Juxiang Li

Prevalence and Risk Factors of Prehypertension and Hypertension in Southern China

Background This study aimed to describe the prevalence and risk factors of prehypertension and hypertension in Jiangxi Province, China. Individuals with prehypertension frequently progress into hypertension and are at high risk of developing cardiovascular disease and stroke. Methods A cross-sectional survey of 15,296 participants (15 years or older) was conducted in Jiangxi Province, China, in 2013, using questionnaire forms and physical measurements. Results The prevalence of prehypertension and hypertension was 32.3% (39.2% in men and 27.6% in women) and 29.0% (30.1% in men and 28.2% in women), respectively. The awareness, treatment, and control rates among all hypertensive participants were 64.8%, 27.1%, and 12.6%, respectively. The prevalence of prehypertension in males declined with age, but the prevalence of hypertension increased in different genders. The prevalence of prehypertension and hypertension increased with increasing body mass index (BMI). The prevalence of prehypertension decreased, in parallel to an increase in the prevalence of hypertension, with increasing waist circumference (WC). A combination of WC and BMI was superior to individual indices in identifying hypertension. A multivariate logistic regression analysis indicated that increasing age, high BMI, high visceral adipose index, and high heart rate were risk factors for prehypertension and hypertension. The high body fat percentage was significantly associated with prehypertension. Living in an urban area, male sex, abdominal obesity, and menopause were correlated with hypertension. Conclusions Prehypertension and hypertension are epidemic in southern China. Further studies are needed to explore an indicator that can represent the visceral fat accurately and has a close relationship with cardiovascular disease.

Prevalence of overweight, obesity, abdominal obesity and obesity-related risk factors in southern China.

Objectives The purpose of this study is to assess the prevalence of overweight/obesity, abdominal obesity and obesity-related risk factors in southern China. Methods A cross-sectional survey of 15,364 participants aged 15 years and older was conducted from November 2013 to August 2014 in Jiangxi Province, China, using questionnaire forms and physical measurements. The physical measurements included body height, weight, waist circumference (WC), body fat percentage (BFP) and visceral adipose index (VAI). Multivariate logistic regression analysis was performed to evaluate the risk factors for overweight/obesity and abdominal obesity. Results The prevalence of overweight was 25.8% (25.9% in males and 25.7% in females), while that of obesity was 7.9% (8.4% in males and 7.6% in females). The prevalence of abdominal obesity was 10.2% (8.6% in males and 11.3% in females). The prevalence of overweight/obesity was 37.1% in urban residents and 30.2% in rural residents, and this difference was significant (P < 0.001). Urban residents had a significantly higher prevalence of abdominal obesity than rural residents (11.6% vs 8.7%, P < 0.001). Among the participants with an underweight/normal body mass index (BMI), 1.3% still had abdominal obesity, 16.1% had a high BFP and 1.0% had a high VAI. Moreover, among obese participants, 9.7% had a low /normal WC, 0.8% had a normal BFP and 15.9% had a normal VAI. Meanwhile, the partial correlation analysis indicated that the correlation coefficients between VAI and BMI, VAI and WC, and BMI and WC were 0.700, 0.666, and 0.721, respectively. A multivariate logistic regression analysis indicated that being female and having a high BFP and a high VAI were significantly associated with an increased risk of overweight/obesity and abdominal obesity. In addition, living in an urban area and older age correlated with overweight/obesity. Conclusion This study revealed that obesity and abdominal obesity, which differed by gender and age, are epidemic in southern China. Moreover, there was a very high, significant, positive correlation between WC, BMI and VAI. However, further studies are needed to explore which indicator of body fat could be used as the best marker to indirectly reflect cardiometabolic risk.

Elevated Serum Bisphenol A Level in Patients with Dilated Cardiomyopathy

Background: This study aimed to determine serum Bisphenol A (BPA) concentrations in patients with dilated cardiomyopathy (DCM) as well as the association between serum BPA and several hormonal parameters in DCM patients compared with a healthy control group. Materials and methods: Eighty-eight DCM patients and 88 age- and gender-matched healthy controls were included. Serum BPA levels and several hormonal parameters (including total testosterone (T), sex hormone-binding globulin (SHBG) and estradiol (E2) were measured by using corresponding ELISA Kits. The free androgen index (FAI) was calculated by the formula: total T in nmol/L × 100/SHBG in nmol/L. Results: BPA levels in the total DCM group were significantly higher compared with that in the controls (6.9 ± 2.7 ng/mL vs. 3.8 ± 1.9 ng/mL, p < 0.001). Significant difference was also observed in SHBG and FAI between DCM patients and controls, (76.9 ± 30.9 nM/L vs. 41.0 ± 15.6 nM/L and 2.9 ± 3.5 vs. 5.3 ± 2.6, respectively, both of p < 0.001). Similar trends were observed in the male and female subgroup. Mean T level was lower in DCM group than in control group (540.8 ± 186.0 pg/mL vs. 656.3 ± 112.9 pg/mL, p < 0.001). Linear regression analysis has shown that increasing serum BPA levels were statistically significantly associated with increased SHBG levels. However, no statistical difference was noted for E2. Conclusion: Our findings firstly demonstrated that BPA exposure increased in DCM patients compared with that in healthy controls, while FAI and T levels decreased. SHBG presented a positive association with BPA. It is concluded that hormone disorder induced by BPA exposure might be an environmental factor in the pathology of DCM.

Brachial–brachial index of systolic blood pressure in the patients under anti-hypertensive therapy

Inter-arm BP difference (IAD) has been demonstrated not only as a useful marker for subclavian artery stenosis [1,2], but also as a predicator for increased cardiovascular morbidity and mortality [1,3]. However, the detection rate of systolic IAD (sIAD) significantly varies with the SBP level in hypertensive patients under antihypertensive therapy [4]. Thus this phenomenon may induce confusion and decrease the clinical values of sIAD for diagnosing subclavian or brachial artery stenosis and predicting cardiovascular events. Therefore, it is necessary to create a new parameter, which could more correctly evaluate the difference between two arms at different BP levels. We hypothesize that systolic brachial–brachial index (sBBI), the ratio of right to left arm SBP, may be a more consistent index than sIAD. This study was to test our hypothesis and primarily evaluate the clinical value of sBBI. From May to November of 2012, 414 (200 males and 214 females, 61.3 ± 13.3 y) consecutively adult hypertensive patients admitted to ourhospitalwardwere enrolled. The inclusion criteriawere the baseline SBP/DBP (taken at admission) of at least 140/90 mmHg on the higher value of two arms. The exclusion criteria were arrhythmia, acute myocardial infarction, aortic coarctation, congenital heart disease, heart failure, hemiplegia, pulseless disease and the history of transradial coronary intervention. All patients were right handedness. The BP of two arms was simultaneously measured using two validated automatic BP measurement devices (Omron, HEM-7112) for 3 times with a 2-min interval. The absolute SBP difference between right (SBPr) and left (SBPl) arms was calculated as SBPr-l. The SBPl-r of 10 mm Hg or more was diagnosed as sIAD [1,5–7]. sBBI was calculated on the formula: SBBI = SBPr / SBPl. The patients with consistent sIAD (diagnosed for 3 determinations) received color Doppler flow imaging examination for bilateral subclavian, axillary and brachial artery [8,9]. Continuous variables were expressed as mean ± SD. The t-test, variance (ANOVA) test and the omnibus test were used for the statistical analysis. The chi-square test was used to compare the IAD detection rate. The inter-measurement agreement was evaluated by Bland–Altman plots [10]. The inter-measurement sIAD or sBBI differences between two measurements (firstminus second, secondminus third, and thirdminus first)were calculated.With thismethod, inter-measurement differences were plotted against their means and the 95% limits of agreement (LoA) were determined (95% LoA = mean inter-measurement difference ± 1.96 standard deviation). In order to compare the inter-measurement agreement, the variability of bias, SD of bias, lower limit and upper limit from 3 Bland–Altman plots on sIAD and sBBI were calculated separately on the formula: variability = SD / Mean. Meanwhile, the plots of outside of 95% and their percentages for each pair of measurements on sIAD and sBBI were calculated separately. P b 0.05 was considered statistically significant. The SBP levels of right armwere higher (about 4 mmHg) than those of left arm in the 3 stages. As SBP levels gradually decreased, SBPr-l gradually decreased, but the sBBIs were very similar. In this study, the abnormal sBBI limit was b0.95 or N1.10 based on the 1242 SBP values from 414 patients (normal limits = 1.023 ± 1.96 × 0.039). On these criteria, the detection rates of abnormal sBBI in three stages decreased from the first to the third as sIAD did, but the decreased extent was significantly less than that of sIAD (5:1 vs 2:1) (Table 1). The Bland–Altman plots on sIAD and sBBI among three measurements are showed in Fig. 1. The Bland–Altman plots on sIAD has rhombus-like left side and discrete right side, while the pictures of Bland–Altman plots on sBBI are like a core (Fig. 1). Meanwhile, the variability on the 4 parameters for sBBI was lower than their relative parameter on sIAD. Furthermore, point percentages located outside the 95% LoA between first and second, the first and third, and the second and third were lower on sBBI than on sIAD (4.59%, 3.87% and 3.38% vs 5.31%, 4.35% and 4.10%, respectively). In this study, ultrasonic examination was performed in 8 cases with consistent sIAD diagnosis [4]. One case with sBBI of 0.88, which

The effect of physician presence on blood pressure.

ObjectivesTo evaluate the effect of physician presence on blood pressure (BP) and the influencing factors. MethodsThis study included 600 adult outpatients, of whom 335 had hypertension and 265 did not have hypertension. An automated BP measurement device was used for all measurements of BP. After a 10-min rest, the first two readings were measured (BP1) in the presence of a physician, and then five BP readings were taken when the patient was left alone in the room and their average as automated office blood pressure (AOBP); finally, the second office BP (BP2) was measured (BP1) when the physician was present again. The differences in BP1 and BP2 with AOBP were calculated as &Dgr;BP1 and &Dgr;BP2. Results(a) Both BP1 and BP2 were significantly higher than AOBP (131±1/79±1 and 127±1/76±1 vs. 125±1/74±1 mmHg, both P<0.05). The hypertension detection rates on BP1 and on BP2 were 38.5 and 32.4%, but only 23.8% on AOBP (both P<0.05). (b) The &Dgr;SBP1 was significantly higher than &Dgr;SBP2 (6.8±9.3 vs. 2.0±7.7 mmHg, P<0.001), and &Dgr;DBP1 was higher than &Dgr;DBP2 (5.9±8.6 vs. 3.2±7.0 mmHg, P<0.001). (c) &Dgr;SBP1, &Dgr;SBP2, and &Dgr;DBP were higher in the hypertension (EH) subgroup than in the nonhypertension (no-EH) subgroup. Meanwhile, in the no-EH group, the &Dgr;SBP1 of the female subgroup were also significantly higher than that of the male subgroup. ConclusionThe presence of a physician, even the second time, is associated with an increase in BP. Hypertensive patients and females have higher BP reaction for physician presence.

Is 10-second electrocardiogram recording enough for accurately estimating heart rate in atrial fibrillation

BACKGROUND At present, the estimation of rest heart rate (HR) in atrial fibrillation (AF) is obtained by apical auscultation for 1min or on the surface electrocardiogram (ECG) by multiplying the number of RR intervals on the 10second recording by six. But the reasonability of 10second ECG recording is controversial. METHODS ECG was continuously recorded at rest for 60s to calculate the real rest HR (HR60s). Meanwhile, the first 10s and 30s ECG recordings were used for calculating HR10s (sixfold) and HR30s (twofold). The differences of HR10s or HR30s with the HR60s were compared. The patients were divided into three sub-groups on the HR60s <80, 80-100 and >100bpm. RESULTS No significant difference among the mean HR10s, HR30s and HR60s was found. A positive correlation existed between HR10s and HR60s or HR30s and HR60s. Bland-Altman plot showed that the 95% reference limits were high as -11.0 to 16.0bpm for HR10s, but for HR30s these values were only -4.5 to 5.2bpm. Among the three subgroups with HR60s <80, 80-100 and >100bpm, the 95% reference limits with HR60s were -8.9 to 10.6, -10.5 to 14.0 and -11.3 to 21.7bpm for HR10s, but these values were -3.9 to 4.3, -4.1 to 4.6 and -5.3 to 6.7bpm for HR30s. CONCLUSION As 10s ECG recording could not provide clinically accepted estimation HR, ECG should be recorded at least for 30s in the patients with AF. It is better to record ECG for 60s when the HR is rapid.

How to evaluate BP measurements using the oscillometric method in atrial fibrillation: the value of pulse rate variation

An oscillometric device is recommended for blood pressure (BP) measurement in atrial fibrillation (AF), but there is still controversy concerning its accuracy. Therefore, evaluation of BP values in AF patients remains a challenge. This study included 251 patients with AF and 154 participants with sinus rhythm (SR). Pulse rate (PR) and BP were measured using an oscillometric device three times. The differences between the highest and lowest PR and the systolic and diastolic BP (SBP and DBP) were calculated as ΔPR, ΔSBP and ΔDBP, respectively. AF patients were stratified with respect to ΔPR in 0–5, 6–10, 11–15 and >15 subgroups. The AF group had a greater ΔPR (12.1±8.6 vs. 4.10±3.21 b.p.m., P<0.001), ΔSBP and ΔDBP than the SR group at similar SBP and DBP. A positive correlation existed between ΔPR and ΔSBP (r=0.255, P<0.001) in AF patients, but no correlation was found in SR subjects. Meanwhile, the ΔSBP in the 0–5 and 6–10 subgroups (9.58±5.61 and 10.67±6.77 vs. 8.45±5.25 mm Hg, nonsignificant) was similar to the SR group, whereas ΔSBP in the 11–15 and >15 subgroups was significantly greater than the SR group. Regardless of ΔPR, the ΔDBP in the AF group was significantly greater than that of the SR group. The AF patients who exhibited greater variability in their PR also had a greater variability in their SBP readings. The SBP measurement for AF patients is accurate as the measurement for patients with SR if the ΔPR is of 0–10 b.p.m. in AF.

BH3-only protein Bim is upregulated and mediates the apoptosis of cardiomyocytes under glucose and oxygen-deprivation conditions

Bim is a potent pro‐apoptotic BH3‐only Bcl‐2 member. However, the expression of Bim and its role in cardiac injury induced by ischemia remain unclear. H9c2 cells were subjected to a glucose and oxygen‐deprived (GOD) condition in vitro, mimicking ischemia environment in vivo. GOD treatment augmented the expression of Bim and induced the apoptosis of H9c2 cells. Silencing of Bim by RNAi significantly attenuated GOD‐induced cytotoxicity, suppressed mitochondrial membrane potential △Ψm loss, inhibited caspase 3 activation and reduced apoptosis. The data demonstrate that Bim is upregulated by GOD in a time‐dependent manner in H9c2 cells, and enhances mitochondrial apoptosis dependent on the activation of caspase 3. Silencing of Bim may be a promising therapeutic strategy in ischemia related heart diseases.

The Inter-Arm Diastolic Blood Pressure Difference Induced by One Arm Ischemia: A New Approach to Assess Vascular Endothelia Function

Objectives To evaluate whether inter-arm diastolic blood pressure difference (DBPl-r) induced by one arm ischemia correlates with flow-mediated dilatation (FMD). Methods Bilateral arm BPs were simultaneously measured with two automatic devices and right brachial artery diameter (D) was measured by ultrasound technique in 108 subjects (56 hypertensives and 52 normotensives). Following baseline diameter (D0) and BP measurement, right brachial artery was occluded for 5 minutes. The diameter was measured at 1, 1.5 and 2 min, and bilateral BPs measured at 3, 4 and 5 min after occlusion release. Their averages were recorded as post-D and post-BP, respectively. The difference between post-D and D0 (ΔD) was calculated as the percentage increase of artery diameter (ΔD/D0). The BP difference between left and right arms was calculated as BPl-r, and the difference of post- BPl-r and baseline BPl-r was recorded as the net change of BPl-r (ΔBPl-r). Results At baseline, bilateral SBPs and DBPs were similar. Right arm ischemia induced significant DBP decline only in the right arm (68.8±12.7 vs 72.6±12.0 mmHg, P<0.05), which led to an increase of ΔDBPl-r (4.00±3.75 vs 0.78±4.47 mmHg, P<0.05). A positive correlation was seen between ΔD/D0 and ΔDBPl-r (r = 0.744, p<0.001). Furthermore, the correlation between age and ΔDBPl-r (r = −0.358, P<0.01) was similar to that between age and D/D0 (r = −0.398, P<0.01). Meanwhile, both ΔDBPl-r and ΔD/D0 were significantly lower in hypertensive patients than in normotensive patients. Conclusion The inter-arm DBP difference induced by one arm ischemia may be a potential index for clinical evaluation of vascular endothelial function.

The Value of a BP Determination Method Using a Novel Non-Invasive BP Device against the Invasive Catheter Measurement

Objective The aim of this study was to evaluate the accuracy of a new blood pressure (BP) measurement method (Pulse method). Methods This study enrolled 45 patients for selective percutaneous coronary intervention (PCI) via right radial artery. A BP device using either oscillometric (Microlife 3AC1-1) or Pulse method(RG-BP11)was used. At the beginning of each PCI, intra-radial BP was measured before Microlife BP or Pulse BP measurement as its own reference, respectively. At the end of PCI, BP was measured again with the measurement order of Microlife BP and Pulse BP reversed. The differences between intra-radial and Microlife (BPi-M) or Pulse BP (BPi-P) on SBP, DBP and mean artery pressure (MAP) were calculated. Meanwhile, in 48 patients the intra-brachial BP and intra-radial artery BP were measured to calculate the brachial -radial BP difference (BPr-b). Results The intra-radial SBP references used prior to both the Microlife and Pulse SBP that were similar (145.1±27.7 vs 145.8±24.2 mmHg), but the Microlife SBP was significantly lower than the Pulse SBP (127.7±20.5 vs 130.3±22.7 mmHg, P<0.05), thus the SBPi-M was higher than SBPi-P (18.1±11.8 vs 14.8±12.8 mmHg, P<0.05). As the mean SBPr-b was 12.4 mmHg, the Pulse SBP was closer to expected intra-brachial SBP by about 3.3 mmHg than was Microlife SBP to expected intra-brachial SBP. Meanwhile, Bland-Altman plots showed that the 95% limits of agreement for intra-radial SBP by Pulse SBP were narrower than those by Microlife SBP (12.0∼17.5 vs 15.5∼20.6 mmHg). However, the 95% limits of agreement for Pulse DBP and MAP were similar to those for Microlife DBP and MAP. Conclusion Against the invasive BP measurement, the pulse method may provide more accurate SBP and comparable DBP and MAP as compared with the oscillometric method.