Relationship Between Brachial–Ankle Pulse Wave Velocity and Risk of New-Onset Acute Myocardial Infarction

Background To investigate the effect of brachial–ankle pulse wave velocity (baPWV) on new-onset acute myocardial infarction (AMI). Methods A retrospective cohort study was performed for the subjects who underwent baPWV examination during the follow-up of Kailuan Study Cohort from 2010 to 2017. The observation subjects were divided into 3 groups based on the levels of baPWV: <14, 14 to <18, and ≥18 m/s. The incidence density of AMI in 3 groups was calculated. Log-rank test was used to compare the differences of cumulative AMI incidence among 3 groups. The influence of baPWV on new-onset AMI was analyzed by Cox proportional risk model and restricted cubic spline. Results A total of 41,405 subjects were included in the study. During 2.66 (1.07–5.39) years’ follow-up, 150 new-onset AMI cases were observed. The incidence density of AMI in 3 groups was 3.69, 12.79, and 26.65 per 10,000 person-years, respectively. Log-rank test result showed the cumulative AMI incidence increased gradually from the subjects with the lowest baPWV to those with the highest baPWV (P < 0.05). Compared with subjects with baPWV <14 m/s, Cox model showed that hazard ratios (95% confidence interval) of AMI in those with baPWV 14 to <18 m/s and baPWV ≥18 m/s were 1.77 (1.04–3.01) and 1.93 (1.03–3.60) after adjusting for age, sex, and other potential confounding factors, respectively. Restricted cubic spline analysis showed that there was a dose–response relationship between the hazard ratio of AMI and baPWV levels. Conclusions The increased baPWV is a risk factor for new-onset AMI.

Effects and Safety of Allisartan Isoproxil Combined With Amlodipine or Indapamide in Patients With Hypertension Who Failed Allisartan Monotherapy

Background To primarily evaluate the effects and safety of a selective angiotensin II type 1 (AT1) receptor blocker (ARB) allisartan isoproxil combined with amlodipine or indapamide in the treatment of patients with essential hypertension who failed allisartan monotherapy. Methods Patients aged 18–75 years with mild-to-moderate essential hypertension [office systolic blood pressure (SBP) 140 to <180 and/or office diastolic blood pressure (DBP) 90 to <110 mm Hg] in 44 study centers between 2016 and 2018 were recruited. Allisartan isoproxil tablet 240 mg was administered per day for 4 weeks, and continued for 8 weeks if office blood pressure (BP) achieved the target of SBP/DBP <140/90 mm Hg. The nonachievers were 1:1 randomly divided into allisartan isoproxil 240 mg + indapamide sustained-release tablet 1.5 mg, or allisartan isoproxil 240 mg + amlodipine besylate 5 mg groups for further 8 weeks of combined therapy. The BP target achieving rate, reduction of sitting BP from baseline, safety and compliance were evaluated as the primary efficacy endpoint. Results A total of 2,212 patients were enrolled, among them 2,126 patients were included in the efficacy analysis, with an average age of 55.1 ± 10.2 years. A total of 1,463 cases (68.8%) were effective after 4 weeks allisartan treatment, and the mean SBP and DBP were significantly decreased by 14.7 ± 12.2 and 8.0 ± 8.4 mm Hg compared with the baseline levels (all P < 0.001). In nonachievers, allisartan combined with indapamide for 8 weeks significantly lowered the sitting BP (SBP/DBP) by 14.0 ± 12.2/8.3 ± 9.2 mm Hg, respectively, compared with 4 weeks monotherapy with allisartan with a BP targeting rate of 57.7% (169/293). In the allisartan + amlodipine group, the SBP/DBP were significantly decreased by (14.4 ± 12.1/8.2 ± 8.2) mm Hg, respectively, with a BP targeting rate of 62.8% (181/288). There was no statistical significance in BP reduction, targeting rate, or adverse reactions between the 2 combined therapies. Conclusions Allisartan isoproxil combined with indapamide or amlodipine can further improve the BP targeting rate when allisartan monotherapy failed in essential hypertension. The 2 combined therapies have similar efficacy and safety.

Elevated BNP and High Brachial Pulse Pressure in Patients with Diabetes

Background Heart failure (HF) is frequent in patients with diabetes mellitus (DM), and early detection improves prognosis. We investigated whether analysis of brachial blood pressure (BP) in daily practice can identify patients with DM and high risk for subsequent HF, as defined by brain natriuretic peptide (BNP) > 50 pg/ml. Methods 3,367 Outpatients with DM without a history of cardiovascular disease were enrolled in a prospective study. Results Age (mean±SD) was 56±14 years, 57% were male, 78% had type 2 DM and HbA1C was 7.4%±1.4%. A history of hypertension was recorded in 43% of patients and uncontrolled BP was observed in 13%. BNP concentration (mean±SD) was 21±21 ng/L and 9% of patients had high risk of incident HF. Brachial pulse pressure (PP) was the best BP parameter associated with high risk of incident HF compared to diastolic, systolic or mean BP (area under the ROC curve: 0.70, 0.65, 0.57 and 0.57 respectively). A multivariate analysis demonstrated that elevated PP was independently associated with high risk of incident HF (odds ratio [95%CI]: 2.1 [1.5–2.8] for PP ≥65mmHg). Study of central aortic BP and pulse wave velocity on 117 patients demonstrated that high risk of incident HF was associated with increased arterial stiffness and subendocardial ischemia. After a mean follow-up of 811days, elevated PP was associated with increased all-cause mortality (hazard ratio [95%CI]: 1.7 [1.1–2.8]). Conclusions Brachial PP is powerful and independent “easy to record” BP parameter associated with high risk of incident HF in diabetic patients.

Prenatal Chronic Hypoxia in Rats Leads to Insulin Resistance and Hypertension in Adult Offspring

Background To investigate the effects of chronic intrauterine hypoxia on insulin resistance, hypertension, and the correlation between them in adult offspring rats. Methods A total of 25 pregnant Sprague Dawley rats were randomly assigned into 4 prenatal chronic hypoxia (H) groups (10% ± 1% oxygen) and a control group (21% oxygen). The H groups were divided into whole (1–21 day), early (1–7 day), mid (8–14 day), and late (15–21 day) gestational hypoxia groups (H1, H2, H3, and H4, respectively) with pregnant rats being housed in a hypoxia box for 3 hours per day. Five male and 5 female offspring in each group were studied at 1 day, 3 months, and 6 months old. Blood pressure, fasting blood glucose, fasting serum insulin, and insulin resistance index were determined. Results The mean blood pressure of offspring rats in H groups was higher at 3 months, and further increased at 6 months old compared to the control group (P < 0.05). The fasting blood glucose and homeostasis model insulin resistance index (HOMA-IR) of male and female offspring in the whole pregnancy (H1) and early pregnancy (H2) hypoxia groups were significantly higher than those in the control group at 6 months (P < 0.05). Fasting blood glucose and HOMA-IR were positively correlated with mean blood pressure (P < 0.05). The renal mass index in H2 group was lower at 3 months, and further decreased at 6 months compared to controls (P < 0.05). The mRNA and protein levels of insulin receptor, insulin receptor substrate (IRS-1 and IRS-2) in the kidneys in hypoxia groups were significantly decreased at 6 months in H1 and H2 hypoxia groups when compared with controls (P < 0.05). Conclusions Chronic intrauterine hypoxia causes insulin resistance and hypertension in adult offspring rats through poor intrauterine growth environment, and insulin resistance is positively associated with hypertension.

The Factors Correlated With the Blood Pressure Control Among the Elderly Hypertension in Hangzhou

Background To evaluate the effectiveness of community health management of elderly hypertension, and to describe the status and related risk factors of blood pressure control. Methods This was a cross-sectional study. Hypertensive patients aged 60 years and above who took part in community health management in Hangzhou were selected. Data on lifestyle, obesity, blood lipids, fasting plasma glucose, and blood pressure were collected. Systolic blood pressure ≥140 and/or diastolic blood pressure ≥90 mm Hg were used to calculate the blood pressure control rate. Results There were 209,768 subjects with mean age (70.7 ± 7.1) years in the present study. The mean value of systolic and diastolic blood pressures was (141.4 ± 16.9) and (80.2 ± 10.0) mm Hg, respectively. The blood pressure control rate was 48.39%. The rate of the subjects with unhealthy lifestyles, obesity (or central obesity), dyslipidemia, and abnormal fasting plasma glucose was 86.27%, 38.20%, 58.16%, and 14.72%, respectively. The unhealthy lifestyle, obesity, abnormal fasting plasma glucose, and dyslipidemia, affected blood pressure control rate, with an odds ratio (95% confidence interval) of 1.18 (1.15–1.21), 1.23 (1.21–1.25), 1.44 (1.40–1.48), and 1.10 (1.09–1.11), respectively. When 4 risk factors were combined, odds ratio (95% confidence interval) was 1.96 (95% confidence interval 1.83–2.09) for poor blood pressure control. Overall, the percentage of isolated systolic hypertension was 34.87% and increased with age. Conclusions The blood pressure control rate of the elderly hypertension patients in the community health management by national essential public health service was 48.39%. Obesity, unhealthy lifestyle, abnormal fasting blood glucose, and dyslipidemia are risk factors of poor blood pressure control and have cumulative effects.