bluuebunny/crossref_metadata_2025 huggingface dataset:
ASSOCIATION BETWEEN CARDIOVASCULAR RISK ESTIMATION BY THE ASCVD RISK ESTIMATOR AND CAROTID-FEMORAL PULSE WAVE VELOCITY IN OLDER INDIVIDUALS
Authors: Ferreira-Filho Sebastião , Souza Denis , Freitas Ercilhana , Peixoto Aldo , Araujo Lucio
Published: April 2021

Objective:

Carotid-femoral pulse wave velocity (c-fPWV) is a noninvasive indirect measure of central arterial stiffness, considered a predictor of cardiovascular events. However, it is not included in any cardiovascular risk calculator, such as the pooled risk equation for atherosclerotic cardiovascular disease (ASCVD) risk estimation. The study aimed to evaluate the association between c-fPWV and CVR in older individuals as determined by ASCVD Risk Estimator.

Design and method:

EVOPIU is a longitudinal study where c-fPWV and ASCVD risk were evaluated in 927 patients aged 60 or older. We measured c-fPWV with the SphygmoCor XCEL model EM4C device (AtCor Medical, Sydney, NSW, Australia). We calculated 10-year ASCVD risk using the pooled equation risk calculator that integrates information on age, gender, systolic BP (and treatment), total and HDL cholesterol, and history of DM. The total area under the ROC curve between ASCVD risk estimator and c-fPWV was identified.

Results:

Average age was 67.8 ± 5.2 years, 38% male, 13% diabetic; 56% hypertensive; total cholesterol 202 ± 37 mg/dl; HDL-cholesterol 52 ± 14 mg/dl, and LDL 119 ± 33 mg /dl. Baseline c-fPWV was 9,3 ± 0,9 m/s. The average ASCVD risk was 21.9%. There was a direct correlation between c-fPWV and ASCVD risk (Spearman's = 0.74 p < 0,0001. Survival analysis showed that CVR or c-fPWV detected higher number of deaths in the largest tertiles (chi2: 8.3; p = 0.002). The area under the curve was 0.86 with 77.4% sensitivity and 77.3% specificity with c-fPWV cutoff = 9.6 m / s.

Conclusions:

There is a positive association between c-fPWV and ASCVD risk estimator. The c-fPWV measurement could complement ASCVD risk estimator in older individuals.
ACTIVITY OF THE ANGIOTENSIN-CONVERTING ENZYME MEDIATES THE ASSOCIATION BETWEEN PLASMA VITAMIN D AND PLASMA ALDOSTERONE IN HYPERTENSIVE PATIENTS
Authors: Bulfone Luca , Catena Cristiana , Da Porto Andrea , Palomba Andrea , Colussi Gianluca , Duratti Andrea , Cavarape Alessandro , Scandolin Laura , Sechi Leonardo
Published: April 2021

Objective:

Deficiency of 25-OH Vitamin D (25OHD) and activation of the renin-angiotensin-aldosterone system (RAAS) are both known cardiovascular risk factors. Some studies have shown that 25OHD has a suppressive effect on RAAS but data in literature are conflicting. The aim of the study was to evaluate the relationships between 25OHD level and RAAS parameters in essential hypertensive (EH) patients without obesity and of severe impairment of renal function.

Design and method:

In 153 EH subjects (age 49 ± 12 years, 87 males, 123 naive, 30 after a wash-out period) we evaluated clinical characteristics, glomerular filtration rate (GFR), plasma levels of 25OHD, 1,25OHD, PTH, potassium, calcium, plasma aldosterone (PA), active renin (AR), angiotensin-converting-enzyme (ACE), 24-h urinary calcium (UCa) and 24-h urinary sodium.

Results:

25OHD level was significantly and directly related with UCa (r = 0.209, P = 0.024), ACE (r = 0.470, P < 0.001), PA (r = 0.272, P = 0.001), and inversely related with age (r = -0.301, P < 0.001) and PTH level (r = -0.188, P = 0.025). At multivariate analysis, 25OHD level was independently associated with levels of PTH (B = -0.213, P = 0.023), ACE (B = 0.488, P < 0.001) and PA (B = 0.201, P = 0.039). PA level was positively related with 25OHD, 1,25-OHD (r = 0.256, P = 0.026), and ACE (r = 0.296, P = 0.006) and inversely related with age (r = -0.260, P = 0.019), plasma potassium (r = -0.261, P = 0.001) and alcohol intake (r = -0.224, P = 0.007). In a multivariate model that did not include ACE, PA was independently associated with levels of plasma potassium (B = -0.227, P = 0.004) and 25OHD (B = 0.197, P = 0.018). After inclusion of ACE, PA level remained independently associated only with plasma potassium (B = -0.244, P = 0.015) and alcohol intake (B = -0.244, P = 0.016). At multivariate analysis with ACE as the dependent variable and 25OHD and PA as independent variables, ACE was independently associated with 25OHD level (B = 0.427, P < 0.001).

Conclusions:

In patients with EH, PA and 25OHD are directly related and this relationship appears to be mediated by the activity of ACE.
INTERVENTIONAL STUDY ON LIFE STYLE OF HEART DISEASES PATIENTS IN PAKISTAN
Authors: Arain Mudassar Iqbal
Published: April 2021

Objective:

Cardiac diseases such as heart failure, cardio myopathies and arrhythmias are increase in our society. Our social habits like tobacco smoking, use of alcohol and sedentary life style are the major factors of cardiac diseases. Hypertension, diabetes, obesity are also contributing in high prevalence of heart diseases in world particularly Pakistan. on the basis of above facts, the current study was designed to analyze the impact of intervention on life style on cardiovascular problems in various areas of Pakistan.

Design and method:

Therefore; an interventional study was designed among 300 patients via purposive sampling for a period of one year from June 2018 to June 2019. An initial evaluation of patients’ lifestyles were performed using individual questions. Follow-up questionnaires were administered at different sessions. We defined successful cholesterol and level of blood pressure control i.e. blood pressure <140 mm Hg systolic and <90 mm Hg diastolic.

Results:

Out of 300 patients, 68.4% of the patients were under the category of sedentary life style. 32.4% hypertensive patients with 30–35 kg/m2 were observed. The interventional technique was applied and results were assessing after six month. Patient's attitude (treatment, diet intake and sleeping and exercise habits) mean scores pre counselling and post counselling for patients were significantly different and improved. Post interventions results show that patients upgraded their practice by intermittently checking their blood pressure level, cholesterol, lipid profile, control smoking habit and maintain their life styles.

Conclusions:

The current study demonstrates the positive results were noted by life style modification and improvement in daily practice. Patient's attitude mean scores pre counselling and post counselling for patients were significantly different and improved. Post interventions results show that patients upgraded their practice by intermittently checking their blood pressure level, control smoking habit, daily exercise and healthy diet and maintain their life styles. This shows that our interventions had positive impact on the awareness, knowledge, life style, disease management and practice of cardiac patients
PREVALENCE AND PREDICTORS OF PREHYPERTENSION AMONG MEDICAL AND ALLIED HEALTH COLLEGE (PARAMEDICAL) STUDENTS AT KING ABDULAZIZ UNIVERSITY IN JEDDAH, SAUDI ARABIA: A CROSS-SECTIONAL STUDY
Authors: Khawandanh Shahad , Alahmadi Reem , Alkhameesi Najwa , Alkhateeb Sarah , Alzahrani Ahad , Kurdi Lujain , Lamfon Ghadeer , Kadi Hanan Al
Published: April 2021

Objective:

Introduction: Prehypertension is a risk factor for hypertension and other cardiovascular diseases. Determining its prevalence and associated risk factors in young populations may indicate appropriate preventive measures. We estimated prehypertension prevalence and risks among healthy medical and paramedical students.

Methods: This cross-sectional study was conducted on 437 students at King Abdulaziz University in Jeddah, Saudi Arabia. Socio-demographic characteristics and medical history were obtained by validated self-administered questionnaires. Weight, height, waist circumference, and body mass index were determined. Blood pressure was recorded under standardized conditions. Prehypertension was defined as systolic blood pressure of 120–139 mmHg and/or diastolic blood pressure of 80–89 mmHg. Significant prehypertension predictors were identified by multivariate logistic regression analysis.

Design and method:

Subjects’ average age was 21.1 ± 1.4 years. Prehypertension was more prevalent among male students (36%) than female students (7%) and was predominantly diastolic in female students (90.5%). Prehypertensive subjects (17%) had significantly higher body mass index. Male students had a higher prehypertension risk (odds ratio 8.4; 95% confidence interval 4.1?17.0). Mean heart rate significantly predicted prehypertension (1.05; 1.02?1.08).Current smoking and obesity (body mass index ?30 kg/m2) increased prehypertension risk (3.6; 1.1?12.3 and 2.3; 1.1?5.0, respectively), but not age, monthly income, physical activity, eating habits, and a family history of prehypertension.

Results:

Sex was the strongest prehypertension predictor. Efforts should be directed at other modifiable risk factors, such as obesity and smoking, to reduce prehypertension risk. Screening for prehypertension and advocating lifestyle modifications in young people is highly recommended to decrease progression to hypertension.
URIC ACID-ASSOCIATED CARDIAC TISSUE DAMAGE CAUSED BY HIGH FAT DIET IS REVERSED BY SODIUM BUTYRATE
Authors: Adeyanju Oluwaseun , Badejogbin Caroline
Published: April 2021

Objective:

Increased global consumption of high-fat/high-calorie diet has led to higher incidence of the multifactorial cardiometabolic syndrome especially among women. The links between glucose deregulation and eventual mortal cardiac diseases are still being investigated. However, several reports have implicated elevated uric acid (UA) in the progression of metabolic disorders especially during high-fructose diet. Also, butyrate (BUT) a short-chain fatty acid is being identified with intriguing therapeutic potentials in metabolic disorders. We therefore hypothesized that high-fat diet-induced glucose deregulation and cardiac tissue damage are associated with elevated UA and attenuated by BUT in female rats.

Design and method:

Twenty-four 10-week-old female Wistar rats with weights ranging from 135 to 150 g were treated with normal rat chow and distilled water (po) or sodium butyrate (200 mg/kg; po) or high-fat diet and distilled water (po) or high-fat diet and sodium butyrate. Treatments lasted for 6 weeks.

Results:

Results showed that high-fat diet caused glucose dysmetabolism, elevated plasma triglyceride (TG), total cholesterol (TC), corticosterone, malondialdehyde (MDA), plasma and cardiac UA, and lactate dehydrogenase (LDH). High-fat diet also led to depressed reduced glutathione (GSH). Histological analysis of cardiac tissue showed cellular infarction, infiltration, and fibrosis in high-fat diet-fed rats. However, all these effects were ameliorated by BUT treatment.

Conclusions:

The findings here showed that high-fat diet resulted in glucose dysmetabolism and cardiac tissue damage through a uric acid (UA) - dependent mechanism and that butyrate (BUT) can protect against high-fat diet-induced cardiometabolic disorders through UA suppression and augmentation of glutathione antioxidant defenses. This study therefore demonstrates that UA is involved in high fat diet-induced cardiometabolic syndrome. However, data here shows that the UA - associated events in high fat diet will chronically engender cardiac tissue damage. Interestingly, with UA suppression, BUT treatment showed plausible beneficial glucoregulatory, anti-inflammatory and antioxidant properties which were potent enough to confer protection on the cardiac tissue preventing overt damage in high fat diet-fed rats. Therefore, BUT may be considered for the development of suitable therapeutic candidate in the treatment of metabolic syndrome and cardiac derangements associated with heightened UA.
DAY-TO-DAY HOME BLOOD PRESSURE VARIABILITY IS ASSOCIATED WITH CEREBRAL SMALL VESSEL DISEASE BURDEN IN A MEMORY CLINIC POPULATION
Authors: De Heus Rianne , Reumers Stacha , Van Der Have Alba , Tumelaire Maxime , Tully Phillip , Claassen Jurgen
Published: April 2021

Objective:

High visit-to-visit blood pressure variability (BPV) has been associated with cognitive decline and cerebral small vessel disease (cSVD), in particular with cerebrovascular lesions. It is likely that the causes and consequences of high BPV depend on which temporal resolution is investigated. Day-to-day BPV has been related to cognitive function, but has not been investigated in relation to cSVD. Therefore, we aimed to investigate the cross-sectional association between day-to-day BPV and total cSVD MRI burden, in older memory clinic patients.

Design and method:

We included outpatients referred to our memory clinic, who underwent cerebral MRI as part of their diagnostic assessment. Four markers of cSVD were visually rated, resulting in a score between 0 and 4: presence of microbleed(s), presence of lacune(s), severe white matter hyperintensities and enlarged perivascular spaces in the basal ganglia. Home blood pressure (BP) measurements were performed for one week according to international guidelines. After removal of day 1, BPV was defined as the coefficient of variation (CV). We used multivariable ordinal logistic regression analyses adjusted for age, sex, smoking, diabetes, history of cardiovascular disease and mean BP to assess the association between total cSVD score and BPV.

Results:

In 82 patients (aged 71.2 ± 7.9 years), mean home BP was 140/79 ± 15/9 mmHg. Dementia and mild cognitive impairment were present in 46% and 34%, respectively. 22% of the study population had a total cSVD score of 0. These frequencies 24%, 26%, 20% and 8% for scores of 1, 2, 3 and 4, respectively. Systolic CV was associated with total cSVD burden, with the adjusted odds ratio per point increase in CV = 1.30, 95% confidence interval = 1.05–1.61, p = 0.018. There were no differences in diastolic CV and mean BP between the cSVD groups. When we differentiated between morning and evening BP, only evening BPV remained significantly associated with total cSVD burden.

Conclusions:

Day-to-day systolic BPV is associated with cSVD burden in memory clinic patients. Future research should indicate whether lowering day-to-day systolic BPV should be included in BP management in older people with memory complaints.
CAROTID VASCULAR RESISTANCE ASSOCIATED WITH COGNITIVE FUNCTION AMONG MIDDLE-AGE ADULTS
Authors: Chuang Shao -Yuan , Cheng Hao -Min , Ko Yu -Ting , Lau Wen -Ling , Wang Pei -Ning , Pan Wen -Harn , Chen Chen -Huan
Published: April 2021

Objective:

Carotid flow velocity and peripheral blood pressure were independently associated with cognitive function among the elderly population, but unknown among middle-aged adults. We aimed to investigate the association between carotid hemodynamics and cognitive performance among the middle-age population.

Design and method:

A total of 490 middle-age adults (between 30 and 60 years) participated in the ongoing survey (2017–2020) of the Cardiovascular Disease Risk Factors two-Township study and received the Montreal Cognitive Assessment (MOCA) to evaluate the global cognitive function. Carotid-formal pulse wave velocity (cf-PWV) was measured using carotid and femoral arterial tonometry. Carotid vascular resistance was calculated by mean carotid pressure divided into mean carotid volume flow.

Results:

MOCA levels were similar between men and women (27.1 vs. 27.2, p = 0.6036). Age(r = -0.22, P < 0.001), and education(r = 0.39, p < 0.001) were associated with MOCA. Controlled for age, gender and education, peak systolic velocity (r = 0.077 @left; r = 0.012@Right, all p > 0.05), end diastolic velocity (r = 0.029, r = -0.062, all p > 0.05), mean flow (r = 0.060; r = -0.038, all p > 0.05), carotid resistive index (r = 0.020, r = 0.05, all p > 0.05), carotid pulsatility(r = 0.015; r = 0.058; p > 0.05), diameter(r = 0.060; r = -0.008, all p > 0.05) at both sides were not associated with MOCA. Only carotid vascular resistance (CVR) at left side was associated with MOCA (r = -0.158, p = 0.0010), but not at right carotid artery (r = -0.030, p = 0.5369). CVR@Left (standard beta = -0.144; p = 0.0022) remains associated with MOCA in the multivariable with further controlling glucose, low density lipoprotein and carotid-formal pulse wave velocity. Those with top, 2nd and 3th quartile of CVR@left had 2.4-fold [Odds Ratio = 2.40; 95% confidence intervals = 1.14–5.04], 1.95-fold(1.95;0.93–4.07) and 0.99-fold (0.99;0.45–2.17) risk for poor cognitive performance (MOCA < 26), compared to those with lowest quartile of CVR@left in the multivariable model.

Conclusions:

Carotid vascular resistance is a marker of cerebrovascular resistance and associated with cognitive performance in middle-aged adults.
HEMODIALYSIS REDUCES CEREBRAL BLOOD FLOW PULSATILITY AND SMALL VESSEL STIFFNESS
Authors: Paré Mathilde , Obeid Hasan , Labrecque Lawrence , Drapeau Audrey , Marquis Karine , Brassard Patrice , Agharazii Mohsen
Published: April 2021

Objective:

Cognitive decline is highly prevalent amongst end-stage renal disease (ESRD) patients and is accelerated upon initiation of hemodialysis (HD). ESRD increases aortic stiffness and blood flow pulsatility, which may damage small vessels of target organs such as the brain. In this pilot study, we aimed to evaluate the acute effect of HD on cerebral blood flow and regional arterial stiffness.

Design and method:

Before, every hour during, and after HD (T0-T4), we measured cerebral flow velocity (FV) using transcranial Doppler, blood pressure (BP) via digital finger cuff (Nexfin), cardiac activity using ECG, and aortic pulse wave velocity (PWV) with Mobile-O-Graph. FV pulsatility index (PI) and transit times between ECG peak and the foot of both FV and BP waveforms (cerebral dT; digital dT) were computed using in house MATLAB-based analysis. Changes during HD were evaluated with Generalized Estimating Equation models adjusting for multiple comparisons in SPSS 26.0.

Results:

In eight participants aged 63 ± 17 y. old (4 diabetics, 3 women), peak FV decreased from baseline at T1 and T2 (-11.2 cm/s, p = 0.007; -12.2 cm/s, p < 0.001), PI decreased at T1 (0.81 to 0.77, p = 0.005), whilst minimum FV, mean BP and partial pressure of CO2 remained unchanged. Digital dT increased at T3 (0.19 to 0.22, p < 0.001) and cerebral dT increased early in HD (T1: p = 0.036; T2: p = 0.048), whereas aortic PWV did not change.

Conclusions:

During hemodialysis, cerebral and digital transit times increased, suggesting decreased stiffness of small peripheral vessels, without significant changes in aortic stiffness. Reduced stiffness of cerebral arteries may partially explain decreased cerebral flow pulsatility during HD.
ARTERIAL HYPERTENSION AND ATRIAL FIBRILLATION: THE DOUBLE TROUBLE AND STROKE
Authors: Gaspar Ludovit , Filipova Slavomira , Vestenicka Veronika
Published: April 2021

Objective:

Arterial hypertension (AH) and atrial fibrillation (AF) are very important risk factors of stroke. Vascular stroke is a very frequent cause of morbidity and mortality, and in patients who suffered stroke, subsequent long-term neurological deficit can persist. It is therefore important and necessary to influence these risk factors.

Design and method:

We retrospectively reviewed a group of patients hospitalized during six months period at our Department of Neurology with the diagnosis of stroke confirmed by imaging (CT, CT angiography, brain MRI). This group consisted of 218 patients, including 145 men (66.5 %) and 73 women (33.5 %). The average age was 70.8 years.

Results:

We detected AH in 199 subjects (91.2 %) and AF in 70 subjects (32.1 %). 182 patients (83.5 %) have been diagnosed with ischemic stroke and 36 patients (16.5 %) with hemorrhagic stroke. In the group of patients with AF only 33 patients (47.1 %) were treated by anticoagulants, what points out an inadequate indication of anticoagulant treatment. It is also noteworthy that in the group of patients with anticoagulant therapy who have developed ischemic stroke in spite of this treatment, we found that in 16 cases (48.5 %) the treatment was underdosed.

Conclusions:

Arterial hypertension and atrial fibrillation were highly prevalent in our cohort of stroke patients. Despite proven effect of anticoagulant treatment, many patients with atrial fibrillation were not anticoagulated and almost half of those on anticoagulation treatment were underdosed. These results emphasize the importance of effective management of arterial hypertension and atrial fibrillation, the most common modifiable risk factors of vascular strokes.
AORTIC AND CAROTID STIFFNESS IN CHILDREN AND ADOLESCENTS: RELATIONSHIP AND DETERMINANTS
Authors: Kollias Anastasios , Stambolliu Emelina , Bountzona Ioanna , Kyriakoulis Konstantinos , Vazeou Andriani , Stergiou George
Published: April 2021

Objective:

Arterial stiffness is an established surrogate measure of preclinical target-organ damage by elevated blood pressure (BP). This study assessed regional (aortic) and local (carotid) arterial stiffness measured by different noninvasive methods in children and adolescents and their relationship with BP levels.

Design and method:

Apparently healthy children and adolescents (age 6–18 years) referred for elevated BP were evaluated with: (i) office BP (OBP) measurement (3 visits, triplicate readings/visit), (ii) 24 h ambulatory BP (ABP) monitoring, (iii) home BP (HBP) monitoring during daytime and nighttime, (iv) M- and B-mode ultrasonography for the assessment of carotid distensibility coefficient (cCD) and carotid intima-media thickness (cIMT), (v) determination of carotid-femoral pulse wave velocity (cfPWV; Complior).

Results:

93 subjects were analyzed (mean age 13.1 ± 2.9 years, 55 males, BMI 24.7 ± 5.2 kg/m2, 18 with 24 h ABP >  = 95th percentile). There was an inverse association between cfPWV and cCD (r = -0.42, p < 0.01). Hypertensive subjects had higher PWV than normotensives (6.3 ± 1.0 vs. 5.3 ± 0.9 m/sec respectively, p < 0.01 after adjustment for age and gender), but similar cCD (57.1 ± 47.6 vs. 57.8 ± 18.4 kPa-1/103, p = NS). cfPWV compared to cCD tended to be more strongly correlated with age (r = 0.65 vs. -0.28, p < 0.01 for comparison), systolic OBP (0.60 vs. -0.31, p < 0.01), systolic ABP (24 h/day/nighttime 0.60/0.57/0.49 vs. -0.39/-0.38/-0.31, p = 0.02/0.04/0.07), systolic HBP (day/nighttime 0.48/0.55 vs. -0.33/-0.26, p = 0.13/ < 0.01), cIMT (0.24 vs. -0.08, p = NS), and similarly to BMI (0.28 vs. -0.26, p = NS for comparison).

Conclusions:

In young individuals aortic PWV as an index of regional stiffness appears to be more closely associated with age and BP levels than local carotid stiffness.
URINARY SOMATIC ANGIOTENSIN CONVERTING ENZYME AND SOLUBLE N-DOMAIN ISOFORMS (90 AND 65KDA) EXPRESSION AND CORRELATION WITH DIFFERENT NUTRITIONAL STATUS/CARDIOVASCULAR RISK PROFILE
Authors: Casarini Dulce Elena , Cruz Nayara , Oliveira Lilian , Fernandes Fernanda , Mill José
Published: April 2021

Objective:

Angiotensin converting enzyme (ACE) has been involved in physiopathology of several diseases including hypertension, diabetes, obesity and metabolic syndrome. The somatic ACE weights from 130–190 KDa and presents N- and C-domains. Two soluble N-domain isoforms have been described in human urine, weighting 65 and 90KDa. Studies have supported that N-domain ACE with 90KDa is a biomarker for hypertension, pre-eclampsia and inflammation.

We evaluated the expression of somatic ACE and soluble N-domain isoforms (90 and 65KDa) in urine of children and adolescents with different nutritional status and cardiovascular risk profile.

Design and method:

The participants aged from 6 to 19 years were classified into four groups according to their BMI percentile; underweight (n = 51), normal weight (n = 53), overweight (n = 53) and obese (n = 49). Waist-height-ratio (WHtR) was used to assess cardiovascular risk profile dividing the participants into normal risk (n = 105) and high risk (n = 101). The urines were concentrated 10-fold and dialyzed with Tris-HCl pH 8 and pure water. Then, we performed western blot analysis using 50 mg of lyophilized urinary protein. ACE expression was proved against the polyclonal antibody Y1. Protein detection was performed by chemiluminescent and analysis was done in Image Labâ (BioRad) software utilizing total protein stain for normalization.

Results:

ACE expression is augmented in obese children when compared with normal weight children (0.09 vs 0.53 arbitrary units, p = 0,04). The higher cardiovascular risk group also presented increased expression of ACE (0.27 vs 0.09 arbitrary units, p = 0.046). The 90KDa N-domain isoform is frequently found in the high cardiovascular risk children (p = 0.02). Additionally, according to Spearman correlation test, the expression of 90KDa N-domain isoform correlates positively with waist circumference (cm), WHtR, BMI percentile and Z-score of BMI.

Conclusions:

Increased ACE expression in obese children contributes to higher cardiovascular risk once this enzyme biosynthesizes Angiotensin II which promotes blood pressure increase, sympathetic nervous system activation and release of glucocorticoids from adrenal gland. ACE expression is also augmented in children with high cardiovascular risk. Presence of 90 KDa N-domain ACE in urine of children and adolescents is a biomarker of poor prognostic for cardiovascular disease in childhood obesity.
URIC ACID IN PEDIATRIC PATIENTS WITH PRIMARY HYPERTENSION
Authors: Szyszka Michal , Skrzypczyk Piotr , Panczyk-Tomaszewska Malgorzata
Published: April 2021

Objective:

Increased concentration of uric acid may play a role in the pathogenesis of primary hypertension (PH). Aim of the study was to assess concentration of uric acid and its correlation with selected clinical and biochemical parameters in children with PH.

Design and method:

In a group of 57 untreated pharmacologically children with PH (44 boys, 13 girls, mean age 14.99 ± 2.84 years) following parameters were assessed: serum uric acid concentration [mg/dL], blood pressure in office measurement and in 24-hour ambulatory blood pressure monitoring, and selected clinical and biochemical parameters. Control group consisted of 20 healthy children (mean 14.11 ± 2.99 years).

Results:

Serum uric acid concentration was significantly higher in children with PH compared to healthy children (5.72 ± 1.38 vs. 4.55 ± 1.07 [mg/dL]; p = 0.001). In patients with PH, its concentration was significantly higher in boys compared to girls ((6.12 ± 1.20 mg/dL vs. 4.35 ± 1.13 mg/dL, p < 0.001), no such difference was found in healthy children. In the PH group, uric acid concentration correlated positively with age (r = 0.426, p = 0.001), height (r = 0.557, p < 0.001), weight (r = 0.518, p < 0.001), weight Z- score (r = 0.296, p = 0.025), BMI (r = 0.316, p = 0.017), neutrophil count (r = 0.280, p = 0.035), systolic blood pressure (r = 0.375, p = 0.004) and pulse pressure (r = 0.444, p = 0.001) in ABPM and negatively with HDL cholesterol, heart rate (r = -0.310, p = 0.02 (1 = -0.309, p = 0.020) and nighttime diastolic blood pressure dip (r = -0.268, p = 0.044) in ABPM. In multivariate analysis, the determinants of uric acid concentration in children with PH were sex (beta = 0,367, 95%CI (0.122–0.611), p = 0.004) and weight Z-score (beta = 0.254, 95%CI (0.005–0.504), p = 0.046).

Conclusions:

Children with primary hypertension have increased serum uric acid concentration compared to healthy children. The risk factors for hyperuricemia in pediatric patients with primary hypertension are male sex and high body weight.
RELATIONSHIP OF HYPERTENSION WITH PATIENTS HAVING DIABETES AT CLINICAL SETUPS OF PAKISTAN
Authors: Ali Muhammad
Published: April 2021

Objective:

Hypertension and Diabetes both are the facets of metabolic syndrome, a pathologic condition that usually includes obesity and cardiovascular diseases. While in some patients Diabetes mellitus and hypertension both recurrently occurs and probably have synergistic disadvantageous effects on the cardiovascular system. The objective of the current study was to sort out the potential relationship and the impact of high blood pressure on patients who had diabetes.

Design and method:

This was a prospective, observational study in which 470 hypertensive patients who had confirmed diagnosis of diabetes type II were enrolled in this study. Samples were from age group of 30–60 years in which 130 males and 340 females were observed. All enrolled hypertensive patients had a diastolic blood pressure greater than 90 mmHg and systolic blood pressure greater than 138mmHg.

Results:

Findings shows that Calcium Channel Blockers, Angiotensin Converting Enzyme (ACE) Inhibitors and Angiotensin Receptor Blockers (ARBs) are preferred agents for Hypertension associated with type 2 Diabetes. In case if targeted blood pressure is not achieved addition of a thiazide diuretic occurs in regimen because it is the preferred 2nd line therapy for hypertension associated with diabetic patients. In another perspective weight loss also seems to be beneficial in the hypertension associated with obesity and diabetes. Candestran and Lisinopril was the most prescribed drugs in earlier patients with hypertension associated with the type 2 diabetes.

Conclusions:

According to the research findings with the usage of the prescribed drugs blood pressure was controlled while alteration of drugs has seen in some cases as well. Chlorthalidone, Candestran and Lisinopril were the most prescribed and seen to be most effective.
AMBULATORY ARTERIAL STIFFNESS INDEX PREDICTS CARDIOVASCULAR EVENTS IN PATIENTS WITH NON-ST ELEVATION MYOCARDIAL INFARCTION: ONE-YEAR FOLLOW-UP STUDY
Authors: Koumelli A. , Tsioufis K. , Kouremeti M. , Mantzouranis M. , Konstantinou K. , Vogiatzakis N. , Tolis P. , Tolis E. , Leontsinis I. , Tousoulis D.
Published: April 2021

Objective:

Ambulatory arterial stiffness index (AASI) has been shown to predict cardiovascular morbidity and mortality in hypertensive patients. However, there are limited data with respect to its prognostic significance among patients with acute myocardial infarction (AMI). Weevaluated the relationship between AASI and long-term cardiovascular outcomes in patients withAMI.

Design and method:

We followed up 254patients (82.7% male; mean age 63.7 years; 71.7% hypertensives; 29.9% with diabetes mellitus) who were hospitalized because of ST-elevation MI (STEMI, 48.8%) and Non-ST–elevation MI (NSTEMI), for a period of 12 months. All patients underwent baseline estimation of clinical and laboratory parameters during their hospitalization. Patients underwent 24-hour ambulatory blood pressuremonitoring (ABPM) during the third day of hospital stay. The AASI was calculated as 1- (slope of diastolic on systolic blood pressureduring ABPM). Endpoints of interest where total and cardiovascular mortalityand cardiovascular morbidity set as hospitalization for congestive heart failure, acute coronary syndrome, stroke, ventricular tachycardia, atrial fibrillation and acute renal failure.

Results:

The AASI failed to predict mortality orthe composite endpoint of cardiovascular morbidity and mortality during the follow-up period either in the entire population or separately for each AMI type. However, AASI demonstrated a significant prognostic role for hospitalization for cardiovascular events in the NSTEMI population in univariate regression analysis (HR = 0.102; 95% CI: 0.048–0.155; p < 0.001). In a model of multivariate regression analysis in the same AMI group, this association was maintained (HR = 0.067; 95% CI: 0.020–0.115; p = 0.006) after adjusting for traditional risk factors and severity of coronary artery disease assessed by the number of affected main vessels.

Conclusions:

AASI emerges as an independent predictor of one-year cardiovascular morbidity in patients with NSTEMI. More data are required to determine the usefulness of this non-invasive tool in risk stratification and management of these patients.
URIC ACID IN ACUTE CORONARY SYNDROME: CORRELATIONS WITH IN-HOSPITAL MORTALITY AND COMPLICATIONS
Authors: Maloberti Alessandro , Rebora Paola , Morici Nuccia , Sacco Alica , Viola Giovanna , Lattuada Francesca , Molinari Valentina , Occhi Lucia , Bassi Ilaria , Portoghese Alessandro , Fortina Matteo , Oliva Fabrizio , Giannattasio Cristina
Published: April 2021

Objective:

Uric acid (UA) has been related to in-hospital mortality in ACS patients. Furthermore, it has been related to early relapse of non-fatal cardiovascular events and to intermediate outcome such as use of intra-aortic balloon pump, noninvasive ventilation, longer inward stay, bleeding but also clinical presentation with AF or Heart Failure (HF). Aim of the study was to evaluate the role of UA as a possible determinants of primary (in-hospital mortality) and secondary outcomes considered as variables indicative of in-hospitale complications (myocardial re-infarction, in-stent thrombosys, bleeding, stroke), worst clinical presentation (presentation with HF or AF, admission EF, three vessels coronaric involvement at the coronary angiogram), in-hospital complication (inotropes, intra-aortic balloon pump and non-invasive ventilation uses during hospital stay) and worst recovery (discharge EF).

Design and method:

retro-prospective cohort study of 563 patients admitted for ACS at the Cardiological Intensive Care Unit of the Niguarda Ca’ Granda Hospital. Cox regression analysis was performed to evaluate the association between UA and primary and seconday outcome adjusted for the following covariates: age, gender, previous myocardial infarction, arterial hypertension, Charlson Comorbidity Index and creatinine.

Results:

mean age was 66.5 ± 12.3 years, 79.2% of the patients were males and 49.9% of the ACS were STEMI. Hyperuricemic subjects were older, with more prominent cardiovascular risk factor and previous myocardial infarction. Furthermore, they more frequently died during hospital stay, they present more frequently heart failure and AF as clinical presentation, have more commonly three vessels disease and use more frequently intra-aortic balloon pump and non-invasive ventilation. Finally, also EF at admission and discharge were lower in hyperuricemic patients. At multivariate analysis UA was a significant determinants of primary and secondary outcomes (except for three vessels coronaric disease, bleeding, stroke, re-infaction and in-stent thrombosys).

Conclusions:

in conclusion UA is an independent determinants of in-hospital mortality and a variables suggestive of worst clinical presentation, in-hospital complications and worst recovery.
COMPARISON OF BLOOD PRESSURE VARIABILITY BETWEEN 24H AMBULATORY MONITORING AND OFFICE BLOOD PRESSURE IN DIABETICS AND NON-DIABETIC PATIENTS A CROSS-SECTIONAL STUDY
Authors: Rouxinol-Dias Ana Lídia , Gonçalves Marta Lisandra , Silva José , Ramalho Diogo , Barbosa Loide , Polónia Jorge
Published: April 2021

Objective:

To examine the relationship of different measurements of Blood Pressure Variability (BPV) both based on 24 h Ambulatory BP Monitoring (ABPM) and on visit-to-visit in office BP (OBP) evaluation in a large set of diabetic (D) and non-diabetic (ND) patients.

Design and method:

A total of 1123 patients with ABPM and OBP measurements were included in a single-center cross-sectional study: 272 (24%) D, 43% male, 41% dyslipidemia, ageing 52 years (range 38- 64), BMI 27.9 kg/m2 (range 24.7–31.3). Comparison of BPV between D and ND used Mann-Whitney U test and a generalized linear model (GLM) including D as only predictor and age <65 years, BMI, gender, dyslipidemia, family history of D, of hypertension, urinary sodium and eGFR as covariates.

Results:

Mean systolic BP (SBP) was significantly higher in D vs ND (p < 0.001), for all 24 h, daytime and nighttime periods of ABPM and for OBP. BPV in daytime ABPM was higher in D vs ND, in unadjusted analysis: coefficient of variation of SBP (CVS) for D: 9.5 (range 8.0–10.9 vs ND: 8.8 (range 7.4–10.7), p < 0.001 but no measure of OBPV showed significant differences between groups. OBPV did not correlate with 24-h BP variability. Morning rise of SBP was higher in ND group (10.9 ± 0.3 vs 9.7 ± 0.6 mm Hg (p = 0.014). GLM analysis confirmed higher ambulatory SBP variability in D vs ND. CVS (24H and daytime BP p < 0.001) was higher in D (vs ND) independently of other covariates. Arterial stiffness index (ASI) was higher (p < 0.001) in D = 0.44 (0.35 -0.56) vs ND = 0.32 (0.20 -0.44) but weakly related with BP variability.

Conclusions:

BP variability on ABPM was higher in diabetic vs ND. BP variability in long-term visit-to-visit in OBP was weakly correlated to short-term ABPM variability. In diabetics the lower morning rise of BP and the higher BPV in ABPM values may indicate different spectra of adjusted vs inadequate autonomic response in D. ABPM BPV may be a relevant component of pathophysiologic path involved in higher incidence of adverse events in diabetic population.
THERAPEUTIC EFFECTS OF A SODIUM GLUCOSE COTRANSPORTER 2 INHIBITOR IN DIABETIC PATIENTS WITH CHRONIC KIDNEY DISEASE
Authors: Hirao Jun , Onoda Shou , Murayama Yoshiki , Uematsu Mayu , Ishimitsu Akira , Kaiga Akiko , Satonaka Hiroshi , Ishimitsu Toshihiko
Published: April 2021

Objective:

Multiple large-scale clinical trials have indicated that sodium glucose cotransporter 2 (SGLT2) inhibitors reduce the incidence of cardiovascular events, the deterioration of renal function and mortality. However, the therapeutic effects of SGLT2 inhibitors are supposed to be limited in patients with reduced renal function considering the mechanism of their action.

Design and method:

In this study, a SGLT2 inhibitor, ipragliflozin was given to 30 type 2 diabetic patients with nephropathy whose estimated glomerular filtration rate (eGFR) was not lower than 30 mL/min/1.73m2. The treatment was continued for 3 to 4 months and the effects on body weight, blood pressure (BP) and laboratory data including renal function, albuminuria and plasma B-type natriuretic peptide (BNP) were evaluated.

Results:

After 3 to 4 months, hemoglobin A1c was decreased by 0.6 % (p < 0.001), body weight was reduced by 1.8 kg (p < 0.01) and blood pressure was lowered by -10/-6 mmHg (p < 0.001/p < 0.001). This was accompanied by reductions in serum uric acid (-0.7 mg/dL, p < 0.001), triglycerides (-25 mg/dL, p = 0.028) and gamma-glutamyl transferase (-8 U/L, p = 0.001). On the other hand, plasma BNP was also decreased by 12 % (p = 0.020) and urinary albumin excretion was reduced by 23 % (p = 0.018) although the eGFR was not significantly changed. It is concluded that ipragliflozin is effective in lowering blood glucose even in patients with diabetic kidney disease and is beneficial in improving accompanying obesity and hypertension. In addition, ipragliflozin is thought to have favorable influences on the metabolisms of uric acid and lipids.

Conclusions:

These properties of ipragliflozin is expected to bring about protective effects against the progression of nephropathy and the development of cardiovascular disease resulting in the improvement of prognosis in diabetic patients with mild to moderate chronic kidney disease.
PREHYPERTENSION AND RISK FOR ALL-CAUSE AND CARDIOVASCULAR MORTALITY BY DIABETES STATUS: RESULTS FROM THE NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEYS
Authors: Huang Jiayi , Yu Yuling , Lin Lin , Chen Chaolei , Shen Geng , Huang Yuqing , Lo Kennth , Feng Yingqing
Published: April 2021

Objective:

The objective of this study was to investigate whether the association between prehypertension and all-cause and cardiovascular mortality was related to diabetes status.

Design and method:

Totally 26070 participants aged >= 18 years were all from the 1999–2014 National Health and Nutrition Examination Surveys (NHANES). Prehypertension was defined as systolic/diastolic blood pressure: 120–139/80-89 mmHg. Participants were followed up for all-cause and cardiovascular mortality until 31 December 2015. Cox proportional hazards models, sensitivity analyses and Kaplan-Meier survival curves were conducted.

Results:

Overall, 15295 (58.67%) of participants did not have diabetes and prehypertension, 8870 (34.02%) had prehypertension alone, 835 (3.20%) had diabetes alone, and 1070 (4.11%) had both diabetes and prehypertension. Compared with participants without either diabetes or prehypertension, the multivariable adjusted hazard ratios for all-cause mortality among participants with prehypertension alone, diabetes alone, and both diabetes and prehypertension were 1.08 (95% CI: 0.95,1.23), 1.26 (0.98,1.62), and 1.67 (1.38,2.03)(P for trend<0.001),as well as for cardiovascular mortality were 1.40 (95% CI: 0.92,2.14), 2.21 (1.12,4.38), and 2.87 (1.65,4.99)(P for trend<0.001), respectively. The associations were robust in the subgroup analysis.

Conclusions:

Our findings suggested that prehypertension with an increased risk for cardiovascular and all-cause mortality based on diabetes status.
BLOOD PRESSURE TELEMONITORING AND REMOTE COUNSELING IN PATIENTS WITH UNCONTROLLED HYPERTENSION: A COST-UTILITY ANALYSIS
Authors: Ionov Mikhail , Zhukova Olga , Zvartau Nadezhda , Konradi Alexandra
Published: April 2021

Objective:

Telehealth is a useful adjunct in hypertension (HTN) management. Despite obvious short-term clinical benefit, long-term social impact and cost-effectiveness have not been fully investigated.

The aim of the study was to perform predictive modeling of long-term clinical and social outcomes and to conduct a cost-utility analysis of blood pressure (BP) telemonitoring and remote counseling (BPTM) in patients with HTN.

Design and method:

A Markov cohort-based (n = 2000 patients) model was developed and adopted a 10-year time horizon with 12-month time cycles. Cost and outcome data collected from the three-month study of 240 patients (160 in BPTM group and 80 controls, 48 y.o.). All patients started at non-complicated HTN state then moving to disease complications with a certain transition probabilities over a discrete time period (1 Markov cycle).

BPTM was compared with usual care in terms of lifetime costs, quality adjusted life years using a Ministry of Health of Russian Federation perspective.

Results:

At the end of a clinical part of the study there was a decrease in office systolic BP by -16,8 ± 2,9 mm Hg -7,9 ± 3,9 mm Hg in BPTM and usual care groups respectively. By the way, there was an improvement in health-related quality of life (measured with MOS SF-36) +16% and +4% in respective groups.

In the long-term run when compared with usual care BPTM was more effective in terms mortality (67 versus 91 patients lost and 9,6 versus 9,71 life years gained) and costs (cost of illness 102 508 000 RUR versus 145 237 700 RUR). Taking quality of life measures into account, the effect of BPTM was also more pronounced (8,31 versus 7,82 QALYs). The resultant incremental cost-utility ratio for BPTM was 275 178,98 RUR/1 QALY gained/1 patient (134837,70 RUR/0,49 QALY/1 patient).

Conclusions:

According to the results of predictive modeling BPTM in clinical practice is likely to lead to reduced cardiovascular morbidity and mortality being also a cost-effective use of healthcare resources. Larger randomized clinical trials will give more information on BPTM cost-effectiveness in other middle-income countries.
AN EFFECTIVE LIFESTYLE DIGITAL THERAPEUTIC FOR HYPERTENSION AND METABOLIC RISK FACTORS
Authors: Colwell Niall , Wienecke Gitte , Egan Jack , O’croinin Micheal , Shepherd Andrew
Published: April 2021

Objective:

Lifestyle modification is a class one indication for control of hypertension, diabetes, metabolic syndrome and other chronic diseases. The success of lifestyle change is fraught, as evidenced by the ballooning syndemic of diabesity. We examined the effect of a prescribed digital lifestyle therapeutic in subjects with prehypertension and hypertension; prediabetes and type II diabetes.

Design and method:

We analysed two cohorts: Cohort 1 consisted of 50 subjects with type II diabetes mellitus who were enrolled by Diabetes Ireland, 39 of the subjects completed the programme. Cohort 2 consisted of 43 patients who were recruited from a primary care setting. These subjects had a mixture of metabolic syndrome (n = 6), prediabetic (n = 14), and Type II diabetic subjects (n = 7); stage 1 hypertensive (n = 11) and Prehypertensive (n = 9).

All subjects were prescribed a digital therapeutic called “RediCare Control” for its effect on blood pressure, HbA1c and other metabolic syndrome parameters over 8–12 weeks. RediCare Control has 5 components, (1) Chronic condition patient education, delivered via algorithm based on patient needs. (2) Resources such as recipes, cooking videos, meal plans and food guides (3) Unlimited access to 1-1 online health coach consultations. (4) A moderated peer support forum. (5) An evidence based whole food dietary protocol. Results were analysed by the student two-tailed t-test.

Results:

Results demonstrate a significant reduction in systolic and diastolic blood pressure, pulse pressure, HbA1c, BMI and triglycerides as shown: (Table 1).

Conclusions:

A prescribed digital therapeutic for lifestyle change in hypertension and type II diabetes has a potent positive effect on blood pressure and metabolic syndrome parameters and can be delivered in a cost-effective manner (60 euros), in primary care and in community settings. This digital therapeutic is malleable, scalable, and compliments the conventional medication approach to treatment.
AN INTEGRATIVE MULTIDISCIPLINARY APP DEVICE FOR HEALTHCARE MONITORING OF PATIENTS WITH UNCONTROLLED HYPERTENSION
Authors: Bortolotto Luiz , Sanchez Renata , Rodrigues Dayane , Rodrigues Sara , Duenas Ana , Pereira Jaqueline , Monteiro Rosangela , Sahota Jaspal , Wilkinson Michael , Teulon Aymeric , Vujasinovic Marko , Ferreira Norberto , Manucci Anderson , Rabello Guilherme
Published: April 2021

Objective:

The most important cause of uncontrolled blood pressure (BP) is a poor adherence to healthy lifestyle and drug treatment. New technologies have provided tools for a better monitoring of the patient and an improvement of treatment adherence by educational and motivational issues.

We aim to present a new approach for patient monitoring at home by a software application (APP) designed to run on a mobile device developed to improve BP control, healthy life style and medication adherence, and quality of life of patients with uncontrolled BP

Design and method:

The APP was developed by an interdisciplinary team including members of a company of artificial intelligence, doctors and other health professional (nutritionist, physical educator, and nurse) and the innovation department of the Hospital.

Results:

The APP (see figure) allows the insertion of BP values measured at home and the list of medications that the patient routinely uses, that can be done manually or by voice system, which is recognized when the patient verbally informs BP values or drugs on use. Also, the patient can interact with the system by answering questions automatically issued regarding physical activity and sodium intake. The APP has warning systems where, from certain information provided by the patient regarding BP values or symptoms, the nursing and/or medical team will contact the patient to provide the adequate management. The APP will be introduced in the outpatient clinic of the hospital and will be offered for the patients with uncontrolled BP despite drug treatment).

Conclusions:

The use of new technologies by APP can be introduced in the clinical practice to improve BP control and adherence to antihypertensive medications and healthy lifestyle providing a strong interaction between patients and healthcare team by distance monitoring. This approach could be extremely useful for underserved patients or during pandemic conditions