| Part1 A Survey of Current Status of Hypertension Diagnosis and Treatment in the Elderly of Shanghai Xin-Zhuang Community Applying the Informatization Management SystemObjective: To evaluate current status of hypertension management and the prevalence of resistant hypertension in the elderly after the informatization management system was established for 5 years in Xin-Zhuang Community of Shanghai, so as to explore the experiences and shortages of the management system.Methods: From June to December in 2012, the Health Center of Shanghai Xin Zhuang Community carried out the check-ups for the elderly who aged at least 60 years. Blood pressures were measured with an electronic sphygmomanometer(Microlife 3AJ1-2) for 3 times, and the average of the 3 readings was used for analysis. The information on the use of antihypertensive drugs was inquired onsite. Blood pressure ?140/90 mm Hg is the threshold to define hypertension and uncontrolled hypertension.Results: 1) A total of 14804 elderly people were invited, 9605(64.9%) participated in the check-up, and the data of 8347(male, 45.7%) was used for analysis. 2) The prevalence of hypertension was 56.9%, and the rates of awareness, treatment, control, and control rate under treatment were 82.0%, 79.1%, 47.8%, and 60.4%, respectively. 3) Among the 3760 treated hypertensive patients, 54.1% were taking only one type of antihypertensive drug, and only 10 patients(0.3%) were taking at least 3 drugs including one diuretic and can be defined as “resistant hypertension”. 4) As for the hypertensive medication, calcium channel blocker(45.1%) was the most frequently used antihypertensive drugs, the second and third were the angiotensin receptor blocker(22.8%) and traditional combination compound(17.6%), and the relatively less frequently used drugs were Beta-blockers(4.2%) and ACE inhibitors(4.1%).Conclusions: The awareness and treatment rates were relatively high in the Xin-Zhuang Community which applying the informatization management system. However, the system needs to be improved to encourage combination therapy, and to increase the control rate of hypertension.Part2 Prevalence and Characteristics of Resistant Hypertension in the China National Blood Pressure RegistryObjective: To analyze the database of the China National Blood Pressure Registry to explore the prevalence and clinical characteristics of resistant hypertension.Methods: From August 2009 to November 2013, we enrolled patients from 59 hospitals in 18 provinces and cities across China. Office and home blood pressure measurement were performed with electronic monitors(Omron HEM-7011-C) and 24-hour ambulatory blood pressure with validated monitors(Space-Labs 90217, Mobil-O-Graph, et al). Information about antihypertensive medications, lifestyle and previous disease history was inquired with the use of a standardized questionnaire. Blood pressure control status was defined based on the level of the ambulatory blood pressures. Variance and covariance analysis were performed to compare the clinical characteristics between resistant hypertension, controlled hypertension and under-treated hypertension.Results: 1) Among registered 2891 patients, 192 were normotensive, and 2626 were hypertensive, among whom 1986 were on antihypertensive treatment and 640 untreated. 2) The blood pressure control rate was 22.7% in the whole population,and 31% in the treated population,24.4% of the population was untreated and 45.8% were under-treated. 3) The prevalence of resistant hypertension was 8.3%, highest among elderly aged 60 to 80 years and lowest below age of 40 years. 4) Compared to the patients with controlled hypertension, patients with resistant hypertension had been diagnosed as hypertensive at a younger age, had longer duration of hypertension and a higher body mass index, more frequently reported smoking and drinking, and more likely had a non-dipper pattern of blood pressure profile. 5) Compared to patients with controlled hypertension,patients with resistant hypertension had greater day-to-day home blood pressure variability. After adjustment for sex, age, BMI, smoking, drinking, diabetes mellitus, the home mean systolic and diastolic blood pressure, and heart rate, the difference remained statistically significant(P<0.05). Similarly, compared to the patients with controlled hypertension, patients with resistant hypertension had a greater coefficient of variance of the 24-hour systolic and diastolic blood pressure, while there was no significant difference in other 24-hour short-term blood pressure variability indices and in parameters of heart rate variability.Conclusions: In our multicenter blood pressure registry study, the prevalence of resistant hypertension was 8.3%. Resistant hypertension was associated with an early diagnosis of hypertension, a long duration of hypertension, smoking and drinking, obesity, a non-dipper blood pressure pattern and greater blood pressure variability.Part 3 Resistant Hypertension and Target Organ DamageObjective: To analyze the data of treated patients enrolled in the Hypertension Clinic of Ruijin Hospital and to explore whether there is difference between resistant hypertension and controlled hypertension in terms of target organ damage.Methods: Totally 412 subjects(mean age 58.8 years; 60% female) were classified based on the 24-hour ambulatory blood pressures into 81 cases with resistant hypertension, 183 with controlled hypertension and 158 with under-treated hypertension. Resistant hypertension were further classified into uncontrolled or controlled resistant hypertension. We used the analysis of variance to compare between groups the difference in the measures of target organ damage, and the multivariate linear regression to analyze the association of target organ measures with the levels and variability of the 24-hour systolic and diastolic blood pressures and heart rate.Results: 1) Patients with uncontrolled resistant hypertension, compared to patients with controlled resistant hypertension and controlled hypertension, had statistically significant(P<0.05) higher urinary microalbumine to creatinine ratio( 4.0 vs 1.7 vs 2.4 mg/mmol), and carotid-femoral(9.5 vs 8.6 vs 8.3 m/s) and brachial-ankle pulse wave velocity(16.7 vs 14.7 vs 14.9 m/s) after adjustment for age, body mass index, duration of hypertension, smoking, drinking, diabetes, chronic kidney disease, the presence of carotid arterial plaques, blood glucose, and serum uric acid level. There was no significant difference between controlled resistant hypertension and controlled hypertension(P>0.05). 2) Urinary albumine to creatinine ratio was significantly associated with 24-hour systolic and diastolic blood pressure(P<0.001). Serum creatinine was closely associated with systolic pressure, but not diastolic blood pressure and heart rate. Estimated glomerular filtration rate was associated with systolic pressure(P=0.049) and heart rate(P=0.02). Both carotid-femoral and brachial-ankle pulse wave velocity were significantly associated with systolic and diastolic blood pressure and heart rate(P<0.001). Central augmentation index was associated with heart rate(P<0.001), but not with systolic and diastolic blood pressure. 3) Most target organ measures were not independently associated with 24-hour blood pressure variability and heart variability indices(P?0.07), except that there were associations of urinary albumine to creatinine ratio with the standard deviation of 24-hour diastolic blood pressure(P=0.009), brachial-ankle pulse wave velocity with standard deviation of 24-hour systolic pressure(P=0.02), and estimated glomerular filtration rate and carotid-femoral pulse wave velocity with heart rate variability(P<0.05).Conclusions: Patients with resistant hypertension had a worse profile of target organ damage measures, especially for the uncontrolled resistant hypertension. Target organ damage was closely associated with systolic and diastolic blood pressure and heart rate. Blood pressure variability and heart rate variability may also play a role in target organ damage associated with hypertension. |
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