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The innovative pharmacological combination of low-dose rivaroxaban plus aspirin provides clinicians with an ideal opportunity to intensify the medical treatment of patients with coronary artery disease (CAD) and comorbid peripheral artery disease (PAD). We aimed to determine the cost-effectiveness of PAD screening using the ankle-brachial index (ABI) test in patients with CAD (with rivaroxaban administered if the PAD screening was positive) compared with no-screening strategy in China. A Markov decision model using a 1-month cycle was developed to simulate the 25-year effectiveness and cost of PAD screening on 75-year-old patients with CAD in China, evaluating the quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio (ICER). One-way, two-way, and probabilistic sensitivity analyses were conducted to assess the impact of variations in the key parameters for ICERs. Our model found an incremental cost of RMB4,959 (US$740) and an incremental QALY of 0.054 after one-time ABI screening, leading to an ICER of RMB91,936 (US$13,717) per QALY gained over a 25-year period. The reduction in all-cause mortality related to rivaroxaban and its cost were the factors most affecting the ICER. The screening would become cost-effective by decreasing the monthly cost of rivaroxaban to RMB184.5 (US$27.5) or by using domestic-brand rivaroxaban according to the threshold of a willingness to pay RMB72,447 (US$10,809) per QALY gained. Our study demonstrated that ABI screening for PAD to decide on low-dose rivaroxaban administration was not cost-effective for patients with CAD in China. Nevertheless, policy-guided cost changes for domestic-brand rivaroxaban could easily resolve this issue. • ABI screening for PAD was not cost-effective for patients with CAD in China. • The reduction in all-cause mortality related to rivaroxaban most affected the ICER. • Policy-guided cost changes for rivaroxaban could easily resolve this issue in China. [ABSTRACT FROM AUTHOR]

Objectives: Arterial stiffness may affect antihypertensive response to antihypertensive treatment. However, sufficient clinical evidence is lacking. This longitudinal study aimed to evaluate the effect of baseline arterial stiffness measured by the brachial-ankle pulse wave velocity (baPWV) on response to short-term and long-term enalapril-based treatment in 3310 hypertensive adults from the China Stroke Primary Prevention Trial (CSPPT)., Methods and Results: Blood pressure (BP) measured at three months (short-term) in 2780 subjects, and the time-average on-treatment BP in 3310 subjects during a median of 4.5-year follow-ups (long-term) were analyzed in the study. After short-term antihypertensive treatment, every 1 m/s increase in baPWV denoted a 7% and 6% decreased chance of achieving systolic BP (SBP) control (odds ratio (OR), 0.93; 95% CI 0.90, 0.96; P < 0.001) and BP control (OR, 0.94; 95% CI 0.91, 0.97; P < 0.001), respectively, after adjustment for age, gender and other variables. After long-term treatment, every 1 m/s increase in baPWV posed an 7% and 6% greater risk of failing to attain SBP control (OR, 0.93; 95% CI 0.90, 0.95; P < 0.001) and BP control (OR, 0.94; 95% CI, 0.92, 0.96; P < 0.001), respectively, not regarding for DBP control after both short- and long-term treatment. Higher baseline baPWV significantly decreased SBP reduction both after three months and the median 4.5-year treatment, while increased DBP reduction after the median 4.5-year treatment., Conclusions: Elevated baseline baPWV significantly decreased BP response to short-and long-term treatment in adults with primary hypertensive. Arterial stiffness improvement may be an essential target to achieve adequate BP control., Competing Interests: Declaration of competing interest The authors report no relationships that could be construed as a conflict of interest., (Copyright © 2020. Published by Elsevier B.V.)

Background: Peripheral arterial disease (PAD) is the third leading cause of atherosclerotic vascular morbidity after coronary heart disease and stroke. Epidemiology data of PAD is very limited in low-income and middle-income countries. A national wide survey was conducted from October 2012 to December 2015 to assess the prevalence of PAD in China., Methods: Data from the China Hypertension Survey (CHS). In total, 56,000 people aged 35 years or older were enrolled in this sub-survey for PAD, and 30,025 participants were eligible for analysis. Ankle-brachial index was measured using an automated ABI device (WatchBP Office device Microlife, China). PAD was defined by ABI and Edinburgh Claudication Questionnaire., Results and Conclusions: Overall, 6.6% (estimated 45.3 million) of the Chinese adult population age 35 years or older had PAD. The weighted prevalence of PAD increased significantly after aged ≥75 years. There were no significant differences in PAD prevalence between urban and rural residents, as well as between males and females. Among individuals with PAD, only 4.9% (95% CI: 0%-10.1%) were aware of their condition, 1.9% (95% CI: 0%-4.0%) received revascularization, and 0.2% (95% CI: 0%-0.4%) achieved ABI >0.9. Older age, Han population, current smokers, education level, hypertension, CAD, diabetes, dyslipidemia, and rural residences all were significantly associated with an increased risk of PAD. In China, there is an increasing prevalence of PAD, but the awareness, treatment, and control were very low. Special attention should be paid to prevent and control PAD in China., Clinical Trial Registration Number: ChiCTR-ECS-14004641., (Copyright © 2018 Elsevier B.V. All rights reserved.)