Objective To investigate the effects of Irbesartan on endothelial function and autonomic nervous system activity of patients with essential hypertension. Methods The endothelium dependent flow mediated dilatation (F-MD) and the endothelium independent nitroglycerin mediated dilatation (NTG-MD) were evaluated by the brachial ultrasound examination. Time-domain indices of heart rate variability (HRV) were measured by 24 h ambulatory electrocardiogram. The changes of blood lipoproteins, blood glucose, insulin levels, endothelial function and heart rate variability in 60 patients with mild-moderate essential hypertension and 20 healthy controls were compared, and the effects of different antihypertensive agents (AT1 receptor blocker and diuretic) for 8-week treatment were observed. Results Endothelial dysfunction and abnormal autonomic nervous activity were observed in patients with mild-moderate essential hypertension as follow: mildly decreased total HRV and mildly increased 24-hour average heart rate, significantly decreased parasympathetic tone-rMSSD and PNN50, obviously lowered endothelium dependent F-MD. The postprandial insulin level and insulin/glucose ratio of patients with hypertension was significantly higher than that of healthy controls. The decreased blood pressure level caused by AT1 receptor blocker (Irbesartan) and diuretic (Indapamide) was similar. Irbesartan for 8-week therapy resulted in a significant improvement of the endothelium dependent F-MD and insulin resistence, the increase of vagal nervous activity and the decrease of 24-hour average heart rate, but Indapamide presented no such effects. Conclusion This study suggested that patients with mild-moderate essential hypertension have significantly abnormal endothelial function and autonomic nervous activity, and the beneficial effect of Irbesartan is associated with an improvement of insulin resistence and heart rate variability, not with the decrease of blood pressure level.

The outbreak of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 has rapidly spread globally. Cancer patients are at a higher risk of being infected with the coronavirus and are more likely to develop severe complications, as compared to the general population. The increasing spread of COVID-19 presents challenges for the clinical care of patients with gynecological malignancies. Concerted efforts should be put into managing gynecological malignancies in an orderly manner by strictly implementing the measures that are specifically developed for controlling the spread of COVID-19. We have drafted Recommendations on Management of Gynecological Malignancies during the COVID-19 Pandemic based on our experience on controlling COVID-19 pandemic in China. We recommend that patients with gynecological malignancies should be managed in hierarchical and individualized manners in combination with local conditions related to COVID-19. Medical care decision should be balanced between controlling COVID-19 pandemic spread and timely diagnosis and treatment for gynecologic oncology patients.