Tranexamic acid (TXA) administered during off-pump coronary artery bypass (OPCAB) surgeries has achieved good blood control in small cohorts. We aimed to investigate the safety issues and hemostasis associated with TXA administration during OPCAB in a large retrospective cohort study.This study included 19,687 patients with OPCAB from 2009 to 2019. A total of 1,307 patients were excluded because they were younger than 18 years or certain values were missing. Among the remaining 18,380 patients, 10,969 were in the TXA group and 7,411 patients were in the no-TXA group. There were 4,889 patients whose TXA dose was ≥50 mg/kg, and the remaining 6,080 patients had a TXA dose of <50 mg/kg. Propensity score matching (PSM) was performed between the TXA and no-TXA groups and between the high-dose and low-dose groups, and statistical analysis was performed.p < 0.001) and 48 h  and total blood loss  after OPCAB than the patients with non-TXA. Therefore, the risk of total blood exposure  or blood component exposure (p < 0.001) was decreased significantly in the patients who administered TXA. The TXA dosage did not impact the patient survival, thromboembolic events, or blood management.Tranexamic acid administration did not increase the risk of hospital death or thromboembolic events. Patients who administered TXA had less blood loss at 24 h (478.32 ± 276.41 vs. 641.28 ± 295.09, The application of TXA was safe and provided blood control in patients with OPCAB, and the dosage did not affect these parameters. Bleeding and blood infusions are common during coronary artery bypass graft (CABG) surgeries . AntifibAlthough CPB avoidance during off-pump CABG (OPCAB) could reduce the blood exposure risk, hypothermia, acidosis, and tissue trauma still contributes to inadequate hemostasis during OPCAB . During A greater activation level of fibrinogen and other acute-phase proteins has been observed in OPCAB compared with on-pump CABG, which may lead to higher thromboembolic event risk in OPCAB . TherefoClinical studies on the application of TXA during OPCAB obtained good blood management results , 11, andThis study included 19,687 patients who underwent OPCAB from January 1, 2009 to December 31, 2019. Patients under 18 years of age and those with missing values were excluded from this cohort. Finally, 18,380 patients were enrolled in the statistical analysis . Among tAll patients received OPCAB surgery with or without TXA administration during the operation according to the anesthesiologists' preference. A 1 g dose of TXA was administered 30 min before skin incision at 2 g/h and continued at 200–800 mg/h during the entire surgical procedure. The continuous infusion protocol was based on the patients' weight and the anesthesiologists' judgment. Heparin (200 IU/kg) was administered before the transection of the internal mammary artery to maintain the activated clotting time (ACT) at 300 s. After the proximal anastomosis was finished and no major hemorrhage was observed, protamine was administered at a ratio of 1 mg protamine to 100 IU heparin. Additional protamine was administered during chest closure or in the intensive care unit (ICU) according to the immediate ACT results and the surgeons', anesthesiologists', and ICU physicians' judgment.Hospital death and thromboembolic events  were defined as primary endpoints. The secondary endpoints consisted of blood loss and blood exposure after OPCAB. Blood loss after surgery included blood loss at 24 and 48 h and total blood loss after OPCAB. Blood exposure after OPCAB included red blood cell (RBC) exposure, fresh frozen plasma (FFP) exposure, and platelet (PLT) exposure after surgery.t-test for normal distribution and Mann-Whitney U test for non-normal distribution of continuous variables. The significant differences in categorical variables between groups were assessed by the χ2-test or Fisher's exact-test before PSM. To calculate the statistical significance of the baseline and perioperative information after PSM, the paired Student's t-test was used for normally distributed variables, the Wilcoxon rank test was used for non-normally distributed variables, while the paired χ2-test was calculated for categorical variables. Conditional logistic regression was selected for the outcome analysis after PSM. The odds ratio (OR) and 95% CIs were used for binary outcome variables.For continuous variables, the mean ± SD was used for normally distributed variables while the median and interquartile range (IQR) were used for non-normally distributed variables. The categorical variables were expressed as numbers and percentages. The statistical significance of the baseline and perioperative variables between the TXA and no-TXA groups or between the high-dose and low-dose groups before PSM was calculated by Student's p < 0.05): age; body mass index; sex ; left ventricular dysfunction; insulin-dependent diabetes; hyperlipidemia; hypertension; chronic kidney disease (CKD); peripheral vascular disease; cerebrovascular accident; previous cardiac surgery; acute coronary syndrome; left main stem disease; three-vessel disease; pre-operative intra-aortic balloon pump; time between coronary angiography and operation <3 days; risk factors for bleeding; use of aspirin, clopidogrel, or ticagrelor within 5 days before surgery; low-molecular-weight heparin within 24 h pre-operatively; angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers; use of nitrates, beta-blockers, calcium-channel blockers, and statins; the surgeons' experience (≥100 CABGs/year); operation year (years from 2009 to 2014 and 2015 to 2019 were divided as binary covariates); emergency surgery; heparin neutralization ratio (HNR); and left internal mammary artery duration of surgery (min).The 1:1 matching propensity score was used for patients between the TXA and no-TXA groups throughout the entire OPCAB cohort or between the high-dose and low-dose groups in the TXA subset. In addition, a caliper width of 0.01 and the nearest-neighbor matching method without replacement were used for PSM. Thirty-two covariates were selected for PSM in accordance with the clinical and statistical significance ; thus, the information for these patients was excluded from the following statistical analysis. A value of “1” was input for the missing INR values based on the normal neutralization as referenced above. Then, 19,684 patients with OPCAB in the entire OPCAB cohort and 11,206 patients in the TXA subgroup were included in the sensitivity analysis. The details of the sensitivity analysis were the same as previously described.All statistical analyses were carried out with IBM SPSS Statistics for Windows, version 22.0 .p < 0.05), whereas after PSM, significant differences were not observed among the variables between these two groups (p < 0.05). The median TXA dose in the high-dose (≥50 mg/kg) group was 66.67 mg/kg, with an IQR from 57.69 to 75.76 mg/kg. The median TXA dose in the low-dose group (<50 mg/kg) was 39.68 mg/kg, with an IQR from 34.72 to 43.87 mg/kg. After PSM, differences were observed in the New York Heart Association III–V  and chronic obstructive pulmonary disease parameters . However, TXA administration did not increase the risk of hospital death, PMI, stroke, AKI, or pulmonary embolism  and 48 h  and less total blood loss  after OPCAB than patients with non-TXA  or RBC , FFP , and PLT transfusion exposure  was decreased significantly with TXA administration (Tranexamic acid administration increased the risk of death and thromboembolic events (primary endpoint) by 1.17-fold . The risk of blood exposure  or blood component exposure was also decreased by TXA application . Moreover, we had a lower risk of seizure in the TXA, no-TXA, and high-dose or low-dose group (0.1%). In the ATACAS study by Myles et al., the seizure risk was 0.7% in the TXA 100 mg/kg group vs. 0% in the no-TXA group and 0.5% in the TXA 50 mg/kg group vs. 0.1% in the no-TXA group. Although the TXA group had a higher risk than the no-TXA group at 100 or 50 mg/kg, the low-dose TXA decreased the seizure rate from 0.7 to 0.5%. Sharma et al.  , which wIn conclusion, TXA administration did not increase the risk of hospital death, thromboembolic events, or seizures in patients who underwent OPCAB surgery. Moreover, TXA administration could decrease blood loss and prevent blood exposure, and differences were not observed between the high-dose and low-dose TXA groups in terms of adverse events and blood conservation.The original contributions presented in the study are included in the article/The studies involving human participants were reviewed and approved by the Medical Ethics Committee of the Fuwai Hospital. The patients/participants provided their written informed consent to participate in this study.EW, SY, and SH contributed to the study design. EW, XY, WC, and XZ contributed to the data collection. EW and YW contributed to the statistical analyses. EW contributed to the manuscript draft. SY and SH contributed to the final revision. All authors contributed to the article and approved the submitted version.Support was provided by the National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, the Chinese Academy of Medical Sciences (Grant No. NCRC2020014), and the National Natural Science Foundation of China (Grant No. 81400242).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Methods. A cross-sectional study was conducted, in which 367 patients undergoing HD participated. Patients were randomly selected from six HD units in various geographical areas of Greece. Data were collected through an anonymous self-completed questionnaire consisting of two parts. The first part contained questions regarding demographic, social, and clinical information such as age, gender, marital status, and duration of dialysis comorbidities. The second part assessed the patients' spiritual wellbeing with the use of the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale-12. Multivariate analysis was performed to extract predictors or determinants of spiritual wellbeing of hemodialysis patients. Results. From the total of the 367 participants, 228 (62.1%) were males and 139 (37.9%) were females, and the mean age was 61.80 ± 15.11. Spiritual wellbeing had a mean value of 30.55 (SD = 8.22), which means that patients had a satisfactory spiritual wellbeing level. Multivariate analysis revealed that place of residence, marital status, educational level, and comorbidities could predict spiritual wellbeing in ESRD patients. Conclusions. There is much evidence in the literature supporting the positive effect of spirituality, health , and quality of life. Integration of spiritual wellbeing evaluation and spiritual care in everyday practice as a part of clinical care can increase the quality of the provided care and improve health outcome for patients undergoing hemodialysis.People with CKD depend on religion and spirituality to deal with their chronic illness, and those are essential means of coping for those living with chronic diseases. The present study aims to evaluate ESRD patients' spiritual wellbeing undergoing hemodialysis treatment and to identify critical variables associated with the spiritual wellbeing of those patients.  Common concerns for human worldwide include questions about life, death, the meaning of existence, and its role in the world. Those questions are usually addressed by religion and spirituality. The World Health Organization considers religion, spirituality, and personal beliefs as important concepts in the evaluation of a person's quality of life .The concept of spirituality is not easy to be determined. Harrison and Bernard argue that there are as many definitions of spirituality as those who are trying to define it. Also, they argue that existing words and definitions are unable to describe the nature of spirituality . In receThe word spirituality comes from the word “spirit,” which means breath, wind, life, intelligence, soul, meaning, and essence, while the concept of spirituality is defined as “the qualities that make up the spiritual level of the person” . AccordiAs an emerging research issue, a lot of researchers tried to define spirituality resulting in many different definitions varying based on the science represented by the researcher who each time tried to define it . Thus, wPeople with CKD depend on religion and spirituality to deal with their chronic illness, which also affects their quality of life. In the context of chronicity, quality of life is a multidimensional, many-sided, dynamic, and subjective view of various degrees of satisfaction related to health. This health-related satisfaction is linked to spiritual wellbeing. Therefore, spirituality or religiousness is an important means of coping for those living with chronic diseases . SpirituStudies examining spirituality in patients with CKD have concluded that these patients have a number of mental needs that are related to and affect the psychological adjustment to the disease and that these needs appear to remain the same throughout the disease continuum . AccordiIn Greece, for many individuals, religion and spirituality are important aspects of their sickness and health. Patients are engaged in various religious practices even during hospitalization. A great percentage attribute health and illness in their relation to God –18. In aA cross-sectional, correlational study design was used in this study. The study sample consisted of patients with end-stage kidney disease who underwent hemodialysis.The study was conducted in 2018 in a private HD unit named “Iatriko Therapeutirio Iliou Medifil A.E.” (Athens) and in five HD units of public hospitals: (i) General Hospital of Lamia , (ii) Panarkadiko General Hospital “Evangelistria” (South Greece), (iii) General Hospital of Chios Island “Skylitseio” (East Greece), (iv) General Hospital of Athens “G. Gennimatas” (Athens), and (v) University Hospital of Alexandroupolis (North Greece) were randomly selected from each one. The sample consisted of 367 patients undergoing HD who were randomly selected from six HD units in Greece's various geographical areas. The inclusion criteria were the following: (i) age above 18, (ii) undergoing HD 3 times/week for at least 6 months, (iii) native language-Greek, (iv) ability to read and sign the consent form, (v) time-space oriented, and (vi) not currently undergoing transplant procedures. Patients who have been diagnosed with mental or cognitive disorders  were excluded from the study.To carry out the study, licenses were obtained from the Data Protection Authority (protocol number: ΓΝ/ΕΞ/4670-3/04-08-2016), and Scientific Councils of the six HD units. In all cases, oral and written information was provided to patients about the aims of the work, the confidentiality, and anonymity of the answers and their right to interrupt at any time during the procedure.The first part contained questions regarding demographic, social, and clinical information such as age, gender, marital status, and duration of dialysis comorbidities. Moreover, some additional information was gathered, such as self-reported religiosity using a single item religiosity “How religious are you?” with a five-point Likert scale ranging within 0–4, where 0 corresponded to not religious and 4 to highly religious. “How close do you feel to God?” was a single item assessing connection to God in a five-point Likert scale ranging within 0–4, where 0 corresponded to not close at all, while 4 corresponded to a close as I can be. Finally, “current activity level” was assessed in a four-point Likert scale ranging within 0–4, where 0 = normal activity, without symptoms, 1 = some symptoms, but do not require bed rest during waking day, 2 = require bed rest for less than 50% of waking day, 3 = require bed rest for more than 50% of waking day, and 4 = unable to get out of bed.α = 0.82 for the FACIT-Sp12 Spirituality Scale.Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp-12). This is a scale created by Cella et al.  and has Data were collected through an anonymous self-completed questionnaire consisting of two parts:n) and relative (%) frequencies. Scores on FACIT-Sp12 Scale were used as the outcomes (dependent variables) and patient characteristics as the determinants (independent variables). Initially, we performed bivariate analyses. Student's t-test and one-way analysis of variance were used for the association between categorical and continuous variables and Pearson's correlation coefficient for the correlation between continuous variables. Multivariate linear regression analysis (stepwise method) was applied to identify predictors of spiritual wellbeing. Stepwise regression is considered to be the appropriate approach as we want to determine predictors of spiritual wellbeing among sociodemographic and clinical characteristics. Stepwise regression is a step-by-step iterative construction of a regression model. During the model's construction, independent variables to be used in a final model are selected and are added or removed in succession and testing for statistical significance after each iteration. The selection of the variables that will be included in the stepwise procedure is based on the bivariate analyses. Variables that were found to be associated with spiritual wellbeing at a significance level p < 0.250 were entered in the procedure [The statistics of the research's empirical data were processed with SPSS v. 22.0 for Windows . Descriptive and inferential statistical methods were generated. Continuous variables were presented with mean, standard deviation, and range (min-max), while categorical variables were presented as absolute (β) with standard errors and 95% confidence intervals were computed. All reported p values were two-tailed, and the statistical significance level was set at 0.05.Regression coefficients . The majority (46.9%) were in the age range of 60–79 years. Regarding the place of their permanent residence, 67.3% lived in an urban area, 15.3% in a semi-urban area, and 17.4% in a rural area. Most patients were married (59.1%) and had 1 to 2 children (51.5%). About 3/4 of the patients did not live alone but with another or others (76.6%). In terms of their educational level, the majority were graduates of secondary education (43.6%) while a relatively small percentage of higher education (17.2%). 61.0% of patients were retired, 10.9% self-employed, 8.2% civil or private employees, and 19.9% unemployed or stay-at-home moms. Regarding religion, the vast majority were Orthodox Christians (95.9%). Self-reported religiosity was found to be 2.56 ± 1.08, connection with God score was 2.54 ± 1.11. When asked about how religious they are and how close they feel to God, the majority  said “somewhat” or “a lot” on the five-point scale that was used. The years undergoing dialysis ranged from 1 to 26 with an average value of 5.69 years (SD = 5.25), while the majority (62.9%) was in the range of 1–5 years. 52.6% of the patients had another health problem. Regarding the current level of activity and the burden of symptoms in everyday life, 31.3% of patients stated that it was at a good level, 29.7% at a moderate level, 19.9% at a bad or very bad level, and 19.1% at a very good level. Finally, the mean score on current activity level of the patients was 2.46 ± 1.09.The Total FACIT-Sp-12 scores  ranged from 3 to 47 with an average value of 30.55 (SD = 8.22) and a mean of 31.00. Both the mean and median values were greater than the value 24 corresponding to the midpoint of the response measurement scale , indicating that the majority of patients had relatively high total spirituality values.The mean value of the individual dimensions of the scale was for “meaning” 11.99 (SD = 3.27), “peace” 9.26 (SD = 3.38), and “faith” 9.30 (SD = 3.95). All dimensions of spirituality showed mean value and median above 8, which corresponds to the middle point of the scale of measuring the answers . Comparatively, the highest mean value was of the “meaning” and the lowest was “peace” with “faith.”A multivariate analysis was performed to identify predictors or determinants of spirituality  of patients undergoing dialysis. In the multivariate analysis, the characteristics of the patients related to spirituality were introduced at the significance level of 0.25 from the bivariate analysis. From the statistical multivariate analysis for the extraction of predictors of spirituality , from the characteristics of the patients, the following were found.R2 = 22.3%). Particularly, the mean value of “meaning” was 1.399 points lower for those living in non-urban areas than for those living in urban areas (β = −1.399 p < 0.001). The mean value of “meaning” was 1.049 points lower in the unmarried than in the married (β = −1.049 p = 0.001). The mean value of “meaning” was by 1.118 points and 1.494 points, respectively, higher in the graduates of secondary and tertiary education in relation to the graduates of primary education (β = 1.118 p = 0.001 and β = 1.494 p = 0.001). Moreover, a change in the estimate of how close they feel to God by 1 point causes a similar change in “meaning” by 0.514 points (β = 0.514 p < 0.001) and change of the current activity by one level causes a similar change of the “meaning” by 0.741 units (β = 0.741 p < 0.001).Place of residence, marital status, educational level, how close they feel to God, and current level of activity have emerged as predictors of the “meaning” dimension. The statistical model's reported variables explain about 22% of the variability of “meaning” (corrected R2 = 22.7%). More specific the mean value of “peace” was 0.919 points lower in the unmarried than in the married (β = −0.919 p = 0.005). The mean value of “peace” was by 1.703 points and 1.369 points, respectively, correspondingly lower in the graduates of primary and secondary education in relation to the graduates of higher education (β = −1.703 p < 0.001 and β = −1.369 p = 0.002). Furthermore, a change in the estimate of how close they feel to God by 1 point causes a similar change in “peace” by 0.778 points (β = 0.778 p < 0.001). The mean value of “peace” was 0.682 points higher in those who do not have any other health problems than those who have (β = 0.682 p = 0.041). A change of the current activity by one level causes a similar change of the “peace” by 0.819 points (β = 0.819 p < 0.001).Marital status, educational level, how close they feel to God, the existence of another health problem, and the current level of activity emerged as predictive factors of the “peace” dimension. The statistical model's mentioned variables explain about 23% of the variability of “peace” (corrected R2 = 37.7%). Particularly, the average value of “faith” was 0.690 points lower for those living in a non-urban area compared to those living in an urban area (β = −0.690 p = 0.048). A change in the estimate of how religious they are by 1 unit causes a similar change in “faith” by 0.855 units (β = 0.855 p = 0.002), and a change in the estimate of how close they feel to God by 1 point causes a similar change in “faith” by 1.420 points (β = 1.420 p < 0.001). Finally, one level change in current activity causes a similar change in “faith” by 0.343 points (β = 0.343 p = 0.023).The place of residence, how religious they are, how close they feel to God, and the current level of activity have emerged as predictors of the “faith” dimension. The statistical model's mentioned variables explain about 38% of the variability of “faith” (corrected R2 = 36.1%). Particularly, the mean value of “total spirituality” was 2.372 points lower for those living in a non-urban area than for those living in an urban area (β = −2.372 p = 0.002). The average value of “total spirituality” was 2.493 points lower in the unmarried than in the married (β = −2.493 p = 0.001). The mean value of “total spirituality” was by 3.237 points and 2.482 points, respectively, lower in the graduates of primary and secondary education in relation to the graduates of higher education (β = −3.237 p = 0.002 and β = −2.482 p = 0.013). In addition, a change in the estimate of how close they feel to God by 1 unit causes a similar change in “total spirituality” by 3.337 units (β = 3.337 p < 0.001) while a change in current activity by one level causes a similar change in “total spirituality” by 1.995 points (β = 1.995 p < 0.001).In addition, the place of residence, the marital status, the educational level, how close they feel to God, and the current level of activity have emerged as predictive factors of “total spirituality.” The statistical model's mentioned variables explain about 36% of the variability of “total spirituality” . This finding is in complete agreement with the modern literature data, which demonstrates the beneficial effect of spirituality on the general state of health [The educational level was found to be associated with high levels of spirituality, a finding that comes to reinforce the already reported results derived from the international literature. In addition, it is widely accepted that, in times of crisis, such as the diagnosis of chronic, life-threatening, or end-stage disease, people tend to be more spiritual in trying to give meaning to the illness and pain they experience , 27. Thef health .Another factor that has been found to be a predictor of high levels of spirituality is the connection with God, that is, feeling close to the divine. Spirituality and religiousness can be two different concepts, as already mentioned, yet there is a close connection between them. A person may be spiritual without being religious, but a person who is religious certainly has high levels of spirituality . BelavicFinally, from the clinical factors, only comorbidity was found to be a predictor in the multivariate model and only in the “peace” dimension of spirituality. This finding is in line with studies that want patients with many health problems to turn to religion and spirituality for support. A study in Australia involving men and women aged 55–85 found that spirituality and participation in religious activities play a beneficial role in receiving social support and can help people manage the presence of multiple diseases in their lives better .For many people, religion and spirituality are central pillars in their lives. These axes should be considered when designing care provision for these patients, as there is a lot of evidence in the literature to support this fact. The values obtained by both the overall spirituality scale and the individual dimensions of meaning, peace, and faith are above average, leading to the conclusion that the patients' spirituality levels in the present study were moderate to high. Taking this into account and relating this finding to Lazarus and Folkman's  transact


To investigate a seasonal variation in blood pressure (BP) for patients undergoing hemodialysis (HD).In this retrospective study, we exported all BP measurements from the information system to investigate a seasonal variation of BP. We also investigated a seasonal variation in BP for patients of different gender types, of different age groups, with diabetic nephropathy (DN), and with non-DN having HD. Multiple linear regression models were used to explore the associations between BP and climatic parameters.In 2019, a total of 367 patients had received HD therapy in the Longwen HD unit. We included nearly 40,000 pre-dialysis BP measurements. The result of our study demonstrated a clear seasonal variation in pre-dialysis BP in general patients with HD, in male and female patients, and patients with DN and non-DN. December seemed to be a peak in the values of pre-dialysis systolic BP (SBP) and diastolic BP (DBP). The nadir values of pre-dialysis SBP and DBP were observed in June and July, respectively. A difference between peak and nadir values of BP is 3.81/2.20 mmHg in patients undergoing HD. Maximal seasonal variation in BP is 9.03/5.08 mmHg for patients with DN. A significant association of SBP and DBP with climatic parameters was found in this study. Pre-dialysis BP was inversely correlated with outdoor temperature, daytime length, and relative humidity.A clear seasonal variation in BP is observed for patients with HD. Pre-dialysis SBP and DBP are inversely associated with outdoor temperature, daytime length, and relative humidity. The magnitude of a seasonal variation in BP increases in patients with DN. Although renal replacement therapy can effectively prolong the survival rate of patients with end-stage kidney disease (ESRD), the 5-year mortality of the maintenance of patients with hemodialysis (HD) is still reached up to 32.3–25.9% . Blood pThe present study has been approved by the Ethics Committee of Zhangzhou Affiliated Hospital of Fujian Medical University (2021LWB165). The declaration of Helsinki of the World Medical Association was followed in this study.Our study period spanned from January 1, 2019, to December 31, 2019. In our previous study, we have described our dialysis center and therapy method . DiffereDuring HD therapy, the patients received BP measurements at least five times, including pre-dialysis BP, post-dialysis BP, and intradialytic BP measurements at least once an hour. The dialysis machine  has a device, which was used for automatically measuring BP. The device is an electronic sphygmomanometer module composed of an inflation pump, a solenoid valve, a pipeline, a filter screen, a circuit IC, and a display module. The method of BP measurement was presented as follows: (1) the BP cuff was wrapped around the patients' upper arm; (2) automatically pressurize the cuff to block the brachial artery blood; and (3) slowly reduce the pressure. During BP measurement, the arm sent out sound and pressure, which were recognized by an HD machine. The receiver converted them into electrical signals. Finally, it was converted into digital signals . When BP was measured, patients were in the supine position. BP measurements were automatically output and stored in the information system.We exported all BP measurements from the information system. Inclusion criteria included (1) patients diagnosed as ESRD by nephrologists and (2) patients receiving HD in the Longwen HD unit from January 1, 2019, to December 31, 2019. We excluded BP measurements when patients initiated dialysis therapy <90 days. We also excluded BP measurements if pre-dialysis SBP was <60 mmHg or diastolic BP (DBP) was <30 mmHg because these were probably the measurement errors.Target values of pre-dialysis and post-dialysis BP in patients with HD were ≤ 140/90 and ≤ 130/80 mmHg, respectively  and Excel software were used to perform data analysis and plot figures. We calculated the means of monthly pre-dialytic and post-dialytic SBP and DBP. The variables were presented as means ± SD. The coefficient of variation (CV) was also calculated. The prevalence of intradialytic hypertension was calculated on a monthly basis. Means of daily maximum temperature, daily minimum temperature, daily temperature, daily daytime length, and relative humidity were also calculated on a monthly basis. One-way ANOVA was used to compare differences in BP  for each month.Blood pressure measurements, UV, and pulse were derived from the information system. We used Excel software to collect and organize data. t-test was used to compare pre-dialysis and post-dialysis BP. The student's t-test was used to compare pre-dialysis BP between the different subgroups .All of the data on BP measurements were grouped by gender, different age groups, and DN/non-DN subgroups. The abovementioned statistical analysis was repeated in men and women, different age groups, and DN and non-DN subgroups. A paired p < 0.05 was considered statistically significant.Multiple linear regression models were used to explore the associations between BP measurements and climatic parameters. In the models, BP measurements  were used as independent variables and climatic parameters were used as dependent variables. The models were adjusted for age, gender, primary diseases, vascular access, HD vintage, and UV. The value of In 2019, a total of 367 patients had received HD therapy in the Longwen HD unit. By December 31, 2019, 356 patients had received HD ≥ 90 days. The mean age of the 356 patients was 53 years. The ratio of male/female was 202/154. By December 31, 2019, the median HD vintage was 29 months (mean HD vintage: 39 months). Major primary diseases were glomerulonephritis (109/356) and DN (87/356). In total, 330 patients used autologous arteriovenous fistula as vascular access.In 2019, 41,278 HD therapies were completed in the Longwen HD unit. We excluded 14 BP measurements because pre-dialysis SBP was <60 mmHg or DBP was <30 mmHg. We excluded HD therapies when the patients initiated the dialysis <90 days. Finally, a total of 38,970 cases of HD therapies were included in this study. In 2018–2019, 208 patients received echocardiography examinations. A total of 21 (10.10%) had a reduced ejection fraction (<50%). Nine patients with a reduced ejection fraction had hypertension. The mean pre-dialysis pulse was 80.08 ± 14.53 /min.p < 0.05). However, we did not find a significant difference between pre-dialysis and post-dialysis DBP.Mean pre-dialysis and post-dialysis BP measurements were calculated on a monthly basis. The results were presented in Among 38,970 pre-dialysis BP measurements, 22,627 (58.06%) pre-dialysis SBP measurements were higher than 140 mmHg. A total of 13,827 (35.48%) pre-dialysis DBP measurements were higher than 90 mmHg. Totally, 27,574 (70.76%) post-dialysis SBP measurements and 23,914 (61.37%) post-dialysis DBP measurements were >130 and >80 mmHg, respectively. In 38,970 HD therapies, the prevalence of intradialytic hypertension was 23.17% . Pre-dialysis and post-dialysis BP measurements in men and women, different age groups, and DN/non-DN subgroups were also presented in The use of antihypertensive drugs was listed on a monthly basis . In 2019p < 0.05).The mean daily maximum temperature, daily minimum temperature, daily outdoor temperature, daily daytime length, and relative humidity were calculated on a monthly basis and presented in A clear seasonal variation of pre-dialysis BP was observed . The chaThe mean value of HD UV among 38,970 HD therapies was 2,880 ± 998 ml/HD. A similar seasonal variation was observed in HD UV. In June, July, and August, the mean UV was <2,800 ml. February had the highest UV .p < 0.05). A clear seasonal variation of pre-dialysis SBP and DBP was observed in both sexes . The result indicated that the pulse pressure significantly increased in patients with DN. Although a similar seasonal variation of pre-dialysis BP was observed in both patients with DN and non-DN, the magnitude of a seasonal effect on pre-dialysis BP was greater in patients with DN   were significant ( < 0.05) . These aAmong 38,970 cases of HD therapy, intradialytic hypertension occurred in 23.17% of HD sessions. Older adult patients with HD had a significantly higher prevalence of intradialytic hypertension (36.45% in patients ≥ 70 years old).In this retrospective study, we included nearly 40,000 pre-dialysis BP measurements in a single HD center. Zhangzhou City, located in southern China, is at the latitude near the Tropic of Cancer. The results from our study demonstrated a clear seasonal variation of pre-dialysis BP in general patients with HD, in men and women, and patients with DN and non-DN. It is consistent with the results of most previous studies based on patients with HD , 11, 15.Since 1961, considerable studies demonstrate that seasonal variation affects BP levels . After 7The special feature of the present study is that the subjects are patients with HD. The regulation of BP is very complex and multifactorial . In clinAn inverse association between pre-dialysis BP of outdoor temperature and relative humidity is observed in our study. Pre-dialysis BP increased in the winter by 3.81/2.20 mmHg (SBP/DBP) in comparison to the summer. The magnitude of a seasonal variation of pre-dialysis BP is relatively small in this study. The change in pre-dialysis BP from the peak to nadir value was 8/7 mmHg . The BP Volume overload is major pathogenesis of hypertension in patients with dialysis , 13. TheIn this study, we also explored the association with BP of climatic parameters in different subgroups. We found that seasonal BP variations exist in both men and women. Age is another factor linked to BP seasonal variability . The assA seasonal variation of BP has also been investigated in patients with DM , 29. SeaThe primary advantage of the present study was that patients with HD were a distinct group. BP seasonal change is associated with mortality and renal outcome in patients with chronic kidney disease . BP seasThe present study also has obvious limitations. The first caveat is that we used pre-dialysis, post-dialysis, and intradialytic BP measurements as the target. During the HD therapy, the accuracy of BP measurements was affected by many factors, including puncture pain, tension, dialysis room environment . PatientA clear seasonal variation in BP is observed for patients undergoing HD. Pre-dialysis SBP and DBP were inversely associated with outdoor temperature, daytime length, and relative humidity. Peak and nadir values of pre-dialysis SBP and DBP were observed in December and June to July, respectively. A seasonal variation of BP increases in patients with DN. A difference between peak and nadir values of BP is 9.03/5.08 mmHg in patients with DN. Seasonal factors should not be neglected in clinical practice.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The present study has been approved by the Ethics Committee of Zhangzhou Affiliated Hospital of Fujian Medical University (2021LWB165). Written informed consent from the participants' legal guardian/next of kin was not required to participate in this study in accordance with the national legislation and the institutional requirements.SC: design research, writing paper, and data analysis. ZW: data collection, processing, analysis, and writing paper. SL: data collection, processing, and analysis. CC: dialysis technician and provide technical support for data collection. YZ and XZ: involving in data collection. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


There is substantial evidence that midlife hypertension is a risk factor for late life dementia. Our aim was to investigate if even high blood pressure at a single timepoint in midlife can predict an increased risk for all-cause dementia, Alzheimer’s disease (AD), or vascular dementia (VaD) later in life.Westmannia Cardiovascular Risk Factors Study. The participants were aged 40 or 50 years when the health examination took place in 1990–2000. Diagnose registers from both hospitals and primary healthcare centers were used to identify individuals who after inclusion to the study developed dementia. The association between midlife high blood pressure (defined as systolic blood pressure >140 and/or diastolic blood pressure >90 mmHg) at a single timepoint and dementia was adjusted for age, gender, body mass index (BMI), fasting blood glucose, education, smoking, and physical activity level. Multivariate binary cox regression analyses were used.The community-based study population comprised 30,102 dementia-free individuals from the After a mean follow-up time of 24 years resulting in 662,244 person/years, 761 (2.5%) individuals had been diagnosed with dementia. Midlife high blood pressure at a single timepoint predicted all-cause dementia  and VaD  but not AD .This study suggests that even midlife high blood pressure at a single timepoint predicts all-cause dementia and more than doubles the risk for VaD later in life independently of established confounders. Even though there was no such association with AD, this strengthens the importance of midlife health examinations in order to identify individuals with hypertension and initiate treatment. The prevalence of dementia is increasing worldwide, and as of today, there is no disease-modifiable treatment –5. This Midlife hypertension has been highlighted since research indicates that antihypertensive treatment lowers the incidence of dementia later in life –10. AlsoWestmannia Cardiovascular Risk Factors Study (WICTORY) with the overall aim of lowering the cardiovascular mortality rate in the county.Screening for cardiovascular risk factors was highlighted during the 1980–1990s in the western countries. The county of Västmanland, situated near Stockholm, Sweden, started, in 1990, a screening program in a large population: the With data from this cohort, we aimed to investigate whether the presence of high blood pressure at a single timepoint at a health examination in midlife is a predictive factor for the development of all-cause dementia, AD, or VaD later in life.The intention of WICTORY was to offer a free screening for cardiovascular risk factors to all inhabitants aged 40 or 50 during 1990–2000 (born 1940–1959) and residing in the county of Västmanland. Of the 56,977 eligible individuals, 34,269 (60%) completed the health examination. All participants gave an informed consent. A detailed overview of the selection procedure for the present study is shown in 2). Blood glucose was measured after 2 h refraining from eating and was analyzed using a factory-calibrated photometer. Education was self-reported as number of years post-elementary school. Smoking habits were self-reported in a questionnaire with five alternatives . Physical activity level was self-reported and defined as low impact exercise for at least 30 min, and a five-grade scale was used .The screening procedure has been presented in detail elsewhere . BrieflyThe DUVA , 2008–2020, was our main diagnoses register since it comprises data from both primary healthcare centers and hospitals in Västmanland county. In addition, hospital diagnoses registers from the National Board of Health and Welfare (NBHW) were used for the years 1963–2007. Individuals from the cohort were considered to have a diagnosis of dementia if they had a record of any of the ICD-10-SE diagnoses of dementia shown in t-tests (continuous variables) and chi-square tests .High blood pressure was defined as systolic blood pressure (SBP) >140 mmHg and/or DBP >90 mmHg. Individuals were dichotomized into a high blood pressure group and a non-high blood pressure group (reference category). Regarding confounders, continuous variables were used for age, BMI, and fB-glucose. Others were dichotomized into previous/current smoker or non-smoker (reference), physical activity less than one time per week/never or at least one time per week (reference), and educational level ≤1 year or >1 year of education after elementary school (reference). Baseline characteristics were analyzed using independent sample p-values ≤ 0.05 considered statistically significant.The association between midlife high blood pressure and dementia was first analyzed using univariate Cox regression models, with all-cause dementia, VaD, and AD as dependent variables and blood pressure as independent variable. After univariate analysis, multivariate Cox regression models were used to further investigate the effect of putative confounding variables. Dementia was used as dependent variable with blood pressure, BMI, fB-glucose, smoking, physical activity, educational level, age at inclusion, and gender as independent variables. A series of sensitivity analyses were conducted to test the robustness of the results. Altered cut-offs were used  and analyzed with multivariate Cox regression models. All statistical analyses were performed using IBM SPSS version 26, with Out of the 30,102 individuals included in the analysis, 7,255 (24.1%) had values defined as high blood pressure at the index investigation. After a mean follow-up time of 24 years , a total of 761 (2.5%) individuals were diagnosed with dementia: 252 in the high blood pressure group and 509 in the non-high blood pressure group. Mean age for first diagnosis of dementia was 71 years.Participants who later were diagnosed with dementia had a higher mean age at inclusion and overall, a more accentuated risk profile including significantly higher SBP, DBP, BMI, fB-glucose, and lower education . They alp-value < 0.001), VaD , and AD . In the multivariate analysis, midlife high blood pressure at a single timepoint did significantly increase the risk for both all-cause dementia  and VaD . For AD, there was no statistically significant association . All results are shown in Out of the 761 individuals diagnosed with dementia, 166 (22%) had received a diagnosis of VaD and 343 (45%) a diagnosis of AD. Since some individuals had more than one dementia diagnosis, there was an overlap between the two groups. Thirty-seven individuals had a diagnosis of both VaD and AD, resulting in 472 (62%) individuals ever diagnosed with AD or VaD. Unadjusted values of midlife high blood pressure at a single timepoint were associated with a significantly increased risk for all-cause dementia  was 1.22 (95% CI: 1.03–1.45) and a higher cut-off (SBP > 150 mmHg and/or DBP > 100 mmHg) was 1.34 (95% CI: 1.08–1.67). Sensitivity analyses for VaD revealed adjusted hazard ratios for a lower cut-off was 1.73 (95% CI: 1.16–2.57) and for a higher cut-off = 1.70 (95% CI: 1.11–2.60). Sensitivity analyses for AD were statistically non-significant.In this community-based prospective cohort study of more than 30,000 individuals with a mean follow-up of 24 years, midlife high blood pressure at a single timepoint predicted all-cause dementia and more than doubled the risk for VaD later in life when adjusted for age, gender, education, and other established midlife vascular risk factors. However, midlife high blood pressure at a single timepoint was not associated with the risk of AD when adjusted for the same confounders.Hypertension has been suggested to be the largest potentially preventable risk factor for cerebrovascular damage . HyperteThere is emerging evidence of a neuropathological overlap between cerebrovascular disease and AD , 19, 23.The validity of using registers of diagnoses might be debatable. In this particular study design, we have not examined the patients ourselves as many previous cohort studies have done , 15, 16,The dementia prevalence of 2.5% in this cohort with individuals aged 60–80 years, mean age 71 for first diagnosis, is considered reliable. According to a Swedish report from 2006, the prevalence of demented individuals aged 65 is 1%, and the figure is expected to be doubled for every 5 years .Moreover, mortality rates in the high blood pressure group were significantly higher than in the total cohort (18% vs. 14%). Considering hypertension being the largest risk factor for cardiovascular disease and all-cause mortality , death cStrengths of this study include the large community-based population and a long follow-up time. Another strength is our differentiating into dementia subtypes, thus contributing to clarify the associated risk for each subtype. At this period of time, brain computed tomography (CT) scan was recommended in the guidelines for dementia investigation, indicating that the differentiation between vascular and neurodegenerative disorders should be reasonably correct. Furthermore, we were able to adjust for several established midlife confounders in the multivariate analyses, and primary results were confirmed by sensitivity analyses. Continuous variables were used when possible to minimize residual confounding.There are several limitations to this study. First, we did not take into account whether individuals were on antihypertensive medication at baseline or during follow-up. This information is available from the NBHW in the prescribed drug register starting 2006 but was not retrieved for the present study. It would be beneficial for future cohort studies to separate individuals with high blood pressure at baseline into those who are on antihypertensive treatment and those who are not. Also, it would be of great value to investigate compliance to prescribed medication by using data from the prescribed drugs register. Another source of limitation was that it was clearly obvious in the registers that round offs had been made when measuring blood pressure. This is the reason why we chose >140/90 mmHg and not ≥140/90 mmHg as our definition of high blood pressure. This can also be considered a strength since we, with this definition, probably have minimized the risk of false high blood pressure values. We did not use the term hypertension since this diagnosis cannot be confirmed by measurements from a single timepoint . RegardiIn conclusion, our study suggests that midlife high blood pressure at a single timepoint predicts all-cause dementia and more than doubles the risk for VaD later in life when adjusted for established confounders. Regarding AD, only unadjusted values showed association between midlife high blood pressure at a single timepoint and AD later in life. We were unable to investigate the validity in using diagnosis registers from primary healthcare centers regarding dementia. This would be desirable in future studies. Also, our study design using midlife high blood pressure values from a single time-point has to be replicated in future studies. Learning from these, we could investigate when midlife health examinations should be initiated in order to start treatment at an optimal age.


APOL1 G1 and G2 kidney risk variants increases the risk for chronic kidney disease (CKD) approximately seven‐fold in SCD.[APOL1 kidney risk variants has been observed in the African American Study of Kidney Disease and Hypertension (AASK) cohort.[APOL1 kidney risk variants.[APOL1 kidney risk variants are not well understood. We hypothesized that co‐inheritance of the APOL1 kidney risk variants may reduce the benefit of ACEi/ARB on the reduction of albuminuria in SCD.Kidney disease is a common complication that leads to increased morbidity and early mortality in patients with sickle cell disease (SCD). Treatmend in SCD. The pote) cohort. In contrvariants. The effeAPOL1 G1 and G2 variants was conducted by Taqman genotyping assays  as previously described.[APOL1 high risk (defined as homozygosity or compound heterozygosity for G1 and G2).We identified 47 SCD patients enrolled in a prospective observational registry who were initiated on an ACE‐inhibitor or ARB between 2011 and 2019. The study was approved by the University of Illinois at Chicago Institutional Review Board, and all patients provided written informed consent prior to blood sampling and clinical data collection. Patients were considered for this analysis if they had 6 months of kidney function values pre‐therapy and remained on therapy for 6 months or longer. The decision to start ACEi/ARB was made by the patients’ treating physicians. Genotyping for the escribed. Changes 0‐thalassemia genotype, 17% were on chronic non‐steroidal anti‐inflammatory drugs, 49% were on HU, and 13% had high risk APOL1. The baseline median eGFR was 118  ml/min/1.73m2, and urine ACR was 263  mg/g creatinine. The ACEi/ARB therapy was lisinopril in 31 (66%), losartan in 14 (30%), and valsartan in two (4%) patients. The median duration of therapy was 20 months , and 34 of 47 (72%) patients remained on ACEi/ARB therapy at the last time of follow‐up. Reasons for discontinuation included adverse effects , pregnancy (n = 2), or patient declining to continue ACEi/ARB therapy (n = 2). The SCD patients that co‐inherited APOL1 high risk had a higher frequency of adverse effects requiring discontinuation of ACEi/ARB therapy . The adverse effects that led to discontinuation in SCD patients with APOL1 high risk included acute kidney injury (n = 2) and hypotension (n = 1).In 47 SCD patients started on ACEi/ARB, the median age was 43 years , 43% were male, 87% were Hb SS/Sβp = 0.01) , after adjusting for age, sex, SCD genotype, and ACEi/ARB use. A trend for an improvement with ACEi/ARB therapy was observed in the fully adjusted model that included APOL1 high risk status  mg/g creatinine) to during therapy (6‐month ß (95% CI): −0.5 (−0.7 to −0.2) mg/g creatinine) (1) Table 1. High‐APOL1 risk status. Nineteen percent (9/47) of SCD patients had to discontinue ACEi/ARB therapy due to adverse side effects potentially related to ACEi/ARB therapy. Discontinuation for adverse effects was more frequently observed in SCD patients with APOL1 high risk. Our findings are consistent with the observed benefit of ACEi on kidney disease in the AASK cohort, although our study is limited by the small sample size. An additional limitation is the unavailability of other potential risk factors, such as socioeconomic and diabetes status or acute kidney injury events, which may affect kidney disease progression and should be evaluated in future prospective studies of ACEi/ARBs. Larger and longer follow‐up studies of ACEi/ARBs as well as new targeted therapies to treat sickle cell nephropathy, particularly in those that co‐inherit the high risk APOL1 kidney risk variants, are urgently needed.Because clinical data are limited, current American Society of Hematology guidelines have conditional recommendations with low levels of certainty for the use of ACEi/ARB to treat sickle cell nephropathy. In a lonThe authors declare no relevant competing financial interests.Jin Han, Andrew Srisuwananukorn, Binal N. Shah, Santosh L. Saraf, Robert E. Molokie, James P. Lash, and Victor R. Gordeuk designed and performed the research, analyzed the data, and wrote the paper.


Oscillometric, non-invasive blood pressure measurement (NIBP) is the first choice of blood pressure monitoring in the majority of low and moderate risk surgeries. In patients with morbid obesity, however, it is subject to several limitations. The aim was to compare arterial pressure monitoring by NIBP and a non-invasive finger-cuff technology (Nexfin®) with the gold-standard invasive arterial pressure (IAP).In this secondary analysis of a prospective observational, single centre cohort study, systolic (SAP), diastolic (DAP) and mean arterial pressure (MAP) were measured at 16 defined perioperative time points including posture changes, fluid bolus administration and pneumoperitoneum (PP) in patients undergoing laparoscopic bariatric surgery. Absolute arterial pressures by NIBP, Nexfin® and IAP were compared using correlation and Bland Altman analyses. Interchangeability was defined by a mean difference ≤ 5 mmHg (SD ≤8 mmHg). Percentage error (PE) was calculated as an additional statistical estimate. For hemodynamic trending, concordance rates were analysed according to the Critchley criterion.2) were enrolled and data from 56 finally analysed. Pooled blood pressure values of all time points showed a significant positive correlation for both NIPB and Nexfin® versus IAP. Pooled PE for NIBP versus IAP was 37% (SAP), 35% (DAP) and 30% (MAP), for Nexfin versus IAP 23% (SAP), 26% (DAP) and 22% (MAP). Correlation of MAP was best and PE lowest before induction of anesthesia for NIBP versus IAP  and after intraoperative fluid bolus administration for Nexfin® versus IAP . Concordance of MAP trending was 90%  for NIBP and 91%  for Nexfin®. MAP trending was best during intraoperative ATP positioning for NIBP (97%) and at induction of anesthesia for Nexfin® (97%).Sixty patients  on June 12, 2017.The non-interventional, observational study was registered retrospectively at ( The standard of care in most low to medium risk surgeries is the oscillometric, non-invasive, intermittent blood pressure measurement (NIBP), which is associated with a lower rate of perioperative complications compared with invasive arterial pressure (IAP) measurements , 2. Howe2) patients are more likely to have a history of type 2 diabetes, arterial hypertension or obstructive sleep apnea syndrome [Obese and morbidly obese  class ≥ II and written informed consent for study participation. Since not only morbidly obese patients defined as a BMI ≥ 40.0 kg/m2 or 35.0 and 39.9 kg/m2 with comorbidities, but also obese patients with BMI > 30 and < 35 kg/m2 and type 2 diabetes may have been scheduled for bariatric surgery [2 criterion was selected. Pre-existing cardiac arrhythmias, peripheral arterial vascular disease Fontaine stadium > 2, pre-existing aortic aneurysm > 4,5 cm and cognitive or linguistic barriers were defined as exclusion criteria.This is a planned secondary analysis of a single-center prospective observational cohort study where the comparison of continuous cardiac index measurements by Nexfin® and a semi-invasive reference method was previously published . The sin surgery , the BMIA description of the study participants’ instrumentation, hemodynamic monitoring and anesthesia was already described previously .NIBP measurement using a forearm cuff on both arms was used for all study participants in order to detect physiological as well as pathological blood pressure differences. Non-invasive blood pressure monitoring  was conducted on the right arm along with relaxometry and pulse oxymetrically measured oxygen saturation. The appropriately sized finger-cuff of the Nexfin® system   was placIn the pre-, intra- and postoperative phase, the arterial pressure was measured at 16 predefined measurement time points at which hemodynamic changes were likely expected.The first measurement was performed in the awake, spontaneously breathing patient in neutral position (baseline measurement time point 1). Directly before the induction of general anesthesia, the patients were placed in 30° anti-Trendelenburg positioning (ATP) as per clinical standard for oxygenation improvement and aspiration prophylaxis (measurement time point 2). The next measurements were taken under general anesthesia, but still in ATP (measurement time point 3), and re-positioned to baseline (measurement time point 4). The following three measurement pairs  were taken during 30° passive leg raising (PLR), again in neutral position and after administration of a 500 ml balanced crystalloid solution bolus infusion . After this preoperative period the patients were transferred to the operating room, where the measurement devices were reconnected and a new zero balance was performed . Further measurements were taken intraoperatively after the pneumoperitoneum (PP) had been applied to 15 mbar , during intraoperative ATP positioning (measurement time point 10) and in that position after another fluid bolus of 500 ml crystalloid solution (measurement time point 11). The last three intraoperative measurements (measurement time points 12–14) were carried out after termination of PP in neutral position, and again in ATP by the end of general anesthesia, followed by a last measurement in neutral position. Measurement time points 15 and 16 were carried out in the post-anesthesia care unit (PACU) upon arrival and after 2 h in ATP posture, before the patient was discharged from PACU. Demographic data including gender, age, height and weight, ASA classification, comorbidities, and type of surgery and anesthesia were collected from all study participants.N = 60 study participants, followed by an intermediate evaluation. For a Bland-Altman analysis, the width w of the confidence interval for the limits of agreement (LOA) was calculated as w = 6.79•σ•1/√n, where n is number of cases and σ is the standard deviation. For a case count of N = 60, the result is w = 0.88 • σ and thus considered a sufficiently large number. Normal distribution of the outcomes was checked and verified by visual inspection of the histogram analysis. First, a Spearman correlation analysis of measurement pairs for SAP, DAP and MAP between the monitoring devices was performed. Furthermore, Bland-Altman analysis was used for the comparison of the pressure variables with calculation of the mean difference (bias) and limits of agreement (LOA) defined as the standard deviation (SD) of the bias ±1.96 accounting for repeated measurements [The primary objective of the study was to test interchangeability of the test (NIPB or Nexfin®) against the invasive reference method (IAP). As there is no global definition of interchangeability, we chose two commonly accepted criteria to allow approximation: 1) the recommended Association for the Advancement of Medical Instrumentation (AAMI) criterion of a mean difference ≤ 5 mmHg and associated SD of ≤8 mmHg , 2) the urements , 33. Theurements . We furtP value of < 0.05 was considered as statistically significant. Statistical analysis was performed using GraphPad Prism 5, GraphPad Software Inc., San Diego, CA, USA.A N = 832) of all planned measurements could be realized. Reasons for lack of measurement data pairs (N = 128) were mostly attributed to intraoperative events preventing measurements (N = 90) and challenges in function and handling of the measurement device, of which the NIBP device failed significantly more frequently (N = 31) than the IAP (N = 2) or Nexfin® monitoring (N = 5). All measurements were pooled and included in the statistical analysis.Sixty patients were enrolled in the study with four patients being excluded from the statistical analysis due to insufficient data acquisition Fig. . Table 1Table The pooled correlation coefficient between NIBP and IAP for MAP was 0.77 . Bland-Altman plots corroborated a correlation with a PE of 30% and a bias of − 3.94 mmHg for MAP . Pooled correlation between Nexfin® and IAP over all measurement time points was 0.88 for MAP . Bland Altman analysis showed a PE of 22% and a bias of 1.43 mmHg for MAP .With respect to hypotension, PE was comparable between NIBP 30%) and Nexfin® (29%) vs. IAP whereas during hypertension, PE was lower for NIBP (28%) and Nexfin® (21%) vs. IAP  and DAP , but only moderate for SAP , missing the predefined AAMI criterion of interchangeability. Trending capability was good with concordance rates of 88–93%. In contrast to our study, measurements were recorded continuously using an interface cable and recording software for 45 min independently of intraoperative events and cleared of obvious artifacts subsequently by visual inspection [2 was unable to show interchangeability of intraoperatively measured absolute arterial pressure values with an observed bias (SD) of 14.3 mmHg (14.1) for SAP, 2.6 mmHg (10.8) for DAP and 5.2 mmHg (10.9) for MAP as compared to IAP [2) with bariatric surgery. In their study, measurements were obtained within 15 min before start of PP in the horizontal position, 3, 15, 30, and 45 min after the beginning of PP in the 30° reverse Trendelenburg position and 3 min after end of PP in horizontal posture. Furthermore, NIBP and Nexfin® were recorded at the ipsilateral arm as opposed to the contralateral measurement in our study. DAP showed best precision (mean difference 0 ± 11 mmHg), followed by MAP (mean difference − 1 ± 11 mmHg) and SAP (mean difference − 7 ± 14 mmHg) between finger-cuff and IAP measurements while NIBP measurement was significantly less precise [2) and young adults during robotic, laparoscopic-assisted bariatric surgery and were able to only show a clinically useful trend ability of the arterial pressure values for CNAP while accuracy for absolute values failed the AAMI criterion [2) undergoing laparoscopic bariatric surgery correspondingly found good trending ability for the CNAP® system compared to continuous IAP measurements obtained with a radial arterial catheter, but again no interchangeability for absolute values [With regard to morbidly obese patients undergoing bariatric surgery, four observational studies have been previously published focussing on the performance of the Nexfin® (Clearsight®) finger-cuff device for arterial pressure monitoring , 26, 27.surement . A furthspection . The pro precise , 25 in pe values .In essence, while results from our and the 5 published studies on interchangeability for absolute values remain inconclusive with a notion that Nexfin is slightly more precise, overall trend behavior of the finger-cuff technology was consistently shown to be clinically useful. The latter was also shown for various subsequent measurement time points in our study where hemodynamic changes become evident in the perioperative phases of laparoscopic bariatric surgery, providing useful clinical information on the presence of arterial pressure variation and its management. Finally, we further analyzed precision in the range of hypo- and hypertension as this is clinically even more relevant than information on “global performance”. With focus on hypotension, Nexfin® and NIBP tended to overestimate arterial pressure, possibly leading to false security in clinical practice while during hypertensive episodes no difference was observed. However, data pairs for hypotension in our study were too limited to be conclusive, most likely because a direct therapeutic intervention was performed for patient safety. In a previous study in 30 awake carotid endarterectomy patients, Noto and coworkers showed that precision of Clearsight® measurements were not interchangeable below an average MAP cut-off value of 69 mmHg .A limitation of our study is that the sample size of 60 patients deviates from the recently updated standard for the validation of blood pressure measuring devices by the AAMI, the European Society of Hypertension (ESH) and the International Organization for Standardization (ISO) collaboration where where a minimum sample size of 85 participants is recommended for studies validating non-invasive sphygmomanometers . HoweverStrengths of our study include the examination of different hemodynamic stresses typically occurring throughout the perioperative course of laparoscopic surgery, particularly due to different postures and on/off-set of PP. Mimicking those physiological stresses using a structured protocol in the pre-, intra- and postoperative phase enhances the “real-life” comparison of the device performance.In the perioperative management of patients undergoing laparoscopic bariatric surgery, our study indicates that NIBP and Nexfin® derived absolute arterial pressure recordings were not interchangeable with IAP, but Nexfin® was more precise than NIBP. However, a good trending ability even under different hemodynamic stresses was found. Thus, Nexfin® may serve clinically useful to detect arterial pressure changes and render perioperative hemodynamic treatment, particularly in those individuals where NIBP cannot be reliably established.


The authors assessed treatment and control of blood glucose, blood pressure (BP), and blood lipids among patients from Inner Mongolia with diabetes mellitus (DM) and hypertension (HTN) and identified the modifiable factors associated with treatment and achievement of blood glucose, BP, and blood lipid targets. The authors used a multistage stratified cluster sampling method according to geographical location and level of economic development in Inner Mongolia. Among patients with DM and HTN, the crude rates of fasting plasma glucose (FPG) treatment and control was 30.76% and 4.73%, respectively. Crude rates of BP treatment and control were 50.81% and 8.70%, respectively. The authors found that treatment rates of HTN and DM and control rates of BP and FPG showed a gradually increasing trend with increased age. Among patients with DM and HTN, the likelihood of treatment for HTN and DM was significantly increased among participants who were older, non‐Mongolian, male, obese, smokers, and those with previous cardiovascular disease. The authors found that control of BP, FPG, and low‐density lipoprotein cholesterol was far from optimal among study participants. Medical and health departments in Inner Mongolia should take appropriate measures to reduce the burden of DM and HTN in the population, such as by promoting and improving the quality of HTN and DM treatment to achieve control goals and reduce the risk of cardiovascular disease. Particularly in developing countries, a substantial gap exists between clinical practice and recommended treatment in the management of patients with DM and HTN. With changes in lifestyles and a growing aging population, the prevalence of DM and HTN among individuals in China has increased rapidly over the past decades. Considerable uncertainty remains about the prevalence of DM and HTN according to age, sex, region, and socioeconomic status, as well as current levels of blood pressure (BP), blood glucose, and blood lipid management among patients in Inner Mongolia. Limited evidence is available on the prevalence and management of patients with DM and HTN in this region. In the present study, we aimed to assess the treatment and control of blood glucose, BP, and blood lipids among patients with patients with DM and HTN in Inner Mongolia and to explore those factors associated with treatment and achievement of blood glucose, BP, and blood lipid target goals. We also provide an effective scientific basis for the prevention and control of CVD and death in high‐risk groups.22.1The data in this study were from the China Patient‐Centered Evaluative Assessment of Cardiac Events Million Persons Project in Inner Mongolia. We used a multistage stratified cluster sampling method in participant selection, conducted during 2015–2017. According to geographic location and economic development level, six cities were randomly selected from the Inner Mongolia Autonomous Region: Hohhot, Wuhai, Chifeng, Xing'an, Ordos, and Hulun Buir. In the second stage, we selected one district or county from each of these cities according to the size of the district or county and population stability. Finally, potential participants from each community or village were invited to participate in the study by local staff through an extensive publicity campaign on television, radio, and in newspapers.This study was approved by the Central Ethics Committee of the National Cardiovascular Center of China. All participants provided written informed consent. We recruited residents aged 35–75 years who had lived in Inner Mongolia for at least 1 year. Finally, a total of 70 380 participants from Inner Mongolia were registered. Among them, 9617 patients with DM and HTN were included in this study.2.2We used trained investigators as well as checks of participants' responses by trained interviewers to ensure the validity of the self‐reported data. We collected basic information of sociodemographic characteristics such as age, sex, ethnic group, education level, annual household income, smoking status, history of disease, and living environment. Data of height, weight, BP, fasting blood glucose (FPG), and blood lipids were obtained in physical examinations or laboratory testing.BP was measured twice by a medical staff member who had received professional training, using an electronic blood pressure monitor  and a standard protocol. One of two cuff sizes (regular adult or large) was chosen according to arm circumference and the procedure was conducted by a trained, certified observer who used an American Heart Association protocol to perform three BP measurements after the participant had been at rest in a seated position for at least 5 min. The mean of the two recorded values of systolic blood pressure (SBP) and diastolic blood pressure (DBP) was used in all analyses. All devices were regularly maintained and calibrated to ensure consistency of the measurements. After at least 12 h of overnight fasting, venous blood samples were collected for the measurement of FPG and lipid. Blood glucose was measured using a glucose analyzer . Blood lipid tests were performed to measure total cholesterol (TC), triglyceride (TG), high‐density lipoprotein cholesterol (HDL‐C), and low‐density lipoprotein cholesterol (LDL‐C) using a rapid lipid analyzer .2.32. Mongol was the main minority ethnic group in this study. The ethnicity of participants was categorized into three groups: Han, Mongol, and other minority ethnic groups. Participants with either TC ≥6.22 mmol/L, LDL‐C ≥4.14 mmol/L, TG ≥2.26 mmol/L, HDL‐C < 1.04 mmol/L, or self‐reported use of lipid‐lowering drugs were classified as having dyslipidemia.Current smokers were defined as having smoked at least one cigarette a day during the past year. Body mass index (BMI) was calculated as weight (in kilograms) divided by height (in meters) squared. According to recommendations of the Working Group on Obesity in China, obesity was defined as BMI ≥28 kg/mPatients with DM were defined as those who regularly took hypoglycemic drugs, received insulin injections, or had an FPG > 7.0 mmol/L or self‐reported diabetes. HTN was defined as SBP ≥140 mm Hg or DBP ≥90 mm Hg or use of antihypertensive medication within the previous 2 weeks (in accordance with 2010 Chinese guidelines for the management of hypertension2.4Continuous variables are presented as mean and standard deviation (SD) or median and compared using the chi‐square test. Categorical variables are shown as number and percentage. We calculated the rates of both treatment and control of BP, FPG, and LDL‐C according to the different subgroups, as well as 95% confidence intervals (CIs). Age‐ and sex‐standardized rates of treatment and control for diabetes and HTN at national level were calculated using a direct method of standardizationp < .05 was considered statistically significant.To analyze the association between individual characteristics and treatment as well as control of DM and HTN, multivariate logistic models were developed with stepwise selection of independent variables. In the multivariate analysis, the independent variables included age group , sex , married status (yes or no), obesity (yes or no), high school degree or above (yes or no), annual income ≥50,000 RMB (yes or no), farmer (yes or no), residence , ethnic group , and history of cardiovascular disease (yes or no). All the analyses were conducted using SAS version 9.4 . Two‐sided 3A total of 9617 patients with DM and HTN were included in this study; the study flow chart is shown in Figure 3.1The treatment and control of FPG, BP, and LDL‐C by different groups are displayed in Tables ptrend < .05). Similarly, the control rates of BP and FPG also increased with age (ptrend < .05). Ethnic Mongolian participants had lower rates of treatment and control for DM, HTN, and hyperlipidemia. The control rates of BP, blood glucose, and LDL‐C in married patients were significantly higher than those in unmarried patients (p < .05). Participants living in urban areas had higher rates of diabetes treatment and control. Furthermore, higher control rates of FPG, BP, and LDL‐C were found in the group with higher education levels. Compared with patients who did not have CVD, those with prior CVD had much higher rates of treatment and control for DM as well as HTN (p < .05).We found that treatment rates for HTN and DM were higher in older patients  among patients with HTN and uncontrolled SBP. The optimal treatment target distance to DBP was calculated as the measured value of DBP minus 90 (mm Hg) among patients with HTN and uncontrolled DBP. The optimal treatment target distance to FPG was calculated as the measured value of FPG minus 7 (mmol/L) among patients with diabetes and FPG ≥7 (mmol/L). The optimal treatment target distance to the target of LDL‐C was calculated as the measured value of LDL‐C minus 1.8 (mmol/L) among patients with uncontrolled LDL‐C and prior CVD. In patients with uncontrolled LDL‐C and without prior CVD, the optimal treatment target distance was calculated as the measured value of LDL‐C minus 2.6 (mmol/L).3.3Using a binary logistic model, we identified several independent influencing factors related to the treatment and control of patients with DM and HTN Figures , 3, 4. PParticipants with Mongol ethnicity had lower odds of being treated for DM compared with those of Han ethnicity Figure . Among pAmong patients with dyslipidemia, patients with prior CVD and those who were older, married, or living in rural areas had difficulty achieving LDL‐C control goals Figure . Accordi4This study was the largest cross‐sectional investigation related to CVD, DM, and HTN in the Inner Mongolia Autonomous Region in recent years. This study, which included a large study population from multiple regions and comprising different minority ethnic groups, provides an up‐to‐date assessment of the treatment and control of FPG, BP, and LDL‐C among patients with DM and HTN in Inner Mongolia and identifies predictive factors for poor FPG, BP, and LDL‐C control. We are confident that the results of our research will help improve public health policies and effectively improve the level of public health in the region.International clinical guidelines strongly recommend that optimal control levels of FPG, BP, and LDL‐C are important to prevent the risk of developing CVD in patients with DM combined with HTN.Whereas previous reports have shown that the prevalence of HTN among individuals in China is slightly lower, on average, than that in Western countries, this study showed that the prevalence of HTN in China is now comparable to that in the West.A series of studies have shown that in the management of patients with DM and HTN, comprehensive control of various risk factors that can aggravate the development of CVD can achieve good preventive effects.According to age group, we found that treatment and control of BP were lower in patients with HTN in the young and middle‐aged groups. The same trend was observed in patients treated with DM, which was consistent with the results of other studies.On the whole, Inner Mongolia should improve its hierarchical diagnosis and treatment system for common diseases such as HTN and DM, optimize the allocation of health resources, and train health workers in other related aspects to contribute to the standardized management of chronic diseases and improve the utilization efficiency of primary health resources.Our study had several limitations. First, we noted that 35% of BP measurement values ended in 0 or 5, which could indicate terminal digit preference among medical staff in recording BP measurements, despite the use of a standardized method. Second, using data for the total population of Inner Mongolia, we adjusted the main asymmetry characteristics of the research population, such as age, sex, and ethnicity. The adjusted estimates for the treatment and control of DM, HTN, and dyslipidemia were slightly lower than the crude estimates. Moreover, owing to sampling bias, we expect that the treatment rate and control rate were overestimated in our study because potential participants were more likely to yield positive results owing to greater concern about their health. This study was based on 2010 guidelines. In comparison with current, more stringent guidelines, the control rates based on 2020 guidelines were overestimated. Finally, only cross‐sectional estimates of BP, FPG, and LDL‐C control were counted and changes in these indicators could not be tracked.5In this study, we investigated prevalence, treatment, and control rates in a representative sample of middle‐aged and older Chinese patients with DM and HTN and found sex‐specific and age‐specific patterns. We found that control of BP and blood glucose was far from optimal in our sample. We also observed that high treatment rates do not mean that these risk factors are well controlled. Therefore, the health sector should adopt a variety of strategies to achieve control objectives, including promotion and improvement of the quality of treatment for DM and HTN.The Authors declare that there is no conflict of interest.Yanqing Bi and Xingguang Zhang contributed the central idea. Yanqing Bi wrote the initial draft of the paper. Wenyan Yan, Min Liu, Yuqian Zhao, Han Bao and Tao Yan analysed the data. The remaining authors contributed to refining the ideas, carrying out additional analyses and finalizing this paper. All authors gave final approval, and agreed to be accountable for all aspects of work ensuring integrity and accuracy .Supporting information.Click here for additional data file.


Intracranial atherosclerotic plaque causing mild luminal stenosis might lead to acute ischemic events. However, the difference between culprit and nonculprit lesions is unclear, as are the factors associated with favorable treatment outcomes.To quantify characteristics of intracranial atherosclerosis with mild luminal stenosis and to identify factors associated with lesion type (culprit or nonculprit) and with clinical outcomes.Prospective293 patients who had acute stroke with mild luminal stenosis (<50%) in the middle cerebral or basilar artery.hrMRI) of intracranial arteries and whole brain MR images.3.0 T higher resolution magnetic resonance imaging  at day 90, with a favorable outcome being defined as a 90‐day mRS ≤2.The odds ratios (ORs) with 95% confidence intervals (CIs) were calculated by a logistic regression model.P < 0.05) and hrMRI enhancement ratio  were independently associated with lesion type. Patients without hypertension had significantly more (P < 0.05) favorable outcomes (124/144) than patients with hypertension (97/149). Most hypertensive patients without any previous blood pressure control (54/63) had a favorable outcome. However, these patients were significantly younger (P < 0.05) than those with adequate blood pressure control. After adjusting for all significant characteristics, hypertension duration , hypertension management , and enhancement ratio  were found to be independent high‐risk factors for outcome prediction.Hypertension (OR 5.2; 95% CI 2.6–10.3; hrMRI provided incremental value over traditional risk factors in identifying higher risk intracranial atherosclerosis with mild luminal stenosis.2Stage 2 Intracranial atherosclerotic disease (ICAD) is a major cause of ischemic stroke worldwide, especially accounting for 40% of stroke in the Asian population.Positive remodeling is often observed in culprit lesions with mild stenosis where plaque grows outwards without causing significant lumen narrowing.Thus the aim of this prospective study was to quantify differences in hrMRI‐defined characteristics between culprit and nonculprit intracranial atherosclerosis causing mild luminal stenosis, and to identify an optimal method to differentiate lesion types and factors associated with clinical outcomes following standard clinical management.This study was approved by the Institutional Review Board of Changhai Hospital of Naval Medical University (Registration number: CHEC2018‐092) and all patients provided written informed consent. Patients attending the neurological clinic who had acute ischemic stroke (onset within 30 days) with mild intracranial stenosis (<50%) in one of or both middle cerebral artery (MCA) or basilar artery (BA), determined by CTA or MRA, were prospectively recruited from January 2013 to December 2018. All patients received standard medical treatment during hospitalization. The inclusion criteria were as follows: 1) aged 18–90 years old; 2) undergoing hrMRI examination during hospitalization within 30 days from onset; and 3) at least one high cardiovascular risk factor, including hypertension, diabetes mellitus, hypercholesterolemia, or cigarette smoking. Patients were excluded if they had: 1) nonatherosclerotic intracranial arterial disease ; 2) suspected cardio‐embolic stroke; 3) presence of notable stenosis of the extracranial arteries (≥50%) assessed by ultrasound; 4) presence of ascending aortic arch atheroma as identified on MRI; 5) known coagulopathy, heart or respiratory failure; 6) intracranial hemorrhage; 7) renal dysfunction (serum creatinine >133 μmol/L); 8) serious disturbance of consciousness; and 9) poor image quality assessed by three readers . The image quality including all of hrMRI images was assessed with the following method: each slice was graded on a 4‐point scale  based on the overall signal‐to‐noise ratio and the contrast between the vessel wall and surrounding tissues. Images with grades ≥3 with most lumen and outer wall boundaries visible were included in this analysis; outer wall boundaries were manually segmented on T2‐weighted (T2W) images at sites of maximum plaque area.2, slice thickness = 1.2 mm, number of excitation (NEX) = 1, matrix = 384 × 192, sequence duration = 4.78 minutes; 2) T2W fast spin echo (FSE): TR/TE = 2883/50 msec, FOV = 10 × 10 cm2, NEX = 3, matrix = 320 × 256, echo‐train length (ETL) = 20, slice thickness = 2 mm, in‐plane image resolution = 0.32 mm × 0.39 mm, and sequence duration = 3.85 minutes; 3) T1‐weighted (T1W) FSE: TR/TE = 567/16 msec, FOV = 10 × 10 cm2, NEX = 2, matrix = 320 × 256, ETL = 6, slice thickness = 2 mm, in‐plane image resolution = 0.32 mm × 0.39 mm, and sequence duration = 5 minutes; 4) contrast enhancement T1‐weighted (CE‐T1W) imaging following a dose of 0.1 mmol/kg Gd‐DTPA injected by power injector at a rate of 2 mL/sec followed by 15 mL of saline solution. Twelve slices were acquired for T1W, T2W, and CE‐T1W sequences.The hrMRI was performed in two 3.0 T whole body systems . The GE system was equipped with an eight‐channel phased‐array head coil, and the Siemens system was equipped with a 20‐channel phased array head and neck coil. After an initial multi‐plane localizer sequence, axial three‐dimensional (3D) time‐of‐flight (TOF) MRA was performed to identify the stenosis. The hrMRI scanning parameters for both MCA and BA were: 1) 3D TOF MRA: repetition time (TR)/echo time (TE) = 29/3.4 msec, field of view (FOV) = 24 × 21 cmMR data were reviewed and analyzed by three radiologists , and the other with more than 25 years' experience [Q.L.]) who were not involved in any statistical analysis. An atherosclerotic plaque was defined as a focal wall thickening identified on hrMRI images with or without luminal stenosis. Each detected plaque was classified as culprit or nonculprit referring to patient clinical presentations and findings in diffusion weighted imaging (DWI) and fluid‐attenuated inversion recovery (FLAIR) images. The culprit plaque was identified as a lesion arising on the ipsilateral side to a fresh infarction on the DWI images with accompanying clinical symptoms. A plaque was considered to be a nonculprit plaque when it occurred in patients with presumed ischemic stroke/TIA but without an infarct on DWI and FLAIR. If more than one plaque was present in the same vascular territory, the most stenotic lesion was chosen for analysis  was defined,S is the signal intensity at the slice of greatest enhancement normalized by the signal from adjacent gray matter .Plaque lumen and outer wall boundaries were manually segmented on T2W images using VascularView . The boundary could be adjusted if necessary. The same contours were used to analyze T1W and CE‐T1W images. The degree of luminal stenosis was measured based on TOF maximum intensity projection using the WASID criterion.The reproducibility of the image analysis was assessed through intra‐ and interobserver studies. Sixty patients were randomly selected, and images were reviewed by one reader (**) twice with an interval of 12 weeks to avoid bias. The same MR images were independently reviewed by another two readers (** and **) for testing the inter‐observer agreement during the first time measured by the first reader.Each patient underwent standard clinical management following guidelines at admission, during the hospital stay and after discharge. Patients' demographics and disease history  and symptoms were recorded. National Institutes of Health Stroke Scale  was recorded to assess the severity of neurological disorder.t‐test or Mann–Whitney U‐test as appropriate for the comparison of continuous variables, and chi‐squared for the comparison of categorical variables) was used to identify parameters associated with plaque type (culprit or nonculprit) and clinical outcomes (mRS ≤2 or mRS >2). Multivariable logistic regression analysis was then performed, which included variables with P < 0.05 in univariate tests. The odds ratios (ORs) with 95% confidence intervals (CIs) were calculated by a logistic regression model. The diagnostic performance was described using receiver operating characteristic (ROC) curves and area under curve (AUC) values. ROC curves were compared using the method developed by DeLong et al.P‐value <0.05 was considered to be statistically significant.Statistical analyses were performed using SPSS 24.0 . Normality testing was performed to assess the variable distribution. Univariable analysis  were eventually included in the study and analyzed. The patient demographics are listed in Table In the following sections, the difference in high risk factors and lesion characteristics between culprit and nonculprit lesions was first analyzed, followed by patient cohort with different treatment outcome, and finally factors associated with unfavorable outcomes were identified.P < 0.05). Multivariable logistic regressions confirmed that hypertension  and enhancement ratio  were strongly associated with culprit plaques. Compared with hypertension alone (AUC =0.683 [95% CI 0.599–0.747]) or enhancement ratio alone (AUC =0.671 [95% CI 0.593–0.721]), the combination of these two factors improved the AUC to 0.829  with sensitivity and specificity being 0.861 and 0.792, respectively , 24.6%  had a poor outcome with mRS ≥2 at 90 days after discharge (Table P < 0.05). As with plaque type, significant differences in plaque volume, plaque burden, MLA, remodeling ratio, and enhancement ratio were found between these two groups . Moreover, patients with nonstrict control of blood pressure, lower plaque enhancement grade, and eccentric lesions had significantly more unfavorable outcomes (P < 0.05).Although most of the acute symptomatic patients with mild intracranial stenosis had favorable outcomes N = 21, 75.4%P < 0.05), hypertension management , and enhancement ratio  were independent high‐risk factors to predict the clinical outcomes. The AUCs were 0.789 (95% CI 0.700–0.870), 0.751 (95% CI 0.650–0.831), and 0.682 (95% CI 0.575–0.769), respectively  were considered, it remained nearly the same that hypertension duration and management together with lesion enhancement ratio were key determinants associated with clinical outcome (170 had favorable outcome and 63 unfavorable). The quantitative comparisons between these two groups were provided in Table If only patients with culprit lesion (N = 28) were subject to strict blood pressure control. Patients without any previous control were younger than those with partial or strict control  (Table P < 0.05) patients without hypertension had a favorable outcome (124/144) than patients with hypertension (97/149). For those without any previous control (N = 63), 86% (54/63) achieved functional independence (mRS 0–2) after standard blood pressure lowering therapy, while only 64% patients in the group with partial control (37/58) had a favorable clinical outcome. On the contrary, only 21% (6/28) patients with a previous strict blood pressure control had a favorable outcome.In the present study, 149 patients suffered from hypertension and culprit lesions were found in 135 of them. Only 9.6% of these patients (N = 58), 21 patients achieved a poor outcome. In these 21 patients, 19.0% (N = 4) had IPH, 42.9% (N = 9) had positive remodeling, 47.6% (N = 10) showed no enhancement and 95.2% (N = 20) were eccentric. Only nine cases in the subgroup having no hypertensive control achieved an unfavorable outcome. In these, hrMRI showed all plaques were without IPH, six cases were without enhancement, four cases were eccentric, and two showed positive remodeling.Furthermore, in the 28 patients with a previous strict blood pressure control, 22 had an unfavorable outcome, as shown in Table The reliability of hrMRI for the identification of morphological and compositional features in ICAD was assessed through the intra‐ and interobserver agreement analysis. The intra‐ and interobserver agreements for all variables were excellent. The ICCs of the intra‐ and interobserver agreement were shown in Table S2. The ICC of intraobserver agreement was 0.89 ± 0.01 and that of interobserver agreement was 0.91 ± 0.02. The kappa values for IPH identification and eccentricity calculation were 0.92 and 0.90, respectively.This study revealed a prevalence of about a third (293/967) of intracranial atherosclerotic plaque without substantial stenosis in symptomatic patients . Logistic regression analysis indicated that hypertension and plaque enhancement ratio were two independent factors strongly associated with culprit lesions and clinical treatment outcomes; patients without a history of hypertension were found to be very likely to have a nonculprit plaque and a good outcome. For those with uncontrolled or partially controlled hypertension, the standard treatment protocol for risk management was effective. However, the current standard treatment strategy was insufficient for patients with previous strict blood pressure control who had predominantly unfavorable outcomes.It has been widely reported that hypertension plays an important role in the development of atherosclerosis, which might eventually result in occlusive and artery‐to‐artery embolic strokes.This implies that the current standard clinical management for these patient cohorts might be improved by accounting for systematic chronic damage induced by high blood pressure. A longer duration of hypertension might induce more damage to the small cerebral arteries and to nearby brain tissues. It is also possible that unidentified high‐risk factors develop within the period when the blood pressure management is applied and hypertension occurs. Unfavorable outcomes were more likely to occur in a hypertensive cohort with previous strict control than in a cohort without any control. This does not mean that previous strict blood pressure control leads to an unfavorable outcome. On the contrary, our findings may have demonstrated the benefit of previous blood pressure control as it may have postponed symptom occurrence. And it was evidenced by the fact that patients without any control were over 10 years younger than those with. High blood pressure with inadequate previous management was likely the main cause of symptoms for this younger patient cohort, and therefore the standard blood pressure lowering clinical treatment was effective.In addition to hypertension, hrMRI provided complementary information to assist in differentiating lesion type and in predicting clinical outcomes. Culprit lesions tended to have a higher enhancement ratio, higher prevalence of IPH, smaller MLA, and larger plaque volume than the nonculprit lesions. Unfavorable outcomes were associated with lower enhancement ratio, smaller MLA and plaque volume, higher plaque burden, and larger eccentricity index. Enhancement ratio is a parameter reflecting local inflammation or edema as results of plaque rupture that could be reduced by treatment in the short term.According to the trial of ORG 10172 in acute stroke treatment (TOAST) classification,Prehospitalization information on management of diabetes and hyperlipidemia was not available and analysis on these aspects was therefore not performed. Although these factors might contribute to the differentiation of lesion type and treatment outcome, compared with hypertension, far fewer patients in this study had diabetes and hyperlipidemia. Moreover, there was no significant difference in the distribution of patients with diabetes or hyperlipidemia between the groups with different type lesions or different clinic outcomes. Furthermore, 28 patients had both diabetes and hypertension, while 27 patients had hyperlipidemia and hypertension, though none of the patients had all three characteristics. Glucose and lipid levels in these patients should be managed following the same pattern as the blood pressure. Therefore, the missing information of the prehospitalization management of diabetes and hyperlipidemia should have a limited impact on the conclusions of this study. Further study limitations include: 1) this was a single‐center study limited to Chinese populations; 2) our analysis was performed using two‐dimensional imaging data. It is possible that the thinner slices that could be achieved with 3D imaging could allow better characterization of plaque features by reducing partial volume effects; 3) longer follow‐up should be performed to ensure the effectiveness of the current treatment strategy in patients with unfavorable outcomes in 3 months; and 4) patients might not remember their exact history of blood pressure management and the uncertainty in the classification of blood pressure control might exist.Hypertension and plaque enhancement were two independent factors strongly associated with culprit lesions and clinical treatment outcomes. hrMRI provided incremental value over traditional risk factors in identifying higher risk intracranial atherosclerosis with mild luminal stenosis. And current standard clinical management might be sub‐optimal for the patients with previous strict blood pressure control.Drs Zhang Shi and Ming Zhao contributed to the study concept and design, analysis and interpretation of data, drafting/revising the manuscript for content, and statistical analysis. Dr Jing Li was involved in analysis and interpretation of data. Zakaria Meddings contributed to the revision of the language of the manuscript. Dr Yibing Shi performed statistical analysis and interpretation of data. Drs Tao Jiang and Qi Liu took part in the study concept and design, analysis, and interpretation of data. Drs Benqiang Deng, Jianping Lu, and Zhongzhao Teng contributed to the study concept and design, acquisition, analysis, and revising the manuscript for content.Table S1.Click here for additional data file.