74 female patients and the backgrounds and biochemical parameters of two groups were compared. Based on this, the relationship between BMI, age and MetS were also analyzed. Results:The prevalence of MetS was significantly higher in male patients with PA than female patients with PA(83.0% vs 58.1%,P<0.001). Compared to PA patients without MetS, PA patients with MetS had a higher level of BMI and greater prevalence of obesity (P<0.05). According to the BMI stratification analysis, we found the prevalence of MetS was higher in obese groups than non-obese groups (P<0.05). Moreover, the obese male patients with PA had higher prevalence of every component of MetS and prevalence of MetS with 5 metabolic factors compared to the non-obese group (P<0.05);while the obese female patients with PA only had higher prevalence of abdominal obesity compared to the non-obese group (P<0.001). Among the patients classified by age, the both prevalence of MetS was higher in male than female, and there was no male:female ratio inverted in patients with PA after menopause. Conclusions:The prevalence of MetS in male patients with PA was higher than female patients with PA. In addition, the obese groups had the higher prevalence of MetS than non-obese groups.

Consensus of Chinese Specialists on Diagnosis and Treatment of Resistant Hypertension

INTRODUCTION Resistant hypertension has become a challenge in the treatment of hypertension.As the population continues to age and obesity,sleep apnea hypopnea syndrome,and chronic kidney disease increase in incidence,resistant hypertension has become an increasingly common issue in clinical practice.Failure to control blood pressure can impair target organs such as the heart,brain,and kidney,facilitating the occurrence of clinical cardiovascular events.

Genetic variants of rs1275988 and rs2586886 in TWIK-related acidsensitive K^+ channel-1 gene may be potential risk factors for obese patients with obstructive sleep apnea

Background: The pathogenesis of obstructive sleep apnea (OSA) remains not fully understood. This study aimed to explore the mechanism of OSA by assessing the association between the human tandem of P domains in a weak inwardly rectifying K^+ channel (TWIK)-related acid-sensitive K^+ channel-1 (TASK-1) gene and OSA. Methods: A total of 164 patients with severe OSA and 171 patients without OSA were recruited from the Center for Hypertension of People’s Hospital of Xinjiang Uygur Autonomous Region (China) from April to December in 2016. Two single nucleotide polymorphisms (rs1275988 and rs2586886) in the TASK-1 gene were selected and genotyped using a kompetitive allele specific polymerase chain reaction genotyping system. Clinical-pathological characteristics and genotype data were compared between the severe and non-OSA groups to explore the association between TASK-1 gene polymorphism and severe OSA. Results: There were no significant differences in genotype distribution, allele frequency, and the recessive and dominant model of the two selected single nucleotide polymorphisms (rs1275988 and rs2586886) between the severe and non-OSA groups in the total population (P < 0.05). However, for patients with a body mass index (BMI)≥28 kg/m2, the distribution of genotypes and alleles, and the recessive model (GG + GA vs. AA) exhibited significant differences between the severe and non-OSA group (for genotypes: P = 0.014 and P = 0.026;for alleles: P = 0.006 and P = 0.011;for the recessive model: P = 0.005 and P = 0.009, respectively). The simple logistic regression analysis revealed that the GG genotype was a risk factor for OSA. The odds ratio (OR) and 95% confidence intervals (CI) were 4.902 (1.582–15.186, P = 0.006) for rs1275988 and 4.420 (1.422–13.734, P = 0.010) for rs2586886, respectively. In multivariate logistic regression analysis, the combination of GG genotypes of rs1275988 with BMI ≥28 kg/m^2 increased the risk of severe OSA (OR = 8.916, 95% CI 4.506–17.645, P < 0.001). Conclusion: Both the GG genotype of rs1275988 and GG genotype of rs2586886 in the TASK-1 gene may play as potential risk factors in obese patients with OSA.

A common variation within the STEAP4 gene exons is associated with obesity in Uygur general population

Background Coordinated regulation of nutrient and inflammatory responses by six transmembrane epithelial antigen of prostate 4 （STEAP4） was essential for metabolic homeostasis. STEAP4 expression in human white adipose tissuewas associated with obesity. This study aimed to evaluate association between STEAP4 genetic polymorphisms and obesity in Uygur Chinese general population.Methods The functional regions of STEAP4 gene were sequenced in 96 Uygur with obesity （body mass index （BMI）〉30 kg/m2）. Representative variations were selected according to the function and linkage disequilibrium and genotyped in 1507 obesity （BMI ≥25 kg/m2） and 825 non-obesity control （BMI ＜25 kg/m2）, all of whom were selected from epidemiology study of obesity-related diseases during January to February 2007 among Uygur population in Hetian area of Xinjiang Uygur Autonomous Region.Results Fourteen novel and 6 known single nucleotide polymorphism （SNPs）, including 2 nonsynonymous SNPs （nsSNPs）, in the STEAP4 gene were identified. Of the 3 representative SNPs, the nsSNP rs1981529 （Gly75Asp, 224A/G）was significantly associated with obesity phenotype （additive P/Pc=0.001/0.006, dominant P/Pc=0.003/0.018, odds ratio （OR） and 95％ confidence interval （CI） adjusted for age, gender and drinking 0.755 （0.641-0.890） and 0.750（0.621-0.907）, respectively）. By the multiple linear regression analysis, the quantitative phenotypes of BMI （P/Pc=0.002/0.004） and waist circumference （P/Pc=0.004/0.008） were found to be significantly associated with the genotypes of rs1981529 （Gly75Asp, 224A/G） in Uygur general population, and effect size （beta value） of one allele G of rs1981529 （Gly75Asp, 224A/G） was-0.553 kg/m2 for BMI and -1.311 cm for waist circumference after controlling age,gender and drinking factors.Conclusions The present study shows an association of the common variation rs1981529 （Gly75Asp, 224A/G） in the STEAP4 gene with obesity in Uygur general population. Further studies should replicate the results using larger populations.