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Objective: Given the high prevalence of hypertension among Chinese adults, this population is at a significantly increased risk of severe COVID-19 complications. The purpose of this study is to assess the willingness of Chinese hypertensive adults to receive the COVID-19 vaccine and to identify the diverse factors that shape their vaccination decisions., Methods: Sampling was conducted utilizing multistage stratified random sampling, and ultimately, a total of 886 adult hypertensive patients from Luzhou City in Southwest China were included in this study. The questionnaire design was based on the Theory of Planned Behaviour and was used to investigate their willingness to be vaccinated with COVID-19. Structural equation modeling was employed for data analysis., Results: The results showed that 75.6% of hypertensive individuals were willing to receive COVID-19 vaccination. The structural equation modeling revealed that Subjective Norms (path coefficient = 0.361, CR = 8.049, P < 0.001) and Attitudes (path coefficient = 0.253, CR = 4.447, P < 0.001) had positive effects on vaccination willingness, while Perceived Behavioral Control (path coefficient=-0.004, CR=-0.127, P = 0.899) had no significant impact on Behavioral Attitudes. Mediation analysis indicated that Knowledge (indirect path coefficient = 0.032, LLCI = 0.014, ULCI = 0.058), Risk Perception (indirect path coefficient = 0.077, LLCI = 0.038, ULCI = 0.124), and Subjective Norms (indirect path coefficient = 0.044, LLCI = 0.019, ULCI = 0.087) significantly influenced vaccination willingness through Attitudes as a mediating factor., Conclusion: The willingness of hypertensive individuals to receive the COVID-19 vaccination is not satisfactory. The Theory of Planned Behavior provides valuable insights into understanding their vaccination intentions. Efforts should be concentrated on enhancing the subjective norms, attitudes, and knowledge about vaccination of hypertensive patients., (© 2024. The Author(s).)

Background: To understand the prevalence of hypertension among Chinese college students over the past decade (2010-2020) and predict its future trend, we aim to provide a basis for preventing and controlling hypertension among college students., Methods: Databases such as Chinese National Knowledge Infrastructure, Wanfang database, PubMed, and Web of Science were searched, and publications on the prevalence of hypertension among Chinese college students from 2010 to 2020 were collected. Search for publications in both Chinese and English databases using keywords "hypertension," "prevalence," "disease status," "cross-sectional survey," "epidemiology," "China," "adolescents," and "college students." Publication screening, data extraction, and quality assessment were independently conducted by 2 researchers. Meta-analysis was performed using Stata 16, and trends in the prevalence of hypertension among college students were analyzed using R 4.2.0., Results: A total of 37 publications were included in this analysis, which involved 233,603 Chinese college students. The Meta-analysis results showed significant heterogeneity among the studies (I2 = 98.9%, P < .05). Using a random-effects model, the overall prevalence of hypertension among college students was estimated to be 3.3% (95% CI = 2.9%-3.6%), with a higher prevalence among male students (6.2%, 95% CI = 5.4%-7.1%) than female students (1.1%, 95% CI = 0.9%-1.3%). The prevalence of hypertension is notably higher in northern regions than in southern regions. The prevalence of hypertension among college students showed an increasing trend from 2010 to 2020. Trend analysis predicted that the prevalence of hypertension among college students will reach 10% and 14.6% by 2030 and 2040, respectively. The risk of hypertension in male students was 4.63 times higher than that of female students (95% CI = 2.97-7.23). Compared normal weight students, overweight and obese students had 3.08 times (95% CI = 2.48-3.82) and 6.69 times (95% CI = 2.25-19.90) higher risk of hypertension, respectively., Conclusion: The prevalence of hypertension in Chinese college students was about 3.3%. The prevalence of hypertension in male college students was higher than that in females, and the prevalence in northern regions was generally higher than that in southern regions. The prevalence of hypertension among Chinese college students will reach 10.0% in the next 10 years and 14.6% in the next 20 years. Male and BMI ≥ 24 were risk factors for hypertension among college students., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Data regarding the association of the waist-to-height ratio (WHtR) with hypertension (HTN) are conflicting. Moreover, little information is available on the association between WHtR and HTN subtypes. Therefore, we aimed to investigate the associations between WHtR and the prevalence of HTN and its subtypes in a Chinese population. In the cross-sectional analysis, 13,947 adults from the China Hypertension Survey study were analysed. We examined the relationship between WHtR and the prevalence of HTN and its subtypes (isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH) and systodiastolic hypertension (SDH)) using multivariate logistic regression analysis. A generalized additive model (GAM) and smooth curve fitting (penalized spline method) were also used. Overall, the mean WHtR was 0.50. The adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for HTN, ISH, IDH and SDH for each standard deviation (SD) increase in WHtR were 1.53 (1.45-1.61), 1.36 (1.28-1.44), 1.41 (1.20-1.65) and 1.47 (1.36-1.59), respectively. The fully adjusted smooth curve fitting revealed a linear association between WHtR and HTN, ISH, IDH, and SDH. Moreover, the positive associations between WHtR and HTN and its subtypes were more strong among younger adults (<60 compared with ≥60 years, P values for interaction <0.001). These findings suggested that WHtR was positively associated with HTN and its subtypes, especially among younger adults (<60 years) in southern China., (© 2021. The Author(s), under exclusive licence to Springer Nature Limited.)

Background: Previous studies on the relationship between the visceral adiposity index (VAI) and peripheral arterial disease (PAD) are limited. Therefore, this study explored the relationship between VAI and PAD in normal-weight patients with hypertension., Methods: A total of 6615 normal-weight patients with hypertension were included in the current study. The VAI, a simple index calculated using blood lipid and waist circumference (WC), can be used as a simple biomarker of body fat distribution. The outcome was PAD, which was defined as present when each side's ankle-brachial index (ABI) was ≤ 0.90., Results: A significant positive association was observed between VAI and PAD prevalence. For per unit increment in LnVAI, the adjusted odds ratios (ORs) of PAD for the total participants and males were 1.55 (95% CI 1.15-2.10) and 2.12 (95% CI 1.46-3.07), respectively. However, the VAI was not associated with PAD in female patients with hypertension (OR 1.28; 95% confidence interval [CI] 0.85-1.95). There was no interaction between sex and VAI (P for interaction = 0.128). Accordingly, in total participants, when VAI was assessed in quartiles and compared with quartile 1 (< 0.84), the PAD prevalence was higher than that of quartiles 2 (0.84 to < 1.36: OR 1.49; 95% CI 0.92-2.44), 3 (1.36 to < 2.25: OR 1.95; 95% CI 1.14-3.32), and 4 (≥ 2.25: OR 1.93; 95% CI 1.04-3.57). There were no significant interactions with the other confounders., Conclusion: This study showed a positive association between VAI and PAD in normal-weight adults with hypertension among men but not among women., (© 2022. The Author(s).)

Background and Aims: As a new simple anthropometric index, the weight-adjusted-waist index (WWI) appears to be superior to body mass index (BMI) and waist circumference (WC) in assessing both muscle and fat mass. We aimed to explore the association of WWI with all-cause and cardiovascular mortality in southern China., Methods and Results: A total of 12,447 participants (mean age, 59.0 ± 13.3 years; 40.6% men) in Jiangxi Province from the China Hypertension Survey study were included. WWI was defined as WC divided by the square root of weight. The outcome was all-cause and cardiovascular mortality. During a median follow-up of 5.6 years, 838 all-cause deaths occurred, with 390 cardiovascular deaths. Overall, there was a nonlinear positive relationship of WWI with all-cause and cardiovascular mortality. Accordingly, compared with participants in quartiles 1-3 (<11.2 cm/√kg), a significant higher risk of all-cause mortality (HR: 1.36, 95% CI: 1.17, 1.58) and cardiovascular mortality (HR: 1.43, 95% CI: 1.15, 1.77) were found in quartile 4 (≥11.2 cm/√kg). Further adjustment for BMI and WC did not substantially alter the results. No significant interactions were found in any of the subgroups (sex, age, area, physical activity, current smoking, current alcohol drinking, hypertension, and stroke)., Conclusion: Higher WWI levels (≥11.2 cm/√kg) were associated with increased the risk of all-cause and cardiovascular mortality in southern China. These findings, if confirmed by further studies, suggested that WWI may serve as a simple and effective anthropometric index in clinical practice., Competing Interests: Declaration of competing interest The authors declared no conflict of interest., (Copyright © 2022 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)

Previous studies reported that the aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AST/ALT) was a risk factor in cardiovascular disease. Peripheral artery disease (PAD) is an important risk factor for cardiovascular death. However, only a few studies investigated the correlations between the AST/ALT ratio and PAD. We analyzed data from 10 900 patients with hypertension from the Chinese Hypertension Registry Study; 350 patients had PAD (prevalence 3.2%). After adjusting for potential confounders, the AST/ALT ratio was independently and positively associated with risk of PAD (OR: 1.31, 95% CI, 1.13-1.59), and a significant increased risk of PAD for the third AST/ALT ratio tertile (T3) compared with the first tertile (T1; OR: 1.49, 95% CI, 1.09-2.04, P = .005) was found. Moreover, when we combined T1 and T2 into one group and used it as a reference group, the risk of PAD increased with the increase in AST/ALT; the risk ratio was 1.52 (95% CI, 1.20-1.95). A higher AST/ALT ratio (≥1.65) was associated with PAD risk in Chinese adults with hypertension. Our results suggest that the AST/ALT ratio may help identify patients at high risk of vascular end points and might be a convenient, economical, and effective tool for evaluating the risk of atherosclerosis.trend = .005) was found. Moreover, when we combined T1 and T2 into one group and used it as a reference group, the risk of PAD increased with the increase in AST/ALT; the risk ratio was 1.52 (95% CI, 1.20-1.95). A higher AST/ALT ratio (≥1.65) was associated with PAD risk in Chinese adults with hypertension. Our results suggest that the AST/ALT ratio may help identify patients at high risk of vascular end points and might be a convenient, economical, and effective tool for evaluating the risk of atherosclerosis.

Background: Current studies support lipid ratios [the total cholesterol (TC)/high-density lipoprotein cholesterol (HDL-C) ratio; the triglyceride (TG)/HDL-C ratio; the low-density lipoprotein cholesterol (LDL -C)/HDL-C ratio; and non-HDL-C] as reliable indicators of cardiovascular disease, stroke, and diabetes. However, whether lipid ratios could serve as markers for hyperuricemia (HUA) remains unclear due to limited research. This study aimed to explore the association between lipid ratios and HUA in hypertensive patients., Methods: The data from 14,227 Chinese hypertensive individuals in the study were analyzed. Multiple logistic regression analysis and smooth curve fitting models examined the relationship between lipid ratios and HUA., Results: The results showed positive associations between the lipid ratios and HUA (all P < 0.001). Furthermore, lipid ratios were converted from continuous variables to tertiles. Compared to the lowest tertile, the fully adjusted ORs (95 % CI) of the TC/HDL-C ratio, the TG/HDL-C ratio, the LDL-C/HDL-C ratio, and non-HDL-C in the highest tertile were 1.79 (1.62, 1.99), 2.09 (1.88, 2.32), 1.67 (1.51, 1.86), and 1.93 (1.74, 2.13), respectively (all P < 0.001)., Conclusions: The study suggested that high lipid ratios (TC/HDL-C ratio, TG/HDL-C ratio, LDL-C/HDL-C ratio, and non-HDL-C) are associated with HUA in a Chinese hypertensive population. This study's findings further expand the scope of the application of lipid ratios. These novel and essential results suggest that lipid ratio profiles might be potential and valuable markers for HUA., Trial Registration: No. ChiCTR1800017274. Registered July 20, 2018., (© 2021. The Author(s).)

Objective: Data on the association between homocysteine (Hcy) and the risk of chronic kidney disease (CKD) in patients with H-type hypertension were limited. This study aimed to examine the relation of Hcy with the prevalence of CKD and estimated glomerular filtration rate (eGFR) among Chinese adults with H-type hypertension., Methods: A total of 12,873 Chinese adults with H-type hypertension aged 27-75 years were enrolled in the final analysis. Hcy concentrations were divided into 11 groups at 2 μmol/L interval. The outcome was CKD, defined as eGFR <60 mL/min/1.73 m 2 ., Results: The prevalence of CKD was 7.58%, and the mean Hcy was 17.58 ± 10.96 μmol/L. The smoothing curve indicated that with the increase of Hcy, the prevalence of CKD increases first and then flattens, eGFR decreases first and then flattens, which supports the L-shaped association of Hcy with the prevalence of CKD and eGFR. Moreover, we further found the inflection point of Hcy was 22 μmol/L. OR (95% CI) of risk of CKD was 1.31 (1.28, 1.35) on the left side of an inflection point and 1.00 (0.99, 1.01) on the right of an inflection point, β (95% CI) of eGFR was -1.58 (-1.65, -1.50) on the left side of an inflection point and 0.00 (-0.03, 0.03) on the right of an inflection point, respectively. Similar results were found in various subgroups., Conclusions: Our study suggested saturation effects of Hcy on the prevalence of CKD and eGFR among Chinese patients with H-type hypertension., (Copyright © 2020 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)

Abstract: Previous studies had shown that an increased aspartate aminotransferase to alanine aminotransferase ratio (AST/ALT ratio) was associated with cardiovascular disease. This study aimed to assess the relationship between AST/ALT ratio and all-cause and cardiovascular mortality in patients with hypertension.By March 31, 2020, a cohort of 14,220 Chinese hypertensive patients was followed up. The end point was all-cause and cardiovascular death. Hazard ratios (HRs) and 95% CIs were calculated for mortality associated with AST/ALT ratio, using Cox proportional hazards models and competing risk model.In an average of 1.7 years of follow-up, 1.39% (n = 198) of patients died, 55.5% (n = 110) of whom from cardiovascular disease. AST/ALT ratio was associated with increased risk of all-cause death (HR:1.37, 95% CI:1.15-1.63) and cardiovascular death (HR:1.32, 95% CI:1.03-1.68) after adjustment for other potential confounders. Compared with low AST/ALT ratio (Tertile 1), high AST/ALT ratio was associated with high cause mortality (Tertile 2: HR:1.35, 95% CI:0.86-2.10; Tertile 3: HR:2.10, 95% CI:1.37-3.21; P for trend <.001). Compared with low AST/ALT ratio (Tertile 1), a statistically significant increased risk of cardiovascular mortality was also observed (Tertile 2: HR:1.27, 95% CI:0.70-2.29; Tertile 3: HR:1.92, 95% CI:1.09-3.37; P for trend <.001). High AST/ALT ratio was also associated with high cardiovascular mortality (Tertile 2: HR:1.27, 95% CI:0.70-2.29; Tertile 3: HR:1.92, 95% CI:1.09-3.37; P for trend <.001).Present study indicated that increased AST/ALT ratio levels were predictive of all-cause and cardiovascular mortality among Chinese hypertensive patients.Trial registration: CHICTR, CHiCTR1800017274. Registered 20 July 2018., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Previous literature reported racial/ethnic disparities in the measure assessment of diabetes medication adherence in the Medicare Part D Star Ratings program., Objective: This study examined the likelihood of inclusion in measure calculation across racial/ethnic groups for adherence metrics in Part D Star Ratings among individuals with diabetes, hypertension, and/or hyperlipidemia., Methods: This was a retrospective cross sectional analysis of a 10% random sample of 2017 Medicare claims linked to Area Health Resources Files. Inclusion in measure calculation was determined based on inclusion/exclusion criteria in adherence metrics for adherence medications for diabetes, hypertension, and hyperlipidemia in Part D Star Ratings developed by the Pharmacy Quality Alliance. Logistic regression and multinomial logistic regression were used to adjust for patient/community characteristics., Results: The study sample size was 2 707 216. Compared to Non-Hispanic White (White) beneficiaries, minorities were more likely to be excluded from measure calculation among individuals with 1 condition. For example, among individuals with hypertension, compared to White individuals, the adjusted odds ratios for exclusion for Black, Hispanic, Asian/Pacific Islander and other individuals were 1.46 (95% confidence interval, or CI = 1.42-1.50), 1.38 (95% CI = 1.33-1.43), 1.28 (95% CI = 1.21-1.35), and 1.08 (95% CI = 1.02-1.15), respectively. Among individuals with more than 1 chronic condition, minorities were more likely to be included in fewer calculations for medication adherence measures. For example, among individuals with all 3 conditions, the adjusted relative risk ratios for Black, compared to White, beneficiaries for being included in 0, 1, and 2 measures, versus all 3 measures, were 2.14 (95% CI = 1.99-2.30), 1.49 (95% CI = 1.41-1.56), 1.20 (95% CI = 1.18-1.23), respectively., Conclusions: Compared to White beneficiaries, racial/ethnic minorities are more likely to be excluded from the calculation for adherence measures among individuals with diabetes, hypertension, and/or hyperlipidemia. Future studies should examine whether such disparities exacerbate existing racial/ethnic disparities in health outcomes and devise solutions for these disparities., (Copyright © 2020 Elsevier Inc. All rights reserved.)

BACKGROUND: Previous studies have documented factors influencing medication nonadherence among the Medicare population, but few studies have examined medication nonadherence among the Medicare low-income subsidy (LIS) population. Furthermore, little is known about the factors associated with nonadherence among this population, especially those with prevalent chronic conditions such as type 2 diabetes, hypertension, or heart failure. OBJECTIVE: To examine factors associated with the likelihood of medication nonadherence among Medicare LIS recipients with type 2 diabetes, hypertension, or heart failure. METHODS: This was a retrospective analysis of 2012-2013 Medicare Parts A, B, and D claims (most recent available for this research) linked to the Area Health Resources Files. Beneficiaries aged 65 years or older with continuous Medicare coverage and receiving any LIS were included. Individuals were categorized into full LIS or partial LIS groups. Nonadherence was determined by the proportion of days covered less than 80% for specified oral type 2 diabetes, hypertension, and heart failure medications, as defined by the Pharmacy Quality Alliance. A multivariate logistic regression was used to determine and compare individual-level and community-level characteristics associated with nonadherence among the entire study sample, the full LIS group, and the partial LIS group. RESULTS: The study sample included 505,771 Medicare beneficiaries, with 448,509 (88.7%) receiving full LIS and 57,262 (11.3%) receiving partial LIS. The proportion of individuals nonadherent was higher among the full LIS population (33.2%) than that of the partial LIS population (30.8%). Among the entire population, younger age was associated with nonadherence (OR = 0.98; 95% CI = 0.98-0.99). Men were more likely to be nonadherent than women (OR = 1.12; 95% CI = 1.11-1.14). Compared with non-Hispanic Whites, racial/ethnic minorities had higher nonadherence. Compared with beneficiaries who were non-Hispanic White, the ORs for those who were Black, Hispanic, Asian, and other were 1.41 (95% CI = 1.38-1.43), 1.58 (95% CI = 1.55-1.61), 1.08 (95% CI = 1.05-1.11), and 1.63 (95% CI = 1.56-1.70), respectively. There were higher nonadherence rates among patients living in communities with lower socioeconomic characteristics, such as a metropolitan statistical area (MSA vs non-MSA; OR = 1.05, 95% CI = 1.04-1.07). A higher risk adjustment summary score, indicating worse health status, was associated with an increased likelihood of medication nonadherence (OR = 1.21; 95% CI = 1.20-1.22). These patterns were similar among the full and partial LIS groups. CONCLUSIONS: Individual- and community-level characteristics were associated with the likelihood of medication nonadherence among Medicare LIS recipients with type 2 diabetes, hypertension, or heart failure. These characteristics included younger age, male sex, racial/ethnic minorities, living in lower socioeconomic communities, and a higher risk adjustment summary score. This study provided insight into medication nonadherence within the Medicare LIS population and identified the need to consider these factors when developing future policies to improve medication adherence. DISCLOSURES: This study was funded by the Pharmaceutical Research & Manufacturers of America (PhRMA), which was involved in the preparation and revision of the manuscript. Dougherty is employed by PhRMA. Todor was a PQA-CVS Health Foundation Scholar who was funded to work on this study. Hines is employed by Pharmacy Quality Alliance. Wang reports grants from AbbVie, Curo, Bristol Myers Squibb, and Pfizer, during the time of this study, and fees from the PhRMA Foundation for work on its Heath Outcomes Research Advisor Committee. The other authors have nothing to disclose. This study was presented as a poster at the online 2020 PQA Annual Meeting, May 7, 2020.

Background: Risk of chronic kidney disease (CKD) is higher in normal-weight metabolically unhealthy people, especially when combined with hypertension. In this context, whether the visceral adiposity index (VAI), which reflects body fat distribution and metabolism, can be used to identify the risk of CKD among normal-weight hypertensive patients is unclear., Objectives: This study aimed to evaluate the association between VAI and renal function in normal-weight hypertensive patients., Methods: In this cross-sectional study, 8591 hypertensive patients with normal BMI from the China H-type Hypertension Registry Study were analyzed. The VAI was calculated with serum triglycerides, serum HDL cholesterol, waist circumference, and BMI. VAI was ln-transformed for analysis on account of the skewed distribution. Estimated glomerular filtration rate (eGFR) was calculated using the CKD-Epidemiology Collaboration equation. CKD was defined as an eGFR <60 mL · min-1 · 1.73 m-2. Multivariable linear and multivariable logistic regression analyses were performed to evaluate the association of VAI with eGFR and CKD., Results: The prevalence rate of CKD was 10.1%. Multivariable linear regression analyses showed that an elevated lnVAI reduced eGFR by 2.63 mL · min-1 · 1.73 m-2 (95% CI: -3.54, -1.72 mL · min-1 · 1.73 m-2). Multivariable logistic regression analysis showed that an elevated lnVAI was independently associated with the prevalence of CKD (OR: 1.59; 95% CI: 1.31, 1.93). As possible confounding factors were removed the association became greater. The higher the VAI was, the greater the decrease in eGFR and the higher the risk of CKD. No significant interactions were found in any of the subgroups (age, sex, physical activity, current smoking, current drinking, fasting glucose, LDL cholesterol, blood pressure, and antihypertensive drugs)., Conclusions: VAI, as a simple surrogate measure of visceral fat accumulation, is independently and inversely associated with renal function in normal-weight Chinese hypertensive adults.This trial was registered at chictr.org.cn as ChiCTR1800017274., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Society for Nutrition.)

We aimed to evaluate the relation of the ankle-brachial index (ABI) with the prevalence of stroke and to examine any possible effect modifiers among hypertensive patients without atrial fibrillation. A total of 10 750 subjects with hypertension aged 27-96 years were included in the current study. The outcome was a stroke. Odds ratios of stroke concerning ABI were calculated using multivariate logistic regression models. Among 10 750 hypertensive participants, 690 (6.42%) had a stroke. Multivariate logistic analyses showed that ABI was negatively correlated with the prevalence of stroke (per SD increment; adjusted OR, 0.88; 95% CI, 0.82-0.94). Compared with participants in Q 1, the odds ratios (95% CI) for those in the Q2 (1.05 to 1.10), Q3 (1.10 to 1.15), and Q4 (≥1.15) were 0.71 (0.56, 0.90), 0.87 (0.70, 1.08), and 0.81 (0.65, 1.01), respectively. However, compared with higher ABI value, lower ABI value (<1.05) would significantly increase the odds of stroke (OR: 1.26, 95% CI [1.05-1.50]), especially in the elderly over 65 years old. A generalized additive model and a smooth curve fitting showed that there existed an L-shaped association between ABI and the prevalence of stroke. Our results suggest that an L-shaped association between ABI and the prevalence of stroke was found in general hypertensive patients, with a turning point at about 1.05. Compared with higher ABI value, lower ABI value (<1.05) would significantly increase the prevalence of stroke (OR: 1.26, 95% CI [1.05-1.50]), especially in the elderly over 65 years old., (© 2020 The Authors. The Journal of Clinical Hypertension published by Wiley Periodicals LLC.)

The authors aimed to evaluate the relationship of serum albumin with peripheral arterial disease (PAD) and investigate any possible effect modifiers in hypertensive patients. In the cross-sectional study, a total of 10,900 Chinese hypertensive patients aged ≥18 years were enrolled. The outcome was PAD, defined as an ankle-brachial index (ABI) <0.90 in either leg. The overall mean (SD) serum albumin was 46.8 (4.2) g/L. There were significant inverse associations of serum albumin with PAD (per SD increment; OR: 0.83; 95% CI: 0.72, 0.94). Compared with the lowest tertile (<45.1 g/L), the multivariate-adjusted ORs (95% CI) for participants in the middle tertile (45.1-48.2 g/L) and highest tertile (≥48.2 g/L) of serum albumin were 0.89 (95% CI: 0.67, 1.16) and 0.65 (95% CI: 0.47, 0.90), respectively. Conversely, lower albumin (<48.2 g/L) concentrations were associated with increased odds of PAD (OR: 1.45; 95% CI: 1.08-1.96) compared with higher concentrations. Furthermore, the albumin-PAD association was significantly stronger in males (OR: 2.08; 95% CI: 1.31, 3.30) than in females (OR: 1.06; 95% CI: 0.70, 1.58; p interaction = .024). In conclusion, among Chinese hypertensive adults, lower serum albumin was associated with the prevalence of PAD only in males but not in females., (© 2020 Wiley Periodicals LLC.)

Background: The low-density lipoprotein cholesterol/high-density lipoprotein- cholesterol (LDL-C/HDL-C) ratio is an excellent predictor of cardiovascular disease (CVD). However, previous studies linking the LDL-C/HDL-C ratio to mortality have yielded inconsistent results and been limited by short follow-up periods. Therefore, the aim of the present study was to determine whether the LDL-C/HDL-C ratio could be an effective predictor of all-cause mortality in elderly hypertensive patients., Methods: A total of 6941 hypertensive patients aged 65 years or older who were not treated with lipid-lowering drugs were selected from the Chinese Hypertension Registry for analysis. The endpoint of the study was all-cause mortality. The relationship between the LDL-C/HDL-C ratio and all-cause mortality was determined using multivariate Cox proportional hazards regression, smoothing curve fitting (penalized spline method), subgroup analysis and Kaplan-Meier survival curve analysis., Results: During a median follow-up of 1.72 years, 157 all-cause deaths occurred. A U-shaped association was found between the LDL-C/HDL-C ratio and all-cause mortality. Patients were divided according to the quintiles of the LDL-C/HDL-C ratio. Compared to the reference group (Q3: 1.67-2.10), patients with both lower (Q1 and Q2) and higher (Q4 and Q5) LDL-C/HDL-C ratios had higher all-cause mortality (< 1.67: HR 1.81, 95% CI: 1.08-3.03; ≥2.10: HR 2.00, 95% CI: 1.18-3.39). Compared with the lower and higher LDL-C/HDL-C ratio groups, patients with LDL-C/HDL-C ratios of 1.67-2.10 had a significantly higher survival probability (log-rank P = 0.038)., Conclusions: The results suggest that there is a U-shaped association between the LDL-C/HDL-C ratio and all-cause mortality. Both lower and higher LDL-C/HDL-C ratios were associated with increased all-cause mortality in elderly hypertensive patients.

Background: Data on the relationship between nontraditional lipid profiles [total cholesterol (TC)/high-density lipoprotein cholesterol (HDL-C) ratio, triglyceride (TG)/HDL-C ratio, low-density lipoprotein cholesterol (LDL-C)/HDL-C ratio, non-high-density lipoprotein cholesterol (non-HDL-C)] and the risk of peripheral artery disease (PAD) are limited. The present study investigated the relationship of nontraditional lipid indices with PAD in hypertensive patients., Methods: This cross-sectional study was performed among 10,900 adults with hypertension. Participants were diagnosed with PAD when their ankle-brachial index (ABI) was < 0.9. The association between nontraditional lipid profiles and PAD was examined using multivariate logistic regression analysis and the restricted cubic spline., Results: All nontraditional lipid indices were independently and positively associated with PAD in a dose-response fashion. After multivariable adjustment, the per SD increments of the TC/HDL-C, TG/HDL-C, LDL-C/HDL-C ratios and non-HDL-C were all significantly associated with 37, 14, 40, and 24% higher risk for PAD, respectively. The adjusted ORs (95% CI) for PAD were 1.77 (1.31, 2.40), 1.71 (1.25, 2.34), 2.03 (1.50, 2.74), and 1.70 (1.25, 2.31) when comparing the highest tertile to the lowest tertile of the TC/HDL-C, TG/HDL-C, LDL-C/HDL-C ratios and non-HDL-C, respectively., Conclusions: Among Chinese hypertensive adults, all nontraditional lipid indices were positively associated with PAD, and the LDL-C/HDL-C and TC/HDL-C ratios were better than the other nontraditional lipid indices for predicting PAD. These findings may improve the risk stratification of cardiovascular disease and dyslipidemia management., Trial Registration: CHiCTR, ChiCTR1800017274 . Registered 20 July 2018.

Objective: Elevated systolic blood pressure (SBP) can significantly increase the bleeding risk in patients with atrial fibrillation (AF). However, it is unclear whether elevated diastolic blood pressure (DBP), in the presence of well-controlled SBP is also associated with bleeding. Therefore, we aimed to examine the specific relationship between DBP and bleeding in patients with AF treated with anticoagulants and had well-controlled SBP., Methods: We analyzed data from 542 of 929 patients with nonvalvular AF (NVAF) treated with dabigatran from the Monitor System for the Safety of Dabigatran Treatment study (MISSION-AF) who had a SBP of 120-140 mm Hg at the time of enrollment. The association between DBP and bleeding was analyzed using multivariate logistic regression and smooth curve fitting (penalized spline method). Threshold saturation effect analysis was used to show the nonlinear relationship between DBP and bleeding., Results: After 3 months of follow-up, 49 bleeding events occurred. Compared with participants with DBP <80 mm Hg, those with DBP ≥80 mm Hg had a 118% higher bleeding risk [hazard ratio (HR): 2.18; 95% confidence interval (CI): 1.19, 3.98; p<0.05]. The smooth curve showed a nonlinear relationship between DBP and bleeding risk, and the inflection point of DBP was 80 mm Hg. When DBP was ≥80 mm Hg, the bleeding risk increased by 59% (HR: 1.59; 95% CI: 1.16, 2.19; p<0.05) for every 5 mm Hg increase in DBP., Conclusion: Upon achieving an optimal SBP (120-140 mm Hg), a higher DBP might be associated with a higher bleeding risk in patients with NVAF treated with dabigatran.

Background: Data are limited on whether TyG index is an independent predictor of arterial stiffness in hypertensive patients. The purpose of this study was to assess the association between the TyG index and arterial stiffness, and examined whether there were effect modifiers, in hypertensive patients., Methods: This study included 4718 hypertensive adults, a subset of the China H-type Hypertension Registry Study. The TyG index was calculated as ln[fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. Arterial stiffness was determined by measuring brachial-ankle pulse wave velocity (baPWV)., Results: The overall mean TyG index was 8.84. Multivariate linear regression analyses showed that TyG index was independently and positively associated with baPWV (β, 1.02; 95% confidence interval [CI] 0.83, 1.20). Consistently, Multiple logistic analyses showed a positive association between TyG index risk of elevated baPWV (> 75th percentile) (odds ratio [OR], 2.12; 95% CI 1.80, 2.50). Analyses using restricted cubic spline confirmed that the associations of TyG index with baPWV and elevated baPWV were linear. Subgroup analyses showed that stronger associations between TyG index and baPWV were detected in men (all P for interaction < 0.05)., Conclusion: TyG index was independently and positively associated with baPWV and elevated baPWV among hypertensive patients, especially in men. The data suggest that TyG index may serve as a simple and effective tool for arterial stiffness risk assessment in daily clinical practice.

Small muscular pulmonary artery remodeling is a dominant feature of pulmonary arterial hypertension (PAH). PSEN1 affects angiogenesis, cancer, and Alzheimer's disease. We aimed to determine the role of PSEN1 in the pathogenesis of vascular remodeling in pulmonary hypertension (PH). Hemodynamics and vascular remodeling in the Psen1-knockin and smooth muscle–specific Psen1-knockout mice were assessed. The functional partners of PSEN1 were predicted by bioinformatics analysis and biochemical experiments. The therapeutic effect of PH was evaluated by administration of the PSEN1-specific inhibitor ELN318463. We discovered that both the mRNA and protein levels of PSEN1 were increased over time in hypoxic rats, monocrotaline rats, and Su5416/hypoxia mice. Psen1 transgenic mice were highly susceptible to PH, whereas smooth muscle–specific Psen1-knockout mice were resistant to hypoxic PH. STRING analysis showed that Notch1/2/3, β-catenin, Cadherin-1, DNER (delta/notch-like epidermal growth factor-related receptor), TMP10, and ERBB4 appeared to be highly correlated with PSEN1. Immunoprecipitation confirmed that PSEN1 interacts with β-catenin and DNER, and these interactions were suppressed by the catalytic PSEN1 mutations D257A, D385A, and C410Y. PSEN1 was found to mediate the nuclear translocation of the Notch1 intracellular domains and activated RBP-Jκ. Octaarginine-coated liposome-mediated pharmacological inhibition of PSEN1 significantly prevented and reversed the pathological process in hypoxic and monocrotaline-induced PH. PSEN1 essentially drives the pathogenesis of PAH and interacted with the noncanonical Notch ligand DNER. PSEN1 can be used as a promising molecular target for treating PAH. PSEN1 inhibitor ELN318463 can prevent and reverse the progression of PH and can be developed as a potential anti-PAH drug. [ABSTRACT FROM AUTHOR]

Background: Several recent studies have shown the relationship between the triglyceride glucose (TyG) index and the risk of stroke in the general population and in a few patient cohorts; however, the role of the TyG index on stroke risk in elderly hypertensive patients has not been determined. Thus, we aimed to investigate the association of the TyG index with first stroke and first ischemic stroke in elderly individuals with hypertension. Methods: We included 8487 elderly subjects with hypertension from the China H-type Hypertension Registry Study for the current analysis. The TyG index was calculated as ln (fasting triglyceride [mg/dL] × fasting glucose [mg/dL]/2). Outcomes were the first stroke and first ischemic stroke. Results: During a median follow-up of 1.72 years, the first stroke was diagnosed in 82 patients (0.97%), and the first ischemic stroke was diagnosed in 48 patients (0.57%). Multivariable Cox proportional hazards models revealed that the TyG index was positively associated with the risk of first stroke (per 1-unit increment; HR: 1.72; 95% CI: 1.07, 2.76) and first ischemic stroke (HR: 2.31; 95% CI: 1.32, 4.05). When the TyG index was assessed as quartiles, significantly higher risks of first stroke (HR: 1.90; 95% CI: 1.04, 3.45) and first ischemic stroke (HR: 2.45; 95% CI: 1.16, 5.20) were found in participants in quartile 4 compared with those in quartiles 1– 3. Conclusion: The TyG index is potentially useful in the early identification of elderly hypertensive patients at high risk of experiencing a first stroke. [ABSTRACT FROM AUTHOR]

Background. The association between triglyceride-rich lipoprotein cholesterol (TRL-C) and diabetes mellitus (DM) remains unclear because of limited research and data. The aim of this study was to explore the independent association between TRL-C and DM in hypertensive patients and to examine whether a healthy lifestyle would have an impact on this relationship. Methods. In this study, data from 13,721 hypertensive patients who were not treated with lipid-lowering drugs were analyzed. TRL-C was calculated from total cholesterol (TC) minus [LDL cholesterol + HDL cholesterol]. DM was defined as fasting plasma glucose of ≥7.0 mmol/L and/or self-reported history of hypoglycemic drug use. Results. After adjusting for potential confounding factors, the TRL-C was significantly positively associated with elevated DM (odds ratio (OR): 1.73 and 95% confidence interval (CI): 1.54–1.94). In subgroup analysis, a healthy lifestyle (HL) failed to modify the positive association between TRL-C and DM (HL: OR 1.93, 95%CI 1.58–2.36; non-HL: OR 1.72, 95%CI 1.50–1.98; P for interaction = 0.38). Conclusion. The results showed a positive association between TRL-C and DM in hypertensive patients. A healthy lifestyle failed to diminish the relationship between TRL-C and DM. The novel findings indicate that TRL-C might be a reliable marker of DM and may provide a new strategy for the prevention and treatment of DM. [ABSTRACT FROM AUTHOR]

Background. Evidence regarding the nonlinear relationship between serum uric acid (SUA) and blood lipids in Chinese population with hypertension is limited. Therefore, the present study aimed to investigate whether there is a nonlinear association between SUA and lipids in Chinese hypertensive population with an estimated glomerular filtration rate (eGFR) ≥30 ml/min/1.73 m2. Methods. A total of 13,355 hypertensive participants with eGFR ≥30 ml/min/1.73 m2 were selected from the Chinese Hypertension Registry Study. Multivariate linear regression was used to examine the linear relationship between SUA and lipids. Smooth curve fitting (penalized spline method) and threshold saturation effects were used to analyze the nonlinear association between SUA and lipids. Results. In the fully adjusted model, the results showed a positive correlation between SUA and TG (β = 0.15; 95% CI: 0.14, 0.16) and LDL-C (β = 0.06; 95% CI: 0.05, 0.07), respectively. However, the relationship between SUA and HDL-C was nonlinear. The inflection point of SUA was 7.24 mg/dL. On the left side of the inflection point (<7.24 mg/dL), SUA was negatively associated with HDL-C (β = −0.02; 95% CI −0.02, −0.01). On the right side of the inflection point (≥7.24 mg/dL), SUA was not related to HDL-C (β = 0.01; 95% CI −0.01, 0.02). Conclusion. After adjusting for all covariates, SUA was positively associated with TG and LDL-C. The relationship between SUA and HDL-C was nonlinear. The negative correlation between SUA and HDL-C only existed when the SUA was less than 7.24 mg/dL in a hypertensive population with eGFR ≥30 ml/min/1.73 m2. [ABSTRACT FROM AUTHOR]