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Association of stage 1 hypertension defined by the 2017 ACC/AHA guideline with cardiovascular events and mortality in Chinese adults

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Chinese Medical Journal 2024年第1期137卷 63-72页

作者： Qiannan Gao Liuxin Li Jingjing Bai Luyun Fan Jiangshan Tan Shouling Wu Jun Cai Hypertension Center Fuwai HospitalState Key Laboratory of Cardiovascular DiseaseNational Center for Cardiovascular DiseasesPeking Union Medical CollegeChinese Academy of Medical SciencesBeijing 100037China Department of Cardiology Kailuan General HospitalNorth China University of Science and TechnologyTangshanHebei 063000China Emergency Center Fuwai HospitalState Key Laboratory of Cardiovascular DiseaseNational Center for Cardiovascular DiseasesPeking Union Medical CollegeChinese Academy of Medical SciencesBeijing 100037China

Background:The 2017 American College of Cardiology/American Heart Association(ACC/AHA)blood pressure(BP)guideline lowered the threshold defining hypertension to 130/80 mmHg.However,how stage 1 hypertension defined using this guideline is associated with cardiovascular events in Chinese adults remains unclear.This study assessed the association between stage 1 hypertension defined by the 2017 ACC/AHA guideline and clinical outcomes in the Chinese population.Methods:Participants with stage 1 hypertension(n=69,509)or normal BP(n=34,142)were followed in this study from 2006/2007 to 2020.Stage 1 hypertension was defined as a systolic blood pressure of 130-139 mmHg or a diastolic blood pressure of 80-89 mmHg.None were taking antihypertensive medication or had a history of myocardial infarction(MI),stroke,or cancer at baseline.The primary outcome was a composite of MI,stroke,and all-cause mortality.The secondary outcomes were individual components of the primary outcome.cox proportional hazards models were used for the analysis.Results:During a median follow-up of 11.09 years,we observed 10,479 events(MI,n=995;stroke,n=3408;all-cause mortality,n=7094).After multivariable adjustment,the hazard ratios for stage 1 hypertension vs.normal BP were 1.20(95%confidence interval[CI],1.13-1.25)for primary outcome,1.24(95%CI,1.05-1.46)for MI,1.45(95%CI,1.33-1.59)for stroke,and 1.11(95%CI,1.04-1.17)for all-cause mortality.The hazard ratios for participants with stage 1 hypertension who were prescribed antihypertensive medications compared with those without antihypertensive treatment during the follow-up was 0.90(95%CI,0.85-0.96).Conclusions:Using the new definition,Chinese adults with untreated stage 1 hypertension are at higher risk for MI,stroke,and all-cause mortality.This finding may help to validate the new BP classification system in China.

关键词： Hypertension Cardiovascular disease All-cause mortality cox regression analysis

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Evidence-Based Therapy May Improve Outcome in Glomerulonephritis—A Prospective Field Survey

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Open Journal of Nephrology 2012年第4期2卷 49-59页

作者： Norbert Braun Anna Schweisfurth Hermann-Josef Grone Guenther Kundt Department of Internal Medicine MediClin Muritz-KlinikumWarenGermany Department of Nephrology and Dialysis HELIOS HospitalSchwerinGermany Department of Cellular and Molecular Pathology German Cancer Research CentreHeidelbergGermany Institute for Biostatistics and Informatics in Medicine University of RostockRostockGermany

Introduction and aims: Although glomerulonephritis is rare in the general population it is the second most important cause for end-stage renal failure. The therapy of glomerulonephritis is guided by a limited number of individual clinical trials and treatment recommendations are based on meta-analysis and Cochrane Systematic Reviews. The impact of such therapy standards on the prognosis of glomerulonephritis is not known. Methods: Between October 2002 and December 2008 patients with abnormal urine findings and/or decreasing renal function of unknown cause were referred for renal biopsy. In a collaboration of out-patient nephrologists with a major teaching hospital, all patients received treatment recommendations according to evidence-based therapy guidelines based on Cochrane Systematic Reviews. Patient charts were systematically reviewed and patients were re-examined for follow-up until November 2009. cox regression analysis was performed to identify independent prognostic factors. Results: Two hundred patients with primary or secondary glomerulonephritis were identified. Complete follow-up data were available from 196 patients with 324 therapeutic interventions. The mean follow-up was 2.8 ± 2.0 years. Among all patients, 37% remained unchanged ill, 13% died, 17% had progressing renal disease, while 19% had a complete and 14% a partial remission. Proteinuria declined in primary glomerulonephritis (5.0 ± 5.4 g/d to 2.1 ± 3.4 g/d, p Conclusions: In a multivariate model of standardised glomerulonephritis therapy the presence of tubulointerstitial fibrosis was associated with death or progresssive renal disease, while prednisolone-based therapy regimens and intensified nephrological follow-up resulted in a significant delay of endstage-renal failure. This result should direct future health care policies because glomerulonephritis accounts for nearly 20% of the dialysis population.

关键词： Glomerulonephritis Therapy Evidence-based Medicine Treatment Recommendation Field Survey Immunosuppression Tubulointerstitial Fibrosis cox regression analysis

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影响严重烧伤患者28天生存状况及并发症的相关因素分析

影响严重烧伤患者28天生存状况及并发症的相关因素分析

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作者：王碧莹昆明医科大学

学位级别：硕士

目的：回顾云南省烧伤研究所2012年1月至2013年7月以来收治的成人严重烧伤患者的住院临床病历资料100例。分析我省严重烧伤休克期液体复苏疗法治疗的现状、特点及存在的问题。探讨影响严重烧伤患者28天生存状况及并发症发生的影响因素,... 详细信息

目的：回顾云南省烧伤研究所2012年1月至2013年7月以来收治的成人严重烧伤患者的住院临床病历资料100例。分析我省严重烧伤休克期液体复苏疗法治疗的现状、特点及存在的问题。探讨影响严重烧伤患者28天生存状况及并发症发生的影响因素,为今后诊疗水平的进一步提供一定的参考。方法：筛选云南省烧伤研究所2012年1月到2013年7月期间收治的所有严重烧伤患者病历100份。对烧伤后前48小时液体复苏情况进行统计,并用实际补液量与全国烧伤补液通用公式预计补液量进行比较分析。以患者的基本情况、烧伤特点、休克期液体复苏情况等作为自变量,以28天生存状况及并发症的发生作为因变量,进行各并发症的Logistic回归分析和28天生存状况的cox回归分析,探讨自变量中与并发症及28天生存状况相关的影响因素。结果：1.本组患者各时间段补液量与全国烧伤液体复苏通用公式所计算的预计补液量比较：第一个8小时补液量的t检验结果为：t=13.58,p=0.000.05,与NFR预计补液量无统计学差异。2.通过对各并发症进行Logistic回归分析和28天生存状况的cox回归分析,得出如下回归方程及OR值或RR值：菌血症：logit (p)=-3.422+2.184气管切开+0.001第一个8小时晶体量,气管切开OR=8.883,第一个8小时晶体量OR=1.001。肺炎：Logti (p)=-3.170+1.142气管切开+0.001第二个24小时胶体量,气管切开OR=3.134,第二个24小时胶体OR=1.001。ARDS:logit (p)=-4.858+1.591气管切开+0.001第二个24小时胶体量气管切开OR=4.91,第二个24小时胶体量OR=1.001。MODS:logit (p)=-4.858+2.238气管切开+0.001第二个24小时胶体量,气管切开OR=9.378,第二个24小时胶体量OR=I.001。28天生存状况：In[h(t)/ho(t)]=1.686吸入性损伤+1.532低血容量休克+0.001第二个24小时实际水分量+2.829肺炎+1.045ARDS吸入性损伤RR=5.296,低血容量休克RR=4.625,第二个24小时实际水分量RR=1.001,肺炎RR=16.924, ARDS的RR=2.844。结论：1.云南省交通欠便利,基层医院烧伤专科不多,存在早期液体复苏治疗不充分的问题,统计结果为烧伤后第一个8h补液总量少于公式预计量。入烧伤中心后积极、有效的抗休克治疗,使得大部分严重烧伤患者较平稳度过休克期,休克期死亡率较低(7%)。2.临床上对于面颈部烧伤及中、重度吸入性损伤的患者积极预防性气管切开,防治窒息的发生。但同时应加强雾化、翻身、吸痰及无菌操作等护理。并且待肺功能改善后应尽早拔管、脱机,降低感染引发各种并发症的风险。(菌血症OR=8.8,肺炎OR=3.1,ARDS OR=4.9,MODS OR=9.4)3.肺炎、ARDS及MODS的回归分析中,除气管切开外,“第二个24小时胶体量偏多“,成为相关危险因素之一,(有待今后临床更多观注总结,OR=1.001)。4.普及火灾急救知识,降低吸入性损伤的发生率及严重程度。积极防治肺炎的发生,打断ARDS到MODS的序贯发生过程。通过合并症和并发症的积极防治,提高患者28天生存率。(由高到低：肺炎RR=16.924,吸入性损伤RR=5.296,低血容量性休克RR=4.626, ARDSRR=2.844,第二个24小时水分RR=1.001)5.烧伤中心补液生存曲线可知严重烧伤患者17天以后的生存率开始明显降低,仅为临床对病情预后判断提供一些参考。

关键词： burn fluid resuscitation complication Logisticregressionanalysis cox regression analysis

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