Abstract:Aim To evaluate whether remnant cholesterol combined with traditional blood lipid parameters can improve the predictive efficacy for major adverse cardiovascular and cerebrovascular events (MACCE) in prehypertensive patients. Methods The clinical data of 421 prehypertensive patients who underwent coronary angiography for coronary heart disease or suspected coronary heart disease in General Hospital of Northern Theater Command from 2004 to 2014 were retrospectively analyzed, and various types of data before coronary angiography were recorded during hospitalization, including basic clinical baseline data such as age, gender, height, weight, blood lipids, and blood glucose. A total of 95 patients were included in the case group when they were readmitted due to MACCE during long-term follow-up (follow-up methods included but not limited to telephone, SMS, etc.); 200 patients with prehypertension but without MACCE in the concurrent cohort were selected as the control group. The differences in clinical baseline data between the two groups were analyzed and compared, multivariate Logistic regression analysis was performed for various lipid parameters to determine their OR, receiver operating characteristic (ROC) curves were used to analyze the predictive value of various lipid parameters and combined predictors for MACCE in prehypertensive patients, and MEDCALC software was used to compare the area under the curve of traditional lipid parameters and combined predictors. Results The levels of remnant cholesterol, low density lipoprotein cholesterol (LDLC), triglyceride (TG), total cholesterol (TC), non-high density lipoprotein cholesterol (non-HDLC), remnant cholesterol/HDLC, and LDLC/HDLC in the case group were significantly higher than those in the control group, and the number of patients with high-salt diet and diabetes in the case group were also higher than those in the control group, and the above differences were statistically significant (P＜0.05). The results of multivariate Logistic regression analysis showed that remnant cholesterol, non-HDLC, TG, TC, remnant cholesterol/HDLC, and LDLC/HDLC were all independent predictors of prehypertension patients after adjusting for gender and age factors (P＜0.01). ROC curve analysis showed that the AUC of remnant cholesterol combined with other lipid parameters in predicting the occurrence of MACCE in prehypertensive patients was 0.704, while the AUC of remnant cholesterol or other lipid parameters in predicting the occurrence of MACCE in prehypertensive patients was less than that of the combined predictor; comparison of the AUC of the combined predictor with the AUC of lipid parameters alone using the DELONG method revealed significant differences in other AUC except for non-HDLC (P＝0.054), which showed borderline positivity (P＜0.05). Conclusions In prehypertensive patients, remnant cholesterol, LDLC, non-HDLC, TG, TC remnant cholesterol/HD-C, and LDLC/HDLC are independent risk factors for MACCE in such patients. The combined predictive value constructed by remnant cholesterol combined with other lipid parameters has a better predictive value for MACCE in prehypertensive patients.

Abstract:Aim To explore the correlation between remnant cholesterol and severity of coronary artery stenosis in patients with prehypertension based on Gensini score. Methods The clinical data of 36 216 coronary angiography patients hospitalized in the Department of Cardiovascular Medicine of Northern Theater Command General Hospital from 2004 to 2014 were retrospectively analyzed, including 421 patients with prehypertension. There were 85 patients with Gensini score ≥20, and 85 patients with Gensini score <20 in this cohort were selected as the control group. The clinical characteristics of the two groups were observed and the relationship between remnant cholesterol and common blood lipid indexes and the degree of coronary artery stenosis in prehypertensive patients was investigated. The seventh report of the National Joint Committee on the prevention, detection, evaluation, and treatment of hypertension in the United States defines prehypertension as systolic blood pressure of 120 to 139 mmHg(1 mmHg＝0.133 kPa) and/or diastolic blood pressure of 80 to 89 mmHg. The European Atherosclerosis Society (EAS) defines remnant cholesterol as total cholesterol－(high density lipoprotein cholesterol＋low density lipoprotein cholesterol). Remnant cholesterol is the amount of cholesterol in triglyceride-rich lipoprotein. Results In the Gensini score≥20 group, the proportion of diabetic patients and left ventricular ejection fraction were higher than those in the Gensini score＜20 group, the difference was statistically significant (P＜0.05). In terms of lipid-related indicators, the levels of remnant cholesterol, triglyceride and total cholesterol in Gensini score≥20 group were higher than those in the Gensini score＜20 group, the differences were statistically significant (P＜0.05). The correlation analysis of remnant cholesterol and triglyceride in Gensini score≥20 group was conducted. The results showed that there was a correlation between remnant cholesterol and triglyceride (r＝0.535, P＜0.01).Subsequently, patients with triglyceride≥1.7 mmol/L were screened for further correlation analysis, and the results showed that the correlation between remnant cholesterol and triglyceride increased further (r＝0.625, P＜0.01). Logistic regression showed that remnant cholesterol (OR＝8.0,5%CI:2.87～27.53, P＜0.01), low density lipoprotein cholesterol (OR＝3.6,5%CI:1.93～6.57, P＜0.01) and diabetes mellitus (OR＝2.4,5%CI:1.10～5.00, P＜0.05) were significantly associated with severe coronary artery stenosis. Conclusion Remnant cholesterol, low density lipoprotein cholesterol, diabetes mellitus and other factors are closely related to the occurrence of severe coronary artery stenosis in patients with prehypertension complicated with coronary heart disease.

Abstract:Aim To investigate the prognostic significance of brachial-ankle pulse wave velocity on the incidence of hypertension in prehypertensive population. Methods Data of the present retrospective survey were collected from the Health Management Center of the 3rd Xiangya Hospital from 2004.12-2012.12. The baseline characteristics and outcomes of 205 prehypertensive population from the data were analyzed. Results During a median follow-up of 5.89 years, 54 people (26.34%) developed into hypertension; According to the tertiles of baseline brachial-ankle pulse wave velocity values the cases were divided into three groups, the cumulative incidence of hypertension increased from the first tertile to the third tertile, and the differences between three groups were statistically significant(P<0.001); Cox regression analysis showed that brachial-ankle pulse wave velocity was an independent risk factor for hypertension in prehypertensive population after adjusting of baseline age, gender, drinking, education, marriage, body mass index, glomerular filtration rate, fasting plasma glucose, total cholesterol, triglycerides, high density lipoprotein, low density lipoprotein. The risk of development of established hypertension in those individuals with the third, second tertile of brachial-ankle pulse wave velocity at baseline were both higher than those with the lowest tertile of baseline brachial-ankle pulse wave velocity (HR=6.647,P<0.001; HR=3.008, P=0.040). In addition, baseline brachial-ankle pulse wave velocity values increased per 100 cm/s, the risk of development of established hypertension increased 22.3%(P=0.002). Conclusions The brachial-ankle pulse wave velocity is an independent risk factor of hypertension and might be used to predict the risk of development of established hypertension in prehypertensive population.

Abstract:Aim To investigate the gender differences in the levels of nitric oxide in prehypertension and its correlation with the number and function of circulating endothelial progenitor cells. Methods Eighty consecutive population, 46.4±4.3 years old, were divided into four groups:normotensive premenopausal women (n=21), prehypertensive premenopausal women (n=20), normotensive men (n=19) and prehypertensive men (n=20). The nitric oxide (NO), granulocyte-macrophage colony stimulating factor (GM-CSF) and vascular endothelial growth factor (VEGF) levels in plasma and secreted by circulating EPCs were measured in the four groups. Results The distribution of plasma NO level, the NO secretion by cultured EPCs in normotensive and prehypertensive premenopausal women were significantly higher than those in normotensive and prehypertensive men (P＜0.05). The plasma NO level or NO secretion by EPC in normotensive men was also higher than that in prehypertensive men (P＜0.05). However, the plasma NO level or NO secretion by EPC in normotensive premenopausal women was almost equal to that of prehypertensive premenopausal women (P＞0.05). The plasma NO level or NO secretion by EPC was related to the number or activity of circulating EPC. No significant difference was found in plasma VEGF or GM-CSF level in the four groups (P＞0.05). Conclusions The plasma NO level and NO secretion of circulating EPC were preserved in prehypertensive premenopausal women, which was correlated with the number and activity of circulating EPC.

Abstract:Aim To investigate the association between vascular endothelial function and arteriosclerosis in prehypertensive, hypertensive and healthy subjects. Methods 810 consecutive subjects were divided into three groups: hypertension group, prehypertension group and control group. Brachial-ankle pulse wave velocity （baPWV） and flow-mediated brachial artery dilation （FMD） were used to evaluate the artery vascular stiffness and endothelial function respectively. Results Prehypertension group had lower baPWV values and higher FMD values than those in hypertension group（1419.98±209.18 cm/s vs 1487.92±316.99 cm/s and 6.84%±2.64% vs 6.45%±2.46%, P＜0.001）. And there were significant differences between prehypertension group and normal group （1243.33±170.52 cm/s and 8.01%±2.78%）. Furthermore, FMD was significantly and negatively correlated to baPWV in overall population （r-0.316,P<0.001）, hypertension （r＝－0.354, P＜0.001） and prehypertension（r＝－0.266, ＜0.001） group but not in normal group （r＝－0.104, P＝0.097）. Stepwise multiple linear regression analysis showed that FMD was significantly correlated to baPWV in prehypertension group. Conclusions Vascular endothelial dysfunction is initiated in prehypetensive subjects. Therefore, it is necessary to detect FMD in prehypertensive subjects to avoid the progress of arteriosclerosis.

Abstract:AimTo investigate the relationship between ambulatory blood pressure parameters and arterial stiffness in prehypertensive patients.MethodsAccording to their blood pressure level, 204 individuals were divided into three groups: namely normotensive controls (n=63), prehypertensive participants (n=74) and hypertensive patients (n=67).The 24 h ambulatory blood pressure monitoring was used to record 24 h systolic blood pressure (24h SBP), 24 h diastolic blood pressure (24h DBP), daytime systolic blood pressure (dSBP), daytime diastolic blood pressure (dDBP), nighttime systolic blood pressure (nSBP), nighttime diastolic blood pressure (nDBP), 24 h pulse pressure (24h PP), daytime pulse pressure (dPP) and nighttime pulse pressure (nPP).Carotid-radial pulse wave velocity (crPWV) was obtained by Complior device.Results24h SBP, 24h DBP, dSBP, dDBP, nSBP, 24h PP, dPP and nPP were higher in prehypertensive than those in normotensives, but lower in hypertensives (p<0.05 or p<0.01).The crPWV in prehypertensives was 9.67±1.12 m/s, which was higher than that in normotensives (8.27±0.99 m/s), but was lower in hypertensives (10.55±1.71 m/s).Multiple linear regression analysis showed that 24h SBP, 24h PP and nSBP were risk factors for crPWV (β=0.385, 0351 and 0.247；all p<0.05).ConclusionArterial stiffness had been increased in prehypertensives.24h SBP, 24h PP and nSBP are the important influencing factors of arterial stiffness.

Abstract:Aim To assess the current epidemic characterization of prehypertension and risk factors among rural male adult groups in Liaoning province,and to provide scientific basis for preventing hypertension and cardiovascular disease in the rural area for government.Methods Resident(≥5 years) group of 15 122 male people aged more than 35 years old were collected with a multi-stage,stratified clustering sampling scheme in seven small towns of Fuxin county of Liaoning province,China.The blood pressure measurement and correlated risk factors were investigated by trained doctors.Results The prevalence rate of prehypertension for male people aged more than 35 years old in rural of Liaoning was 51.2%,and the prevalence rate of hypertension was 35.8%.With the age increasing,the prevalence rate of prehypertension was obviously down and the prevalence rate of hypertension was up.Multivariable logistic regression revealed overweight and obesity,Mongolian and drinking status were risk factors associated with prehypertension.Conclusions The prevalence of prehypertension of Liaoning rural male adult people is dramatically high;it associated with many risk factors.Comprehensive lifestyle modifications such as weight loss,limitation of alcohol intake to decrease the incidence of prehypertension should be taken,so as to prevent these people from hypertension and cerebrovascular disease.