bluuebunny/crossref_metadata_2025 huggingface dataset:
ASSOCIATION BETWEEN ARTERIAL STIFFNESS AND LEFT ATRIAL FUNCTION IN PATIENTS WITH HYPERTENSION
Authors: Kim Minkwan , Jung In Hyun , Bae Sunga
Published: June 2023

Objective:

The association between arterial stiffness and left ventricle (ventricular-arterial coupling) has been demonstrated by several studies. Left atrial reservoir strain (LARS), one of the indicators of left atrial function, is known to predict prognosis, early diagnosis, and recurrence after an intervention. However, the association between arterial stiffness and LARS is not well studied.

Design and method:

From August 2021 to November 2022, we obtained data retrospectively from the patients with hypertension visiting a cardiovascular clinic and conducting both exams of transthoracic echocardiography and brachial-ankle pulse wave velocity (baPWV) in a single referral hospital. Patients with significant structural heart disease were excluded. Pearson's correlation analysis was used to analyze the linear correlation between baPWV and LARS. In addition, we used multivariable logistic regression analysis to evaluate the diagnostic performance of LARS to predict increased arterial stiffness.

Results:

The 202 participants were enrolled in the present study (62.3 ± 14.0 years and 57.7% male). The median baPWV value was 15.6 m/s (interquartile range 13.7 to 18.4). Fifty-four participants (26.7%) had more than 18.0 m/s. Participants with increased arterial stiffness were older and had higher systolic blood pressure, and higher use of calcium channel blocker, but lower level of hemoglobin and estimated glomerular filtration rate. Among echocardiographic parameters, participants with increased arterial stiffness had lower septal e’, but higher septal E/e’, peak velocity of tricuspid regurgitation, and LA volume index. There were no significant differences in systolic parameters, including left ventricular (LV) ejection fraction and LV global longitudinal strain. LARS showed a modest correlation with baPWV (r = -0.320, p<0.001). Participants with increased arterial stiffness had lower LARS than those without (25.0 ± 9.2% vs. 30.4 ± 7.2%, p<0.001). In multivariable logistic regression analysis, LARS was an independent variable affecting increased arterial stiffness with demographic, laboratory, and echocardiographic parameters (adjusted odds ratio 3.41, 95% confidence interval 1.14-10.22, p = 0.029)

Conclusions:

Increased arterial stiffness measured by baPWV was associated with decreased LA function evaluated with LARS.
FEATURES OF MYOCARDIA DEFORMATION PROPERTIES IN PATIENTS WITH ARTERIAL HYPERTENSION
Authors: Bekmetova Sevara , Abdullaeva Guzal , Khamidullaeva Gulnoz , Yusupova Khafiza
Published: June 2023

Objective:

Determination of myocardium deformation properties depending on degree of arterial hypertension and the presence/absence of left ventricular hypertrophy (LVH) in patients with arterial hypertension.

Design and method:

74 patients of both sexes, with I–III degrees of AH (ESC/ESH, 2018) were studied. Average age of patients was 58.72 ± 11.9 years; AH duration was 10.8 ± 7.2 years. Speckle-tracking EchoCG was performed to obtain an objective and quantitative assessment of global and regional myocardial function using the ACUSON x 700 PV 2.0 manufactured by SIEMENS. Among the parameters for assessing the longitudinal deformation of the left ventricle, we have chosen: global longitudinal strain -GLS (%); Strain Rate-SR. To study the segmental LV contractility, analyzed the apical 4-chamber, 3-chamber and 2-chamber section. Results are presented as M±SD.

Results:

The patients were divided into 3 groups: I- patients with AH I degree, n = 21 (28.4%); II n = 28 patients with II degree of AH (37.8%); III n = 25 (33.8%) patients with III degree of AH. A comparative analysis of groups showed that in patients with grade III AH, the indicators of GLS and the rate of myocardial deformation are significantly lower than in groups of patients with grades I and II of AH. The index of GLS in group III was: 10.3±3.6%, while in group I - 18.1±4.4% and in group II - 11.8% (p = 0.000). The same was noted in terms of SR: 1.0±0.3 s-1 versus 1.5±0.6 s-1 and 1.1±0.5 s-1, respectively (p = 0.001). To study the deformation properties of the myocardium, patients were divided into 2 groups: patients with LVH and without LVH. In 1st group, the GLS index was lower, 14.9±5.8%, than in 2nd group – 17.9±6.1% (p<0.05); the SR index in the group of patients with LVH was also lower- 1.64±0.75 s-1, than in the group of patients without LVH - 1.87±0.81 s-1 (p<0.05).

Conclusions:

Thus, significant violations of the deformation properties of LV are formed in patients with AH with an increase of degree of AH and the presence of LVH.
METABOLIC PREDICTORS OF TARGET ORGAN DAMAGE IN ESSENTIAL HYPERTENSION
Authors: Allievi Luca , Gherbesi Elisa , Meazza Roberto , Villarini Anna , Lombardi Federico , Carugo Stefano
Published: June 2023

Objective:

First, to verify the relationship between hypertension-mediated organ damage (HMOD) and measures of abdominal obesity in essential hypertension. Secondly, to evaluate which condition between overweight (BMI>25 kg/m2), high waist circumference (WC>80/94 cm in females/males) and waist-to-height ratio (WHtR>0.54) is more predictive of HMOD.

Design and method:

We selected a cohort of adult treated essential hypertensive subjects followed at our Hypertension Center. Blood pressure (BP), height, weight and WC were measured in all subjects. Various investigations were also performed to identify HMOD, such as echocardiography, carotid ultrasound, carotid-femoral pulse wave velocity (PWV) and fundoscopy.

Results:

114 subjects were enrolled (46/68 females/males, mean age 69±2 years, mean BP 135/77±3/2 mmHg). WC and WHtR were higher in patients with all expressions of HMOD except for hypertensive retinopathy. In particular, left ventricular mass index (LVMi/BSA) correlates with WHtR (p<0.05), while in obese subjects, in which ventricular mass was indexed as LVMi/h2.7, both WC and WHtR significantly correlate (p<0.05). In subjects with WHtR>0.54, there was a significant risk of increased arterial stiffness by PWVs (OR = 2.479, p = 0.04). This data is confirmed in subjects with BMI>25 kg/m2 (OR = 2.888, p = 0.04) but not in subjects with BMI<25 kg/m2, while no significance was observed for high WC. In the presence of HMOD, a significantly higher number of metabolic syndrome factors (MetS) was observed (3.1 vs. 2.06, p = 0.0008). An OR of 7.55 (p = 0.01) for the presence of HMOD was observed in subjects diagnosed with MetS.

Conclusions:

In our population, the presence of abdominal obesity may indicate a greater risk of developing HMOD (especially left ventricular hypertrophy and increased arterial stiffness) in essential hypertensive patients. WHtR may be a more sensitive indicator than WC. Furthermore, the significant increase in the risk of HMOD in the presence of MetS may indicate that the synergy between multiple risk factors correlates more strongly with the development of HMOD. Therefore, in the management of essential hypertension, it is of great importance to combine drug therapy with a strategy of reduction of abdominal adipose tissue and the other MetS factors.
ASTRAGALOSIDE IV IMPROVED OXIDATIVE STRESS INDUCED INJURY THROUGH PINK1/PARKIN-MEDIATED MITOPHAGY IN H9C2 CELLS
Authors: Miaomiao Qi , Sun Runmin , Wang Qiongying , Yu Jing
Published: June 2023

Objective:

To explore the mechanisms of Astragaloside IV on improving the oxidative stress induced injury in H9c2 cells.

Design and method:

H9c2 cells were divided into normal control group (cultured without intervention), H2O2 model group (cultured with 200umol/L H2O2 for 2 hours), As-IV with H2O2 group (pretreated with 100umol/L As-IV for 1 hour, then incubated with H2O2 for 2 hours) and Mdivi-1 with H2O2 group (pretreated with 5umol/L Mdivi-1 for 1 hour, then incubated with H2O2 for 2 hours). The activity of lactate dehydrogenase (LDH) in cell culture medium was measured to evaluate the degree of oxidative damage of cells, and the protein levels of Bax, Bcl-2, Drp1, LC3, PINK1 and Parkin in each group were detected by Western blot. The statistical analysis of the experimental results was carried out by SPSS13.0 software.

Results:

1. Apoptosis of cells in each group: Compared with the normal control group, the expression of Bax in the H2O2 group increased (P<0.05), and the expression of Bcl-2 decreased [P<0.05]; compared with H2O2 group, the expression of Bax in As-IV group decreased (P<0.05), Bcl-2 The expression increased (P<0.05). 2. Oxidative stress damage of cells in each group: Compared with the normal control group, the LDH activity of cells in the H2O2 group increased, and compared with the H2O2 group Compared with that, the LDH activity of As-IV group decreased. 3. Mitochondrial dynamic expression: Compared with the normal control group, the expression of Drp1 in the H2O2 group increased; compared with the H2O2 group, the expression of Drp1 in the As-IV group and the Mdivi-1 group decreased. 4. The expression of mitophagy-related proteins in each group: Compared with the normal control group, the ratio of autophagy-related proteins LC3-II/LC3-I in the H2O2 group increased, and the expression of PINK1 increased (P<0.05), the expression of Parkin was significantly increased (P<0.05); compared with the H2O2 group, LC3-II/LC3-I in As-IV group and Mdivi-1 group decreased, the expression of PINK1 and Parkin proteins in As-IV group and Mdivi-1 group decreased .

Conclusions:

As-IV inhibited mitophagy through the PINK1/Parkin pathway, and alleviated oxidative stress induced injury in H9c2 cells.
BLOOD LEVELS OF INTERLEUKIN-17A IN PATIENTS WITH ARTERIAL HYPERTENSION AND ITS RELATIONSHIP WITH THE CHARACTERISTICS OF THE COURSE OF DISEASE
Authors: Koval Sergiy , Snihurska Irina , Starchenko Tetyana , Lytvynov Vadim , Penkova Marina , Mysnychenko Olga , Lytvynova Olga
Published: June 2023

Objective:

One of the most important links in the pathogenesis of arterial hypertension (AH) is currently considered to be the activation of subclinical inflammation. Interleukin-17A (IL-17A) is a proinflammatory cytokine produced by cells of the immune system, predominantly Th17 lymphocytes. The objective of the study was to evaluate the changes in blood levels of IL-17A in patients with AH and its relationship with the characteristics of the course of the disease.

Design and method:

The study involved 65 patients with grade 2-3 AH (34 men and 31 women aged 37 to 59 years) and 22 practically healthy individuals in the control group (12 men and 10 women aged 19 to 47 years). Patients were examined using standard clinical, laboratory and instrumental methods. The scope of the study also included the determination of blood levels of IL-17A and highly sensitive C-reactive protein (hsCRP) by the enzyme immunoassay. Examination of all patients and persons of the control group was carried out before the start of the war in Ukraine.

Results:

A significant increase in blood levels of IL-17A was established in general in the group of patients with 2-3 degree AH ((7.12 [4.74;10.67]) pg/mL, P <0.05) in comparison with practically healthy individuals ((3.24 [0,96;4,59]) pg/mL). The highest blood levels of IL-17A were found in patients with AH with a more pronounced increase in blood pressure (BP) up to the 3rd degree of AH ((9.87 [5.98;13.56]) pg/mL, P<0.05) compared with the levels of this factor in patients with 2nd degree of AH ((5.85 [3,66;8,12]) pg/mL). Significant positive correlations were found between blood levels of IL-17A and hsCRP (P = 0,023), left ventricular mass index (P = 0,027) and systolic BP (P = 0,036).

Conclusions:

In patients with grade 2-3 AH, a significant increase in blood levels of proinflammatory cytokine IL-17A and its relationship with indicators of activation of subclinical inflammation, the severity of hypertrophic remodeling of the heart, and the severity of hypertension were found.
THE EFFECT OF A DIGITAL HEALTH INTERVENTION ON PEOPLE WITH DIAGNOSED AND UNDIAGNOSED HYPERTENSION: A RETROSPECTIVE COHORT ANALYSIS
Authors: Ogboye Ayoposi , Munnee Maria Moosa , Ifeolu Ayanfe , Malumi Oluwaseyi , Mobisson Nneka
Published: June 2023

Objective:

This study aims to show that a digital health intervention can help people with diagnosed or undiagnosed hypertension reduce their blood pressure and control their disease.

Design and method:

This retrospective study was conducted in January 2023 on people who reported a diagnosis of hypertension (self-reported group) or who logged in a systolic blood pressure of > = 140 mmHg or a diastolic blood pressure of > = 90 mmHg (undiagnosed group) who were enrolled on CompleteHealth™ between January and June 2022. CompleteHealth™ is a digital platform that allows members to access both a coach-led multidisciplinary care team and a platform for monitoring and tracking their health. The care team (comprising nutritionists, behavioural wellness coaches, and a fitness coach) engages with the members through an omnichannel approach. It provides regular digital nudges on monitoring their blood pressure, health education, and nutritional advice. The members work with their health coaches to create personalised action plans to achieve their health goals, e.g increased exercise, weight loss, and better diets.

Results:

1,203 people in both groups enrolled on CompleteHealth™ over the study period and entered a baseline and follow-up value for their blood pressure. 242 (20.12%) of these people self-reported a diagnosis of hypertension, while 961 (79.88%) presented with a baseline blood pressure of >140/90 mmHg. In the self-reported group, 93 people (38.43%) had controlled blood pressure at baseline, which rose to 150 (61.98%) at the end of the study. The group saw their average blood pressure fall from 149/95 mmHg to 131/85 mmHg at the end of the study. The undiagnosed group saw the number of people with controlled blood pressure rise from 68 (7.08%) to 695 (72.32%), while the average blood pressure of the group fell from 140/94 mmHg to 129/82 mmHg at the end of the study.

Conclusions:

While there is a need for further awareness about hypertension, especially to encourage testing and diagnosis, we have been able to show that the combination of a digital health intervention and virtual health coaching can help people who have hypertension or elevated blood pressure control their blood pressure.
COMPARISON OF FIRST RESULTS OF RADIOFREQUENCY RENAL DENERVATIONS WITH FIRST AND SECOND GENERATION TECHNIQUES
Authors: Légrády Péter , Fejes Imola , Schulcz Domonkos , Nagy Ferenc Tamás , Ungi Imre , Ruzsa Zoltán , Ábrahám György
Published: June 2023

Objective:

A form of renal denervation, when using radiofrequency technique, thermal energy destroys the nerve-fibres around the renal artery. The Symplicity FlexTM was the first such catheter, an improved new generation version of it is the Symplicity SpyralTM catheter. In the Albert Szent-Györgyi Health Center of the University of Szeged, renal denervations were performed with both devices in hypertensive patients whose blood pressure could not be reduced to the goal range with multiple antihypertensive combinations.

Design and method:

With the first generation catheter, only the main branch was ablated at 4-5 points per side, and with the Symplicity SpyralTM catheter, even the segmental small branches together with the main branches were ablated at a total of at least 16-18 points per side.

Results:

With the old method after RDN, SBP decreased by 40 mmHg and DBP by 20 mmHg. The reduction was greatest 1 month after the intervention, 45 and 35 mm Hg. But did not reach the goal values. With new method after RDN, SBP decreased by 38 mmHg and DBP by 27 mmHg. The reduction was greatest 1 month after the intervention, 49 and 37 mm Hg. With the new the SBP was already in the target range after the intervention and remained there for 6 months. In addition, the number of antihypertensives could be significantly reduced. With the old method the goal BP value could not be achieved. Vascular complications did not occur in either case of interventions.

Conclusions:

Our first result with the Symplicity SpyralTM catheter according to the new concepts supports the view that more accurate ablation and preferably distal ablation can lead to more effective blood pressure reduction.
CHARACTERISTIC OF RESPONDERS TO RENAL DENERVATION - CROATIAN REAL-LIFE STUDY
Authors: Jelakovic Ana , Begic Zvonimir , Basic Matija , Barisic Klara , Perkov Drazen , Lovric Mila , Sarac Antonela , Dika Zivka , Stambuk Sandra Karanovic , Zivko Marijana , Josipovic Josipa , Ambramovic Ivana , Kacinari Patricia , Jelakovic Bojan
Published: June 2023

Objective:

Heterogeneity in response to renal denervation (RDN) is acknowledged phenomena and one of most important tasks in this field is to find reliable predictive biomarker for positive response. Our aim was to analyse characteristics of resistant hypertensive patients who were responders 6 months after RDN.

Design and method:

Out of 31 truly resistant patients whom secondary forms of hypertension were ruled out and were enrolled into the Croatian Spyral RDN registry, 18 (10 m, 8 w, average age 49.3) were eligible for analyses. Office BP, ABPM, central BP and PWV were measured with Omron M6, Molbilograph and Sphygmocor devices, respectively. Sympathetic/parasympathetic activity was measured with ANX-3.0 ANSAR device.

Results:

Responders were 6.7 years older, less obese with at basal slightly higher eGFR (88.6 vs. 79.8), uric acid (406.5 vs. 376.4), salt intake (12.6 g/day vs.9.8 g/day) and had significantly higher basal office BP (169.5/99.7 vs. 153.3/96.5) as well as ABPM values. Central aortic systolic BP and Aix were higher in responders (154.5 vs, 147.1; 31.5 vs 27.3) without difference in PWV (10.1 vs. 9.6). Responders had lower values of PP amplification (1.22 vs. 1.33). Significantly higher basal sympathetic activity (LFa/RFa) was determined in responders than in non-responders (6.68 vs. 1.25).

Conclusions:

Responders were older with higher basal office BP, ABPM but also higher central BP and Aix with lower pulse pressure amplification. They ingested more salt, had higher values of uric acid and importantly had more exaggerated sympathetic activity. Whether some of identified parameters could be considered as a biomarker for positive response in resistant hypertensive patients should be determined in larger cohort of patients.
EFFECT OF RENAL DENERVATION ON THE PLASMA ADIPONECTIN CONCENTRATION IN PATIENTS WITH RESISTANT HYPERTENSION
Authors: Adamczak Marcin , Czerwienska Beata , Lelek Michal , Gojowy Damian , Surma Stanislaw , Mizia-Stec Katarzyna , Wiecek Andrzej
Published: June 2023

Objective:

Adiponectin is produced by white adipose tissue and has anti-diabetic, anti-atherosclerotic, anti-thrombotic, anti-inflammatory, and cardioprotective properties. In patients with arterial hypertension plasma concentration of adiponectin is lower than in healthy subjects. Renal denervation (RDN) i.e. percutaneous ablation of fibers from the sympathetic nervous system located in the wall of the renal arteries by radio frequency waves, is a method of resistant arterial hypertension treatment. The aim of this single center, interventional, clinical study was to assess the effect of RDN on the plasma adiponectin concentration in patients with resistant arterial hypertension.

Design and method:

Twenty-six patients (12 women, 14 men) aged 54.0±7.8 years with resistant hypertension who underwent RDN using Simplicity catheters (Medtronic, Inc., Northridge, CA) were enrolled in the study. Plasma adiponectin concentration was determined using the Human Adiponectin ELISA Kit (Otsuka Pharmaceutical Co, Tokyo, Japan) before the RDN and 6 and 12 months after this procedure.

Results:

Blood pressure (BP) values before RDN and 6 and 12 months after RDN were as follow: systolic BP - 190.4±24.5, 160.8±14.5, 155.7±17.9 mmHg (p<0.001) and diastolic BP - 111.7±18.9, 88.9±8.3, 91.2±10.2 mmHg (p<0.001), respectively. Body mass index (BMI) before RDN, 6 and 12 months after RDN were 31.5±4.2, 30.5 ±4.4, 30.2±4.0 kg/m2, (p = 0.057), respectively. Plasma adiponectin concentration before the RDN and 6 and 12 months after RDN were 6.93±4.85, 7.94±3.97, 8.83±6.12 [μg/ml] (p = 0.007), respectively. In the follow up i.e. 6 and 12 months after RDN plasma adiponectin concentration increases significantly in responders (systolic BP decrease higher or equal 25 mmHg) (7.93±6.14, 8.87±4.68, 10.57±7.51 [μg/mL]; respectively]; p = 0.03, and did not change significantly in low-responders to RDN (systolic BP decrease < 25 mmHg) (5.76±2.45, 6.86±2.76, 6.81±3.19 [μg/mL]; respectively; p = 0.2).

Conclusions:

1. Plasma adiponectin concentration increases significantly after successful RDN in patients with resistant arterial hypertension. 2. Higher plasma adiponectin concentration may participate - beyond blood pressure reduction - in the cardiovascular benefits related to successful RDN, however clinical consequences of our results need further investigations.
FACTORS ASSOCIATED WITH DECREASED LONGITUDINAL FUNCTION IN RENAL FAILURE HYPERTENSIVE PATIENT
Authors: Bendiab Nabila Taleb , Nigassa Nawel Brikci , Bencheboub Izzeddine , Benkhedda Salim
Published: June 2023

Objective:

Although the combination of arterial hypertension and renal insufficiency (RI) increases the risk of left ventricular (LV) dysfunction, the impact of renal insufficiency on LV geometry and subclinical dysfunction in hypertensive patients with normal ejection fraction (EF) has rarely been evaluated. The objective of this work is to study the correlation between renal failure and the early onset of hypertensive heart disease, as well as the determination of the associated factors influencing this subclinical heart attack.

Design and method:

A cross-sectional analytical study was carried out in 200 hypertensive patients recruited from the outpatient cardiology consultation, divided into: 100 patients with and 100 without concomitant renal failure.

Hypertensive patients with or without renal failure underwent cardiac echocardiography coupled with an evaluation of the global longitudinal deformity (GLS) of the LV

Results:

Among the 200 patients with hypertension (mean age 61.7 ± 8.5 years) and EF >55%, 100 had associated renal impairment. Patients with IR had more diabetes(60.5%vs. 36%, p = 0.002), higher BP levels (160±19/81±13 vs. 139±14/74±11, p = 0.000), higher VG mass index (116.05±31.1vs. 110.6±24.8g/m2, p = 0.007) andhigher relative wall thickness (0.46±0.08 vs. 0.44±0.07 p = 0.0001). They more frequently had concentric remodeling (28(28%) vs. 19(19%), p = 0.008), concentric hypertrophy (46(46%) vs. 38(38%), p<0.0001), pressures filling volumes (7.4±3.0vs. 6.0±2.1, p = 0.001), indexed left atrial volumes greater than 28 mL/m2 (18.8±8.1 vs.15.5±6.0, p = 0.004), and reduced GLS less than 18% (70% vs. 48%, p < 0.0001). After adjusting for BP and diabetes, IR remains an independent determinant of GLS decline (OR = 2.26, 95% CI 1.11–4.61, p = 0.023).

Conclusions:

Left ventricular geometry and subclinical LV function assessed with GLS are more impaired in hypertensive patients with renal failure. Preventive approaches to control the risk of onset of renal failure in hypertensive patients should be emphasized.
INVASIVE VALIDATION OF THE ANTARES ALGORITHM FOR ESTIMATING CENTRAL BLOOD PRESSURE IN PATIENTS WITH CHRONIC KIDNEY DISEASE
Authors: Stäuber Alexander , Piper Cornelia , Eckert Siegfried , Richter Stefan , Dörr Marcus , Ohlow Marc-Alexander , Hoppe Matthias Wilhelm , Johannes Baulmann
Published: June 2023

Objective:

Chronic kidney disease (CKD) is characterized by decreased renal autoregulatory capacity, increased proteinuria, and direct transmission of systemic blood pressure to the glomeruli. Thereby, an increase in central (aortic) blood pressure (cBP) accelerates the progression of CKD. Antares is a pulse wave analysis algorithm designed to allow a non-invasive estimation of cBP using automated oscillometric blood pressure devices. We aimed to compare the invasively measured cBP with the estimated cBP using the Antares algorithm in patients with CKD.

Design and method:

26 patients with stages 3-5 CKD (eGFR <60 ml/min/1.73m2, 88% stage 3 CKD, age 78±9 years, BMI 29±5 kg/m2, 65% male) were included and cBP was measured invasively during elective coronary angiography and simultaneously non-invasively using the custo screen 400 device (custo med GmbH, Ottobrunn, Germany) with the integrated Antares algorithm (Redwave Medical GmbH, Jena, Germany).

Results:

The mean difference for cBP was -0.7 ± 6.3 mmHg for central systolic BP (cSBP), -2.0 ± 5.1 mmHg for central mean arterial pressure (cMAP) and -4.2 ± 7.2 mmHg for central diastolic BP (cDBP). High correlations were found between estimated and invasively measured cBP (cSBP, r = 0.96; cMAP, r = 0.92; cDBP, r = 0.77; all p<0.001).

Conclusions:

The present study demonstrates that the Antares algorithm can estimate cBP with high accuracy in patients with CKD. Measurement of cBP and subsequent therapeutic interventions could improve renal and cardiovascular prognosis in these patients.
THE RELATIONSHIP BETWEEN ARTERIAL STIFFNESS, SUBCLINICAL HEART FAILURE, CARDIAC FIBROSIS AND RENAL FUNCTION IN CHRONIC KIDNEY DISEASE, IGA NEPHROPATHY
Authors: Kovács Tibor József , Vas Tibor , Csepregi Rita Klaudia , Horváth-Szalai Zoltán , Nagy Judit , Csiky Botond , Sági Balázs
Published: June 2023

Objective:

IgA nephropathy (IgAN) is the most common primary glomerular disease worldwide. Arterial stiffness may predict cardiovascular (CV) mortality and morbidity in chronic kidney disease (CKD). Heart failure is very common in advanced CKD stages. Onset of myocardial fibrosis may be a pathophysiological alteration in CKD patients with heart failure.

Design and method:

In our cross-sectional study, we examined 90 patients who cared for IgAN in our clinic. Arterial stiffness was determined by measuring carotis-femoral pulse wave velocity (cfPWV) using the ShygmoCor device. N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and carboxy-terminal telopeptide of collagen type I (CITP) were measured using ELISA kits. Renal function was detected by the estimated glomerular filtration rate (eGFR-CKD-EPI). Furthermore, a routine echocardiography examination was performed.

Results:

Of the 90 patients included in the study, 50 were male, with a mean age of 54.9 ± 14.4 years. Patients were divided into two groups based on eGFR (CKD 1-2 and CKD 3-5). There were significantly higher NT-proBNP (p = 0.035), cfPWV (p = 0.004), and central aortic systolic pressure (p = 0.037), but not CITP, in the CKD 3-5 group. The number of patients with combined biomarker positivity (NT-proBNP and CITP) was also significantly higher in the CKD3-5 group (p = 0.035) compared to the CKD 1-2 group. The central aortic systolic pressure was significantly higher in the diastolic dysfunction group (p = 0.034), but the systolic blood pressure was not. eGFR and hemoglobin level showed a strong negative correlation, while left ventricular mass index (LVMI), aortic pulse pressure, central aortic systolic pressure, and cfPWV showed a positive correlation with NT-proBNP. cfPWV, aortic pulse pressure, and LVMI showed a strong positive correlation with CITP by Spearman's correlation. Only eGFR was an independent predictor of NT-proBNP by linear regression analysis.

Conclusions:

A possible mechanism for the development of heart failure in CKD patients may be an elevation of central aortic systolic pressure. NT-proBNP and CITP biomarkers may help to identify IgAN patients at high risk for subclinical heart failure and further atherosclerotic disease.
HEMATOLOGICAL AND THYROID DISTURBANCE IN AN ALGERIAN POPULATION OF CHRONIC HEMODIALYSIS PATIENTS
Authors: Nawal Habak , Nadjet Rouibah , Ammar Chikouche
Published: June 2023

Objective:

Hemodialysis patients suffer in the majority of cases from normocytic normochromic anemia, due to the decrease of erythropoietin production. Thyroid abnormalities are also observed in these patients. They are represented by hypothyroidism which is characterized by low levels of FT3, normal levels of free thyroxine, and often high levels of TSH

The objective is to estimate the prevalence of hypothyroidism and anemia in an Algerian population with end-stage chronic renal failure on hemodialysis.

Design and method:

This is a descriptive cross-sectional study carried out in the Biochemistry laboratory in collaboration with the Hematology laboratory of CPMC. 94 patients with end-stage chronic renal failure .

Results and discussion

Results:

The mean age of our hemodialysis patients was 59.62 years, with a sex ratio of 0.69. Most of our patients (47%) had arterial hypertension (AH) and 20% of patients had diabetes. Our results show a prevalence of normocytic normochromic anemia in 88.30% of hemodialysis patients. The TSH and FT3 hormone assays in our patients revealed a prevalence of hypothyroidism of 38%, with a female predominance. FT3 was low in 24 patients, 12 patients had high TSH levels. The hypothyroid profile was characterized by normal TSH levels associated with low FT3 levels (25% of patients), 12 patients had high TSH levels associated with normal FT3 concentrations. Thyroid abnormalities in chronic hemodialysis patients (CDH) are secondary to hormonal disorders. They are often represented by hypothyroidism. (Captein, 1996). The results of the comparison of the distribution of hypothyroid and anemic patients show an independence of the distribution of the number of cases according to the symptoms of hypothyroidism.

Conclusions:

The similarity of symptoms between anemic and hypothyroid hemodialysis patients can mislead the clinician if he does not think to measure thyroid hormones, knowing that the therapeutic conduct is different in the two situations, and the impact on the health economy is very important.
THE INFLUENCE OF GLP-1RAS (ORAL SEMAGLUTIDE) ON TENSIONAL CONTROL IN DIABETIC PATIENTS WITH CHRONIC RENAL DISEASE
Authors: Rodriguez Carlos Mañero , Gila Juan De Dios López-Gonzalez , Chumillas Vanesa García , Garrido Maria Dolores Prados
Published: June 2023

Objective:

GLP-1 receptor agonists (GLP-1RAs) represent one of the pharmacological groups of choice for the diabetic management of patients with cardiovascular disease and chronic kidney disease (CKD). Their hypotensive effect has not been sufficiently evaluated in association with the usual antihypertensive drugs. The main objective is to study the hypotensive effect of oral semaglutide at a maintenance dose of 7mg per day in a cohort of patients with stage 3b CKD (glomerular filtration rate -GFR- 44 to 30ml/min by CKD-EPI) with poor diabetic control and without previous treatment with GLP-1 receptor agonists or iSGLT2.

Design and method:

Sixteen patients of both sexes were selected and divided into two follow-up arms of eight patients each. In one arm, the combination of oral semaglutide with an angiotensin receptor blocker (ARB) (such as losartan at a maintenance dose of 50-100mg per day) is evaluated, and in the other, dietary measures are intensified together with ARB at the same doses. After 4 months of treatment, the primary and secondary variables were assessed: body weight, glycosylated haemoglobin (HbA1c), renal function and albuminuria (albumin/creatinine ratio - ACC).

Results:

Mean age was similar in both groups (69 vs 70 years). The reduction in mean blood pressure (BP) values obtained with standardised measurements in a nephrology consultation in the semaglutide + ARB arm was -12mmHg (systolic) and -5mmHg (diastolic) compared to those in the ARB arm alone (-5mmHg systolic and -3mmHg diastolic), with statistical significance (p<0.05). The other comparative variables between the two groups were: reduction in body weight (-2.5kg vs -0.5kg, p<0.05); reduction in mean HbA1c (-1.2% vs -0.1%, p<0.05); changes in eGFR (+2ml/min/1.73m2 vs -3ml/min/1.73m2, p>0.05) and mean reduction in ACC (-257mg/g vs +12mg/g, p<0.05).

Conclusions:

Orally administered GLP-1 receptor agonists (semaglutide) are drugs with a hypotensive potential complementary to renin angiotensin system inhibitors in diabetic renal patients. This property, together with their antiproteinuric effect, makes them an ideal choice in situations of hypertension and moderate renal dysfunction. Larger, controlled studies are needed to measure the renal effect alongside the various antihypertensive groups.
NATRIURESIS INDUCED BY ACUTE INTRAVENOUS SALINE INFUSION IN MICE IS MEDIATED BY TUMOR NECROSIS FACTOR-ALPHA (TNF) - EVIDENCE FOR PHYSIOLOGICAL ROLE OF THIS CYTOKINE IN KIDNEY
Authors: Majid Dewan S. A. , Castillo Alexander
Published: June 2023

Objective:

Chronic high salt (HS) intake in diet is associated with exacerbation of inflammation as well as hypertension. HS intake, through ‘osmoreceptor function’, induces an immune mechanism that activates the mononuclear phagocyte system (MPS) cells in the myeloid tissues which then circulated and infiltrated in many organs including the kidney. These infiltrated MPS cells release TNF that appears in the circulation in its soluble form (sTNF). We hypothesize that the intravenous saline infusion can also induce the production of sTNF from MPS cells due to an increase in salt content in immune tissues and this sTNF influences saline induced natriuretic response in the kidney.

Design and method:

To examine this hypothesis, we measured the changes in sTNF levels in plasma and urinary excretion rate (UTNFV) during intravenous infusion of isotonic saline (0.9% NaCl), first at euvolemic conditions (3 μL/min for 60 min; Baseline period) and then at an enhanced infusion rate (12 μL/min for 90 min; saline volume infusion period) in anesthetized mice (n = 5). The concentration of sTNF in plasma and urine samples were determined using ELISA kit (Ebioscience, Woburn, MA) for measuring this cytokine.

Results:

Baseline level of plasma sTNF was undetectable, however, the level was increased to 3.7±1.3 pg/mL during saline volume infusion period. Baseline UTNFV level was 0.01±0.002 pg/min/g of kidney wt, which was increased to 0.11±0.03 pg/min/g (P<0.05) during volume infusion period. In another group of mice (n = 5) pretreated with a TNF inhibitor, etanercept (0.5 mg/kg intraperitoneally once daily for 3 days prior to the experiment day), it was observed that this increase in UTNFV during saline volume infusion period was markedly attenuated (0.003±0.002 to 0.006±0.004 pg/min/g; P = n.s.). The usual natriuretic response (0.5±0.2 to 3.8 ±1.1 μmol/min/g; P<0.05) to saline volume infusion observed in control mice was seen markedly attenuated (0.4±0.1 to 0.8±0.3 μmol/min/g; P = n.s.) in etanercept pretreated mice.

Conclusions:

These findings demonstrate for the first time that an intravenous saline volume infusion resulted an increase in sTNF level in plasma and in urine. These results strongly suggest a physiological role for sTNF in regulating renal excretory function during saline volume expansion.
SEX DIFFERENCES IN RENAL MICROCIRCULATION OF HYPERTENSIVE PATIENTS
Authors: Hendriks-Balk Mariëlle , Damianaki Aikaterini , Theiler Kenji , Polychronopoulou Erietta , Brito Wendy , Pruijm Menno , Wuerzner Gregoire
Published: June 2023

Objective:

Arterial hypertension is associated with alterations in the morphology and function of the microvascular structure. Whether these changes are sex-specific in the kidney of hypertensive patients is unknown. Contrast-enhanced ultrasonography (CEUS) enables the quantification of renal microcirculation. The objective of this study was to compare the cortical microcirculation in hypertensive (HT) women versus HT men, and assess the response to a cold pressure test (CPT).

Design and method:

This was a prospective observational study. Hypertensive (HT) participants underwent two separate CPT of 2 minutes. Doppler ultrasound was used to measure renal resistive index (RRI) and CEUS to measure the perfusion index (PI) as a proxy of renal tissue microcirculation. Renal Doppler and CEUS were performed before and during the CPT. We compared baseline renal measures and responses to CPT of HT women and HT men using a mixed analysis model.

Results:

Twenty-two HT men and eleven HT women were included. Age and body mass index were similar for both groups. Baseline RRI was similar in both genders, but HT women had higher baseline PI (median with interquartile range): 2344 U(1553-2685) vs 1264 U(591-1741), p = 0.007. The CPT did not affect the RRI in HT women and men. Overall the PI was higher in women (p = 0.006) and the PI increased during CPT (p<0.001), but there was no significant difference in the response to CPT between the genders (no interaction).

Conclusions:

Hypertensive women had a higher PI than hypertensive men, suggesting that microcirculation is better preserved in HT women compared to HT men. The increase in PI during the CPT is similar in both genders suggesting the absence of sex-specific reactivity of the microvasculature during CPT.
MEDICAL VERSUS SURGICAL TREATMENT IN PATIENTS WITH NON-FUNCTIONING KIDNEY
Authors: Gebara Nicole , Machado Filipe , Lazkani Aida , Ahmar Marc Al , Lorthioir Aurélien , Riancho Julien , Baron Stéphanie , Azizi Michel , Amar Laurence
Published: June 2023

Objective:

Non-functioning kidney (NFK) can be responsible in whole or in part for hypertension. Patients with a lateralized renin secretion can be treated either medically or surgically.

Objective:

assess the benefice of nephrectomy over medical treatment in the management of lateralized NFK in hypertensive patients diagnosed after renal vein sampling (RVS). The profit is based on the blood pressure (BP) control, the number of BP lowering drugs or the daily-defined dose (ddd).

Design and method:

We conducted an observational retrospective study at the Hypertension Unit at Georges-Pompidou European Hospital in France, between January 2004 and January 2021, that analyzes RVS in hypertensive patients. We studied the data (N = 68) at the time of diagnosis and at two follow up visits: the first after RVS or nephrectomy (V1) and the last visit (V2).

Results:

At V1, in patients with a lateralized NFK:

- 18 underwent nephrectomy: 11 vascular disease, 4 urologic disease, 2 trauma and 1 another cause.

- 5 were treated medically: all had a vascular disease

In patients who underwent nephrectomy, between the diagnosis, V1 and V2 (N = 12) respectively:

In patients with medical treatment, between the diagnosis, V1 and V2 (N = 4) respectively:

a) systolic BP dropped from 189 to 170,33 to 133,33 mmHg

b) number of molecules increased from 3 to 4,8 at V1 and V2

c) ddd increased from 63,35 to 118,3 to 267

d) at V1 and V2: 1 had a controlled HTN

Conclusions:

In patients with lateralized NFK, nephrectomy helps in the control of the BP and reduces systolic BP, number of drugs and ddd. The effect on the BP control seems not to be maintained on the long term. Further studies, with a bigger sample, are needed to define subgroups that can benefit the most from nephrectomy.
RELATION BETWEEN WAIST CIRCUMFERENCE AND THE RENAL HEMODYNAMIC IN PATIENTS WITH UNCOMPLICATED HYPERTENSION GRADE 1-2
Authors: Bosch Agnes , Kannenkeril Dennis , Ott Christian , Guenes-Altan Merve , Striepe Kristina , Schiffer Mario , Schmieder Roland E.
Published: June 2023

Objective:

Abdominal adiposity, measured by waist circumference (WC), is associated with increased mortality in patients with hypertension. Little is known about the impact of abdominal obesity on the renal perfusion and function in patients with hypertension. We analyzed whether abdominal adiposity changes renal hemodynamics in 36 patients with uncomplicated hypertension grade 1-2 without other cardiovascular (CV) disease.

Design and method:

We analysed the renal hemodynamic using steady state input clearance with infusion of para-aminohippuric acid and inulin, respectively. Intraglomerular pressure and resistances of the afferent (RA) and efferent (RE) arterioles were calculated according to the Gomez equation. The study population was divided in into two groups based on median of WC of the total study population.

Results:

The study cohort consisted of 36 male, non-smoking individuals, aged 36 ± 10 years with mean WC of 96.1 ± 10.4 cm and mean BMI of 27 ± 3.8 kg/m2. True hypertension was confirmed using 24-hour ambulatory blood pressure (BP) measurement. Patients in the high WC group (19 patients) showed mean office BP of 145/ 90 mmHg and mean 24-hour ambulatory BP of 139/ 86 mmHg, whereas patients in the low WC group (17 patients) showed mean office BP of 144/ 88 mmHg and mean 24-hour-ambulatory BP of 140/ 86 mmHg (office BP: p = 0.895/ p = 0.662, 24-hour-ambulatory BP: p = 0.645/ p = 0.918). Renal vascular resistance and RA were higher in the high WC compared to the low WC group, whereas glomerular filtration rate and renal plasma flow were lower in the high WC compared to the low WC group (table 1).

Conclusions:

Higher WC in young, male patients with hypertension grade 1-2 without other cardiovascular disease was associated with increased renal vascular resistance predominantly at the afferent site leading to reduced glomerular filtration rate.
REVEAL-CKD: PREVALENCE OF UNDIAGNOSED STAGE 3 CHRONIC KIDNEY DISEASE IN PATIENTS WITH DIAGNOSED HYPERTENSION IN CANADA
Authors: Peach Emily , Wittbrodt Eric , Barone Salvatore , Chen Hungta , Järbrink Krister , Tangri Navdeep
Published: June 2023

Objective:

Hypertension is a risk factor for and complication of chronic kidney disease (CKD), a progressive condition affecting 11.1% of the global population. Early recognition and diagnosis of CKD is crucial for effective management to slow disease progression and improve patient outcomes. This REVEAL-CKD study assessed the prevalence of, and factors associated with, undiagnosed stage 3 CKD in patients with hypertension.

Design and method:

REVEAL-CKD is an observational study using secondary data from electronic medical records (EMR) and claims data. Data were extracted from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) database, that consists of primary care EMR data from approximately 1,500 general practice clinicians across eight provinces and one territory of Canada. The study cohort included patients aged at least 18 years with two consecutive estimated glomerular filtration rate (eGFR) values 30-59 mL/min/1.73m2 recorded 91-730 days apart between 2015-2021. The date of the second qualifying eGFR was the index date. Included patients were required to have hypertension diagnosis code before index. Patients with no CKD diagnosis code before and up to 6 months after index were considered undiagnosed. This study was granted approval by the CPCSSN data access committee (project number: 2022SRE147).

Results:

Of the 45,914 patients meeting the study inclusion criteria for stage 3 CKD, median age at index date was 77 years (interquartile range [IQR]: 69-84 years) and 19,597 (42.7%) were male. Of these patients, 32,192 (70.1%) also had an existing diagnosis of hypertension. Among patients meeting the criteria for stage 3 CKD and having a diagnosis of hypertension there were 30,523 patients, (94.8%) who did not have a recorded diagnosis of CKD up to 6 months after index. Of these patients, only one fifth was diagnosed with CKD after 4 years.

Conclusions:

A large proportion of patients in Canada with hypertension and stage 3 CKD do not have a recorded CKD diagnosis, and there is substantial diagnostic delay despite clinical evidence. This likely results in patients not receiving guideline-directed management to reduce the risk of disease progression and adverse clinical outcomes that could have been avoided by early detection of CKD.
WATER LOAD EFFECT ON URINARY HYALURONIDASE ACTIVITY IN NORMOTENSIVE OFFSPRING OF NORMOTENSIVE AND HYPERTENSIVE SUBJECTS: A POSSIBLE LINK TO HYPERTENSION DEVELOPMENT
Authors: Bongrani Alice , Verzicco Ignazio , Tedeschi Stefano , Maestrini Fabio , Graiani Gallia , Cavazzini Stefania , Figus Giuliano , Vicini Vanni , Coghi Pietro , Calvi Anna , Montanari Alberto , Perlini Stefano , Cabassi Aderville
Published: June 2023

Objective:

Alterations in sodium and water intake-excretion balance are currently admitted as a relevant factor in arterial hypertension development. Hyaluronic acid metabolism in renal medullary has been proved to play a relevant role in the regulation of water resorption by the collecting duct, and hyaluronidase excretion in urine has been found to be inversely related to hydration status. Thus, the aim of our study was to assess urinary hyaluronidase activity in response to water loading in hypertensive and normotensive subjects with and without familial predisposition to hypertension.

Design and method:

Eighty-six adult Caucasian men underwent a water loading test consisting of oral administration of 15-20 ml of water/kg body weight over 40-45 min. Urinary hyaluronidase activity was assessed by turbidimetric assay at baseline and every 60 min for 4 hours. The study cohort included 21 hypertensive patients (HT) and 65 normotensive offsprings of normotensive (NT neg, n = 29) and hypertensive subjects (NT pos, n = 36).

Results:

Urinary hyaluronidase activity decreased in response to water loading in all groups, attaining the lowest levels at 60 and 120 min. However, while at baseline and after 240 min hyaluronidase activity was similar for all subjects, between 60 and 180 min NT pos subjects maintained significantly highest levels than both NT neg and HT patients (p<0.0001 and p<0.001 at 120 min, respectively).

Conclusions:

Consistent with previous findings, our results show that hyaluronidase activity in urine is inversely correlated with hydration status as we observed in all studied groups in response to water loading. However, while baseline levels did not differ between groups, the decrease in hyaluronidase activity was significantly lower in the subgroup of subjects having a family history of hypertension. Since hyaluronidase activity in the renal medullary has been postulated to be associated with ADH metabolism, individuals genetically predisposed to hypertension might exhibit increased renal sensitivity to ADH action resulting in alterations in the management of water loading by the vasopressinergic system that could precede and contribute to hypertension development.
INCREASED ARTERIAL STIFFNESS ASSOCIATED WITH BLOOD PRESSURE IS THE PREVALENT HYPERTENSION MEDIATED ORGAN DAMAGE IN YOUNG PATIENTS WITH FIRST DIAGNOSED SYSTOLIC HYPERTENSION
Authors: Triantafyllidi Helen , Benas Dimitrios , Birmpa Dionyssia , Fambri Anastasia , Schoinas Antonis , Thymis Ioannis , Kostelli Gavriela , Ikonomidis Ignatios
Published: June 2023

Objective:

Early onset arterial hypertension (AH) is associated with a considerably increased risk for cardiovascular (CV) disease if left untreated. Hypertension mediated organ damage (HMOD) evaluation is necessary in order to estimate cardiovascular risk in each hypertensive patient. We investigated the incidence of HMOD in young first diagnosed and never-treated patients with systolic arterial hypertension (SH) trying to identify those young patients in high CV risk based on the presence of HMOD.

Design and method:

In 220 patients, <50 years [median (IQR) age = 43(38-47) years], with SH diagnosed by ambulatory blood pressure monitoring (24-h ABPM), CV risk factors [smoking, obesity (BMI), hyperlipidemia] and 5 HMOD [arterial stiffness (PWV), left ventricular diastolic dysfunction [(DD (EEa)], cardiac hypertrophy (LVMI), coronary arteries microcirculation (CFR), and carotid intima-media thickness (cIMT)] were evaluated before treatment initiation.

Results:

Smoking (40%) and obesity [median (IQR) BMI = 30(26-32) kg/m2] were found in young hypertensives. HMOD were found in 50% of hypertensives (>1 HMOD while 10% had > 2 HMOD. The most prevalent HMOD were the increased cIMT (32%), PWV (19%), LVH (9%), impaired CFR (6%) and DD (1%). Only PWV (beta = 0.27, p<0.001) and LVMI (beta = 0.41, p<0.001) were associated to systolic BP burden (Figure). In a subgroup analysis, the population with >2 any studied HMOD was older with increased office BP and 24-h ABPM, impaired lipid profile and increased levels of LVMI, PWV, CFR and cIMT compared to the rest of the hypertensives.

Conclusions:

The presence of >2 any studied HMOD (PWV, LVMI, cIMT, E/Ea, CFR) in young hypertensives characterizes a truly “high-risk population”. Arterial stiffness represents the predominant HMOD in the whole population as well as in the “high-risk hypertensive population”.