Yingxin Zhao

Prevalence of prehypertension and hypertension in a Chinese rural area from 1991 to 2007

Shandong Province is located in the east of China. The province is characterized by robust economic development, with a rural population accounting for 56% of the total population. However, no data are available regarding temporal changes in the prevalence, awareness, treatment and control of hypertension among this population. Three independent cross-sectional surveys were performed in 1991 (n=8359), 2002 (n=18922) and 2007 (n=20167) in the rural area population, aged 35–74 years. The sampling included a survey on blood pressure and associated risk factors. Although the rate of smoking and alcohol consumption decreased significantly from 1991 to 2007, the prevalence of overweight and obesity increased, whereas that of high-strength physical activity decreased remarkably. In 1991, 2002 and 2007, the prevalence of prehypertension was 33.8, 61.5 and 54.6%, respectively. The prevalence of hypertension was 20.4, 24.5 and 30.6%, respectively. Overall, the rate of hypertension awareness, treatment and control showed a steady increase over the 16-year period, although the control rate of hypertension is still far from being satisfactory. In conclusion, among the Chinese rural population, the prevalence of prehypertension and hypertension increased significantly from 1991 to 2007. Public health programs are required to improve this situation in Chinese rural populations.

Correlation of peripheral Th17 cells and Th17-associated cytokines to the severity of carotid artery plaque and its clinical implication.

OBJECTIVE Atherosclerosis is a chronic inflammatory disease regulated by T lymphocyte subsets. Th17 cells reportedly play important roles in the development of inflammatory and autoimmune diseases. In this study, we investigated the contributions of circulating Th17 cells and plasma Th17-associated cytokines to carotid artery plaques. METHODS Based on carotid artery ultrasonography, 280 atherosclerosis patients were categorized both by: (1) 4 levels for extent and severity of plaques (Level 1=least severe; Level 4=most severe) and (2) 5 groups for ultrasound features of carotid artery plaques (none, flat, soft, hard, ulcerated). Peripheral blood Th17 cell frequencies and plasma concentrations of Th17-associated cytokines (IL-17, IL-6, and TNF-α) were also determined. RESULTS For groups categorized by the extent and severity of carotid artery plaques, Th17 cell frequencies, common carotid artery intima-media thickness (CCA-IMT), and Crouse scores were significantly increased in higher level groups (Levels 3 and 4) than in lower level groups (Levels 1 and 2), and plasma concentrations of IL-17, IL-6, and TNF-α increased with increased levels of plaque severity. The same pattern was found for groups categorized by ultrasound features of carotid artery plaques. The results of Pearson correlation and multiple linear regression analyses showed that both CCA-IMT and Crouse scores for carotid artery plaques were significantly and positively correlated with Th17 cell frequencies and plasma Th17-associated cytokine concentrations. CONCLUSION These results suggest that increased frequencies of circulating Th17 cells and Th17-associated cytokines are correlated to the severity and progression of carotid artery plaques.

Treatment with telmisartan/rosuvastatin combination has a beneficial synergistic effect on ameliorating Th17/Treg functional imbalance in hypertensive patients with carotid atherosclerosis

OBJECTIVES To explore synergistic effect between angiotensin II receptor blockers (ARBs) and statins on Th17/Treg functional imbalance in hypertensive patients with carotid atherosclerosis. METHODS This study was a 2 × 2 factorial randomized, prospective, double-blind, placebo-controlled trial. One hundred and fifty nine hypertensive patients with carotid atherosclerosis were randomized to the administration of control group, telmisartan group, rosuvastatin group, and combination group (telmisartan plus rosuvastatin) base on hydrochlorothiazide treatment. Carotid ultrasonography, parameters of Th17/Treg functional axis, interleukin (IL)-1β, IL-2, interferon (IFN)-γ, hypersensitive C-reactive protein (hsCRP), monocyte chemotactic protein (MCP)-1 were evaluated. RESULTS Blood pressure level markedly reduced in four groups. There was significantly synergistic effect of combination of telmisartan with rosuvastatin on reducing carotid imtima-media thickness (IMT), Th17 cells frequency, IL-17, IL-6, IL-23, tumor necrosis factor (TNF)-α, expression of retinoic acid receptor-related orphan receptor (ROR)γt mRNA, Th17/Treg ratio, IL-1β, IL-2, IFN-γ, hsCRP, and MCP-1, and increasing Treg cells frequency, IL-10, transforming growth factor(TGF)-β1, and expression of forkhead/winged helix transcription factor (Foxp3) mRNA (all P<0.05). Change rate of IMT statistical positively related to descent rates of Th17 cells frequency, IL-17, IL-6, IL-23, TNF-α, expression of RORγt mRNA, Th17/Treg ratio, IL-1β, IL-2, IFN-γ, hsCRP, and MCP-1, and negatively related to increased rates of Treg frequency, IL-10, TGF-β1, and expression of Foxp3 mRNA, respectively (all P<0.05). CONCLUSION There is a synergistic effect of combination of telmisartan with rosuvastatin on ameliorating Th17/Treg functional imbalance in hypertensive patients with carotid atherosclerosis.

Salt loading and potassium supplementation: effects on ambulatory arterial stiffness index and endothelin-1 levels in normotensive and mild hypertensive patients.

The authors investigated effects of excessive salt intake and potassium supplementation on ambulatory arterial stiffness index (AASI) and endothelin‐1 (ET‐1) in salt‐sensitive and non–salt‐sensitive individuals. AASI and symmetric AASI (s‐AASI) were used as indicators of arterial stiffness. Plasma ET‐1 levels were used as an index of endothelial function. Chronic salt‐loading and potassium supplementation were studied in 155 normotensive to mild hypertensive patients from rural northern China. After 3 days of baseline investigation, participants were maintained sequentially for 7 days each on diets of low salt (51.3 mmol/d), high salt (307.7 mmol/d), and high salt+potassium (60 mmol/d). Ambulatory 24‐hour blood pressure (BP) and plasma ET‐1 were measured at baseline and on the last 2 days of each intervention. High‐salt intervention significantly increased BP, AASI, s‐AASI (all P<.001); potassium supplementation reversed increased plasma ET‐1 levels. High‐salt–induced changes in BP, s‐AASI, and plasma ET‐1 were greater in salt‐sensitive individuals. Potassium supplementation decreased systolic BP and ET‐1 to a significantly greater extent in salt‐sensitive vs non–salt‐sensitive individuals (P<.001). Significant correlations were identified between s‐AASI and ET‐1 change ratios in response to both high‐salt intervention and potassium supplementation (P<.001). Reducing dietary salt and increasing daily potassium improves arterial compliance and ameliorates endothelial dysfunction.

Trends in Hypertension Prevalence, Awareness, Treatment, and Control Rates in Shandong Province of China

J Clin Hypertens (Greenwich). 2012; 14:637–643.

Excessive variability in systolic blood pressure that is self-measured at home exacerbates the progression of brain white matter lesions and cognitive impairment in the oldest old

To investigate the effects of variability in self-measured systolic blood pressure at home on the progression of cognitive impairment and white matter lesions in the oldest old. Between April 2009 and October 2009, 248 oldest old aged 80 years or older were eligibly enrolled from geriatric practices and community-dwelling areas of Shandong, China. Self-measured blood pressure at home (HBP) was measured for 7 consecutive days at the baseline, and the Mini-Mental State Examination (MMSE) score and brain white matter hyperintensities (WMH) were assessed at the baseline and during the final follow-up visit. Variability in systolic HBP was evaluated using coefficient of variation (CV) in serial daily systolic HBP measurements of the last 6 consecutive days. After an average of 2.3 years of follow-up visits, 232 oldest old were included in and 16 were excluded from the analysis. The MMSE score declined −4.76 (interquartile ranges: −10.71, −0.83) %, the periventricular WMH, deep WMH, total WMH and WMH fraction increased 16.46 (s.d.: 6.72)%, 10.05 (s.d.: 6.40)%, 14.69 (s.d.: 6.07)% and 15.95 (s.d.: 6.32)%, respectively, in the total oldest old. A declined percentage of the MMSE score and increased percentages of the periventricular WMH, deep WMH, total WMH and WMH fraction in the high group divided by tertile of the CV of the systolic HBP at baseline were greater than those in the low group (P<0.05). The significant differences were retained after adjusting for covariates, including the MMSE score, periventricular WMH, deep WMH and WMH fraction at the baseline (P<0.05). Excessive variability in self-measured systolic HBP exacerbates the progression of cognitive impairment and brain white matter lesions in the oldest old.

Day-by-day variability in self-measured blood pressure at home: effects on carotid artery atherosclerosis, brachial flow-mediated dilation, and endothelin-1 in normotensive and mild-moderate hypertensive individuals.

ObjectiveTo investigate variability in self-measured home blood pressure (HBP) and its effects on carotid artery atherosclerosis and endothelial function in normotensive and mild–moderate hypertensive individuals. Materials and methodsThis is a cross-sectional study. HBP monitoring over 7 consecutive days, carotid artery ultrasound, and brachial artery flow-mediated dilation (FMD) were performed in 314 normotensive, prehypertensive, and mild–moderate hypertensive volunteers. Variability in HBP was assessed by the SDs of the daily BP average of the last 6 consecutive days. The plasma endothelin-1 (ET-1) level was tested using an enzyme-linked immunosorbent assay. ResultsThe tendency of SD of systolic HBP increased significantly from the normotension to the moderate hypertension group. SD of systolic HBP was significantly correlated with carotid intima-media thickness (IMT) (r=0.569, P<0.001), stiffness parameter &bgr; (r=0.447, P<0.001), FMD (r=−0.636, P<0.001), and ET-1 (r=0.649, P<0.001). SD of diastolic HBP was also correlated with carotid IMT, stiffness parameter &bgr;, FMD, and ET-1, but the strength of the correlation was weaker than SD of systolic HBP (all P<0.001). After adjustment of all covariants, SD of systolic HBP was always significantly associated with carotid IMT, stiffness parameter &bgr;, FMD, and ET-1. ConclusionDay-by-day variability in HBP increased with increasing BP level. This was significantly associated with carotid artery atherosclerosis and endothelial function in normotensive and mild–moderate hypertensive individuals. Day-by-day variability in HBP may serve as an important prognostic factor for atherosclerosis and endothelial dysfunction.

Excessive visit-to-visit glycemic variability independently deteriorates the progression of endothelial and renal dysfunction in patients with type 2 diabetes mellitus

BackgroundGlycemic variability (GV) creates challenges to glycemic control and may be an independent marker for unfavorable outcome in management of patients with diabetes. This study was designed to investigate the effect of excessive visit-to-visit GV on the progression of endothelial and renal dysfunction in patients with type 2 diabetes mellitus (T2DM).MethodsTwo hundred and thirty nine patients with T2DM, who were recruited from outpatient, completed 48-month follow-up visit. Visit-to-visit GV was calculated by the standard deviation (SD) and coefficient of variation (CV) of serially measured HbA1c and fasting plasma glucose (FPG). Endothelial and renal function was assessed at baseline and end of follow-up.ResultsAt end of follow-up, brachial flow-mediated dilation (FMD), nitric oxide (NO), creatinine-based estimated glomeruar filtration rate (eGFR-Cr), and cystatin C-based estimated glomeruar filtration rate (eGFR-Cys C) increased, and endothelin-1 and urine albumin/creatinine ratio (ACR) declined as compared with baseline in overall (P < 0.05). The increment of FMD, NO, eGFR-Cr, and eGFR-Cys C and the decrement of endothelin-1 and ACR in first tertile group were significantly greater than those in third tertile group classified by tertile of either SD of HbA1c or SD of FPG. Change percentage of FMD, NO, eGFR-Cr, and eGFR-Cys C were positively, and change percentage of endothelin-1 and ACR were negatively correlated with SDs of HbA1c and FPG, and CVs of HbA1c FPG (P < 0.01, respectively). After adjusted for mean HbA1c, mean FPG, baseline demographic, and clinical characteristics, SD of HbA1c and SD of FPG were always statistically correlated with change percentage of FMD, NO, endothelin-1, ACR, eGFR-Cr, and eGFR-Cys C.ConclusionExcessive visit-to-visit GV independently deteriorates the progression of endothelial and renal dysfunction in patients with T2DM.

Visit-to-visit variability in systolic blood pressure: correlated with the changes of arterial stiffness and myocardial perfusion in on-treated hypertensive patients

Abstract Background: Visit-to-visit variability in blood pressure (BP) was demonstrated to correlate with cardiovascular events independent of mean BP. The goal of the present study was to investigate the correlation of visit-to-visit BP variability with artery stiffness and myocardial perfusion in on-treated hypertensive patients. Methods: BP was measured in 271 hypertensive patients at every visit over the course of the antihypertensive treatment, and the standard deviation (SD), coefficient of variation (CV), maximum, and minimum in serial BP were calculated. Non-invasive pulse wave analysis was performed in all patients. Results: Compared with baseline, carotid-femoral pulse wave velocity (cfPWV), aortic augmentation index (Aix) and Aix adjusted to a “standard heart rate” of 75 beats/min (Aix@HR75) were markedly declined, and sub-endocardial viability ratio (SEVR) was obviously increased in each group (p < 0.001). The changes of cfPWV, SEVR, Aix and Aix@HR75 in patients with lower SD of systolic blood pressure (SBP) were significantly greater than those in patients with higher SD of SBP. And the changes were statistically correlated with both SD and CV of serial SBP during follow-up, even after adjusted for mean SBP and mean diastolic blood pressure (DBP). Conclusion: Visit-to-visit SBP variability is independently correlated with changes of artery stiffness and myocardial perfusion in on-treated hypertensive patients.

Low carotid artery wall shear stress is independently associated with brain white-matter hyperintensities and cognitive impairment in older patients

BACKGROUND & AIMS Brain white-matter lesions and cognitive impairment are increasing because of the increasing number of patients aged ≥80 y. Wall shear stress (WSS) plays a pivotal role as a fluid mechanical mediator in vascular reactivity and atherosclerosis. In this study, we investigated the associations among common carotid artery (CCA) WSS, white-matter lesions, and cognitive impairment in patients aged ≥80 y METHODS We enrolled 384 patients aged ≥80 y. All subjects had CCA-WSS, brain white-matter hyperintensities (WMH), and Mini-Mental State Examination (MMSE) assessments and were divided into three groups using tertiles of mean and peak CCA-WSS. RESULTS For groups classified by the tertile of mean CCA-WSS, WMH, and WMH fraction were decreased; the MMSE score increased from low to high in the respective groups. Differences in WMH, WMH fraction, and the MMSE score were significant between any two groups (all adjusted p < 0.001). Groups classified by the tertile of peak CCA-WSS had the same pattern. Mean and peak CCA-WSS were significantly and inversely correlated with WMH (r = -0.575 and -0.570, respectively; p < 0.001) and WMH fraction (r = -0.574 and -0.569, respectively; p < 0.001) but positively correlated with the MMSE score (r = 0.390 and 0.278, respectively; p < 0.001). Multiple linear backward stepwise regression indicated the mean and peak CCA-WSS were significantly and independently associated with WMH, WMH fraction, and the MMSE score (all adjusted p < 0.001). CONCLUSION Carotid artery WSS was independently associated with brain white-matter lesions and cognitive impairment in patients aged ≥80 y.