bluuebunny/crossref_metadata_2025 huggingface dataset:
TOWARDS NOVEL CIRCULATING MARKERS FOR ABDOMINAL AORTIC ANEURYSM PROGNOSIS
Authors: Galán María , Sánchez-Infantes David , Nus Meritxell , Navas-Madroñal Miquel , Pérez Belén , Camacho Mercedes , Martínez-González José , Rodriguez Cristina , Mallat Ziad
Published: April 2021

Objective:

Abdominal aortic aneurysm (AAA) is increasing due to aging of the population and is a major cause of death among the elderly. Ultrasound screening programs are useful in early diagnosis but aneurysm size is not always a good predictor of rupture. Thus, there is an urgent need to find new potential prognostic factors. Our aim is to determine whether a battery of immune, inflammatory and oxidative stress markers, previously described to be involved in other cardiovascular diseases, may be used as potential biomarkers to provide personalized prediction of AAA progression for the clinical practice.

Design and method:

To address this, human abdominal aneurysmatic aortas (N = 80) and blood samples (N = 94) were obtained from patients undergoing open repair or endovascular surgery repair for AAA, whereas healthy aortas (n = 15) and blood samples (n = 46) were obtained from healthy donors.

We studied the immune infiltrate in paraffin sections of human aneurysmatic tissue and quantified IgM and IgG circulating levels in our AAA patient cohort. Circulating levels of ROS, CD38, CD36, GDF15 and S100A4 were measured by ELISA and their tissue expression was studied by real Time PCR and by immunostaining. Potential correlations with the aneurysm diameter or with peak wall stress, determined by finite element analysis, were measured by the Pearson product-moment correlation.

Results:

Our study shows for the first time the alteration of IgM, IgG, ROS, CD38, GDF15 and S100A4 levels in plasma and in aneurysmatic tissue of AAA patients in comparison with controls. After performing the corresponding statistical analysis we could exclude age and sex as confounding factors of our current observations. Circulating levels of IgG, CD38 and GDF15 were positively correlated with abdominal aortic diameter and peak wall stress.

Conclusions:

Our data indicate that IgG, CD38 and GDF15 may have potential to aid AAA prognosis as indicators of the progression of the aneurysm growth.
LACK OF CHANGES IN FOOD BEHAVIOUR OF FIRST-GENERATION CHINESE MIGRANTS THROUGH THE YEARS OF RESIDENCE IN ITALY
Authors: Modesti Pietro Amedeo , Marzotti Ilaria , Pellegrino Alessio , Ermini Elena , Bartoletti Alessio , Mascherini Gabriele , Galanti Giorgio
Published: April 2021

Objective:

The length of residence in the host country is frequently associated with progressive modifications in lifestyle and diet, adapting to the host country habits with implications on CV risk. Information on diet changes in first-generation Chinese migrants to Europe is lacking.

To explore the associations between the length of residence in Italy with modifications in food behavior and physical activity of first-generation Chinese migrants living in Prato, Italy.

Design and method:

Chinese first-generation migrants aged 14 80 were enrolled in a cross-sectional survey starting from 2014. Participants underwent administration of validated questionnaire to evaluate dietary habits (food frequency) and physical activity (sedentary, light, moderate, vigorous).

The relationship of quartiles of years lived in Italy with main foods consumption, physical activity was investigated using a univariate and multivariate regression analysis (adjusted for age, gender, education, work category).

Results:

On average participants had lived in Italy 12 ± 6 years (range 1–32). Results of linear regression analyses are reported in the following Table. Although a trend to increase physical activity was observed, a huge number of subjects reported sedentary habit (642 out of 718).

Conclusions:

First generation Chinese migrants do not change their dietary habit, alcohol use or smoking through the years of residence in Italy. A large part of investigated subjects self-reported sedentary habit.
TRENDS IN THE DIETARY HABITS OF THE BULGARIAN POPULATION DURING A NINE YEARS PERIOD-2010-2018
Authors: Gruev Ivan , Tsanova-Savova Silvia
Published: April 2021

Objective:

Bulgaria is one of the European countries with highest rate of cardiovascular morbidity and -mortality.

In attempt to find out the reasons for this negative fact, we tried to analyze the changes in the typical Bulgarian diet during the last decade.

Design and method:

We used the household consumption data from National Statistical Institute of Bulgaria for the mean consumption of the main food products per person per year. The available information included period of 9 years-2010-2018.

Results:

There is a decrease of the consumption of sugar from 8.5 kg/person/year to 6.9 kg/person/year, but there is increase of the consumption of sugary (from 1.4 to 1.7 kg/person/year) and chocolate products (from 1.1 to 1.5 kg/person/year). There is also significant increase of the intake of soft drinks (known to be the most powerful source of hidden sugar) - from 50.9 to 66.5 l/person/year.

The salt consumption slightly decreased (2.0 to 1.8 kg/person/year) but the intake of dried and processed (and very salty) meat products increased from 3.2 to 4.0 kg/person/year.

The intake of the traditional Bulgarian sunflower oil decreased from 14.1 to 12 l/person/year, but the consumption of butter increased from 0.2 to 1.0 kg/person/year.

The consumption of red meat increased and that was mainly due to increased intake of pork-from 6.9 to 10.5 kg/person/year. On the opposite- the trend of increased consumption of fish until year 2013 was negatively reversed in the following years, reaching the lowest point of 5.2 kg/person/year in 2018.

The consumption of fruits and vegetables remained relatively stable, but there is a negative trend of decreased intake of local products (rich of antioxidants) such as apples, pepper and cabbage.

Alcohol consumption increased significantly (23.6–31 l/person/year), mainly due to increased beer intake.

And finally, despite of law restrictions- the intake of cigarettes increased from 591 to 674 person/year.

Conclusions:

Our conclusion is that the trends in the dietary habits of the Bulgarian population during a nine years period-2010–2018 are generally negative. We must improve the level of dietary education from early age and involve the whole society in this process.
SKIN NA+ EXCESS IN HYPERTENSIVE PATIENTS: ISOTONIC NATURE AND CLINICAL CORRELATES
Authors: Rossitto Giacomo , Chen Jun Yu , Mary Sheon , Chew Khai Syuen , Montezano Augusto , Welsh Paul , Petrie Mark C. , Touyz Rhian M. , Delles Christian
Published: April 2021

Objective:

Our traditionally nephrocentric view of Na+ homeostasis has recently been challenged by the concept of Na+ accumulation in tissues, predominantly skin, observed in hypertension. Its proposed water-independent (hypertonic) nature, carrying pathogenic potential, lacks firm demonstration. This study investigates the nature and clinical correlates of skin Na+ accumulation in hypertensive patients.

Design and method:

Responses to a validated salt intake questionnaire, measures of transepidermal water loss (TEWL), blood samples and a skin punch biopsy were collected from adult, non-pregnant and consenting hypertensive patients at the Glasgow Blood Pressure Clinic. Histochemical analysis was conducted by splitting the skin into epidermis/superficial dermis (ESD) and deep dermis (DD) layers. Water was measured by gravimetric approach (wet weight – dry weight), and Na+ and K+ by flame photometry.

Results:

Seventy-six patients consented to skin biopsy (age: 58 ± 15, range 22–86 years; females = 47.4%; BMI: 30.3, IQR 27.5–36.3). Na+ concentration ([Na+]) and K+ concentration ([K+]) was lower and higher in ESD (richer in cellularity) compared to DD, respectively (112.6 ± 8.57 and 30.17 ± 4.88 vs 119.0 ± 11.81 and 17.28 ± 3.62 mmol/l), respectively (p < 0.001 for both). Virtually none of the patients had [Na++K+] exceeding normal physiological levels in either layer, thus excluding hypertonic extracellular Na+ accumulation. Water content was positively and negatively correlated with Na+ and K+, respectively. Female DD, which is richer in fat content, contained less water, Na+ and K+ than male dermis (p < 0.01 for all), with no difference in concentrations or in ESD. Age was associated with an increase in ESD water and [Na+], and a decrease in [K+] in both layers, suggestive of oedema accumulation and independent of sex, BMI and estimated Na intake (padj < 0.005). The latter independently predicted epidermal water content (padj = 0.017). Patients with uncontrolled BP had higher ESD [Na+] (padj = 0.02). NT-proBNP levels mirrored all measures of skin oedema accumulation, while no significant interaction with medications or TEWL was observed.

Conclusions:

Skin Na+ accumulation in hypertensive patients is isotonic, prevalent and reflects subclinical oedema. Tissue architecture considerably impacts on Na+ content and concentration, whereas TEWL has minimal effect. These results have mechanistic, diagnostic and therapeutic implications.
ELEVATED TRIGLYCERIDE TO HIGH-DENSITY LIPOPROTEIN CHOLESTEROL RATIO INCREASED RISK OF HYPERURICEMIA IN CHINESE ADULTS: A 4-YEAR COHORT STUDY
Authors: Chen Jingyuan , Liu Xingyao , Lu Yao , Yuan Hong
Published: April 2021

Objective:

Previous studies showed that high serum uric acid (SUA) levels associated with elevated triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio. However, evidence is lacking regarding whether TG/HDL-C is an independent risk factor. Our aim was to investigate the association between TG/HDL-C and the risk of hyperuricemia in Chinese population after adjusting for relevant risk factors.

Design and method:

This retrospective cohort study included 15,198 participants with an average age of 43 years who did not have hyperuricemia at baseline. The association between TG / HDL-C and the risk of hyperuricemia in the total sample was examined by multiple logistic regression analysis. To completely rule out the impact of metabolic syndrome on the relationship between TG/HDL-C and hyperuricemia, we reevaluate the relationship between TG/HDL-C and hyperuricemia in participants without metabolic syndrome (N = 12,813).

Results:

During a 4-year follow-up, 2,365 (15.6%) participants developed hyperuricemia. With the increase of the TG/HDL-C quartile, the cumulative incidence of hyperuricemia increased significantly (5.9,10.8, 18.4, and 27.5%, respectively). After multivariate adjustment, the odds ratio (OR) for hyperuricemia in the highest compared with the lowest quartile of TG/HDL-C was 1.80 (95% confidence interval [CI] 1.49, 2.18), and each SD increment of TG/HDL-C ratio caused a 10% additional risk for hyperuricemia. The cumulative incidence of hyperuricemia was also significantly elevated with increasing TG/HDL-C quartiles (5.6, 9.4, 15.5, and 24.0%, respectively) in participants without metabolic syndrome. The OR for hyperuricemia in the highest compared with the lowest quartile of TG/HDL-C was 1.70 (95% CI 1.38–2.10), and each SD increment of TG/HDL-C ratio caused a 18% additional risk for hyperuricemia in people without metabolic syndrome after adjusting for all confounders.

Conclusions:

Elevated TG/HDL-C ratio increased future risk of hyperuricemia in Chinese population. This association suggested the potential of TG/HDL-C ratio to serve as an independent risk indicator in the prevention of hyperuricemia.
MEDICATION-FREE BLOOD PRESSURE (B.P.) MANAGEMENT IN INDIVIDUALS WITH PRE-HYPERTENSION OR STAGE 1 HYPERTENSION
Authors: Sachla Zacharo , Koursioumbas Georgios , Tsoutsouli Vasiliki , Paskalis Georgios-Charis , Christodoulou Emmanouil , Gkogkos Konstantinos
Published: April 2021

Objective:

Hypertension is defined as systolic blood pressure (S.B.P.) > 140 mm Hg and/or diastolic blood pressure (D.B.P.).) > 90 mm Hg at rest. Further classification of hypertension generates 4 groups of patients. Those with normal high blood pressure (S.B.P. > 130–139 mm Hg and /or D.B.P. > 85–89 mm Hg) and with stage 1 hypertension (SAP > 140–159 mm Hg and / or D.A.P. > 90–99 mm Hg), form a special category in which, the implement of medication creates debatable and controversial opinions among health care professionals, due to borderline values and patients’ low compliance. We aim to evaluate the management of B.P. without medication in patients with high normal blood pressure or stage 1 hypertension.

Design and method:

180 individuals, 77 men (43%) and 103 women (57%), aged 40–70 years, without comorbidities except of dyslipidemia, were classified as pre-hypertensive or stage 1 hypertensive patients after measuring their B.P. three times a day for a week. Subsequently, they were weighed and recommended to follow hygienic-dietary measures such as Mediterranean diet, reduced sodium intake, weight loss and exercise with a daily walk of about 4 kilometers. After a period of 6 months, they were reevaluated with a new record of body weight and a special questionnaire regarding the observance of doctor's recommendations. Of the total sample, 122 (67%) were considered suitable for the study, 55 of which were men (45%).

Results:

122 (67%) were considered suitable for the study, 55 of which were men (45%). 83 of these patients (69%), 36 men and 47 women, presented regulation of their B.P. at normal levels. In addition, there was a significant reduction of LDL levels in half of the patients (35/68). Medication for hypertension was given to the remaining 39, approximately 1/3 of the initial patients.

Conclusions:

The adoption of hygienic-dietary measures contributes to regulation of B.P. and improvement of lipid status in a major proportion of patients with marginally high B.P or with stage 1 hypertension, avoiding the need for medication at least for some years, justifying the guidelines that insist in taking such measures.
CADASIL-CAUSING NOTCH3 MUTATION CONTRIBUTES TO THE DEVELOPMENT OF PULMONARY ARTERIAL HYPERTENSION IN MALES
Authors: Morris Hannah , Neves Karla , Montezano Augusto , Joutel Anne , Maclean Margaret , Touyz Rhian
Published: April 2021

Objective:

Notch3 signalling has been associated with changes in the pulmonary vasculature leading to pulmonary arterial hypertension (PAH). Mice with the CADASIL-causing R169C Notch3 mutation (TgNotch3R169C) exhibit gain-of-function Notch3 signalling and develop peripheral vascular dysfunction and injury. Here we investigated whether the R169C mutation contributes to PAH development.

Design and method:

Briefly, 24-week male and female mice overexpressing either a WT or R169C mutant Notch3 gene were exposed to 2 weeks normoxia (N) or chronic hypobaric hypoxia (10% O2) (H). PAH was assessed by in vivo haemodynamic measurements, Fulton index analysis of right ventricle hypertrophy (RVH), and histological remodelling analysis by elastin staining of pulmonary arteries under 80 microns in diameter. Pulmonary artery wire myography was also performed.

Results:

RV systolic pressure increased in hypoxic animals vs normoxic (WT H 27.5 ± 1.0 vs WT N 22.8 ± 2.2mmHg); and was exacerbated only in male R169C hypoxic animals (R169C H 32.2 ± 1.1 mmHg vs R169C N 23.6 ± 1.4) (p < 0.05). Male R169C hypoxic animals also exhibited significant RV hypertrophy (H 0.26 ± 0.033 vs N 0.16 ± 0.012), p < 0.05. RVH was not significantly different between female groups. R169C pulmonary arteries from males were significantly hypercontractile to 5HT (Emax: R169C 142 ± 10% vs WT 92 ± 6%); an effect attenuated by ROCK inhibitor Fasudil (Emax: R169C ± Fas. 117 ± 20%). Female R169C arteries were not hypercontractile to 5HT (R169C 113.3 ± 11% vs WT 120.3 ± 8%) but Fasudil reduced contraction (Emax: R169C + Fas. 96.8 ± 10%). Notch3 effector gene Hes5, implicated in PAH, was significantly increased in male R169C lung (8.7 fold change vs WT) suggesting increased Notch3 activation. RhoA/ROCK activating Rho-guanine nucleotide exchange factors LARG and PDZ mRNA were upregulated in R169C lung (R169C 33.5 fold vs WT, R169C 18.7 fold vs WT respectively). These changes were not observed in lungs from female mice.

Conclusions:

Notch3 R169C mutation may contribute to PAH susceptibility and pulmonary vascular hypercontractility in males. ROCK signaling plays an important role in these processes.
MICROVASCULAR ANGINA IS ASSOCIATED WITH SYSTEMIC DYSFUNCTION OF PERIPHERAL RESISTANCE ARTERIES
Authors: Michielon Alberto , Lanza Oreste , Ingrasciotta Gesssica , Ferrera Armando , Cesario Vincenzo , Marino Gaetano , Ruscio Eleonora , Filice Monica , De Vita Antonio , Crea Filippo , Volpe Massimo , Lanza Gaetano A. , Savoia Carmine
Published: April 2021

Objective:

Microvascular angina (MVA) is characterized by functional and structural alterations of resistance coronary arteries without any significant alterations of epicardial coronary arteries. Whether MVA patients present also dysfunction of peripheral resistance arteries is still a matter of debate. We sought to evaluate whether MVA is associated with parameters of systemic microvascular dysfunction.

Design and method:

Thirteen patients with MVA and 13 healthy control subjects were enrolled in this study. The diagnosis of MVA was based on the presence of typical symptoms of ischemic heart disease, evidence of myocardial ischemia on exercise stress testing and normal epicardial coronary arteries at angiography. Parameters of peripheral microvascualar alterations, arterial stiffness (Pulse Wave Velocity, PWV), and central blood pressure (cBP) and Subendocardial Viability Ratio (SEVR, and index of subendocardial microvascular dysfunction), were evaluated by applanation tonometry.

Results:

Patients and controls were similar with respect to metabolic parameters, BMI, and renal function.

MVA patients were on therapy with beta-blockers (50%), calcium channel blockers (37%), nitrates (12%), renin-angiotensin-blockers (44%), and statins (25%). MVA patients were slightly older than controls (63.6 ± 1.9 vs 53.1 ± 2.0 years, p < 0.05). Albeit in the normal range, peripheral (pSBP) and central (cSBP) systolic BP were significantly higher in MVA patients as compared to controls (pSBP:134.3 ± 2.9 vs 118.5 ± 3.5 mmHg, p < 0.002; and cSBP:124.8 ± 2.9 vs 109.7 ± 2.9 mmHg, p < 0.001). Diastolic BP was similarly preserved in both groups. SEVR, an index of subendocardial microvascular dysfunction, was lower in MVA patients as compared to controls (139.7 ± 4.1 vs 160.4 ± 8.5 %, p < 0.05). Augmentation index (AI), reflected (RPH), and forward (FPH) pulse height, all parameters of peripheral microvascular dysfunction, were also altered in MVA patients as compared to controls (AI:29.0 ± 1.0 vs 19.9 ± 2.4%, p < 0.003; RPH:22.3 ± 1.4 vs 15.3 ± 0.9 mmHg, p < 0.001; FPH:31.0 ± 1.4 vs 24.2 ± 1.4 mmHg p < 0.005). The index of aortic stiffness PWV was similar in both groups (7.20 ± 07 vs 6.6 ± 0.2 m/sec, NS).

Conclusions:

Patients with MVA on optimal anti-schemic therapy exhibit alterations of parameters of both subendocardial and peripheral microvascular dysfunction, suggesting that coronary microvascular dysfunction is part of a more generalized disorder also involving peripheral resistance arteries.
RELATION OF PERIAORTIC ADIPOSE TISSUE WITH PARAMETERS OF METABOLIC SYNDROME IN YOUNG PEOPLE WITH ABDOMINAL OBESITY
Authors: Zheleznova Ekaterina , Zhernakova Yu , Chazova I. , Blinova N. , Azimova M. , Shariya M. , Gorieva Sh
Published: April 2021

Objective:

The main aim of study was to investigate the association between periaortic fat (PF) and metabolic parameters, subcutaneous (SF), visceral (VF), epicardial (EF) fat in patients with abdominal obesity (AO).

Design and method:

127 patients 18–45 y.o. (average age 38,4 ± 6,0) with AO (men (M) – 58,3%) were enrolled in study. Height, weight, BMI, waist circumference, blood tests (fast glucose (FG),glucose tolerance (GT), insulin, HOMA-IR, lipid profile) were measured. MS was defined as AO (cut-off of > 80 cm in women (W) and > 94 cm in M) plus > 1 sign: HDL < 1,30 (w)/1,04(m)mmol/l; triglycerides > 1,7mmol/l; FG > 5,6mmol/l; violation GT; BP > 140/90mmHg. SF, VF, PF, EF (range: -150 to -30 HU) was measured by computed tomography. We calculated ratio subcutaneous to visceral fat (RSV). 24 hour blood pressure monitoring was performed. We formed 2 groups: AO (AO plus 1 or less sing of MS) and MS.

Results:

Tab. 1. Correlations PF with sex r = 0,223 (p = 0,009), with BMI r = 0,347 (p = 0,000), with WC r = 0,525 (p = 0,000), with uric acid r = 0,425 (p = 0,000), FG r = 0,27 (p = 0,002), insulin level r = 0,40 (p = 0,000), with HOMA r = 0,41 (p = 0,000), TG r = 0,32 (p = 0,000), HDL r = -0,37 (p = 0,000), LDL r = 0,23 (p = 0,005), with VF r = 0,55 (p = 0,000), SF r = 0,31 (p = 0,000), EF r = 0,69 (p = 0,000), RSV r = -0,300 (p = 0,000) were found.

Conclusions:

PF are directly related to most of metabolically parameters. PF in people with abdominal obesity is involved in metabolic syndrome.
N-METHYL-D-ASPARTATE RECEPTOR INHIBITION PREVENTS GLUCOMETABOLIC DYSREGULATION AND CARDIAC INJURY IN NICOTINE-EXPOSED MALE RATS
Authors: Michael Olugbenga , Ojo Gideon , Olatunji Lawrence , Soladoye Ayodele
Published: April 2021

Objective:

Since non-smoking nicotine exposure has been associated with cardiometabolic disorders and smoking cessation therapies are of great global and medical significance. N-methyl-D-aspartate receptor (NMDAR) activity has been implicated in diabetes. Although NMDAR is also expressed in cardiomyocytes, there is dearth of information on its activity on cardiometabolic dysfunctions and its associated mechanism yet to be fully elucidated. It is therefore hypothesized that NMDAR inhibition by low-dose ketamine would improve nicotine-induced glucometabolic deregulation and cardiac injury.

Design and method:

Male Wistar rats (n = 6/group) aged 10 weeks were given (p.o.) vehicle, nicotine (1.0 mg/kg) with or without ketamine (0.2 mg/kg) daily for 28 days. Oral glucose tolerance test was performed 24-hours to the end of the experiment. The insulin resistance was estimated using the homeostasis model assessment for insulin resistance (HOMA-IR).

Results:

Data showed that nicotine exposure led to insulin resistance, hyperinsulinemia, elevated 1-hour postload glucose, glucose intolerance, triglyceride-glucose index. Likewise, plasma and cardiac uric acid, malondialdehyde, lactate, triglyceride (TG), TG/HDL-C, oxidized glutathione (GSSG) levels, creatinine kinase (CK), lactate dehydrogenase (LDH), adenosine deaminase (ADA), xanthine oxidase (XO) activities were increased in nicotine-exposed rats. On the other hand, plasma and cardiac nitric oxide level was reduced by nicotine exposure. However, ketamine treatment also led to elevated TG, LDH, lactate, CK activity, nitric oxide, and reduced TG/HDL-C, uric acid, MDA, GSSG levels, XO and ADA activities when compared to control. However, these nicotine-induced cardiometabolic disorders were ameliorated in ketamine-treated rats.

Conclusions:

The results demonstrated that low-dose ketamine prevents glucose dysregulation, plasma and cardiac TG, uric acid, lactate accumulation and suppressed ADA, XO and CK activities. Therefore, these findings imply that inhibition of NMDAR by low dose-ketamine improves glucometabolic regulation and ameliorates cardiac injury through ADA/XO/CK-dependent mechanisms.
OBESITY: A MAJOR PUBLIC HEALTH HAZARD AND LEADING CAUSE OF METABOLIC DISEASES
Authors: Arain Mudassar Iqbal
Published: April 2021

Objective:

Obesity has become a major public health hazard and its prevalence continues to rise in Pakistan faster than ever. Obesity is major risk factor for many cardiovascular diseases. High cholesterol is a key factor for the development of type-II diabetes mellitus, dyslipidaemia, chronic kidney disease, and non-alcoholic fatty and liver disease. There is a linkage between serum cholesterol and triglyceride levels and atherosclerotic cardiovascular disease in type I and type II of hyperglycaemia. The relationship between obesity and type-II diabetes mellitus is multifaceted and closely intertwined with other co-morbidities present in obesity

Design and method:

An interventional study was designed for a period of six months among 300 patients selected via purposive sampling with 95% confidence interval using slovin's formula. All the interventions were performed as per standard guidelines later the same tests were carried out to assess the outcomes. Pre and post interventional Proforma/data analysis sheet were filled by the investigator and then the outcomes were compared.

Results:

Majority (25.5%) of the patients who participated in the study were in the age group 60–96 which shows an increase in obesity occurrence with advanced age. About 48% patients have had BMI more than 30 and about 29.5% have had BMI range of 25–29.9. most of the patients about 35.5% didn’t check their blood glucose level before intervention and 121(60.5%) patients have had high cholesterol level and 79 patients with high cholesterol had glucose level above 126 mg/dl.

Conclusions:

The study findings revealed that Patients’ attitude (treatment, diet intake, sleeping and exercise habits) mean scores, pre-counselling and post-counselling for patients were significantly different and had improved after our interventions. Post interventions results revealed that the patients upgraded their practice by intermittently checking their blood glucose level, control smoking habit and maintain their life styles.
OBESITY AND ELEVATED LEVELS OF VON WILLEBRAND FACTOR IN PATIENTS WITH HYPERTENSION AND EARLY CORONARY ATHEROSCLEROSIS
Authors: Urazgildeeva Soreiia , Shugurova Irina , Vasina Lubov , Muzalevskaya Maria , Baranova Elena , Shurygina Valeria , Gurevich Victor , Perepech Nikita
Published: April 2021

Objective:

Obesity is one of the additional risk factors for early development of atherosclerosis and cardiovascular complications in patients with hypertension. Von Willebrand factor (vWF) is a plasma glycoprotein which plays an important role in the thrombogenesis. On the other hand it is considered as a marker of the endothelial dysfunction. The objective of our study was to assess the level of vWF in patients with hypertension and early manifestations of coronary atherosclerosis depending on the presence of obesity.

Design and method:

79 middle-age (49,88 ± 7,77) patients with hypertension and established coronary atherosclerosis (71 men and 8 women) were involved into study. According to the calculating body mass index (BMI), all subjects were divided into 2 groups: 22 obese people (BMI above 30 kg/m2) and 57 non-obese patients. In all patients we analyzed family history, smoking status, history of diabetes. The plasma lipid profile and vWF level were estimated using EIA kit (Uscn Life Science Inc., Cloud-Clone Corp., USA).

Results:

Both groups did not differ in the family history of cardiovascular disease, smoking status and diabetes. Though all patients received statins triglycerides levels were significantly higher in obese patients [95%CI: 1.50; 2.57] compared with patients in the other group [95% CI: 1.29; 1.70] (p < 0.05). Almost all but one obese patient had high levels of vWF [95% CI: 53.87; 72.38]. Among patients with a BMI below 30 kg/m2, normal values of vWF were detected in 21 patients [95% CI: 41.38; 52.76]. The groups significantly differed in the level of vWF, both when calculating the odds ratio (OR) using the Pearson chi-square criterion [OR: 5,6; p = 0.0035] and when comparing samples according to the Student's t-criterion (p < 0.005).

Conclusions:

Results of the study suggest enhanced endothelial dysfunction as one of the possible links between obesity and increased risk of cardiovascular complications in patients with hypertension.
COMPOUND 21 IMPROVES VASCULAR FUNTION IN THE THORACIC AORTA FROM OBESE MICE: IMPLICATION OF AT2, MAS AND B2 RECEPTORS
Authors: González-Blázquez Raquel , Gil-Ortega Marta , Alcalá Martín , Viana Marta , Unger Thomas , Steckelings Ulrike Muscha , Fernández-Alfonso Maria Soledad , Somoza Beatriz
Published: April 2021

Objective:

The angiotensin AT2 Receptor (AT2R) is known to form heterodimers with either the Mas (MasR) or the bradykinin B2 receptor (B2R). Compound 21 (C21), a highly selective AT2R agonist, induces vascular relaxation through stimulation of nitric oxide (NO). Since AT2R is overexpressed in obese models, we hypothesize that C21 might prevent the development of vascular alterations associated with obesity. The aim of this study was to assess the effect of C21 on endothelial function in a model of diet-induced obesity and the potential crosstalk between AT2R, MasR and/or B2R in this response.

Design and method:

Eleven-week-old male C57BL6J mice (n = 20/group) were fed a standard (Chow) or a very high-fat diet (HF) for 6 weeks. Half of mice per group were simultaneously treated with C21 (1 mg/kg/day in drinking water, Chow-C21, HF-C21). Vascular reactivity experiments were performed in rings from thoracic aorta. NO production was determined in human endothelial cells (EA.hy926) using DAF-2DA (10-5 M).

Results:

Thoracic aortas from HF mice exhibited impaired relaxations to acetylcholine (Ach) compared to the Chow group. This alteration was prevented by treatment with C21 [Ach, ChowEmax = 85,6 ± 1,7%; HFEmax = 63,8 ± 3,0% vs HF-C21Emax = 86,0 ± 1,8%, P < 0.001]. In addition, NO availability calculated from the area under the Ach curve in presence and absence of L-NAME (NO synthase inhibitor) was significantly lower in HF mice and increased by C21 treatment [Chow = 237 arbitrary units (AU), HF = 168 AU vs HF-C21 = 239 AU; P < 0.001]. Aortic rings from HF mice exhibited stronger contractions to angiotensin II (Ang II, 10-9-10-6 M). PD123177 (AT2R antagonist, 10-7 M), A779 (MasR antagonist, 10-6 M) or HOE-140 (B2R antagonist, 10-7 M) significantly enhanced Ang II-induced contractions in Chow- but not in HF-rings. HF-C21 aortas exhibited similar responses to Chow rings. In EA.hy926 cells, C21 (10-6 M) significantly increased levels of phosphorylated eNOS and NO production. Both effects were abolished by PD123177, A779 or HOE-140, respectively.

Conclusions:

In conclusion, our data suggest that C21 improves endothelial dysfunction induced by HF-feeding due to an increase in endothelial NO availability via AT2R activation. In addition, both MasR and B2R are implicated in this response and seem necessary for mediating C21 effects.
L-GLUTAMINE SUPPLEMENTATION PROTECTS AGAINST DISRUPTED CARDIAC GLUTATHIONE ANTIOXIDANT DEFENSE AND POOR FETAL OUTCOME FOLLOWING LATE GESTATIONAL TESTOSTERONE EXPOSURE
Authors: Usman Taofeek , Layonu Naheemat , Oyediran Opeyemi , Olaiya Ajibola , Olabisi Adijat , Nurudeen Ramadan , Wahab Raseedat , Olatunji Lawrence
Published: April 2021

Objective:

Gestational testosterone exposure has been linked with low birth weight and the development of cardiometabolic disorders in both the mother as well as offspring. Increase in circulating testosterone has been associated with pregnancy pathologies such as preeclampsia. L-glutamine supplementation in healthy humans has been shown to cause reduction in pro-inflammatory cytokines as well as improve the glutathione antioxidant defenses. However, the effect of L-glutamine on circulating and cardiac inflammation as well as glutathione antioxidant defenses in gestational testosterone-exposed animals is yet to be determined. This study therefore aimed to investigate the effect of L-glutamine supplementation on circulating and cardiac inflammation, oxidative stress, glutathione antioxidant defenses as well as fetal outcome following late gestational testosterone exposure.

Design and method:

Pregnant Wistar rats were allotted into four groups (n = 6) receiving vehicle (distilled water, p.o and olive oil, s.c), testosterone (0.5 mg/kg body weight s.c), L-glutamine (1 g/kg body weight p.o) or a combination of testosterone and L-glutamine between gestational days 15 and 19.

Results:

The findings of this study shows that late gestational testosterone exposure led to an increase in circulating and cardiac inflammatory (adenosine deaminase, xanthine oxidase, uric acid) and oxidative stress (lactate dehydrogenase, malondialdehyde) markers as well as a disruption in the circulating and cardiac glutathione antioxidant defenses (glutathione, glutathione peroxidase, glutathione disulfide and glucose-6-phosphate dehydrogenase) and fetal outcome (fetal weight and number of pups). However, supplementation with L-glutamine led to a reduction of the gestational testosterone-induced increase in circulatory and cardiac inflammatory and oxidative stress markers. L-glutamine supplementation also improved the testosterone-induced disrupted circulating and cardiac glutathione antioxidant defenses as well as the fetal outcome.

Conclusions:

The findings of this study demonstrate that supplementation with L-glutamine prevents disruption of the glutathione antioxidant defenses and poor fetal outcome associated with late gestational testosterone exposure. This was accompanied by an improvement in the inflammatory and oxidative stress profile of these animals.
ROLE OF NOVEL ECHOCARDIOGRAPHIC METHODS TO DETECT EARLY MYOCARDIAL DYSFUNCTION IN WOMEN WITH PREECLAMPSIA
Authors: Hristova-Tselova Krasimira , Marinov Rumen , Tselov Nikolay , Stamenov Georgi , Chacheva Kristina , Racheva Anelia
Published: April 2021

Objective:

Normal pregnancy is associated with reversible changes in both systolic and diastolic mechanics, consistent with an increase in preload and decrease in afterload and systemic vascular resistance. The aim of the study is to evaluate left ventricular cardiac mechanics via speckle tracking echocardiography in a population of pregnant women with per partum cardiomyopathy and preeclampsia(PE) after invitro fertilization (IVF) during different stages of pregnancy.

Design and method:

The study population included 42 pregnant women with PE, after IVF, 10 of them with multiple pregnancy (46.5 ± 3 years) and 20 healthy nonpregnant women (33 ± 4years). 2D images were acquired (65 ± 7 frames/s) during the first, second and third trimester of the pregnancy, as well as up to two months post partum. The curves of longitudinal(GLS), circumferential(GCS), radial strain(GRS) and LVT /LVUR were extracted using a commercial software.

Results:

Peak LVT and LVUR increased significantly in the 3rd trimester in both pregnancy groups (13.48 ± 2.90°,13.12 ± 3.30°,16.83 ± 3.61°,P < 0.001; and -111.52 ± 23.54°/sec,-107.40 ± 26.58°/sec,-144.30 ± 45.14°/sec, P < 0.001; in the 1st, 2nd, and 3rd trimester, The pregnants with twins have the highest value for LVT and LVUR (p < 0.01),.An independent correlation was found between the change in LVT and LV end-systolic volume in 1st and 3rd trimester (r = 0,56). Peak LVUR at the 3rd trimester correlated significantly with LV end-diastolic volume. Multiple regression analysis indicates that only systolic blood pressure (r = 0.394, P = 0.005) was an independent predictor for increased LV torsion. Arterial hypertension (AH) and prevalence of preeclampsia (PE) are more often in IVF group. Longitudinal strain decreased significantly (p < 0.001) during 3th trimester in women with AH and PE. Global longitudinal strain measures of the LV were non-significantly different between the different groups in first and second trimester (GLS-20.6 ± 3,14 vs.-19,29 ± 2,17).

Conclusions:

LV twist and peak untwisting rate increase in the 3rd trimester and correlate with end-systolic and end-diastolic volume, respectively. Blood pressure and condition of multiple pregnancy are independently associated with increased torsion during pregnancy and may predict the new onset heart failure and perinatal cardiomyopathy. Global longitudinal strain is the main predictor of new onset peripartum cardiomyopathy
A RARE CASE OF PHEOCROMOCYTOMA IN PREGNANCY EXACERBATED BY METOCLOPRAMIDE
Authors: Negro Aurelio , Santi Rosaria , Verzicco Ignazio , Giunta Alessandro , Tedeschi Stefano , Graiani Gallia , Volpi Riccardo , Cabassi Aderville
Published: April 2021

Objective:

Pheocromocytoma (PHEO) is a rare catecholamines secreting tumor presenting with variable clinical setting, mostly with headaches, sweating, palpitation and poor controlled arterial hypertension. In 85–90% of cases, tumors are of adrenal gland origin while in 10–15% are commonly located in paravertebral sympathetic plexus. The prevalence of PHEO in hypertensive patients ranges between 0.1 and 0.6%; PHEO is extremely rare during pregnancy with a prevalence of 1 in 54000 pregnancies thus, delayed diagnose may cause life-threatening situations. Accurate identification of PHEO during the antenatal period reduces the risk of mortality for mother and fetus.

Design and method:

We described a case of 33 years old pregnant woman with a one-year history of grade I hypertension.

Results:

The patient has been previously evaluated by endocrinologist for the onset of “striae rubrae” associated with illness, muscle pain, asthenia, anxiety, palpitations and weakness; lab tests were negative for hypercortisolism thus clinicians hypothesized a “functional syndrome”. However, during the 28th week of gestation she was admitted to the emergency room because of severe headache and severe arterial hypertension. CT brain scan was negative for acute events, lab tests showed mild hypokalemia and proteinuria. An in depth revaluation of the clinical history revealed a treatment with metoclopramide taken one week earlier.

Conclusions:

Metoclopramide can stimulate catecholamine- and granin-derived peptide secretion from PHEO cells through activation of serotonin type 4 (5-HT4) receptors and induced PHEO crisis. Thus, under suspicion of PHEO exacerbated by metoclopramide we performed lab tests resulted positive for catecholamines secretion while aldosterone and renin levels were normal.

Abdomen ultrasound and MRI showed oval lesion located in right adrenal gland confirming diagnosis of PHEO. We started treatment with alpha and beta blockers associated with calcium-antagonist; at 33th week, patient underwent a caesarean section and after seven weeks a videolaparoscopic right adrenalectomy, obtaining a normalization of blood pressure levels.
ASSESSING THE KNOWLEDGE, ATTITUDE AND AWARENESS OF ADULT HYPERTENSIVE PATIENTS REGARDING HYPERTENSION
Authors: Patil Vishal , Patil Mansi
Published: April 2021

Objective:

The aim of this study was to assess the awareness, knowledge, attitude, and practice of hypertensive patients and its relation to demographic data in those attending the out-patient services.

Design and method:

The study included 400 patients between the age 18–60 years were recruited who were previously diagnosed with hypertension as per JNC 7 criteria and were on regular anti-hypertensives for at least 6 months, and did not have any known or previously diagnosed psychological problem. Data was collected using a 2-parts closed ended questionnaire using a 4-point Likert scale. Data was analysed using both descriptive and inferential statistics (student's t-test, Pearson correlation coefficient and Spearman correlation coefficient).

Results:

A significant relationship was established between knowledge score and age of the participants (p = 0.002), but not between age and awareness and attitude (p >; 0.05). A significant relation was observed between duration of hypertension and knowledge score (p < 0.05). There is a significant relationship between knowledge score and educational level (p < 0.05). There is a significant difference between men and women's awareness score (p < 0.005), but this difference is not seen in other aspects (knowledge, attitude) (p >; 0.05). Women's awareness score was more than men (p = 0.0007). Data analysis showed that there is significant relationship between awareness and knowledge (P = 0.003), awareness and attitude (P = 0.0001).

Conclusions:

The blood pressure of the participants was not controlled in spite of good awareness and attitude. The knowledge score was low and community based programs to improve knowledge should be initiated. Adequate training for home blood pressure measurement should be given to rule out incoorect blood pressure measurement practics. Also, other barriers like physician turn over, non-adherence to protocol, incorrect prescriptions need to be assessed.
WHAT ARE THE PREFERRED BLOOD PRESSURE MEASUREMENT METHODS BY DOCTORS TO DETECT, DIAGNOSE AND TREAT HYPERTENSION? A SURVEY STUDY IN A CHINESE POPULATION
Authors: Lee Kam Pui , Choi Ryan Chun Ming , Liu Licheng , Yip Benjamin Hon-Kei , Gao Ting , Wong Samuel Yeung-Sha
Published: April 2021

Objective:

Hypertension(HT) is the most common chronic disease and is the leading cause of morbidity and mortality. Its detection, diagnosis and management depend heavily on accurate blood pressure(BP) measurement. It is recommended that the diagnosis of HT should be confirmed or assisted by out-of-office BP measurement, including ambulatory BP measurement(ABPM) and home BP measurement(HBPM). When office BP is used, automated BP measurement(AOBP), which automatically provides an average of 3–5 BP readings, is preferred. This study aimed to describe the BP measurement methods used by doctors working in primary care to detect, diagnose and treat hypertension.

Design and method:

This is a cross-sectional survey. All doctors registered in the “Primary Care Directory” were mailed a questionnaire, asking their preferred methods to detect, diagnose and treat hypertension. Furthermore, the number of BP readings they usually obtained on office BP or HBPM to diagnose or manage HT was asked.

Results:

Four hundred and forty-five doctors responded. Manual measurement by a mercury or aneroid devices was the commonest method to detect(63.1%), diagnose(56.4%), and manage(72.4%) HT. There was an underuse of ABPM and only 1.6% of doctors used ABPM to diagnose HT. 22.2% of doctors used HBPM to diagnose HT; and 56.8% of doctors used HBPM to manage HT. A quarter (26.7%) of participants only obtained one BP reading when they used office BP. Only 40% of participants obtained at least 12 BP readings when HBPM was used. Doctors who obtained specialist qualification in family medicine were more likely to use AOBP in clinics and to obtain enough office BP readings for diagnosis and management of HT.

Conclusions:

Doctors in primary care in Hong Kong prefer to use manual office BP, especially mercury or aneroid devices, to screen, diagnose and treat HT. There is an underuse of AOBP and out-of-office BP. Studies are needed to understand the underlying reasons and to minimize the gap between real-life clinical practice and scientific advances.
EFFECTIVENESS OF THE EASY HYPERTENSION CLINIC MODEL: A 3-YEAR OUTCOME FROM SRINAGARIND HOSPITAL, KHON KAEN UNIVERSITY, THAILAND
Authors: Kotruchin Praew , Mitsungnern Thapanawong , Im-Oun Supap
Published: April 2021

Objective:

From the National Health Examination Survey, one-fourth of Thai population had hypertension (HTN) but more than half were unaware of their high blood pressure (BP). Furthermore, only one-third of treated HTN patients had their BP under control. Uncontrolled HTN is a major risk factor for cardiovascular events, especially in low and middle-income countries. Therefore, we aimed to determine the effectiveness of the EASY HTN clinic model in terms of BP outcome.

Design and method:

The EASY HTN clinic was established in the year 2013 with 3 goals; easy access, minimal resource use, and provide standard treatment. The EASY concept included “Encourage home BP monitoring (HBPM), Adequate health education, Stage of change behavioral theorY”. The clinic consists of a doctor who was responsible for medication adjustment, and a well-trained nurse who was responsible for health education, and reinforcing a BP goal and healthy lifestyles. The clinic was run 6 hours per session, 1 day per week. The first 30 minutes was for group health education, and a question/answer session modulated by the nurse. Every new case was health-educated individually. Treatment was according to standard HTN guidelines. Doctor's treatment time was 7–10 minutes per case, including HBPM check. The follow-up was scheduled every 4 weeks by online messaging and every 3 months at the clinic. The effectiveness of the clinic model in terms of BP control and complication rate from 1st January 2016 to 30th September 2018 were analyzed.

Results:

There were 269, 312, and 206 new patients in 2016,2017, and 2018, respectively. The BP control rate (<140/90 mmHg) was 56.7% in 2016 and increased to 63.7% and 80.8% in 2017 and 2018. Anti-HTN medication can be down-titrated safely in 15.2%, 11.8%, and 12.3% of patients in 2016, 2017, and 2018. There was 2% of patients who can sustainably stop anti-HTN medication for 2 years. Low rate of cardiovascular complications were observed (1.8%).

Conclusions:

The EASY HTN clinic model is effective for BP control. It may be a good model for the primary care clinic in Southeast Asia due to the minimal medical resources need.
CHANGES THE LEVELS OF ANGIOTENSIN 1-7 DEPENDING ON TREATMENT WITH BLOCKERS OF RENIN-ANGIOTENSIN SISTEM IN PATIENTS WITH HYPERTENSION AND TYPE 2 DIABETES
Authors: Koval S. , Yushko K. , Snihurska I. , Mysnychenko O.
Published: April 2021

Objective:

The leading pathogenetic role in development of hypertension plays the renin-angiotensin system (RAS). The angiotensin 1–7 is the novel part of RAS, the metabolic product of angiotensin-II and the important protective cardiovascular factor. The aim of this study was to evaluate the effect of combined treatment with such blockers of RAS as angiotensin-II receptor blocker (ARB) olmesartan or angiotensin-converting enzyme inhibitor (ACEi) ramipril on the blood levels of angiotensin 1–7 in patients with hypertension and type 2 diabetes (T2D).

Design and method:

The study involved 76 patients with hypertension grades 2–3 and T2D (37 men and 39 women) aged 43 to 70. Depending on antihypertensive treatment, the patients randomized into two groups: patients treated with ARB olmesartan (20–40 mg/day) and calcium channel blocker lercanidipine (10–20 mg/day) (n = 38) and patients received ACEi ramipril (5–10 mg/day) with lercanidipine (10–20 mg/day) (n = 38). All patients treated with lipid-lowering therapy (atorvastatin 20–40 mg/day) and antidiabetic therapy (metformin 1000–2000 mg/day) additionally. The angiotensin 1–7 levels determined by ELISA at baseline and after 12 months of therapy.

Results:

Both groups did not differ significantly by angiotensin 1–7 levels at baseline. In the olmesartan group the levels of angiotensin 1–7 were 108,39(92,32;121,17) ng/l and in the ramipril group were 104,37(87,16;122,83) ng/l (p > 0,05). After 12 months from the start of the treatment in both groups there was powerful antihypertensive effect. Targeted blood pressure levels were reached in 84.2% of patients (n = 32) treated with olmesartan and in 81.6% of patients (n = 31) treated with ramipril (p > 0.05 - intergroup). In the end of the treatment the levels of angiotensin 1–7 were differed significantly only in patients treated with olmesartan - there was increasing in its concentration by 20.3% (from 108.39(92.32;121.17) ng/l to (130.43(124.42;138.37) ng/l, p < 0.01). In patients treated with ramipril the levels of angiotensin 1–7 were 112.09(104.3;115.33) ng/l, which were not significantly different from basal levels (p > 0.05).

Conclusions:

The using of ARB olmesartan, unlike ACEi ramipril, significantly increased angiotensin 1–7 blood levels in patients with hypertension and T2D. The increasing the levels of angiotensin 1–7 may have additional cardioprotective value of ARB olmesartan, which requires further study.