Dingli Xu

Prehypertension and incidence of cardiovascular disease: a meta-analysis

BackgroundProspective cohort studies of prehypertension and the incidence of cardiovascular disease (CVD) are controversial after adjusting for other cardiovascular risk factors. This meta-analysis evaluated the association between prehypertension and CVD morbidity.MethodsDatabases (PubMed, EMBASE and the Cochrane Library) and conference proceedings were searched for prospective cohort studies with data on prehypertension and cardiovascular morbidity. Two independent reviewers assessed the reports and extracted data. The relative risks (RRs) of CVD, coronary heart disease (CHD) and stroke morbidity were calculated and reported with 95% confidence intervals (95% CIs). Subgroup analyses were conducted on blood pressure, age, gender, ethnicity, follow-up duration, number of participants and study quality.ResultsPooled data included the results from 468,561 participants from 18 prospective cohort studies. Prehypertension elevated the risks of CVD (RR = 1.55; 95% CI = 1.41 to 1.71); CHD (RR = 1.50; 95% CI = 1.30 to 1.74); and stroke (RR = 1.71; 95% CI = 1.55 to 1.89). In the subgroup analyses, even for low-range prehypertension, the risk of CVD was significantly higher than for optimal BP (RR = 1.46, 95% CI = 1.32 to 1.62), and further increased with high-range prehypertension (RR = 1.80, 95% CI = 1.41 to 2.31). The relative risk was significantly higher in the high-range prehypertensive populations than in the low-range populations (χ2= 5.69, P = 0.02). There were no significant differences among the other subgroup analyses (P>0.05).ConclusionsPrehypertension, even in the low range, elevates the risk of CVD after adjusting for multiple cardiovascular risk factors.

Association of all-cause and cardiovascular mortality with prehypertension: A meta-analysis

BACKGROUNDnStudies of prehypertension and mortality are controversial after adjusting for other cardiovascular risk factors. This meta-analysis sought to evaluate the association of prehypertension with all-cause and cardiovascular disease (CVD) mortality.nnnMETHODSnThe PubMed, EMBASE, Cochrane Library databases, and conference proceedings were searched for studies with data on prehypertension and mortality. The relative risks (RRs) of all-cause, CVD, coronary heart disease (CHD), and stroke mortality were calculated and presented with 95% CIs. Subgroup analyses were conducted according to blood pressure, age, gender, ethnicity, follow-up duration, participant number, and study characteristics.nnnRESULTSnData from 1,129,098 participants were derived from 20 prospective cohort studies. Prehypertension significantly increased the risk of CVD, CHD, and stroke mortality (RR 1.28, 95% CI 1.16-1.40; RR 1.12, 95% CI 1.02-1.23; and RR 1.41, 95% CI 1.28-1.56, respectively), but did not increase the risk of all-cause mortality after multivariate adjustment (RR 1.03, 95% CI 0.97-1.10). The difference between CHD mortality and stroke mortality was significant (P < .001). Subgroup analyses showed that CVD mortality was significantly increased in high-range prehypertension (RR 1.28, 95% CI 1.16-1.41) but not in low-range prehypertension (RR 1.08, 95% CI 0.98-1.18).nnnCONCLUSIONnPrehypertension is associated with CVD mortality, especially with stroke mortality, but not with all-cause mortality. The risk for CVD mortality is largely driven by high-range prehypertension.

Prehypertension and the risk of stroke A meta-analysis

Objective: In this meta-analysis, we sought to evaluate the association between prehypertension and the risk of stroke. Methods: We searched PubMed and EMBASE databases for studies with data on prehypertension and stroke. Two independent reviewers assessed the reports and extracted data. Prospective studies were included if they reported multivariate-adjusted relative risks (RRs) with 95% confidence intervals (CIs) for the associations between stroke and prehypertension or its 2 subranges (low-range prehypertension: 120–129/80–84 mm Hg; high-range prehypertension: 130–139/85–89 mm Hg). We conducted subgroup analyses according to blood pressure ranges, stroke type, endpoint, age, sex, ethnicity, and study characteristics. Results: Pooled data included the results of 762,393 participants from 19 prospective cohort studies. Prehypertension increased the risk of stroke (RR 1.66; 95% CI 1.51–1.81) compared with optimal blood pressure (<120/80 mm Hg). In the secondary outcome analyses, even low-range prehypertension increased the risk of stroke (RR 1.44; 95% CI 1.27–1.63), and the risk was greater for high-range prehypertension (RR 1.95; 95% CI 1.73–2.21). The RR was higher with high-range than with low-range prehypertension (p < 0.001). There were no significant differences in any of the subgroup analyses (all p > 0.05). Conclusions: After adjusting for multiple cardiovascular risk factors, prehypertension is associated with stroke morbidity. Although the increased risk is largely driven by high-range prehypertension, the risk is also increased in people with low-range prehypertension.

Prehypertension and Incidence of ESRD: A Systematic Review and Meta-analysis

BACKGROUNDnStudies of the association of prehypertension with the incidence of end-stage renal disease (ESRD) after adjusting for other cardiovascular risk factors have shown controversial results.nnnSTUDY DESIGNnSystematic review and meta-analysis of prospective cohort studies.nnnSETTING & POPULATIONnAdults with prehypertension.nnnSELECTION CRITERIA FOR STUDIESnStudies evaluating the association of prehypertension with the incidence of ESRD identified by searches in PubMed, EMBASE, and Cochrane Library databases and conference proceedings, without language restriction.nnnPREDICTORnPrehypertension.nnnOUTCOMESnThe relative risks (RRs) of ESRD were calculated and reported with 95% CIs. Subgroup analyses were conducted according to blood pressure (BP), age, sex, ethnicity, and study characteristics.nnnRESULTSnData from 1,003,793 participants were derived from 6 prospective cohort studies. Compared with optimal BP, prehypertension significantly increased the risk of ESRD (RR, 1.59; 95% CI, 1.39-1.91). In subgroup analyses, prehypertension significantly predicted higher ESRD risk across age, sex, ethnicity, and study characteristics. Even low-range (BP, 120-129/80-84 mm Hg) prehypertension increased the risk of ESRD compared with optimal BP (RR, 1.44; 95% CI, 1.19-1.74), and the risk increased further with high-range (BP, 130-139/85-89 mm Hg) prehypertension (RR, 2.02; 95% CI, 1.70-2.40). The RR was significantly higher in the high-range compared with the low-range prehypertensive population (P = 0.01).nnnLIMITATIONSnNo access to individual patient-level data.nnnCONCLUSIONSnPrehypertension is associated with incident ESRD. The increased risk is driven largely by high-range prehypertension.

White-coat hypertension is a risk factor for cardiovascular diseases and total mortality

Background: Whether white-coat hypertension (WCH) is an innocent phenomenon is controversial. Method: In this study, we evaluated the association of WCH and the risk of cardiovascular diseases (CVDs) and mortality, stratified by baseline antihypertensive treatment status. Databases (PubMed, EMBASE, CINAHL Plus, Scopus, and Google Scholar) were searched for prospective studies with data on CVD and total mortality associated with WCH. The primary outcomes were the risk of CVD and total mortality associated with WCH stratified by antihypertensive treatment status. The relative risks of events compared with normotension were calculated. Results: A total of 23 cohorts (20u200a445 individuals), 11 cohorts (8656 individuals), and 12 cohorts (21u200a336 individuals) were included for analysis of cardiovascular risk associated with WCH in patients without baseline antihypertensive treatment (untreated), or under antihypertensive treatment (treated) or mixed population (including both untreated and treated patients), respectively. In untreated cohorts, WCH was associated with a 38 and 20% increased risk of CVD and total mortality compared with normotension, respectively. In the mixed population, WCH was associated with a 19 and 50% increased risk of CVD and total mortality. However, in the treated patients, neither the risk of CVD, nor total mortality was increased in WCH. Meta-regression analyses indicated that neither differences of clinic blood pressure, nor out-of-office blood pressure variables were correlated with risk of CVD in WCH. Conclusion: We concluded that WCH is associated with long-term risk of CVD and total mortality in patients without antihypertensive treatment. Close follow-up should be performed in WCH patients.

Prehypertension and the Risk of Coronary Heart Disease in Asian and Western Populations: A Meta‐analysis

Background The results of studies on the association between prehypertension (blood pressure 120 to 139/80 to 89 mm Hg) and coronary heart disease (CHD) remain controversial. Furthermore, it is unclear whether prehypertension affects the risk of CHD in Asian and Western populations differently. This meta‐analysis evaluated the risk of CHD associated with prehypertension and its different subgroups. Methods and Results The PubMed and Embase databases were searched for prospective cohort studies with data on prehypertension and the risk of CHD. Studies were included if they reported multivariate‐adjusted relative risks (RRs) with 95% CIs of CHD from prehypertension. A total of 591 664 participants from 17 prospective cohort studies were included. Prehypertension increased the risk of CHD (RR 1.43, 95% CI 1.26 to 1.63, P<0.001) compared with optimal blood pressure (<120/80 mm Hg). The risk of CHD was higher in Western than in Asian participants (Western: RR 1.70, 95% CI 1.49 to 1.94; Asian: RR 1.25, 95% CI 1.12 to 1.38; ratio of RRs 1.36, 95% CI 1.15 to 1.61). The population‐attributable risk indicated that 8.4% of CHD in Asian participants was attributed to prehypertension, whereas this proportion was 24.1% in Western participants. Conclusions Prehypertension, even at the low range, is associated with an increased risk of CHD. This risk is more pronounced in Western than in Asian populations. These results supported the heterogeneity of target‐organ damage caused by prehypertension and hypertension among different ethnicities and underscore the importance of prevention of CHD in Western patients with prehypertension.

Association between job strain and risk of incident stroke: A meta-analysis.

Objective: Prospective cohort studies regarding job strain and the risk of stroke are controversial. This meta-analysis aimed to evaluate the association between job strain and the risk of stroke. Methods: The PubMed, Embase, and PsycINFO databases were searched for prospective cohort studies with data on job strain and the risk of stroke. Studies were included if they reported adjusted relative risks (RRs) with 95% confidence intervals (CIs) of stroke from job strain. Subgroup analyses were conducted according to sex and stroke type. Results: Six prospective cohort studies comprising 138,782 participants were included. High strain jobs were associated with increased risk of stroke (RR 1.22, 95% CI 1.01–1.47) compared with low strain jobs. The result was more pronounced for ischemic stroke (RR 1.58, 95% CI 1.12–2.23). The risk of stroke was significant in women (RR 1.33, 95% CI 1.04–1.69) and nonsignificant in men (RR 1.26, 95% CI 0.69–2.27), but the difference in RRs in sex subgroups was not significant. Neither active (RR 1.07, 95% CI 0.90–1.28) nor passive (RR 1.01, 95% CI 0.86–1.18) job characteristics were associated with an increased risk of stroke compared with low strain jobs. Conclusions: Exposure to high strain jobs was associated with an increased risk of stroke, especially in women. Further studies are needed to confirm whether interventions to reduce work stress decrease the risk of stroke.

Prevalence and risk factors associated with prehypertension in Shunde District, southern China

Objective To explore the prevalence and combined cardiovascular risk factors of prehypertension in southern China. Design A retrospective study; the logistic regression model was used to find the risk factors of prehypertension. Setting The study was conducted in Shunde District, southern China, using the community-based health check-up information. Participants Participants aged ≥35u2005years with complete health check-up information data between January 2011 and December 2013 were enrolled and divided into hypertension, prehypertension and optimal blood pressure (BP) groups. Prehypertension was further divided into low-range (BP 120–129/80–84u2005mmu2005Hg) and high-range (BP 130–139/85–89u2005mmu2005Hg) subgroups. Outcome measures The prevalence of prehypertension and the combined cardiovascular risk factors within the prehypertensive subgroups. Results Of the 5362 initially reviewed cases (aged ≥35u2005years), 651 were excluded because of missing data. The proportions of optimal BP, prehypertension and hypertension were 39.1%, 38.6% and 22.3%, respectively. The average age, proportion of male sex, overweight, impaired fasting glucose (IFG), dyslipidaemia and hyperuricaemia were significantly higher in the prehypertension group than in the optimal BP group (all p <0.05). Compared with low-range prehypertension, the proportions of overweight, dyslipidaemia and IFG were higher in the high-range prehypertension group (all p<0.05). Multivariate logistic regression analysis showed that overweight (OR=2.84, 95% CI 1.55 to 5.20), male sex (OR=2.19, 95% CI 1.39 to 3.45), age (per 10u2005years, OR=1.21, 95% CI 1.02 to 1.44, p=0.03) and hyperuricaemia (OR=1.70, 95% CI 1.14 to 2.54) were independent risk factors of prehypertension. Conclusions Prehypertension is highly prevalent in southern China. Prehypertensive individuals presented with many other cardiovascular risk factors. There was heterogeneity of combined risk factors within the prehypertensive subgroups.

Characterization of the Myocarditis during the worst outbreak of dengue infection in China.

AbstractMyocarditis is a common complication of severe dengue infection. However, data about prevalence and characterization of myocarditis in dengue are still lacking. In 2014, the worst outbreak of dengue in the last two decades in China occurred. In this study, we described the clinical and laboratory diagnostic features of dengue with myocarditis. Totally, 1782 diagnosed dengue patients were admitted from August to October, 2014, all of whom were subjected to electrocardiogram, ultrasound cardiogram, and cardiac enzyme test. About 201 cases of dengue patients were diagnosed with myocarditis and the prevalence of myocarditis in hospitalized dengue was 11.28%. The prevalence of myocarditis in nonsevere dengue with warning signs and severe dengue [NSD(WS+)/SD] and nonsevere dengue without warning signs [NSD(WS–)] was 46.66% and 9.72%, respectively. The NSD(WS+)/SD patients with myocarditis presented with higher incidence of cardiac symptoms, supraventricular tachycardia (14.29% vs. 0%, Pu200a<u200a0.001), atrial fibrillation (25.71% vs. 10.24%, P = 0.019) and heart failure compared with NSD (WS–) patients with myocarditis. About 150 cases of dengue patients without myocarditis in the same period of time in department of Cardiology were recruited as control group. The proportion of NSD(WS+)/SD in dengue patients with and without myocarditis was 17.41% and 2.53%, respectively. Dengue patients with myocarditis experienced longer hospital stay than those without myocarditis (7.17u200a±u200a4.64 vs. 5.98u200a±u200a2.69, P = 0.008). There was no difference between patients with and without myocarditis in the proportion of symptoms, auxiliary methods abnormality, arrhythmia, and heart failure on the discharge day. Our study demonstrates the prevalence of myocarditis in worst outbreak of dengue in China was 11.28% and the incidence of myocarditis increased with the severity of dengue. The NSD(WS+)/SD patients with myocarditis presented with higher incidence of cardiac complication compared with NSD (WS–) patients with myocarditis. The prognosis of dengue patients with and without myocarditis had no significant difference even if myocarditis patients experienced longer hospital stay.

GW29-e0367 PTEN Induced Putative Kinase 1 (PINK1) Regulates Mitophagy to Alleviate Angiotensin II-Induced Cardiac Injury

Angiotensin Ⅱ (Ang Ⅱ)-induced cardiac injury can result in elevated oxidative stress and decreased mitochondrial quality. Meanwhile, PTEN induced putative kinase 1 (PINK1) participate in mitochondrial quality control. However, the mechanism of PINK1 in Ang Ⅱ-induced cardiac injury remain