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Twenty‐four‐hour urine collection is the gold standard method for the evaluation of salt intake, but it is often impractical in large‐scale investigations, especially in resource‐poor areas. Methods for the estimation of 24‐hour urinary sodium excretion (USE) using a spot urine sample have been established, but have not been validated in Chinese Tibetans. Therefore, the authors aimed to evaluate the Kawasaki, Tanaka, and the International Cooperative Study on Salt, Other Factors, and Blood Pressure (INTERSALT) formulas for the prediction of 24‐hour USE in Chinese Tibetan adults. The authors analyzed the bias, correlation, agreements between estimated values and measured values, and the relative and absolute differences and misclassification at the individual level for the three methods in 323 Tibetan participants from the Ganzi Tibetan Autonomous Prefecture of Sichuan Province, China. The mean biases between the measured values and the estimated 24‐hour USE using the Kawasaki, Tanaka, and INTERSALT methods were 5.4 mmol/day (95% confidence interval [CI]: 0.8–10.1 mmol/day), −40.8 mmol/day (95% CI: −44.6 to −36.9 mmol/day), and −57.1 mmol/day (95% CI: −61.9 to −52.4 mmol/day), respectively. The Pearson correlation coefficients for the relationships between the measured values and the estimated 24‐hour USE were 0.43 (Kawasaki), 0.38 (Tanaka), and 0.27 (INTERSALT), respectively (all p

Gou, Qiling, Rufeng Shi, Xin Zhang, Qingtao Meng, Xinran Li, Xi Rong, Zhabu Gawa, Nage Zhuoma, and Xiaoping Chen. The prevalence and risk factors of high-altitude pulmonary hypertension among native Tibetans in Sichuan Province, China.

Research reports on associations of urinary sodium excretion with central hemodynamic parameters and vascular changes are quite limited in general or non‐hypertensive population. The purpose of the current study was to explore such associations in Chinese general Tibetans living at high altitude. This cross‐sectional study was conducted in Luhuo County, Ganzi Tibetan Autonomous Prefecture with average elevation of 3800 meters from December 2018 to January 2019. A total of 294 Tibetans were included in the current study. Twenty‐four hour urinary sodium excretion was estimated by second fasting spot urine in the morning using Kawasaki formula. Central hemodynamic parameters, including central systolic blood pressure (CSBP), central diastolic blood pressure (CDBP), central pulse pressure (CPP), central mean arterial pressure (CMAP), augmentation pressure (AP), and augmentation index standardized for heart rate of 75 (AIx75), were evaluated using the SphygmoCor system. Vascular structures and functions were assessed by carotid intima media thickness (CIMT) test and brachial ankle pulse wave velocity (baPWV), respectively. Estimated mean 24h urinary sodium excretion of Tibetans in Luhuo County was 5.26±1.61 g. After adjustment, estimated 24h urinary sodium was positively associated with CSBP (β = 1.15, p = .008) and CPP (β = 0.87, p = .013). Line graph of means across urinary sodium quartiles showed that associations of 24 h urinary sodium excretion with AIx75 and baPWV presented approximate “J” shape after controlling for confounders. Estimated 24 h sodium excretion was independently and positively associated with CSBP and CPP. Moreover, association between urinary sodium excretion and arterial elasticity, as evaluated by baPWV and AIx75, presented “J” shape. Further studies are needed to verify J‐shaped association and “safe” zone of sodium intake.

IntroductionThe control rate of hypertension is low in China, especially in rural, western and minority areas. This is related to poor medical skills among physicians in primary care institutions and low levels of trust among patients. However, primary healthcare institutions are the main battleground for the prevention and treatment of hypertension. It is worth exploring how to most effectively integrate patients, primary care physicians and cardiologists in tertiary hospitals, to build a long-term mechanism for the prevention and treatment of hypertension. In this study, we aim to evaluate the clinical effectiveness and conduct a health economic evaluation of an internet-based patient–primary care physician–cardiologist integrated management model of hypertension in areas of China with different socioeconomic levels.Methods and analysisThis is a 12-month, multicentre, randomised controlled trial involving patients with hypertension in urban communities and rural areas of Sichuan Province, China. Each primary healthcare institution will cooperate with their tertiary hospital through the Red Shine Chronic Disease Management System (RSCDMS). Patients will be randomly assigned 1:1 to two groups: (1) a traditional care group; (2) an intervention group in which primary care physicians and cardiologists can share patient data and manage patients together through the RSCDMS. Patients can upload their blood pressure (BP) values and communicate with physicians using the system. The primary outcome is the change in systolic BP over a 12-month period. Secondary outcomes are changes in diastolic BP, BP control rate, values of 24-hour ambulatory BP monitoring, difference in cost-effectiveness between the groups, patient satisfaction, medication adherence and home BP monitoring compliance. All data will be recorded and stored in the RSCDMS and analysed using IBM SPSS V.26.0.Ethics and disseminationThis study has been approved by the Biomedical Research Ethics Committee of the West China Hospital of Sichuan University in Sichuan, China (No. 2020-148). Written informed consent will be obtained from all participants. The results of this study will be disseminated to the public through academic conferences and peer-reviewed journals.Trial registration numberChiCTR2000030677.

Previous studies suggest sedentary behavior (SB) is a risk factor for hypertension. However, buddhist activities related to SB in Tibetan monks is quite different from common SB. Meditation, chanting, and buddhist teaching are the main features during sitting. There is no study to examine the association between buddhist activities related to sitting and hypertension. There were 594 Tibetan monks included for analysis. Buddhist activities related to SB involve hours of meditation, chanting, and buddhist teaching for a typical weekday and weekend day. After controlling potential risk factors, compared with Tibetan monks who has the sedentary time

The objectives of the study were to investigate the relationship between religion and hypertension, as well as the theoretical mechanism through which religion exerts effect on hypertension. A MEDLINE literature search was performed on articles describing religion and hypertension (N = 543) excluding unqualified ones such as those without expected information, those neither correcting confounding factors nor matching the comparison groups and those reporting repeated trials. Eight extra articles from references of reviews were added to the included studies. Finally, 79 articles were formerly evaluated. Briefly, there are limited trials on correlation between religion and hypertension and their results are inconsistent. First of all, longitudinal investigations, especially the high-quality ones, are deficient. Secondly, studies evaluating religion as an integral are scarce, although they can assess religions most comprehensively. Third, few studies use several religious measurements that represent distinct dimensions of religion. Moreover, divergence exists among diverse populations, even if they are assessed by the same indicator. In addition, 59% studies are concerned with an unspecified species of religion, and Christianity is studied the most among those with a specific category of religion. Finally, the possible mechanism underlying religion and hypertension is complex, which can partially explain the different results among various populations. Comprehensive evaluation of a specific religion should be encouraged. In addition, for a specific population, the correlation between religion and hypertension should be examined particularly, even if similar investigations in other populations have been conducted. Finally, more evidence focused on the effects of distinct religions/sects is also required.

Tibetans have a higher essential hypertension prevalence compared with other ethnics in China. The reason might be due to their unique environmental influence, as well as genetic factor. However, limited studies focus on Tibetan genetics and its association with hypertension. The aim of this study was to investigate the association between With-No-Lysine (K) Kinase 1 (WNK1), Serine/Threonine kinase 39(STK39) genes variants and hypertension in the Tibetan population. 204 Tibetan hypertensive patients and 305 normotensive controls were recruited in an epidemiological survey conducted at 2 sites in the Ganzi Tibetan autonomous region. Patients were genotyped for nineteen WNK1 candidate tag single nucleotide polymorphisms (SNPs) and three STK39 SNPs, and haplotype analysis was performed. Results showed that the allele A in rs1468326 was overrepresented in hypertensive patients versus control (53.4% vs 42.9%, P < 0.05). The multivariable-adjusted odds ratio (OR) for hypertension among CA + AA genotypes carriers was 1.60 (95% CI: 1.02-2.62, P < 0.05), and they also had a higher systolic blood pressure (136.5 ± 28.6 vs 131.7 ± 24.8 mmHg, P < 0.05). However, the TT genotype ratio in rs6749447 was lower in hypertensives (5.4% vs 10.8%, P < 0.05), and the hypertension risk for the TT genotype carriers in rs6749447 decreased after adjustment (OR 0.49, 95% CI 0.19-0.95, P < 0.05). Subjects with haplotype AGACAGGAATCGT showed 1.57 times higher risk of hypertension (95% CI 1.02-2.41, P < 0.05). In conclusion, SNP rs1468326 of WNK1, rs6749447 of STK39, and WNK1 haplotype AGACAGGAATCGT were associated with hypertension in Tibetan individuals. Environ. Mol. Mutagen. 59:151-160, 2018. © 2017 Wiley Periodicals, Inc.

Background Hyperuricemia is a common and serious public health problem. There has been no broad epidemiological survey of hyperuricemia in China, especially in Tibetan area. This study was therefore investigated the prevalence of hyperuricemia and its correlated factors among people aged 18–85 years in Ganzi Tibetan Autonomous Prefecture, Sichuan Province, China. Methods We carried out a cross-sectional study among 3093 participants in Ganzi Tibetan Autonomous Prefecture using questionnaires in face-to-face interviews, anthropometric measurements and biochemical tests. We included 1416 subjects with complete data including serum uric acid and medical history to analyze the prevalence of hyperuricemia and correlated factors. Hyperuricemia was defined as a fasting serum uric acid level higher than 420 μmol/L in men and 360 μmol/L in women. Results The overall crude prevalence of hyperuricemia was 37.2%, and was greater in men than women (41% vs 34.4%, P = 0.011). The age-adjusted prevalence was 33.0%. Characteristics linked to hyperuricemia were farmers-herdsmen (OR: 1.749, 95% CI: 1.022–2.992), low to moderate education level (low OR:1.57, 95% CI: 1.102–2.237; moderate OR: 1.86, 95% CI: 1.167–2.963), current drinking (OR: 1.795, 95% CI: 1.193–2.702), hypertension (OR: 1.48, 95% CI: 1.091–2.006), higher body mass index (1 unit increase) (OR: 1.116, 95% CI: 1.077–1.156) and higher serum creatinine (1 unit increase) (OR: 1.046, 95% CI: 1.034–1.059). Serum uric acid was positively related to triglycerides and total cholesterol and negatively related to high density lipoprotein cholesterol in all subjects. Hyperuricemia was a risk factor for high triglyceride ((OR: 2.13, 95% CI: 1.156–3.9266) and high total cholesterol (OR: 2.313, 95% CI: 1.364–3.923) in men and for high low-density lipoprotein cholesterol (OR: 2.696, 95% CI: 1.386–5.245) in women. Conclusion There is a high prevalence of hyperuricemia in Ganzi Tibetan Autonomous Prefecture. The government needs to prevent and manage hyperuricemia in this area.

Sleep disorders are known to increase the risk of hypertension, yet few studies have investigated the relation between sleep disorders and morning blood pressure (BP). This study aimed to determine, whether the morning BP is associated with sleep quality and sleep-disordered breathing. A total of 144 hypertensive patients were included in this cross-sectional study. Each subject underwent anthropometric measurements, biochemical testing, 24-h ambulatory BP monitoring, and polysomnography (PSG). Sleep quality and sleep-disordered breathing were determined by PSG parameters of sleep architecture and sleep respiratory. There were no significant differences between subjects with and without morning hypertension in the parameters of sleep architecture and sleep respiratory. In multiple regression analysis, morning BP was independently associated with night-time BP and morning BP surge, but not with the parameters of sleep architecture and sleep respiratory. Further analysis showed that both night-time BP and morning BP surge were independently associated with the sleep respiratory parameters. In conclusion, sleep-disordered breathing might indirectly affect the morning BP by elevated night-time BP, yet neither poor sleep quality nor sleep-disordered breathing was major determinants of elevated morning BP in hypertensive patients.

The branched chain amino acids (BCAA), leucine, isoleucine and valine, are essential for mammalians, and they play a positive role in exercise capacity, muscle development, and a lean body phenotype. BCAA supplementation is commonly paired with exercise in order to promote muscle growth, increase resistance to fatigue and reduce muscle soreness. On the other hand, elevated serum BCAA is strongly and positively correlated with the development of insulin resistance, coronary heart disease, and type II diabetes, and is predictive of patient response to therapeutics and intervention outcomes. We have previously shown that defective BCAA catabolism in mice impaired glucose metabolism in the heart and increased susceptibility to stress-induced cardiac damage. In this study we sought to determine the effects of elevated BCAA levels on skeletal muscle performance and response to exercise training using mouse models with systemically elevated BCAA levels. Supplementation of BCAA (1.5mg/g bodyweight/day, ratio of Leu:Ile:Val = 1.5:0.8:1) was administered to mice with impairment of BCAA catabolism due to the deletion of mitochondrial-localized protein phosphatase 2C (KO), a key enzyme in activating BCAA catabolism, and their littermate controls (CON). Mice were subjected to one week of daily exercise training via forced treadmill running and an exercise capacity test was performed at the beginning and end of training. Baseline maximum running time was decreased in the KO compared to CON (mean 73.4 and 82.5 min, respectively). One week of training resulted in increased exercise capacity in CON with an attenuated increase in KO mice (mean 136 and 112 min, respectively). BCAA supplementation did not further improve exercise capacity in CON (mean 131 min) and abrogated the response to training in KO (mean 70.1 min). Reduced exercise capacity positively correlated with elevated serum BCAA levels. Additionally, KO supplemented with BCAAs demonstrated elevated serum succinate, alanine and glutamate levels, which are metabolic markers of physiological stress. We conclude that short term supplementation of BCAA has no benefit for exercise capacity and accumulation of BCAAs has a negative effect on endurance exercise capacity.

Low health literacy is associated with poor clinical outcomes. The relationship between literacy and blood pressure (BP) has been inconsistent. We investigated the determinants of health literacy and the potential relationship between health literacy and hypertension management. We conducted a retrospective cohort trial of 360 hypertensive patients. Scale measurements, physical examination, and laboratory tests were performed based on a standard protocol. To determine factors associated with health literacy, multiple logistic regression analysis was performed and the discriminatory power of the scale score for hypertension control was assessed by the area under the receiver operating curve. After adjusting for potential confounders, our findings show that the level of education, home blood pressure measurement, regular medication, and systolic blood pressure are significantly associated with health literacy. Moreover, patients with high health literacy have better hypertension control, a lower risk of ischemic cardiovascular disease (ICVD), lower brachial ankle pulse wave velocity values, and better health-related quality of life. In addition, our study also demonstrates that we can identify the health literacy level of hypertensive patients using the Chinese Health Literacy Scale for Hypertension. At a cut-off value of 13.5, we predict that patients will achieve long-term hypertension control. Adequate health literacy is a contributing factor to better blood pressure (BP) control and better perceived quality of life in hypertensive patients. Low health literacy increases the 10-year risk of ICVD and incidence of artery stiffness in hypertensive patients. Improving health literacy should be considered an important part of the management of hypertension.

The aim of the study is to compare the effects of hydrochlorothiazide and indapamide on the kidney in patients with hypertension inadequately controlled with losartan. A total of 140 patients who met the criteria and inadequately controlled with losartan 50 mg per day for 2 weeks were randomized in two groups and administered either hydrochlorothiazide 12.5 mg per day (n=70) or indapamide (sustained release) 1.5 mg per day (n=70) in combination with losartan 50 mg per day. Office blood pressure (BP) were collected at baseline and upon each follow-up visit. Creatinine, urine albumin–creatinine ratio (ACR), urine neutrophil gelatinase-associated lipocalin (NGAL) and renal resistive index (RRI) were also collected at baseline and at the 24-week follow-up. None of the baseline characteristics was statistically significantly different between the two groups. After excluding those patients with office BP uncontrolled, 46 patients in the hydrochlorothiazide group (45.7% males, 58.8±10.8 years) and 44 patients in the indapamide group (38.4% males, 61.5±10.9 years) were analysed. There were insignificant changes in creatinine and significant decreases in ACR, NGAL and RRI compared to baseline levels in the two groups. The decrease in ACR (3.8 (0, 28.7) vs 4.2 (0.4, 64.8) mg g−1, P=0.485) was not significantly different between the two groups, while the decrease in NGAL (16.07±7.07 vs 28.77±7.64 ng ml−1, P

Antihypertensive therapy is effective to control blood pressure (BP) and to prevent cardiovascular events, but the further treatment strategies for patients who cannot achieve goal BP with low-dose monotherapy is still under dispute. Our study investigates the effects of high-dose amlodipine and valsartan and their low-dose combination on blood pressure variability (BPV) and pulse wave velocity (PWV) to provide references for clinical medication.This study was a prospective, randomized, parallel, case-controlled trial performed in a medical center. A total of 134 outpatients newly diagnosed with essential hypertension or receiving low-dose monotherapy were enrolled and 119 completed the trial. They were randomized into amlodipine 10mg group (n = 40), valsartan 160mg group (n = 38) and amlodipine 5mg + valsartan 80mg (n = 41) in a 1:1:1 allocation ratio for a 10-week treatment. Demographic data and laboratory indicators were collected at the randomization and 10 weeks after the treatment. The 24-hour ambulatory BP and brachial-ankle PWV were also monitored.All therapies reduced systolic and diastolic BP (P0.05). The 24-hour systolic BPV was significantly decreased in amlodipine and combination groups (3.55 ± 2.57, 4.11 ± 2.20 versus 2.23 ± 2.54mmHg, P0.05). The effects on diastolic BPV differed between different treatments. PWV was lowered by 3 antihypertensive schemes; the degree of which from strongest to weakest were valsartan, combination and amlodipine (228.87 ± 60.41 versus 152.49 ± 49.25 versus 99.35 ± 35.57cm/second, P0.01).All further strategies can effectively control BP. The combination treatment reduces both BPV and PWV noticeably, whereas double-dose amlodipine achieves the greatest BPV decrease and valsartan is best in controlling PWV.

Introduction: Orthostatic hypotension (OH) is an independent risk factor for cardiovascular morbidity and often unrecognized in the elderly. The association between measures of central pulsatile hemodynamic load or arterial stiffness with OH is unclear. This study evaluated the usefulness of these indexes to identify OH. Hypothesis: We hypothesize that direct measures of central pulsatile hemodynamic load (e.g. central systolic blood pressure) and arterial stiffness (pulse wave velocity) both associated with OH. And Measures of central pulsatile hemodynamic load may represent a better indicator of OH. Methods: A sample of 1099 participants was recruited from the general population who attended health check-ups. Questionnaire, physical examination and laboratory tests were performance by a standard protocol. To assess the correlation between central hemodynamic indexes and the probability of OH, multiple logistic regression analysis was used to estimate the odds ratio in different models, and the discriminatory power of hemodynamic indexes for OH was assessed by the area under the receiver operating curve (ROC). Results: The prevalence of OH in this population was 5.6 %. Compared with those without OH, OH subjects had a higher age, SBP in sitting position, BP in supine position, brachial-ankle PWV (BaPWV) and central systolic blood pressure (CSBP) (all P Conclusion: BaPWV appears to be a better indicator of OH in the elderly. If a patient’s BaPWV is greater than 18m/s, Clinicians should better to carry out supine to standing blood pressures measurement in routine clinical practice.

The association between central pulsatile hemodynamic load, arterial stiffness, and orthostatic hypotension (OH) is unclear. The authors recruited 1099 participants from the community. Questionnaire, physical examination, and laboratory tests were performed. To assess the correlation between central pulsatile hemodynamic load, arterial stiffness, and OH, multiple logistic regression analysis was performed, and the discriminatory power was assessed by the area under the receiver operating curve. The prevalence of OH in this population was 5.6%. After adjusting for potential confounders, brachial-ankle pulse wave velocity (BaPWV) was significantly and positively correlated with OH in both the hypertension and nonhypertension groups (all P

Objective:The causality of synmpathetic activity and metabolic syndrome(MS) remained to be a “chicken and egg” question. The aim of the study is to reveal the causality of synmpathetic activity and MS and to investigate whether there is gender difference in the relationship between sympathetic activ