Examining the Role of Psychosocial Stressors in Hypertension

Despite advances in medicine and preventive strategies, fewer than 1 in 5 people with hypertension have the problem under control. This could partly be due to gaps in fully elucidating the etiology of hypertension. Genetics and conventional lifestyle risk factors, such as the lack of exercise, unhealthy diet, excess salt intake, and alcohol consumption, do not fully explain the pathogenesis of hypertension. Thus, it is necessary to revisit other suggested risk factors that have not been paid due attention. One such factor is psychosocial stress. This paper explores the evidence for the association of psychosocial stressors with hypertension and shows that robust evidence supports the role of a chronic stressful environment at work or in marriage, low socioeconomic status, lack of social support, depression, anxiety, post-traumatic stress, childhood psychological trauma, and racial discrimination in the development or progression of hypertension. Furthermore, the potential pathophysiological mechanisms that link psychosocial stress to hypertension are explained to address the ambiguity in this area and set the stage for further research.     

二甲双胍对老年非糖尿病性高血压肾脏的保护

目的：研究二甲双胍对老年非糖尿病性高血压肾脏的保护作用。方法；将患者分为硝苯地平及硝苯地平＋二甲双胍治疗二组，三个月后观察体重指数、血胰岛素、尿蛋白、尿素氮、血和尿β2微球蛋白的变化。结果：上述指标加二甲双胍组较单用硝苯地平组明显改善（P＜0．001）。结论：二甲双胍对老年高血压病的肾脏有保护作用。     

Role of Zinc in Diabetic Kidney Disease

Diabetic Kidney Disease (DKD) represents the most common cause of Chronic Kidney Disease (CKD) in developed countries. Approximately 30% to 40% of diabetes mellitus (DM) subjects develop DKD, and its presence significantly increases the risk for morbidity and mortality. In this context, Zinc seems to have a potential role in kidney and body homeostasis in diabetic individuals as well as in patients at a high risk of developing this condition. This essential element has functions that may counteract diabetes-related risk factors and complications, which include stabilization of insulin hexamers and pancreatic insulin storage and improved glycemic control. In our review, we analyzed the current knowledge on the role of zinc in the management of renal impairment in course of DM. Several studies underline the critical role of zinc in reducing oxidative stress levels, which is considered the common denominator of the mechanisms responsible for the progression of kidney disease. Reaching and maintaining a proper serum zinc level could represent a valuable target to reduce symptoms related to DM complications and contrast the progression of kidney impairment in patients with the high risk of developing end-stage renal disease. In conclusion, analyzing the beneficial role of zinc in this review would advance our knowledge on the possible strategies of DM and DKD treatment.     

DNA甲基化在胃癌发生中的作用

DNA甲基化是重要的表观遗传修饰之一,它在基因表达调控过程中起着重要作用。DNA甲基化异常与肿瘤发生关系密切。启动子区域CpG岛高甲基化导致抑癌基因表达失活是目前肿瘤研究中的热点课题。本文就DNA甲基化在胃癌发生中的作用予以综述,旨在为揭示胃癌发生机制、寻找胃癌早期诊断的分子标志物及干预治疗的靶点提供新的思路。     

健康教育在高血压治疗中的作用

我国高血压患病率在不断增多 ,高血压患者在用药、饮食、休息、自我监测等方面普遍存在不同程度的问题 ,直接影响患者的康复预后。2 0 0 2年 1月至 2 0 0 3年 1月河南省南阳市中心医院心内科对患者开展了高血压健康教育 ,效果总结如下。对象与方法1 对象　 1 0 8例高血压患者 ,其中男 77例 ,女 3 1例。年龄 3 5～ 84岁。 1期 3 0例 ,2期 66例 ,3期 1 2例 ,病程 2～ 2 5年。2 方法　以问卷的形式对调查对象在干预前后分别进行调查。3 干预措施　对 1 0 8例患者在治疗和护理过程中进行健康教育、合理用药教育、生活方式教育、病情监测教育…     

饮食问卷调查在高血压预防中的作用

目的通过膳食中钠盐摄人情况，评价其作为高血压社区预防和干预指标的意义。方法广州市某社区内以问卷形式了解118名50-80岁老人长期和最近1周饮食咸淡情况。分析最近1周饮食咸淡和尿钠水平的一致性，及饮食咸淡与高血压发病情况的关系。结果问卷调查中女性饮食咸淡与尿钠水平一致，并和高血压发病相关；男性则饮食咸淡与尿钠水平、高血压发病间无统计学相关。结论问卷调查饮食咸淡在一定程度上可作为高血压社区预防的指标。对于男性高血压，社区预防和干预可能要更注重健康教育的引导。     

The Role of Altered Vascular Reactivity in Hypertension

Physicians have long recognized that therapeutic effects of pharmacologically inactive agents can be a complicating factor in medical research. Not only pills but also other features of the physician-patient encounter may recruit the healing response. Deliberate use of the placebo response may improve both patient satisfaction and treatment efficacy.     

妊娠期高血压和子痫前期对肾脏功能的长期影响

目的:评估妊娠期高血压(GH)和子痫前期(PE)对肾脏功能的长期影响。方法:回顾性分析本院2013年1月—2015年8月3 583例GH(GH组)、811例PE(PE组)和10 457例健康(对照组)初产妇的临床资料。随访2年,比较3组孕妇慢性肾脏病(CKD)、肾病入院等情况。结果:GH和PE初产孕妇的CKD发生率分别为5.2%(188/3 583)和7.5%(61/811),对照组CKD发生率为3.9%(405/10 457)。校正前PE组CKD危险比为2.02(95%CI:1.53~2.67),GH组为1.37(95%CI:1.15~1.64);校正年龄、产龄、体质量指数(BMI)、文化程度和吸烟状况后,CKD危险比分别为1.92(95%CI:1.45~2.56)和1.36(95%CI:1.14~1.63)。Logistic回归分析显示,PE组CKD危险比高于GH组,且两组CKD危险比、肾病入院危险比皆高于对照组(危险比为1)。结论:GH和PE增加了初产孕妇的CKD风险,发病早于血压正常初产孕妇。     

The Role of Ambulatory Medical Care in Hypertension Screening

Data from the 1975-1976 National Ambulatory Medical Care Survey conducted by the National Center for Health Statistics were examined retrospectively to determine the extent to which blood pressure was measured during visits to office-based physicians in the conterminous United States. Blood pressure was more often measured for females (especially black) than for males although males (especially black) in certain age groups had a higher prevalence of hypertension and comprised the higher proportion of undiagnosed hypertensives. Blood pressure measurement increased with age, but was rarely measured for those under 15 years of age. Blood pressure was measured about 79 per cent of the time when hypertension was present but only 30 per cent of the time when hypertension was absent. When diseases shown to be frequently concomitant with hypertension were diagnosed in the absence of hypertension, blood pressure checks ranged from 24 per cent of visits diagnosed neuroses to 66 per cent diagnosed obesity. Blood pressure was measured during about 12 per cent of visits for diseases of the nervous system and sense organs as well as diseases of the skin and subcutaneous tissue; 24 per cent of visits for infective and parasitic diseases, diseases of the respiratory system, and mental disorders. Blood pressure was measured most often when diagnoses were in the categories of diseases of the circulatory system and endocrine, nutritional, and metabolic diseases. Opportunities for blood pressure measurement during routine visits did not appear to be fully utilized, nor did some specialists take frequent blood pressure measurements. (Am. J. Public Health 69:19-24, 1979.)     

The Role of Personal Attributes in the Genesis and Progression of Lung Disease and Cigarette Smoking

Objectives. We examined early maladaptive personal attributes (e.g., depression), later lung disease, and later maladaptive personal attributes over a significant part of a woman’s life.Methods. We gathered longitudinal data on a prospective cohort of community-dwelling women (n = 498) followed from young adulthood to late midlife.Results. We used structural equation modeling to assess the interrelations of maladaptive personal attributes, cigarette smoking, lung disease, and financial strain. The results supported a mediational model through which early maladaptive personal attributes were associated with smoking (b = 0.17, P < .001), which in turn predicted later lung disease (b = 0.33, P < .001), and lung disease was related to later family financial difficulties (b = 0.09, P < .05), which in turn were associated with later maladaptive personal attributes (b = 0.35, P < .001).Conclusions. Our results address a number of important public health and clinical issues. An understanding of the interrelations of smoking, underlying mental health conditions, financial stress, and later mental health conditions on the part of physicians and other health care providers can be critical in managing patients with lung disease.Lung disease remains a major cause of mortality in developed nations as well as developing countries.1 The role of cigarette smoking in causing lung disease has been widely known since the classic studies of lung cancer by Wynder and Graham2 and Doll and Hill.3 Cigarette smoking increases the risk of developing lung cancer.4 In addition, cigarette smoking causes nonneoplastic lung diseases, such as emphysema and chronic bronchitis, and increases the risk of dying of chronic bronchitis or emphysema.4In contrast to studies on the relationship of cigarette smoking to lung disease,5 few studies involving community samples have focused on the role of maladaptive personal factors (e.g., depression, anxiety) in the development and progression of lung disease. Although the devastating psychological impact of advanced lung disease and the high rate of psychopathology in patients with lung disease have been described in small studies,6,7 there have been few systematic investigations of the role of maladaptive personal attributes in predicting lung disease and contributing to its progression over several decades (but see Katz et al.8 for a longitudinal study involving a community sample). In this study, we assessed psychosocial predictors and concomitants of lung disease among women from young adulthood to late midlife.With respect to the role of maladaptive personal attributes, there is some evidence that negative emotions and behaviors are related to chronic obstructive pulmonary disease (COPD) and to deterioration in lung function.9–11 According to Laurin et al.,12 patients with psychiatric disorders are at greater risk for exacerbations of COPD than are individuals without psychiatric disorders. In a recent study, Katz et al.8 reported that the prevalence of depression among individuals with COPD is quite high. One of the possible mediators between maladaptive personal attributes and lung disease is cigarette smoking. Cigarette smoking has been linked to early maladaptive personal attributes, such as depressive symptoms and anxiety,9,13,14 and to later lung disease.4According to self-medication theory, people smoke to relieve psychological tension.15 Personal factors, such as a lack of self-control, may also influence a person’s decision to smoke despite knowledge of the harmful consequences of cigarette smoking.14,16 There is also evidence that lung disease is related to family financial distress17,18 and maladaptive personal attributes,19–23 and economic stress13 has been linked to maladaptive personal attributes.24 In addition, in the United States, lower socioeconomic status is related to increased rates of cigarette smoking.25Overall, evidence on the associations of maladaptive personal attributes with lung disease as well as the relation of lung disease to later financial difficulty and maladaptive personal attributes in women is sparse. Therefore, these associations merit further investigation in large-scale studies of women. Indeed, the recent literature suggests that women are particularly susceptible to lung disease.26,27Our overall goal was to assess whether maladaptive personal attributes predict the development of lung disease among women. We hypothesized that the linkage between earlier personal attributes and later development of lung disease would be mediated by cigarette smoking. We also predicted that earlier lung disease would be related to both later financial difficulty and maladaptive personal attributes.     

The Role and Mechanism of Gut Microbiota in Pulmonary Arterial Hypertension

Pulmonary arterial hypertension (PAH) is a malignant pulmonary vascular disease characterized by increased pulmonary vascular resistance, pulmonary vasoconstriction, and right ventricular hypertrophy. Recent developments in genomics and metabolomics have gradually revealed the roles of the gut microbiota (GM) and its metabolites in cardiovascular diseases. Accumulating evidence reveals that the GM plays important roles in the occurrence and development of PAH. Gut microbiota dysbiosis directly increases the gut permeability, thereby facilitating pathological bacterial translocation and allowing translocation of bacterial products such as lipopolysaccharides from the gut into circulation. This process aggravates pulmonary perivascular inflammation and exacerbates PAH development through the endothelial–mesenchymal transition. Additionally, a shift in the composition of PAH also affects the gut metabolites. Changes in gut metabolites, such as decreased short-chain fatty acids, increased trimethylamine N-oxide, and elevated serotonin, contribute to pulmonary perivascular inflammation and pulmonary vascular remodeling by activating several signaling pathways. Studies of the intestinal microbiota in treating pulmonary hypertension have strengthened linkages between the GM and PAH. Probiotic therapy and fecal microbiota transplantation may supplement existing PAH treatments. In this article, we provide new insight for diagnosing, preventing and treating PAH by adding to the current knowledge of the intestinal flora mechanisms and its metabolites efficacy involved in PAH.     

Racial/Ethnic Disparities in Hypertension Prevalence: Reconsidering the Role of Chronic Stress

Objectives. We investigated the association between anticipatory stress, also known as racism-related vigilance, and hypertension prevalence in Black, Hispanic, and White adults.Methods. We used data from the Chicago Community Adult Health Study, a population-representative sample of adults (n = 3105) surveyed in 2001 to 2003, to regress hypertension prevalence on the interaction between race/ethnicity and vigilance in logit models.Results. Blacks reported the highest vigilance levels. For Blacks, each unit increase in vigilance (range = 0–12) was associated with a 4% increase in the odds of hypertension (odds ratio [OR] = 1.04; 95% confidence interval [CI] = 1.00, 1.09). Hispanics showed a similar but nonsignificant association (OR = 1.05; 95% CI = 0.99, 1.12), and Whites showed no association (OR = 0.95; 95% CI = 0.87, 1.03).Conclusions. Vigilance may represent an important and unique source of chronic stress that contributes to the well-documented higher prevalence of hypertension among Blacks than Whites; it is a possible contributor to hypertension among Hispanics but not Whites.Racial and ethnic disparities in hypertension are some of the most widely studied and consequential sources of social disparities in health in the United States.1–3 For example, recent prevalence estimates show that roughly 40% of Black adults but only 30% of White adults have hypertension.4 In addition, the incidence of hypertension occurs at younger ages for Blacks than Whites.1 These disparities are reflected in the larger burden of hypertension-related health and economic costs carried by non-White than White Americans. For example, mortality rates attributable to hypertension are roughly 15 deaths per 100 000 people for White men and women; the mortality rate for Black women is 40 per 100 000 and more than 50 per 100 000 for Black men.5 Among all health conditions, hypertension accounts for the greatest portion of disparities in years of lost life.6 Economically speaking, if Black Americans had the hypertension prevalence of White Americans, about $400 million would be saved in out-of-pocket health care expenses, about $2 billion would be saved in private insurance costs, and $375 million would be saved from Medicare and Medicaid—per year.7Despite the tremendous amount of research devoted to clarifying the factors that generate these disparities, most studies find that they persist after adjustment for a wide range of socioeconomic, behavioral, and biomedical risk factors.8 In fact, although disparities exist for several of these risk factors (e.g., socioeconomic status), numerous studies have shown no disparities in many others (e.g., smoking, obesity for men, lipid profile).2 Despite substantial investment in interventions to eliminate hypertension disparities, evidence suggests that these disparities have actually grown over the past few decades,9 suggesting that numerous unknown factors drive disparities in hypertension.3     

Chronic Kidney Disease: Role of Diet for a Reduction in the Severity of the Disease

Chronic kidney disease affects ~37 million adults in the US, and it is often undiagnosed due to a lack of apparent symptoms in early stages. Chronic kidney disease (CKD) interferes with the body’s physiological and biological mechanisms, such as fluid electrolyte and pH balance, blood pressure regulation, excretion of toxins and waste, vitamin D metabolism, and hormonal regulation. Many CKD patients are at risk of hyperkalemia, hyperphosphatemia, chronic metabolic acidosis, bone deterioration, blood pressure abnormalities, and edema. These risks may be minimized, and the disease’s progression may be slowed through careful monitoring of protein, phosphorus, potassium, sodium, and calcium, relieving symptoms experienced by CKD patients. In this review, the current Kidney Disease Outcomes Quality Initiative (KDOQI) recommendations are highlighted, reflecting the 2020 update, including explanations for the pathophysiology behind the recommendations. The Dietary Approaches to Stop Hypertension, the Mediterranean diet, and the whole foods plant-based diet are currently being examined for their potential role in delaying CKD progression. Biological explanations for why the whole foods plant-based diet may benefit CKD patients compared to diets that include animal products are examined. Strong evidence continues to support the importance of diet meeting the daily requirement in the prevention and progression of kidney disease, and medical nutrition therapy with a registered dietitian is a critical aspect in medical intervention for CKD.     

NK受体KIR及其HLA配体对肾移植急性排斥反应的作用

目的探讨杀伤细胞免疫球蛋白样受体（KIR）及其配体人类白细胞抗原（HLA）对肾移植患者术后发生急性排斥反应（AR）的作用。方法随机采集2009年3月-2012年3月实行肾移植的45对供受者,采用PCR-SSP方法进行HLA-Cw和KIR基因分型,然后依据受者移植后移植肾功能恢复状态分为AR组（16例）和非AR组（29例）,分析供受者HLA-Cw和KIR基因型、受者KIR/供者HLA-Cw组合型与受者术后肾移植发生AR反应的相关性,籍此研究KIR及配体HLA-Cw对肾移植急性排斥反应的作用。结果在AR组中受者表达KIR2DL2/2DS2明显低于非AR组（P〈0.05）;非AR组中供受者KIR2DL2/HLA-Cw1、2DL3/HLA-Cw1和2DS2/HLA-Cw1组合型的匹配几率明显高于AR组（P〈0.05）。结论特定的KIR基因（2DL2/2DS2）以及供受者KIR2DL2/HLA-Cw1、2DL3/HLA-Cw1和2DS2/HLA-Cw1组合型在异基因移植免疫应答中具有传导抑制信号的作用。