Arterial stiffness plays a key role in the pathogenesis of cardiovascular disease. However, the relationship between lipid levels and arterial stiffness is controversial. We aimed to investigate the association between lipid parameters and brachial-ankle pulse-wave velocity (baPWV) in Chinese patients with hypertension. A total of 14 071 participants with hypertension in the China Stroke Primary Prevention Trial (CSPPT) were enrolled in the present study. Patients were assigned to 4 equal groups according to their baPWV. Participants in the highest baPWV group were older with a higher prevalence of stroke and diabetes mellitus as well as higher body mass index (BMI), blood pressure, fasting plasma glucose, uric acid, total cholesterol (TC), triglycerides (TG), homocysteine (Hcy), and vitamin B12 levels (P < .001). After adjusting for age, sex, BMI, and other cardiovascular risks, highdensity lipoprotein cholesterol (HDL-C) was negatively related to baPWV (b ¼ À0.22, P ¼ .012), TC (b ¼ 0.08, P ¼ 0.001), TG (b ¼ 0.14, P ¼ .001); non-HDL-C (b ¼ 0.12, P ¼ .001) and positively related to baPWV. The effect was not observed for lowdensity lipoprotein cholesterol (LDL-C; b ¼ 0.12, P ¼ .335).These results suggested that non-HDL-C, TG, and TC were associated with arterial stiffness in a Chinese population with hypertension. HDL-C was inversely associated with arterial stiffness.

Hyper-homocysteinemia (HHcy) is associated with microalbuminuria and glomerular injury in general and diabetic populations. However, HHcy’s role in hypertensive patients was not studied. We investigated whether HHcy is an independent risk factor for renal function decline and development of chronic kidney disease (CKD) in hypertensive men and women. This was a community-based prospective cohort study of 2,387 hypertensive adults without CKD at baseline, with a mean follow-up of 4.4 years. Baseline and follow-up levels of plasma Hcy, folate, vitamin B12, blood pressure and other pertinent covariables were obtained. CKD was defined as an estimated glomerular filtration rate (eGFR) <60 ml/min/per 1.73 m2 and an eGFR decline rate >1 ml/min/per 1.73 m2/year. There was a graded association between Hcy tertiles and eGFR decline. Subjects in the 3rd tertile of Hcy levels had an accelerated rate of eGFR decline and an increased risk of incident CKD, as compared with those in the 1st tertile, after adjusting for age, gender, baseline diabetes, SBP, BMI, smoking, dyslipidemia, eGFR, folate and vitamin B12 levels. In conclusion, in this prospective cohort of Chinese hypertensive adults, elevated baseline plasma Hcy can serve as an independent biomarker to predict renal function decline and incident CKD.

Background and Purpose-We sought to determine whether folic acid supplementation can independently reduce the risk of first stroke associated with elevated total cholesterol levels in a subanalysis using data from the CSPPT (China Stroke Primary Prevention Trial), a double-blind, randomized controlled trial. Methods-A total of 20 702 hypertensive adults without a history of major cardiovascular disease were randomly assigned to a double-blind daily treatment of an enalapril 10-mg and a folic acid 0.8-mg tablet or an enalapril 10-mg tablet alone. The primary outcome was first stroke. Results-The median treatment duration was 4.5 years. For participants not receiving folic acid treatment (enalapril-only group), high total cholesterol (≥200 mg/dL) was an independent predictor of first stroke when compared with low total cholesterol (<200 mg/dL; 4.0% versus 2.6%; hazard ratio, 1.52; 95% confidence interval, 1.18-1.97; P=0.001). Folic acid supplementation significantly reduced the risk of first stroke among participants with high total cholesterol (4.0% in the enalapril-only group versus 2.7% in the enalapril-folic acid group; hazard ratio, 0.69; 95% confidence interval, 0.56-0.84; P<0.001; number needed to treat, 78; 95% confidence interval, 52-158), independent of baseline folate levels and other important covariates. By contrast, among participants with low total cholesterol, the risk of stroke was 2.6% in the enalapril-only group versus 2.5% in the enalapril-folic acid group (hazard ratio, 1.00; 95% confidence interval, 0.75-1.30; P=0.982). The effect was greater among participants with elevated total cholesterol (P for interaction=0.024). Conclusions-Elevated total cholesterol levels may modify the benefits of folic acid therapy on first stroke. Folic acid supplementation reduced the risk of first stroke associated with elevated total cholesterol by 31% among hypertensive adults without a history of major cardiovascular diseases. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00794885.

URL: http://www.clinicaltrials.gov. Unique identifier: NCT00794885.

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BackgroundThe optimal range of blood pressure variability remains unclear. We aimed to stratify the degree of risk of stroke based on visit‐to‐visit systolic blood pressure (SBP) variability in a large Chinese hypertensive population in 32 communities.Methods and ResultsWe retrospectively analyzed the data of 20 702 hypertensive patients from the China Stroke Primary Prevention Trial. The participants were randomized into 2 treatment groups to receive either enalapril or enalapril plus folic acid. Their blood pressures were measured every 3 months. The outcome was the first stroke. Three parameters of SBP variability were calculated: standard deviation, coefficient of variation, and average real variability. The records of first 4, 6, 8, 10 and 12 visits at which SBP was measured were used to calculate SBP variability and to predict subsequent stroke risk in adjusted Cox regression models. After median follow‐up of 4.5 years, 597 patients had experienced stroke. Visit‐to‐visit SBP variability was an independent predictor of subsequent stroke (eg, the hazard ratio for the highest quintile of average real variability [22.67–61.07 mm Hg] over 6 visits was 1.55, 95% CI 1.07–2.25, P=0.021), independent of mean SBP over the follow‐up period. Its value was more predictive when more blood pressure records were used.ConclusionsVisit‐to‐visit SBP variability is an independent predictor of primary stroke in Chinese hypertensive patients. This predictive value depends on the number of blood pressure measurements used to calculate variability but is independent of mean SBP.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00794885.

Objectives There are growing data and a continuing controversy over the efficacy of folic acid supplementation in stroke prevention. We conducted a meta-analysis based on relevant, up-to-date published randomised trials to further examine this issue. Methods Relative risk (RR) was used to measure the effect of folic acid supplementation on risk of stroke with a fixed-effects model. Results Overall, folic acid supplementation reduced the risk of stroke by 8% (n=55, 764, RR: 0.92, 95% CI 0.86 to 1.00, p=0.038). In the 10 trials with no or partial folic acid fortification (n=43 426), the risk of stroke was reduced by 11% (0.89, 0.82-0.97, p=0.010). Within these trials, a greater beneficial effect was observer among trials with a lower percent use of statins (<80% (median), 0.77, 0.64-0.92, p=0.005), and a meta-regression analysis also suggested a positive dose-response relationship between percent use of statins and log-RR for stroke associated with folic acid supplementation ( p=0.013). A daily dose of 0.4-0.8 mg folic acid appeared to be adequate for stroke prevention in comparison with larger doses. In the remaining 5 trials conducted in populations with folic acid fortification (n=12 338), folic acid supplementation had no effect on stroke risk (1.03, 0.88-1.21, p=0.69). Conclusions Our analysis indicated that folic acid supplementation is effective in stroke prevention in populations with no or partial folic acid fortification. Additionally, a greater beneficial effect was observed among trials with a lower percent use of statins. Our Heart 2012;98(Suppl 2): E1-E319 E149 ABSTRACTS on 12 May 2018 by guest. Protected by copyright.

In this prospective cohort of middle-aged Chinese adults, we showed a dose-response relationship between baseline SBP/DBP and eGFR decline without a clear threshold, and such relationship differed remarkably by sex and baseline eGFR level. Men with eGFR below 110 were particularly vulnerable to the adverse renal effects of elevated SBP and DBP.