Search

The prevalence of uncontrolled hypertension is high and increasing in low-income and middle-income countries. We tested the effectiveness of a multifaceted intervention for blood pressure control in rural China led by village doctors (community health workers on the front line of primary health care).In this open, cluster randomised trial (China Rural Hypertension Control Project), 326 villages that had a regular village doctor and participated in the China New Rural Cooperative Medical Scheme were randomly assigned (1:1) to either village doctor-led multifaceted intervention or enhanced usual care (control), with stratification by provinces, counties, and townships. We recruited individuals aged 40 years or older with an untreated blood pressure of 140/90 mm Hg or higher (≥130/80 mm Hg among those with a history of cardiovascular disease, diabetes, or chronic kidney disease) or a treated blood pressure of 130/80 mm Hg or higher. In the intervention group, trained village doctors initiated and titrated antihypertensive medications according to a standard protocol with supervision from primary care physicians. Village doctors also conducted health coaching on home blood pressure monitoring, lifestyle changes, and medication adherence. The primary outcome (reported here) was the proportion of patients with a blood pressure of less than 130/80 mm Hg at 18 months. The analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, NCT03527719, and is ongoing.Between May 8 and November 28, 2018, we enrolled 33 995 individuals from 163 intervention and 163 control villages. At 18 months, 8865 (57·0%) of 15 414 patients in the intervention group and 2895 (19·9%) of 14 500 patients in the control group had a blood pressure of less than 130/80 mm Hg, with a group difference of 37·0% (95% CI 34·9 to 39·1%; p0·0001). Mean systolic blood pressure decreased by -26·3 mm Hg (95% CI -27·1 to -25·4) from baseline to 18 months in the intervention group and by -11·8 mm Hg (-12·6 to -11·0) in the control group, with a group difference of -14·5 mm Hg (95% CI -15·7 to -13·3 mm Hg; p0·0001). Mean diastolic blood pressure decreased by -14·6 mm Hg (-15·1 to -14·2) from baseline to 18 months in the intervention group and by -7·5 mm Hg (-7·9 to -7·2) in the control group, with a group difference of -7·1 mm Hg (-7·7 to -6·5 mm Hg; p0·0001). No treatment-related serious adverse events were reported in either group.Compared with enhanced usual care, village doctor-led intervention resulted in statistically significant improvements in blood pressure control among rural residents in China. This feasible, effective, and sustainable implementation strategy could be scaled up in rural China and other low-income and middle-income countries for hypertension control.Ministry of Science and Technology of China.

This paper proposes and validates a completely adaptive transfer function (CATF) based on an autoregressive exogenous (ARX) model which adjusts the gain and phase of a generalized transfer function (GTF) simultaneously to estimate the aortic pressure waveform from a brachial pressure waveform.Invasive aortic and brachial pressure waveforms were recorded from 34 subjects for the validation of the proposed method. Individual transfer functions (ITFs) were trained based on the pressure waveforms using an ARX model. The GTF was derived by averaging the ITFs. CATF was then obtained by adjusting both the gain and phase of the GTF using regression formulas calculated from the ITFs and brachial hemodynamic parameters. Meanwhile the quantitative contributions of the adaption of gain and phase of the GTF were investigated respectively. The root-mean-square-error of the total waveform and absolute errors of common hemodynamic indices including systolic and diastolic blood pressures (SBP and DBP, respectively), pulse pressure (PP) and augmentation index were used to evaluate the performance of the proposed method in the data divided into low, middle and high PP amplification groups.The CATF achieved lower errors for DBP and PP in the low PP amplification group (1.79 versus 2.10 mmHg and 5.08 versus 6.23 mmHg, respectively, both P 0.05) and PP in the middle amplification group (1.43 versus 1.92 mmHg, P 0.05) compared with the GTF.The proposed method provides a step towards the development of an improved and clinically useful non-invasive approach for estimating the aortic pressure waveform from a peripheral pressure waveform.

Background Recently, the novel Peguero-Lo Presti electrocardiographic criteria to diagnose left ventricular hypertrophy (LVH) were developed from Caucasian American population with a relatively high sensitivity. However, further validation on a large Asian population has never been conducted. Thus, this study was to test and validate the overall performance of this index in a general population from China. Methods A total of 10,614 permanent residents ≥35 years of age were included in this study. All participants completed 12-lead electrocardiography and echocardiography at the same visit. A receiver-operating characteristic curve was used for comparing the performance of electrocardiographic indices in diagnosing echocardiographic LVH. Results The Peguero-Lo Presti criteria had higher sensitivity but lower specificity than Cornell and Sokolow-Lyon voltage according to the recommended criteria. The area under the curve of this novel Peguero-Lo Presti voltage was lower than that of Cornell for predicting LVH defined by both left ventricular mass/body surface area (0.665 vs 0.699 in males; 0.689 vs 0.721 in females) and left ventricular mass/height2.7 (0.623 vs 0.681 in males; 0.642 vs 0.709 in females) (all Ps Conclusions The novel Peguero-Lo Presti voltage may not be a better screening tool for LVH in Asian population. In comparison with this new index, Cornell voltage could be a better screening test for LVH by changing its cutoff values to obtain maximum sensitivity.

Previous evidences suggested that atorvastatin not only reduced blood lipids but also reduced myocardial hypertrophy and remodeling. And it was reported that C/EBPβ (CCAAT/enhancer-binding protein β) played a pivotal role both in the physiologic and pathological cardiac hypertrophy. However, it has not been reported before whether this signaling pathway of C/EBPβ participates in protective effect of atorvastatin for hypertrophy cardiomyocytes. In present study, We found that overexpression of C/EBPβ significantly abrogated the effect of atorvastatin on increasing Bcl-2/Bax and PGC-1α while the early and late apoptosis rate increased and mitochondrial membrane potential (MMP) was reduced. In conclusion, we further identified the protective effect of atorvastatin on hypertrophic cardiomyocytes induced by Angiotensin II by rescuing the MMP and inhibiting apoptosis, which might be at least partly attributed to down-regulation of C/EBPβ. And C/EBPβ might be a new target to rescue mitochondrion function and apoptosis in pathological cardiac hypertrophy.

To evaluate the prevalence of early repolarization pattern (ERP) in the general rural Chinese population and identify the contributing risk factors.A cross-sectional study of 11,956 permanent residents of Liaoning Province ≥35y of age was conducted between January and August 2013 (response rate 85.3%). ERP was diagnosed if there was J-point elevation of ≥0.1mV in ≥2 leads in the inferior (II, III, aVF) or lateral (I, aVL, VThe overall prevalence of ERP was 1.3%, and it was higher in men than women (2.6 vs. 0.2%, P0.001), decreasing with increasing age. Percent of ERP positive in lateral leads, inferior, and both was 73.0%, 15.3%, and 11.7%, respectively. Stepwise logistic regression demonstrated that independent clinical factors for ERP included age (odds ratio [OR] 0.68; P0.001), male sex (OR 17.09; P0.001), systolic blood pressure (SBP) (OR 0.77; P=0.022), stroke (OR 0.14; P=0.055), RR interval (OR 1.27; P=0.001), QTc interval (OR 0.76; P=0.008), QRS duration (OR 0.67; P=0.001), Cornell voltage (OR 0.28; P0.001), and Sokolow-Lyon voltage (OR 2.03; P0.001).Although the prevalence of ERP in general rural Chinese population is low, younger age, male sex, lower SBP, non-stroke history, longer RR interval, shorter QTc interval, shorter QRS duration, lower Cornell voltage, and higher Sokolow-Lyon voltage are independent risk factors.

OBJECTIVE: To ascertain whether sleep abnormalities including daytime sleepiness, snoring, apnea, sleep disruption and sleep duration abnormity are significantly associated with hyperhomocysteinemia (Hhcy). METHODS: A total of 5992 participants were involved in the cross-sectional study. Sleep abnormalities were evaluated by a structured questionnaire. Hhcy was defined as plasma levels of homocysteine ≥15μm/L. RESULTS: After adjustment for age, gender, education, current smoking status and current drinking status, daytime sleepiness (OR, 1.597; 95%CI, 1.210-2.110, P=0.001), sleep duration 8h (OR, 1.205; 95%CI, 1.065-1.364, P=0.003) were significantly associated with Hhcy. While snoring (OR, 1.065; 95%CI, 0.950-1.195, P=0.279), apnea (OR, 1.170; 95%CI, 0.924-1.482, P=0.193), and sleep disruption (OR, 1.065; 95%CI, 0.852-1.331, P=0.580) were not. After further adjustment for body mass index, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglyceride, total cholesterol, physical activity, diabetes, coronary heart disease, stroke, depression, glomerular filtration rate, hypertension and hyperuricemia, still the increased OR could be found in the daytime sleepiness group (OR, 1.569; 95%CI, 1.145-2.150, P=0.005). However, sleep duration 8h groups (OR, 1.080; 95%CI, 0.883-1.320, P=0.453) were no longer significantly associated with Hhcy. CONCLUSIONS: Daytime sleepiness, but not sleep duration abnormity, snoring, apnea and sleep disruption was an independent risk factor for Hhcy.Copyright © 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved. Language: en

Summary Introduction The metabolically healthy obese (MHO) refers to obese individuals with a favorable metabolic profile. It is unknown whether metabolically healthy status in persons with obesity or overweight decreases the risk of hyperuricemia. This study aims to explore the association of MHO with risk of hyperuricemia. Methods We performed a cross-sectional study including 11,435 (5300 men and 6135 women) general population aged ≥35 years in Liaoning Province. Anthropometric measurements, laboratory examinations and self-reported information on lifestyle factors were collected by trained personnel. Metabolically healthy overweight/obesity was defined according to body mass index and ATP-III criterion of metabolically healthy status. Hyperuricemia was defined as SUA ≥7mg/dl (420mmol/L) in men or ≥6mg/dl (360mmol/L) in women. Logistic regression analyses were performed to explore the association between overweight/obesity with different metabolic status and risk of hyperuricemia. Results Among total subjects, 470 (4.2%) were metabolically healthy obese (MHO) and 1567 (14.0%) were metabolically unhealthy obese (MUO). For metabolically healthy female participants, the prevalence of hyperuricemia with overweight was similar to with a normal BMI (2.5% vs. 3.1%, P =0.314). Multivariate logistic regression analyses showed that MHO (OR=2.48, 95% CI: 1.81–3.41) and MUO (OR=4.81, 95% CI: 3.97–5.83) were significantly associated with hyperuricemia. However, the odds ratio in females with metabolically healthy overweight was 0.85 (95% CI: 0.53–1.37). Conclusions Metabolically healthy might decline the risk of hyperuricemia, but overweight and obesity with metabolically healthy had also strong associations with hyperuricemia, except in females with metabolically healthy overweight.

To evaluate the prevalence of atrial fibrillation (AF) in physical laborers in rural China and identify contributing risk factors.A cross-sectional study of 11,956 permanent residents of Liaoning Province in rural China≥35y of age (primarily physical laborers) was conducted between January and August 2013 (response rate 85.3%). All participants completed a questionnaire and underwent a physical exam, echocardiography and electrocardiography. Blood samples were drawn for laboratory analyses, and AF was diagnosed on the basis of history and electrocardiograph findings. Risk factors for AF were evaluated with a stepwise logistic regression analysis.The prevalence of AF was 1.2% overall, but rose steeply with age (0.1% in those 35-44y of age, and 4.6% in those≥75y); there was no significant gender difference at any age. Independent risk factors for AF were age (odds ratio [OR] 1.89; P0.001), diabetes (OR 2.07; P=0.001), history of myocardial infarction (OR 5.91; P0.001), low left ventricular ejection fraction (OR 1.85; P=0.005), and low physical activity (OR 1.72; P=0.003), whereas obesity, hypertension, cholesterol and triglyceride levels, current smoking and drinking, left ventricular hypertrophy, and family history of AF were not significant contributors.Although the prevalence of AF in physical labors in rural China is low, age, diabetes, history of myocardial infarction, low left ventricular ejection fraction, and low physical activity are independent risk factors.

a Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China b Department of Clinical Epidemiology, Library, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China c Department of Prevention of Chronic Non-communicable Diseases, Center for Disease Prevention and Control of Liaoning Province, Shenyang, Liaoning, People's Republic of China d Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu, People's Republic of China

Objective Obesity increases the risk of hypertension and other chronic diseases, which are little known in rural China. This study aimed to investigate the epidemiologic features and the association with hypertension of obesity in rural Chinese women. Methods A cross-sectional survey was conducted during 2004 through 2006, which used a multistage cluster sampling method to select a representative sample in Liaoning Province, China. In total 23 178 rural participants at least 35 y of age were examined (the percentage of subjects >64 y old was 14.5%). Data on demographic variables (age, sex, and race), smoking status, use of alcohol, physical activity, and education level were obtained by interview. Overweight and obesity were defined according to the World Health Organization classification. Hypertension was defined according to the criteria established by the Seventh Report of the Joint National Committee, and untreated hypertensive subjects were further classified into three subtypes: isolated systolic hypertension, isolated diastolic hypertension, and systolic and diastolic hypertension. Multivariable models and performed Poisson logistic regression analysis were used to determine associations among body mass index (BMI), waist circumference, and variables. Results Overall, the prevalences of overweight and obesity were 24.4% and 2.7%, respectively, as defined by BMI, whereas the prevalences were 48.6% and 4.9% as defined by waist circumference. Poisson regression revealed that high levels of physical activity (defined by BMI, moderate: prevalence ratio [PR] 0.976, 95% confidence interval [CI] 0.965–0.988, high: PR 0.985, 95% CI 0.971–0.999; defined by waist circumference, moderate: PR 0.955, 95% CI 0.944–0.965, high: PR 0.973, 95% CI 0.960–0.985) and current smoking status (defined by BMI, PR 0.950, 95% CI 0.938–0.962; defined by waist circumference, PR 0.966, 95% CI 0.954–0.978) were protective factors and ethnicity was a risk factor (defined by BMI, Mongolian nationality: PR 1.042, 95% CI 1.030–1.054; defined by waist circumference, PR 1.043, 95% CI 1.033–1.054) for overweight or obese participants. There were other risk factors for overweight or obese participants such as high levels of education defined by BMI (PR 1.033, 95% CI 1.010–1.058) and diet score defined by waist circumference (PR 1.004, 95% CI 1.000–1.008). After adjustment, BMI and waist circumference were associated with the greatest likelihood of systolic and diastolic hypertension (for BMI ≥30 kg/m 2 , PR 2.455, 95% CI 1.786–3.374; for waist circumference ≥88 cm, PR 1.517, 95% CI 1.133–2.031). BMI was more related to isolated diastolic hypertension than to isolated systolic hypertension, whereas waist circumference was more related to isolated systolic hypertension than to isolated diastolic hypertension. Conclusion Although the prevalence of overweight and obesity as defined by BMI was low, it was relatively high as defined by waist circumference in rural Chinese women. High levels of physical activity and current smoking status had negative relations to overweight or obesity, whereas ethnicity, high levels of education, and diet score showed positive relations. Obese women defined by BMI or waist circumference had an increased risk of hypertension.

Obesity is often accompanied by metabolic abnormalities, and both of them are risk factors for cardiovascular diseases. However, a subgroup of obesity which is not accompanied by metabolic abnormalities, also known as metabolically health obesity (MHO), appears to be a lower risk for cardiovascular

Increased plasma total homocysteine (tHcy) is a known cardiovascular disease (CVD) risk factor. Observational studies have supported the role of lifestyle factors such as physical activity, diet and alcohol consumption in CVD prevention. The prevalence of hyperhomocysteinemia (Hhcy) and the