Analysis of the duration and extent of the legacy effect in patients with type 2 diabetes: A real-world longitudinal study

AimsTo analyze the duration and extent of the legacy effect on diabetic complications in real-world patients with type 2 diabetes.MethodsThis was a retrospective cohort study. We included the following three cohorts of patients: diabetic retinopathy (DR) (n = 1107), diabetic kidney disease (DKD) (n = 1486), and cardiovascular disease (CVD) (n = 1485). Patients were enrolled from 1995 to 1999 and followed up to 2017. Endpoints were DR incidence, ≥40% decrease in estimated glomerular filtration rate, and CVD incidence. The relationships between HbA1c as a time-dependent variable and the risk of reaching each endpoint were analyzed using multivariate Cox regression models.ResultsA total of 313 patients developed DR, 316 developed DKD, and 177 developed CVD. Hazard ratios as a function of time-dependent HbA1c (moving mean) accumulated over time. This accumulation was largest for DR, followed by DKD and CVD. The hazard ratios for each endpoint reached a plateau during the preceding 14–19 years.ConclusionsThe effect of past glycemic control may continue during 14–19 years, with a greater effect during ≤10 years. Therefore, the end of the legacy effect could be 15–20 years. This effect may be the greatest for DR, followed by DKD, and the smallest for CVD.     

用动态血压监测的方法评价塞利洛尔的降压疗效

目的用２４ｈ动态血压监测的方法评价塞利洛尔降压疗效及作用持续时间。方法符合入选条件的轻中度高血压病患者３２例，平均４８．６±７．８岁。服安慰剂２周后，每天服用塞利洛尔１００～３００ｍｇ共６周，治疗前后分别监测２４ｈ动态血压。结果治疗后２４ｈ、白天、夜间的ＳＢＰ和ＤＢＰ均有明显下降（Ｐ＜０．０１）；血压负荷值亦明显减小（Ｐ＜０．０１）；ＳＢＰ及ＤＢＰ谷峰比值均＞５０％。心率无明显变化（Ｐ＞０．０５）。结论：塞利洛尔的降压作用能持续２４ｈ以上，且安全有效。     

Evaluation of extent of shortening versus velocity of shortening at the endocardium and midwall in hypertensive heart disease

To assess the incremental value of velocity of shortening velocity parameters compared with simpler, more widely used, extent of shortening parameters in compensated left ventricular hypertrophy, we studied 52 patients with left ventricular hypertrophy and 63 age-matched controls. Velocity parameters did not provide incremental information beyond that obtained by extent of shortening parameters.     

Influence of the extent of hepatectomy on the portal hypertensive state in patients with hepatoma.

BACKGROUND/AIMS: Portal hypertensive symptoms, such as esophageal varices and hypersplenism, are frequently observed in patients with hepatocellular carcinoma (HCC). We investigated whether or not the extent of hepatectomy for HCC has an influence on the deterioration of the portal hypertensive state. METHODOLOGY: Fifty-four patients who underwent curative hepatectomy for HCC at our institute were retrospectively studied. The 54 patients were classified in two groups according to the extent of hepatectomy: Group A patients (n = 38) underwent minor hepatectomy (subsegmentectomy or less) and Group B patients (n = 16) underwent major hepatectomy (segmentectomy or more). On the basis of the endoscopic findings for the esophageal varices and the blood platelet counts, the alterations of portal hypertensive state were evaluated before and after hepatectomy. RESULTS: The number of patients whose esophageal varices deteriorated post-operatively, amounted to 9 (23.7%) in Group A and 1 (6.3%) in Group B (not significant). No significant differences were found in the platelet counts between pre- and post-operative states in each Group (A and B). In all of the 6 patients whose esophageal varices first came about after hepatectomy, the advent of the varices occurred more than 1 year after surgery. CONCLUSIONS: These results suggest that in the patients undergoing hepatectomy for HCC, the clinical deterioration of the portal hypertensive state in not caused by the extent of hepatectomy, but by the advance of the coexisting chronic hepatic diseases or tumor recurrence.     

Lercanidipine, enalapril and their combination in the treatment of elderly hypertensive patients: placebo-controlled, randomized, crossover study with four ABPM

This double-blind, placebo-controlled, four-way balanced design crossover study included hypertensive patients aged 60-85 years with mean office-measured sitting systolic blood pressure (SBP) 160-179 mm Hg and daytime SBP > or =135 mm Hg. After a 2-week run-in period, during which previous medications were discontinued, each patient received the following four treatments in randomized order for 4 weeks each: lercanidipine 10 mg (L), enalapril 20 mg (E), lercanidipine 10 mg plus enalapril 20 mg (L/E) and placebo (P). At the end of each treatment period, office trough blood pressure (BP) was measured and a 24-h Ambulatory Blood Pressure Monitoring (ABPM) was performed. Seventy-five patients (mean age 66 years, office BP 168/92 mm Hg, daytime SBP 151 mm Hg) were randomized and 62 completed the study with four valid post-baseline ABPMs. The administration of P, L, E and L/E was associated with a mean 24-h SBP of 144, 137, 133 and 127 mm Hg, respectively. All active treatments significantly reduced the mean 24-h SBP in comparison with placebo, but L/E was significantly more effective than L and E alone. Similarly, office SBP was significantly more reduced with L/E (-16.9 mm Hg) than with L (-5.0 mm Hg) or E (-5.9 mm Hg). A BP <140/90 mm Hg was recorded in 18% of patients with L, 19% with E and 45% with L/E. Two patients on P and two on L/E were withdrawn from the study due to adverse events. In conclusion, combination therapy with L/E has additive antihypertensive effects on both ambulatory and office BP in elderly patients and is well tolerated.     

Prognostic value of QKD interval corrected by QRS duration in hypertensive patients

OBJECTIVES: The QKD interval is measured between the onset of QRS on the ECG and detection of last Korotkoff sound by a microphone placed on the brachial artery while measuring BP. It is the sum of preejection time and pulse transmission time and thus is correlated to pulse wave velocity (PWV). This interval is automatically monitored with BP and HR every 15 minutes during 24 h with an ambulatory blood pressure monitoring device (Diasys integra, Novacor, France). The 96 measurements obtained allow to automatically calculate the QKD(100-60), QKD value for 100 mmHg SBP and 60 bpm HR. This indice of arterial stiffness has been shown to be linked to future cardiovascular (CV) events, independently of 24 h BP. However this interval may be abnormally prolonged in case of left bundle branch blocks (LBBB). METHODS: We tested the effects of simply removing QRS duration from QKD(100-60) value on the prediction of CV events in a population of 412 hypertensives (247 males: age = 53 +/- 14 years; office BP = 158 +/- 19/97 +/- 11 mmHg; 24 h BP = 133 +/- 17/86 +/- 11 mmHg) followed prospectively. RESULTS: Mean follow up was 65 months, 32 pts were lost, 49 CV events occurred including 11 deaths. Cox model showed that baseline QKD(100-60) (m = 202 +/- 19; 142-254 ms) was significantly (p < 0.05) associated to events independently of age, 24h SBP and other traditional risk factors. Removing QRS duration (m = 85 +/- 10: 61-158 ms) improves the relation to events (monovariate khi2 = 38 vs 30). CONCLUSION: Removing QRS duration from QKD(100-60) improves its predictive value of future CV events and allows using this method in patients with LBBB.     

Evaluation of the chronotropic property of captopril in hypertensive patients

Captopril was administered (50 mg orally) to 88 untreated hypertensive patients (70 with essential hypertension, eight with renal arterial disease, 10 with renal parenchymal disease) and to 25 hypertensive patients treated with sympatholytic or beta-blocking agent (20 with essential hypertension, five with renal arterial disease). In the former group, captopril caused a decrease in heart rate (HR) in 18 patients and an increase in only two. As a whole, captopril caused significant decreases in blood pressure without increase in HR. Significant negative correlation was observed between change in HR and plasma renin activity obtained before captopril administration (n = 79, r = -0.425, p less than 0.0001). Hypotensive and chronotropic effects of captopril were almost identical in untreated and treated patients. Hypotensive effects caused by captopril and nifedipine (20 mg orally) were almost identical. Nifedipine caused reflex tachycardia, while captopril caused slight bradycardia. Absence of compensatory tachycardia appears to be related to reduction of endogenous angiotensin II by captopril.U     

动态血压监测多方法同时比较评价依那普利降压疗效

目的 用动态血压评价依那普利降压疗效并进行总体疗效判断和4种判效方法学比较。方法 对58例严格选择的轻－中度高血压病人用依那普利单盲法治疗前后比较动态血压和偶测血压结果,并进行A、B、C、D4种方法比较。结果 A法降压总有效率89．6％,B法79．3％、C法72．5％、D法67．2％;判断一致性（K值）在A与B、C、D之间分别为0．11、0．04、0．18（P值均＞0．05）,B与C或D之间分别为0．44（P＜0．05）、0．33（P＞0．05）、C与D间为0．68（P＜0．01）;平均特异性和敏感性分别为A法16．4％和92．5％、B法41．1％和87．5％、C法56．7％和84．2％、D法73．6％和77．3％。结论 依那普利中小剂量晨起一次性给药4周后能平稳降低全天血压,但有效率判断方法中不同方法有不同效果,推荐以D法为佳。     

老年高血压患者发生衰弱对预后的影响

目的探讨衰弱对老年高血压患者不良预后的影响。方法随机选取2015年3月至2016年10月在解放军总医院门诊就诊或常规查体的老年高血压患者314例为研究对象,对患者的一般人口学特征、既往病史等进行问卷调查,应用Charlson合并症指数(CCI)对老年患者的共病状态进行评估,微型营养评估简表(MNA-SF)进行营养评估,Barthel指数进行日常生活能力评估。依据衰弱状态分为3组:正常组(n=65)、衰弱前期组(n=208)和衰弱组(n=41)。进行18个月的随访,依据是否发生跌倒分为2组:跌倒组(n=41)和非跌倒组(n=273);依据是否发生全因住院分为2组:住院组(n=133)和非住院组(n=181)。采用SPSS 19.0软件进行数据处理。依据数据类型,组间比较分别采用t检验或χ~2检验。对单因素分析有统计学意义的指标进行多因素logistic回归分析,筛选出独立的危险因素。结果 314例老年高血压患者应用Fried标准共检出衰弱者41例,检出率为13.1%,且衰弱的检出率随年龄的增加而增加。经校正的回归模型显示,步速减低与跌倒具有显著相关性(OR=2.88,95%CI 1.26~6.56,P0.05),步速减低与全因住院的相关性差异无统计学意义(OR=1.13,95%CI0.57~2.22,P=0.726)。结论老年高血压患者衰弱的检出率随年龄的增加而增加,步速减低是老年高血压患者发生跌倒的独立危险因素。     

The trained observer better predicts daytime ABPM diastolic blood pressure in hypertensive patients than does an automated (Omron) device

OBJECTIVES: Accurate blood pressure measurement is critical to successful clinical trials. Concerns about observer errors have led to the use of automated oscillometric devices without evidence that their performance is similar to that of trained observers. This study compares blood pressures obtained by trained observers and with an oscillometric device (Omron 705CP) to 24-h ambulatory blood pressure monitoring. METHODS: We performed a post-hoc analysis of 313 untreated hypertensive patients at the end of the washout phase of a Novartis hypertension trial. Patients had three seated trained observer mercury auscultatory blood pressure measurements followed by 24-h ambulatory blood pressure monitoring. The next day, the ambulatory blood pressure monitoring was removed and three seated readings were obtained with an Omron 705CP. Correlations for systolic blood pressure and diastolic blood pressure were obtained between daytime ambulatory blood pressure monitoring (0900 and 2100) and the two office methods. In addition, we investigated the degree of difference of trained observer and Omron measurements from ambulatory blood pressure monitoring. RESULTS: For systolic blood pressure, the correlation with ambulatory blood pressure monitoring of the trained observer was significantly better than with that of the Omron 705CP (0.641 vs. 0.555, P=0.01). For diastolic blood pressure values, even greater disparity between the two office method correlations with ambulatory blood pressure monitoring was observed (trained observer=0.593 vs. Omron=0.319, P<0.0001). Both trained observer and Omron readings were consistently higher than ambulatory blood pressure monitoring for systolic blood pressure (P<0.0001) and diastolic blood pressure (P<0.0001). Omron measurements, however, deviated from ambulatory blood pressure monitoring more than those of the trained observer (P<0.0001 for systolic blood pressure and diastolic blood pressure). CONCLUSIONS: For clinical trials using diastolic blood pressure targets, the Omron 705CP cannot replace the auscultatory blood pressure measurements of a trained observer. For systolic blood pressure, the Omron device and the trained observer had similar correlations with ambulatory blood pressure monitoring; however, both methods gave consistently higher systolic blood pressure values. Further study of oscillometric devices should be conducted before universally replacing auscultatory blood pressure determinations by trained observers in clinical trials.     

动态血压监测多方法同时比较评价依那普利降压疗效

目的用动态血压评价依那普利降压疗效并进行总体疗效判断和4种判效方法学比较.方法对58例严格选择的轻-中度高血压病人用依那普利单盲法治疗前后比较动态血压和偶测血压结果,并进行A、B、C、D4种方法比较.结果A法降压总有效率89.6%、B法79.3%、C法72.5%、D法67.2%;判断一致性(K值)在A与B、C、D之间分别为0.11、0.04、0.18(P值均>0.05),B与C或D之间分别为0.44(P<0.05)、0.33(P>0.05)、C与D间为0.68(P<0.01);平均特异性和敏感性分别为A法16.4%和92.5%、B法41.1%和87.5%、C法56.7%和84.2%、D法73.6%和77.3%.结论依那普利中小剂量晨起一次性给药4周后能平稳降低全天血压,但有效率判断方法中不同方法有不同效果,推荐以D法为佳.     

临床决策支持系统对高血压患者心血管病风险的评估及管理效果评价

目的:分析临床决策支持系统(CDSS)对高血压患者心血管病风险评估及管理效果。方法:2017年5月至2018年4月,从吉林长春市电子医疗数据库提取62家社区健康服务中心高血压患者就诊的临床资料,使用CDSS管理的社区健康服务中心有9家,共计3 296例高血压患者,将其作为观察组;未使用CDSS管理的社区健康服务中心有53家,按照1∶5的匹配原则选取16 480例高血压患者作为对照组。比较两组基线就诊时实验室检查指标及管理后就诊次数、血脂异常检出率、降压达标率等指标;并对观察组基线就诊与末次就诊时的心血管病风险评估、生活质量等指标进行分析。结果:两组基线就诊时性别、年龄、BMI、合并症、血糖、血压和血脂等基线资料,差异无统计学意义(P>0. 05)。接受心血管病管理后观察组患者与对照组患者比较,每月每千人就诊次数[680(375,960) vs. 242(29,516)]、血脂检测异常率(57. 8%vs. 30. 0%)、高血压规范治疗率(81. 3%vs. 65. 1%)、降压达标率(69. 2%vs.55. 0%)等指标均有显著提高(均P<0. 05)。观察组基线就诊时与末次就诊时比较,心血管病评估系数下降(5. 76±5. 28) vs.(4. 9±4. 71)比较差异有统计学意义(均P<0. 05)。结论:将CDSS系统应用于社区高血压病管理中,有助于促进降压治疗效果,提升患者预防意识,控制与改善其他心血管疾病,提高患者生活质量。     

Short sleep duration is an independent predictor of stroke events in elderly hypertensive patients

Data relating habitual sleep duration to the risk of silent or overt stroke are sparse. We tested the hypothesis that short duration of sleep is associated with increased risk of silent cerebral infarct (SCI) and stroke events in hypertensive patients. We performed ambulatory BP monitoring in 1268 hypertensives (mean age: 70.4 years) and followed them for 50 months. Brain MRI was performed in 932 of these subjects for the assessment of SCI, and these subjects were analyzed in this study. Cox proportional hazard models were used to calculate the hazard ratios (HR) of sleep-duration-associated risk for cardiovascular events while controlling for significant covariates. In multivariable Cox regression analysis, a sleep duration <7.5 h was independently associated with the risk of stroke (HR = 2.21; P = 0.003). The presence of SCI was also associated with stroke events (HR = 2.60; P = 0.005). When the subjects were divided into an SCI(+) group and SCI(?) group, the short sleep duration was a significant predictor for incident stroke only in the SCI(+) group (HR = 2.52; P = 0.001). Shorter sleep duration was an independent risk for future incidence of stroke events in hypertensive patients, especially those with SCIs.     

Nifedipine and isometric exercise. Evaluation of the pressure response in hypertensive patients

Because of isometric efforts are a normal component of the usual life, we studied 35 patients suffering from mild and moderate essential hypertension, by means of an isometric exercise test, using the "handgrip method". The purpose of the experimental work was the evaluation of pressure changes at the top of an isometric stress in basal conditions and the demonstration of the protective effect against pressure increase of nifedipine, acutely administered (20 mg sublingual). The results largely confirmed the usefulness of nifedipine in the treatment of hypertension at rest and at the top of an isometric exercise. Moreover, the pressure increase during the same effort after nifedipine administration is smaller than during a therapy with others antihypertensive drugs.     

Evaluation,risk stratification and management of hypertensive patients in the perioperative period

Uncontrolled hypertension represents an important cause for postponing a non-cardiac surgery. Perioperative management of hypertensive patients should focus on cardiovascular risk stratification, evaluation of blood pressure levels and hypertension control, registration of the ongoing antihypertensive regimen and counseling about clinical decisions related to the expected perioperative blood pressure fluctuations. To date, there is a lack of evidence on how hypertensive patients should be perioperatively treated, while an empirical clinical approach is usually pursued in the usual practice. The present review appraises the gaps in the evidence and illustrates the current empirical approach of perioperative management of hypertension in non-cardiac surgery.     

N-acetylcysteine potentiates the antihypertensive effect of ACE inhibitors in hypertensive patients

Sulfhydryl group donors, such as N-acetylcysteine (NAC), may enhance the antihypertensive effect of some drugs through a nitric oxide (NO) mechanism. It has been observed that the hypotensive effect of angiotensin-converting enzyme inhibitors (ACEIs) is, at least partially, mediated by NO. We performed a within patient crossover study with the aim to investigate the potential effect of NAC on the ACEI antihypertensive action, via an NO-dependent mechanism. We studied 18 smoker (> 10 years of habit and > 10 cigarettes daily) hypertensive patients (15 males and three females, aged 69 +/- 5 years) on ACEI therapy (11 captopril and seven enalapril). Patients were randomly allocated to two treatment arms. In one arm, the patients (n = 10) initially received the addition of NAC (600 mg t.i.d.) to the ACEI regimen. In the other group (n = 8), the patients remained only on ACEI. After 21 days, the therapeutic patterns were crossed. The first group received only ACEI, and the second group received ACEI and NAC and completed other 21-day treatment period. We evaluate the effect of NAC on each patient by ambulatory blood pressure monitoring (ABPM), performed at the end of each therapeutic regimen. A significant decrease in systolic and diastolic 24-h blood pressure (24 hBP) and daytime BP (dtBP) was achieved with the combination of ACEI and NAC (ACEI + NAC) when compared to the period with only ACEI: 24 hBP = 146.1 +/- 4.2 vs 137 +/- 3.1 (p < 0.05) and 89.2 +/- 2.8 vs 83.5 +/- 3.7mmHg (p = 0.01). DtBP: 149.7 +/- 5.6 vs 141 +/- 3.7 and 92.1 +/- 4 vs 86 +/- 3.2 (both, p < 0.05). No significant difference was observed in night-time BP (ntBP). The NAC effect was not statistically different for the two ACEIs. In conclusion, the addition of NAC to an ACEI potentiates its antihypertensive effect during 24hBP and dtBP in smoker hypertensives. This effect may be mediated by an NO-dependent mechanism, probably through the protective effect of NAC on NO oxidation.     

Pulmonary circulation in patients with different types of "hypertensive heart"

The comparison of clinical and instrumental findings of the state of pulmonary hemodynamics with respect to the type of "hypertensive heart" as determined by ultrasonic location of heart chambers, suggested that, in the absence of left-ventricular hypertrophy or in the presence of concentric myocardial hypertrophy combined with hyperfunction of this heart chamber and normal left ventricular size, increased diastolic pressure in pulmonary artery does not reflect left ventricular decompensation; rather, it is a consequence of increased vascular resistance in the pulmonary arterial system irrespective of its pathogenesis.