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Objective: Different forms of full coverage policy of essential medicines (FCPEMs) have been adopted worldwide to lower medication expenditure and improve adherence. This study aims to analyse the effect of FCPEMs on patients' medication adherence in Taizhou city, China., Methods: This study was a quasi-experimental study and set treatment and control groups. We extracted Electronic Health Records (EHRs) for hypertension and diabetes 1 year before and after FCPEMs implementation and their medication adherence level assessed by physicians. We applied the propensity score matching (PSM) method to balance the bias between the two groups. Then, the descriptive analysis was used to compare the differences in the reported medication adherence. Using the Difference-In-Differences (DIDs) method, the fixed-effect model with the logistic regression was built to analyse the effects of FCPEMs., Results: 225,081 eligible patients were identified from the original database. In the baseline year, FCPEM covered 39,251 patients. After PSM, 6,587 patients in the treatment group and 10,672 patients in the control group remained. We found that the proportion of patients with high adherence in the treatment group increased by 9.1% (60.8 to 69.9%, P < 0.001) and that in the control group increased by 2.6% (62.5 to 65.2%, P < 0.001). The regression results showed that FCPEMs significantly increased patients' medication adherence (OR = 2.546, P < 0.001)., Conclusion: FCPEMs significantly improved medication adherence. Socially disadvantaged individuals might benefit more from continuing FCPEM efforts. Expanding the coverage of FCPEMs to other medicines commonly used in patients with chronic diseases may be a promising strategy to manage chronic diseases and promote patient outcomes., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer DZ declared a shared affiliation with the authors to the handling editor at the time of the review., (Copyright © 2022 Guo, He, Li, Zheng, Shi and Guan.)

Full coverage policies for medicines have been implemented worldwide to alleviate medicine cost burden and promote access to medicines. However, few studies have explored the factors associated with free medicine use in patients with chronic diseases. This study aimed to analyze the utilization of free medicines by patients with hypertension and diabetes after the implementation of the full coverage policy for essential medicines (FCPEM) in Taizhou, China, and to explore the factors associated with free medicine use. We conducted a descriptive analysis of characteristics of patients with and without free medicine use and performed a panel logit model to examine factors associated with free medicine use, based on an electronic health record database in Taizhou from the baseline year (12 months in priori) to three years after FCPEM implementation. After FCPEM implementation, the proportion of patients without any free medicine use decreased from 31.1% in the baseline year to 28.9% in the third year, while that of patients taking free medicines rose from 11.0% to 22.8%. Patients with lower income or education level, those with agricultural hukou , patients aged 65 and above, married patients, and patients in the Huangyan district were more likely to take free medicines. In conclusion, FCPEM contributed to improved medicine access, especially in vulnerable populations. Local policy makers should consider expanding the coverage of FCPEM to other types of medicines and cultivate the potential of social supports for patients to enhance the effectiveness of FCPEM policies.

Insulin resistance (IR) plays an important role in the development of hypertension. Triglyceride and glucose index (TyG index), and triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-c) as effective IR surrogate indexes have been verified in numerous studies. Therefore, the authors conducted a large cross-sectional study to explore the association of TyG index and TG/HDL-c with prehypertension and hypertension in the same normoglycemic subjects from Tianjin, China. A total of 32 124 adults were eligible for this study. According to the level of blood pressure, the enrolled individuals were divided into three groups, which were normotension, prehypertension, and hypertension. In multiple logistic regression analysis, there was associated with prehypertension and hypertension when comparing the highest TyG index to the lowest TyG index and corresponding ORs were 1.795 (1.638, 1.968) and 2.439 (2.205, 2.698), respectively. For TG/HDL-c, the corresponding ORs were 1.514 (1.382, 1.658) and 1.934 (1.751, 2.137), respectively. Furthermore, when comparing the fourth quartile to the first quartile of TyG index and TG/HDL-c, respectively, both corresponding ORs of hypertension were higher than prehypertension. Elevated TyG index and TG/HDL-c levels were associated with prehypertension and hypertension in normoglycemic individuals. Moreover, the TyG index was more significant than TG/HDL-c in distinguishing hypertension. They have the potential to become cost-effective monitors in the hierarchical management of prehypertension and hypertension., (© 2021 The Authors. The Journal of Clinical Hypertension published by Wiley Periodicals LLC.)

Background: To analyze the risk factors for hypertension in different age groups of urban and rural residents in Tianjin., Methods: A total of 33,997 people (35-75 years old) from 13 community health service centers and primary hospitals in Tianjin participated in this study. They were divided into the youth group (≤ 40 years old), middle-aged group (41-65 years old), and elderly group (> 65 years old). Then, a questionnaire survey was administered, followed by physical and blood biochemical examinations. The demographic characteristics and prevalence were recorded and counted. Subsequently, risk factors were analyzed using univariate and stepwise multivariate logistic regression analysis., Results: In the youth, middle-aged, and elderly groups, the prevalence rate of hypertension was 18.65, 51.80, and 76.61%, respectively. Logistic regression analysis showed that obesity(OR: 3.263, 95% CI: 1.039-1.656), men (OR: 2.117, 95% CI: 1.691-2.651), diabetes (OR: 1.978, 95% CI: 1.398-2.799), high triglycerides(OR 1.968 95% CI: 1.590-2.434) and family history of stroke (OR: 1.936, 95% CI: 1.287-2.911) are the five factors in youth. In middle-aged group, the significantly associating factors were obesity (OR: 2.478, 95% CI: 2.330-2.636), diabetes (OR: 2.173, 95% CI: 1.398-2.799), family history of stroke (OR: 1.808, 95% CI: 1.619-2.020), maleness (OR: 1.507, 95% CI: 1.412-1.609),Hypertriglyceridemia (OR 1.490 95% CI: 1.409-1.577),family history of cardiovascular disease (OR: 1.484, 95% CI: 1.307-1.684),Hypercholesterolemia (OR 1.228 95% CI: 1.160-1.299). In the elderly group, obesity (OR: 2.104, 95% CI: 1.830-2.418), family history of strokes (OR: 1.688, 95% CI: 1.243-2.292), diabetes mellitus (OR: 1.544, 95% CI: 1.345-1.773), family history of cardiovascular disease (OR: 1.470, 95% CI: 1.061-2.036), hypertriglyceridemia (OR: 1.348, 95% CI: 1.192-1.524) increased the risk for hypertension. Waist circumference (WC) and waist-to-height ratio (WHtR) increased with age, and the value of these two measures for predicting hypertension was better than BMI in middle-aged group., Conclusion: Obesity is the most important risk factor for hypertension in all age groups. Diabetes, family history of strokes and high triglyceride were also significant risk factors for all age groups. There was a gender difference between the young and middle-aged groups, with men more likely to hypertension. Waist circumference (WC) and waist-to-height ratio (WHtR) were better predictors of hypertension than BMI in middle-aged group.

Introduction: This study aims to examine the medication prescriptions for hypertension in Tianjin., Methods: Patients with hypertension in Tianjin were enrolled in this study. The patients' ages ranged from 35 to 75 years. A questionnaire survey and physical examination were completed to collect clinical data. Thereafter, a statistical analysis of the medication prescriptions was conducted with different age groups and different grades of hypertension., Results: The results show that, in the total population, and for the young, middle-aged, and older groups, the proportions of single-drug use were 62.97%, 59.26%, 62.76%, and 63.49%, respectively, and the highest rate was for calcium channel blocker (CCB) use. The rates of the two drug classes were 24.51%, 29.63%, 25.13%, and 23.15%, respectively. The drug use rate of CCBs combined with angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor antagonists (ARBs) was the highest. The rates of the three drug classes were 4.08%, 4.94%, 4.36%, and 3.52%, respectively, and the highest was ACEI/ARB and CCB combined with diuretics. The rates of the four drug classes were low. Regarding the hypertension grade, in grade 1, grade 2, and grade 3, the rates of single-drug use were 63.53%, 62.69%, and 58.38%, respectively. The rates of the two drug classes were 24.62%, 23.97%, and 25.05%, while the rates of the three drug classes were 3.86%, 4.39%, and 5.34%, respectively., Conclusion: The rate of single-drug use was high, and the rate of combined drug use in the youth group was slightly higher than in the middle-aged and older age groups. The combination of two drugs was common. In grades 2 and 3 hypertension, the rate of combined drug use remained low.

To describe the prevalence of self-reported coronary heart disease (CHD) and assess the influence of varied risk factors on it in Tianjin. Methods: This study included a total of 102,576 individuals aged 35 to 75 from 13 community health centers and grassroots hospitals in Tianjin. Basic information, questionnaire responses, physical examinations, and laboratory tests of each participant were researched, and documented. Participants were categorized into CHD group and non-CHD group. Multivariate logistic regression was utilized to evaluated the relationships between associated factors and CHD. Results: The prevalence of self-reported CHD was 2.56%, 3.97% among men and 1.69% among women. In multivariate logistic regression analysis, older age (41– 65 years: OR: 7.37, 95% CI: 4.56– 11.94; > 65 years: OR:17.88, 95% CI: 11.02– 29.01), female sex (OR: 0.40, 95% CI: 0.36– 0.44), education (sedentary level: OR: 0.88, 95% CI: 0.79– 0.97; high level: OR: 0.74, 95% CI: 0.63– 0.87), family annual income (10,000– 50,000 yuan: OR: 0.68, 95% CI: 0.60– 0.77; > 50,000 yuan: OR: 0.71, 95% CI: 0.62– 0.82), recently drinking habits (2– 4 times /month: OR: 0.75, 95% CI: 0.63– 0.90; 2– 3 times/week: OR: 0.69, 95% CI: 0.56– 0.86; > 4 times/week: OR: 0.72, 95% CI: 0.63– 0.83), obesity (OR: 1.17, 95% CI: 1.07– 1.28), central obesity (OR: 1.51, 95% CI: 1.33– 1.71), hypertension (OR: 1.60, 95% CI: 1.43– 1.80), dyslipidemia (OR: 0.90, 95% CI: 0.83– 0.98), diabetes mellitus (OR: 2.02, 95% CI: 1.85– 2.19), stroke (OR: 1.42, 95% CI: 1.24– 1.63), family history (CVD: OR: 4.48, 95% CI: 4.00– 5.01; stroke: OR: 1.83, 95% CI: 1.58– 2.12) were associated with CHD (P < 0.05). Conclusion: These findings highlight growing concerns regarding the escalating rates of CHD. Implementing multifaceted, population-based interventions is crucial to mitigate the burden of cardiovascular conditions. Clinical Trial Registry Number: The study received approval from the Ethics Committee of Tianjin Chest Hospital (approval number: 2018KY-003-01). Written informed consent was obtained from all survey participants. [ABSTRACT FROM AUTHOR]

The full coverage policy for essential medicines (FCPEMs) was proposed and implemented in Taizhou city of Zhejiang Province, China, to promote equal access and adherence to medicines. This study aimed to examine the effects of FCPEMs on the income-related inequality in medication adherence among local patients with hypertension or diabetes. We collected electronic health records of patients with hypertension or diabetes of three districts of Taizhou from 2011 to 2016. As the implementation schedule of the FCPEMs varied across districts, we applied a retrospective longitudinal study design and assigned records from 1 year before to 3 years following the implementation of FCPEMs as baseline and follow-up data. We thus generated a dataset with 4-year longitudinal data. The concentration index (CI) and its decomposition method were employed to measure factors contributing to inequality in medication adherence and the role played by FCPEMs. The sample size rose from 264,836 at the baseline to 315,677, 340,512, and 355,676 by each follow-up year, and the proportion of patients taking free medicines rose from 17.6 to 25.0 and 29.8% after FCPEMs implementation. The proportion of patients with high adherence increased from 39.9% at baseline to 51.6, 57.2, and 60.5%, while CI decreased from 0.073 to −0.011, −0.029, and −0.035. The contribution of FCPEMs ranked at 2nd/13, 7th/13, and 2nd/13 after the implementation of FCPEMs. Changes in CI of medication adherence for every 2 years were −0.084, −0.018, and −0.006, and the contribution of FCPEMs was −0.006, 0.006, and 0.007, ranking at 2nd/13, 2nd/13, and 1st/13, respectively. Most changes in CI of medication adherence can be attributed to FCPEMs. The medication adherence of patients with hypertension or diabetes improved after the implementation FCPEMs in Taizhou, although inequality did not improve consistently. In general, FCPEMs could be a protective factor against income-related inequalities in access and adherence to medicines. Future research is needed to investigate the change mechanism and the optimal design of similar interventions. [ABSTRACT FROM AUTHOR]

Background: Plasma aldosterone escape is found during long-term angiotensin-converting enzyme inhibitor therapy. Evidence for aldosterone production in cardiovascular tissues raised the question of whether or not aldosterone escape occurs in these tissues. Method: Spontaneously hypertensive rats were treated with enalapril (20 mg/kg/day) and losartan (50 mg/kg/day) for 20 weeks; untreated spontaneously hypertensive and Wistar rats were used as positive and normal controls, respectively. Ex vivo mesenteric artery and heart perfusion, high-performance liquid chromatography, and radioimmunoassay for aldosterone were performed. Results: The results showed that enalapril failed to significantly inhibit aldosterone production in mesenteric artery, myocardium and plasma. Losartan significantly inhibited aldosterone production to that of Wistar rats in the mesenteric artery, myocardium and plasma. Conclusion: This study provides the first evidence that long-term angiotensin-converting enzyme inhibition therapy induces aldosterone escape in hypertensive cardiovascular tissues, and angiotensin II subtype 1 receptor antagonist does not induce aldosterone escape in mesenteric artery, myocardium and plasma of spontaneously hypertensive rats.Copyright © 2002 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

This study is to confirm the role of glycyrrhizin on blood pressure and to test the effects of glycyrrhizin on production of vascular aldosterone and corticosterone in rats. Male Wistar rats received glycyrrhizin (Sigma) 200 mg/kg/day p.o. for 5 weeks, and blood pressure was monitored by a pressure transducer. Systolic blood pressure significantly increased in Wistar rats treated with glycyrrhizin compared to that without glycyrrhizin. Mesenteric artery perfusion ex vivo and pressor responses to norepinephrine were performed. The pressor responses to norepinephrine in mesenteric arteries treated with glycyrrhizin were significantly increased. The perfusate from the mesenteric arteries was collected and applied to a Sep-Pak C 18 cartridge column, used for reverse-phase high-performance liquid chromatography, and measured for both aldosterone and corticosterone by radioimmunoassay. Levels of aldosterone were decreased but those of corticosterone increased in perfusate from arteries treated with glycyrrhizin. RT-PCR showed that glycyrrhizin inhibited the expression of 11β- HSD2 and CYP11B2 mRNA in mesenteric arteries. These results confirm that glycyrrhizin is able to induce hypertension, and provide evidence that it inhibits the transcriptions of both 11β-HSD2 and CYP11B2 in the vasculature, leading to lower aldosterone and higher corticosterone production in vessels, and increased vasoconstrictor responses to norepinephrine. [ABSTRACT FROM AUTHOR]

Aldosterone is synthesized in extra-adrenal tissues such as blood vessels and brain. Damage to blood vessels could play a crucial role in perpetuating hypertension. In this study, we determined both aldosterone production and aldosterone synthase gene-CYP11B2 mRNA expression in vessels of spontaneously hypertensive rats (SHR). The results showed that aldosterone was overproduced in the vasculature of SHR, by means of ex vivo mesenteric artery perfusion, HPLC, and RIA, and that CYP11B2 mRNA expression was upregulated in aortas of SHR, confirmed by RT-PCR and Southern blot. [ABSTRACT FROM AUTHOR]