Search

Objective To compare and analyze the recommendations for the timing and frequency of home blood pressure monitoring (HBPM) in clinical practice guidelines to help clinicians select the best recommendations and provide suggestions for the development of recommendations in the future. Methods Clinical practice guidelines related to hypertension published in the last five years were systematically searched and screened, and the recommendations for the timing and frequency of HBPM were extracted for statistical analysis. Results A total of 21 guidelines developed by institutions in 16 countries or regions were included, containing recommendations related to the timing and/or frequency of HBPM. For the HBPM timing, all guidelines recommend that blood pressure measurements be taken twice a day, in the morning and evening. In the morning blood pressure should be measured before taking antihypertensive medication (94.4%, 17/18), before breakfast (72.2%, 13/18) and after urination (55.6%, 10/18), while in the evening it should be taken before dinner (50.0%, 8/16), before bedtime (37.5%, 6/16) or 2 hours after dinner (6.3%, 1/16).For HBPM frequency, 9 (40.9%, 9/22) guidelines recommend at least 3 consecutive days of measurement in the week before the visit, and others suggest that measurements should be taken consecutively for at least 4 d (18.2%, 4/22), 5 d (13.6%, 3/22) or 7 d (27.3%, 6/22) days. Conclusions The guidelines of different countries and regions have great differences in recommendations on the timing and frequency of HBPM. It is recommended that future guideline developers develop the best recommendations after a thorough search, evaluation, and synthesis of the evidence, with full consideration of the balance of pros and cons, feasibility, patient preferences and values, as well as the context in which the guidelines are implemented.

Background Current evidence on the association between serum urate and risk of atrial fibrillation ( AF ) is limited by cross-sectional designs and 1-time measurement of serum urate. The roles of serum urate, gout-related inflammation, and systemic inflammation in the etiology of AF are currently unknown. This gap is important, given that systemic inflammation is a recognized risk factor for AF . Methods and Results We conducted a prospective cohort study of 123 238 Chinese patients from 2006 to 2014. Serum urate concentrations were measured in 2006, 2008, 2010, and 2012. Incident AF cases were identified via biennial 12-lead ECG assessment. We used a Cox proportional hazards model to examine the sex-specific associations of cumulative average serum urate and changes in serum urate accounting for baseline level with risk of incident AF . We also assessed the joint associations of serum urate and high-sensitivity C-reactive protein levels. Comparing extreme categories, participants with the highest quintile of serum urate had 1.91-fold higher risk of AF (adjusted hazard ratio: 1.91; 95% CI, 1.32-2.76; P=0.001 for trend). Participants with both high serum urate and high-sensitivity C-reactive protein had 2.6-fold elevated risk of incident AF compared with those with normal levels of serum urate and high-sensitivity C-reactive protein (adjusted hazard ratio: 2.63; 95% CI, 1.63-4.23). Conclusions High serum urate levels and increases in serum urate over time were associated with increased risk of incident AF . Patients with high levels of both serum urate and high-sensitivity C-reactive protein had substantially higher risk of AF .

Background The American Heart Association recently released an updated algorithm for evaluating cardiovascular health—Life's Essential 8 (LE8). However, the associations between changes in LE8 score over time and risk of cardiovascular disease (CVD) remain unclear. Methods We investigated associations between 6-year changes (2006–12) in LE8 score and risk of subsequent CVD events (2012–20) among 53 363 Chinese men and women from the Kailuan Study, who were free from CVD in 2012. The LE8 score was calculated based on eight components: diet quality, physical activity, smoking status, sleep health, body mass index, blood lipids, blood glucose and blood pressure. Multivariable-adjusted Cox proportional-hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Results We documented 4281 incident CVD cases during a median of 7.7 years of follow-up. Compared with participants whose LE8 scores remained stable in a 6-year period, those with the large increases of LE8 score over the 6-year period had a lower risk of CVD, heart disease and stroke in the subsequent 8 years [HRs and 95% CIs: 0.67 (0.64, 0.70) for CVD, 0.65 (0.61, 0.69) for heart disease, 0.71 (0.67, 0.76) for stroke, all P trend < 0.001]. Conversely, those with the large decreases of LE8 score had 47%, 51% and 41% higher risk for CVD, heart disease and stroke, respectively. These associations were consistent across the subgroups stratified by risk factors. Conclusions Improving LE8 score in a short- and moderate-term was associated with a lower CVD risk, whereas decreased LE8 score over time was associated with a higher risk. [ABSTRACT FROM AUTHOR]

Evergreen broad-leaved forest (EBLF) is climax vegetation in East China, and Jiangxi Province is located at the center of EBLF. Although many phytosociological studies have provided detailed descriptions on this forest at local and regional scales, knowledge on the high-level classification of EBLF and factors controlling their tree species composition and distribution are still lacking. We aim at providing a high-level classification framework for EBLF in Jiangxi and exploring the roles of topographic and climatic factors in driving their distributions. We investigated 205 EBLF plots covering the main alliances across Jiangxi Province. Two-way indicator species analysis (TWINSPAN) and detrended correspondence analysis (DCA) were used to distinguish the EBLF types. Diagnostic and indicator species were detected. The nonparametric Kruskal–Wallis test was used to compare the differences between the groups of EBLFs. We also used redundancy analysis and variation partitioning to estimate the effects of climatic, geographical and topographical factors on the distribution of EBLFs in Jiangxi. The EBLFs in Jiangxi were classified into four types based on the diagnostic taxa and verified by TWINSPAN, i.e. lowland, ravine monsoon, montane typical and dwarf cloud EBLF types. These four EBLF types are associated with climatic and topographic conditions, and their distribution pattern reflects biogeographic differences. Our study provides an important basis for the syntaxonomic classification of EBLFs and further in-depth studies on humid EBLFs in East China. We also emphasize the importance of conservation practices to protect these forests as diversified Tertiary relict plants. [ABSTRACT FROM AUTHOR]

Nitrogen (N) deposition has changed plants and soil microbes remarkably, which deeply alters the structures and functions of terrestrial ecosystems. However, how forest fungal diversity, community compositions, and their potential functions respond to N deposition is still lacking in exploration at a large scale. In this study, we conducted a short-term (4–5 years) experiment of artificial N addition to simulated N deposition in five typical forest ecosystems across eastern China, which includes tropical montane rainforest, subtropical evergreen broadleaved forest, temperate deciduous broadleaved forest, temperate broadleaved and conifer mixed forest, and boreal forest along a latitudinal gradient from tropical to cold temperature zones. Fungal compositions were identified using high-throughput sequencing at the topsoil layer. The results showed that fungal diversity and fungal community compositions among forests varied apparently for both unfertilized and fertilized soils. Generally, soil fungal diversity, communities, and their potential functions responded sluggishly to short-term N addition, whereas the fungal Shannon index was increased in the tropical forest. In addition, environmental heterogeneity explained most of the variation among fungal communities along the latitudinal gradient. Specifically, soil C: N ratio and soil water content were the most important factors driving fungal diversity, whereas mean annual temperature and microbial nutrient limitation mainly shaped fungal community structure and functional compositions. Topsoil fungal communities in eastern forest ecosystems in China were more sensitive to environmental heterogeneity rather than short-term N addition. Our study further emphasized the importance of simultaneously evaluating soil fungal communities in different forest types in response to atmospheric N deposition. [ABSTRACT FROM AUTHOR]

Nitrogen (N) deposition is known to increase carbon (C) sequestration in N‐limited boreal forests. However, the long‐term effects of N deposition on ecosystem carbon fluxes have been rarely investigated in old‐growth boreal forests. Here we show that decade‐long experimental N additions significantly stimulated net primary production (NPP) but the effect decreased with increasing N loads. The effect on soil heterotrophic respiration (Rh) shifted from a stimulation at low‐level N additions to an inhibition at higher levels of N additions. Consequently, low‐level N additions resulted in a neutral effect on net ecosystem productivity (NEP), due to a comparable stimulating effect on NPP and Rh, while NEP was increased by high‐level N additions. Moreover, we found nonlinear temporal responses of NPP, Rh and NEP to low‐level N additions. Our findings imply that actual N deposition in boreal forests likely exerts a minor contribution to their soil C storage. [ABSTRACT FROM AUTHOR]