Chang- Sheng

Four-Limb Blood Pressure as Predictors of Mortality in Elderly Chinese

The predictive value of blood pressure (BP) for cardiovascular morbidity and mortality diminishes in the elderly, which may be confounded and compensated by the BP differences across the 4 limbs, markers of peripheral arterial disease. In a prospective elderly (≥60 years) Chinese study, we performed simultaneous 4-limb BP measurement using an oscillometric device in the supine position, and calculated BP differences between the 4 limbs. At baseline, the mean age of the 3133 participants (1383 men) was 69 years. During 4 years (median) of follow-up, all-cause and cardiovascular deaths occurred in 203 and 93 subjects, respectively. In multiple regression analyses, arm BPs on the higher arm side of systolic BP did not predict mortality (P≥0.06) except for a negative association between mean arterial pressure and total mortality (P=0.04). However, in adjusted analyses, the hazard ratios associated with a 1-SD decrease in ankle-brachial BP index or increase in interarm or interankle BP difference were 1.15 to 1.23 for total mortality (P⩽0.01) and 1.17 to 1.24 for cardiovascular mortality (P⩽0.04). In categorical analyses, similar results were observed for a decreased ankle-brachial index (⩽0.90, ⩽0.95, or ⩽1.00) or increased interarm or interankle difference (≥15 mm Hg or ≥10 mm Hg). In conclusion, in the elderly, above and beyond arm BP level and together with ankle-brachial index, the interarm and interankle BP differences improve prediction of mortality. Simultaneous 4-limb BP measurement has become feasible with current technology and might be useful in cardiovascular prevention.

Association of Serum Uric Acid With Aortic Stiffness and Pressure in a Chinese Workplace Setting

BACKGROUND In the present analysis, we investigated the association of serum uric acid with aortic stiffness and pressure as measured by carotid-femoral pulse wave velocity (cf-PWV) and central systolic blood pressure (SBP), respectively. METHODS Our study was conducted in the framework of cardiovascular health examinations for the employees of a factory and their family members (ages 15-79 years). We performed arterial measurements using the SphygmoCor device. Hyperuricemia was defined as a serum uric acid concentration of at least 420 micromol/l in men and 360 micromol/l in women. RESULTS The 940 study participants included 207 (22.0%) hypertensive patients, of whom 92 (9.8%) took antihypertensive medication. Men (n = 620), compared with women (n = 320), had significantly (P < or = 0.03) higher serum uric acid concentration (363 +/- 76 vs. 272 +/- 64 micromol/l), prevalence of hyperuricemia (17.9% vs. 7.5%), cf-PWV (7.41 vs. 7.16 m/s), and central SBP (114.4 vs. 108.8 mm Hg). Both before and after adjustment for age, serum uric acid was significantly (P < or = 0.02) and positively associated with cf-PWV and central SBP in all subjects and in men and women separately. After full adjustment for covariates, the association with cf-PWV remained statistically significant (P < or = 0.009) in all subjects and men, and with central SBP in all subjects only. Categorical analyses were confirmatory. In all subjects, patients with hyperuricemia had significantly (P = 0.03) higher cf-PWV (7.51 vs. 7.29 m/s) and central SBP (114.9 vs. 112.1 mm Hg) than those with normal serum uric acid. CONCLUSIONS Serum uric acid was associated with aortic stiffness and pressure in a Chinese workplace setting, especially in men.

Microalbuminuria in relation to the metabolic syndrome and its components in a Chinese population

BackgroundWe investigated the prevalence of microalbuminuria and its association with the metabolic syndrome and its components in a Chinese population.MethodsThe study subjects were recruited from a newly established residential area in the suburb of Shanghai. We measured anthropometry, blood pressure (BP), fasting plasma glucose, and serum lipids, and collected spot urine samples for the determination of albumin-creatinine ratio. We defined microalbuminuria as a urinary albumin-to-creatinine ratio of 30 to 299 mg/g. The metabolic syndrome was defined according to the International Diabetes Federation criteria.ResultsThe 1079 participants included 410 (38.0%) hypertensive patients, and 66 (6.1%) diabetic patients. The prevalence of microalbuminuria (4.3%) was 3.2 times higher in 167 patients with the metabolic syndrome than 912 subjects without the metabolic syndrome (12.0% vs. 2.9%, P < 0.0001). In multiple regression adjusted for sex, age, body mass index, current smoking, alcohol intake and the use of antihypertensive drugs, and mutually adjusted for the components, microalbuminuria was significantly associated with diastolic BP (odds ratio 1.74 for +10 mmHg; 95% confidence interval [CI] 1.10-2.76; P = 0.02) and fasting plasma glucose (1.18; 95% CI 1.01-1.41; P = 0.04), but not with waist circumference, systolic BP, or serum HDL cholesterol and triglycerides (P > 0.10).ConclusionsMicroalbuminuria is common in the Chinese population, and much more prevalent in the presence of the metabolic syndrome, mainly attributable to elevated diastolic BP and plasma glucose.

Prevalence, awareness, treatment and control of hypertension in elderly Chinese

We studied the prevalence, awareness, treatment and control of hypertension in an elderly Chinese population. The study subjects (age ⩾60 years) were recruited from a suburban town of Shanghai from 2006 to 2008. We administered a standardized questionnaire to collect information on medical history, the use of medications and lifestyle. We measured blood pressure three times consecutively using a validated Omron 7051 oscillometric device (Kyoto, Japan) after the subjects had rested for at least 5 min in the sitting position. We defined hypertension as a blood pressure of at least 140 mm Hg systolic or 90 mm Hg diastolic or as the use of antihypertensive drugs. The 3949 participants (mean age of 68.3 years) included 2185 (55.3%) women, 182 (4.6%) obese subjects (body mass index ⩾30 kg m−2) and 366 (9.3%) diabetic patients. The prevalence of hypertension was 59.4%. In the 2345 hypertensive patients, the awareness, treatment and control (<140/90 mm Hg) rates were 72.5%, 65.8% and 24.4%, respectively. In the 1542 treated hypertensive patients, 1196 (77.6%) used fixed-dose combinations of thiazide and reserpine or clonidine (n=1157, 75.0%) or of an angiotensin receptor blocker and hydrochlorothiazide (n=1) or free combinations (n=38, 2.5%), and 346 (22.4%) used a monotherapy of short-acting calcium channel blockers (n=217, 14.1%) or other classes of antihypertensive drugs (n=129, 8.3%). The corresponding control rates were 37.3% and 36.4%, respectively. In a stepwise logistic regression, the risk of uncontrolled hypertension was higher with older age (+10 years, odds ratio (OR) 1.19, P=0.03), female sex (OR 1.40, P=0.01), obesity (OR 2.35, P=0.0002) and heavy drinking (⩾300 g per week, OR 2.18, P=0.0007). In conclusion, in elderly Chinese, the prevalence of hypertension is high. In spite of reasonably high awareness and treatment rates, the control rate remains low, most likely due to an unhealthy lifestyle and the underuse and/or underdose of antihypertensive drugs.

Brachial-Ankle Pulse Wave Velocity as a Predictor of Mortality in Elderly Chinese

Pulse wave velocity (PWV) is a measure of arterial stiffness and predicts cardiovascular events and mortality in the general population and various patient populations. In the present study, we investigated the predictive value of brachial-ankle PWV for mortality in an elderly Chinese population. Our study subjects were older (≥60 years) persons living in a suburban town of Shanghai. We measured brachial-ankle PWV using an automated cuff device at baseline and collected vital information till June 30, 2013, during follow-up. The 3876 participants (1713 [44.2%] men; mean [±SD] age, 68.1±7.3 years) included 2292 (59.1%) hypertensive patients. PWV was on average 17.8 (±4.0) m/s and was significantly (P<0.0001) associated with age (r=0.48) and in unadjusted analysis with all-cause (n=316), cardiovascular (n=148), stroke (n=46), and noncardiovascular mortality (n=168) during a median follow-up of 5.9 years. In further adjusted analysis, we studied the risk of mortality according to the decile distributions of PWV. Only the subjects in the top decile (23.3–39.3 m/s) had a significantly (P⩽0.003) higher risk of all-cause mortality (hazard ratio relative to the whole study population, 1.56; 95% confidence interval, 1.16–2.08), especially in hypertensive patients (hazard ratio, 1.86; 95% confidence interval, 1.31–2.64; P=0.02 for the interaction between PWV and hypertension). Similar trends were observed for cardiovascular, stroke, and noncardiovascular mortality, although statistical significance was not reached (P≥0.08). In conclusion, brachial-ankle PWV predicts mortality in elderly Chinese on the conditions of markedly increased PWV and hypertension.

Accuracy of a Novel Non-Invasive technology based EZSCAN system for the diagnosis of diabetes mellitus in Chinese

BackgroundA new simple technique based on iontophoresis technology (EZSCAN, Impeto Medical, Paris, France) has recently been developed for the screening of diabetes. In the present study, we investigated the accuracy of this system for the diagnosis of diabetes mellitus in Chinese.MethodsWe performed the EZSCAN test in diabetic and non-diabetic subjects. EZSCAN measures electrochemical conductance (EC) at forehead, hands and feet, and derives a diabetes index with a value ranging from 0 to 100. Diabetes mellitus was defined as a plasma glucose concentration of at least 7 mmol/l at fasting or 11.1 mmol/l at 2 hours after glucose load, or as the use of antidiabetic drugs.ResultsThe 195 study participants (51% men, mean age 52 years) included 75 diabetic patients (use of antidiabetic drugs 81%) and 120 non-diabetic subjects. EC (micro Siemens, μSi) was significantly (P < 0.001) lower in diabetic patients at the hands (44 vs. 61) and feet (51 vs. 69) locations, but not at the forehead (15 vs. 17, P = 0.39). When a diabetes index of 40 (suggested by the manufacturer) was used as the threshold, the sensitivity and specificity for the diagnosis of diabetes mellitus was 85% and 64%, respectively. In 80 patients who underwent an oral glucose tolerance test, EC at hands and feet and the diabetes index were significantly (P < 0.001) associated with both 2-hour post-load plasma glucose and serum glycosylated haemoglobin.ConclusionsEZSCAN might be useful in screening diabetes mellitus with reasonable sensitivity and specificity.

Cardiac structure and function in relation to central blood pressure components in Chinese.

Background Data are limited with regard to the association of central blood pressure (BP) components with cardiac structure and function. Methods Our study was conducted in the framework of cardiovascular health examinations for the current and retired employees of a factory and their family members. We measured central BP by SphygmoCor and cardiac structure and function by echocardiography. Results The 826 participants (mean age 43.0 years) included 285 (34.5%) women and 184 (22.3%) hypertensive patients, of whom 78 (42.4%) took antihypertensive drugs. After adjustment for age, sex, body weight, body height, antihypertensive treatment, current smoking and alcohol intake, left atrial volume and left ventricular mass were significantly associated with brachial and central BP components (r = 0.09–0.21, P ⩽ 0.01), whereas left ventricular diastolic dysfunction, evaluated by E/A ratio and deceleration time of E wave (DTE), was only significantly associated with brachial and central SBP (r = 0.14–0.18, P < 0.001). However, these correlation coefficients were quantitatively but nonsignificantly different between brachial and central BP (P ≥ 0.06). In regression models with similar adjustments, with 1-SD increase in central SBP (16.7 mmHg), E/A ratio significantly decreased by 5.5 ± 1.2% and DTE significantly increased by 4.66 ± 1.22 ms (P < 0.001). Sensitivity analyses in men and women separately and after exclusion of patients on antihypertensive medication were confirmatory. Conclusion Cardiac structure was significantly and comparably associated with central BP components, but left ventricular diastolic dysfunction was only significantly associated with central SBP.

Age dependency of peripheral and central systolic blood pressures: cross-sectional and longitudinal observations in a Chinese population

Few studies have described the age-related changes in both peripheral and central systolic blood pressures (SBPs) in populations. We addressed this issue in 1066 women and 978 men, all untreated (mean age, 45.1 years; 27.2% hypertensive) and randomly selected from a Chinese population, of whom 369 and 330 underwent a repeat examination after 3.6 years (median). In cross-sectional analyses, central SBP increased more with age than peripheral SBP in women below age 50 (1.21 vs. 1.01 mm Hg per year; P<0.001) and in men below age 60 (0.73 vs. 0.48 mm Hg per year; P<0.001), whereas in older women (0.64 vs. 0.58 mm Hg per year; P=0.27) and older men (0.45 vs. 0.44 mm Hg per year; P=0.79), the slopes of central and peripheral SBPs on age were similar. Compared with men, women had steeper (P<0.001) age-related increases in peripheral and central SBPs. Systolic augmentation pressure increased with age, but this increase was substantially smaller (P<0.0001) for peripheral than central augmentation (women, 0.086 vs. 0.45 mm Hg per year; men, 0.083 vs. 0.39 mm Hg per year). In multivariable-adjusted regression, age contributed ⩾89.7% of the explained variance in peripheral and central SBPs. In longitudinal analyses, the annual percentage increases from baseline to follow-up in peripheral and central SBP were similar (P⩾0.76) in both women (2.14% vs. 2.16 % per year) and men (1.33% vs. 1.34 % per year; P–values for sex difference ⩽0.044). In conclusion, in younger subjects assessed cross-sectionally, the age-related increase was larger for central than peripheral SBP, whereas the corresponding cross-sectional estimates in older subjects and the longitudinal estimates in all subjects showed similar age-related increases in central and peripheral SBP.

Isolated nocturnal hypertension and arterial stiffness in a Chinese population

ObjectiveWe reported previously that normotensive Chinese had higher nighttime diastolic blood pressure (BP) compared with non-Chinese. We, therefore, studied the prevalence and characteristics of isolated nocturnal hypertension and its association with arterial stiffness, an intermediate sign of target organ damage. MethodsWe recorded ambulatory BP, the central and peripheral systolic augmentation indexes, the ambulatory arterial stiffness index, and brachial-ankle pulse wave velocity in 677 Chinese enrolled in the JingNing population study (53.6% women; mean age: 47.6 years). ResultsThe prevalence of isolated nocturnal hypertension (≥120/70 mmHg from 22 : 00 to 4 : 00 h) was 10.9%. Patients with isolated nocturnal hypertension, compared with participants with ambulatory normotension (45.8%), were older (53.7 vs. 40.7 years), more often reported alcohol intake (68.9 vs. 51.0%), and had faster nighttime pulse rate (62.8 vs. 60.7 bpm), higher serum cholesterol (5.12 vs. 4.77 mmol/l), and higher blood glucose (4.84 vs. 4.38 mmol/l). They also had higher indexes of arterial stiffness (P<0.05) than participants with ambulatory normotension. Of 74 patients with isolated nocturnal hypertension, only four (5.4%) had hypertension on conventional office BP measurement (≥140/90 mmHg). ConclusionIsolated nocturnal hypertension can only be diagnosed by ambulatory BP monitoring, is prevalent among Chinese, and is associated with increased arterial stiffness.

The prevalence, incidence, management and risks of atrial fibrillation in an elderly Chinese population: a prospective study

BackgroundThere is limited information on prevalent and incident atrial fibrillation in Chinese. We aimed to investigate the prevalence, incidence, management and risks of atrial fibrillation in an elderly Chinese population.MethodsIn a population—based prospective study in elderly (≥60 years) Chinese, we performed cardiovascular health examinations including a 12-lead electrocardiogram at baseline in 3,922 participants and biennially during follow-up in 2,017 participants. We collected information on vital status during the whole follow-up period.ResultsThe baseline prevalence of atrial fibrillation was 2.0 % (n = 34) in 1718 men and 1.6 % (n = 36) in 2204 women. During a median 3.8 years of follow-up, the incidence rate of atrial fibrillation (n = 34) was 4.9 per 1000 person-years (95 % confidence interval [CI], 3.4–6.9). In univariate analysis, both the prevalence and incidence of atrial fibrillation were higher with age advancing (P < 0.0001) and in the presence of coronary heart disease (P ≤ 0.02). Of the 104 prevalent and incident cases of atrial fibrillation, only 1 (1.0 %) received anticoagulant therapy (warfarin). These patients with atrial fibrillation, compared with those with sinus rhythm, had significantly higher risks of all-cause (n = 261, hazard ratio [HR] 1.87, 95 % CI, 1.09–3.20, P = 0.02), cardiovascular (n = 136, HR 3.78, 95 % CI 2.17–6.58, P < 0.0001) and stroke mortality (n = 44, HR 6.31, 95 % CI 2.81–14.19, P = 0.0003).ConclusionsAtrial fibrillation was relatively frequent in elderly Chinese, poorly managed and associated with higher risks of mortality.