bluuebunny/crossref_metadata_2025 huggingface dataset:
IMPROVEMENT OF RENAL HAEMODYNAMICS AND ECHOCARDIOGRAPHIC PARAMETERS IN PHARMACOLOGICAL CONTROLLED HYPERTENSIVES
Authors: De Rosa Maria Leonarda , Atripaldi Luigi Giuseppe , Iovine Sabrina , Ferrara Nicola
Published: May 2024

Objective:

A study was carried out to evaluate the influence of blood pressure lowering treatment with combined doses of olmesartan plus amplodipina compared with those of either drug at a single dose level.

Design and method:

By double-blind, three-way crossover study (balanced Latin square design) in 102 subjects (mean age 51.9 +/- 7.42 years) with essential hypertension we used Olmesartan 40 mg plus Amplodine 5 mg compared with those of either drug at a single and higher dose level (40 or 10 mg daily, respectively). Left ventricular mass and function were evaluated by M-B mode echocardiography, renal function by glomerular filtration rate (GFR) and by serum and 24-h urinary Na+ and K+ during wash-out period and after 24 weeks of treatment.

Results:

The supine blood pressure for subjects given placebo was 171/103 mmHg. After 24 weeks of treatment, systolic and diastolic supine blood pressure were significantly lower with 40 mg iolmesartan plus 5 mg amplodipine (134/84 mmHg) than with 10 mg amplodipine (137/84 mmHg) or with 40 mg olmesartan (144/85 mmHg). Left ventricular posterior wall and septal thickness were significantly and similarly reduced in all groups. Left ventricular systolic and diastolic end diameters were not significantly changed. Left ventricular mass (LVM) was significantly reduced in Olmesartan plus Amplodipine group and Olmesartan group. GFR was not significantly altered. The 24-h urinary Na+ significantly increased with olmesartan, more so than amplodipine. The combination was tolerated better than either monotherapy. We observed no clinically significant changes in laboratory variables including blood lipoproteins.

Conclusions:

The combination of olmesartan plus amplodipina reduced blood pressure more effectively and was better tolerated than other drug alone. All three groups showed similar changes in echocardiographic indices and no change in renal function.
GENDER DISPARITIES IN HYPERTENSIVE PATIENTS ACROSS THE LIFETIME: AN AGE-STRATIFIED ANALYSIS
Authors: Marozzi Marialuisa Sveva , Corvasce Francesco , Persia Simona , Desantis Vanessa , Amodio Gianfranco , Santoro Giuseppe , Falcone Giuseppe , Vacca Angelo , Cicco Sebastiano
Published: May 2024

Objective:

This study aims to explore the influence of gender on vascular and renal damage across distinct age brackets. In particular, investigates the intricate interplay between gender, aging and the onset of vascular and renal injuries. Additionally, the study incorporates an examination of the Triglyceride-Glucose (TYG) index, a surrogate indicator of insulin resistance, to discern its role in clarifying gender-specific variations in health outcomes across different life stages. This analysis aims to enhance our comprehension of age-specific vulnerabilities and contribute valuable insights to the field of gender-related health research.

Design and method:

We selected 210 Caucasian patients, all affected by hypertension, and we divided them previously in two groups, male and female, and in each group we splitted 3 clusters based on their age (under 50, 50 to 70 and over 70 years old). All patients underwent a comprehensive physical examination, with systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR). Blood samples obtained from all patients were analyzed for the complete blood count, low/high density lipoproteins and triglycerides, glycaemia and renal function, including albuminuria and proteinuria. Moreover, all patients went through ankle-brachial index (ABI) and pulse wave velocity. Lastly we calculated the TYG index of all patients.

Results:

Regardless of the well-known correlation between TYG index and hypertension, we found that there was no gender difference between the TyG index and gender or aging. Moreover, no differences were underlined among vascular and renal injuries, neither changes in aortic stiffness were associated to gender but to age-related effects

Conclusions:

Despite what expected, the menopausal transition was not associated with a higher renal or vascular damage, nor to a higher risk of insulin resistance. Large-scale prospective cohort studies are needed to validate these findings, also detecting the influence of gender and aging on heart damage.
CORRELATION ANALYSIS BETWEEN VASCULAR OVERLOAD INDEX AND LEFT VENTRICULAR HYPERTROPHY IN HYPERTENSION
Authors: Zhang Wenchen , Yue Jianwei , Yue Jianwei
Published: May 2024

Objective:

The vascular overload index (VOI) is commonly used to assess the’overload’phenomenon induced by hypertension,and vascular overload is one of the pathogenic mechanisms for left ventricular hypertrophy(LVH)associated with hypertension. The left ventricular mass index (LVMI) is the most frequently used diagnostic indicator for LVH. Research has found that VOI derived from office blood pressure readings is correlated with LVH,but it doesn’t evaluate the relationship between vascular load during different periods of the day and LVH. This study aims to investigate the correlation between VOI obtained from 24-hour ambulatory blood pressure and LVH.

Design and method:

A total of 591 hypertensive patients hospitalized from July 2020 to July 2022 were included. Echocardiography was performed in each patient,and the LVMI was calculated; The 24-hour VOI(VOI24h=1.33×SBP24h-0.33×DBP24h-133.3mmHg),daytime VOI(VOId),and nighttime VOI(VOIn)were calculated based on the 24-hour ambulatory blood pressure results. A multivariate logistic regression was utilized to explore the correlation between VOI at different times and LVH,adjusting for covariates such as gender,age,BMI,triglycerides,cholesterol,HDLand LDL.

Results:

The age of the 591 hypertensive patients was 63.8±13.3years and BMI was 25.7±3.6Kg/m2.Univariate linear regression analysis showed that VOI24h,VOId,and VOIn were positively correlated with LVMI(P<0.001). After adjusting,all of VOI remained correlated with LVMI. Compared with the lowest tertile of VOI24h, the highest tertile had β (95%CI) of 9.25(6.09∼12.4). For VOId,the highest tertile compared to the lowest had β (95%CI) of 8.70(5.55∼11.86),and for VOIn,it was 9.48(6.32∼12.64).Univariate logistic regression analysis indicated that all of VOI were significantly associated with LVH(P<0.001),and after adjusting for confounders,all of VOI still correlated with LVH,with OR(95%CI)respectively being 1.04(1.02∼1.07),1.04(1.02∼1.07),and 1.03(1.01∼1.05). Subgroup analysis revealed that regardless of the comorbidity of the hypertensive patients,all of VOI were all related to LVH.However, when analyzed by season,VOI24h and VOId were significantly associated with LVH in summer and winter, but not in spring and autumn; VOIn was only associated with LVH in winter.

Conclusions:

In the hypertensive patients,VOI derived from 24-hour ambulatory blood pressure is significantly correlated with LVH. Compared to spring and autumn,vascular load during summer and winter is significantly associated with LVH. Therefore,not only should steady blood pressure control over 24 hours be emphasized,but also pay attention to the impact of vascular load on LVH during summer and winter.
LIPIDS INCREASE IN HYPERTENSIVES DURING THE FIRST YEAR STEROID TREATMENT FOR GRANULOMATOSIS WITH POLYANGIITIS (GPA)
Authors: Marozzi Marialuisa Sveva , Corvasce Francesco , Desantis Vanessa , Noviello Silvia , Cirulli Anna , Solimando Antonio Giovanni , Ria Roberto , Vacca Angelo , Cicco Sebastiano
Published: May 2024

Objective:

Granulomatosis with polyangiitis (GPA) is an ANCA-associated small-vessel vasculitis. Vessel wall inflammation induces multiple vascular damages leading to accelerated atherosclerosis. Metabolic profile and cardiovascular risk are marginally known in the GPA patients. Our purpose is to evaluate lipid profile and ASCVD-risk in GPA patients.

Design and method:

We selected 36 patients who received GPA diagnosis (T0) and evaluated them after 1 (T1) and 2 (T2) years follow-up. All patients were treated with high-dose glucocorticoid, one-year tapered, associated with immunosuppressants. Pathological history and a complete list of drugs at different time points were recorded.

Results:

The study reveals noteworthy alterations in lipid profiles, with a substantial increase observed in total cholesterol during both T1 and T2 in comparison to T0. A similar trend was noted in LDLand triglycerides. Conversely, no discernible differences were identified in HDL levels. Additionally, a considerable decrease in high-sensitivity C-reactive protein was observed at T1 and T2 in relation to T0, with no significant variance between T2 and T1. Furthermore, a notable reduction in erythrocyte sedimentation rate was noted at T2 as opposed to both T1 and T0, as well as at T1 compared to T0. Moreover, an interesting observation pertains to hypertensive patients who exhibited a marked escalation in lipid levels, juxtaposed with a gradual reduction in inflammation when compared to normotensive individuals. In particular, notable distinctions emerge between the two groups at both T1 and T2 concerning total cholesterol and LDL (p=0.027), despite comparable baseline values at T0. Then, while triglyceride levels start at similar values at T0, a substantial increase is observed at T1 in hypertensive patients and, conversely, at T2, normotensive individuals experience a significant rise in triglyceride levels, accompanied by a noteworthy reduction in hypertensive subjects.

Conclusions:

The findings indicate that lipid profile alterations, likely influenced by glucocorticoid treatment, may not be directly linked to inflammation. Furthermore, there is a higher relation between hypertension and these alterations. Actual data doesn’t reveal increased mortality in hypertensive GPA patients but further research is required to pinpoint specific patterns characterizing cardiovascular risk and progression in this context.
STATUS AND SURVIVAL RISK OF PATIENTS WITH CHRONIC KIDNEY DISEASE AND HYPERTENSION
Authors: Tian Yixin , Wang Zengwu , Cao Xue , Hu Zhen
Published: May 2024

Objective:

To provide nationwide data on status of control and survival risk of patients with hypertension and chronic kidney disease in China.

Design and method:

A total of 39,094 participants aged 35 years and above, without prior cardiovascular disease (CVD), were enrolled from a sub-study of the China Hypertension Survey. CKD defined as presence of impaired kidney function (eGFR of <60 mL/min/1.73m2). Hypertension defined as 140/90 mmHg or higher. CVD events and all-cause mortality, with follow-up from 2018 to 2019. Multivariable Cox proportional hazards models were employed to estimate hazard ratios (HRs) of patients with CKD in Chinese adults with hypertension.

Results:

The mean age was 56.18 years, and the proportion of women was 54.4%. There were 16 276 adults with hypertension. The estimated proportion of CKD in patients with hypertension were 15.79% in China. The proportions of CKD were 13.22%, 17.26%, 21.64% at stage 1, 2, and 3 hypertension, respectively. Among the adults with hypertension, 21.07%, 63.14%, 13.07%, 2.32%, and 0.4% were at stage 1, 2, 3a, 3b, and 4 to 5 CKD, respectively. In patients with hypertension and CKD, the proportions of combined use of 2 or more antihypertensive drugs were 3.87%, 7.37%, 9.41%, 14.79%, and 10.80%, and the control rate of hypertension were 15.13%, 19.74%, 22.94%, 24.60%, and 21.54% at stage 1, 2, 3a, 3b, and 4 to 5 CKD, respectively. Among the hypertensive patients, after adjusting for age, sex, educational levels, alcohol drinking, smoking, and BMI, people with CKD had 58.8% higher risk of CVD (HR=1.588, 95%CI 1.341–1.881) and 34.3% higher risk in all-cause mortality (HR=1.343, 95%CI 1.138–1.584), compared with people without CKD. Significant higher risk of CVD and mortality at 3a, 3b, 4 to 5 CKD compared with stage 1 CKD.

Conclusions:

Among Chinese adults with hypertension, the proportion of CKD increased with higher blood pressure. Patients with hypertension and CKD had limited control rates of hypertension and high risks of CVD and all-cause mortality, which need more attention.
RELEVANCE OF THE OBESITY-RELATED ORGAN DAMAGE AND METABOLIC SYNDROME CLASSIFICATION IN CARDIOVASCULAR AND RENAL RISK STRATIFICATION IN PATIENTS WITH ESSENTIAL HYPERTENSION
Authors: Circosta Francesco , Marino Luca , Gigante Antonietta , Sarlo Francesca , Servello Adriana , Cimò Antonino , Petramala Luigi , Letizia Claudio
Published: May 2024

Objective:

Hypertension is relevant cardiovascular comorbidity. Adipose tissue represents a metabolically active tissue involved in the regulation of blood pressure and metabolic alterations. In recent decades several classifications for the Metabolic Syndrome (MS) have been proposed. Recently, a new syndrome called “Cardiovascular-kidney-metabolic” was identified, in order to identify patients at high cardiovascular and metabolic risk; the aim of the study was to compare different classifications in a large population of hypertensive patients.

Design and method:

Between September 2022 and August 2023, we have consecutively enrolled 772 hypertensive patients (407M; 365W; mean age 52.2±15.1yrs), evaluating anthropometrics, biochemical and instrumental parameters (transthoracic echocardiogram, carotid echo-Doppler, 24-h ambulatory blood pressure monitoring, fundus oculi).

Results:

Using different classifications we have found MS prevalence: ATP-III 28.8%, IDF 31.5%, CKM 40.7%. CKM Class 3 and 4 showed higher BMI and waist circumference with respect to other groups. Compared to ATP-III and IDF, CKM Class 4 showed higher 24-hrs systolic blood pressure, lower percentage of controlled hypertension, increased interventricular septum and posterior wall, reduced ejection fraction and greater prevalence of hypertensive arterial retinal damage.

Conclusions:

visceral obesity and MS are frequent conditions with healthy impact, becoming an important trigger for the development of cardiovascular and metabolic complications. The different MS classifications allow the early identification of patients at high risk of cardio-metabolic complications. The new CKM syndrome proves useful to identify individuals at high risk for CKM morbidity and mortality.
HYPERCOAGULATION OF BLOOD AND THROMBOCYTOPENIA AFTER SARS-COV-2 – PNEUMONIA AS PREDICTORS OF AN UNFAVORABLE PROGNOSIS IN PATIENTS WITH ARTERIAL HYPERTENSION
Authors: Wang Zheming , Talibov Faiz , Zbyshevskaia Elizaveta , Makeeva Tatiana , Butaev Tamerlan , Bitakova Fatima
Published: May 2024

Objective:

To evaluate the dynamics of hypercoagulation parameters of blood plasma and platelets in patients with arterial hypertension (AH) in the early and late post-covid period.

Design and method:

The prospective study included 340 AH patients aged 41 to 89 years (mean 69; m/f 175/165) infected with SARS-CoV-2 diagnosed by PCR. Of these, 177 people (group 1) were diagnosed with acute pneumonia with the lung damage volume according to CT ranging from 15% to 85%; 163 patients (group 2) had an acute respiratory viral disease. The groups were comparable in age, gender, and concomitant comorbid pathology. Coronary heart disease (CHD) was detected in 85.6% of patients; diabetes mellitus (DM) in 31.5%. The patients were examined three times: on the 30th day from the onset of the disease, at the end of the 3rd month and after 9 months. C-reactive protein (CRP) (0-5 mg/l), ferritin (20-250 mg/l), D-dimer (0-230 ng/ml), fibrinogen (2-4 g/l), lymphocytes, and blood platelets were analyzed.

Results:

On day 30, group 1 patients showed signs of inflammation: ferritin 258±61.2; CRP 12.3±5.1; lymphocytes 27±8.3%; platelets 160±70.4∗10^9/l; ESR 17±13.7 mm/h. The tendency to hypercoagulation was detected by the indicators of D-dimer (715±241.3) and fibrinogen (3.7±0.9). By the end of the 3rd month, the levels of D-dimer (585±159.4; p=0.015); ferritin (177±59.1; p=0.0002) and CRP (7±5.6; p=0.001) remained elevated. Only after 9 months, D-dimer (100±9.1; p=0.0001) and CRP (2.6±0.2; p=0.0001) were normalized; lymphocyte (32±5.1%; p=0.00001) and platelets (305±69.2∗10^9/l; p=0.00001) increased with a persistent elevated ferritin level (213±124.8; p=0.047). In group 2, the indicators of hypercoagulation and inflammation were moderately elevated. Only after 9 months CRP and D-dimer levels were normalized and the number of platelets increased.

Conclusions:

In the early and late post-covid period, AH patients with comorbid pathology retain an inflammatory reaction and a procoagulant state, which, in combination with endothelial dysfunction, is a trigger for venous and arterial thrombosis.
INTRAVENOUS IMMUNOGLOBULINS LEAD TO FUNCTIONAL VASCULAR AMELIORATION IN LONG-COVID
Authors: Seibert Felix , Wiemers Lea , Stervbo Ulrik , Bertram Sebastian , Babel Nina , Westhoff Timm
Published: May 2024

Objective:

The Long-COVID syndrome constitutes a major physical and psychological challenge for many patients after the recovery from COVID-19. We have previously shown positive effects of intravenous immunoglobulins (IVIG) on multiple symptoms. The effect of this therapeutical approach on vascular function and different levels of disease burden remains elusive.

Design and method:

We performed a prospective study, enrolling 21 patients with diagnosed Long-COVID, who received 3 monthly courses of IVIG (0.5 g/kg Privigen, CSL Behring, Austria) alongside supportive therapy (group 1). The control group (group 2; n=29) was addressed by supportive therapy, only. The study population was homogeneous for age, comorbidities and time since SARS-CoV-2 infection. We assessed vascular endothelial function by flow mediated dilation (FMD). Long-COVID associated fatigue intensity, related disability and quality of life were assessed by Short Form Health Survey-36, Chalder and Bell scale. Neuropsychological assessments utilized the German version of the ’Consortium to Establish a Registry for Alzheimer's Disease Neuropsychological Assessment Battery’ (CERAD-Plus).

Results:

The median FMD at baseline in group 1 was 5.0% (interquartile range [IQR] 4.2-6.1%). We saw a substantial amelioration (+27%) of FMD after IVIG, reaching a median of 6.6% (IQR 4.5-9.4%; p=0.039). Baseline FMD in the comparison group was 5.2% (IQR 3.5-7.6%), supportive treatment resulting in unsignificant increase (FMD 6.1% [IQR 4.6-7.7%; p=0.177). Baseline CERAD-Plus scores were comparable between groups (p=0.280). Only treatment with IVIG resulted in a relevant amelioration of neurocognition (p=0.05; group 2 p=0.430). Furthermore, less Fatigue (Chalder Fatigue scale bimodal and Likert p=0.002, each) and disability was seen after 3 months of IVIG (Bell Score, p=0.008), supportive treatment did not ameliorate this burden (Chalder Fatigue Scale bimodal p=0.086 and Likert p=0.952; Bell Score p=0.121). Health related quality of life (SF-36) increased for both groups (group 1 p=0.003, group 2 p=0.017).

Conclusions:

Using a broad test battery, addressing neuropsychological function, fatigue, related disability and health related quality of life as well as vascular function, we were able to confirm the potential beneficial effect of IVIG in Long-COVID. IVIG might be a candidate approach in this context, that requires further evaluation in randomized controlled trials.
ASSESSMENT OF THE RISK OF TROMBOSIS IN PATIENTS WITH ATRIAL FIBRILLATION AND CONCOMITANT ARTERIAL HYPERTENSION AFTER EXPERIENCING THE CORONAVIRUS DISEASE (COVID-19)
Authors: Stasyshena Oksana , Sychov Oleg , Romanova Olena , Getman Taisia , Sribna Olga , Mikhalieva Tatiana , Marchenko Olena , Solovian Anna , Torbas Olena
Published: May 2024

Objective:

Determine the risk of the probability of thrombosis according to the CHA2DS2-VASc scale in patients with AF and arterial hypertension after suffering from COVID-19.

Design and method:

The main part of the study consisted of 116 patients (pts) with AF aged 63.8 ± 0.6 years who from 1 to 12 months ago (5.1 ± 0.2 months on average) were infected with COVID-19. Group 1 (G1) 80 pts (69%) who had AF before CI. Group 2 (G2) 36 pts (31%) it appeared after the transferred CI. A control group (CG) 49 pts with AF who did not have a history of COVID-19 the average age was 59.0 ± 0,6 years.

Results:

Among AF patients who experienced COVID-19, compared with patients in the control group, which included patients with AF but no history of COVID-19 infection, more people had a CHA2DS2-VASc score of 3 or greater, a high risk of thrombosis. Patients in the main group compared to the control group had a higher risk of thrombosis (70.7% vs. 55.1%, p < 0.001). This applies to patients who developed AF after COVID-19 (G1), as well as those patients who had AF before the infection of COVID-19 (72.2% vs. 55.1%, p < 0.001).

Conclusions:

Patients in whom AF and concomitant hypertension appeared after COVID-19 or this infection worsened the course of the arrhythmia were characterized by a higher risk of thrombosis compared to patients with AF without a history of COVID-19 infection.
BLOOD PRESSURE CONTROL IN TERTIARY-CARE HYPERTENSIVE PATIENTS DURING COVID-19 PANDEMIC
Authors: Nieckarz Anna , Wolf Jacek , Panfil Anna , Bialas Aleksandra , Sternicka Julia , Jedrzejewski Lukasz , Hoffmann Michal , Szyndler Anna , Prejbisz Aleksander , Burnier Michel , Narkiewicz Krzysztof
Published: May 2024

Objective:

Cardiovascular risk factors distribution during the pandemic suggests worsening of the cardiovascular risk profile of hypertensive patients. At the same time, data on quality of hypertension control during the COVID-19 pandemic are scarce, in Poland. The aim of the study was to analyse the quality of blood pressure (BP) control in a group of patients who required regular control in tertiary care.

Design and method:

The study included hypertensive patients regularly monitored in tertiary-care out-patient clinic for at least 4 years with at least 2 visits a year prior the analysis. The size of the group was calculated based on the original data of first 50 consecutive records of patients (power of 90%). Records were retrospectively analysed with respect to office blood pressure (oBP) control. Additionally, within-visit BP variability was calculated (difference of maximum and minimum BP from 3 measurements); body weight, age, sex, duration of hypertension, number of visits per year, seasonal BP variability, use of telemedical services, comorbidities and BP-lowering treatment were recorded.

Results:

The study enrolled 220 patients. The values of systolic BP (sBP) before and after the break in the whole group were 135.8 ± 17.1 mm Hg vs. 137.9 ±19.5 mm Hg; P=0.08, and a diastolic BP (dBP) of 80.3 ±11.4 mm Hg vs. 82.6 ±12.2 mm Hg; p = 0.001. After adjusting for seasonal variation of BP, the respective differences were: sBP: 134.8 ± 16.5 vs. 138.0 ± 19.4; p = 0.03, and dBP: 79.4 ±10.9 vs. 82.2 ± 11.9; p = 0.004. Before 2020, 61.4% of patients were controlled (BP < 140/90 mm Hg), whereas after the pandemic-driven break in regular visits the control rate decreased to 55.5% (p = 0.21).

Conclusions:

BP control worsened during the COVID-19 pandemic in a group of patients requiring tertiary care for hypertension.
ARTERIAL HYPERTENSION AND COVID-19: A RETROSPECTIVE STUDY
Authors: Latsabidze Nino
Published: May 2024

Objective:

The aim of this study was in patients who had COVID-19 to rate the frequency of newly verified or worsened existing hypertension.

Design and method:

The retrospective study was done, which lasted from April 2021 to May 2022, 78 patients (29 males, 49 females) who have had COVID-19 were analyzed at the Emergency department in our clinic. In order to be categorized as a COVID patient, a positive PCR test at a single point in time was required. According to the accepted definitions of COVID-19 and its manifestations in respect to time from a positive PCR test, the patients were divided into two groups: acute COVID patients (PCR test positive < 30 days ago) and post-acute COVID patients (PCR test positive > 30 days ago). Patients’ age, history, BMI, laboratory values, and antihypertensive therapy were recorded.

Results:

Out of 78 patients studied, 16(12.48%) had either newly verified (9) or worsened existing (7) arterial hypertension. Among those, the median time from a verified SARS-CoV-2 infection to onset of symptoms was 90 days. Compared to the rest of the study population, patients presenting with arterial hypertension had significantly higher systolic (median 160 vs. 128 mmHg, p = 0.004) and diastolic (median 97 vs 80 mmHg, p = 0.02) blood pressure and were non-significantly younger (median 49 vs 57 years, p = 0.067).

Conclusions:

Arterial hypertension following COVID-19, either newly verified or worsened existing, is a relatively common (12.04% of our patient pool) occurrence and more effort should be directed into evaluating patients’ blood pressure values following COVID-19 in order to make a timely diagnosis and start proper treatment early.
THE ROLE OF RIGHT VENTRICLE FUNCTIONALITY IN THE CARDIOPULMONARY STATUS OF HYPERTENSIVE PATIENTS HOSPITALIZED FOR SARS-COV-2 INFECTION
Authors: Kariori Maria , Fragkoulis Christos , Chysohoou Christina , Tsioufis Panagiotis , Andrikou Ioannis , Grigoriou Kalliopi , Papakonstantinou Panteleimon , Stathoulopoulou Maria , Kalos Theodoros , Eirini Siafi , Tatakis Fotios , Manta Eleni , Iliakis Panagiotis , Mantzouranis Emmanouel , Konstantinidis Dimitrios , Thomopoulos Costas , Tsioufis Konstantinos
Published: May 2024

Objective:

There is little data concerning the impact of SARS-Cov-2 infection on the cardiopulmonary status and right ventricle (RV) function of patients with arterial hypertension (HTN). The purpose of our study was to investigate whether hospitalization for COVID-19 affects the functional status of hypertensive patients, using cardiopulmonary exercise test and echocardiographic parameters, 3 months after the infection onset.

Design and method:

All subjects underwent cardiorespiratory exercise using Bruce or modified Bruce protocol where all cardiorespiratory parameters were evaluated. Echocardiographic parameters including right ventricle longitudinal strain were analyzed using an offline program. Subjects with a history of HTN were divided into two groups according to hospitalization for Covid-19 infection. Group I included 28 subjects who were hospitalized for Sars-Cov-2 infection and Group II included 34 subjects without the need for hospitalization.

Results:

Out of a total population of 198 patients with COVID-19 infection, 62 subjects had a hypertension history (mean age: 61±10 years, 58.1% males, history of coronary artery disease: 16.1%) and they were evaluated 3 months after the symptoms’ onset. Hospitalized patients were older (63±8 vs. 52±11 years, p<0.001). Analysis of cardiopulmonary test parameters, oxygen consumption both maximum (21±4 vs. 23.5±4, p: 0.01) and during the 1st minute of recovery (15.5±2 vs. 21±25, p: 0.02), VO2_AT (17±4 vs. 27.5±32) and PETCO2 (39±4 vs. 38±19 mmHg, p: 0.03) were impaired comparing to non-hospitalized subjects. Out of echocardiographic parameters, the diameter of the left atrium (mm), differed significantly between the two groups (41±6 vs.38±5 p: 0.02). Furthermore, in hospitalized patients, the absolute mean value of right ventricle strain (RVLS, (%): 13±8 vs. 23±3, p:0.04) was impaired despite a similar left ventricle ejection fraction between the two groups. Finally, using linear regression analysis adjusted for age, gender, hypertension history, and hospitalization, hospitalization proved to be an independent predictive factor for RVLS in hypertensive patients.

Conclusions:

To conclude our study highlighted the negative impact of hospitalization for Sars-Cov-2 infection in the capacity for exercise and in right ventricle functionality, implying the severity of the disease as a negative independent predictive factor in hypertensive patients.
COMPREHENSIVE PRE-DISCHARGE SYMPTOMS ASSESSMENT IN HYPERTENSIVE PATIENTS HOSPITALIZED FOR COVID-19 ALLOWS TO PREDICT PERSISTENCE OF SYMPTOMS AT 3 MONTHS
Authors: Honchar Oleksii , Ashcheulova Tetiana
Published: May 2024

Objective:

To study the prognostic value of survey-based respiratory, physical, emotional, and cognitive symptoms assessment in hypertensive patients hospitalized for COVID-19 in prediction of symptoms persistence at 3 months after discharge.

Design and method:

88 hospitalized patients with COVID-19 and a history of hypertension (mean age 57.8+-11.8 years, 53% female) underwent a comprehensive survey-based symptoms assessment 1-2 days prior to discharge that included MRC Dyspnea scale, CAT and CCQ questionnaires, HADS, the physical symptoms subscale of the EFTER-COVID questionnaire, and the Memory, Thinking, and Communication subscale of the SBQ-LC questionnaire. Marginal effects in logistic regression analysis were used to gauge the predictive value of resulting scores and separate symptoms. 500 SANN-based classification models were subsequently trained for various combinations of significant predictors, with an automatic ranging of obtained models by their predictive accuracy.

Results:

77% of participants have reported an incomplete ecovery at 3 month after hospital discharge. In the order of decreasing predictive value for persistence of symptoms, significant (p < 0,05) risk factors included EFTER-COVID physical symptoms score (Somers’ D-statistic = 0,63), HADS depression subscale (D = 0,58), SBQ-LC Memory, Thinking, and Communication score (D = 0,52), MRC dyspnea class (D = 0,45), and CAT score (D = 0,30); among the specific symptoms, significant predictors included dyspnea (D = 0,42), dizziness (D = 0,38), muscles and joints pain (D = 0,38), and difficulties in remembering things (D = 0,40).

Out of the derived machine-learning based classification models, the optimal performance was observed for the one using gender, pre-discharge MRC dyspnea class, and summary scores on EFTER-COVID physical symptoms and SBQ-LC Memory, Thinking, and Communication subscales. The model exhibited a 100% predictive acccuracy in classifying the pre-specified test/validation subset of the study group into those who would subsequently report persistence of symptoms or complete recovery.

Conclusions:

Survey-based pre-discharge assessment of symptoms in hypertensive patients hospitalized for acute COVID-19 yields a high prognostic value. The combination of gender and survey-based measures of dyspnea, physical and cognitive symptoms may be used in this setting to predict the persistence of symptoms at 3 months after hospital discharge.
HYPERRENINISM - A COMMON PHENOMENON IN HOSPITALIZED COVID-19 PATIENTS
Authors: Bertram Sebastian , Racovitan Diana , Hölzer Bodo , Rohn Benjamin , Doevelaar Adrian , Seibert Felix , Babel Nina , Westhoff Timm
Published: May 2024

Objective:

Since the beginning of the worldwide pandemic the interaction of SARS-CoV2 on renin-angiotensin-aldosterone system is discussed intensively. Since ACE-2 was identified as the cellular receptor of SARS-CoV-2, the debate started with the question, whether treatment with ACE-inhibitors (ACE-I) and angiotensin receptor blockers (ARB) should be discontinued during the pandemic. In contrast, current studies investigate a potential benefit by ACE-I, ARB and mineralocorticoid receptor antagonists. However, data on renin and aldosterone concentrations in patients with COVID-19 are sparse.

Design and method:

We performed a cross-sectional study in 52 patients hospitalized for moderate COVID-19 (peripheral ward, no intensive care) assessing renin and aldosterone after admission. Blood pressure, comorbidities and medication were documented.

Results:

50% of the patients had increased renin concentrations with a median of 57.35ng/ml (IQR 34.3 - 80.1). 13.5% had decreased concentrations. 36.5% had a renin concentration within normal range. Median renin concentration in the overall study population was 24ng/ml (IQR 6.8 - 60.28). Despite the high percentage of patients with hyperreninism, only 13.5% showed increased levels of aldosterone 366pg/ml (IQR 268-384). There were no cases of primary hyperaldosteronism. Median aldosterone concentration was 81.5pg/ml (IQR 34.3-80.1) in the overall population. Those patients with secondary hyperaldosteronism revealed hypokalemia in 0%, metabolic alkalosis in 0%, and hypertension in 0%. Median renin concentration did not significantly differ in subjects with and without ACE-I or ARB 17ng/ml (5,6-69.6) vs. 24.4ng/ml (5.5-57.3), p = 0.91.

Conclusions:

Hyperreninism is a frequent phenomenon and occurs in every second patient hospitalized for COVID 19. This finding could not be explained by volume depletion, hypotension, or use of ACE-I/ARB. Both the reason for this finding and the infrequent translation into secondary hyperaldosteronism will have to be investigated in future studies.
FACTORS ASSOCIATED WITH MORTALITY AMONG HOSPITALIZED CORONA VIRUS DISEASE 2019 ADULT PATIENTS WITH CHRONIC NON-COMMUNICABLE DISEASES IN DIRE DAWA, EASTERN ETHIOPIA
Authors: Ayele Dagmawi Abebe , Kassa Nega Assefa , Gemeda Assefa Tola
Published: May 2024

Objective:

To assess factors associated with mortality among hospitalized COVID-19 adult patients with chronic non-communicable diseases in Dire Dawa, Eastern Ethiopia.

Design and method:

A facility-based unmatched case-control study with a case to control ratio of 1:2 was conducted from December 15, 2022 to January 15, 2023. Cases were COVID-19 hospital deaths registered from June 1, 2020 and June 30, 2022 and those who recovered during same time were selected as controls. Data were extracted from randomly selected medical records of COVID-19 patients using data abstraction tool. The data were entered into Epi-data version 3.1 and analyzed using SPSS version 22 software. Descriptive statistics such as frequency, proportion, mean and SD were computed. Logistic regression model were used for statistical analysis to identify the risk factors of COVID-19 mortality. AOR with 95% CI and p-value <0.05 were used to declare the level of statistical significance.

Results:

A total of 372 charts (125 cases and 247 controls) were included in the analysis. Charts with incomplete data 9(2.4%) were excluded. The mean age of cases (60 year, ±14.7) was higher compared to controls (53 year, ±15.9). Half of cases were 63(50.4%) female and 157 (63.6%) of controls were male. The most common co-morbidities were diabetes mellitus 178 (47.8%) and hypertension 176 (47.3%). In multivariable analysis, People aged 60 year and above (AOR=2.5, 95% CI (1.1-5.63)), being male (AOR=0.5, 95% CI (0.32-0.92)), hypertension (AOR = 2, 95% CI (1.14- 3.35)), diabetes mellitus (AOR = 1.9, 95% CI (1.1- 3.16)), severe COVID-19 (AOR = 4.9, 95% CI (2.25- 10.86)), critical COVID-19 (AOR = 6.2, 95% CI (2.38-16.06)) and ICU admission (AOR = 2.9, 95% CI (1.5-5.56)) were significantly associated with COVID-19 mortality.

Conclusions:

This study revealed that being male had less chance of mortality. Aged 60 years and above, having hypertension, being diabetic, severity of disease, and being hospitalized in the ICU were significantly associated with an increased odds of COVID-19 mortality. We recommended, strengthening and maintaining of COVID-19 preventive and control measures intensively addressing these risk group and improving critical care serves.
ANTIHYPERTENSIVE EFFECTIVENESS OF VARIOUS THERAPEUTIC APPROACHES IN RESISTANT HYPERTENSION PATIENTS WITH OR WITHOUT DIABETES MELLITUS: TWO YEARS FOLLOW-UP
Authors: Moiseeva Anna , Caraus Alexandru , Abras Marcel , Ciobanu Nicolae
Published: May 2024

Objective:

Comparative evaluation of pharmacological treatment with SNS-blockers versus radiofrequency renal denervation on blood pressure values in non-diabetic and diabetic resistant hypertension patients.

Design and method:

Comparative evaluation of pharmacological treatment with SNS-blockers versus radiofrequency renal denervation on blood pressure values in non-diabetic and diabetic resistant hypertension patients.

Results:

A statistically significant reduction in SBP m/24 h was noted in all six groups starting at 6 months, the groups of patients undergoing renal denervation showing superiority over both groups of pharmacological treatment. The progressive improvement continued until the end of the study, so at 2 years of evaluation in observational groups supplemented with Moxonidine the reduction in SBP m/24 h were – 7,28 ± 0,37 mmHg in group I and -7,42 ± 0,36 in group IV mmHg from baseline, in Bisoprolol group – 7,22 ± 0,72 mmHg and – 7,32 ± 0,60 in groups II and V, in renal denervation groups with a total reduction of – 9,76 ± 0,54 mmHg and – 10,0 ± 1,39, p <0,05.

The maximum reduction in DBP m/24 h were registered at 2 years of evaluation, a comparative analyses of dynamics between groups showing a presence of statistical difference due to superiority of renal denervation in amelioration of this parameter.

Conclusions:

All three regimens have been shown to be effective in reducing SBP and DBP m/24 h in treatment of resistant hypertension diabetic and non-diabetic patients, with a comparable effect of Moxonidine and Bisoprolol and the absolute superiority of renal denervation, the beneficial effect being maintained for a period of 2 years.
TEN YEAR FOLLOW-UP OF PATIENTS WITH RESISTANT HYPERTENSION RANDOMIZED TO RENAL DENERVATION OR ANTIHYPERTENSIVE DRUG TREATMENT
Authors: Halvorsen Lene , Larstorp Anne Cecilie K. , Søraas Camilla L. , Hoffmann Pavel , Fossum Eigil , Haig Ylva , Stenehjem Aud E. , Rostrup Morten , Fadl Elmula Fadl Elmula M. , Kjeldsen Sverre E. , Høieggen Aud
Published: May 2024

Objective:

Renal denervation (RDN) is a treatment option in resistant hypertension. The procedure is considered safe, although randomized trials only demonstrate a moderate blood pressure (BP) lowering effect, when considering medication adherence. Some observational studies describe reduction in BP several years after the procedure. The aim of the study was to describe long-term safety and potential benefits of RDN after ten years, compared to optimized drug treatment, measuring serum concentration of antihypertensive drugs to ensure adherence.

Design and method:

We report data from ten year follow-up of patients randomized to RDN (n=9) or drug adjustment (n=10). Initially the patients had treatment-resistant hypertension, defined as daytime systolic ambulatory BP >= 135 mmHg after witnessed intake (directly observed therapy, DOT) of >= 3 antihypertensive drugs including a diuretic and therefore considered as adherent. One year after RDN or drug adjustment, we optimized antihypertensive medication for all patients. Thereafter, patients received appropriate antihypertensive treatment in primary or secondary care, according to their BPs. Patients were informed of serum concentration measurements performed at the 7-year visit. At the 10-year visit, serum drug measurements before DOT and ambulatory BP measurement (ABPM) were used for evaluation of adherence. Antihypertensive agents were registered, glomerular filtration rate (eGFR) was estimated by the CKD-EPI formula using creatinine and Cystatin C, and renal arteries were examined by CT or MRI.

Results:

All living patients (n=18) attended the 10-year visit, now mean age 69 years, using 4±2 antihypertensive agents, with no difference between groups. Serum concentrations confirmed that all patients were adherent to reported medication. There were significant and similar BP reductions in both groups compared to baseline; daytime ABPM -22±15/9±8 mmHg in the RDN group, and -20±15/13±7 mmHg in the control group (figure). No patients developed renal artery stenosis. The decrease in eGFR was similar in both groups.

Conclusions:

To our knowledge this is the RCT with the longest follow-up supporting long-term safety of RDN in patients with resistant hypertension. Daytime ABPM improved during 10 years of follow-up, not explained by RDN, but due to adjustments in antihypertensive regimens and probably better adherence to medication.
NIGHTTIME BLOOD PRESSURE ASSESSED USING HOME OR AMBULATORY MONITORING IN HYPERTENSIVE PATIENTS WITH TYPE 2 DIABETES/PREDIABETES: RELATIONSHIP WITH PRECLINICAL TARGET-ORGAN DAMAGE
Authors: Ntousopoulos Vasilieos , Kollias Anastasios , Bountzona Ioanna , Destounis Antonios , Menti Ariadni , Theodosiadi Aikaterini , Kyriakoulis Konstantinos , Stergiou George
Published: May 2024

Objective:

To investigate the relationship between nighttime blood pressure (BP) measurements using home (HBPM) or ambulatory BP monitors (ABPM), with indices of preclinical hypertension mediated organ damage (HMOD) in individuals with hypertension and type 2 diabetes mellitus (DM2) or prediabetes.

Design and method:

Adults with hypertension (treated or untreated) and DM2 or prediabetes underwent 24h ABPM (measurements at 20 minutes intervals, Microlife WatchBP03) and HBPM (duplicate morning/evening measurements for 7 days, 3 nights with 3 measurements/night, Microlife WatchBPHome-N). Participants were also subjected to: (i) echocardiographic measurement of left ventricular mass index (LVMI), (ii) carotid ultrasonography for determination of common carotid intima-media thickness (cIMT) and carotid plaque score, (CPS), (iii) measurement of brachial-ankle pulse wave velocity (PWV; oscillometric device Microlife PWV/ABI), and (iv) measurement of urine albumin-to-creatinine ratio (ACR; two morning urine samples).

Results:

Data from 113 participants were analyzed (mean age [SD] 65±9.1 years, 67% men, body mass index 30.7±4.8 kg/m2, 84% with DM2, 22% cardiovascular disease, 94% treated hypertension). Average daytime HBPM was 129.2±13.2/73.3±7.8 mmHg, and ABPM 126.7±12.1/72.5±7.4 mmHg (systolic/diastolic, p<0.01/p=NS), whilst nighttime HBPM was 115.3±13.1/63.6±7.6 mmHg and ABPM 113.9±13.4/63±7.1 mmHg (systolic/diastolic, p<0.05/p=NS). Nighttime pulse pressure (PP) assessed by both HBPM and ABPM was correlated with LVMI (r=0.25/0.20, respectively, p<0.05 for both), cIMT (r=0.35/0.34, p<0.01), PWV (r=0.21/0.22, p<0.05), CPS (r=0.29/0.26, p<0.01) and ACR (r=0.45/0.38, p<0.01). Z-test for all the above comparisons between HBPM and 24h ABPM was non-significant.

Conclusions:

In individuals with hypertension and DM2 or prediabetes, nighttime BP assessed using a novel home BP monitor is associated with indices of asymptomatic HMOD to a similar degree as reference ABPM.
RELATIONSHIP OF SHORT- AND MID-TERM GLUCOSE VARIABILITY WITH BLOOD PRESSURE PROFILE PARAMETERS IN ADOLESCENTS AND YOUNG ADULTS WITH TYPE 1 DIABETES
Authors: Theodosiadi Aikaterini , Vakali Elena , Kyriakoulis Konstantinos , Destounis Antonios , Vazeou Andriani , Stergiou George , Kollias Anastasios
Published: May 2024

Objective:

The aim of the study was to investigate the association between blood pressure (BP) profile parameters and short- and mid-term glucose variability (GV) in young individuals with Type 1 Diabetes (T1D).

Design and method:

Individuals aged 12-30 years with T1D underwent simultaneous 24h-ambulatory BP monitoring (ABPM) (20-min intervals, Microlife WatchBP O3) and continuous glucose monitoring for 3 days (day before-during-after ABPM). GV indices [standard deviation (SD), coefficient of variation (CV), mean sensor glucose levels (MSG), mean amplitude of glycemic excursions (MAGE), time in range (TIR)] were assessed for 24h of ABPM, as well as for the 3 days. BP profile parameters (mean values, SD, CV, nighttime BP dip) were also evaluated.

Results:

61 individuals were analyzed [34 males (56%), 35 (58%) on insulin pump therapy, mean age 22±5.6 years, BMI 23±4 kg/m2, HbA1c 7.1±1.0%, T1D duration 11±6.6 years, 24h ABPM 111±8.4/67±5.4 mmHg (systolic/diastolic), 24h ambulatory hypertension 4.9%]. Nighttime BP dip was inversely correlated with 24h nighttime MAGE (r=-0.30/-0.26 systolic/diastolic, p<0.04), whereas nighttime pulse pressure (PP) was inversely correlated to 24h TIR (r=-0.25, p=0.05). 24h daytime MAGE demonstrated inverse associations with SD and CV of daytime HR (r=-0.26/-0.26, p=0.04). A trend was observed between 24h nighttime MAGE and SD and CV of nighttime systolic BP (r=-0.20/-0.23, p=0.1/0.08 respectively). Furthermore, T1D duration was correlated with nighttime HR (r=0.26, p=0.04) and SD of nighttime diastolic BP (r=0.29, p=0.03). When GV indices derived from the 3-day period were examined, nighttime systolic BP correlated with 3-day MAGE (r=0.25, p=0.05) and inversely with 3-day TIR (r=-0.28, p=0.03). Lastly, daytime systolic BP was associated with 3-day daytime MAGE (r=0.28, p=0.03) and 24h systolic BP with 3-day SD of glucose (r=0.28, p=0.03) and 3-day MAGE (r=0.27, p=0.03).

Conclusions:

These data suggest that in young individuals with T1D there is a relationship between GV and BP parameters. The average BP levels, as well as nocturnal BP dip, were associated with several indices of GV, implying a potential common pathophysiologic background.
BLOOD PRESSURE AND GLUCOSE VARIABILITY IN ADOLESCENTS AND YOUNG ADULTS WITH TYPE 1 DIABETES: ASSOCIATION WITH PRECLINICAL TARGET-ORGAN DAMAGE
Authors: Theodosiadi Aikaterini , Vakali Elena , Kyriakoulis Konstantinos , Destounis Antonios , Vazeou Andriani , Stergiou George , Kollias Anastasios
Published: May 2024

Objective:

To investigate the relationship between blood pressure (BP) and glucose variability with indices of preclinical target-organ damage in adolescents and young adults with type 1 diabetes (T1D).

Design and method:

Individuals aged 12-30 years with T1D underwent simultaneous 24h-ambulatory BP monitoring (ABPM) (20-min intervals, Microlife WatchBP O3) and continuous glucose monitoring for 3 days (day before-during-after the ABPM), as well as assessment of indices of preclinical target-organ damage [left ventricular mass index (LVMI), intima-media thickness of common carotid artery (IMT), albumin-to-creatinine ratio (ACR) in two different morning urine samples]. Glucose variability indices [standard deviation (SD), coefficient of variation (CV), mean sensor glucose levels (MSG), mean amplitude of glycemic excursions (MAGE), time in range (TIR)] were calculated. BP profile parameters (mean values, SD, CV, nighttime BP dip) were also evaluated.

Results:

Data from 61 individuals were analyzed [34 males (56%), 35 individuals (58%) on insulin pump therapy, mean age 22±5.6 years, BMI 23±4 kg/m2, HbA1c 7.1±1.0%, T1D duration 11±6.6 years, 24h ABPM 111±8.4/67±5.4 mmHg (systolic/diastolic), 24h ambulatory hypertension 4.9%]. Nighttime systolic BP was correlated with both LVMI and IMT (r=0.33/0.47, respectively, p<0.02). BP variability indices were not correlated with target-organ damage. IMT was inversely correlated with the 3-day TIR (r=-0.34, p<0.02) and positively with 3-day MSG (r=0.33, p=0.01), 3-day MAGE (r=0.29, p=0.03), 3-day SD of glucose (r=0.28, p=0.03), and T1D duration (r=0.27, p=0.04). LVMI was inversely associated with daytime TIR on the ABPM day (r=-0.34, p=0.02). Participants with ACR at the upper quartile of the distribution (>=7.5 mg/g) showed an association between nighttime systolic BP and ACR (r=0.58, p=0.02). Lastly, there was a trend towards an association between ACR and HbA1c (r=0.54, p=0.06).

Conclusions:

These findings suggest that among mainly normotensive young individuals with T1D, increased BP level and glycemic variability are associated with early target organ damage.