Objectives:To explore the feasibility of using hemodynamic phenotypes to guide antihypertensive treatment medication. Methods:This study prospectively included 100 hypertensive patients who received outpatient treatment at Haidian Hospital in Beijing from January 2021 to December 2021.Evaluation of blood pressure was conducted using laboratory and home blood pressure measurements,impedance cardiogram(ICG)detection was performed.Following hemodynamic phenotypes and therapeutic phenotypes were established:hyperkinetic phenotype(increased heart rate)using β-blockers,large artery phenotype(increased large artery resistance index)using calcium antagonists,peripheral vascular phenotype(increased peripheral vascular resistance index)using renin angiotensin system inhibitors,and high-volume phenotype(increased blood volume saturation)using diuretics.Patients were randomly divided into ICG group(n=50,medication treatment based on hemodynamic characteristics)and control group(n=50,treatment based on hypertension guidelines and clinical experience).Patients were followed up for 8 weeks and the blood pressure reduction amplitude and compliance rate were compare between the two groups. Results:There was no statistically significant difference in baseline data such as sex,age,height,weight,and hemodynamic parameters between the two groups(all P＞0.05).There was no statistically significant difference in the types of baseline medication between the two groups(P＞0.05).After medication adjustment,the types of medication increased,but the difference between the two groups was still not statistically significant(P＞0.05).Clinic blood pressure:After 8 weeks,decreases in systolic([8.38±27.78]mmHg,1 mmHg=0.133 kPa)and diastolic([3.94±18.15]mmHg)blood pressure were greater in the ICG group as compared to the control group(both P＜0.05).The blood pressure compliance rate(＜140/90 mmHg)was higher in the ICG group than that in the control group(66.0%vs.42.0%,P＜0.05).Family blood pressure:after 8 weeks,the reduction in systolic([8.22±21.31]mmHg,P＜0.01)and diastolic([4.76±13.88]mmHg,P＜0.05)blood pressure was greater in the ICG group compared to the control group.The blood pressure compliance rate(＜135/85 mmHg)was higher in the ICG group than that in the control group(70.0%vs.48.0%,P＜0.05).Changes in corresponding hemodynamic parameters before and after two different antihypertensive drugs:the heart rate,arterial resistance index,peripheral vascular resistance index,and blood volume saturation of the ICG group all significantly decreased compared to baseline(all P＜0.05).The control group showed a significant decrease in peripheral vascular resistance index compared to baseline(P＜0.05),while there was no statistically significant difference in heart rate,large artery resistance index,and blood volume saturation compared to baseline(all P＞0.05). Conclusions:By using impedance cardiogram to assess hemodynamic phenotypes and accurately guide the selection of antihypertensive drugs based on hemodynamic phenotypes,it is possible to more effectively lower blood pressure and improve blood pressure compliance.

Objective:To investigate the development of hypertension specialty and chronic disease management of county-level hospitals in China, for reference in improving the standardized chronic disease management level of hypertension in the counties.Methods:From September to November 2020, a questionnaire survey on 597 county-level hospitals in 24 provinces was conducted on a voluntary basis. The survey covered such areas as the setup of hypertension specialty, team building of professionals and the management regulations of chronic hypertension of the hospital. The survey data were analyzed by descriptive statistics.Results:Among the 597 county-level hospitals, 54(13.5%) hospitals had independent hypertension departments, 147(24.6%) had hypertension clinics, and 143(24.0%) hospitals had hypertension beds. 431(72.2%) hospitals had hypertension diagnosis and treatment process in outpatient clinics, 454(76.0%) hospitals had hypertension diagnosis and treatment process in wards, and 535(89.6%) hospitals had graded diagnosis and treatment process of hypertension. 473(79.2%) hospitals had established county medical alliance as the lead unit, including 167 compact medical alliances. 97.7% of the hospitals were equipped with basic hypertension risk stratification screening items, and 63.8% could carry out primary screening of secondary hypertension.Conclusions:The pattern of chronic diseases management of hypertension in county-level medical institutions has basically taken shape, but there is still room for improvement. In the future, we should focus on the construction of professional teams of hypertension, the standardized management of diagnosis and treatment of hypertension, and a smoother path of tiered medical service, so as to increase the health management level of hypertension in China.

The clinical application of immune checkpoint inhibitors (ICIs) has significantly improved the prognosis of hepatocellular carcinoma (HCC) patients. With the widespread applica-tion of ICIs in HCC, the management of immune-related adverse events (irAE) gained more and more attention. However, the complicated disease characteristics and various combination therapies in HCC throw out challenges to irAE management. Therefore, the editorial board of the 'Chinese expert consensus on the management of immune-related adverse events of hepatocellular carcinoma treated with immune checkpoint inhibitors (2021 edition)' organizes multidisciplinary experts to discuss and formulate this consensus. The consensus focuses on issues related to HCC irAE manage-ment, and puts forward suggestions, in order to improve standardized and safety clinical medication, so as to maximize the benefits of immunotherapy for patients.

Objective To survey the status of aspirin application asautiplatelet therapy for secondary prevention of coronary artery disease (CAD) in Beijing communities.Methods A cross-sectional survey on status of aspirin use was conducted among 60 communities in Beijing from September 2014 to January 2015.Items of survey included the duration of aspirin application,aspirin dosage,application time,reasons for interruption and reasons for non-application.Results Total 61 000 questionnaires were delivered and 56 969 valid ones were retrieved with a recovery of 93.39％.The aspirin application rate was 78.22％ (15 105/19 311)among patients with diagnosed CAD,while that was 81.42％ (1 319/1 620) among patients with self-reported CAD (x2=9.06,P＜0.01).There was no effect of early cardiovascular disease family history on aspirin application among patients with diagnosed CAD (P =0.77).Among the patients with diagnosed CAD,the reasons of no aspirin application were:rejection with unknown reasons,worry about stomach side effects,clopidogrel application,not suitable subjectsand other antiplatelet drugs application.Conclusions The proportion of aspirin application is relatively high among coronary artery disease patients in Beijing communities.The results of survey provide the direction of patient education in the future.

Objective: To evaluate the long-term efficacy and prognostic factors of childhood acute lymphoblastic leukemia (ALL) enrolled in Shanghai Children's Medical Center-Acute Lymphoblastic Leukemia-2005(SCMC-ALL-2005) multicenter study. Methods: Between May 2005 and December 2014, 1 497 newly diagnosed ALL patients were enrolled and treated in 5 hospitals of SCMC-ALL-2005 study group, using risk-stratified SCMC-ALL-2005 protocol. Risk group classification and treatment intensity were based on clinical features, genetic abnormalities, early response to treatment and levels of minimal residual disease (MRD). Kaplan-Meier method was used to generate overall survival (OS) and event-free survival(EFS) curves. Cox proportional hazards models were used for multivariate analyses. Results: The patients were followed up to December 31, 2016, the median follow-up time was 69 months (24-141 months). The 5-year and 10-year OS rates were (80.0±1.0)% and (76.0±2.0)%. The 5-year and 10-year EFS rates were (69.0±1.0)% and (66.0±2.0)%. The 5-year and 10-year relapse rates were (23.0±1.0)% and (25.0±2.0)%. The 5-year OS and EFS for low risk (LR), intermediate risk (IR) and high risk (HR) were (91.1±1.4)% and (83.3±1.8)%, (79.2±1.5)% and (68.9±1.7)%, (52.9±4.4)% and (30.0±3.8)%, respectively. MRD negative status (<0.01%) on day 55 was seen in 792 patients (82.8%) and positive MRD on day 55 was associated with poor prognosis (OR=1.9, 95%CI: 1.3-2.7, P=0.001). Twenty-four HR patients received allogeneic hematopoietic stem cell transplantation and 17(70.8%) of them were alive and in remission. A total of 164 severe adverse events occurred, 46 of them died, treatment-related mortality was 3.1%. Conclusions In this large sample research, the overall outcome for multi-center SCMC-ALL-2005 study was favorable. This helps to promote the standardized treatment of childhood ALL to the whole country. MRD results on day 55 of induction therapy have important prognostic and therapeutic implications.

Objective: To analyze plasma levels of catestatin (CST) in patients with different blood pressure (BP) and metabolic status.
Methods: Our research included in 3 groups: Control group,n=60 subjects with normal BP from physical examination in our hospital; 131 patients with essential hypertension (EH) were divided into 2 groups: Isolated EH group,n=90 and MS (metabolic syndrome) group,n=41. Plasma levels of CST, norepinephrine (NE) were examined, the ratio of CST/NE was calculated, and those indexes were compared among different groups.
Results: Compared with Control group, plasma levels of CST and the ratios of CST/NE were decreased in Isolated EH and MS groups,P<0.05-0.01. As BP increasing, plasma levels of CST were gradually decreased; compared with Isolated EH group, plasma level of CST and CST/NE were reduced in MS group,P<0.05.
Conclusion: Plasma levels of CST and the ratio of CST/NE were obviously decreased in EH patients, CST was even lower in MS patients which implied that CST might be involved in the development of EH and MS.

Consensus ; Humans ; Hypertension

Objective To analyze the outcome of childhood B-cell acute lymphoblastic leukemia treated (ALL) with SCMC-ALL-2005 protocol. Methods Newly diagnosed B-cell ALL from May 1, 2005 to April 30, 2009 in ifve hospitals were treated and followed up according to SCMC-ALL-2005 protocol. Results A total of 601 cases with newly diagnosed B-cell ALL were enrolled. Among them, 539 cases (89.68%) were followed up until September 30, 2011. In 601 patients, there were 284 low-risk cases (LR group), 231 moderate-risk cases (MR group) and 86 high-risk cases (HR group) which were treated with SCMC-ALL-2005 protocol. The total complete remission rate during the period of induction was 98.84%and 7 cases did not achieve complete remission. The median time of the ifrst event occurring was 35 months (2.94 years). Among 539 cases completing follow-up, 403 cases (74.77%) completed treatment including 223 cases (86.43%) in LR group, 150 cases (73.17%) in MR group and 30 cases (39.47%) in HR group. The rate of cases completing treatment was signiifcantly different among three groups (P=0.001). The completion rate was highest in LR group and lowest in HR group. The 3-year overall survival (OS) rate was (83.3±1.8)%, and the 3-year EFS (event-free survival) rate was (79.2±1.9)%using a Kaplan-Meier method. The 5-year OS rate was (79.5±3.3)%, and the 5-year EFS rate was (70.9±3.7)%. There were signiifcant differences in 3-year EFS rate and 5-year EFS rate among three groups (P<0.05). Conclusions Childhood B-ALL treated with SCMC-ALL-2005 protocol achieved a better therapeutic effect and prognosis. The multi-center collaborative research is useful for the standard treatment of ALL.

Objective To evaluate the efficacy of Nebivolol on patients with mild or moderate essential hypertension(EH) using different methods of ambulatory blood pressure monitoring.Methods Forty-seven patients with mild or moderate EH were enrolled as our subjects after a 2-week administration of placebo.They were administrated Nebivolol (5 mg) once daily for 12 weeks.All the patients completed ambulatory blood pressure monitoring before and after taking Nebivolol for 12 weeks.The overall and individual methods were used to calculate the trough-to-peak ratio (T/P ratio) and smooth index (SI).Results (1) For all of 42 patients treated with Nebivolol (5 mg) for 12 weeks,the systolic blood pressure(SBP),diastolic blood pressure(DBP) of the whole-day,daytime and nighttime after treatment were decreased compared to before treatment (the whole day:(144.1 ± 9.8),(124.4 ± 10.4) mmHg vs.(93.2 ± 6.3),(79.2 ± 7.2) mmHg;daytime:(148.9 ± 9.7),(128.3 ± 10.5) mmHg vs.(96.8 ±6.1),(82.2 ±7.5) mmHg;nighttime:(133.9 ± 11.9),(115.9 ± 12.0) mmHg vs.(85.7 ± 8.0),(72.5 ± 7.5) mmHg),and there was significant difference (t =8.06,8.74,8.00,8.82,5.75,and 6.57 respectively; P ＜ 0.01).T/P ratios of SBP/DBP calculated by overall method were 78.4％ (17.4/22.2) and 61.2％ (9.0/14.7),but it were (79.3 ±0.4) ％ and (58.5 ±0.5) ％ by individual calculation method.(2) Among 30 patients with better effect,the SBP,DBP of the whole-day,daytime and nighttime after treatment were decreased compared to before treatment (the whole day:(143.4 ± 9.1),(127.5 ±10.7) mmHgvs.(92.6 ±6.2),(81.6±7.6) mmHg;daytime:(147.8 ±9.1),(131.0 ±10.5)mmHg vs.(95.8 ± 6.4),(84.1 ± 7.5) mmHg; nighttime:(134.7 ± 11.6),(119.6 ± 13.2) mmHg vs.(86.2 ± 7.4),(75.2 ± 8.5) mmHg),and there was significant difference(t =11.18,12.77,11.14,12.85,7.37,and 8.74 respectively,P ＜0.01).T/P ratios of SBP/DBP were 78.9％ (18.3/23.2),75.3％ (11.6/15.4) and SIof SBP/DBP were 7.4(19.5/2.6),7.1 (14.2/2.0) calculated by overall method,but T/P ratios of SBP/DBPwere (78.4 ± 0.4) ％,(74.6 ± 0.4) ％ and SI were (1.35 ± 0.73),(1.34 ± 0.54) calculated by individualmethod.Conclusion Nebivolol (5 mg once daily) can significantly reduce ambulatory blood pressure.Overall calculation method is better than individual method in terms of assessing the time of durative action and smooth effect by trough peak ratio and smooth index.

Objective To investigate blood pressure control the glucose metabolism,cardiovascular risk factors of patients who were regularly followed up at professional hypertension clinics in China.Methods A cross-sectional survey was conducted in 32 004 patients from 127 professional hypertension clinics across China.The questionnaires included case history and related treatment physical examination and laboratory biochemical tests were also taken at the same time.Results The mean blood pressure of overall population was (151 ± 13)/(92 ± 10) mm Hg(1 mm Hg =0.133 kPa).Totally 3424 patients (10.7％) had never taken any anti-hypertension medicine.Among patients treated with anti-hypertension drugs,19 818 were of mono-therapy (69.3％) and 8762 were of combination therapy.The most frequently used drug was reninangiotensin system inhibitor,followed by calcium-channel blocker.Fixed compound preparations accounted for 15.6％.The overall blood pressure control rate (＜ 140/90 mm Hg) was 26.8％,among them,27.7％,30.0％,25.4％ and 21.3％ patients were complicated with coronary heart disease,diabetes mellitus,kidney diseases and cerebral stroke respectively.About 70.3％ hypertensive patients had abnormal glucose metabolism whose mean glycosylated hemoglobin (GHbA1 c) was 7.84％,which was significantly higher than 7.0％,the target value defined by ADA.Even among them,20.2％ patients have never received any anti-diabetic drugs.Low-risk and medium-risk patients accounted for 16.0％.Totally 48.0％ patients were classified in high-risk group and 36.0％ in very high risk group.About half of all patients had different target organ dysfunction.About 49.0％ patients had associated comorbidities.Conclusions Co-existence of hypertension and abnormal glucose metabolism is common in Chinese population.Among these patients,target organ dysfunction and comorbidities are prevalent,but blood pressure is only effectively controlled in less than 30％ patients.Low proportion of combination therapy is one of the reasons for unsatisfied control of blood pressure.It indicates that effective management of hypertension is urgent.