Hypertension prevalence and control in Ulaanbaatar,Mongolia

This study examines the prevalence, awareness, treatment, and control of hypertension in Ulaanbaatar, Mongolia, using both the American Heart Association and conventional thresholds (130/80 and 140/90 mm Hg, respectively). In this randomized cross‐sectional study, two‐stage cluster sampling was used to obtain a sample of 4515 individuals aged ≥20 years. Hypertension was defined by the use of antihypertensives in the last 2 weeks or a blood pressure at or above the thresholds of 140/90 and 130/80 mm Hg. The mean age of the participants was 41.1 ± 14.0 years and 54.5% were women. Hypertension prevalence was 25.6% (using 140/90 mm Hg) and 46.5% (using 130/80 mm Hg). Prevalence increased with age and below 50 years men were consistently more likely to be hypertensive. Among hypertensive participants, the rates of awareness, treatment, and control were 69.7%, 46.8%, and 24.0% (using 140/90 mm Hg) and 49.1%, 25.8%, and 6.4% (using 130/80 mm Hg, respectively). Men had lower rates of awareness, treatment, and control compared with women, with the most pronounced differences at younger ages. This study shows that awareness, treatment, and control rates in Ulaanbaatar are better than in most low‐ and middle‐income countries but are still suboptimal. The largest “care gap” was in young men where a regulatory requirement for annual workplace blood pressure screening has the potential to enhance care. A major hypertension control program has just been initiated in Ulaanbaatar.     

老年高血压病患者血液流变学分析

对48例老年高血压患者（合并冠心病21例，糖尿病10例）进行血液流变学测定。结果老年高血压组纤维蛋白原（Fg）、血浆粘度（ηP）与对照组比较，P＜0．01。全血粘度（ηb）、全血还原粘度（ηh）、血沉（ESR）、血小板粘附率（PAD）及体外血栓干重（DW）与对照组比较，P＜0．05；高血压合并冠心病组与单纯高血压组比较，ηb，ηh，PAD及体外血栓长度（L）、湿重（MW）（P＜0．05），DW（P＜0．01）；高血压合并糖尿病组与单纯高血压组比较，Fg（P＜0．01），ηh，ηh，ESR，PAD，L，DW，（P＜0．05）。结果提示，老年高血压病患者血液流变学改变表现为纤维蛋白原增高、红细胞刚性增加、红细胞变形能力降低，致红细胞聚集性增强。高血压合并冠心病或糖尿病组，均以血小板反应性增高、红细胞聚集性增强、内皮功能受损及体外血栓形成能力增强更为突出。     

Is tinnitus an early voice of masked hypertension? High masked hypertension rate in patients with tinnitus

Objectives: Tinnitus is hearing a sound without any external acoustic stimulus. There are some clues of hypertension can cause tinnitus in different ways. The aim of the study was to evaluate the relationship between tinnitus and masked hypertension including echocardiographic parameters and severity of tinnitus.

Methods: This study included 88 patients with tinnitus of at least 3 months duration and 85 age and gender-matched control subjects. Tinnitus severity index was used to classify the patients with tinnitus. After a complete medical history, all subjects underwent routine laboratory examination, office blood pressure measurement, hearing tests and ambulatory blood pressure monitoring. Masked hypertension is defined as normal office blood pressure measurement and high ambulatory blood pressure level.

Results: Baseline characteristics in patients and controls were similar. Prevalence of masked hypertension was significantly higher in patients with tinnitus than controls (18.2% vs 3.5%, p = 0.002). Office diastolic BP (76 ± 8.1 vs. 72.74 ± 8.68, p = 0.01), ambulatory 24-H diastolic BP (70.2 ± 9.6 vs. 66.9 ± 6.1, p = 0.07) and ambulatory daytime diastolic BP (73.7 ± 9.5 vs. 71.1 ± 6.2, p = 0.03) was significantly higher in patients with tinnitus than control group. Tinnitus severity index in patients without masked hypertension was 0 and tinnitus severity index in patients with masked hypertension were 2 (1–5).

Conclusion: This study demonstrated that masked hypertension must be kept in mind if there is a complaint of tinnitus without any other obvious reason.     

The Use of Short-Term Ambulatory Blood Pressure Monitoring in Differing Forms of Hypertension

Single blood pressure readings represent the conventional approach for determining the presence and severity of hypertension. However, the relationship between single (casual) readings and the whole-day blood pressure average is weak, especially in patients with borderline hypertension and in the elderly. In this study we have compared casual blood pressures with the averages of blood pressures obtained during short-term (two-hour) and long-term (24-hour) ambulatory monitoring in patients with mild (n=19), moderate (n=11), or predominant systolic (n=11) essential hypertension. The blood pressure averages obtained during long-term monitoring were significantly lower than the casual blood pressure in all three subgroups. The averages of short-term monitoring in the morning were in between the other two blood pressure levels. The correlation coefficients between two-hour morning averages of pressure and whole-day averages were highly significant (p<0.01 or better), and stronger than those between casual and whole-day average pressures, in the group of patients as a whole and in all three subgroups. The slopes of the regression equations were close to unity. Therefore, ambulatory short-term monitoring of blood pressure in the morning is superior to casual blood pressure and probably is an adequate substitute for whole-day observations in quantifying whole-day blood pressure levels in hypertensive patients, especially in patients with mild hypertension and in those with predominant systolic hypertension.     

Non-interventional management of resistant hypertension

Hypertension is one of the most popular fields of re-search in modern medicine due to its high prevalence and its major impact on cardiovascular risk and con-sequently on global health. Indeed, about one third of individuals worldwide has hypertension and is under increased long-term risk of myocardial infarction, stroke or cardiovascular death. On the other hand, resistant hypertension, the "uncontrollable" part of arterial hy-pertension despite appropriate therapy, comprises a much greater menace since long-standing, high levels of blood pressure along with concomitant debilitating entities such as chronic kidney disease and diabetes mellitus create a prominent high cardiovascular risk milieu. However, despite the alarming consequences, resistant hypertension and its effective management still have not received proper scientific attention. As-pects like the exact prevalence and prognosis are yet tobe clarified. In an effort to manage patients with resis-tant hypertension appropriately, clinical doctors are still racking their brains in order to find the best therapeutic algorithm and surmount the substantial difficulties in controlling this clinical entity. This review aims to shed light on the effective management of resistant hyper-tension and provide practical recommendations for cli-nicians dealing with such patients.     

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肺动脉高压(PH)是一种潜在的致命性疾病,若未及时诊断、积极干预,大多数患者预后极差。如何早期诊断、规范治疗PH仍然是广大临床医师面临的一个重要挑战。随着现代医疗技术的进步与发展,人们对PH发病机制的认识不断深入,新的诊断技术和治疗手段不断涌现,在此基础上,基于循证医学证据的指南或专家共识不断更新。这些指南或专家共识对于促进对PH的规范化诊断和治疗,具有重要的指导价值。     

The Role of Salt in Hypertension

There is considerable evidence that salt is an important cause of hypertension. Primitive societies who ingest little or no salt have no hypertension. Also when diets very low in salt such as the rice and fruit diet are given to hypertensive patients, the blood pressure often falls toward normal. Unfortunately, when diets only moderately low in sodium have been given only minor reductions in blood pressure occur. Salt-induced hypertension has been produced in both man and experimental animals. The basic cause of the hypertension is an inability of the kidney to excrete the increased salt. Hemodynamic changes then occur which raise the blood pressure and so excrete the excess salt by pressure diuresis. The ability to excrete salt at normal levels of blood pressure varies from one individual to another. Those who require a higher than normal blood pressure are said to be “salt-sensitive”. Those who can excrete excess salt at normal levels of blood pressure are called “salt resistant”. The difference may be due to an inherited defect in the kidney to excrete salt. In any event, salt sensitive hypertension is effectively controlled with the administration of diuretics.     

我国七城市社区老年人高血压患病调查

目的抽样调查我国部分城市社区老年人高血压的流行现状及主要相关因素，以制订合理的防治对策。方法选择７个脑卒中高发城市（北京、上海、哈尔滨、长春、郑州、长沙、银川），按统一标准，测量社区人群中９５９７名老年人的血压，并对一些相关危险因素进行问卷调查。结果７个城市合计确诊高血压患病率为２６．４％，临界高血压患病率１４．１％。其中北京确诊高血压患病率高达３２．２％。女性确诊高血压高于男性，纯收缩期高血压亦明显高于男性（Ｐ值＜０．０１）。分析相关因素显示，体重指数与高血压密切相关。结论高血压是危害老年人健康的主要疾病之一，需进一步加强宣传教育力度     

Redo of percutaneous renal denervation in a patient with recurrent resistant hypertension after primary treatment success

A 79‐year‐old patient was treated with percutaneous renal denervation (RDN) due to resistant arterial hypertension in the summer of 2010. After primary treatment success with a decrease of blood pressure from 170/100 to 130/80 mm Hg 6 months postablation, the blood pressure rose again at 12 months despite maintenance of the pharmacologic regimen and the decision was made to perform a second RDN procedure. Three months following the second RDN procedure, blood pressure was lowered to 130/77 mm Hg. © 2012 Wiley Periodicals, Inc.     

肾交感神经阻断术治疗难治性高血压

交感神经的普遍激活是高血压病发病机制的重要环节,并参与难治性高血压的维持。外科交感神经切除术大大提高了难治性高血压的存活率,显示了良好的降压效果;但由于手术风险及严重术后并发症而被降压药物所代替。肾交感神经阻断术是一种新的非药物治疗方法,有损伤小、恢复快、无全身不良反应的优点,再次点燃了抑制交感神经治疗高血压病的希望。     

Audit of the aetiology and prevalence of pulmonary hypertension in a tertiary hospital setting

Appropriate diagnosis and initiation of disease‐specific treatment is an important therapeutic goal in idiopathic pulmonary arterial hypertension. We evaluated the prevalence and aetiology of moderate‐to‐severe pulmonary hypertension in a cohort of patients referred for inpatient echocardiography, with significant pulmonary hypertension documented in 4.6%. Pulmonary hypertension complicating left heart disease was the most common aetiology, with idiopathic pulmonary arterial hypertension less frequent.     

Treatment of hypertension in the elderly

Summary Treatment of hypertension in the elderly is beneficial, and benefit exceeds risk, but in some individuals it may be difficult to decrease blood pressure to goal or normotensive levels. Recent data suggest that the use of diuretics and, in some instances, beta-adrenergic inhibitors will reduce morbidity and mortality in elderly hypertensives and will probably not alter metabolic parameters to a clinically significant degree in most individuals.     

门静脉高压相关性肺动脉高压1例

一、病例资料 患者,女性,47岁,于1个月前出现胸闷、气短、呼吸困难,活动后加重,伴头昏,休息后稍好转.4年前发现乙型肝炎表面抗原阳性,平时无纳差、厌油腻等症状,未予治疗.有月经过多引起的贫血史10年,2007年和2009年分别输血1次.入院查体:血压114/91 mm Hg(1 mm Hg=0.133 kPa),端坐呼吸.贫血貌,皮肤巩膜轻度黄染.双肺呼吸音清,无干湿啰音.心界稍扩大,心率80次/min,肺动脉区第二心音亢进,心脏各瓣膜区未闻及杂音.腹软,肝肋下未触及,脾肋下5cm,质中,移动性浊音阴性.双下肢轻度凹陷性水肿.     

21例特发性门脉高压临床及病理特点分析

目的分析特发性门脉高压(idiopathic portal hypertension,IPH)的临床及病理特点。方法回顾性分析2012年1月—2016年12月在解放军第三〇二医院住院治疗(资料完整)的21例IPH患者的临床及病理特点。结果 21例IPH患者中,男女比例6∶15,平均发病年龄(38.1±12.7)岁,临床以门脉高压症表现为主,肝功能无明显减退,主要并发症为上消化道出血及腹水。21例肝组织病理主要表现为肝细胞板排列基本正常,无假小叶形成,汇管区扩大,门静脉周围纤维化,门脉周围有不同程度的细胞浸润,血管紊乱,中央静脉及小叶间静脉扩张,肝窦扩张,窦周纤维化。结论 IPH患者门脉高压和肝功能损害不平行,门脉高压表现较重,确诊仍须病理学检查,治疗以防治并发症为主。     

Effect of Masked Hypertension on Aortic Elastic Properties

Aortic stiffness is increased in patients with sustained hypertension (SH). The aim of this study was to investigate the relationship between aortic elastic properties and masked hypertension (MH). We evaluated aortic elastic properties in 35 individuals with MH, 35 patients with SH, and 35 normotensive healthy volunteers using transthoracic Doppler echocardiography. All aortic distensibility values were carried out at the same time or immediately after the blood pressure (BP) measurement. Baseline clinical and demographic characteristics of the patients were similar in all three groups. Aortic stiffness index and elastic modulus values were higher in MH group compared to SH group and control group (8.9 ± 6.3 vs. 5.4 ± 2.2 vs. 4.2 ± 2.5, P < .001 and 9.0 ± 6.3 vs. 6.4 ± 2.5 vs. 4.1 ± 2.4, P < .001, respectively). Aortic strain values were lower in MH group compared to SH group and control group (7.4 ± 5.3 vs. 9.5 ± 4.1 vs. 14.6 ± 7.1, P < .001, respectively). Aortic distensibility values were lower in MH and SH groups compared to controls (3.1 ± 1.9 vs. 3.7 ± 1.6 vs. 6.4 ± 3.4, P < .001, respectively). Furthermore, diastolic aortic diameter, left ventricular mass index, interventricular septum, and posterior wall thickness were higher in MH and SH groups when compared to controls. This study shows that masked hypertensive patients are at higher risk of “aortic” stiffness, a risk factor for cardiovascular morbidity and mortality, than normotensive and sustained hypertensive patients.     

Survival of hypertensive subjects identified on screening: results for sustained and unsustained diastolic hypertension.

Casual readings of blood pressure predict mortality and may reflect either the risk of sustained hypertension, additional components of 'white coat' hypertension or variable blood pressure. This study investigated mortality in 442 men and 360 women with a diastolic pressure (Phase IV) of 90 mmHg and over, unsustained on two subsequent monthly visits, followed for an average of 11 years and compared with a matched control cohort with an initial diastolic pressure (DBP) of less than 90 mmHg. Subjects were identified between 1975 and 1979 by screening 28,257 subjects aged 18-65 years on the lists of general practitioners in seven practices in the United Kingdom. Additionally, 912 men and 844 women with sustained hypertension (DBP > 90 mmHg on at least two out of three occasions) were identified and matched with normotensive controls. In men with sustained hypertension the relative risk (RR) for death from circulatory disease was 1.76, P < 0.01, 95% confidence interval 1.21, 2.58 and in women 1.85, P < 0.05, 95% confidence interval 1.06, 3.24 respectively, while in men with unsustained hypertension the RR = 1.52, P = 0.2, 95% confidence interval 0.81, 2.84. Few circulatory deaths occurred in women with transient hypertension or their controls (five and seven respectively). Despite the screening programme and further treatment, newly discovered subjects with sustained hypertension, both men and women, remain at high risk of cardiovascular mortality. The 95% confidence interval for men with transient hypertension does not exclude a similar adverse effect.