Objective Current clinical evidence on the effects of home blood pressure telemonitoring(HBPT)on improving blood pressure control comes entirely from developed countries.Thus,we performed this randomized controlled tr...Objective Current clinical evidence on the effects of home blood pressure telemonitoring(HBPT)on improving blood pressure control comes entirely from developed countries.Thus,we performed this randomized controlled trial to evaluate whether HBPT plus support(patient education and clinician remote hypertension management)improves blood pressure control more than usual care(UC)in the Chinese population.Methods This single-center,randomized controlled study was conducted in Beijing,China.Patients aged 30-75 years were eligible for enrolment if they had blood pressure[systolic(SBP)≥140 mmHg and/or diastolic(DBP)≥90 mmHg;or SBP≥130 mmHg and/or DBP≥80 mmHg with diabetes].We recruited 190 patients randomized to either the HBPT or the UC groups for 12 weeks.The primary endpoints were blood pressure reduction and the proportion of patients achieving the target blood pressure.Results Totally,172 patients completed the study,the HBPT plus support group(n=84),and the UC group(n=88).Patients in the plus support group showed a greater reduction in mean ambulatory blood pressure than those in the UC group.The plus support group had a significantly higher proportion of patients who achieved the target blood pressure and maintained a dipper blood pressure pattern at the12th week of follow-up.Additionally,the patients in the plus support group showed lower blood pressure variability and higher drug adherence than those in the UC group.Conclusion HBPT plus additional support results in greater blood pressure reduction,better blood pressure control,a higher proportion of dipper blood pressure patterns,lower blood pressure variability,and higher drug adherence than UC.The development of telemedicine may be the cornerstone of hypertension management in primary care.展开更多
Introduction: The management of hypertension is mostly based on pharmacotherapy and hygienic and dietary measures (HDMs) for which little data is available in Cameroon. The concern to improve the quality of life of hy...Introduction: The management of hypertension is mostly based on pharmacotherapy and hygienic and dietary measures (HDMs) for which little data is available in Cameroon. The concern to improve the quality of life of hypertensive patients led us to study the knowledge, compliance and effect of HDMs among Cameroonian hypertensive patients. Methods: This was a cross-sectional study carried out at the Douala General Hospital;the census of patients was carried out from 05 March to 10 May 2018. The data evaluated were knowledge and compliance with HDMs with an inference of their effect on blood pressure control. Results: We recruited 330 participants at mean age of 60 ± 11 years, 37.9% men;57.3% with blood pressure (BP) controlled. Out of 330 subjects, 308 (93.3%) who had been educated about dietary health measures for hypertension were assessed on knowledge, compliance and effect of these measures against 22 (6.7%) who had never heard about them. Around 85.7% of participants had good knowledge of HDMs and 78.9% had good compliance with them. There was no statistically significant influence of knowledge and compliance with HDMs on blood pressure control. Conclusion: The level of knowledge and adherence to HDMs of hypertensive patients at the Douala General Hospital was appreciable. It is however appropriate for physicians to intensify patient education on HDMs and BP control.展开更多
Objective:To explore the risk factors of diabetic nephropathy and its correlation with blood pressure control.Methods:A retrospective analysis of 80 patients with diabetic nephropathy(diabetic nephropathy group)and an...Objective:To explore the risk factors of diabetic nephropathy and its correlation with blood pressure control.Methods:A retrospective analysis of 80 patients with diabetic nephropathy(diabetic nephropathy group)and another 80 patients with diabetes(diabetic group)who were admitted to the Department of Nephrology and Endocrinology at our hospital from October 2021 to October 2022 was conducted.The general data of the two groups were compared,the influencing factors associated with the two groups were analyzed unilaterally,and unconditional dichotomous logistic regression was performed to analyze the influencing factors in patients with diabetic nephropathy.Results:There were no significant differences in high-density lipoprotein,systolic blood pressure,diastolic blood pressure,and creatinine between the two groups(P>0.05);however,compared with the diabetic group,the DN group had significantly elevated glycated hemoglobin,low-density lipoprotein,24-h urine protein,insulin resistance,and diabetes duration≥10 years(P<0.05).Conclusion:The clinical research on the correlation between the incidence of hypertension and the control of blood pressure in patients with diabetic nephropathy should be strengthened in order to formulate reasonable and feasible treatment plans.展开更多
Acute stress concentration plays an important role in plaque rupture and may cause stroke or myocardial infarction.Quantitative evaluation of the relation between in vivo plaque stress and variations in blood pressure...Acute stress concentration plays an important role in plaque rupture and may cause stroke or myocardial infarction.Quantitative evaluation of the relation between in vivo plaque stress and variations in blood pressure and flow rates is valuable to optimize daily monitoring of the cardiovascular system for high-risk patients as well as to set a safe physical exercise intensity for better quality of life.In this study,we constructed an in vivo stress model for a human carotid bifurcation with atherosclerotic plaque,and analyzed the effects of blood pressure,flow rates,plaque stiffness,and stenosis on the elastic stress and fluid viscous stress around the plaque.According to the maximum values of the mechanical stress,we define a risk index to predict the risk level of plaque rupture under different exercise intensities.For a carotid bifurcation where the blood flow divides,the results suggest that the stenosis ratio determines the ratio of the contributions of elastic shear stress and viscous shear stress to plaque rupture.A n increase of the plaque stiffness enhances the maximum elastic shear stress in the plaque,indicating that a high-stiffness plaque is more prone to rupture for given stenosis ratio.High stress co-localization at the shoulder of plaques agrees with the region of plaque injury in clinical observations.It is demonstrated that,due to the stress-shield effect,the rupture risk of a high-stiffness plaque tends to decrease under high-stenosis conditions,suggesting the existence of a specific stenosis corresponding to the maximum risk.This study may help to complement risk stratification of vulnerable plaques in clinical practice and provides a stenosis mechanical property-specific guide for blood pressure control in cardiovascular health management.展开更多
Objective: The association hypertension and diabetes is important. The two pathologies may influence each other. The aim was to study the correlation between glycemic control and blood pressure control and to determin...Objective: The association hypertension and diabetes is important. The two pathologies may influence each other. The aim was to study the correlation between glycemic control and blood pressure control and to determine the factors associated with blood pressure control. Methodology: This was a descriptive cross-sectional study with an analytical focus over 7 months. Patients were recruited as outpatients and all underwent ambulatory blood pressure measure, glycated hemoglobin and creatinine measurements, and assessment of compliance with treatment. Results: During this period 116 patients were collected. The predominance was female 69%. The mean age of the patients was 62 ± 7 years with a peak between 60 and 70 years. The average age of hypertension was 12 years and that of diabetes 6 1/2 years. The most frequently associated cardiovascular risk factor was a sedentary lifestyle (71.5%) after age. 57.8% of patients were not controlled at the office, with a predominance of systolic hypertension (58.2%). 61.6% of patients were controlled by ambulatory blood pressure measure, a rate of 47.8% of white coat hypertension. Glycemic control was observed in 42.2% of cases and 87% of patients had good renal function (glomerular filter rate ≥ 60 ml/mn). Therapeutic compliance was good in 53.4% of cases and dual therapy was the most used therapeutic modality 44.8% (52 patients) followed by triple therapy. The factors associated with poor blood pressure control were glycemic imbalance, non-compliance and monotherapy. Dual therapy had a protective effect. Conclusion: The association of hypertension and type 2 diabetes is frequent. The risk of occurrence increases with age. Ambulatory blood pressure measure is the best method to assess blood pressure control. Optimization of blood pressure control should also include optimization of glycemic control.展开更多
Objective To investigate the impacts of blood pressure control on coronary flow reserve(CFR)in hypertensive patients.Methods A total of 236 patients without significant coronary stenosis(defined as<50%luminal narro...Objective To investigate the impacts of blood pressure control on coronary flow reserve(CFR)in hypertensive patients.Methods A total of 236 patients without significant coronary stenosis(defined as<50%luminal narrowing confirmed by coronary angiography or coronary artery CT scan)between January 2011 and July 2015were retrospectively enrolled in this study.CFR展开更多
Objective:Home blood pressure monitoring(HBPM)is viewed as a facilitating factor in the initial diagnosis and long-term management of treated hypertension.However,evidence remains scarce about the effectiveness of HBP...Objective:Home blood pressure monitoring(HBPM)is viewed as a facilitating factor in the initial diagnosis and long-term management of treated hypertension.However,evidence remains scarce about the effectiveness of HBPM use in the real world.This study aimed to examine the associations of HBPM use with blood pressure(BP)control and medication adherence.Methods:This prospective cohort study included hypertensive patients with high cardiovascular risk who were aged≥50 years.At baseline,information about types of BP monitor,frequency of HBPM,perception of anti-hypertensive treatment,and measured office BP were collected.During the 1-year follow-up(visits at 1,2,3,6,and 12 months),information on medication adherence was collected at each visit.The 2 major outcomes were BP control at baseline and medication adherence during the 1-year follow-up.A log-binomial regression model was used to examine the association between frequency of HBPM and outcomes,stratified by the perceptions of anti-hypertensive treatment.Results:A total of 5,363 hypertensive patients were included in the analysis.The age was(64.6±7.2)years,and 41.2%(2,208)were female.Of the total patients,85.9%(4,606)had a home BP monitor and 47.8%(2,564)had an incorrect perception of anti-hypertensive treatment.Overall,24.2%(1,299)of patients monitored their BP daily,37.6%(2,015)weekly,17.3%(926)monthly,and 20.9%(1,123)less than monthly.At baseline,the systolic BP and diastolic BP were(146.6±10.8)mmHg and(81.9±10.6)mmHg,respectively,and 28.5%(1,527)of patients had their BP controlled.Regardless of whether the patients had correct or incorrect perceptions of anti-hypertensive treatment,there is no significant association between HBPM frequency and BP control at baseline.During the 1-year follow-up,23.9%(1,280)of patients had non-adherence to medications at least once.In patients with an incorrect perception of anti-hypertensive treatment,those monitoring BP most frequently(daily)had the highest non-adherence rate(29.9%,175/585).Compared with those monitoring their BP less than monthly,patients who monitored their BP daily were more likely not to adhere to anti-hypertensive medications(adjusted relative risk=1.38,95%confidence interval:1.11–1.72,P=0.004).Conclusions:HBPM performance among hypertensive patients in China is,in general,sub-optimal.No association was observed between using HBPM alone and hypertension control,indicating that the effects of HBPM could be conditional.Patients’misconceptions about anti-hypertensive treatment may impair the role of BP monitoring in achieving medication adherence.Fully incorporating the correct perception of hypertension into the management of hypertensive patients is needed.展开更多
Objective:Oncocardiology is increasingly hot research field/topic in the clinical management of cancer with anti-angiogenic therapy of vascular endothelial growth factor(VEGF)that may cause cardiovascular toxicity,suc...Objective:Oncocardiology is increasingly hot research field/topic in the clinical management of cancer with anti-angiogenic therapy of vascular endothelial growth factor(VEGF)that may cause cardiovascular toxicity,such as hypertension via vascular dysfunction and attenuation of eNOS/NO signaling in the baroreflex afferent pathway.The aim of the current study was to evaluate the potential roles of VEGF/VEGF receptors(VEGFRs)expressed in the baroreflex afferent pathway in autonomic control of blood pressure(BP)regulation.Methods:The distribution and expression of VEGF/VEGFRs were detected in the nodose ganglia(NG)and nucleus of tractus solitary(NTS)using immunostaining and molecular approaches.The direct role of VEGF was tested by NG microinjection under physiological and hypertensive conditions.Results:Immunostaining data showed that either VEGF or VEGFR2/VEGFR3 was clearly detected in the NG and NTS of adult male rats.Microinjection of VEGF directly into the NG reduced the mean blood pressure(MBP)dose-dependently,which was less dramatic in renovascular hypertension(RVH)rats,suggesting the VEGF-mediated depressor response by direct activation of the 1st-order baroreceptor neurons in the NG under both normal and disease conditions.Notably,this reduced depressor response in RVH rats was directly caused by the downregulation of VEGFR2,which compensated the up regulation of VEGF/VEGFR3 in the NG during the development of hypertension.Conclusion:It demonstrated for the first time that the BP-lowering property of VEGF/VEGFRs signaling via the activation of baroreflex afferent function may be a common target/pathway leading to BP dysregulation in anti-angiogenic therapy.展开更多
Ambulatory blood pressure monitoring(ABPM)has become indispensable in the current management of hypertension.ABPM is particularly useful in the accurate diagnosis of hypertension.Its diagnostic thresholds had been rec...Ambulatory blood pressure monitoring(ABPM)has become indispensable in the current management of hypertension.ABPM is particularly useful in the accurate diagnosis of hypertension.Its diagnostic thresholds had been recently established based on hard clinical outcomes.Cross-classification of patients according to office and ambulatory blood pressure identifies white-coat,masked,and sustained hypertension.ABPM is also useful in cardiovascular(CV)risk assessment.It provides information on daytime and nighttime blood pressure and circadian rhythm,particularly nighttime blood pressure dipping.Nighttime blood pressure is predictive of CV risk independent of office and daytime blood pressure.Isolated nocturnal hypertension is a special form of masked hypertension,with normal daytime but elevated nocturnal blood pressure.It also helps in the evaluation of blood pressure fluctuation and variation,such as morning blood pressure surge and reading-to-reading blood pressure variability.ABPM may derive several other indexes,such as ambulatory blood pressure index and salt sensitivity index,which may be useful in CV evaluations.展开更多
A community-based multi-center randomized controlled trial was conducted to evaluate the effectiveness of blood pressure control for hypertension patients in communities in urban Shanghai by integrated intervention.At...A community-based multi-center randomized controlled trial was conducted to evaluate the effectiveness of blood pressure control for hypertension patients in communities in urban Shanghai by integrated intervention.At present,patients(n=1395)from four communities have completed follow-up for one year,including the intervention group(n=921)and usual care group(n=474).The intervention programs included disease manage-ment by a care manager.Blood pressure of each patient was measured regularly.Compared with the control group,the net change of mean systolic blood pressure(SBP)was–6.75(95%CI:–7.79 to–5.71,P<0.001)mmHg,mean diastolic blood pressure(DBP)was–4.29(95%CI:–5.08 to–3.49,P<0.001)mmHg,and mean pulse pressure(PP)was–2.46(95%CI:–3.50 to–1.43,P<0.001)mmHg in the intervention group.The net change extent was larger in patients with regular pharmacological treatment than in those with irregular pharmacological treatment or non-pharmacological treat-ment.The measures of integrated intervention for hypertension patients in communities can lower signifi-cantly not only SBP and DBP,but also PP.It is suggested that measures of integrated intervention can decrease the risk of cardiovascular diseases in hypertension patients.展开更多
基金The Project of the National Ministry of Industry and Information Technology[2020-0103-3-1-1]The Project of Beijing Science and technology“capital characteristics”[Z181100001718007]。
文摘Objective Current clinical evidence on the effects of home blood pressure telemonitoring(HBPT)on improving blood pressure control comes entirely from developed countries.Thus,we performed this randomized controlled trial to evaluate whether HBPT plus support(patient education and clinician remote hypertension management)improves blood pressure control more than usual care(UC)in the Chinese population.Methods This single-center,randomized controlled study was conducted in Beijing,China.Patients aged 30-75 years were eligible for enrolment if they had blood pressure[systolic(SBP)≥140 mmHg and/or diastolic(DBP)≥90 mmHg;or SBP≥130 mmHg and/or DBP≥80 mmHg with diabetes].We recruited 190 patients randomized to either the HBPT or the UC groups for 12 weeks.The primary endpoints were blood pressure reduction and the proportion of patients achieving the target blood pressure.Results Totally,172 patients completed the study,the HBPT plus support group(n=84),and the UC group(n=88).Patients in the plus support group showed a greater reduction in mean ambulatory blood pressure than those in the UC group.The plus support group had a significantly higher proportion of patients who achieved the target blood pressure and maintained a dipper blood pressure pattern at the12th week of follow-up.Additionally,the patients in the plus support group showed lower blood pressure variability and higher drug adherence than those in the UC group.Conclusion HBPT plus additional support results in greater blood pressure reduction,better blood pressure control,a higher proportion of dipper blood pressure patterns,lower blood pressure variability,and higher drug adherence than UC.The development of telemedicine may be the cornerstone of hypertension management in primary care.
文摘Introduction: The management of hypertension is mostly based on pharmacotherapy and hygienic and dietary measures (HDMs) for which little data is available in Cameroon. The concern to improve the quality of life of hypertensive patients led us to study the knowledge, compliance and effect of HDMs among Cameroonian hypertensive patients. Methods: This was a cross-sectional study carried out at the Douala General Hospital;the census of patients was carried out from 05 March to 10 May 2018. The data evaluated were knowledge and compliance with HDMs with an inference of their effect on blood pressure control. Results: We recruited 330 participants at mean age of 60 ± 11 years, 37.9% men;57.3% with blood pressure (BP) controlled. Out of 330 subjects, 308 (93.3%) who had been educated about dietary health measures for hypertension were assessed on knowledge, compliance and effect of these measures against 22 (6.7%) who had never heard about them. Around 85.7% of participants had good knowledge of HDMs and 78.9% had good compliance with them. There was no statistically significant influence of knowledge and compliance with HDMs on blood pressure control. Conclusion: The level of knowledge and adherence to HDMs of hypertensive patients at the Douala General Hospital was appreciable. It is however appropriate for physicians to intensify patient education on HDMs and BP control.
文摘Objective:To explore the risk factors of diabetic nephropathy and its correlation with blood pressure control.Methods:A retrospective analysis of 80 patients with diabetic nephropathy(diabetic nephropathy group)and another 80 patients with diabetes(diabetic group)who were admitted to the Department of Nephrology and Endocrinology at our hospital from October 2021 to October 2022 was conducted.The general data of the two groups were compared,the influencing factors associated with the two groups were analyzed unilaterally,and unconditional dichotomous logistic regression was performed to analyze the influencing factors in patients with diabetic nephropathy.Results:There were no significant differences in high-density lipoprotein,systolic blood pressure,diastolic blood pressure,and creatinine between the two groups(P>0.05);however,compared with the diabetic group,the DN group had significantly elevated glycated hemoglobin,low-density lipoprotein,24-h urine protein,insulin resistance,and diabetes duration≥10 years(P<0.05).Conclusion:The clinical research on the correlation between the incidence of hypertension and the control of blood pressure in patients with diabetic nephropathy should be strengthened in order to formulate reasonable and feasible treatment plans.
基金This work was supported by the National Key R&D Program of China(Grant 2017YFE0117100)the National Natural Science Foundation of China(Grants 11872040 and 11232010)+1 种基金the Outstanding Clinical Discipline Project of Shanghai Pudong(Grant PWYgy-2018-08)the Science and Technology Commission of Shanghai Municipality(Grant 18ZR1433900).
文摘Acute stress concentration plays an important role in plaque rupture and may cause stroke or myocardial infarction.Quantitative evaluation of the relation between in vivo plaque stress and variations in blood pressure and flow rates is valuable to optimize daily monitoring of the cardiovascular system for high-risk patients as well as to set a safe physical exercise intensity for better quality of life.In this study,we constructed an in vivo stress model for a human carotid bifurcation with atherosclerotic plaque,and analyzed the effects of blood pressure,flow rates,plaque stiffness,and stenosis on the elastic stress and fluid viscous stress around the plaque.According to the maximum values of the mechanical stress,we define a risk index to predict the risk level of plaque rupture under different exercise intensities.For a carotid bifurcation where the blood flow divides,the results suggest that the stenosis ratio determines the ratio of the contributions of elastic shear stress and viscous shear stress to plaque rupture.A n increase of the plaque stiffness enhances the maximum elastic shear stress in the plaque,indicating that a high-stiffness plaque is more prone to rupture for given stenosis ratio.High stress co-localization at the shoulder of plaques agrees with the region of plaque injury in clinical observations.It is demonstrated that,due to the stress-shield effect,the rupture risk of a high-stiffness plaque tends to decrease under high-stenosis conditions,suggesting the existence of a specific stenosis corresponding to the maximum risk.This study may help to complement risk stratification of vulnerable plaques in clinical practice and provides a stenosis mechanical property-specific guide for blood pressure control in cardiovascular health management.
文摘Objective: The association hypertension and diabetes is important. The two pathologies may influence each other. The aim was to study the correlation between glycemic control and blood pressure control and to determine the factors associated with blood pressure control. Methodology: This was a descriptive cross-sectional study with an analytical focus over 7 months. Patients were recruited as outpatients and all underwent ambulatory blood pressure measure, glycated hemoglobin and creatinine measurements, and assessment of compliance with treatment. Results: During this period 116 patients were collected. The predominance was female 69%. The mean age of the patients was 62 ± 7 years with a peak between 60 and 70 years. The average age of hypertension was 12 years and that of diabetes 6 1/2 years. The most frequently associated cardiovascular risk factor was a sedentary lifestyle (71.5%) after age. 57.8% of patients were not controlled at the office, with a predominance of systolic hypertension (58.2%). 61.6% of patients were controlled by ambulatory blood pressure measure, a rate of 47.8% of white coat hypertension. Glycemic control was observed in 42.2% of cases and 87% of patients had good renal function (glomerular filter rate ≥ 60 ml/mn). Therapeutic compliance was good in 53.4% of cases and dual therapy was the most used therapeutic modality 44.8% (52 patients) followed by triple therapy. The factors associated with poor blood pressure control were glycemic imbalance, non-compliance and monotherapy. Dual therapy had a protective effect. Conclusion: The association of hypertension and type 2 diabetes is frequent. The risk of occurrence increases with age. Ambulatory blood pressure measure is the best method to assess blood pressure control. Optimization of blood pressure control should also include optimization of glycemic control.
文摘Objective To investigate the impacts of blood pressure control on coronary flow reserve(CFR)in hypertensive patients.Methods A total of 236 patients without significant coronary stenosis(defined as<50%luminal narrowing confirmed by coronary angiography or coronary artery CT scan)between January 2011 and July 2015were retrospectively enrolled in this study.CFR
基金supported by the National Key Research and Development Program of China(2018YFC1312404,2018YFC1312400)by the National Clinical Research Center for Cardiovascular Diseases,Fuwai Hospital,Chinese Academy of Medical Sciences(NCRC2021001).
文摘Objective:Home blood pressure monitoring(HBPM)is viewed as a facilitating factor in the initial diagnosis and long-term management of treated hypertension.However,evidence remains scarce about the effectiveness of HBPM use in the real world.This study aimed to examine the associations of HBPM use with blood pressure(BP)control and medication adherence.Methods:This prospective cohort study included hypertensive patients with high cardiovascular risk who were aged≥50 years.At baseline,information about types of BP monitor,frequency of HBPM,perception of anti-hypertensive treatment,and measured office BP were collected.During the 1-year follow-up(visits at 1,2,3,6,and 12 months),information on medication adherence was collected at each visit.The 2 major outcomes were BP control at baseline and medication adherence during the 1-year follow-up.A log-binomial regression model was used to examine the association between frequency of HBPM and outcomes,stratified by the perceptions of anti-hypertensive treatment.Results:A total of 5,363 hypertensive patients were included in the analysis.The age was(64.6±7.2)years,and 41.2%(2,208)were female.Of the total patients,85.9%(4,606)had a home BP monitor and 47.8%(2,564)had an incorrect perception of anti-hypertensive treatment.Overall,24.2%(1,299)of patients monitored their BP daily,37.6%(2,015)weekly,17.3%(926)monthly,and 20.9%(1,123)less than monthly.At baseline,the systolic BP and diastolic BP were(146.6±10.8)mmHg and(81.9±10.6)mmHg,respectively,and 28.5%(1,527)of patients had their BP controlled.Regardless of whether the patients had correct or incorrect perceptions of anti-hypertensive treatment,there is no significant association between HBPM frequency and BP control at baseline.During the 1-year follow-up,23.9%(1,280)of patients had non-adherence to medications at least once.In patients with an incorrect perception of anti-hypertensive treatment,those monitoring BP most frequently(daily)had the highest non-adherence rate(29.9%,175/585).Compared with those monitoring their BP less than monthly,patients who monitored their BP daily were more likely not to adhere to anti-hypertensive medications(adjusted relative risk=1.38,95%confidence interval:1.11–1.72,P=0.004).Conclusions:HBPM performance among hypertensive patients in China is,in general,sub-optimal.No association was observed between using HBPM alone and hypertension control,indicating that the effects of HBPM could be conditional.Patients’misconceptions about anti-hypertensive treatment may impair the role of BP monitoring in achieving medication adherence.Fully incorporating the correct perception of hypertension into the management of hypertensive patients is needed.
基金supported by the National Natural Science Foundation of China(31171122,81573431,81971326 for B.-y.,Li).
文摘Objective:Oncocardiology is increasingly hot research field/topic in the clinical management of cancer with anti-angiogenic therapy of vascular endothelial growth factor(VEGF)that may cause cardiovascular toxicity,such as hypertension via vascular dysfunction and attenuation of eNOS/NO signaling in the baroreflex afferent pathway.The aim of the current study was to evaluate the potential roles of VEGF/VEGF receptors(VEGFRs)expressed in the baroreflex afferent pathway in autonomic control of blood pressure(BP)regulation.Methods:The distribution and expression of VEGF/VEGFRs were detected in the nodose ganglia(NG)and nucleus of tractus solitary(NTS)using immunostaining and molecular approaches.The direct role of VEGF was tested by NG microinjection under physiological and hypertensive conditions.Results:Immunostaining data showed that either VEGF or VEGFR2/VEGFR3 was clearly detected in the NG and NTS of adult male rats.Microinjection of VEGF directly into the NG reduced the mean blood pressure(MBP)dose-dependently,which was less dramatic in renovascular hypertension(RVH)rats,suggesting the VEGF-mediated depressor response by direct activation of the 1st-order baroreceptor neurons in the NG under both normal and disease conditions.Notably,this reduced depressor response in RVH rats was directly caused by the downregulation of VEGFR2,which compensated the up regulation of VEGF/VEGFR3 in the NG during the development of hypertension.Conclusion:It demonstrated for the first time that the BP-lowering property of VEGF/VEGFRs signaling via the activation of baroreflex afferent function may be a common target/pathway leading to BP dysregulation in anti-angiogenic therapy.
基金The study was financially supported by grants from the National Natural Science Foundation of China(Nos.91639203,81770455,82070432,and 82070435)Ministry of Science and Technology(No.2018YFC1704902)+3 种基金Commission of Health,Beijing,China(No.2016YFC0900902)the Shanghai Commissions of Science and Technology(No.19DZ2340200 and"Sailing Program"19YF1441000)Health,Shanghai,China("Three-year Action Program of Shanghai Municipality for Strengthening the Construction of Public Health System"GWV-10.1-XK05 and a special grant for"leading academics")from the Clinical Research Program,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai,China(No.2018CR010)。
文摘Ambulatory blood pressure monitoring(ABPM)has become indispensable in the current management of hypertension.ABPM is particularly useful in the accurate diagnosis of hypertension.Its diagnostic thresholds had been recently established based on hard clinical outcomes.Cross-classification of patients according to office and ambulatory blood pressure identifies white-coat,masked,and sustained hypertension.ABPM is also useful in cardiovascular(CV)risk assessment.It provides information on daytime and nighttime blood pressure and circadian rhythm,particularly nighttime blood pressure dipping.Nighttime blood pressure is predictive of CV risk independent of office and daytime blood pressure.Isolated nocturnal hypertension is a special form of masked hypertension,with normal daytime but elevated nocturnal blood pressure.It also helps in the evaluation of blood pressure fluctuation and variation,such as morning blood pressure surge and reading-to-reading blood pressure variability.ABPM may derive several other indexes,such as ambulatory blood pressure index and salt sensitivity index,which may be useful in CV evaluations.
文摘A community-based multi-center randomized controlled trial was conducted to evaluate the effectiveness of blood pressure control for hypertension patients in communities in urban Shanghai by integrated intervention.At present,patients(n=1395)from four communities have completed follow-up for one year,including the intervention group(n=921)and usual care group(n=474).The intervention programs included disease manage-ment by a care manager.Blood pressure of each patient was measured regularly.Compared with the control group,the net change of mean systolic blood pressure(SBP)was–6.75(95%CI:–7.79 to–5.71,P<0.001)mmHg,mean diastolic blood pressure(DBP)was–4.29(95%CI:–5.08 to–3.49,P<0.001)mmHg,and mean pulse pressure(PP)was–2.46(95%CI:–3.50 to–1.43,P<0.001)mmHg in the intervention group.The net change extent was larger in patients with regular pharmacological treatment than in those with irregular pharmacological treatment or non-pharmacological treat-ment.The measures of integrated intervention for hypertension patients in communities can lower signifi-cantly not only SBP and DBP,but also PP.It is suggested that measures of integrated intervention can decrease the risk of cardiovascular diseases in hypertension patients.
