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Essential hypertension (EH) results when the balance between vasoconstriction and vasodilation is shifted in favor of vasoconstriction. This balance is controlled by the interaction of genetic and epigenetic factors. When there is an unstable balance, vitamin D deficiency as an epigenetic factor triggers a shift to the side of vasoconstriction. In this article, we critically analyze clinical findings on the effect of vitamin D on blood pressure, combined with progress in molecular mechanisms. We find that vitamin D repletion exerts a clinically significant antihypertensive effect in vitamin D-deficient EH patients. Of note, a few trials reported no antihypertensive effect from vitamin D due to suboptimal study design. Short-term vitamin D supplementation has no effect on blood pressure in normotensive subjects. This could explain the mixed results and may provide a theoretical basis for future trials to identify beneficial effects of vitamin D in intervention for EH. KeywordsEssential Hypertension; Vitamin D; Clinical Trial; Molecular Mechanism Essential Hypertension (EH)One billion people worldwide suffer from hypertension (HTN) [1]. Of these patients, 95% have hypertension of unknown etiology, called essential hypertension (EH), and cannot maintain normal blood pressure (BP) without daily treatment [2]. Many signaling pathways are involved in BP regulation in EH. These include the angiotensin II (Ang II)-sympathetic nerve-CD4 + T cell system [3], a pathway consisting of a series of genes participating in the control of renal salt handling [4], and pathways mediating constriction and dilation of vascular smooth muscle (VSM) cells [5,6]. Dysfunction of any one of these pathways leads to increased VSM tone and remodeling in resistance arteries, resulting in high BP. However, Address correspondence to: Songcang Chen MD, Assistant Professor, Center for Clinical & Translational Science, 2500 California Plaza, Omaha, NE USA 68178, Ph: (402) 280-3488, SongcangChen@creighton.edu. Potential conflicts of interest/financial disclosure: None All authors have read the journal's authorship agreement and publication policy and declare no conflict of interest.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. HHS Public Access Author Manuscript Author ManuscriptAuthor ManuscriptAuthor Manuscript the exact etiology and pathogenesis of EH is poorly understood, leading to nonspecific and less-effective treatment. In America, 50% of hypertensive patients (∼68 million) do not have their BP well-controlled and about 5 million patients are resistant to antihypertensive treatment with a c...

Background: Short sleep duration was reported to be associated with an increased risk of hypertension among adults. The present study aimed to investigate this association in children and adolescents. Hypothesis: Short sleep duration is related to higher risk of hypertension among children and adolescents. Methods: We conducted a cross-sectional study of 4902 children and adolescents age 5 to 18 years. Blood pressure (BP) was measured at the research center and classified using the population-based percentiles. Sleep duration and related information were determined through questionnaires. Results: The prevalence of hypertension and prehypertension were 20.3% and 15%, respectively. The median sleep duration was 8.77 ± 1.07 hours (mean ± standard deviation). A short sleep duration (<9 hours) was associated with a higher risk of hypertension when compared with the group sleeping longer (9

Background: Various anthropometric indices can be used to estimate obesity, and it is important to determine which one is the best in predicting the risk of coronary heart disease (CHD) and to define the optimal cut-off point for the best index. Methods: This cross-sectional study investigated a consecutive sample of 11,247 adults, who had lived in rural areas of China and were older than 35 years of age. Eight obesity indices, including the body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), abdominal volume index (AVI), body adiposity index (BAI), body roundness index (BRI) and a body shape index (ABSI) were investigated. The risk of CHD was evaluated by the 10-year coronary event risk (Framingham risk score). Receiver operating characteristic (ROC) curve analyses were used to evaluate the predictive ability of the obesity indices for CHD risk. Results: Of the whole population, 3636 (32.32%) participants had a risk score higher than 10%. Those who suffered medium or high CHD risk were more likely to have higher mean anthropometric indices, except for BMI in males. In the multivariate-adjusted logistic regression, all these anthropometric measurements were statistically associated with CHD risk in males. After adjusting for all the possible confounders, these anthropometric measurements, except for ABSI, remained as independent indicators of CHD risk in females. According to the ROC analyses, ABSI provided the largest area under the curve (AUC) value in males, and BMI showed the lowest AUC value, with AUC varying from 0.52 to 0.60. WHtR and BRI provided the largest AUC value in female, and similarly, BMI showed the lowest AUC value, with AUC varying from 0.59 to 0.70. The optimal cut-off values were as follows: WHtR (females: 0.54), BRI (females: 4.21), and ABSI (males: 0.078). Conclusions: ABSI was the best anthropometric index for estimating CHD risk in males, and WHtR and BRI were the best indicators in females. Males should maintain an ABSI of less than 0.078, and females should maintain a WHtR of less than 0.54 or a BRI of less than 4.21.

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1Background: Overweight and obesity are now considered as a serious health problem, and a very important risk factor for many diseases. Objective: This study was designed to investigate the epidemiologic features of overweight and obesity among rural adults in China. Method and Procedures: A cross-sectional survey was conducted during 2004-2005, using a multistage cluster sampling method to select a representative sample in Fuxin county, Liaoning province, China. A total of 29,970 adults, aged ≥35 years, were examined. At baseline, lifestyle and other factors were obtained. Overweight and obesity were defined according to the classification by the World Health Organization. Results: Overall, the prevalence of overweight was 18.6%; 15.1% in men and 22.1% in women. The prevalence of obesity was 1.7%; 1.2% in men and 2.2% in women. Multivariable logistic regression revealed certain risk factors of obesity that included being a women, Mongolian nationality and education status of over junior high school level. Moderate physical activity alone was shown as protective factor. Discussion: Although the prevalence of obesity was low, overweight was relatively high in the Chinese rural population, especially in adult women. Gender, diet, physical activity, education levels, and ethnicity were associated with the prevalence of these health conditions.

BackgroundFew studies investigate sex difference in stroke incidence in rural China hypertensive population.MethodsA total of 5097 hypertensive patients aged ≥35 years (mean age, 56.3 ± 11.2 years; 43.8% men) were included in our analysis with a median follow-up 8.4 years in Fuxin county of Liaoning province in China. Cox proportional hazard models were used to analyze the association between the potential factors and incident stroke.ResultsWe observed 501 new strokes (310 ischemic, 186 hemorrhagic, and 5 unclassified stroke) during the follow-up. The overall incidence of stroke was 1235.21 per 100,000 person-years; for men, the rates were 1652.51 and 920.80 for women. This sex difference in all stroke can be explained by approximately 25% through age, systolic blood pressure, body mass index, low-density lipoprotein-cholesterol, current smoking, current drinking, antihypertensive drugs, education and physical activity. Subgroup analysis indicated that in hemorrhagic stroke this sex difference was more remarkable (63.89% can be explained).ConclusionsThe incidence of stroke was higher in men than that in women and this difference was partly explained by several traditional cardiovascular risk factors.

Background: Type A influenza viruses are important pathogens of humans, birds, pigs, horses and some marine mammals. The viruses have evolved into multiple complicated subtypes, lineages and sublineages. Recently, the phylogenetic diversity of type A influenza viruses from a whole view has been described based on the viral external HA and NA gene sequences, but remains unclear in terms of their six internal genes (PB2, PB1, PA, NP, MP and NS).