中华心血管病杂志最新文献

Objective: To explore the relationship between long-term blood pressure variability and arteriosclerosis in women with a history of hypertensive disorders in pregnancy (HDP). Methods: This study was a retrospective cohort study. Data were obtained from the Kailuan Research Database. Women with a history of HDP who delivered between January 1990 and December 2020 and completed brachial-ankle pulse wave velocity (baPWV) measurement in the postpartum period were enrolled. Baseline data were obtained from the first post-delivery health examination, while the outcome measure was the baPWV recorded during the last follow-up visit, synchronized with blood pressure measurements. Based on long-term blood pressure variability, the enrolled study subjects were divided into the first, second, and third tertile groups in ascending order using the tertile method, and intergroup differences in clinical characteristics were compared. Multivariable logistic regression was performed to evaluate the impact of long-term blood pressure variability levels on arteriosclerosis risk in women with a history of HDP. Sensitivity analyses excluded individuals with multiple deliveries to validate the robustness of findings. Subgroup analyses were conducted based on delivery age (<40 vs. ≥40 years) and blood pressure measurement frequency (3 vs. >3 times) to explore the potential impact of different population characteristics on the study results. Results: A total of 421 study subjects were enrolled, aged (36.07±6.05) years, with a baPWV value of (1 376.80±238.18) cm/s. Long-term blood pressure variability was 4.66 (3.41, 6.50) mmHg (1 mmHg=0.133 kPa). The first, second and third quartile group included 140, 141 and 140 individuals, respectively. In the total population, the incidence of arteriosclerosis was 40.4% (170/421). The incidence rates in the first, second, and third tertile groups were 34.3% (48/140), 39.0% (55/141), and 47.9% (67/140), respectively. Multivariate logistic regression analysis showed that increased long-term blood pressure variability was an independent risk factor for arteriosclerosis in women with a history of HDP (OR=1.702, 95%CI 1.018-2.844, P=0.043). The results of sensitivity analyses were consistent with that of the primary analysis (OR=1.758, 95%CI 1.044-2.959, P=0.034). Subgroup analyses further indicated that in the subgroups with delivery age <40 years (OR=2.116, 95%CI 1.153-3.885, P=0.016) and blood pressure measurement frequency >3 times (OR=1.894, 95%CI 1.069-3.355, P=0.029), the association between long-term blood pressure variability and arterial stiffness risk was more significant. Conclusions: For women with a history of HDP, elevated long-term blood pressure variability may increase the risk of arteriosclerosis, and this effect is more pronounced in younger women (delivery age <40 years) and those with high-frequency

Objective: To investigate the ultra-long-term antihypertensive efficacy, safety, major adverse events, and survival benefits of renal denervation (RDN) in patients with resistant hypertension (rHTN) and mild chronic kidney disease (CKD). Methods: This real-world, single-center retrospective study enrolled patients with rHTN and mild CKD who underwent RDN at Tianjin First Central Hospital between October 2011 and June 2016. Office blood pressure, home self-measured blood pressure, 24-hour ambulatory blood pressure, serum creatinine, estimated glomerular filtration rate, and urine albumin-to-creatinine ratio were collected at baseline and at 1, 5, and 13 years post-RDN. The total daily defined dose of antihypertensive medications at 13 years post-RDN was recorded, along with endpoint events during follow-up, including cardiovascular death, all-cause death, hospitalization for heart failure, myocardial infarction, and stroke. Patients were stratified according to CKD stage (G1-G2 vs. G3a) and baseline systolic blood pressure (mild-to-moderate vs. severe hypertension), and follow-up data were compared across subgroups. Results: A total of 40 patients were included, aged (51±15) years, including 26 (65%) males. At the 13-year follow-up, office systolic blood pressure (SBP) and diastolic blood pressure (DBP) decreased by (-32±20) mmHg and (-15±14) mmHg (1 mmHg=0.133 kPa), respectively; reductions in home self-measured blood pressure (SBP: (-25±14) mmHg, DBP: (-10±11) mmHg) and 24-hour ambulatory blood pressure (SBP: (-16±9 mmHg, DBP: (-10±6) mmHg) were also observed, alongside a reduction in the total daily defined dose of antihypertensive medications by (1.1±0.9) compared to baseline. Renal function assessments showed no significant differences at 13 years versus baseline in serum creatinine ((105±51) μmol/L vs. (96±22) μmol/L), estimated glomerular filtration rate ((72±22) ml·min^-1·1.73 m^-2 vs. (78±17) ml·min^-1·1.73 m^-2), or urine albumin-to-creatinine ratio ((101±86) mg/g vs. (127±82) mg/g) (all P>0.05). All-cause and cardiovascular mortality rates during follow-up were 13% (5/40) and 8% (3/40), respectively. Subgroup analysis results showed that, although CKD G1-G2 patients had smaller reductions in office SBP ((-31±20) mmHg vs. (-34±19) mmHg) and DBP ((-13±10) mmHg vs. (-25±18) mmHg) compared to G3a patients at 13 years, intergroup differences were not significant (all P>0.05). In contrast, severe hypertension subgroup exhibited greater reductions in office SBP ((-55±13) mmHg vs. (-20±10) mmHg) and DBP ((-24±17) mmHg vs. (-13±10) mmHg) versus mild-to-moderate hypertension subgroup (all P<0.05). Conclusion: RDN demonstrates sustained antihypertensive efficacy with favorable renal safety in rHTN patients with mild CKD. Patients with higher baseline systolic blood pressure may exhibit better responsiveness to RDN.

Objective: To explore an initial target rate for resuscitation attempted by bystanders for patients experiencing out-of-hospital cardiac arrest in China. Methods: We searched seven electronic databases, including CNKI, VIP, Wanfang, CBM, PubMed, Cochrane, EMBase, for Utstein-style reports of out-of-hospital cardiac arrest, containing data on bystander resuscitation and survival to discharge or 30 days after arrest. All patients with cardiac arrest diagnosed at prehospital emergency medical services were included. Meta-analysis was performed to pool rate ratios (RR) with 95% confidence intervals (CI) of the rate of survival to discharge or 30 days. The population attributable risk percent (PARP) was calculated with RR, and the growth rate curve of PARP following bystander cardiopulmonary resuscitation rate was plotted. We established a multiple linear regression model to show the change in survival to discharge or 30 days with increasing rates of resuscitation attempted by bystanders. Results: We included 24 cohorts with 279 641 patients experiencing out-of-hospital cardiac arrest. The median rates of bystander cardiopulmonary resuscitation and survival to discharge or 30 days after arrest in seven cohorts from China were 2.8% and 0.47%, respectively, both far below the first tertiles in all cohorts worldwide (10.0% and 2.70%, respectively). The meta-analysis showed that resuscitation attempts by bystanders increased the chance of survival to discharge or 30 days (RR=5.91, 95%CI 3.28-10.66; I²=0, P=0.990). The growth rate curve on PARP showed a rapid attenuation in the increase of PARP after the bystander resuscitation rate reached 10%. The multiple linear regression showed that resuscitation attempted by bystanders could explain 74.4% of the variation in the rates of survival to discharge or 30 days. By increasing the bystander resuscitation rate to 10%, the rate of survival to discharge or 30 days could increase to 1.40% (95%CI 0.76%-2.05%), and the PARP could increase from 19.7% to 32.9%. Conclusions: Low rate of resuscitation attempted by bystanders is currently the main reason for the poor survival rate of out-of-hospital cardiac arrest in China. It is recommended to increase the rate of resuscitation attempted by bystanders in stages with an initial target rate of 10%.