Trend of anti-hypertensive medications and risk of stroke among hypertensive patients in Taiwan: Based on the NHI database

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Abstracts

proportion, however, the highest proportion in group 4 was elderly (Chisquare = 47.541, P b 0.001). (3) Among the subjects with OSAHS, there were 54 subjects accompanied with coronary heart disease, 52 with diabetes mellitus, 129 with hyperlipidemia, 59 with ischemic cerebrovascular disease and 16 with primary aldosteronism. Conclusion: Among female sleep apnea associated hypertension patients, patients with severe obstructive sleep apnea syndrome have higher body mass index, waist circumference and it was common in elderly. It is frequently accompanied with carbohydrate diseases. Female sleep apnea associated hypertension has a negligible correlation with diversified systemic diseases. Great importance should be attached to the issue of female sleep apnea associated hypertension to improve prognosis and induce morbidity and mortality of cerebrovascular diseases. doi:10.1016/j.ijcard.2011.08.602 0237 Hypertension and its relative risk factors in Chinese physicians — Blood pressure control of Chinese physicians and measurement of key treatment goals (benchmark study) ZHIYI MA, NINGLING SUN People's Hospital of Peking University, Beijing, China Objective: This study aimed to make a cross-sectional survey on hypertension, hyperlipidemia, diabetes mellitus and other cardiovascular risk factors in Chinese physicians and their cognition condition on hypertension diagnosis. Methods: From January 1st to December 15th in 2010, the physicians from fifty-four hospitals of 11 provinces in China were included in our study. They were internists and surgeons. Results: There were 11,249 physicians who finished our survey, including 10,247 internists and 1002 surgeons. The average age of internists was 39.1± 6.8 years old and the average age of surgeons was 39.3 ±6.9 years old. 53.80% of internists and 63.47% of surgeons had high normal blood pressure.18.45% internists and 12.67% surgeons had hypertension history. Among these physicians who had hypertension history, there were 83.08% of internists and 76.38% of surgeons whose blood pressure was still higher than 140/90 mmHg. According to body mass index, 31.53% of internists and 25.95% of surgeons were overweight or obese. The smoking rate was higher in surgeons (18.11%) than in internists (12.75%). There were 13.90% internists and 3.21% surgeons who had hyperlipidemia history. There were 3.79% internists and 1.48% surgeons who had the history of diabetes or impaired glucose tolerance. There were 10.50% internal doctors and 11.98% surgeon doctors who gave the wrong answers to the diagnosis standard for hypertension. Conclusion: Even for Chinese physicians, the control rate of hypertension was still low. It seemed that there were more internists who had the cardiovascular risk factors than surgeons. There were quite a few physicians who had the misunderstanding on the diagnosis standard of hypertension. doi:10.1016/j.ijcard.2011.08.603 0248 Replication of the Global BPgen consortium genome-wide association study on essential hypertension in East Asians BO XIa, YUE SHENb, JIE MIb a Shandong University, Jinan, China b Capital Institute of Pediatrics, Beijing, China Objective: The recent genome wide association study identified eight hypertension susceptibility loci in Europeans. Subsequently, several studies have investigated these associations among East Asian populations. However, the results were inconsistent. In this study, a meta-analysis was performed to assess the association of five

most studied polymorphisms, including CSK rs1378942, CYP17A1 rs11191548, MTHFR rs17367504, FGF5 rs16998073, ZNF652 rs16948048, with hypertension risk. Methods: Published literature from PubMed, ISI web of science and EMBASE databases were retrieved. All studies evaluating the associations between five polymorphisms and hypertension risk in East Asians were included. Pooled odds ratio (OR) with 95% confidence interval (CI) was calculated using fixed- or random-effects model. Results: Six studies (14,676 cases/18,539 controls) for CSK rs1378942 polymorphism, six studies (13,996 cases/17,616 controls) for CYP17A1 rs11191548 polymorphism, four studies (7994 cases/12,844 controls) for MTHFR rs17367504 polymorphism, three studies (6026 cases/8393 controls) for FGF5 rs16998073 polymorphism, and three studies (4297 cases/ 5561 controls) for ZNF652 rs16948048 polymorphism were included in the meta-analysis. The results suggested that both CYP17A1 rs11191548 and FGF5 rs16998073 polymorphisms were significantly associated with hypertension risk in East Asians (CYP17A1 rs11191548: OR = 1.19, 95% CI 1.14–1.24, P = 0.000; FGF5 rs16998073: OR = 1.30, 95% CI 1.23–1.37, P = 0.000); whereas no significant associations were observed for CSK rs1378942 (OR = 1.10, 95% CI 0.97–1.25, P = 0.141), MTHFR rs17367504 (OR = 1.06, 95% CI 0.98–1.14, P = 0.126) or ZNF652 rs16948048 polymorphism (OR = 0.95, 95% CI 0.80–1.13, P = 0.566). Conclusion: The present meta-analysis indicated the significant associations of both CYP17A1 and FGF5 genes with hypertension susceptibility in East Asians.

doi:10.1016/j.ijcard.2011.08.604 0268 Association between gamma-glutamyltransferase and prehypertension in a Chinese population XUZHEN QINa, LING QIUa, TAO XUb, SHAOMEI HANb, XINQI CHENGa, JIE WUa a Department of Clinical Laboratory, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, China b Institute of Basic Medical Sciences of Chinese Academy of Medical Sciences & School of Basic Medicine of Peking Union Medical College, Beijing, China Objective: Basline γ-glutamyltransferase (GGT) has been found to associate with prehypertension; however, to date the data from China are limited. Methods: A cross-sectional study was performed among 2205 subjects from Hei Longjiang Province in China. Results: Multiple logistic regression analyses revealed a significant association of baseline GGT with prehypertension [1.53 (95% confidence interval (CI), 1.13– 2.08), comparing quartile 4 to quartile 1]. In subgroup analyses, the association between GGT and prehypertension was found stronger in Korean, men, drinkers and subjects with prediabetes. ROC analysis showed when GGT was higher than 20 U/L, the risk of developing prehypertension was aggravated. Conclusions: Although serum GGT was always used to be a biochemical liver test, our findings suggest baseline GGT may act as a predictor of prehypertension in Chinese.

doi:10.1016/j.ijcard.2011.08.605 0293 Trend of anti-hypertensive medications and risk of stroke among hypertensive patients in Taiwan: Based on the NHI database NAINFENG CHUa,b, SERWEI CHUb a Department of Community Medicine, SHH-TMU, Taipei, Taiwan b School of Public Health, NDMC, Taipei, Taiwan

Abstracts

Objective: Hypertension (HTN) is an important and prevalent risk factor for cardiovascular diseases. The purpose of this study is to evaluate the trend of anti-hypertensive medications and also examine the risk of stroke among these HTN patients from 2001 to 2005 in Taiwan. Methods: Based on the National Health Insurance (NHI) database, we randomly selected 10% hypertension outpatients from the NHI claim database on 2001 and then follow their anti-HTN medications and occurrence of stroke for a 4-year follow-up period. Results: In 2001, there were 1,931,436 patients with ICD-9 coding of hypertension, we selected 194,547 subjects as the study population, after excluding those who visited less than 3 times or subjects without anti-HTN, there were 135,660 subjects in the finally analyses. The prevalence of stroke among hypertension patients slightly decreased from 12.0 to 11.3% since 2001 to 2005 (for male from 20.1 to 19.8 and for females from 17.7 to 16.7%). There are 27.6% patients with only one anti-HTN medication and 37.0% patients with 3 or more medications for HTN. Among these anti-HTN patients, 68.2% used CCB, 55.1% for beta-blocker, and 42.5% with ACEI and 31% with diuretics. Among these patients, 9395 (4402 males and 5128 females) had both information on 2001 and 2004. The prevalence of stroke was 7.3% in 2001 and increased to 13.6% in 2004. Using Cox proportion hazard model, gender (male) and age were important factors to predict the occurrence of stroke. Compared with betablockers, diuretics had higher relative risk for stroke but the risk was attenuated after adjusting for other confounders (HR = 1.3, 95% CI 0.7–2.6). Conclusions: From this study, we found that the out-patient medical costs for hypertension were increased from 2001 to 2004 in Taiwan. However, the occurrence of stroke among hypertensive patients was also increased during this period. There was no significant protective effect for stroke among hypertensive patients using different anti-HTN medications. Further studies may be indicated to evaluate the cost-effectiveness of different medications on hypertensive-related disorders. doi:10.1016/j.ijcard.2011.08.606 0315 Influences of hypertension and metabolic factors on left ventricular hypertrophy of the patients with metabolic syndrome QIANHUI SHANG, YUBAO WANG, QIANFENG JIANG Institute of Clinical Medicine, Department of Cardiology of Affiliated Hospital, Zunyi Medical College, Guizhou, China Objective: To investigate the effects of hypertension and metabolic factors such as plasma glucose, lipid, and obesity on the left ventricular hypertrophy in the patients with metabolic syndrome. Methods: Fasting plasma glucose (FPG), serum total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C) were detected in 202 patients who visited our hospital from 2006 to 2007. According to whether they suffered hypertension or other metabolic items, the subjects were divided into 9 groups: normal control group, essential hypertension, hypertension with hyperglycemia (group A), hypertension with dyslipidemia (group B), hypertension with obesity (group C), hypertension with hyperglycemia and dyslipidemia (group D), hypertension with hyperglycemia and obesity (group E), hypertension with dyslipidemia and obesity (group F), hypertension with hyperglycemia, obesity and dyslipidemia (group G, n = 24). Left ventricular end-diastolic dimension (LVEDd), left ventricular posterior wall thickness (LVPWT) and interventricular septal thickness (IVST) were determined by echocardiogram. Left ventricular mass index (LVMI) was calculated based on these parameters. Results: Compared with normal control group (72.6 ± 13.8) mm, LVMI was significantly elevated. LVMI from A to G was obviously increased as compared

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with essential hypertension, and LVMI in D to G was significantly higher than that in A, B, or C. LVMI correlated with FPG, TG, TC, HDL-C and LDL-C respectively (r = 0.33, r = 0.19, r = 0.17, r = − 0.27, r = 0.22, r = 0.29 respectively, P b 0.05). Systolic blood pressure (SBP), FPG and HDL-C were independent risk factors by multiple regression analysis (R2 = 0.311, P b 0.01). Conclusion: With the high prevalence of hypertension with metabolic syndrome factors, LVMI is increased in metabolic syndrome patients. SBP, FPG and HDL-C are independent risk factors to induce left ventricular hypertrophy.

doi:10.1016/j.ijcard.2011.08.608 0350 Safety evaluation of enriched-potassium salt in Chinese population YINGXIA MAa,b, CUNBAO LIb, XIUXIAN HUANGc, HONGSHUI YOUa, HONGYE ZHANGa a Beijing Hypertension League Institute, Beijing, China b Neimenggu Medical College, Huhehaote, China c Qinghe Xian Chinese Medicine Hospital, Xingtai, China Objective: Many studies have documented that reducing sodium intake and increasing potassium consumption can decrease blood pressure (BP) in population level. The aim of our study was to assess the safety of long term use of enriched-potassium salt (NaCl: KCl = 1:1) in the Chinese population. Methods: The subjects were the family members whom volunteered to participate in the prevention study of enriched-potassium salt in the Qinghe county. Totally 112 persons (male 43 and female 70) with complete data were analyzed. During the survey we gave them health education and dispensed enriched-potassium salt every 3 months. Results: In the baseline, the mean of serum creatinine, potassium, sodium and chloride were 58.92 ± 11.9 μmol/dL, 4.5 ± 0.4, 141 ± 2.6 and 102 ± 2 mmol/L respectively. After a one year intervention, the mean of serum creatinine was 63.9 ± 13.8 μmol/dL, and 4.2 ± 0.4, 140± 1.5, 102 ± 1.5 mmol/L for serum K, Na and Cl, respectively (paired T-test: P N 0.05). There was a 6.6 u/L decrease for serum ALT after a one year intervention. The spot urinary ratio of sodium to potassium from baseline to a year's intervention was significantly reduced from 11.4 to 4.0 (paired T-test: P b 0.05). Conclusion: The results showed that the low sodium and high potassium salt (NaCl:KCl = 1:1) was safe and had no side effects on the liver and kidney function. Due to the limitation of the sample size and time, further studies are needed.

doi:10.1016/j.ijcard.2011.08.609 0352 The relationship between antihypertensive therapy and renal function in 152 hypertensives LIHUA LIU, YU ZHANG, SUHUAN ZHAO, JIANCHENG WANG, WEI YU, AIJING WANG, XIXUE CUI Hypertension Research Studio 731 Hospital China Aerospace Science and Industry Corporation, Beijing, China Objective: To observe the effects of antihypertensive therapy on serum creatinine (CRE) and estimated glomerular filtration rate (eGFR) in hypertensive patients. Methods: Totally 152 hypertensives were randomly divided into four groups (group A: amlodipine+ telmisartan, B: amlodipine + amiloride, C: amlodipine+ telmisartan+ simvastatin, D: amlodipine+ amiloride + simvastatin). They were followed for 2 years. Results: After 3 months of treatment, means of SBP and DBP