Wei-Fang Zeng

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.

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.

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.

Association of Anthropometric and Bioelectrical Impedance Analysis Measures of Adiposity with High Molecular Weight Adiponectin Concentration.

Objective To investigate the relationship between adiposity measures and plasma concentration of high molecular weight (HMW) adiponectin. Methods In a Chinese sample (n = 1081), we performed measurements of anthropometry and bioelectrical impedance analysis (BIA). We defined overweight and obesity as a body mass index between 24 and 27.4 kg/m² and ≥ 27.5 kg/m², respectively, and central obesity as a waist circumference ≥ 90 cm in men and ≥ 80 cm in women. Plasma HMW adiponectin concentration was measured by the ELISA method. Results Plasma HMW adiponectin concentration was significantly (P < 0.0001) higher in women (n = 677, 2.47 μg/mL) than men (n = 404, 1.58 μg/mL) and correlated with advancing age in men (r = 0.28) and women (r = 0.29). In adjusted analyses, it was lower in the presence of overweight (n = 159, 1.26 μg/mL in men and n = 227, 2.15μg/mL in women) and obesity (n = 60, 1.31 μg/mL and n = 82, 2.10 μg/mL, respectively) than normal weight subjects (n = 185, 2.07μg/mL and n = 368, 2.94 μg/mL, respectively) and in the presence of central obesity (n = 106, 1.28 μg/mL and n = 331, 2.12 μg/mL, respectively) than subjects with a normal waist circumference (n = 298, 1.74 μg/mL and n = 346, 2.74 μg/mL, respectively). In multiple regression analyses stratified for gender, adjusted for confounders and considered separately each of the adiposity measures, all adiposity measures were significantly (r -0.18 to -0.31, P < 0.001) associated with plasma HMW adiponectin concentration. However, in further stratified and adjusted regression analyses considered stepwise all adiposity measures, only waist-to-hip ratio was significantly (P < 0.05) associated with plasma HMW adiponectin concentration in men (r = -0.10) and women (r = -0.15). Conclusions Anthropometric measures of obesity, such as waist-to-hip ratio, but not BIA measures, are independently associated with plasma adiponectin concentration.

Validation of the AVITA BPM15S wrist blood pressure monitor for home blood pressure monitoring according to the European Society of Hypertension International Protocol revision 2010.

ObjectiveThe present study aimed to evaluate the accuracy of the automated oscillometric wrist blood pressure monitor AVITA BPM15S for home blood pressure monitoring according to the International Protocol revision 2010 of the European Society of Hypertension. MethodSystolic and diastolic blood pressures were sequentially measured in 33 Chinese adults (15 women, mean age 51 years) using a mercury sphygmomanometer (two observers) and the AVITA BPM15S device (one supervisor). Ninety-nine pairs of comparisons were obtained from 33 participants for judgments in two parts with three grading phases. ResultsThe AVITA BPM15S device achieved the targets in part 1 of the validation study. The number of absolute differences between the device and observers within 5, 10, and 15 mmHg were 85/99, 94/99, and 98/99, respectively, for systolic blood pressure, and 82/99, 96/99, and 98/99, respectively, for diastolic blood pressure. The device also achieved the criteria in part 2 of the validation study. Thirty-two and 28 participants for systolic and diastolic blood pressure, respectively, had at least two of the three device–observer differences within 5 mmHg (required≥24). No participant had all of the three device–observer comparisons greater than 5 mmHg for systolic or diastolic blood pressure. ConclusionThe AVITA wrist blood pressure monitor BPM15S fulfilled the requirements of the International Protocol revision 2010 and hence can be recommended for home use in an adult population.

Validation of the Kingyield BP101H blood pressure monitor for home blood pressure monitoring according to the European Society of Hypertension International Protocol

ObjectiveThis study aimed to evaluate the accuracy of the automated oscillometric upper arm blood pressure monitor BP101H (Kingyield Technology, Shenzhen, China) for home blood pressure monitoring according to the International Protocol of the European Society of Hypertension. MethodSystolic and diastolic blood pressures were sequentially measured in 33 adult Chinese participants (13 women, 52.6 years of mean age) using a mercury sphygmomanometer (two observers) and the BP101H device (one supervisor). Ninety-nine pairs of comparisons were obtained from 15 participants in phase 1 and further 18 participants in phase 2 of the validation study. Data analysis was done using the ESHIP Analyzer. ResultsThe BP101H device successfully passed phase 1 of the validation study with a number of absolute differences between device and observers within 5, 10, and 15 mmHg for at least 34/45, 42/45, and 43/45 measurements, respectively. The device also achieved the targets for phase 2.1, with 79/99, 94/99, and 96/99 differences within 5, 10, and 15 mmHg, respectively, for systolic blood pressure, and with 81/99, 94/99, and 98/99 within 5, 10, and 15 mmHg, respectively, for diastolic blood pressure. In phase 2.2, 27 and 28 participants had at least two of the three device-observers differences within 5 mmHg (required ≥22) for systolic blood pressure and diastolic blood pressure, respectively. ConclusionThe Kingyield upper arm blood pressure monitor BP101H has passed the International Protocol requirements, and hence can be recommended for home use in adults.

Validation of the fully automated A&D TM-2656 blood pressure monitor according to the British Hypertension Society Protocol.

ObjectiveThe present study aimed to evaluate the accuracy of the fully automated oscillometric upper-arm blood pressure monitor TM-2656 according to the British Hypertension Society (BHS) Protocol 1993. MethodsWe recruited individuals until there were 85 eligible participants and their blood pressure could meet the blood pressure distribution requirements specified by the BHS Protocol. For each individual, we sequentially measured the systolic and diastolic blood pressures using a mercury sphygmomanometer (two observers) and the TM-2656 device (one supervisor). Data analysis was carried out according to the BHS Protocol. ResultsThe device achieved grade A. The percentage of blood pressure differences within 5, 10, and 15 mmHg was 62, 85, and 96%, respectively, for systolic blood pressure, and 71, 93, and 99%, respectively, for diastolic blood pressure. The average (±SD) of the device–observer differences was −2.1±7.8 mmHg (P<0.0001) and −1.1±5.8 mmHg (P<0.0001) for systolic and diastolic blood pressures, respectively. ConclusionThe A&D upper-arm blood pressure monitor TM-2656 has passed the requirements of the BHS Protocol, and can thus be recommended for blood pressure measurement.

Validation of the A&D UA-1020 upper-arm blood pressure monitor for home blood pressure monitoring according to the British Hypertension Society Protocol.

ObjectiveThe present study aimed to evaluate the accuracy of the automated oscillometric upper-arm blood pressure (BP) monitor A&D UA-1020 with two different-shaped cuffs for home BP monitoring according to the British Hypertension Society (BHS) Protocol. MethodsWe recruited individuals for each of the two cuffs (D-ring and cylindrical) until there were 85 eligible participants (255 pairs of comparisons) and their BP could meet the BP distribution requirements specified by the BHS Protocol. For each participant, we sequentially measured the systolic and diastolic BP using a mercury sphygmomanometer (two observers) and the UA-1020 device (one supervisor). ResultsFor the D-ring cuff, the device achieved grade A. The percentage of BP differences within 5, 10, and 15 mmHg was 67, 87, and 96%, respectively, for systolic BP, and 70, 90, and 99%, respectively, for diastolic BP. The average (±SD) of the device–observer differences was −0.2±7.3 mmHg (P=0.64) and 1.7±5.8 mmHg (P<0.0001) for systolic and diastolic BP, respectively. For the cylindrical cuff, the device also achieved grade A. The percentage of BP differences within 5, 10, and 15 mmHg was 67, 88, and 97%, respectively, for systolic BP and 64, 89, and 98%, respectively, for diastolic BP. The average of the device–observer differences was −0.1±7.0 mmHg (P=0.89) and 2.0±6.3 mmHg (P<0.0001) for systolic and diastolic BP, respectively. ConclusionThe UA-1020 device has passed the requirements of the BHS Protocol with both the D-ring and the cylindrical cuffs, and hence can be recommended for home use in adults.

234 ESTIMATION OF SKELETAL MUSCLE MASS BY DUAL-ENERGY X-RAY ABSORPTIONMETRY APPENDICULAR LEAN SOFT MASS IN CHINESE ADULT

Objective: We studied whether total body skeletal muscle (SM) mass could be accurately estimated from appendicular lean soft tissue (ALST) mass measured by dual-energy X-ray absorptionmetry (DXA), and investigated the validity of equations of prediction reported previously and derived from the data of the present study. Methods: We measured body composition by magnetic resonance imaging (MRI) and DXA in 194 Chinese stratified for sex, age and body mass index. The equation of prediction was generated by linear regression. The agreement between measured and predicted SM mass was assessed by the use of intraclass correlation analysis, paired t test, Bland-Altman plot. TABLE 1 Characteristics of the study subjects. Results: The total body SM mass measured by MRI (18.1±4.8 kg) was closely correlated with ALST mass (19.4±4.7 kg), with a correlation coefficient of 0.95, 0.84 and 0.89 in all subjects, men and women, respectively. If the previously published equations were used, the difference of SM mass measured by MRI and estimated from ALST was 3.37±1.75 kg and 3.25±1.70 kg in the absence and presence of age in the equation, respectively. On the basis of our own data, we generated 2 equations without or with age: SM=0.98*ALST-0.99 (R2=0.91, P<0.0001) and SM=0.97 * ALST-0.03*Age+0.66 (R2=0.92, P<0.0001). By the application of these equations, the difference between measured and estimated SM mass decreased to -0.05±1.46 kg and -0.03±1.39 kg, respectively. FIGURE 1. Skeletal muscle (SM) mass vs. appendicular lean soft tissue (ALST) measured by dual-energy X-ray absorptiometry in total subjects. FIGURE 2. Bland-Altman plots for the comparison of skeletal muscle mass measured by MRI and estimated by the Kims equation: Kims equation1 SM=1.19×ALST-1.65. Conclusions: Estimation of SM mass by ALST is plausible, but requires population-specific equations of prediction. Our equations should be validated in other studies in Chinese.