Innate immunity plays a central role in the pathogenesis of severe asthma, and it is closely linked to elevated IgE and Toll-like receptor 4 (TLR-4) levels. However, there is a scarcity of information about the association of the TLR-4 receptor polymorphism in the pathogenesis of severe asthma. This study highlights the level of gene expression of different alleles in asthmatic patients compared to healthy control individuals. This was a randomized control trial, which included 150 patients with asthma (with high serum levels of IgE) with a matching 150 healthy control individuals. Participants had a series of blood tests to measure various immune parameters: interleukin-1 (IL-1), interleukin-6 (IL-6), tumor necrosis factor (TNF), intercellular adhesion molecule-1 (ICAM1) and detect allele type and gene expression of the TLR-4 gene. Patients with asthma had significantly higher levels of IL-8 when compared to the healthy control participants. In addition, in the rs91 genotyping, there were significant differences in the levels of IL-8 and TNF between CC and TT genotyping. While in rs90 TLR-4, TNF levels were significantly higher in AA vs. AG and GG genotypes among the asthmatic patients when compared to the control group. The results showed that in TLR-4, rs4986791 were significantly associated with asthma risk. Polymorphisms in TLRs play essential roles in asthma. Asthma TLR-4 protects against Gram-negative bacteria by possessing LPS receptors. Also, the molybdenum produced from compounds can interfere with LPS that activate TLR-4 and cause acute or chronic inflammation, depending on the type of single nucleotide polymorphisms (SNPs) for TLR-4 , 6. Modeet al. in their study . TLR4 is an essential factor in regulating innate immune responses [TLR-4 gene have been reported to be associated with many diseases. The mutant alleles of TLR-4 SNPs seem to have originated in Africa in an environment where malaria appears as a major evolutionary pressure. The role of Thr399Ile polymorphisms in the pathogenesis of type 2 diabetes remains controversial. Some studies have proven that Thr399Ile polymorphisms are correlated with susceptibility to types of allergy [TLR-4 lead to an increase in asthmatic subjects. The increasing levels of many cytokines such as IL-8, IL-17 and others indicate that hypersensitivity is the probable reason for the activation of TLR4- [In this study, patients with asthma showed significantly higher levels of IL-8 than the controls. Regarding the CC genotype, IL-8 concentrations were significantly higher in the asthma group 56.0±25.4) than in the control group 40.9±11.9). Regarding the CT genotype, IL-8 concentration was significantly higher in the asthma group 51.9±18.7) than in the control group 43.6±14.4). These results are in agreement with other studies which reported that patients with asthma had higher levels of IL-8 than normal individuals .4. These. In seve.7 than if asthma –23. Howe1.9. Rega results . In factf asthma . A high  than in TLR-4 in human monocytes. Activated TLR-4 mediates the inflammatory response . This response is associated with TLR-4 gene polymorphisms.In patients with severe asthma, hypersensitivity is always accompanied by elevated levels of innate cytokines in the blood, which stimulates the expression of The approval for this study was obtained from the Human Research Ethics Committee of the University of Kufa (approval ID: MEC-20The participants entered the study voluntarily and their confidentiality was kept.The authors declare that there is no conflict of interest.


Hypertension is a leading risk factor for heart attack and stroke. Undiagnosed hypertension increases the risk of heart attack and stroke. The risk of hypertension is increased for those with type 2 diabetes mellitus (T2DM). Diabetes self-management education (DSME) has been shown to be effective at improving clinical outcomes, including reducing blood pressure, but few studies have evaluated the effects of DSME for Native Hawaiians and Pacific Islanders.This study examined the baseline prevalence of diagnosed hypertension and undiagnosed high blood pressure and differences in health care access between those with diagnosed hypertension versus undiagnosed high blood pressure. The sample consisted of 221 Marshallese adults with T2DM participating in a DSME randomized controlled trial in northwest Arkansas. The study also examined the effects of DSME interventions on participants’ blood pressure, comparing an Adapted-Family DSME with a Standard DSME.Nearly two-thirds of participants had blood pressure readings indicative of hypertension, and of those, over one-third were previously undiagnosed. The frequency of doctor visits was significantly lower for those with undiagnosed high blood pressure. There were no differences in health insurance coverage or forgone medical care between those with undiagnosed high blood pressure versus diagnosed hypertension. Across all participants, a significant reduction in systolic blood pressure occurred between baseline and post intervention, and a significant reduction in diastolic blood pressure occurred between baseline and post-intervention, 6 months, and 12 months post-intervention. No differences were observed by study arm.This study is the first to document the prevalence of diagnosed hypertension and undiagnosed high blood pressure, as well as the effects of DSME on blood pressure among a sample of Marshallese adults with T2DM. Hypertension is one of the leading risk factors for heart attack and stroke. Over 100 million adults aged 20 years and older in the United States (US) have hypertension . The risMore than 11 million adults in the US have hypertension that is undiagnosed . UndiagnDespite the growing population of NHPI in the US, which has increased 40% from 2000 to 2010 , NHPI arN = 396) found 38.4% had T2DM and 41.2% had hypertension. Among those with blood pressure readings indicative of hypertension, 66.0% had not been previously diagnosed with hypertension by a healthcare professional [Arkansas has experienced a significant increase in NHPI community members, most of whom are Marshallese. The growing Marshallese population, now estimated at more than 10,000 residents , is primessional .Intervention Description below.) Results of this RCT demonstrated significantly greater improvements in adjusted mean HbA1c in the Adapted-Family DSME arm compared with the Standard DSME arm at post-intervention  [Diabetes self-management education (DSME) has been shown to be effective at improving clinical outcomes, including reducing blood pressure ,19. Howe = 0.04) . HoweverThe study aims to report the prevalence of diagnosed and undiagnosed hypertension among a sample of Marshallese adults with T2DM, explore if healthcare access is associated with lack of a previous diagnosis, and evaluate the effect of a culturally adapted DSME intervention on blood pressure.1c ≥6.5%). Eligible participants were provided information about the study in English and/or Marshallese and were provided opportunities to enroll in the study. Participants were consented and randomly assigned to one of two arms: the Adapted-Family DSME or the Standard DSME.The RCT took place in Washington and Benton counties in northwest Arkansas. Bilingual Marshallese research staff recruited potential participants through community-driven methods which have been described elsewhere . ParticiThe Standard DSME provided a total of 10 hours of education, covering eight core elements across sessions consistent with the American Diabetes Association (ADA) and American Association of Diabetes Educators’ (AADE) recommendations regarding self-care behaviors, including healthy eating, being active, managing stress, and taking prescribed medications . ParticiThe Adapted-Family DSME also provided 10 total hours and covered the same eight core elements of the Standard DSME. The Adapted-Family DSME was culturally adapted using a community-based participatory research (CBPR) approach to include culturally appropriate ontologies and examples. Participants were encouraged to invite family members to participate in the intervention, and the curriculum focused on the importance of engaging family members in behavioural changes. The Adapted-Family DSME was conducted in participants’ homes. The interventions were implemented between 2015 and 2018. A detailed description of each intervention has been published elsewhere ,24.Retention efforts across both study arms included bi-weekly participant email and phone contact. A $20 gift card was provided at each of the four data collection events . The University of Arkansas for Medical Sciences Institutional Review Board approved the study (#203482), and it was registered at clinicaltrials.gov (#NCT02407132) and HSRProject (#HSRP20152031).ever told you that you had hypertension?” Health care access was determined by the survey questions “Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare?” and “Was there a time in the past 12 months when you needed to see a doctor but could not because of cost?”At each of the four data collection events, self-reported diagnosis of hypertension and health care access were obtained using items from the Behavioral Risk Factor Surveillance System (BRFFS) . Self-reTrained study staff took participants’ blood pressure. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured with a sphygmomanometer and stethoscope or digital blood pressure device, with the participant seated and arm elevated. Participants were considered to have hypertension at baseline based on established diagnostic criteria: SBP ≥130 mm Hg or DBP ≥80 mm Hg [A total of 221 Marshallese adults with T2DM were enrolled. All of the enrolled participants were analysed to determine the prevalence of previously diagnosed hypertension and undiagnosed high blood pressure. Blood pressure readings were indicative of hypertension for 139 participants at baseline. All 139 participants with blood pressure readings indicative of hypertension at baseline were examined to determine if participation in DSME reduced blood pressure over time and/or differentially by intervention study arm. Of those 139 participants with blood pressure readings indicative of hypertension at baseline, 135 responded to the survey question regarding previous hypertension diagnosis. These 135 participants comprised the sample used to determine the prevalence of diagnosed hypertension and undiagnosed high blood pressure and to determine if there was an association between health care access and undiagnosed high blood pressure; See Descriptive statistics were used to determine the percentage of participants with hypertension and the percentage of participants with undiagnosed high blood pressure. The number of times patients visited a doctor, nurse, or other health professional in the past 12 months and hypertension diagnosis was examined using an independent t-test. Insurance coverage and foregone medical care due to cost and hypertension diagnosis were examined using chi-square tests. To determine if participation in DSME reduced blood pressure over time and/or differentially by intervention study arm, two linear mixed-effects regression models for repeated measures were fitted to estimate the impact on SBP and DBP. Three repeated time-point comparisons were used: baseline to 9-weeks, 6-months, and 12-months post-intervention.Both regression models were adjusted for participant characteristics . Study arm and control variables were treated as fixed effects, while time was treated as a random effect, with the assumption of unstructured covariance for both models. Interaction between study arm and time-points was tested within the model. All analyses were performed using SAS/STATv14.2 . An a prAmong the 221 participants enrolled in the DSME trial, 139 (62.9%) had blood pressure readings indicative of hypertension at baseline. Among those 139 participants, more than half (56.8%) were women, and the mean age was 54 years (SD = 10.5). Among the 135 with blood pressure readings indicative of hypertension and valid responses to the item regarding previous hypertension diagnosis, 52 (38.5%) had undiagnosed high blood pressure. Mean = 1.96, SD = 2.60) compared with those with previously diagnosed hypertension  . There were no statistically significant differences based on insurance coverage or forgone medical care between those with undiagnosed high blood pressure versus those with previously diagnosed hypertension.Participants with undiagnosed high blood pressure reported seeing the doctor significantly fewer times per year (p = 0.26) or DBP (p = 0.06). Therefore, it was not included in subsequent models. Parameter estimates resulting from the two final mixed-effects regression models are provided in In the first two mixed-effects models, the interaction between study arm and time was not significant for SBP (n = 139), there was a significant decrease in systolic blood pressure between baseline and immediate post-intervention , but not between baseline and 6-month (p = 0.34) or 12-month post-intervention (p = 0.07). However, there was no statistically significant difference in systolic blood pressure between study arms (p = 0.31). Second, a significant decrease in diastolic blood pressure between baseline and immediate post-intervention , 6-month , and 12-month  post-intervention was achieved; however, there was no statistically significant difference between study arms (p = 0.72).First, among all participants with blood pressure readings indicative of hypertension at baseline , more than three times the prevalence of hypertension (19.2%) recorded in the only prior study reporting hypertension (≥140/90) among Marshallese with T2DM . Among t%, more tThis study found that participants with T2DM and undiagnosed high blood pressure visited the doctor significantly less frequently than those who had been previously diagnosed with hypertension. However, this study did not find significant differences between having diagnosed hypertension or undiagnosed high blood pressure and insurance status. This finding is in contrast to prior research from the National Health and Nutrition Examination Survey (NHANES) that showed 30% of hypertensive adults without health insurance were unaware of their hypertension compared with 14.4% of those with health insurance . This stThe high prevalence of undiagnosed high blood pressure paired with reduced frequency of health care provider visits for those with undiagnosed high blood pressure poses a significant concern, because hypertension is a leading risk factor for heart attack and stroke ,37, and Consistent with prior literature in other populations, exposure to DSME improved blood pressure . While t1c. Similarly, because the primary outcome of the study was change in HbA1c, information regarding current blood pressure medication was not captured and therefore could not be controlled for in the current analyses. Finally, the intervention was aimed at improving the management of T2DM, rather than high blood pressure. Future studies should be powered to test for differences in blood pressure outcomes between various treatments, each designed specifically to reduce blood pressure through a variety of educational and health care options.This study only included Marshallese participants with T2DM living in Arkansas and cannot be generalized to Marshallese living outside of Arkansas, other populations, or those without T2DM. The study sample was limited to those who had blood pressure readings indicative of hypertension at baseline. This led to a slight underestimate of hypertension prevalence in the overall sample, as any participants with a previous diagnosis of hypertension but currently controlled blood pressures were excluded from analyses. Furthermore, the analytic sample was refined based on self-reported previous diagnosis of hypertension. Although self-reported hypertension status is not as accurate as medical records and/or laboratory measures, it is a commonly used measure in population-based studies such as the BRFSS, NHANES, and NHIS and has been validated in numerous races/ethnicities as well as in other countries –49. AddiDespite these limitations, this is the first study to document diagnosed hypertension and undiagnosed high blood pressure among Marshallese with T2DM and the effect of DSME on blood pressure. This study makes a significant contribution to the literature on an understudied population facing stark health disparities.S1 Dataset(XLSX)Click here for additional data file.


Cigarette smoking affects blood pressure and is a major risk factor for cardiovascular diseases. The role of smoking cessation programs with respect to blood pressure remains inconclusive. Thus, this study aimed to investigate the effects of a smoking cessation program on blood pressure.Participants who attended the smoking cessation program in an outpatient clinic of a tertiary medical center in Taiwan from 2017 to 2018 were enrolled in this retrospective cohort study. Their smoking cessation status was traced via phone calls during the third month, and the researchers collected participant characteristics and blood pressure before and after the program. Differences in the participants’ blood pressure, based on those with and those without hypertension, were compared using analysis of covariance. Univariable logistic regression models were used to determine factors associated with success in smoking cessation. In total, there were 721 participants. The participants had a mean age of 55.8±11.4 years and 68.1% of the participants were hypertensive.During the program, the overall systolic blood pressure decreased by 4.0±17.9 mmHg and diastolic blood pressure decreased by 2.5±12.0 mmHg, from the baseline. Hypertensive participants showed a more prominent blood pressure lowering effect compared to non-hypertensive participants in terms of the subtraction difference of systolic blood pressure  and diastolic blood pressure . After multivariate control, the results showed that the adjusted subtraction difference of diastolic blood pressure was still more significant in the hypertensive group than in the non-hypertensive group.The smoking cessation program significantly reduced both systolic blood pressure and diastolic blood pressure in the entire cohort. The results were more significant in the hypertensive group compared to the non-hypertensive group. High blood pressure can lead to organ damage2, cardiovascular diseases (CVDs)3, and even premature death4. It affects more than 1 billion people worldwide5; indeed, it has become a global epidemic that is considered a major public health issue6.Hypertension is a global health issue9. However, research results on the relationship between smoking cessation and blood pressure vary. Some researchers found a paradoxical association between cigarette smoking and blood pressure, with current smokers showing lower blood pressure than ex-smokers10 or non-smokers11. In one study, smokers had higher daytime ambulatory systolic blood pressure than non-smokers12. However, in another study, blood pressure did not differ among current smokers, past smokers, and non-smokers13. Smoking increases the risk of coronary, cerebrovascular, and renal diseases in hypertensive patients and is considered a major modifiable risk factor for hypertension14.Cigarette smoking influences some cardiovascular parameters, including blood pressure15. To alleviate the health hazard of tobacco use, it is necessary that regional healthcare systems provide tobacco abstinence programs.According to World Health Organization (WHO) estimates, tobacco kills more than 7 million people each year. The WHO has been dedicated to tobacco cessation and the WHO Framework Convention on Tobacco Control addressed a policy of accessible and free or affordable medication provided by national policy or health insurance16, and 14.5% in 201717. However, despite the steady observed decline, major economic losses related to tobacco use remain high at approximately 50 billion New Taiwan dollars annually18. Historically, Taiwan established national health insurance in 1995, and 99.6% citizens have joined to date19. Because of the high prevalence of tobacco use and its associated health threats, the Ministry of Health and Welfare initiated a smoking cessation program in 2002 paid by the national health insurance. The outpatient program was designed to encourage doctors to integrate smoking cessation counseling in routine outpatient visits16. Doctors who attended the 8-hour workshop and passed the exam became qualified to hold smoking cessation outpatient service programs in clinical practice. Smokers who visited the clinics received counseling from a doctor in the 5As , 8 weeks of pharmacotherapy  for a maximum of two courses per year, and health education including tobacco abstinence skills and feedback during the course from trained and certificated nurses or counselors. The counselors conducted a telephone follow-up after 3 months, and participants underwent a thorough interview to provide updates on their cessation status and dynamics as well as to give feedback 6 months after the program ended. The participants returned to clinics every 2 to 4 weeks for pharmacological therapy, which was affordable at a maximum of 200 New Taiwanese dollars (about 6.85 US$) per visit. The smoking cessation program was established properly, and studies showed that rates of receiving quitting advice increased among all smokers16. The number of participants in the smoking cessation program increased from 13142 in 2002 to over 0.7 million in 201817.In Taiwan, the prevalence of smoking among adults was approximately 22% in 200812. Epidemiological research has reported different results in this regard20. Some found a positive association between cigarette smoking and blood pressure, whereas others found a possible negative correlation. However, findings are inconsistent, in part, due to the lack of experimental data. Therefore, we sought to clarify the relationship between the two in this cohort study and resolve the discrepancies in the previous findings. At the same time, we sought to elucidate whether and how a well-established smoking cessation program could contribute to healthier outcomes. Because there have been so few reports on the health outcomes of participants22, we attempted to measure the effects of attending a health promotion program, specifically a smoking cessation program, on blood pressure.The relationship between smoking cessation and blood pressure is controversialThis was a retrospective cohort study. We searched the database at our institution for patients who had attended the smoking cessation program in the outpatient clinics at the Mackay Memorial Hospital, Taipei, Taiwan, from January 2017 to December 2018. For the study, we selected 721 participants aged 18–74 years, with complete data and physical parameters considered. We divided the participants into two groups: the non-hypertensive group and the hypertensive group. The hypertensive group consisted of those who had been diagnosed with hypertension or with the disease code I10 in The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) according to their medical records at Mackay Memorial Hospital and patients who were currently using antihypertensive medication.23, using a questionnaire administered by trained nurses, during the participants’ first smoking cessation outpatient clinic visit. FTND scores range from 0 to 10 and reflect nicotine dependence, with higher scores representing greater dependence. Smokers with FTND scores ≥7 will possibly have strong withdrawal symptoms and relapse early24.We retrieved the participants’ basic characteristics such as gender, age, pack-years (packs per day × years), the number of daily cigarettes, and the Fagerström test of nicotine dependence (FTND) scoreTrained nurses also measured the participants’ baseline body weight (kg) and exhaled carbon monoxide (ppm) concentrations. Doctors measured the patients’ rest blood pressure using a sphygmomanometer after a 10-minute rest, and participants were categorized as having cardiovascular diseases (CVDs) if the team noted any of the following conditions or diagnoses in the data sets or in the patients’ medical records: ST-segment elevation or non-ST-segment elevation myocardial infarction, CVDs with stent, any stroke, angina, ischemic heart disease, or peripheral arterial diseases. Participants were categorized as having diabetes if we found a diagnosis of diabetes or a record of any antidiabetic medication in the data sets or in their medical records.The smoking cessation program is well-established in the clinic, and every patient who joins the clinic receives information on the program, a clear concept of lifestyle modification, and the healthy lifestyle they need to adopt. In the hospital, we conducted the smoking cessation program in the outpatient clinics of family physicians and internal medicine physicians. Participants were to provide an accurate abstinence date at their first clinical visit. Doctors prescribed varenicline or nicotine replacement therapy after evaluation, despite contraindications such as allergies. The patients were also asked to throw away all their cigarettes and lighters. Certificated counselors or nurses arranged to interview the participants in person, provide abstinence skills and advise them to declare on social media and on their personal web pages that they were quitting smoking and to tell their families and friends. The counselors also asked the participants to avoid places with a chance of tobacco exposure, and advised them that if they thought about smoking, they could distract themselves by drinking water, taking a deep breath, or doing some exercise. The counselors also encouraged a regular daily routine and sleep, and the patients were scheduled to return to the clinic every 2 to 4 weeks during medication use.We obtained data on the participants’ final blood pressure, exhaled concentration of carbon monoxide (ppm), final daily cigarettes and body weight within 3 months after attending the program. The counselors also followed up with the patients via telephone to track their smoking status during the third month. During thorough interviews, the counselors asked the patients to confirm their smoking status, specifically whether they had smoked during the previous 2 weeks. If the patient answered ‘yes’ then the patient was considered to have failed the smoking cessation program, whereas a response of ‘no’ was confirmed as success.We calculated mean arterial pressure using systolic and diastolic blood pressure. We also calculated the differences between the patients’ baseline and follow-up at 3 months values for body weight (including the percent difference), daily number of cigarettes, and both the systolic and diastolic blood pressure (including percent difference).We conducted a series of univariate analyses of the quantitative data using IBM SPSS version 20, and the two-tailed test significance level was set at p<0.05. We used independent t-test to calculate the continuous variables, such as the basic demographic data, with the variables presented as either mean ± SD or percent difference. We used the chi-squared test for the categorical variables, which are presented as frequencies and percentages. We used analysis of covariance (ANCOVA) to calculate the means and percent differences in the participants’ blood pressure, both with and without hypertension, adjusting for age, gender, diabetes, CVD, FTND score, pack-years, successful smoking cessation during the 3 months after the program, varenicline use and antihypertensive medication use during the 3-month follow-up period, body weight percent difference, and total number of outpatient clinic visits. We reviewed the data sets for the antihypertensive medications, and the patient was considered as using antihypertensive medication if we found a record of any angiotensinconverting enzyme inhibitors, angiotensin receptor blockers, direct renin inhibitors, beta-blockers, calcium-channel blockers, alpha-blockers, diuretics, or direct-acting vessel dilators for at least 28 consecutive days. Finally, we used univariable logistic regression models to determine whether blood pressure, reduced blood pressure, and the difference between the two, were associated with success in smoking cessation.There were 721 participants in this study. Their basic characteristics are presented in We further analyzed the hypertensive and nonhypertensive groups separately, and their average age was 57.6±10.5 years and 52.1±12.2 years, respectively (p<0.001). There were 451 (91.9%) men in the hypertensive group and 176 (76.5%) in the nonhypertensive group (p<0.001). The body weight was higher in the hypertensive group than in the nonhypertensive group . The average pack-years were 34.7±11.8 and 29.0±12.9 in the hypertensive and non-hypertensive groups, respectively (p<0.001). Participants in the hypertensive group had a lower average FTND score (6.0±2.4) than the non-hypertensive group (6.5±2.3) (p=0.018), and baseline systolic and diastolic blood pressure values were higher in the hypertensive group (135.9±19.1 mmHg and 81.2±13.6 mmHg) than in the non-hypertensive group (126.5±16.0 mmHg and 75.9±10.6 mmHg) (p<0.001). Participants with hypertension also showed a higher incidence of diabetes (p<0.001) and CVD (p<0.001) .By the third month, 228 participants (31.6%) had successfully quit smoking. As shown in After the program, 374 (51.9%) participants recorded lower systolic blood pressure and 353 (49.0%) recorded lower diastolic blood pressure. In terms of the differences, the subtraction difference for systolic blood pressure was as high as -4.0±17.9 mmHg, and the percent difference was -2.0±12.8%; for diastolic pressure, the subtraction difference was -2.5±12.0 mmHg on average and the percent difference was -1.8±14.6%. At the end of the program, 286 (54.6%) patients in the hypertensive group recorded lower systolic blood pressure and 252 (51.3%) recorded lower diastolic blood pressure compared with the non-hypertensive group that showed 106  participants with lower systolic blood pressure and 100  with lower diastolic blood pressure. The subtraction difference for systolic blood pressure was -5.0±19.0 mmHg in the hypertensive group and -1.9±15.2 mmHg in the non-hypertensive group (p=0.018), and the percent difference for systolic blood pressure was -2.5±13.0 % in the hypertensive group and -0.8±13.2% in the non-hypertensive group (p=0.095). The subtraction difference for diastolic blood pressure was -3.1±12.9 mmHg in the hypertensive group and -1.1±9.6 mmHg in the non-hypertensive group (p=0.016), and the percent difference for diastolic blood pressure was -2.4±14.8% in the hypertensive group and -0.4±13.9% in the non-hypertensive group (p=0.076) .After control for the covariates of sex, age, diabetes, CVD, FTND score, pack-years, successful smoking cessation during the third month, varenicline use, percent difference of body weight, total number of outpatient clinics visit, use of antihypertensive medication and the independent variable of hypertension, the results showed a non-significant difference in adjusted systolic blood pressure subtraction difference between the hypertensive (-5.4±1.0 mmHg) and the non-hypertensive (-1.2±1.9 mmHg) (p=0.094) groups after the smoking cessation program. The results also showed a non-significant difference between the hypertensive and nonhypertensive groups in the adjusted systolic blood pressure percent difference . The adjusted subtraction difference for diastolic blood pressure was significantly different between the hypertensive group (-3.6±0.7 mmHg) and the non-hypertensive group (-0.6±0.8 mmHg) (p=0.043). The adjusted percent difference for diastolic blood pressure was also non-significantly different between the hypertensive group (-2.8±0.9%) and the non-hypertensive group (0.1±1.5%) (p=0.151) .Whether and by how much systolic or diastolic blood pressure decreased were not related to the smoking cessation rate in the third month . The facThe results of this study revealed that during the smoking cessation program, both systolic and diastolic blood pressure improved significantly in the whole cohort. After we adjusted for the covariates, the diastolic blood pressure subtraction difference was greater in the hypertensive group than in the non-hypertensive group. As for the association between blood pressure subtraction difference during the program and the 3-month smoking cessation rate, we observed no significant changes. In fact, we could identify no specific factor associated with lowered blood pressure.Meanwhile, education provided by doctors does play an important role in patients’ lifestyle changes. In this study, it is also possible that joining the program itself encouraged the participants to lead healthier lifestyles or to make an effort to quit smoking. We assumed that doctor education played an important role in changing the patients’ lifestyles and that it might have contributed to lowering blood pressure in the two groups.9. A study involving diabetic patients revealed that both blood pressure and pulse rate decreased significantly after one month or later in the smoking cessation group25. In that retrospective cohort study involving 35 diabetic patients conducted at a smoking cessation clinic, systolic blood pressure significantly decreased by -7.0 mmHg during the first month (p=0.035) of the 12-month follow-up program25, but these results were only observed in the smoking cessation group, and their scale was small. Overall, previous research focused on the blood pressure changes between quitters and non-quitters and still yielded contradicting results11.Nicotine in cigarette smoke leads to an increase in a smoker’s blood pressure because it triggers the release of epinephrine and norepinephrine hormones26. Hypertension is a multifactorial disease, and one of the risk factors associated with it is arterial stiffness; in turn, blood pressure is a principal determinant of arterial stiffness29. In a previous study, duration of smoking cessation in ex-smokers had significant linear relationships with improved pulse wave velocity, augmentation index, and transit time, with arterial stiffness parameters returning to non-significant levels after a decade of smoking cessation30. In contrast, arterial stiffness might not directly affect blood pressure in non-hypertensive patients with only mild stiffness31. Therefore, we assumed in this study that the impact of the smoking cessation program in the non-hypertensive group would be less significant than that in the hypertensive group. However, further investigations are needed to explore this in depth.In the current study, we used ANCOVA to correct the group difference between hypertensive and non-hypertensive groups. Although the true mechanism remains unclear, we posit that arterial stiffness explains the blood pressure subtraction difference from baseline between the hypertensive and nonhypertensive groupsThe results of the current study also reveal that the blood pressure change observed during the smoking cessation program was not related to success in smoking cessation in either the hypertensive or the non-hypertensive group. Therefore, we went a step further to explore the physiological parameter changes during the smoking cessation program, and the results revealed significantly lower blood pressure, particularly in the hypertensive group. There are no previous studies that can help explain these results. We observed significantly lower blood pressure among all participants in the smoking cessation program in this study, but further research is needed to explore this.One of the main strengths of this study is that the participants were recruited from a smoking cessation clinic that was visited by smokers; therefore, its findings can be applied to real cases. In terms of the study’s limitations, we collected the blood pressure data used herein randomly during the smoking cessation program, that is, not within a specific timeframe. It was also difficult to establish whether the participants had successfully quit smoking during the cessation program, and therefore, we could not draw any conclusions on whether a particular smoking status was associated with the lowered blood pressure we observed. Additionally, we recruited as participants the smokers who were attending a smoking cessation program, and the study findings would be strengthened with results from a control group who had not attended the program.There are other limitations as well. First, we used a relatively small sample in this study, and a larger study cohort would yield more accurate results. Second, we retrieved the study participants’ blood pressure readings from their medical records, meaning the values had been measured at different times; therefore, the different readings could contain mistakes and bias. Third, we used a relatively short follow-up period after the smoking cessation program (only 3 months). A longer follow-up period would help future research to better evaluate the findings of such a study. Finally, we did not consider other possible confounding factors that could affect blood pressure, such as alcohol intake, exercise, diet, and salt intake; a similar study’s findings would be more robust if these factors were considered together.The findings of this study reveal that 51.9% of the patients who attended the smoking cessation program benefited in the form of lowered systolic and diastolic blood pressure. The effect was more significant among the participants in the hypertensive group than in the non-hypertensive group.Click here for additional data file.


The proportion of neutrophils among peripheral-blood leukocytes was the highest in the patients biopsied within a month after onset of purpura (G1: 71 ± 8%). In the patients with an interval >6 months, the neutrophil proportion was lower, 60%. Moreover, the glomerular mesangial proliferation score correlated with the serum total IgA concentration (p = 0.0056). In conclusion, IgAVN patients biopsied <1 month from purpura onset showed an elevated percentage of blood neutrophils and glomerular leukocytes, consistent with an acute-onset inflammatory reaction. In all IgAVN patients, the mesangial proliferation score correlated with the serum IgA level.Patients with IgA vasculitis (IgAV), an immune complex-mediated disease, may exhibit kidney involvement—IgAV with nephritis (IgAVN). The kidney-biopsy histopathologic features of IgAVN are similar to those of IgA nephropathy, but little is known about histopathologic disease severity based on the interval between purpura onset and diagnostic kidney biopsy. We assessed kidney histopathology and clinical and laboratory data in a cohort of adult patients with IgAVN (n = 110). The cases were grouped based on the interval between the onset of purpura and kidney biopsy: Group 1 , Group 2 , and Group 3 . Glomerular leukocytes were more common in G1 than in the other groups ( IgA vasculitis (IgAV), formerly known as Henoch–Schönlein purpura, is a systemic immune complex-mediated, small-vessel leukocytoclastic vasculitis. It is characterized by nonthrombocytopenic palpable purpura and/or arthritis, and abdominal pain . IgAV, tA minority of pediatric IgAV patients exhibits kidney involvement—IgAV with nephritis (IgAVN)—usually 4–6 weeks after the onset of purpura ,3,4,5. TIgAV in adults has a more severe course and poor outcome due to the high frequency of glomerulonephritis, i.e., IgAVN—the most serious complication of this vasculitis. However, there is limited information about the histopathologic disease severity as related to disease onset.In this study, we assessed the kidney histopathology and clinical and laboratory data in a large cohort of adult patients with IgAVN whose diagnostic kidney biopsies had been performed at different intervals after the onset of purpura.This is a retrospective study of 110 adult patients with IgAVN. All patients underwent a diagnostic kidney biopsy between 2002 and 2013 at the Department of Nephrology, Huashan Hospital, Fudan University, Shanghai, China. The diagnosis of IgAVN was based on the documented hematuria and proteinuria associated with a characteristic purpuric eruption, or abdominal or joint pain. IgA as the predominant mesangial immunoglobulin as per immunofluorescence microscopy in kidney biopsy specimens was required for inclusion in the study. We excluded patients whose biopsies contained <8 glomeruli, a number considered inadequate for appropriate histopathologic scoring (12), as detailed below.The appearance of purpura defined the onset of IgAV. The 110 patients were divided into three groups based on the interval between purpura onset and diagnostic kidney biopsy: Group 1, <1 month (n = 14); Group 2, 1–6 months (n = 58); and Group 3, >6 months . All biopsies were performed for subjects who exhibited proteinuria in an outpatient setting . The clinical features, laboratory data from the time of biopsy, and histopathologic findings in the biopsy specimens were retrospectively compiled for each group. However, no data from the outpatient follow-up visits since the onset of purpura or after kidney biopsy were available for this study. No personal identification information was collected. The study was approved by the ethics board of Huashan Hospital, Fudan University, Shanghai, China.All clinical, laboratory, and demographic data were collected at the time of the kidney biopsy. The demographic data included age, gender, and comorbidities such as hypertension, diabetes mellitus, and cardiovascular disease. The characteristics of IgAVN included skin rash, gastrointestinal and joint manifestations, and kidney involvement. Proteinuria was evaluated by a 24-h urine measurement, hematuria was defined as 22 or more red blood cells (RBC) per microliter of urine (microscopic), or visible hematuria (macroscopic). The serum albumin, creatinine, urea nitrogen, uric acid, complement C3, and total IgA levels were measured at the time of kidney biopsy in the central clinical laboratory of Huashan Hospital. The number of urinary RBC had been determined by using a Sysmex UF-1000i analyzer . Peripheral blood cell profiling was performed using a Sysmex xn-2000 analyzer  and expressed as the total number of leukocytes and relative proportions of neutrophils and eosinophils .Two pathologists examined and graded the histopathological changes. To evaluate the glomerular mesangial-cell proliferation, the cellularity of each glomerulus was graded as per the Oxford classification  <4 mesa.t-test. Nonnormally distributed variables are expressed as the median with interquartile range and were compared using the rank sum test. Categorical variables are expressed as percentages and compared using Pearson’s chi-square test or Fisher’s exact test. All tests were two-tailed, and statistical significance was defined as p < 0.05. The SPSS statistical software program  was used for all analyses.Normally distributed variables are expressed as the mean ± standard deviation (SD) and were compared using one-way analysis of variance (ANOVA) or Student’s IgAVN patients (n = 110) in this study had a mean age of 36.5 ± 16.0 years at the time of kidney biopsy and consisted of 50 males and 60 females . All pat2 as per the MDRD formula. Twenty-seven patients (25%) had received an ACEi and/or an ARB before kidney biopsy.Microscopic hematuria was observed in 86 patients (78%). Hypertension was present in 23 patients (21%) and 4 patients (4%) had diabetes mellitus (DM). Seven patients (6%) had reduced kidney clearance function, with an eGFR <60 mL/min/1.73 mp = 0.038; eGFR: 93 ± 32 mL/min/1.73 m2 vs. 109 ± 28 mL/min/1.73 m2, p = 0.009).The light-microscopic features for this cohort are summarized in t-test, the only significant difference between the groups was for M1 between Group 2 and Group 3 (p = 0.006). Furthermore, glomerular leukocytes were more common in Group 1 (57%) compared to Group 2 and Group 3 (p = 0.0008)  were calculated . Using A 0.0008) . Thus, Ip = 0.001), being the highest in patients biopsied within a month after onset of purpura   .IgAV is the most common vasculitis in children but it can also occur in adults. IgAV spontaneously resolves in about 94% of children and 89% of adults , althougPathogenesis of both IgAN and IgAVN is thought to occur through a multi-hit process . This prCirculating levels of Gd-IgA1 and Gd-IgA1-specific IgG autoantibodies are elevated in patients with IgAVN but not in patients with IgAV , supportIn this study of 110 adult patients with IgAVN, we assessed histopathologic disease severity based on interval between purpura onset and diagnostic kidney biopsy and correlated the findings with clinical and laboratory data. IgAVN patients biopsied <1 month since the onset of purpura more commonly had glomerular leukocytes and had the highest percentage of neutrophils among peripheral-blood leukocytes. These findings are consistent with an acute-onset inflammatory reaction in patients with IgAVN who were biopsied <1 month after the onset of purpura. Moreover, serum total IgA concentration correlated with the glomerular mesangial proliferation score.A limitation of this study is the relatively small number of patients from a single center who were of single ethnicity. The patients were followed regularly for up to 6 months after the appearance of purpura at their respective local-area hospitals. However, these data were not been available for this study. This limitation implies that these findings need to be assessed in other cohorts and different ethnic groups, ideally with regular follow-up after the onset of purpura until biopsy as well as after biopsy.Our study demonstrates a chronological association between leukocytic infiltration and glomeruloproliferative responses in IgAVN patients. These findings raise a question whether patients with IgAV should be followed frequently after the onset of purpura to detect nephritis in the early stages and whether assessment of biomarkers, such as Gd-IgA1- and Gd-IgA1-specific IgG autoantibodies, should be included.


Chronic kidney disease (CKD) is a progressive loss of the kidney function which leads to a decreased kidneys' ability to process waste in the blood and it affects the other important functions of the kidney. The disease has different stages that can alter the health status of individuals. During the early stages, patients may present with a normal or slight decrease in glomerular filtration rate (GFR) and albuminuria. Later, it progresses and leads to end-stage renal disease (ESRD) or kidney failure. Hypertension is considered as the major contributing risk factor of CKD.  This study was aimed to assess the prevalence and associated factors of chronic kidney disease among adult hypertensive patients in referral hospitals of the Northwest Ethiopia.  An institution-based cross-sectional study was conducted among 581 adult hypertensive patients in a chronic follow-up clinic in referral hospitals, Northwest Ethiopia, from July to August 2020. Systematic random sampling was used to select the study participants. Data were collected using the interviewer-administered questionnaire and participants medical records. Both bivariable and multiple logistic regression analyses were performed. Model fitness was assessed using a Hosmer—Lemeshow test.  The total prevalence of CKD among adult hypertensive patients was 17.6% (95% CI: 14.7–20.8). Diastolic blood pressure ≥90 mmHg , duration of hypertension ≥10 years , stage II HTN , comorbid disease , proteinuria , dyslipidemia , and serum creatinine ≥1 mg/dl  were associated with chronic kidney disease among adult hypertensive patients.  In this study, the prevalence of CKD among hypertensive patients found was 17.6%. Regarding associated factors, dyslipidemia, proteinuria, comorbid disease, serum creatinine greater than 0.9 mg/dl, duration of hypertension greater than 10 years, and diastolic blood pressure greater than 90 mmHg are factors associated with the occurrence of chronic kidney disease among hypertensive patients. Chronic kidney disease (CKD) can be explained as a progressive loss of kidney function which results in decreased kidneys' ability to process waste and it affects the other important functions of the kidney . The disCKD usually gets worse over time though treatment has been shown to slow progression. If left untreated, it can progress to kidney failure and early cardiovascular disease. When the kidneys stop working, dialysis or kidney transplant is needed for survival. These would have negative impacts and burdens on patients, their families, and healthcare setups at large to the countries , 9.Globally, the prevalence of CKD is significantly rising, and it is associated with major morbidity and mortality that demands special attention as one of the growing public health problems . As it iCKD is associated with an increase in CVD and premature mortality, with detrimental societal and economic challenges , 14.In 2017, CKD was the 12th leading cause of death worldwide and it resulted 1.2 million deaths, Besides, 7.6% of all CVD deaths (1.4 million) attributed to impaired kidney function. Deaths due to CKD or to CKD-attributable CVD accounted for 4.6% of all-cause mortality .As the global burden of disease 2015 study, CKD was the leading cause of death and one of the fastest rising major causes of deaths in which overall mortality due to CKD has increased by 31.7% from 2005 to 2015 . MoreoveThe prevalence of CKD among the general population in India, Korea, Pakistan, and Southern China were 17.2%, 13.7%, 12.5%, and 9.4%, respectively , 18, 19.A systematic review in Africa continent indicates that the prevalence of CKD differs from 2% to 41%, and the prevalence among hypertensive patients is ranging from 13%–51%. This systematic review showed that the prevalence of CKD in Burundi, Mali, Nigeria, Egypt, Seychelles, Uganda, Congo, Kenya, Ghana, Cameroon, South Africa, Tanzania, Sudan, Senegal, and Morocco was 45.7%, 40.8%, 29.7%, 18%, 15.3%, 15.2%, 12.4%, 11.5%, 10.2%, 10%, 7.4%, 7%, 6.4%, 6.1%, and 2.9%, respectively .A cross-sectional study conducted in Ethiopia at Tigray teaching hospital and Jimma University both indicate that the prevalence of CKD among hypertensive patients was 22.1% and 26%, respectively , 22.As studies showed in the Glob, age, sex, educational status, residence, marital status, body mass index, comorbidity, type of antihypertensive medications, smoking, alcohol intake, and sedentary lifestyle were the associated factors with CKD , 21–28.The World Health Organization (WHO) report, Ethiopia 2018, indicates that more than 39% of yearly deaths were recorded as a result of the noncommunicable disease including CKD and hypertension . AdditioAn institution-based cross-sectional study was conducted from July to August/2020.The study was conducted in Northwest Ethiopia referral hospitals, namely, the University of Gondar Teaching Referral Hospital (UOGTRH), Felege Hiwot Referral Hospital (FHRH), and Debre Markos Referral Hospital (DMRH).Each of them were estimated to serve for 5–7 million peoples in their catchment area, and UOGTRH has 1200 hypertensive patients, FHRH has 800 hypertensive patients, and DMRH has 600 hypertensive patients, which makes a total of 2600 hypertensive patients attending the chronic illness follow-up clinic in these catchment areas. UOGTRH is found in the Northern part of Amhara Region in Gondar town which has 9 nurses and 4 doctors who work in the chronic illness follow-up clinic regularly. FHRH is found in Bahirdar city, which is the capital city of Amhara Region, which has 8 nurses who work in the clinic regularly, and DMRH is again found at the east of Gojam in Amhara regional state, Northwest Ethiopia, which has 8 nurses who work in the clinic regularly.All hypertensive patients aged 18 years and above who had follow-up at the chronic illness clinic of referral hospitals in Northwest Ethiopia were the source population and those who attended during the data collection were the study population.All adult hypertensive patients who had hypertension treatment follow-up at the three referral hospitals and who had medical records.Pregnant women who were diagnosed with pregnancy-induced hypertension were excluded.To get the adequate sample size, both the single population proportion formula and significantly associated factors from other study were computed .n represents the initial sample size; Z α/2 represents the standardized normal distribution value for the 95% CI = 1.96; P represents the proportion of chronic kidney disease (22.1%); d represents the margin of error 4%.Accordingly, a single population proportion formula was calculated considering the following assumptions: 95% confidence interval (CI), 22.1% population proportion from the previous study , and 4% By considering a 10% nonresponse rate, the sample size was 413 + 41 = 454.By considering a 10% nonresponse rate, the final sample size was 528 + 53 = 581. Since the largest sample size (581) was found in associated factors, it was taken as the final sample size.The total of 581 sample populations were proportionally allocated to each referral hospitals. About 268, 179, and 134 participants were selected in the University of Gondar Comprehensive Specialized Hospital, Felege Hiwot Referral Hospital, and Debre Markos Referral Hospital, respectively. Finally, study participants were selected using systematic random sampling as per their coming order. To avoid the recycling of data, special marks were put in participants' medical charts.Chronic kidney disease (yes/no)Dependent variableSociodemographic characteristics: age, sex, religion, educational status, occupation, income, marital status, residence, and family history of hypertension.Clinical characteristics: BP status, baseline systolic BP, baseline diastolic BP, stage of hypertension, type of hypertension, type of drugs, duration of drugs, number of drugs, comorbidity, dyslipidemia, proteinuria, and obesity.Lifestyle characteristics: smoking, alcohol use, and exercise.Independent variables  Chronic kidney disease: CKD is defined and identified as when physicians diagnosed the patient as already having chronic kidney disease .  Controlled blood pressure: BP < 140/90 mmHg in the last follow-up using a digital sphygmomanometer for adult hypertensive clients without diabetes mellitus and chronic kidney disease and blood pressure <130/80 mmHg using a digital sphygmomanometer for adult hypertensive clients with diabetes mellitus and chronic kidney disease in the last follow-up record .2, normal weight 18.5–24.9 kg/m2, overweight 25–29.9 kg/m2, and obese for patients with BMI ≥ 30 kg/m2 [  BMI (body mass index): A measure of the person's weight in kilogram divided by his height in meter square; based on this calculation, bodyweight was classified as underweight for a patient with less than 18.5 kg/m  Proteinuria: according to the laboratory result, if a patient had plus one and above, we classify as having proteinuria in the last laboratory result .  Hypertension: it was defined as those who had a documented diagnosis of hypertension  or those on antihypertensive agents. Target control BP was defined as BP < 140/90 mmHg for nondiabetic and <130/80 mmHg for diabetic patients [2). In this case, BSA will be calculated by using the Mosteller formula, that is, BSA is equal to   Estimated GFR: this is a test that is used to assess how well kidneys are working. The test estimates the volume of blood that is filtered by the kidneys over a given period. It can be measured by using readily available equations and formulas like Cockcroft–Gault. Cockcroft–Gault formula ): (140 − age (years)) × weight (kg) ×  × 1.73/72 × serum creatinine (mg/dL) × BSA . Odds ratios with 95% confidence interval at p value <0.05, cleaning, and analysis were computed to determine the level of significance.Data were entered into Epi-Info version 7.2.2.6 and then transferred to SPSS version 23 for analysis. Summary statistics were used to look for any missing, and logistic regression was also used to determine crude and adjusted odds ratio (OR). Bivariate analysis was carried out to assess an association between the dependent and all the independent variables, and variables with a In this study, 581 patients were included with a response rate of 100%. Of these, 55.1% were females, the median and standard deviation of the age was 54.71 and 11.397, respectively, 476 (81.9%) were married, 120 (20.7%) had no formal education, 429 (73.8%) were urban inhabitants, 497 (85.5%) were orthodox followers, and 140 (24.1%) were government employee .Of 581 study subjects, 64 (11%) and 54 (9.3%) of them have greater than and equal to 140 mmHg for systolic and 90 mmHg for diastolic blood pressure, and 429 (73.8%) of them have a BMI of 18.5–24.9. Also, 288 (49.6%) of them are in the second stage of hypertension, 221 (38%) of them have the comorbid disease, and 394 (67.8%) of patients use calcium channel blockers for the treatment of hypertension .Among the 581 study subjects, 119 (20.5%) of them are alcohol users and only 28 (4.8%) of them are doing exercise on regular basis .The total prevalence of CKD among hypertensive patients was 17.6% (95% CI: 14.7–20.8).p value <0.2.In bivariable analysis, age less than 60 years, systolic blood pressure greater than 140 mmHg, diastolic blood pressure greater than 90 mmHg, stage II and III hypertension, duration of hypertension greater than 10 years, comorbid disease, drugs other than hypertension, proteinuria, dyslipidemia, serum creatinine, body swelling, beta-blocker, diuretics, and vasodilators, smoking, alcohol use, and exercise were associated with chronic kidney disease at p value <0.05.However, in multivariable analysis, DBP ≥90 mmHg, duration of hypertension ≥10 years, stage II HTN, proteinuria, dyslipidemia, and serum creatinine ≥0.9 mg/dl were associated with chronic kidney disease among hypertensive patients at The odds of CKD were 8.65 times  higher among those who had diastolic blood pressure greater than 90 mmHg as compared to their counter parts.Patients with duration of hypertension ≥10 years were  more likely to develop CKD as compared to patients with duration of hypertension <10 years.Being stage II HTN patients was 2.61  times higher among those patients at stage I HTN.The odds of having CKD was 4.59 times  higher among proteinuria as compared to those patients free from proteinuria. Patients with the comorbid disease were 7 times  more likely to develop CKD as compared to their counter parts. Regarding to serum creatinine, patients who had creatinine greater than 1 mg/dl had 8.9 times  higher odds of CKD as compared to serum creatinine less than 1 mg/dl. Patients with dyslipidemia had 3.5 times ) higher odds of CKD as compared to patients with no dyslipidemia .This study was determined the prevalence of CKD among adult hypertensive patients attending the chronic illness follow-up clinic at Northwest Ethiopia referral hospitals and identified associated factors with CKD among adult hypertensive patients.In the current study, the prevalence of CKD among adult hypertensive patients was 17.6% (95% CI: 14.7–20.8%). This result was in line with the studies conducted in Jimma (26%)  and AddiHowever, the finding of this study was lower than the findings of studies conducted in Ghana (46.9%) , NigeriaThis result was higher than studies conducted in Pakistan (12%) . This diAccording to this study, long duration of hypertension was associated with chronic kidney disease among adult hypertensive patients, which showed that the duration of hypertension greater than 10 years was almost nine times more likely to develop chronic kidney disease as compared to their counterpart. This finding was in agreement with the studies conducted in Ethiopia , Jimma , and SouIn this study, presence of comorbid (diabetes and CHF) also associated with CKD among adult hypertensive patients showed that patients with the comorbid disease were 7 times more likely to develop chronic kidney disease as compared to their counterpart. This finding was similar to a study conducted in South Asia  and SoutThis study also identified elevated diastolic blood pressure as a significant factor for CKD among adult hypertensive patients, which showed that patients with diastolic blood pressure greater than 90 mmHg were 8.65 times more likely to develop chronic kidney disease as compared to their counterpart. This might be due to patients with increased diastolic blood pressure can cause arteries around the kidney to narrow, weaken, or harden and damages filtration .Based on this study, finding dyslipidemia was associated with CKD among adult hypertensive patients, which showed that patients with dyslipidemia were nearly three and half times more likely to develop chronic kidney disease as compared to their counterpart. This result is similar to a study conducted in Iran , EthiopiAccording to this study, serum creatinine greater than 1 mg/dl was associated with chronic kidney disease among hypertensive patients, which showed that patients with serum creatinine greater than 1 mg/dl were 9 times more likely to develop chronic kidney disease among adult hypertensive patients as compared to their counterparts. This result is similar to a study conducted in India . This miAccording to this study, proteinuria was associated with chronic kidney disease among adult hypertensive patients, which showed that patients with proteinuria were 4.59 times more likely to develop chronic kidney disease as compared to their counterparts. This finding is similar to a study conducted in Ethiopia , 27.According to this study, stage II HTN was associated with chronic kidney disease, which showed that patients with proteinuria were 2.61 times more likely to develop chronic kidney disease as compared to their counterparts. This finding is similar to a study conducted in India . This miThe limitation of this study was secondary data, as we could not get potential predictors. It shares also the limitation of the cross-sectional study design.In this study, the prevalence of CKD among hypertensive patients was found to be 17.6%. Besides dyslipidemia, proteinuria, comorbid disease, serum creatinine greater than 1 mg/dl, duration of hypertension greater than 10 years, and diastolic blood pressure greater than 90 mmHg are factors associated with the occurrence of chronic kidney disease among hypertensive patients.


However, there are no studiesshowing the changes in NIRS values in response to hemodynamic variationsduring stages of carotid endarterectomy (CEA) procedure and clinicalimplications of these changes. The aim of this study was to determine ifhemodynamic changes affect NIRS values during carotid endarterectomy and ifour results may help to provide strategies for hemodynamic management inthese patients.Near-infrared spectroscopy (NIRS) is a non-invasive technique to detectcerebral ischemia by monitoring changes in regional cerebral oxygenation diastolic  and mean  blood pressures when the patient was under general anaesthesia.NIRS values were significantly lower than pre-incision values just afterclamping of carotid artery in both hemispheres (P=0.005 forthe right and P<0.001 for the left side).NIRS values on the right and left sides were correlated with systolic (rightNIRS values measured in our study show that there is a correlation betweenhemodynamic changes and cerebral oxygenation. This effect is especiallypronounced while the patient is asleep and intubated, which implies theimportance of close monitoring of patients with carotid disease during anysurgery requiring general anaesthesia. On the other hand, the procedureitself carries a risk of stroke, which can be due to thrombosis, embolism, orintraoperative ischemia related to hypoperfusion during cross-clamping (CC) of thecarotid artery . Therefore,monitoring techniques to determine adequacy of cerebral circulation are used andinclude electroencephalography (EEG), somatosensory-evoked potentials (SSEP),motor-evoked potential (MEP), transcranial Doppler, stump pressure and cerebraloximetry . Carotid endarterectomy (CEA) is a well-established procedure to prevent developmentof future stroke in symptomatic and asymptomatic patients with a high-grade internalcarotid artery stenosis 2) inthe frontal lobes. NIRS is easy to apply and has a relatively low cost compared toother non-invasive techniques. Various studies compared NIRS with stump pressure,6, EEG ,and transcranial Doppler  andproposed it as a reliable and safe substitute for these traditional techniques.However, there are no studies showing the changes of NIRS values in response tohemodynamic variations during stages of CEA procedure and clinical implications ofthese changes. Some surgeons believe that an increase in mean arterial bloodpressure, usually by 20% or systolic arterial blood pressure above 150 mmHg duringCC of carotid artery is quite enough to prevent cerebral ischemia. Nevertheless,there is no scientific data supporting this practice. In the current study, weevaluated the NIRS values at certain stages during carotid endarterectomy and theirrelation to hemodynamic changes at these time points. The aim was to determine ifhemodynamic changes affect NIRS values while the other factors, such as arterialoxygen saturation, were kept relatively constant. We also intended to provide ascientific basis for the increased blood pressure protocol during carotidendarterectomy, hoping that our results will be helpful for future hemodynamicmanagement protocols for patients with carotid stenosis.Near-infrared spectroscopy (NIRS) is a non-invasive technique to detect cerebralischemia by monitoring changes in regional cerebral oxygenation , and the individual informedconsent was waived. Indications for CEA were symptomatic or asymptomatic carotidstenosis >70% or symptomatic patients with 50-69% carotid stenosis, as stated inguidelines All operations were done by the same team. CEA was performed under generalanesthesia in all patients in accordance to the surgeon’s preference. Patientsat high risk for general anaesthesia and others who underwent operation withregional anaesthesia were not included in the study to provide a morehomogeneous group. Routine monitoring with ECG and pulse oximetry were used.Intra-arterial blood pressure was measured and recorded continuously using a20-gauge catheter placed in the radial artery. Heparin (5000 U) was administeredintravenously 3 minutes before CC of the carotid artery. Activated clotting timewas used to monitor heparin treatment with the aim of a value above 200 secondsand an additional dose was administered when necessary. A standard longitudinalendarterectomy was performed in all patients with primary or patch closure ofarteriotomy, depending on the arterial diameter and the surgeon’s preference.Our strategy to use shunting is when NIRS values drop 20-25% from baseline orwhen the clamp time is anticipated to be long due to the anatomy of the patientand the carotid lesion. Clamp time is the duration from the start of internalcarotid artery clamping to the removal of this clamp and operation time is theduration from the start of carotid surgery skin incision to the closure of thisincision. In patients with concomitant coronary artery bypass grafting, CEAprocedure was completed before cannulation for cardiopulmonary bypass. . After CC was removed, blood pressure was regulated tokeep it within normal limits. Patients were extubated after the return ofspontaneous respiration and were transferred to the intensive care unit forfollow-up on the first night. All patients were on dual antiplatelet therapy,with 75 mg of acetylsalicylic acid and clopidogrel, in the postoperativeperiod.Initially, patients’ blood pressure was regulated and kept within normal limitsand hypertension was avoided. After CC of the carotid artery, NIRS at firstminute was measured and then systolic blood pressure was increased above 150mmHg and vasoactive medications were used, if required. Ephedrine was used asthe preferred vasoactive medication 2 measurements were performed using a MasimoCerebral Oximeter , by 2 sensors placed on the forehead.NIRS values from both hemispheres were recorded simultaneously at certain timepoints and were compared with each other to evaluate the changes at differentstages of operation as follows: before the start of the operation, when thepatient was awake, after the patient is asleep just before incision, at thefirst minute of CC of carotid artery, just after increasing blood pressure,every 5 minutes after CC, after removal of CC and when the patient is awake andextubated. All these values were compared ipsilaterally with each other (rightNIRS vs. right NIRS) and also right and left NIRS values werecompared with each other at each time point. Continuous bilateral rSOP value of 0.05 or less was considered significant.Statistical analysis was performed with IBM SPSS software version 20 . All data are presented as mean ± standard deviation forcontinuous variables, as numbers with percentages for categorical variables. TheShapiro-Wilk test was used to evaluate the normality of variable distribution.In the comparison of two independent groups, the Student’s t-test was used fornumerical variables with normal distribution. The correlations of systolic,diastolic and mean pressures with NIRS at different time points wereinvestigated using Pearson’s correlation coefficient and Bland-Altman analysis.A A total of 50 consecutive patients who underwent CEA under general anaesthesiabetween October 2018 and September 2019 were prospectively included in thestudy. Data for all patients were collected prospectively and were complete. Themean age was 69.04±6.6  and most patients had a riskfactor for atherosclerosis .Most paAll patients underwent either right (44%) or left (56%) CEA under generalanaesthesia. In 18 patients with bilateral lesions, a left CEA was performed inmost patients (14). Primary closure of the arteriotomy was preferred in mostpatients (78%) and shunt was not used in any patient. Postoperatively, there wastransient hemiparesis in 1 patient and local hematoma of the surgical site wasobserved in 4 patients, 2 of whom required re-exploration. The patient withtransient hemiparesis underwent left CEA and woke from anaesthesia withright-sided hemiparesis that lasted 2 days. At the time of operation of thispatient, NIRS values showed a decline of about 25% from baseline 5 minutes afterclamping, but it was not possible to insert a shunt due to anatomical problems.The CT scan of this patient showed no pathology and the patient was dischargedwithout any neurological deficits. There were no major stroke, nerve injury ordeath in any other patient. Surgical and early postoperative data are summarizedin NIRS values of the right and left hemispheres were compared with each other andwere not different from each other at any of the time points . We alsoP=0.005 for theright side and P<0.001 for the left side). At this point,blood pressures were being regulated to keep them within normotensive limits.Systolic blood pressures increased above 150 mmHg and NIRS values were observedto increase immediately and were comparable to values before intubation andincision, as seen in th minute after CC, NIRS values were observed to fall from thevalues in systolic blood pressures of 150 mmHg (P=0.8 for theright side and P<0.001 for the left side). However, theyincreased and were stable after 10 minutes of CC of carotid artery. In NIRS values were observed to drop significantly from pre-incision values justafter CC of carotid artery in both hemispheres . After completing the procedure and removing CC of carotid arteries, NIRS valuesincreased to pre-incision levels. When compared to preoperative awake values,postoperative awake values did not increase significantly on the right side, butwere found to be increased on the left . Only in thosepatients with more than 20% decrease in NIRS values, the decrease was ipsilateral tothe clamped carotid artery in all. It is possible that this decrease occurs inpatients with problems of intracerebral circulation and in patients with an intactcircle of Willis, the cerebral oxygenation is affected bilaterally or globally afterclamping one side, regardless of the side. An anatomical study with a larger numberof patients that includes screening the completeness of circle of Willis isnecessary to prove this finding. Another finding in the present study was the correlation of the right- and left-sidedNIRS values with each other, regardless of the side of the lesion. This was true forall time points of measurement, including those after clamping. Moreover, 18patients with bilateral lesions showed similar pattern of NIRS changes to thepatients with unilateral lesions (One important shortcoming of this study is the relatively small number of patients.Since the number of postoperative neurological complications is very low, it is alsonot possible to interpret the full clinical implication of our findings. Moreover,there are no similar studies to compare our results, which on the other hand makesthe study unique. Authors are also aware that NIRS monitoring has its shortcomingsand the results may be affected by many factors, as stated. However, this is apreliminary study with important results and we believe it will lead to furtherstudies to assess the factors affecting cerebral oxygenation during carotidendarterectomy and their clinical implications.As an acceptable monitoring tool during CEA, NIRS values show a correlation betweenhemodynamic changes and cerebral oxygenation. This effect is especially pronouncedwhile the patient is asleep and intubated, which implicates the importance of closemonitoring of patients with cartotid disease during any surgery that requiresgeneral anaesthesia.


Based on the XGBoost algorithm, the prediction model of the risk of deep vein thrombosis (DVT) in patients after total knee arthroplasty (TKA) was established, and the prediction performance was compared. n = 60) and a test set (n = 40). The training set data was used to construct the XGBoost algorithm prediction model and to screen the predictive factors of postoperative DVT in TKA patients. The prediction effect of the model was evaluated by using the test set data. An independent sample T-test was used for comparison between groups, and the χ2 test was used for comparison between counting data groups.  A total of 100 patients with TKA from January 2019 to December 2020 were retrospectively selected as the study subjects and randomly divided into a training set ( The top five items were combined with multiple injuries (35 points), time from injury to operation (28 points), age (24 points), combined with coronary heart disease (21 points), and D-dimer 1 day after operation (16 points). In the training set, the area under the curve of the XGBoost algorithm model was 0.832 (95% CI: 0.748-0.916).  The model based on the XGBoost algorithm can predict the incidence of DVT in patients after TKA with good performance. Total knee arthroplasty (TKA) is an effective method for the treatment of end-stage knee osteoarthritis, which can significantly relieve the pain in patients and promote functional recovery . Deep veIn recent years, the extreme Gradient Boosting (XGBoost) model has become one of the common tools for solving classification problems due to its high efficiency, flexibility, and accuracy . The XGBIn recent years, a large number of studies have reported high-risk factors related to DVT , but theFrom January 2019 to December 2020, 100 patients with TKA who met the inclusion and exclusion criteria were selected as research objects.Inclusive criteria are patients younger than 80 years old who received unilateral TKA for the first time and without cognitive impairment and able to cooperate with the researcher and patients with stable condition at discharge without postoperative complications and who informed and agreed to participate in the study.Exclusion criteria are patients with severe cardiovascular and cerebrovascular diseases and malignant tumors, patients with mental disorders who are unable to cooperate, patients with hip and ankle joint deformities that affect knee joint function, patients who have undergone TKA surgery or bilateral TKA surgery at the same time, and recent participants in other researches.n = 60) and a test set (n = 40). The training set was used to construct the XGBoost algorithm prediction model, and the test set data was used to evaluate the prediction effect of the XGBoost model. According to the ultrasound results of both lower limbs after the operation, the patients in the training set were divided into a DVT group and a non-DVT group.All patients with TKA were randomly divided into a training set , American Society of Anesthesiologists (ASA) classification, injury severity score (ISS), time from injury to operation, operation time, intraoperative blood transfusion volume, intraoperative blood loss, hemoglobin 1 day after operation, D-dimer 1 day after operation, hospital time, and combined with multiple injuries.ISS<16 is a minor injury, 16 < ISS ≤ 25 is a moderate injury, and ISS > 25 is a severe injury . AccordiThe risk assessment of thromboembolism was carried out regularly for all patients after operation. To prevent DVT, patients without contraindications of anticoagulation were injected subcutaneously with low molecular weight heparin sodium 0.4 mL every day. At the same time, the plantar vein pump was performed twice a day for 20 minutes each time. One day after the operation, blood samples were collected from all patients, and the D-dimer, blood routine, and coagulation were monitored. Ultrasound examination of veins of lower limbs was performed 3-5 days after the operation. Positive patients were given low molecular heparin calcium 0.4 mL twice a day, and the plantar venous pump was stopped for DVT treatment. All patients stopped using anticoagulants 12 hours before operation and started using anticoagulants 12 hours after operation.The outcome of the study was that DVT occurred in TKA patients 3-5 days after the operation. The inner diameter of the deep vein of lower limbs was observed from bottom to top along with the operation site, and DVT was diagnosed if the following phenomena occur: The lumen below the embolic site is enlarged, and the venous lumen cannot be closed. There is a solid echo with unequal intensity in the lumen. When the occlusion is complete, pulse and color Doppler show a small amount or no blood flow signal.The XGBoost algorithm is an optimized distributed gradient computing integration algorithm. The idea of this algorithm comes from the gradient lifting iterative decision tree algorithm. Based on the gradient lifting iterative decision tree algorithm, a second-order Taylor function is added to classify the data, which is specifically completed by the following:i = 1, 2, ⋯, n, n is the number of samples, F is the set corresponding to all regression trees, and fk is the function in F.Goal function:The regular term is the damage function of the model:l is a model for integrating data standardization, O represents the difference between the predicted value of the last formula and the recorded value of the actual data, and β represents the normalized processing coefficient, which is used to calculate the positive value after data weighting to prevent data confusion. Formulas  and test set (n = 40). The training set was used to construct the XGBoost algorithm prediction model, and the test set data was used to evaluate the prediction effect of the model. According to the ultrasound results of both lower limbs after operation, the patients in the training set were divided into the DVT group (n = 24) and the non-DVT group (n = 36). The predictive factors included all the items of observed indicators. 100 patients with TKA were randomly divided into the training set , time from injury to operation (28 points), age (24 points), combined with coronary heart disease (21 points), and D-dimer 1 day after operation (16 points). In addition, the other three items were combined with hypertension (14 points), hemoglobin 1 day after operation (11 points), and gender (9 points), as shown in As shown in With the change of population structure, the number of elderly patients with TKA is increasing . DVT is Clinical studies have found that DVT after TKA is a risk factor for poor prognosis and death . HoweverPatients over 60 years have decreased physical function, easily damaged intima of blood vessels, and decreased elasticity of blood vessels and blood circulation, which increases the risk of DVT. Nybo and Hvas provided that age is a risk factor for DVT . Gómez-JDavagdorj et al. built a model of noncommunicable diseases caused by smoking based on the XGBoost framework, which can realize a more accurate prediction . In addiThere are some limitations to our study. This study was a retrospective study of a small single-center sample, which needs further verification in the prospective study of a large multicenter sample. Secondly, there are not enough influencing factors in the analysis, and there was no hierarchical analysis of these factors. In addition, although the XGBoost algorithm model has unique advantages in dealing with high-dimensional variables, complex interactions among variables, and nonlinear relationships, the effectiveness of the prediction model will also be limited by the nature, number, type, and sample of variables.The model based on the XGBoost algorithm can predict the occurrence of DVT in patients after TKA with good prediction performance. The items including combined with multiple injuries, time from injury to operation, age, coronary heart disease, and D-dimer at 1 day after operation can be used as predictive indicators of DVT after TKA.


To explore the effects of nifedipine tablets combined with magnesium sulfate on blood coagulation indexes, oxidative stress and levels of NO and ET-1 in patients with Pregnancy-induced hypertension syndrome (PIH).A total of 110 patients with hypertension during pregnancy were admitted to our hospital from January 2020 to January 2021. According to the random number table method, 110 patients were divided into the control group and the therapy group, with 55 cases in each group. The blood pressure levels (systolic and diastolic blood pressure), coagulation indexes , oxidative stress indexes , vascular endothelial function , clinical efficacy and adverse reactions of the two groups were compared.P < 0.05). After therapy, PT, TT, and APTT in two groups were significantly increased, and Fib was significantly decreased, and PT, TT, APTT in the therapy group were higher than those in the control group, and Fib was lower than that in the control group (P < 0.05). After therapy, LPO and MDA in two groups were significantly decreased, and SOD was significantly increased, and LPO and MDA in the therapy group were lower than those in the control group, and SOD was higher than that in the control group (P < 0.05). After therapy, ET-1 in two groups were significantly increased, and NO and ET-1/NO was significantly decreased, and ET-1 in the therapy group was higher than that in the control group, and NO and ET-1/NO were lower those in the control group (P < 0.05). The total clinical effective rate of patients in the therapy group was 94.5%, and in the control group was 81.8%, the therapy group was significantly better than the control group (P < 0.05). The total incidence of adverse reactions in the therapy group was 7.3%, and in the control group was 21.8%, the therapy group was significantly lower than the control group (P < 0.05).After therapy, the systolic blood pressure and diastolic blood pressure of the two groups were significantly decreased, and the therapy group was significantly lower than the control group (Nifedipine tablets combined with magnesium sulfate in the treatment of PIH can improve the blood coagulation function of patients, reduce oxidative stress damage, adjust the serum levels of ET-1 and NO, and improve the clinical efficacy. Pregnancy-induced hypertension syndrome (PIH) is also known as pregnancy-induced hypertension. It usually occurs at 20 weeks of gestation or 2 weeks after delivery. In addition to high blood pressure, it can also be accompanied by edema, proteinuria, thrombocytopenia, and liver Clinical manifestations such as functional impairment , 2. PIH P > 0.05).A total of 110 patients with hypertension during pregnancy were admitted to our hospital from January 2020 to January 2021. According to the random number table method, 110 patients were divided into the control group and the therapy group, with 55 cases in each group. The patients in the therapy group were 21–36 years old, with an average age of (29.64 ± 2.13) years; 40 cases of primiparas and 15 cases of postpartum women; gestational age was 32–40 weeks, with an average of (36.02 ± 2.13) weeks; systolic blood pressure was 141–165 mmHg, average systolic blood pressure (153.64 ± 2.13) mmHg; diastolic blood pressure 93–109 mmHg, average diastolic blood pressure (96.15 ± 2.58) mmHg. The control group was 22–35 years old, with an average age of (28.95 ± 2.06) years; 38 cases of primiparous women and 17 cases of postpartum women; gestational age was 33–39 weeks, with an average of (35.67 ± 2.01) weeks; systolic blood pressure was 140–161 mmHg, The average systolic blood pressure was (151.38 ± 2.06) mmHg; the diastolic blood pressure was 91–105 mmHg, and the average diastolic blood pressure was (93.06 ± 2.11) mmHg. All patients met the relevant diagnostic criteria of our hospital for pregnancy-induced hypertension. There was no statistically significant difference between the two groups of patients in general information such as age, gestational age, and birth experience . All patients underwent routine fundus examination, blood coagulation function examination, biochemical index examinations such as heart, liver, kidney function, blood electrolytes, fetal growth and development index examination, cardiac ultrasonography, liver, gallbladder, spleen and kidney ultrasound examination to rule out important organ diseases. This subject was approved by the hospital ethics committee, and the patients and their families voluntarily participated in this experiment and signed an informed consent form.Patients with history of hypertension, history of diabetes, abnormal blood biochemistry and urine tests before pregnancy. Patients with liver, kidney and other organ diseases. Those who were allergic to the drugs used in this study. Complicated with hematological diseases. Combined with malignant tumor. Cognitive impairment. Incomplete clinical data.Patients in the control group were given magnesium sulfate intervention treatment. The total dosage of magnesium sulfate was 20 g for 24 h on the 1st day; the loading dose was 25% magnesium sulfate injection  20 ml (5 g) Dilute with 20 ml of 5% glucose injection, and slowly inject intravenously within 15–20 min; then used a maintenance meter, that was, 60 ml (15 g) of 25% magnesium sulfate and dilute with 500 ml of 5% glucose injection for intravenous infusion, 1–2 g/h intravenous drip for maintenance. After that, 60 ml (5 g) of magnesium sulfate was used daily. Knee tendon reflex examinations should be done regularly before and during medication to measure the patient's breathing frequency and urine output. If the knee tendon reflex was found to be significantly weakened or disappeared, or the number of breaths was <16 times/min, the patient's urine output was <25 ml/h, the medication should be stopped immediately, 7 days as a course of treatment. On the basis of the control group, the therapy group was given nifedipine , 3 times a day, 10 mg each time, orally with warm water, 7 days as a course of treatment.The principle of medication is to be treated in strict accordance with the treatment standards for hypertension in pregnancy in the Guidelines for the Diagnosis and Treatment of Hypertension in Pregnancy. During the administration and treatment of the two groups of patients, the relevant medical staff should pay close attention to the patients' usual urine output, fetal heart rate, respiration, and magnesium ion levels to prevent the patients from experiencing poisoning symptoms. And during the treatment, the patient's blood pressure, heart rate, and breathing changes are recorded in detail, and adverse reactions and changes in symptoms such as dizziness and headache are observed. Record the occurrence of pregnancy complications.The systolic blood pressure (SBP) and diastolic blood pressure (DBP) of the two groups of patients before and after therapy were measured and compared.Before and after therapy, 5 ml of fasting cubital venous blood was collected from the two groups of patients in the morning during the obstetric examination, centrifuged at 3,500 r/min for 10 min to take the upper serum, and placed in the refrigerator at −80°C for later use. Use CA8000 automatic blood coagulation analyzer  and supporting kits to measure coagulation function related indexes, including prothrombin time (PT), thrombin time (TT), fibrinogen (Fib), activated thrombin Original time (APTT).Take the sera of the two groups of patients in 1.5.2, and ELISA kit  to detect the serum levels of lipid peroxide (LPO), malondialdehyde (MDA), and superoxide dismutase (SOD).Take the serum of the two groups of patients in 1.5.2, use the BS-800 automatic biochemical analyzer (Zhengzhou Nanbei Instrument Equipment Co.Ltd.) to detect serum endothelin 1 (ET-1), nitric oxide (NO) and ET-1/ NO level.Compare the clinical effects of the therapy group and the control group. Significantly effective: after therapy, the patient's systolic blood pressure is less than or equal to 140 mmHg, and the diastolic blood pressure is less than or equal to 90 mmHg; or the patient's systolic blood pressure drops >30 mmHg, and the diastolic blood pressure drops >15 mmHg; the patient's dizziness, headache and abdominal discomfort and other clinical symptoms have basically disappeared, and no postpartum complications appear. Effective: after therapy, the patient's systolic blood pressure is ≧140 and ≦150 mmHg, and the diastolic blood pressure is ≧90 and ≦100 mmHg. The clinical symptoms such as dizziness, headache, and abdominal discomfort are significantly improved, and no postpartum complications occur. Ineffective: after therapy, the patient has systolic blood pressure ≧150 mmHg, diastolic blood pressure ≧100 mmHg, clinical symptoms are not improved or even worsened, with mild edema and proteinuria.Observe and record the occurrence of adverse pregnancy outcomes such as premature birth, postpartum hemorrhage, fetal distress, and very low birth weight infants in the two groups.t-test was in accordance with the normal distribution, and the Wilcoxon test was not in accordance with the normal distribution. The measurement data used χ2, and P < 0.05 indicated that the difference was statistically significant.Graphpad priam 8.0 software was used for data analysis, and the measurement data were expressed as mean ± standard deviation. The P > 0.05). After therapy, the systolic blood pressure and diastolic blood pressure of the two groups were significantly decreased, and the therapy group was significantly lower than the control group (P < 0.05)  .P > 0.05). After therapy, PT, TT, and APTT in two groups were significantly increased, and Fib was significantly decreased, and PT, TT, APTT in the therapy group were higher than those in the control group, and Fib was lower than that in the control group (P < 0.05)  .P > 0.05). After therapy, LPO and MDA in two groups were significantly decreased, and SOD was significantly increased, and LPO and MDA in the therapy group were lower than those in the control group, and SOD was higher than that in the control group (P < 0.05)  .P > 0.05). After therapy, ET-1 in two groups were significantly increased, and NO and ET-1/NO was significantly decreased, and ET-1 in the therapy group was higher than that in the control group, and NO and ET-1/NO were lower those in the control group (P < 0.05)  .P < 0.05)  .P < 0.05)  .P < 0.05). The results of this study are consistent with the above reports.Pregnancy hypertension refers to a state in which both increased blood pressure and pregnancy coexist. It has a serious impact on the health of pregnant women and fetuses. If they cannot be effectively controlled in time, they will cause serious consequences with maternal or perinatal death . TherefoWhen the body's blood coagulation function is abnormal, the blood coagulation function and anticoagulant function in the body will be out of balance . The coaStudies have found that the occurrence and development of hypertension are closely related to the excessive production of reactive oxygen species leading to oxidative stress or the body's ability to resist internal antioxidants . In patiIn summary, nifedipine tablets combined with magnesium sulfate in the treatment of pregnancy-induced hypertension can improve the coagulation function of patients, reduce oxidative stress damage, regulate the levels of ET-1 and NO in patients' serum, and improve clinical efficacy.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.The studies involving human participants were reviewed and approved by the Ethics Committee of the Weifang People's Hospital. The patients/participants provided their written informed consent to participate in this study.XY and QZ made equal contributions, including the design of the study, the evaluation of the results, and the writing of the paper. QZ guided the whole study as the supervisor of the whole study. 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.