bluuebunny/crossref_metadata_2025 huggingface dataset:
DIAGNOSTIC APPROACH IN PRIMARY HEALTHCARE FOR CARDIAC AMYLOIDOSIS: CASE REPORT
Authors: Chyczij Fabiana , Alexandre Jose
Published: May 2024

Objective:

Cardiac amyloidosis occurs through the accumulation of amyloid in cardiac tissue, This is the most common form of restrictive cardiomyopathy in the Western world. In recent years, significant advances in the knowledge of cardiac amyloidosis have been consolidated, bringing a profound reformulation of its clinical meaning.

The purpose of this case report is to demonstrate the importance of primary health care in the suspicion and diagnosis of patients with cardiac amyloidosis.

Design and method:

Interview with patient, bibliographical review and revision of medical records.

Results:

We describe here, the case of a 70-year-old caucasian man with no known personal or family history. He was consulted by his family doctor for unmedicated essential arterial hypertension associated with progressive worsening of fatigue during light exertion over 4 months of evolution.

On physical examination, he was normotensive, tachycardic and had symmetrical bimalleolar edema.

The electrocardiogram demonstrated atrial fibrillation with a heart rate of 100 - 120 bpm without other changes. Transthoracic echocardiogram showed dilation of the left ventricle, markedly thickened walls and hyperechogenic appearance, diffuse hypokinesia with compromised ejection fraction (±21%); binaural dilation and dilated right ventricle (RV) with compromised longitudinal function; without significant valvular changes. He started oral hypocoagulation and beta-blockers and was referred to a Cardiology consultation.

Cardiac magnetic resonance demonstrated changes phenotypic characteristics and pattern of late gadolinium enhancement compatible with cardiac amyloidosis. Scintigraphy with technesium 99 diphosphonic-1,2-propane carboxylic acid (Tc99m-DPD) positive for ATTR amyloidosis.

The diagnosis of heart failure with reduced EF due to ATTR amyloid cardiomyopathy was assumed. Exfoliating therapy with diuretic was performed, prognosis-modifying therapy and Tafamidis were initiated with excellent clinical response.

Conclusions:

Cardiac amyloidosis is a rare pathology, its diagnosis requires a high index of suspicion based on the clinic and the findings of complementary non-invasive tests, particularly transthoracic echocardiography and cardiac resonance.

The family doctor plays a fundamental role not only in early diagnosis, but also in the first therapeutic approach, whenever possible, also referring all situations that require more specialized healthcare at hospital level.
MORIN, A BIOFLAVONOID, ATTENUATES MYOCARDIAL ISCHEMIA-REPERFUSION INJURY BY ATTENUATING RISK/SAPK PATHWAY
Authors: Bhatia Jagriti , Verma Vipin Kumar , Arya D S
Published: May 2024

Objective:

It is important to address the impact of rising incidence of mortality and morbidity associated with myocardial infarction (MI). There is need to explore new safer and efficacious drugs with novel mechanisms to manage MI. Morin, (2-(2,4-Dihydroxyphenyl)-3, is a bioflavanoid which is found in Maclura cochinchinensis, Maclura tinctoria, Maclura pomifera and leaves of Psidium guajava. It possesses good anti-apoptotic, anti-inflammatory, and antioxidant activity. Hence, we have evaluated the cardio-protective effect of Morin in Myocardial Ischemia-Reperfusion (IR) injury model of rat.

Design and method:

Male albino Wistar rats were pre-treated with Morin (40 and 80 mg/kg; p.o.) for 28 days and on the 29th day, the chest cavity was opened and myocardial ishemia was induced for 45 minutes by ligatiing the LAD coronary artery. Thereafter, reperfusion was carried out for 60 minutes. The hemodynamic parameters as well as left ventricular pressures (±LV dp/dt and LVEDP) were recorded throughout the ischemia and reperfusion. At the end of the procedure, the blood and heart were collected for evaluation of cardiac-injury markers, antioxidant-oxidant parameters, inflammatory markets, histopathological evaluation and molecular signalling pathway protein expressions.

Results:

Morin pretreatment for 28 days at 40 mg/kg and 80 mg/kg doses significantly controlled hemodynamic parameters, reduced cardiac injury markers, inflammation and apoptosis and reduced oxidative stress and mitigated histological changes following IR injury in rat heart. Morin also downregulated expression of pro-inflammatory and pro-apoptotic SAPK pathway proteins (p38 and JNK), and upregulated the survival kinase protein expression i.e. RISK pathway (ERK, eNOS).

Conclusions:

Morin reduced myocardial oxidative stress, inflammation and apoptosis in ischemia-reperfusion induced cardiac injury through upregulation of RISK and downregulation of SAPK pathways proteins.
DELETION OF BRADYKININ TYPE 2 RECEPTORS SELECTIVELY IN THE RENOMEDULLARY INTERSTITIAL CELLS OF THE KIDNEY MEDULLA ATTENUATES ANGIOTENSIN II-INDUCED HYPERTENSION IN MICE
Authors: Zhuo Jia Long , Hassan Rumana , El-dahr Samir S , Li Xiao Chun
Published: May 2024

Objective:

The present study tested the hypothesis that deletion of vasoactive peptide bradykinin B2 receptors selectively in the renomemdullary interstitial cells (RMICs) of the kidney medulla attenuates angiotensin II-induced hypertension in mice.

Design and method:

To test the hypothesis, we employed inducible Tenascin-C-CreER2 and bradykinin B2 receptor-floxed recombination approach to generate a novel mouse model with deletion of B2 receptors selectively in the RMICs of the kidney medulla (RMIC-B2R-/-). Basal blood pressure and urine osmolality and their responses to angiotensin II (Ang II, ∼500 μg/kg/day, i.p., for 2 weeks) were determined in adult male wildtype (WT) and RMIC-B2R-/- mice (n=10 per group), respectively.

Results:

Mice with deletion of B2 receptors selectively in RMICs of the kidney medulla developed normally without structural abnormalities in the kidney medulla. However, basal telemetry systolic, diastolic, and mean arterial blood pressure were significantly lower in RMIC-B2R-/- than WT mice (WT: 123 ± 3 mmHg vs. RMIC-B2R-/-: 106 ± 3 mmHg, P<0.01). The hypotensive phenotype in RMIC-B2R-/- mice was associated with significant decreases in 24 h urine output (WT: 1.86 ± 0.15 mL/24 h vs. RMIC-B2R-/-: 1.09 ± 0.15 mL/24 h, P<0.05) and urine osmolality (WT: 1893 ± 441 mOsm/Kg H2O vs. RMIC-B2R-/-: 1311 ± 78 mOsm/Kg H2O, P<0.01). In response to Ang II infusion (∼0.5 mg/kg/day, i.p., for 2 weeks), systolic blood pressure increased to 166 ± 6 mmHg in WT mice (P<0.01 vs. Basal), but it increased only to 139 ± 5 mmHg in RMIC-B2R-/- mice (P<0.01 vs. WT). By comparison, infusion of DDAVP (1-deamino-8-D-arginine vasopressin, ∼0.5 mg/kg/day, i.p., for 2 weeks) did not significantly alter blood pressure in WT and RMIC-B2R-/- mice (n.s.). However, infusion of Ang II for 2 weeks significantly increased urine osmolality in WT mice (P<0.01), and restored urine osmolality in RMIC-B2R-/- mice to the WT basal level (1995 ± 315 mOsm/Kg H2O, P<0.01).

Conclusions:

In conclusion, the present study demonstrates for the 1st time that bradykinin B2 receptors in the RMICs of the kidney medulla plays an important role in maintaining basal blood pressure and urine osmolality homeostasis and the development of Ang II-induced hypertension.
ECHINOCOCCUS MULTIOCULARIS IN ADRENAL GLAND - THE UNEXPECTED CAUSE OF SECONDARY HYPERTENSION IN A YOUNG MAN
Authors: Wilk-sledziewska Katarzyna , Leszkowicz Danuta , Anikie Katarzyna , Piotrowska Weronika , Zbroch Aleksandra , Wawierna Julia , Zdanska Adrianna , Wysocka Anna , Malinowska Dominika , Baranowska Magdalena , Cabaj Marta , Czajkowski Mateusz , Gawryluk Mateusz , Zimnowski Mateusz , Nazarko Weronika , Panas Zuzanna , Zbroch Edyta
Published: May 2024

Objective:

The case report presents the patient with hydatid cyst of Echinococcus multiocularis located in the adrenal gland. Hydatid cysts in adrenal glands occur very rarely, and symptoms are nonspecific. The aim of this case report is to draw attention to atypical causes of arterial hypertension.

Design and method:

Th case report of the male-patient with Echinococcus multiocularis hydatid cyst in right adrenal gland complicated with extensive thrombosis of inferior vena cava and both renal veins, as well as right hepatic vein with preserved marginal flow and developed collateral circulation.

Results:

32-year-old man, with a history of arterial hypertension treated since 3 weeks was admitted to the Department of Internal Medicine and Hypertension due to chest pain and peripheral oedemaMoreover, patient reported lower back pain and high blood pressure values despite of multidrug therapy. Laboratory tests indicated elevated creatinine level and proteinuria. An ultrasound examination revealed kidney enlargement and suspicion of right renal artery stenosis, prompting further investigation.

Angio-CT of the abdomen and pelvis uncovered a contrast-enhanced polycyclic mass with calcifications in the right adrenal gland and several similar lesions in the liver, some of which had star-shaped calcifications. The imaging also revealed extensive thrombosis in the inferior vena cava, renal veins, and right hepatic vein, with preserved marginal flow and developed collateral circulation.

The patient was started on therapeutic anticoagulation with low molecular weight heparin.

After performing a series of diagnostic tests and consultations, the infection of Echinococcus multilocularis was diagnosed by serological tests. Albendazole in a dose of 400 mg twice a day was added to the therapy.

The patient's condition remained stable, and surgical removal of the cysts was planned.

Conclusions:

The case shows how important is collaboration between specialists. Holistic approach to patient enabled to find out the cause of high blood pressure. It was renal vein thrombosis due to Echinococcus multiocularis infection.
LONG-TERM BLOOD PRESSURE VARIATION AND CARDIOVASCULAR EVENTS IN PATIENTS WITH PRIMARY ALDOSTERONISM
Authors: Tulak Simili , Luo Qin
Published: May 2024

Objective:

Blood pressure variability (BPV) has been reported to be associated with cardiovascular risks. Patients with primary aldosteronism (PA) have a high risk of cardiovascular morbidity and mortality, while the association of BPV and cardiovascular events in PA patients is unclear. This study aimed to explore the association of BPV with cardiovascular events in PA patients

Design and method:

This study was a retrospective cohort study. We included hypertensives with confirmed PA in hypertension center of People's Hospital of Xinjiang Autonomous Region between December 2004 and December 2021. BPV includes the variability of the coefficient of variation (CV), standard deviation (SD), and extreme range (MMD). The primary outcomes of the study were first occurring cardiovascular events, including acute coronary syndrome, coronary revascularization (coronary stenting, coronary artery bypass grafting CABG), heart failure, stroke, and death related to CVD disease. Multivariate analysis was performed using logstic regression, including demographic variables (age and sex, BMI, etc.); clinical characteristics (i. e., smoking, drinking fasting glucose, etc.) and mean blood pressure as adjusted covariates; two-sided test at 0.05.R 4.3.1 was used for the above statistical analysis

Results:

The present study included 2483 patients with PA with BP measurement more than three times and more than one month apart, including 1329 male and 1154 female patients. After adjusting for multiple confounding factors (eg., age, gender, duration of hypertension, and history of diabetes mellitus), pulse pressure BPV was significantly associated with cardiovascular disease (OR 1.02, P 0.02.), and systolic SD (0R=1.03; P 0.024) also showed a association of diastolic BPV

Conclusions:

Long-term pulse pressure BPV, systolic pressure SD may be an important clinical implication for prevention of cardiovascular disease in patients with PA.
MITOCHONDRIAL DEACETYLASE SIRTUIN 3 IN THE PROXIMAL TUBULES OF THE KIDNEY PLAYS A PROTECTIVE ROLE AGAINST ANGIOTENSIN II-INDUCED HYPERTENSION AND KIDNEY INJURY IN MICE
Authors: Li Xiao Chun , Hassan Rumana , Katsurada Akemi , Sato Ryosuke , Zhuo Jia Long
Published: May 2024

Objective:

Sirtuin 3 (Sirt3), a major NAD-dependent deacetylase in the mitochondrial matrix, exerts anti-oxidative, anti-inflammation, and cardiovascular effects by counteracting angiotensin II (Ang II)-induced responses in the mitochondria. The present study tested the hypothesis that Sirt3 in the mitochondria of the proximal tubules plays a protective role against angiotensin Ang II-induced hypertension and kidney injury.

Design and method:

To test the hypothesis, we generated mice with proximal tubule-specific deletion of Sirt3, PT-Sirt3-/-, using the iL-Sglt2-Cre/Sirt3f/f recombination approach. Three groups (n=10 each) of adult male wildtype (WT) and PT-Sirt3-/- mice were infused with Ang II (∼0.5 mg/kg/day, i.p., 2 weeks) or induced with 2 h ischemia and reperfusion (I/R) kidney injury.

Results:

PT-Sirt3-/- mice developed and grew normally without structural abnormalities in the proximal tubules of the kidney. Basal telemetry blood pressure (WT: 118 ± 3 mmHg vs. PT-Sirt3-/-: 102 ± 5 mmHg, P<0.01) and glomerular filtration rate (WT: 165.3 ± 8.4 μl/min vs. PT-Sirt3-/-: 121.3 ± 5.3 μl/min, P<0.01) were significantly lower. However, 24 h urine (WT: 1.38 ± 0.16 mL/24 h vs. PT-Sirt3-/-: 1.82 ± 0.25 mL/24 h, P<0.01) and urinary sodium excretion were higher in adult male PT-Sirt3-/- mice (WT: 158.0 ± 5.2 μmol/24 h vs. PT-Sirt3-/-: 208.0 ± 5.8 μmol/24 h, P<0.01). Deletion of Sirt3 selectively in the proximal tubules significantly increased renin mRNA expression in PT-Sirt3-/- mice (WT: 1173 ± 141 copies/ng RNA vs. PT-Sirt3-/-: 1741 ± 125 copies/ng RNA, P<0.01), but not HIF-1-alpha, fibronectin, or KIM-1 mRNA in the kidney cortex under basal conditions. In response to Ang II infusion, however, deletion of Sirt3 selectively in the proximal tubules of the kidney significantly augmented the pressor response in PT-Sirt3-/- mice (WT: 27 ± 3 mmHg vs. PT-Sirt3-/-: 38 ± 5 mmHg, P<0.01), and increased HIF-1-alpha, TGF-beta1, fibronectin, or KIM-1 mRNA expression in response to 24-h I/R-induced kidney injury (P<0.01).

Conclusions:

Our data support the hypothesis that Sirt3 in the mitochondria of the proximal tubules plays an important protective role against Ang II-induced hypertension and I/R-induced kidney injury.
THE PREVALENCE, CHARACTERISTICS, AND PREDICTORS OF HYPERTENSION PHENOTYPES IN A CHINESE POPULATION
Authors: Huanhuan Miao , Yang Shijie , Zhou Zhangyang , Yin Zheng , Zhang Yuqing
Published: May 2024

Objective:

Different phenotypes of hypertension are associated with varying degrees of cardiovascular risk. However, there is limited data available regarding the features and predictors of hypertension phenotypes in Chinese populations. This study aimed to evaluate the prevalence, characteristics, and predictors of different patterns of hypertension in a Chinese population.

Design and method:

In this study, a cross-sectional design was employed, and a total of 13,073 community participants were included. Hypertension phenotypes were defined as isolated systolic hypertension (ISH, systolic blood pressure (SBP) no less than 140 mmHg and diastolic blood pressure (DBP) less than 90 mmHg), isolated diastolic hypertension (IDH, SBP less than 140 mmHg and DBP no less than 90 mmHg), and systolic-diastolic hypertension (SDH, SBP on less than 140 mmHg and DBP no less than 90 mmHg). Univariate and multivariate logistic regression analyses were utilized to investigate the predictors of various hypertension phenotypes.

Results:

The mean age of participants was 56.1 years, and 8625 (66%) were women. The prevalence rates of normotension, ISH, IDH, and SDH were 77.7%, 15.6%, 1.2%, and 5.6%, respectively. Compared with the normotensive group, participants with ISH were more likely to be older, men, overweight, obese, presenting with abdominal obesity, artery stiffness, and diabetes, as well as having lower levels of serum creatinine. Patients with IDH demonstrated a higher likelihood of being younger, men, presenting with abdominal obesity, and having higher levels of heart rate compared to normotensive individuals. Furthermore, male gender, alcohol consumption, overweight, obesity, abdominal obesity, artery stiffness, and higher levels of heart rate were predictors for SDH compared to normotension.

Conclusions:

Male gender and abdominal obesity were identified as common risk factors for three phenotypes of hypertension. However, age had a varying effect on the prevalence of distinct patterns of hypertension.
NOVEL ABPM PARAMETERS AND BLOOD PRESSURE PHENOTYPES IN CKD
Authors: Athavale Bahaar , Shah Hardik , Kirpalani Dilip , Kirpalani Ashok
Published: May 2024

Objective:

Our study aims to compare novel ABPM parameters between CKD and non-CKD patients and also within various subgroups of CKD.

Design and method:

100 consecutive hypertensive patients-{Group A with CKD Stage 1 to 4 (n=50) and Group B - without CKD (n=50)}; underwent measurement of single clinic BP (SOBP, by Omron 7113), averaged automated clinic BP (AOBP, by Omron HEM 907) and 24 hours ABPM (by SunTech Oscar 2).

Results:

When compared with daytime ABPM, mean AOBP (136.8/78.5 mm Hg) correlated significantly better than mean single clinic BP (141.2/81.6 mm Hg); (r=0.75 versus 0.59). Group A had significantly higher (p<0.05) awake, asleep and 24 hour mean systolic BP {144.8, 133.4, 141.9} than Group B {139.6, 125.3, 136.7 mm Hg respectively}. Group A had significantly higher (p=0.03) masked hypertension (38% vs. 20% in Group B). Group A had EMBS (36% vs. 22%, p=0.04) and higher non dipping of BP (60% vs. 46%, p=0.04) as well as nocturnal heart rate (14% vs. 12%, p=0.06) than Group B. BP variability was significantly higher (p<0.05) in Group A (Average real variability: 12.9+4.18 vs. 11.6+3.63; Variability independent of the mean: 24.74+16.25 vs. 22.2+13.3).

Conclusions:

As compared to non-CKD population, CKD patients have higher prevalence of ABPM phenotypes such as masked hypertension, nocturnal hypertension, EMBS and BP variability irrespective of age, stage of CKD and level of control of office BP. Utilization of novel ABPM parameters can guide towards holistic management of hypertension in CKD.
EFFECTS OF ALLISARTAN ON URIC ACID, LEFT ATRIAL, LEFT VENTRICULAR AND ARTERY STIFFNESS IN MILD-TO-MODERATE ESSENTIAL HYPERTENSION
Authors: Sun Yancui , Wu Hanqiong , Song Wei , Jiang Yinnong
Published: May 2024

Objective:

Our study aimed to explore the effects of allisartan on blood pressure, uric acid (UA), left atrial, left ventricular structure and function and artery stiffness in mild-to-moderate essential hypertension.

Design and method:

Our study is a randomised, double-blind, crossover design involving 98 patients with mild-to-moderate essential hypertension. Participants were administered allisartan (240mg) or olmesartan (20mg) once daily for 12 weeks each in varying sequences.

Results:

Both allisartan and olmesartan led to a significant decrease in systolic blood pressure (SBP) levels from baseline, with no significant difference between the two drugs (δ= 6.5mmHg, P<0.001 and δ= 5.64mmHg, P=0.002). Notably, allisartan exhibited a more pronounced reduction in diastolic blood pressure compared to olmesartan (δ= 3.66mmHg, P=0.001), with superior efficacy in lowering diastolic blood pressure (DBP) (δ= 3.39mmHg, P=0.016). Allisartan significantly dropped serum UA levels (δ= 26.37 μmol/L, P<0.001), whereas olmesartan did not achieve a significant reduction compared to allisartan (δ= 33.63 μmol/L, P<0.001). In terms of cardiac and artery stiffness, allisartan demonstrated significant reductions in left atrial volume index (LAVI) (δ= 2.86 ml/m2, P<0.001), left ventricular mass index (LVMI) (δ= 4.82 g/m2, P=0.010) and ankle-brachial pulse wave velocity (baPWV) (δ= 154.49 cm/s, P<0.001), all-surpassing olmesartan significantly (all P<0.01).

Conclusions:

In conclusion, compared to olmesartan, allisartan demonstrates significant reductions in serum UA, blood pressure, LAVI, LVMI and baPWV in patients with mild to moderate essential hypertension. This study provides new evidence supporting the efficacy of allisartan in treating mild-to-moderate essential hypertension and reducing serum UA levels in this population.
SYNERGISTIC EFFECT OF SODIUM AND WATER BALANCE POLYMORPHISMS ON THE DEVELOPMENT OF ARTERIAL HYPERTENSION
Authors: Henriques Carolina , Sousa Ana Célia , Miranda Rubina , Barreto Francisco , Fernandes Rui , Carvalhinha Carolina , Henriques Eva , Rodrigues Mariana , Freitas Sonia , Borges Sofia , Oliveira Maria Joao , Guerra Graça , Ornelas Ilidio , Mendonça Isabel , Reis Roberto Palma Dos
Published: May 2024

Objective:

Arterial hypertension (AHT) is a multifactorial pathology in which environmental and genetic factors interact leading to the development of this pathology. The genetic influence on the onset of AHT has been addressed in candidate gene studies. Polymorphisms that interfere with sodium and water balance are described in the literature as associated with increased risk of AHT. However, there are few studies that study the synergism between them in the risk of AHT.

Objective: Evaluate whether there is a synergistic effect between two polymorphisms that interfere with sodium and water balance, alpha adducin (ADD1 G460W rs4961) and sodium epithelial channel (SCNN1G G(-173)A rs5718), in the increased risk of AHT.

Design and method:

A case-control study was conducted with a population of 1712 individuals (mean age of 51.0±7.9), depending on whether or not they had AHT. We obtained two groups: 860 hypertensive patients and 852 controls. All subjects collected blood for analytical tests and DNA for genetic analysis. The polymorphisms rs4961 and rs5718 were evaluated in both groups. The Odds Ratio (OR) with 95% confidence intervals were calculated. Data analysis was performed using SPSS for Windows, version 25.0. The significance threshold was set at p<0.05.

Results:

The WW genotype of ADD1 was more frequent in the hypertensive group than in the control group (OR 2.76; 95%CI:1.38-5.55; p=0.004). The GG genotype of SCNN1G was not statistically significant between both groups (OR 0.95; 95%CI: 0.78-1.16; p=0.597). However, when we associate the two genetic variants, there is an increased risk of AHT, with an OR of 7.68 (95% CI 1.75-33.73) with statistical significance (p=0.007).

Conclusions:

With our results, we can conclude that the alpha adducin polymorphism (ADD1 G460W) is a statistically significant risk factor for AHT, and the sodium epithelial channel polymorphism (SCNN1G G(-173)A) alone is not associated with AHT onset. However, when together, these two polymorphisms increase the risk of AHT to na OR of 7.7. These results lead us to conclude that AHT is not explained in a simple way with a single polymorphism, since there are synergistic effects between genes that favor the development of AHT.
THE EFFECTS OF RENIN-ANGIOTENSIN SYSTEM BLOCKERS IN REAL-LIVE HEMODIALYZED PATIENTS
Authors: Symonides Bartosz , Zaborska-dworak Maria , Lewandowski Jacek , Marcinkowski Wojciech , Zawierucha Jacek , Prystacki Tomasz , Malyszko Jolanta
Published: May 2024

Objective:

The prevalence of hypertension among patients with end-stage kidney disease (ESKD) undergoing hemodialysis (HD) ranges from 82-89% depending on applied diagnostic criteria and chosen method of blood pressure measurement. Despite the guidelines recommendations suggesting the wide use of renin-angiotensin system blockers (RASB) in patients with kidney disease, using RASB in patients on hemodialysis (HD) may be suboptimal, especially in patients with preserved diuresis.

Aim:This study aimed to compare hypertensive HD patients on multiple antihypertensive drug regimens, including diuretics, treated with RASB (RASB(+) group) or without RASB (RASB(-)).

Design and method:

From the database of 5879 patients receiving hemodialysis (mean age 65.2±14.2 yrs., 60% of males) of the biggest provider of HD in the country, we selected the subgroup treated with at least 3 antihypertensive medications including diuretics and compared patients treated with RASB(+) with counterparts (RASB(-)).

Results:

RASB(+) have similar age and gender proportions as well as BMI and bioimpedance compared with. However, dry body mass was significantly lower in RASB(+) group (78.1±18.3 kg vs. 80.0±18.2 kg, p<0.017). Diabetes mellitus prevalence was similar in both groups, but RASB(+) patients have cardiovascular diseases more frequently (70.1% vs. 60.8%; p<0.001). Systolic blood pressure and the number of antihypertensive drugs used were significantly higher in RASB(+) patients than in counterparts (146±16 mmHg vs. 144±15 mmHg; p<0.001 and 4.1±0.9 vs. 3.5±0.5; p<0001 respectively). RASB(+) patients have significantly longer dialysis vintage (52.7±44.4 months vs. 40.2±40.9 months; p<0.001) and dialysis time (722±87.1 min./week vs. 713±93.4 min./week; p<0.017) than counterparts. Also ultrafiltration was similar in both groups with even slightly higher eKt/V in RASB (+)(1.37±0.3 vs 1.33±0.3). Serum potassium was slightly, but significantly higher in RASB(+) (5.3±0.8 mmol/L vs. 5.1±0.7 mmol/L; p<0.01).

Conclusions:

In the real-life world, RASB can be safely used in HD patients treated with diuretics without compromising HD. Since many HD patients present numerous compelling indications for RASB, these drugs should not only be used as another drug for the treatment of poorly controlled hypertension, but also in a broader spectrum of HD patients.
BAROREFLEX SENSITIVITY AND HEMODYNAMIC RESPONSES DURING PHYSICAL AND MENTAL TESTS: A COMPARATIVE STUDY BETWEEN HEMODIALYSIS AND PERITONEAL DIALYSIS PATIENTS
Authors: Faitatzidou Danai , Theodorakopoulou Marieta , Dipla Konstantina , Koutlas Aggelos , Karagiannidis Artemios , Georgiou Areti , Dimitriadis Chrysostomos , Pateinakis Panagiotis , Papagianni Aikaterini , Zafeiridis Andreas , Sarafidis Pantelis
Published: May 2024

Objective:

Cardiac arrhythmias and sudden death are the leading causes of mortality in end-stage kidney disease (ESKD) and autonomic dysfunction is considered to play a predominant role. This is the first study to compare baroreflex sensitivity (BRS) and hemodynamic responses after mental- and physical-stimulation maneuvers between hemodialysis (HD) and peritoneal (PD) patients.

Design and method:

68 ESKD patients (34 HD and 34 PD patients matched for age, sex, and dialysis-vintage) were included. Continuous recordings from Finometer-PRO at rest and during mental-arithmetic, orthostatic, and handgrip-exercise tests were used for calculation of BRS and hemodynamic responses in each individual.

Results:

The two groups were similar in terms of age, sex, dialysis vintage and major comorbidities. BRS during mental (HD 3.59±2.62 vs PD 5.50±9.40 ms/mmHg, p=0.280) and physical stress tests (orthostatic: HD 3.23±2.42 vs PD 2.07±2.69 ms/mmHg, p=0.777) was similar between HD and PD patients. During mental test, both groups presented increases in SBP/DBP levels compared to rest (SBP HD: 156.3±27.7 vs 142.7±20.0mmHg, p<0.05; PD: 158.0±25.6 vs 143.1±23.6mmHg, p<0.05, respectively), but without significant between-group differences (p=0.853/p=0.611 respectively for SBP/DBP). Similarly, no significant between-group differences were noted in stroke volume, cardiac output, and total peripheral resistance during the same testing period. The mean SBP levels during the orthostatic test were significantly decreased compared to rest in both groups (HD: 135.4±26.8 vs 142.2 ±20.1 mmHg; p<0.05; PD 135.3±21.9 vs 143.1±23.6 mmHg; p<0.05), but the overall response was not different between-groups (p=0.937). Similarly, the responses to the other hemodynamic parameters were similar between HD and PD. Finally, the hemodynamic responses during handgrip exercise and recovery were not differed between HD and PD.

Conclusions:

BRS and hemodynamic responses to mental and physical stress tests were similar between HD and PD patients, suggesting that ANS function in ESKD is not affected by dialysis modality.
IMPACT OF HYPERTENSION ON OUTCOMES IN PATIENTS WITH MEMBRANOUS NEPHROPATHY
Authors: Sener Yusuf Ziya , Jabrayilov Jabrayil , Celebi Gorkem , Haberal Guldehan , Erdut Arda , Ayhan Arzu Saglam , Yeter Haci Hasan , Yildirim Tolga , Yilmaz Seref Rahmi , Altun Bulent , Erdem Yunus , Arici Mustafa
Published: May 2024

Objective:

Hypertension often accompanies glomerular diseases. There is existing data regarding the relationship between hypertension and worse outcomes in primary membranous nephropathy (MN). We aimed to evaluate the impact of hypertension on both renal and cardiovascular outcomes in cases with primary MN.

Design and method:

All patients diagnosed with MN between 2001 and 2022 were screened and cases with accessible data were enrolled. Coronary revascularization, occurence of atrial fibrillation, stroke, venous thromboembolic events and all-cause mortality were determined as cardiovascular outcomes. Progression to end-stage renal disease was described as the renal outcome.

Results:

A total of 172 patients were included. Mean age of the study population was 47.6±14.2 years and 57.6% of them were male. Hypertension was present in 74 (43%) patients. Patients with hypertension were older (54.8±12.1 vs. 41.5±13.2; p<0.001) and baseline glomerular filtration rate (85 vs. 110; p<0.001) was lower in cases with hypertension. Median follow-up was 109.4 (4.8-265.6) months. Baseline characteristics and outcomes are presented in Table 1. Coronary revascularization (16.2% vs. 3.1%; p=0.005) and all-cause mortality rates (24.3% vs. 8.2%; p=0.007) were significantly higher in patients with hypertension. There were no differences in the rates of stroke, atrial fibrillation, progression to end-stage renal disease and venous thromboembolic events between the two groups (Table 1). The predictors of all-cause mortality were coronary artery disease (HR:3.8, 95% CI=1.1-12.6; p=0.027) and albumin level (HR:0.4, 95% CI=0.18-0.86-12.6; p=0.019).

Conclusions:

Coronary revascularization and all-cause mortality rates are higher in primary MN cases with hypertension. Hypertension is not an independent predictor of all-cause mortality however increased comorbidity burden, accompanied coronary artery disease and low serum albumin levels indicating higher amounts of albuminuria seems to be the underlying causes of increased mortality.
HIGH BLOOD PRESSURE IN HEMODIALYSIS: PREVALENCE AND PROGRESSION
Authors: Saidi Fouzia , Bouaichi Yugarithen , Kherraz Sabrina , Ziani Mouloud
Published: May 2024

Objective:

High blood pressure (hypertension) is frequently found in chronic hemodialysis patients. It affects the prognosis by increasing the morbidity and mortality of patients.

The objective of our study was to assess the prevalence of hypertension and to study its evolutionary profile in chronic hemodialysis patients at the University Hospital of Béjaia

Design and method:

This is a three-year retrospective cross-sectional study of 40 patients who have been chronic hemodialysis patients for at least one year and are over 18 years of age. For each patient, we recorded age, sex, initial nephropathy, date of start of hemodialysis, blood pressure balance, fluid status and different treatments prescribed.

Results:

We included 40 haemodialysis patients: 24 men and 16 women. The average age of our population was 54.37± 15.33 years. The duration of hemodialysis was 08.17± 7.5 years. High blood pressure was found in 67.5%. All of our patients were on antihypertensive therapy at the start of dialysis. After 3 years of evolution, 55% of patients had reached the blood pressure target, 30% had a correct blood pressure without any therapy and 15% had not reached the blood pressure targets despite triple therapy.

Blood pressure balance in dialysis patients; Of course, it depends on adherence to treatment and hygienic and dietary rules, but also on effective dialysis and strict control of fluid balance in order to fight against volo-dependent hypertension.

Conclusions:

The control of hypertension in dialysis patients is essential and must include, in addition to adherence to treatment and dietary rules, adequate dialysis and strict control of dry weight, which must be assessed and adjusted periodically.
AMPK ACTIVATION AMELIORATES ANGIOTENSIN II-INDUCED DOWNREGULATION OF PODOCYTE ZO-1
Authors: Ha Tae Sun
Published: May 2024

Objective:

Angiotensin II (Ang II) promotes the development and progression of proteinuria and renal diseases and induces podocyte apoptosis. ZO-1 (zonular occludens-1) protein as a component of the slit diaphragm plays a pivotal role in glomerular permeability by connecting slit diaphragm structure and actin cytoskeleton. AMP-activated protein kinase (AMPK), as a sensor of cellular energy status, has been known to play an important role in the pathophysiology of metabolic diseases, including diabetes, and its renal complications. We investigated the role of AMPK on the changes of ZO-1 of podocyte induced by Ang II.

Design and method:

Mouse podocytes were incubated in media containing various concentrations of Ang II and AMPK-related agents. The changes of ZO-1 and permeability were observed by confocal imaging, western blotting, and permeability assay in the presence of Ang II.

Results:

Ang II induced the fusion of microvilli and the gap pores on podocytes, which were improved by AICAR, an AMPK activator. Ang II also reduced and disrupted the intercellular ZO-1 staining, resulting in increased podocyte intercellular permeability. The intensities of fluorescences and bands of ZO-1 protein were decreased by Ang II in a dose-dependent manner by confocal microscopy and western blot analysis, respectively. AICAR and metformin, AMPK activators, ameliorated the abnormal distributional changes and the protein of ZO-1. Losartan, Ang II type I receptor blocker, also ameliorated the decrease of ZO-1 protein.

Conclusions:

Our findings suggest that Ang II induces the relocation and suppression of podocyte ZO-1 via Ang II type 1 receptor which is ameliorated by AMPK-activating agents.
ALBUMINURIA IS AN IMPORTANT PREDICTOR FOR ALL CAUSE MORTALITY IN GENERAL RURAL POPULATION
Authors: Domislovic Marija , Capak Krunoslav , Gellineo Lana , Jelakovic Ana , Dika Zivka , Prlic Margareta Fistrek , Stambuk Sandra Karanovic , Brinar Ivana Vukovic , Dapic Kresimir , Jelakovic Bojan
Published: May 2024

Objective:

Albuminuria stands as a robust predictor of both cardiovascular and all-cause mortality, despite that there remains a notable gap in understanding how albuminuria's association with mortality varies across subgroups defined by sex, comorbidities and estimated glomerular filtration rate (eGFR). The aim of this study was to determine whether the association between albuminuria and mortality differs according to eGFR, sex, and comorbidities.

Design and method:

This prospective observational study includes 857 adult subjects from the ENAH rural study in Croatia. Albuminuria, the ratio of urinary albumin to creatinine (ACR) was subsequently categorized into two levels as >30mg/g (group A) and <30mg/g (group B).

Results:

Subjects from the group A were older (70.5 vs. 49.0 years), had a higher BMI (29.7 vs. 27.4 kg/m2), and lower eGFR (69.3 vs. 85.2 ml/min/1.73m2). They had higher prevalence of arterial hypertension (AH) (78.2% vs. 53.3%) and diabetes (DM) (30.8% vs. 11.9%) (p<0.001 for both). A significantly higher mortality rate (64.1% vs. 27.3%, p<0.001) was observed in Group 1 compared to the group 2.

In logistic regression analysis the highest odds of mortality were observed for ACR>30mg/g (OR=2.43, 95%CI=1.40-4.19, p=0.002), followed with male gender (OR=1.79, 95%CI=1.28-2.49, p<0.001), DM (OR=1.71, 95%CI=1.10-2.67, p=0.018), eGFR < 60 (OR=1.71, 95%CI 1.00-2.94 and AH (OR=1.55, 95%CI=1.06-2.27, p=0.025).

Conclusions:

Our study underscores the significant impact of albuminuria on all-cause mortality in general rural population indicating that this diagnostic tool should be included in everyday clinical work.
DOSE-RESPONSE EFFECT OF SODIUM REDUCTION ON BLOOD PRSSURE IN TREATED HYPERTENSIVES: A SYSTEMATIC REVIEW AND INSTRUMENTAL VARIABLE META-ANALYSIS
Authors: Song Jing , Chen Liangkai , Xiong Hui , Ma Yuan , Pombo-rodrigues Sonia , Macgregor Graham , He Feng
Published: May 2024

Objective:

To evaluate the dose-response effects of a reduction in dietary sodium intake on blood pressure (BP) in hypertensive individuals who were on antihypertensive treatments. The impact of antihypertensive-drug class was also examined.

Design and method:

We searched Medline (via Ovid), Embase, Scopus, Cochrane Central Register of Controlled Trials, and reference lists of relevant articles up to 12 November 2023. We included randomised controlled trials (RCTs) comparing the effect on BP between different levels of dietary sodium intake in adults who were diagnosed as primary hypertension and treated with constant antihypertensive medications during the study period. We excluded RCTs with duration < 2 weeks. Dietary sodium intake was measured using 24-hour urinary sodium excretion. Instrumental variable meta-analyses were conducted to evaluate the dose-response effects of sodium reduction on BP. Subgroup analysis and multivariate meta-regression analysis were performed to examine the impact of antihypertensive-drug class.

Results:

35 studies with 2885 participants were included. The pooled estimates of mean reduction in 24-hour urinary sodium excretion, systolic BP (SBP), diastolic BP (DBP), and mean arterial pressure (MAP) were 68.74 (95% confidence interval: 62.30-75.19) mmol, 4.33 (3.37-5.29) mmHg, 2.60 mm Hg (2.04-3.17), and 3.19 (2.50-3.87), respectively. For every 100 mmol reduction in 24-hour urinary sodium excretion, SBP, DBP, and MAP decreased by 6.81 (4.96-8.66) mmHg, 3.85 (2.26-5.43) mmHg, and 4.83 (3.22-6.44) mmHg, respectively (Fig 1). The observed dose-response effects differed across class of antihypertensive medication (P-diff = 0.084 for SBP, and P-diff<0.05 for DBP and MAP). In Beta-blockers, Renin-Angiotensin-Aldosterone System (RAAS) inhibitors, and dual therapy groups, significant dose-response effects of sodium on SBP, DBP and MAP were observed. In Calcium Chanel Blockers (CCB) group, the dose-response relationship was only found for SBP. No dose-response effect on BP was observed in diuretics monotherapy group.

Conclusions:

Pooled evidence of RCTs suggests a dose-response relationship between sodium reduction and BP in treated hypertensives, which is impacted by class of antihypertensive medications.
PERSISTENT EFFECT OF SALT REDUCTION IN SCHOOLCHILDREN AND THEIR FAMILIES: ONE-YEAR FOLLOW-UP AFTER A RANDOMISED CONTROLLED TRIAL
Authors: Li Yuan , Zhang Puhong , He Feng J , Luo Rong , Song Jing , Wang Changqiong
Published: May 2024

Objective:

A previous 12-month randomised controlled trial (RCT) demonstrated the effectiveness of an application-based education program, conducted through schoolchildren, in reducing the salt intake and systolic blood pressure of their adult family members. This study aimed to assess whether the effect at 12 months persisted at 24 months.

Design and method:

As a follow-up survey of a cluster RCT with 54 schools randomly assigned to either the intervention or control group, all participants who completed the baseline survey were contacted again at 24 months, following a 12-month non-intervention period after the RCT. The primary outcome was the difference in salt intake change between the intervention and control groups at 24 months versus baseline and 12-month follow-up, measured by the mean two consecutive 24-hour urinary sodium excretions. The secondary outcome was the difference in blood pressure change.

Results:

At 24 months, 542 children and 974 adults were followed up, accounting for 91.6% and 82.3% of the participants, respectively. The mean salt intake in adults at baseline, 12 months and 24 months was 10.0 g/day (standard deviation 3.5), 8.9 g/day (standard deviation 3.2) and 9.4 g/day (standard deviation 3.5) in the intervention group and 10.0 g/day (standard deviation 3.6), 9.8 g/day (standard deviation 3.9) and 9.8 g/day (standard deviation 3.9) in the control group. The mean difference in salt intake change in adults between the intervention and control groups after adjusting for confounding factors is -0.38 g/day at 24 months versus baseline (95% confidence interval -0.81 to 0.05, P=0.086), and 0.45 g/day at 24 months versus 12 months (95% confidence interval 0.01 to 0.85, P=0.046). The mean difference in systolic blood pressure change after adjusting for confounding factors is -2.19 mm Hg (95% confidence interval -3.63 to -0.76, P=0.003) at 24 months versus baseline and -0.40 mm Hg (95% confidence interval -1.86 to 1.07, P=0.596) at 24 months versus 12 months.

Conclusions:

The effect of the education program on adults’ salt intake faded, but the systolic blood pressure lowering effect remained 12 months after the RCT. Continuous salt reduction education is recommended to maintain the effect.
ALCOHOL DRINKING MAY MODIFY THE ASSOCIATION BETWEEN HDL-CHOLESTEROL AND CORONARY CALCIUM SCORE IN AN OLDER POPULATION
Authors: Chuang Shao -Yuan , Wu Ming -Ting , Chung Ren -Hua , Lai Chia -Hung , Liu Wen -Ling , Chang Hsing -Yi , Hsiun Chao Agnes , Chuang Shu -Chun , Wu I -Chien , Hsu Chih -Cheng
Published: May 2024

Objective:

The associations between lipids and Coronary Calcium Score (CAC score) remain controversial. We aimed to investigate if high-density lipoprotein cholesterol (HDL-C) is correlated with Coronary Calcium Score among older adults.

Design and method:

A total of 819 older aged more than 55 years old (Men: 378 and Women: 441) without coronary sent from the Healthy Aging Longitudinal Study in Taiwan were evaluated the Coronary Calcium Score by Low-Dose CT Scan in 2023. The metabolic features were measured at baseline (2nd wave 2014∼2019). CAC score was calculated by the Agatston score formula by an FDA-approved automated AI program (AView, Coreline) and modified by an experienced cardiac CT technologist if necessary. Linear and logistic regression were used to investigate the association between HDL-cholesterol and CAC score.

Results:

The median [Q1 and Q3] of CAC score was 122.6 [23.2 and 392.7]. The proportion of all older adults was 20.15% (n=165) for CAC Score less than ten, 55.31% (n=453) for CAC score between 11 and 400, and 24.5% for CAC score more than 400. HDL-Cholesterol (age-sex adjusted R [adj-R]=-0.208, p<.0001) and triglycerides (adj-R=0.122, p<.0001) were significantly associated with log-CAC, but LDL-cholesterol (adj-R=-0.005, p=0.8915) and total cholesterol(adj-R=-0.054, p=0.1237) did not. All blood pressure measures, body mass index, and waist circumference were significantly positively associated with log-CAC. Older age, male gender, elevated systolic blood pressure, higher HBA1C, and lower HDL-C were independently associated with CAC. Furthermore, HDL-C was significantly associated with log-CAC Score in those with alcohol drinking habits (standardized beta [STB] = -0.207, p=0.003), but not in those without alcohol drinking habits (STB=-0.05, p=0.2717) (p-value for interaction=0.016). The odds ratios of low HDL-cholesterol (<40 for men and <50 mg/dL for women) at baseline for higher CAC (<10, 11∼400, 400+) were 1.91 (95% confidence intervals: 1.10∼3.31) and 1.26 (0.85∼1.85) for those with and without alcohol drinking habits, respectively.

Conclusions:

Lower HDL-cholesterol was associated with higher future CAC scores among older adults in this retrospective design. Furthermore, this association could be altered by alcohol consumption.
CORRELATES OF BODY FAT MASS INDEX (FMI) AND FAT FREE MASS INDEX (FFMI) WITH HYPERTENSION IN THE HMAR TRIBES OF NORTHEAST INDIA
Authors: Lalnuneng Abigail
Published: May 2024

Objective:

The ongoing obesity epidemic highlights the significant impact of body fat on health. The present aim to understand the relationship between hypertension and height-normalized indices, namely the fat-free mass index (FFMI) and fat mass index (FMI).

Design and method:

A cross-sectional sample of 1207 Hmar adults (Scheduled Tribes of India), with 615 from rural and 592 from urban areas in Manipur, Northeast India, was collected. Body composition was assessed using an Omron Bioelectrical Impedance Analyzer (OBIA). Body Mass Index (BMI) was divided into FMI (BFM in kg divided by the square of height in meters) and FFMI (FFM in kg divided by the square of height in meters). Blood pressure (BP) data were collected using a standard mercury sphygmomanometer and a stethoscope, cross-validated with a digital BP monitor, and classified based on the 7th Report of the Joint National Committee (JNC) guidelines on hypertension.

Results:

Table 1 shows that 36.4% and 17.4% of Hmars in rural areas had pre-hypertension and hypertension, respectively. In urban areas, these proportions are 40.9% and 24.7%, respectively. There are differences in hypertension between rural and urban areas, and between males and females within rural and urban areas.

Table 2 shows the prevalence of hypertension by FFMI and FMI according to sex and settings. Hypertension is significantly associated with higher FFMI and FMI in males, except for FFMI in rural men. Males with higher FFMI (Chi-square = 7.08∗∗) and FMI (Chi-square = 7.63∗∗) have experienced different risks of hypertension depending upon places of residence. In females, the prevalence of hypertension is significantly higher in women who have higher FFMI and FMI in both the settings. Unlike males, females experienced a similar risk of hypertension in both the settings at the same FMI and FFMI.

Conclusions:

In conclusion, the findings from this study provide crucial insights into the prevalence of hypertension among the Hmar population, emphasizing the significance of body composition indices –FMI and FFMI. The observed disparities in hypertension prevalence between rural and urban areas, as well as between genders, underscore the need for targeted public health interventions.
CARDIORESPIRATORY FITNESS, HIGH BODY FAT PERCENTAGE AND THE RISK OF CORONARY CALCIFICATION IN MIDDLE–AGED MEN
Authors: Koh Jonghoon , Kang Minjeang , No Changseok
Published: May 2024

Objective:

Low levels of cardiorespiratory fitness (CRF) have been showed to increase the risk of cardiovascular disease(CVD). We tested the hypothesis that central obesity is associated with coronary artery calcification (CAC), but that fitness attenuates this association.

Design and method:

We analyzed men who participated in a health screening program. We measured CAC using multidetector computed tomography (MDCT) with a calculation of Agatston coronary artery calcium score. CAC score over 400 were defined as the prevalence of moderate to severe subclinical atherosclerosis.

Central obesity was defined as body mass index (BMI) over 25kg/m2 and body fat percentage (BFP) over 30% in men. Fitness was directly measured by peak oxygen uptake (VO2peak) and divided into unfit (low tertile) and fit (middle and upper tertile) categories based on age-specific VO2peak percentiles.

Results:

Compared with normal weight men, central obese men was associated with a higher prevalence of CAC after adjusting for age, SBP, lipid profile, logCRP, s-glucose, heart rate, diabetes, and hypertension. The fit men was associated with lower odds ratios for having CAC. However, the fit with central obesity had odds ratios for CAC that were similar to those of the fit with normal weight.

Conclusions:

Our findings demonstrate that BMI and BFP are associated with increased risk of moderate to severe CAC score, but that high fitness appears to attenuate the risk in men.