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简介：Pulmonaryhypertensionisnotasingleentityandnotallformshavethesameprognosis.Thepurposeofthiseditorialistoprovideinformationtothegeneralcardiologistrelatingtowhichtypeofpulmonaryhypertensionthepatientisexperiencing.Inordertodothisproperly,onemustdeterminethecause,theseverity,theprognosis,anddeveloptreatmentplansforthedifferentformsofpulmonaryhypertension.Pulmonaryarterialhypertension(PAH)isthemostmalignantofthedifferenttypesofpulmonaryhypertension.Whiletypicallybeingdiagnosedinayoungerpopulationthantheothertypes,PAHmaybeshowingatrendtowardsdiagnosislaterinthelifethanwhatwasthoughtfromolderregistrydata[1].TheusualcausesofcardiovasculardeathinpatientswithPAHincludesrightheartfailureandsuddendeath[2].

简介：AbstractHypertension in pregnancy is currently defined as a systolic blood pressure (BP) of 140 mmHg or more, or a diastolic BP of 90 mmHg or more. This level of BP warrants antihypertensive therapy. Treating to a target BP of 135/85 mmHg halves the risk of severe hypertension that is itself associated with adverse maternal and perinatal outcomes, similar in magnitude to preeclampsia. While based on the results of the Control of Hypertension in Pregnancy Study (CHIPS) trial, this finding is consistent with all antihypertensive trials to date. Also, in the CHIPS trial, "tight" BP control also halved the risk of progression to thrombocytopenia and elevated liver enzymes for the mother, without adverse effects for the fetus or newborn. This was true regardless of the gestational age at which BP control was instituted. While methyldopa, labetalol, and nifedipine are the most commonly-recommended oral antihypertensives, it is not clear that one antihypertensive agent has advantages over the others for treatment of non-severe hypertension in pregnancy. No antihypertensives, including renin-angiotensin-aldosterone system (RAAS) inhibitors, have been shown to be teratogenic, although there may be an increase in malformations associated with the underlying condition of chronic hypertension. Atenolol and RAAS inhibitors should not be used once pregnancy is diagnosed, based on fetotoxicity. At present, BP treatment targets used in clinic are the same as those used at home as the differences are quite variable among hypertensive women. For treatment of acute severe hypertension, the most commonly-recommended antihypertensives are oral nifedipine, IV labetalol, and IV hydralazine, although oral agents have also been shown to be effective in the majority of women; while concerns raised about IV hydralazine-induced maternal hypotension and its consequences have not been confirmed, this medication may be an inferior antihypertensive to oral nifedipine. While treatment recommendations are based on evidence, women should be engaged in decision-making, as their values may alter target BP and antihypertensive choice. Future work will clarify the optimal target BP based on home BP measurements; whether BP targets should be lowered further if the definition of hypertension is based on a lower BP; which, if any, antihypertensive medication for non-severe hypertension is better with regards to maternal and perinatal outcomes; and whether factors beyond BP level (such as variability, race, and other physiological variables) should inform antihypertensive therapy in pregnancy.

简介：Hypertensionisaleadingriskfactorforcardiovasculardisease,theleadingcauseofdeathandmorbidityinoursocietyandonaglobalscale.Majorcomponentsofcardiovasculardiseaseincludestroke,coronaryarterydisease,heartfailure,andchronickidneydisease,inallofwhichhypertensionplaysamajorrole.Theriskofthesecomplicationsincreasesdirectlyandlinearlywithsystolicbloodpressurestartingat115mmHg.Althoughusuallyasymptomatic,hypertensionisreadilydetectableonphysicalexaminationandisamenabletobothlifestylemodificationandpharmacologictreatmentinmostpatients.However,largeproportionsofthehypertensivepopulationremainundetectedandundertreated.Numerousguidelineshavebeenissuedduringthepastfewdecadestopromotedetectionandoptimaltherapy.Despitetheincreaseinriskwithsystolicbloodpressuregreaterthan115mmHg,thegenerallyacceptedthresholdfordiagnosisandtreatmenthasbeensystolicbloodpressuregreaterthan139mmHganddiastolicbloodpressuregreaterthan80mmHgbecauseuntilrecentlytreatmenttolowerlevelshasbeenassociatedwithanunfavorablerelationbetweenclinicalbenefitandharm.Inthepastseveralyears,newguidelines,advisories,commentaries,andclinicaltrialshaveprovidedevidenceforapotentialchangeincurrentrecommendationsforthemanagementofhypertension.Inthisregard,thelong-awaitedeighthreportoftheJointNationalCommitteeonthePrevention,Detection,Evaluation,andTreatmentofHighBloodPressurerecommendedpatientsolderthan60yearsbetreatedtoasystolicbloodpressureoflessthan150mmHg,whichhasgeneratedconsiderablecontroversyandcaution.ThestrikingfindingsoftheSystolicBloodPressureInterventionTrial(SPRINT)havereceivedconsiderableattentionbecauseofthedemonstrationthatintensivetherapytoatargetsystolicbloodpressurebelow120mmHgdecreasescardiovascularmortalityandmorbiditymorethanlessintensivetreatmenttoatargetsystolicbloodpressurebelow140mmHg

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简介：AbstractAmbulatory 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.

简介：AbstractImportance:Extensive population-based studies have explored the prevalence of primary hypertension (HTN) in children and adolescents. However, there is little published data on the characteristics of different types of pediatric HTN and the causes of secondary HTN.Objective:To investigate the characteristics of different types of pediatric HTN and the causes of secondary HTN in a hospital setting.Methods:The study cohort comprised pediatric inpatients (<18 years of age) discharged with a diagnosis of HTN from Beijing Children’s Hospital during 2015-2020. Pediatric patients with HTN were allocated to secondary and primary HTN groups on the basis of comprehensive analyses of their diagnoses, family history of HTN, and findings on physical examination, as documented in their medical records. The Mann-Whitney U test, χ2 and Fisher’s exact test were used to assess differences in characteristics of patients with different HTN types and causes of secondary HTN.Results:Data of 1470 inpatients with HTN from 18 clinical departments were included in the analysis. Among them, 458 (31.2%) had primary HTN, and 1012 (68.8%) had secondary HTN. Compared with patients had primary HTN, children with secondary HTN were younger and had lower body mass indexes and longer lengths of stay. Moreover, children with primary HTN had mostly been managed by the Endocrinology and Cardiology Departments, 75.8% of them having obesity-related comorbidities. In contrast, most patients with secondary HTN had been managed by the Nephrology Department, renal diseases being the leading cause of their HTN (46.3%).Interpretation:Secondary HTN is more common than primary HTN in pediatric clinical settings, renal diseases being the leading cause of secondary HTN.

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简介：BackgroundMicroRNAshaverecentlybeenconsideredasbiomarkersinseveraldifferentcardiovasculardiseases,however,sofartherearenocirculatingmiRNAsdataabouthypertension.Therefore,theaimofthepresentpilotstudywastoidentifycirculatingmiRNAsforhypertensionbiomarkers.MethodsUsinganAgilentmicroarray,plasmamiRNAswereprofiledfromplasmasamplesof10patientswithuntreatedessentialhypertensionand10healthycontrols.CandidatebiomarkersidentifiedintheprofilesweresubjectedtovalidationbyusingquantitativePCRinanindependentsamplesetof20patientswithuntreatedessentialhypertensionand20healthycontrols.Then,weassessedtheselectedmiRNAsforthedetectionanddiagnosisofhypertensionfromplasmasamplesof70patientswithuntreatedessentialhypertensionand20healthycontrols.TheSpearmancorrelationcoefficientwasusedtoassessedtheselectedmiRNAscorrelationswithbloodpressure.Theareaunderthereceiveroperatingcharacteristiccurve(AUC)wasusedtoevaluatediagnosticaccuracy.ResultsTheexpressionsofselected8miRNAswereinvestigatedindependentlyinplasmasamplesfrom10hypertensionpatientsand10healthysubjects.ThelevelsofcirculatingmiR-30c-5p,miR-133b,miR-29b-3p,miR-29a-3p,miR-29c-3p,miR-30a-3p,miR-let7b-3pexpressionweresignificantlydownregulatedinhypertensiongroupcomparedwithhealthygroupandthelevelofhsa-miR-92b-3pwassignificantlyunregulatedbetweenthegroups.WeusedqRT-PCRassaytoconfirmtheexpressionof8candidatemiRNAs,miR-30c-5p(P<0.001),miR-29b-3p(P<0.001),miR-29a-3p(P=0.027),miR-29c-3p(P<0.001),miR-92b-3p(P=0.003),miR-30a-3p(P=0.704),miR-133b(P=0.346),andmiR-let7b(P=0.161).ThediagnosticaccuracyofmiR-30c-5p,miR-29b-3p,miR-29a-3p,miR-29c-3pandmiR-92b-3p,asmeasuredbyAUC,were0.897,0.90,0.829,0.825and0.832,respectively,withallP<0.001.ConclusionsTheplasmalevelsofmiR-30c-5p,miR-29b-3p,miR-29a-3p,miR-29c-3pandmiR-92b-3passociatedwithhypertensionwhichprovideanimp

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简介：Accordingtothemostrecentepidemiologicaldata,theprevalenceofhypertensionrangedfromabout25%inChineselivingeitherinthemainlandorinTaiwanandKoreans,toapproximately40%inMongolians.Thecontrolrateofhypertensionwasabout35%inKoreansandJapanese,24%inMongolians,andlessthan10%inChinese.Fourplacebo-controlledtrialsinChinaunequivocallyprovedthatantihypertensivetherapymaypreventstrokeandothercardiovascularcomplicationsinhypertensionorpatientswithahistoryofstrokeortransientischemicattack.Fouractively-controlledtrialsinJapandidnotshowsignificantdifferencebetweenvariousclassesorcombinationsofantihypertensivedrugs.TwotrialsthatcomparedintensivewithlessintensivebloodpressurecontrolinelderlyJapanesehypertensivepatientsdidnotshowfurtherbenefitofcontrollingsystolicbloodpressuretoalevelbelow140mmHgincomparisonwithbloodpressurecontroltoalevelof140mmHgorabove.Thesetrialsthatcomparedvariousclassesofantihypertensivedrugsorintensivewithlessintensivebloodpressurecontroloftenhadsmallsamplesizeandhenceinadequatepowertodetectmodestormoderatebenefit.ThereisstillaneedforhighqualityoutcometrialdatainEastAsians.

简介：Rightventricularfailure(RVF)remainstheprimarycauseofdeathinpatientswithpulmonaryarterialhypertension.WereviewthepathophysiologyofRVF,includingtheremodelingandventriculoarterialuncouplingthatoccurswhenthefailingrightsideoftheheartisunabletocompensateforarisingafterload.Secondly,thenoninvasiveimagingtechniquesusedintheassessmentofRVFareexplored,includingechocardiography,cardiacmagneticresonanceimaging,computedtomography,andpositronemissiontomography.Third,wedescribehowtheseimagingtechniquesandapatient’sclinicalcharacteristicsmaybeusedtodetermineprognosis.Lastly,weexplorethemedicalandsurgical/interventionaltreatmentoptionsforRVF.Despitethesetreatmentoptions,morbidityandmortalityremainhighinthispatientpopulation.Thediscoveryofnewprognosticindicators,useofhybridimagingforearlydetectionofRVF,andstrategiestopreventthedevelopmentofRVFwillbeimportantifoutcomesinthispatientpopulationaretoimprove.

简介：ObjectivesToinvestigatetheprevalenceofhypertensionanditsprimaryriskfactorsinpatientswithdilatedcardiomyopathy(DCM).MethodsThreehundredandsixty-twopatientswithDCM(DCMgroup)and401age-matchedresidents(controlgroup)wereenrolledrandomlyinthestudy,thehypertensiveprevalenceratewerecalculatedrespectivelyinthetwogroupsandwerecomparedwitheachother;thepatientsintheDCMgroupweredividedintotwosubgroups(hypertensionsubgroupandnon-hypertensionsubgroup)accordingtowhetherthepatientshavehypertension;theclinicaldatarelatedtobloodpressurewascomparedbetweenthetwosubgroups.ResultsTheprevalenceofhypertensioninDCMgroupwassignificantlyhigherthanthatinthecontrolgroup(32.8%vs.20.1%,P<0.01);Therewerenosignificantdifferencesontheage,gender,occupationandleftventricularejectionfraction(LVEF)betweenthetwosubgroups,butthemeanheartrateandthepercentageofpatientswhohadfamilyhistoryofhypertensionweresignificantlyhigherinthehypertensionsubgroupthanthatinthenon-hypertensionsubgroup(P<0.05andP<0.01).ConclusionsTheprevalenceofhypertensioninpatientswithDCMwashigh;TheincreasedactivityofsympatheticnervoussystemandthehypertensivegeneticfactormaybethemainriskfactorsofhypertensioninpatientswithDCM.

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简介：BackgroundPregnancycomplicatingpulmonaryarterialhypertension(PAH)isalife-threateningobstetricalcomplication.FewstudieshavereportedtheclinicalcharacteristicsandoutcomesofpregnantwomenwithPAH.MethodsRetrospectivelyanalysiswasconductedon86casesofpregnantwomenwithPAHattheDepartmentofObstetricinGuangdongGeneralHospitalbetween2009and2014.Dataincludedpatients'age,theetiologiesofPAH,clinicalclassificationoftheNewYorkHeartAssociation(NYHA),gestationalweeks,deliverymode,maternalandfetaloutcomes.Results1Therewere2casesofidiopathicpulmonaryarterialhypertension(IPAH)and84casesofsecondarypulmonaryarterialhypertension.Thelatterwascomposedby40(47.61%)casesofcongenitalheartdisease(CHD),38(45.23%)casesofrheumaticheartdisease(RHD),3(3.57%)casesofsystemiclupuserythematosus(SLE)and1(1.19%)caseofpartialhydatidiformmole.ThenumberofpatientsclassifiedinNYHAI~IVwere8(9.30%),41(47.67%),26(30.23%)and11(12.7%),respectively.Andthemortalitywas3.48%(3/86).2Amongthe86patients,31(36.04%)womengavebirthattermand36(41.86%)hadprematuredelivery.Inaddition,16(18.6%)womenhadanabortionlessthan28weeks.Therewereatotalof65(75.58%)livebirths,61(93.84%)ofwhomweredeliveredviacesareansection,whiletheother4(6.15%)werevaginaldeliveries.3Patientsweredividedinto3groups,12ofmild(<40mmHg),35ofmoderate(40~70mmHg)and39ofsevere(≥70mmHg)regardingthepulmonaryarterysystolicpressure(sPAP)measuredbyultrasound.WedefinedtheformertwoasgroupAandthelatterasgroupB.Thesignificancewasseenstatisticallyingestationalweeks(32.86±8.86gvs28.76±9.84),therateoftransferringtoICU(19.14%vs53.84%),neonatalbirth-weight(2725.69±467.43vs2044.82±665.75g),APGARscoring(9.97±0.16vs8.68±2.08),maternalstatusofheartfunctionandadversepregnantoutcomes,whencomparedgroupAwithB.AlltheP-valuesmentionedabovew

简介：BackgroundLeftventricularhypertrophy(LVH)inducedbysystemichypertensionrepresentsamaladaptiveresponsetotheincreasedoverload.HoweverantihypertensivetreatmentsarenotalwaysusefultoregressorpreventLVH.Thoroughlyunderstandingthemechanismswillhelptofindnewtherapeutictargetsthatpreventorreverseleftventricularhypertrophy.Anumberofregulatorsandmolecularsignalingpathwayshavebeenshowntobeinvolvedinthehypertrophicprocess,suchasangiotensinII,heatshockproteins90,microRNAs,TRPC,mTOR,HDACandPI3K/Aktsignalingpathways.Therefore,othertreatments,suchasG1cyclinantagonists,HSP90inhibitor,Rho-kinaseinhibitor,calcineurinblockers,CS866,statins,scutellarin,andaldosteroneantagonistcouldpreventleftventricularhypertrophy.

简介：The5thChina-JapanJointHypertensionSymposiumwasheldonNovember6th,2002inGuangdongCardiovascularInstitute,GuangdongProvincialPeople’sHospital,Guangzhou,China.Therewereatotalof96paperspublished(includedspeciallectures,oralpresentations,posters).Almost200cardiologists,whocamefromJapanandChina,attendedthesymposium.

简介：ObjectiveThestudywillexploreeffectsoftheautoantibodiesagainstAT1receptorandangiotensinⅡontherefractoryhypertension.MethodsSeventy-sevenpatients(46menand31women)withessentialhypertensionweredividedintogroupsofrefractoryhypertension(RH)andhypertension(HT)accordingtothe1999WHO-ISHGuidelinesfortheManagementofHypertension.Fortynormotensives(22men)wererecruitedascontrols.Themeanagewas54.3±13yearsoldinRHgroup,53.5±9yearsoldinHTgroupand51.2±11.9yearsoldinnormotensives(NT)group.Themeanbloodpressurewas154.2±9.4/98.4±8.2mmHginRHgroupand130.1±7.6/80.5±6.7mmHginHTgroupaftercombinationdrugtherapyofhypertensionfor4weeks.BloodpressureinNTgroupwas120.8±11.7/76.4±7.2mmHg.Theepitopeofthe2ndextracellularloopsofAT1receptorwassynthesizedandusedasantigenstoscreentheautoantibodiesbyELISA.Plasmaangiotensin(Ang)IIwereexaminedbyaradioimmunoassay.ResultsT

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