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   Table of Contents - Current issue
Coverpage
October-December 2018
Volume 3 | Issue 4
Page Nos. 117-144

Online since Wednesday, December 19, 2018

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CLINICAL REGISTRY STUDY  

Comparing an internet-based medical model with a conventional medical model in the management of patients with hypertension in China: Methodology of a cluster randomized study p. 117
Jie Jiang, Ningling Sun, Jianping Li, Xinhua Zhang, Bei Shi, Chen Yao, Dong Zhao, Hongwei Sun, Shengyuan Wu, Chengming Gu, Yong Huo
DOI:10.4103/cp.cp_31_18  
Background: The awareness, treatment, and control of hypertension are low in China. New and effective management model other than conventional hospital-based practices is needed to optimize the assessment and treatment of hypertension. Objectives: The objective of the study is to design a study that compares blood pressure (BP) control rate in hypertensive patients managed through an internet-based medical model versus conventional medical model. Methods: The study designed is a cluster randomized, unblinded controlled study which will be performed in 14 primary care clinics in Guizhou Province in southwest China. Sites will be randomized to provide BP management services to the patient through an internet-based medical model including home BP monitoring (HBPM) and telemonitoring by primary care physicians, or through a conventional medical model including HBPM and periodical visits to the clinic. Patients aged 45–75 years with two measurements of resting systolic BP (SBP) ≥140 mmHg and/or diastolic BP (DBP) ≥90 mmHg on different days during screening will be enrolled. The primary endpoint is the BP control rate, defined by the percentage of patients achieving target office BP (SBP <140 mmHg and DBP <90 mmHg). Using a superiority design, at least 958 patients were calculated to be sufficient to detect a 10% difference in BP control rate between groups, with a power of 85% and 15% drop out rate. Other outcomes include BP value, BP variability, treatment compliance, medical expense, and treatment satisfaction. Discussion and Conclusion: The results of the trial will be applicable to primary care services in China, especially in the west of China, where medical resources are less readily available. If successful, the internet-based management model with HBPM and telemonitoring from primary care physician may help to improve the BP control in patients in China. Clinical.gov Registration: NCT03527563.
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REVIEW ARTICLE Top

From intensive statins to intensive lipid lowering: Amplitude of low-density lipoprotein-cholesterol lowering is the core for atherosclerosis cardiovascular disease prevention p. 122
Daoquan Peng
DOI:10.4103/cp.cp_27_18  
Cholesterol is a risk factor for atherosclerotic cardiovascular disease (ASCVD). The epidemiology, clinical intervention trials, and genetic studies that low-density lipoproteins (LDLs) cause ASCVD. Lowering LDL-C is a cornerstone and important strategy for the prevention and treatment of ASCVD. The benefit of reducing ASCVD by statins is completely dependent on the absolute reduction of LDL-C. Several recent large trials have also now shown that lowering LDL with non-statins reduces cardiovascular events. In ASCVD patients on statins, adding ezetimibe or a PCSK9 inhibitor led to reductions in CV events in the IMPROVE IT, FOURIER, and the ODYSSEY-OUTCOMES trials. Compared with high-dose statins, statins combined with nonstatins, such as ezetimibe, can more effectively lower LDL-C and can result in a more significant reduction in the risk of CVD. Therefore, this therapy is a lipid-lowering option with significant efficacy and sufficient evidence of benefit in clinical practice.
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RESEARCH ARTICLES Top

Incidence of atrial fibrillation and risk factors analyzing in 126 cases of aortic surgery p. 127
Yaping He, Hao Peng, Kaitao Jian, Qingzhi Li, Wei Liu, Yanlin Li
DOI:10.4103/cp.cp_23_18  
Objective: This study aims to determine the current incidence of atrial fibrillation postaortic repair surgery and further identify its clinical predictors. Patients and Methods: Over a 17-month period starting on September 1, 2016, and ending on January 31, 2018, diverse types of aortic surgery were performed on 126 consecutive patients (age range, 8–75 years and median age, 43 years) with aneurysm (n = 67) or dissection (n = 59) of the ascending, arch, thoracic, or abdominal aorta. Totally 41 patients received operations on an emergency basis because of acute Type A dissection. Potential predictors of postoperative atrial fibrillation (POAF) were estimated by a logistic regression model. Results: The incidence of postoperative new onset of atrial fibrillation (AF) was 26.2% (n = 33). Patients who developed POAF were more likely to be of advanced age (51 ± 16 vs. 40 ± 14, P < 0.01), and female patients were more likely to develop POAF compared with male patients (48.5% vs. 26.9%, P = 0.02). Patients with cardiac dysfunction (39.4% vs. 10.8%, P < 0.01), and those who underwent operations on the ascending aorta (48.5% vs. 29.0%, P = 0.04) were also more likely to develop POAF. Multivariate logistic regression analysis revealed that only advanced age and cardiac dysfunction were independent predictors of POAF (P = 0.029, odds ratio [OR] = 1.01, 95% confidence interval [CI]: 0.001–0.012; P = 0.003, OR = 1.34, 95% CI: 0.103–0.487). Conclusions: The prevalence of POAF is not rare in terms of patients undergoing aortic repair surgeries. Perioperative heart failure and increasing age may be correlating risk factors.
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The traditional Chinese medication nuanxin capsule aids in the treatment of chronic heart failure p. 132
Qing Zhou, Yun Zhang, Zhongwen Zhang, Panpan Hao
DOI:10.4103/cp.cp_33_18  
Background: Nuanxin capsule is a standardized Chinese herbal medication that is commonly used alongside conventional treatment for chronic heart failure (CHF) in China. However, whether or not it improves outcomes is unknown due to the lack of high-quality randomized controlled trials (RCTs). Methods: We did a patient-level pooled-analysis of 14 RCTs in which 1112 CHF patients from nine medical centers in China were enrolled. These patients were randomly assigned to treatment with Nuanxin capsule in addition to conventional treatment, conventional treatment with placebo, or conventional treatment alone. Our primary outcomes were mortality and rehospitalization rate. Secondary outcomes included New York Heart Association (NYHA) functional classification, plasma brain natriuretic peptide, 6-min walking distance, echocardiographic parameters, and noninvasive hemodynamic parameters. Results: Treatment with Nuanxin capsule significantly decreased mortality (risk ratio [RR] = 0.30, 95% confidence interval [CI] 0.15–0.58, P = 0.0003, I2 = 0%) and rehospitalization rate (RR = 0.47, 95% CI 0.36–0.62, P < 0.00001, I2 = 0%). Nuanxin capsule therapy also had favorable effects on secondary outcomes. Fail-safe = 0.05 value for NYHA functional classification showed negligible publication bias, with a very low probability that future studies can change the current conclusion. Conclusion: We provided conclusive evidence for the beneficial effects of Nuanxin capsule in patients with CHF.
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GUIDELINE AND CONSENSUS Top

Recommendations for the clinical application of Angiotensin II receptor blocker in patients with coronary heart disease in 2018 p. 138
Jianping Li, Yundai Chen, Chuanyu Gao, Yong Li, Guohai Su, Ningling Sun, Yida Tang, Jiguang Wang, Meng Wei, Xiaowei Yan, Yong Huo
DOI:10.4103/cp.cp_34_18  
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CASE REPORT Top

Hyperkalemia-induced brugada phenocopy complicated with supraventricular tachycardia: A case report of rare electrocardiogram manifestation p. 142
Manyun Guo, Yangyang Deng, Yue Wu, Jianqing She
DOI:10.4103/cp.cp_22_18  
In rare clinical cases, hyperkalemia can present with a type 1 Brugada EKG pattern, which correlates with fatal cardiac arrhythmia but could be resolved after hyperkalemia lowering treatment. In this case report, we present a rare EKG manifestation of hyperglycemia induced Brugada phenocopy complicated with supraventricular tachycardia. Early detection and quick diagnose for this kind of EKG presentation is crucial for making prompt and accurate treatment.
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