Prevalence estimates of depression in hypertensive patients varied widely in existing studies. We conducted a systematic review and meta-analysis of observational studies to summarize the point prevalence of depressive symptoms in adults with hypertension.Comprehensive electronic searches of PubMed, Web of Knowledge, China National Knowledge Internet (CNKI), Wangfang, and Weipu databases were conducted to identify any study in each database published from initial state to November 31, 2014, reporting the prevalence of depression in hypertensive patients. Random-effects model was used to estimate the prevalence of depressive symptoms. We also limited the analyses to studies using clinical interview and prespecified criteria for diagnosis. All statistical calculations were made by using the Stata Version 12.0 (College Station, TX) and Statsdirect Version 2.7.9.We identified 41 studies with a total population of 30,796 in the present meta-analysis. The summarized prevalence of depression among hypertensive patients is 26.8% (95% confidence interval (CI): 21.7%–32.3%). Subgroup analysis shows the following results: for male 24.6%, 95% CI: 14.8%–35.9%, for female 24.4%, 95% CI: 14.6%–35.8%. For China: 28.5% (95% CI: 22.2%–35.3%); for other region (22.1%, 95% CI: 12.1%–34.1%); for community: 26.3% (95% CI: 17.7%–36.0%), for hospital: 27.2% (95% CI: 20.6%–34.5%). Estimated prevalence by interview was 21.3% (95% CI: 14.2%–30.0%); prevalence of depressive symptoms adjudicated by self-rating scales was 29.8% (95% CI: 23.3%–36.7%).The observed heterogeneity in depression prevalence of hypertension may be attributed to differences in method of evaluation. Self-report scales should be cautious of estimating the presence of depression. Thus, interview-defined depression affects approximately one third of hypertensive patients. Effective interventions for depression on patient-centered are needed.

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ObjectiveTo compare important clinical outcomes between early and delayed initiation of antiretroviral therapy (ART) in adults who had a co-infection of human immunodeficiency virus (HIV) and tuberculosis (TB).MethodsWe performed a systematic search for relevant publications on PubMed, EMBASE, and the International Clinical Trials Registry Platform. We included randomized controlled trials (RCTs) that compared early ART initiation (within four weeks after anti-TB treatment starting) and delayed ART initiation (after eight weeks but less than twelve weeks of anti-TB treatment starting) in the course of TB treatment. Pooled estimates with corresponding 95% confidence interval (95%CI) were calculated with random-effects model. Sensitivity analysis was performed to investigate the stability of pooled estimates.ResultsA meta-analysis was evaluated from six RCTs with 2272 participants. Compared to delayed ART initiation, early ART initiation significantly reduces all-cause mortality in HIV-positive patients with TB [incidence rate ratio (IRR) 0.75, 95%CI 0.59 to 0.95; I2 = 0.00%; p = 0.67], even though there is an increased risk for IRD [IRR 2.29, 95%CI 1.81 to 2.91; I22 = 0.00%; p = 0.56]. Additionally, early ART initiation was not associated with an increased risk for grade 3-4 drug-related adverse events [IRR 0.99, 95%CI 0.83 to 1.18; I2 = 0.00%; p = 0.56].ConclusionsAlthough limited evidence, our results provide support for early ART initiation in the course of anti-TB treatment. However, more well-designed cohort or intervention studies are required to further confirm our findings.

BackgroundLeft ventricular hypertrophy (LVH) was suggested to be an important risk factor for hypertensive vascular complications. Previous studies had also shown that red cell distribution width (RDW) was associated with morbidity and mortality of cardiovascular disease. However, few have yet investigated possible association between RDW and LVH. The aim of the present study was to evaluate the relationship between LVH and RDW levels in hypertensive patients.MethodsPhysical examination, laboratory tests and echocardiography were conducted in 330 untreated newly diagnosed hypertensive patients attending the cardiology consultation unit at the Anzhen Hospital of Beijing. The multivariate logistic regression model was used to verify the independent association between RDW and LVH.Results174 patients without LVH and 156 patients with LVH were rolled in the study. The patients with LVH had higher mean SBP, albumin to creatinine ratio, total cholesterol, RDW and fasting glucose compared with non-LVH group. The mean HDL-cholesterol level was significantly lower in patients with LVH than patients without LVH. The multiple logistic regression model suggested that patients with a higher RDW level were more likely to be LVH (OR=2.187, 95%CI: 1.447-3.307, P<0.001). Other predictive factors for LVH were mean SBP, serum creatinine, glucose level. The receiver operating characteristics (ROC) curves indicated area under the curve was 0.688(95%CI: 0.635-0.737, P<0.001) with a cut-off value of 12.9, the RDW predicted LVH status among hypertensive patients with a sensitivity of 72.4% and a specificity of 60.3%.ConclusionsThe higher RDW level was observed in the LVH group compared with the non-LVH group. RDW might be associated with LVH in hypertensive patients. These data highlight the role of RDW as a predictor of organ damage in essential hypertensive patients.