bluuebunny/crossref_metadata_2025 huggingface dataset:
FACTORS ASSOCIATED WITH A SUCCESSFUL BLOOD PRESSURE CONTROL IN HYPERTENSIVE URGENCY PATIENTS
Authors: Kotruchin Praew , Khamphukaew Thanawat , Mitsungnern Thapanawong , Im-Oun Supap
Published: April 2021

Objective:

Hypertensive urgency (blood pressure (BP) > 180/110 mmHg without target organ damages) is a common presentation in the emergency room (ER). Standard treatments in the ER are resting and oral anti-hypertensive drugs. Guidelines state that a short-term outcome is not necessary to meet a strict BP target. But, patients should be in the targeted BP within weeks or a few months. However, there is limited data on the follow-up BP outcome and its determinants. We aimed to evaluate the factors that associated with a successful BP control after a few months of treatment.

Design and method:

This was a retrospective cohort study conducted at a university hospital in the Northeast of Thailand from 1st January 2012 to 31st December 2016. We enrolled hypertensive urgency patients who visited the ER and were received standard treatment and followed up in the hypertensive crisis clinic for at least 8–12 weeks. Pharmacological and non-pharmacological treatments were given in all enrolled patients. Office BP at the second follow up were measured and analysed.

Results:

A successful BP control (<140/90 mmHg) was observed in 129 patients (56.1%). The factor that was associated with a successful BP control was the achievement of three-lifestyle modification including medication adherence, aerobic exercise, and salt restriction (OR 1.79; 95%CI, 1.01–3.19; P = 0.048), while the baseline BP, type of medications, and underlying diseases were not.

Conclusions:

Lifestyle modification was an effective strategy to achieve a targeted BP in the hypertensive urgency patient. Therefore, patients should be educated and encouraged to have a healthy lifestyle in conjunction with the pharmacological treatment.
IONIZED MAGNESIUM IN ELDERLY HYPERTENSIVES
Authors: Kisters Klaus , Gremmler B. , Wroblewski F. , Deutsch A. , Kisters L. , Westhoff T.
Published: April 2021

Objective:

Due to recent publications a magnesium deficiency in elderly is up to 50%, depending on co - morbidity, drugs and nutritional status. On the other hand it is well known that a magnesium insufficiency is a pathogenetic factor in the development of hypertension. In this context calcium magnesium antagonism, sodium magnesium antiport, disturbed vitamin D metabolism or disturbed magnesium channels are of special interest.

In this context magnesium metabolism was of interest in elderly hypertensives. Ionized magnesium is the active form and was measured additionally.

Design and method:

We studied 45 essential hypertensive patients with normal renal function. None of the patients received diuretics or magnesium. No diabetics were included. The age of patients was beyond 65 years, 23 persons were male, 22 female.

Measurements of magnesium were performed either in serum (Cobass, Roche, Germany) or ionized in blood (NOVA, Rödermark, Germany).

Results:

In serum magnesium concentrations only 1 person had values below 1.5 mg/dl, all other elderly hypertensives had a normal serum magnesium concentration.

In contrast ionized magnesium concentrations was significantly decreased in 12 of 45 patients, showing values below 0.5 mmo/l (p < 0.0)1, that is about 27%.

In addition, no correlation between total serum and ionized blood magnesium exists (ns, Pearson or Spearmann rank test, p value 0.91 and 0.41).

Blood pressure was controlled and below 150/90 mmHg.

Conclusions:

There is no correlation between serum and ionized blood magnesium content. This is of special importance as a normal serum magnesium content doesn‘t exclude a deficiency of ionized magnesium. As ionized magnesium is the vasoactive form of magnesium in the body and acts on vessels, it is mor useful to determine ionized magnesium concentrations in assessing body magnesium stores.

In elderly hypertensives under blood pressure control nearly 27% showed an ionized magnesium deficieny despite normal serum magnesium values.
RENAL SODIUM HANDLING IN RELATION TO ENVIRONMENTAL AND GENETIC FACTORS IN UNTREATED CHINESE
Authors: Kang Yuanyuan , Li Yan , Wang Ji-Guwang
Published: April 2021

Objective:

Renal tubular sodium handling plays a key role in blood pressure regulation. Several studies reported association between higher proximal tubule fractional reabsorption of sodium and genetic variations response to blood pressure, but no previous study evaluated the contributions of environmental and genetic cues to renal sodium handling in a population-based study.

Design and method:

Our study subjects were suspected hypertensive patients being off antihypertensive medication for at least 2 weeks and referred to our hypertension clinic for 24-hour ambulatory blood pressure monitoring. We collected serum and 24-hour urine for measurement of sodium, creatinine and lithium concentration. Sodium and creatinine concentrations were measured by coupled plasma mass spectrometry. Fractional excretion of lithium (FELi) and fractional distal reabsorption rate of sodium (FDRNa) were calculated as markers of proximal and distal sodium handling, respectively. We used the ABI SNapShot method and genotyped 12 SNPs from candidate genes (ADD1, ADD2, ADD3, LSS, ABCB1, HSD3B1, NEDD4L, AGTR1 and WNK1) and 6 SNPs (rs10502933, rs2345088, rs12513375, rs16817782, rs2461911, rs16893522) generated from a genome wide association study.

Results:

The 1409 study participants included 664 men and had a mean age of 51.0 years. In adjusted analysis, FELi was positively associated with age but negatively with the total-to-high density lipoprotein cholesterol ratio. FDRNa was negatively associated with current smoking and waist circumference (P < = 0.003). Both indexes were also significantly associated with season and humidity explaining with ∼1.3% and ∼3.5% of the variance, respectively. After adjustment for host and environmental factors and Bonferroni multiple testing, among the 19 studied genetic variants, only rs12513375 potentially play a role in sodium reabsorption and was significantly associated with either FELi or FDRNa of the variance and explained about 1.7% of the variance.

Conclusions:

In conclusion, renal sodium handling as measured by endogenous lithium clearance was sensitive to major host, environmental and genetic factors.
HYPERTENSION: A GLOBAL EPIDEMIC AND ROLE OF LIFE STYLE MODIFICATION IN ITS MANAGEMENT
Authors: Arain Mudassar Iqbal
Published: April 2021

Objective:

Hypertension is one of the epidemic disease that contributes globally as a crisis that relates to co-morbidity. The co-relation of body mass index and obesity are autonomous risk factors along with some physiological and environmental factors, leading to the development of hypertension and high blood pressure which is directly associated with other diseases such as chronic kidney disease, ischemic heart disease, stroke, dementia, non-alcoholic fatty liver disease, and obstructive sleep apnoea leading to disability & mortality among the patients. The current study analyze the impact of life style management as a primary therapy of hypertensive patients.

Design and method:

An interventional study was designed among 500 patients selected via purposive sampling for a period of one year from Aug 2018 to Aug 2019. The study was based to analyse the life style of hypertensive patients using an approved questionnaire with the recommended guidelines of WHO. Follow-up questionnaires were administered at 5th, 9th, and 12th week. Our operational definition of successful blood pressure control is 120 mm Hg systolic and 90 mm Hg diastolic.

Results:

Out of 500 patients, 76.4% of the patients reported to have had sedentary life style. About 23.4% hypertensive patients, with 30–35 kg/m2 were observed. The interventional technique i.e. Patient's attitude (treatment, diet intake, sleeping and exercise habits) mean scores, pre-counselling and post-counselling for patients was applied and results were assessed after six months’ time. Post interventions results showed that patients who intermittently checked their blood pressure levels, controlled smoking habit and maintained their life styles had significantly improved levels.

Conclusions:

The current study demonstrates that the positive results were noted by life style modification. This shows that our interventions had positive impact on the awareness, knowledge, life style, disease management and practices of patients.
HIGH-SALT DIET CAUSES DROP IN BLOOD PRESSURE DURING DEVELOPMENT OF ONE-KIDNEY ONE-CLIP RENOVASCULAR HYPERTENSION IN FEMALE RATS
Authors: Volynnikova Evgeniya , Medvedeva Nataliya
Published: April 2021

Objective:

The aim of this research was to study high-salt diet (HSD) impact on development of renovascular hypertension (RH) in male and female Wistar rats.

Design and method:

Male and female Wistar rats were divided into three groups. The RH/CTRL group had a standard diet (0.25% NaCl). The RH/HSD group gets HSD (4% of NaCl). The RH/DC group had HSD during the first 4 weeks of experiment only. After two-week diet adaptation period Goldblatt's one-kidney one-clip surgery was conducted for all groups of the animals. The RH dynamics was monitored for the next 5 weeks. Blood and urine samples were taken on the 1st, 4th and 7th weeks.

Results:

There was no diet impact on systolic blood pressure (SBP) before the surgery. In male rats after the surgery an accelerated blood pressure elevation in RH/HSD and RH/DC groups was observed on the 3rd week (mean ± SEM: RH/CTRL 151 ± 4 mm Hg; RH/DC 169 ± 10, p = 0.08; RH/HSD 176 ± 8, p < 0.05). Diet change in RH/DC group resulted in prevention of further elevation of SBP. The SBP in RH/DC group was lower than in RH/HSD group by the 7th week of the experiment (RH/HSD 188 ± 9 mm Hg; RH/CTRL 179 ± 6, p = 0.50; RH/DC 167 ± 5, p < 0.05).

In female rats an acceleration of SBP elevation in RH/HSD and RH/DC groups was lower than that in male groups (RH/CTRL 159 ± 7 mm Hg; RH/DC 173 ± 7; RH/HSD 174 ± 6). The significant decrease of SBP was in RH/HSD and RH/DC groups on the 5th week (RH/HSD -29 ± 3; RH/DC -29 ± 10 mm Hg, p < 0.05). It was followed by the further elevation of blood pressure in RH/HSD group, but not in RH/DC group. SBP was lower in RH/DC group than in RH/HSD and RH/CTRL groups on the 7th week of the experiment (RH/HSD 175 ± 7 mm Hg; RH/CTRL 170 ± 9; RH/DC 141 ± 4).

Creatinine clearance in male rats rises on the 4th week and decreases on the 7th week. In female there was a contrary dynamics.

Conclusions:

The influence of HSD on development of RH differs between male and female rats. In female rats HSD leads to a significant decrease of blood pressure during the third week of RH development.
THE EFFECTS OF CARDIAC REHABILITATION ON HYPERTENSIVE BURDEN AND ARTERIAL STIFFNESS IN HYPERTENSIVE PATIENTS. A RANDOMIZED CROSSOVER STUDY
Authors: Kallistratos Manolis , Tsinivizov Pavlos , Poulimenos Leonidas , Latsou Dimitra , Andriopoulou Maria , Dimaki Niki , Kouremenos Nikos , Koukouzeli Aggeliki , Pittaras Andreas , Kyfnidis Kostas , Triantafyllis Andreas , Varvarousis Dimitris , Manolis Athanasios
Published: April 2021

Objective:

To investigate the effect of continuous versus intermittent exercise on hypertensive burden as well as the correlation of pulse wave velocity (PWV) with various parameters of CPX testing.

Design and method:

A randomized crossover study that will enroll 150 hypertensive patients. Patients will be randomized on continuous or intermittent exercise program for three months, then will follow a month of wash out period and the patients will be cross over from continuous to intermittent and vice versa for another three months of exercise. In all subjects, routine blood chemistry, including SUA determination, echocardiographic examination, office and 24 h ambulatory blood pressure (BP) as well as 24 h ambulatory PWV and central (BP) measurement as well as CPX testing will be performed in all study stages.

Results:

We present the preliminary results of 32 hypertensive patients (mean age 65.1 ± 11.3 years). A negative correlation was found between PWV and Peak VO2 (r = -0.540, p = 0.002), (r = -0.508, p = 0.045) at baseline and after 3 months of exercise. Peak VO2 was inversely correlated with PWV (r = -0.512, p = 0.003) and positive with diastolic BP (r = 0.469, p = 0.008), but not with systolic BP levels (p = ns). Eighteen patients until now have completed the 3 months of exercise. PWV, systolic and diastolic BP levels were decreased while Peak VO2 levels were increased between baseline and after 3 months of exercise but with no statistically significant differences. Specifically, the mean baseline PWV was 9.26 (±1.60) m/sec and the final PWV was 9.23 (±1.60) m/sec (p = 0.769). The mean of systolic and diastolic BP 127.59 (±7.94)/ 78.12 (±8.57) and 124.59 (±7.57)/ 77.24 (±8.57) mmHg for baseline and after three months of exercise (p = ns). The mean of Peak VO2 levels were 21.63 (±4.61) and 22.24 (±3.97) ml/kg/min for baseline and after three months of exercise (p = 0.394). It has to be mentioned however that in 6 patients (33%) the antihypertensive drug regiment was reduced.

Conclusions:

PWV was significantly correlated with functional capacity levels irrespectively of the levels of systolic BP. Cardiac rehabilitation may decrease BP levels or the number of antihypertensive drugs.
PROLONGED OBSERVATION OF SEXUAL DISORDERS BY HYPERTONIC PATIENTS AFTER NURSING INTERVENTION
Authors: Labudova Monika , Benacka Jozef
Published: April 2021

Objective:

Objective of this prolonged work was to observe progress in severity of erectile dysfunction as an expression of endothelial damage) by hypertensive patients with or without cardiovascular organic changes after one year nursing intervention on modifiable lifestyle risk factors in half of recruited probands.

Design and method:

Method: The presence and severity of ED in the group of 200 hypertensive patients, aged 40–70 years, were studied in the beginning and after one year. With half of the enrolled patients was performed periodic targeted nursing intervention (one year duration), focused on respect of the life style principles. Questionnaire method was used for data collection at the beginning and at the end of the annual reporting period, as well as after next 4 years. Questionnaires were focused on antropometric dates, lifestyle, QoL and ED.

Results:

Results: The research results showed that by hypertensive patients with organic CV changes is a higher incidence of moderate and severe ED than in hypertensive patients without organ changes. Those result were similar at start, as well as on the end of monitoring after 4 years. At the same time, a higher incidence of ED in the group of patients with organic complications than without them. In groups without nursing intervention was an increase in the number of patients with severe ED by 18% (group without organic complications), respectively 37% (with organic complications). The severity of ED by groups without intervention increased also, bud less intensive. The differences have been statistically significant. After 4 years monitoring – worsening of ED was observed, more intensive (statistically significant) by group of patients with cardiovascular organic changes.

Conclusions:

Conclusions: The results confirmed the assumption of a positive effect of targeted and repeated nursing interventions aimed at compliance with healthy lifestyle and quality of life on ED by hypertensive patients. In the end, paper makes recommendations regarding the highlighting of motivational factors affecting the adoption of healthy lifestyle and explains the role of nurses in applying the principles of secondary prevention of CV disease.
EFFECT AND ACCEPTABILITY OF MINDFULNESS-BASED STRESS REDUCTION PROGRAM ON PATIENTS WITH ELEVATED BLOOD PRESSURE OR HYPERTENSION: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS
Authors: Lee Kam Pui , Yeung Nelson Cy , Xu Zijun , Zhang Dexing , Yu Chun Pong , Wong Samuel Ys
Published: April 2021

Objective:

Mindfulness-based stress reduction program (MBSR) may reduce blood pressure (BP) in patients with hypertension (HT) or elevated BP. However, some important parameters including asleep BP were not investigated in previous reviews and a well-conducted meta-analysis is lacking. This meta-analysis investigated the effect and acceptability of MBSR, when compared to active and inactive controls, on patients with elevated BP and HT.

Design and method:

Multiple databases including MEDLINE, EMBASE, APA PsycInfo etc were searched. Included studies were randomized-controlled trials that included patients with elevated BP, have a control group and investigated effect of MBSR. The mean office and out-of-office (including 24-hour, daytime, and asleep) systolic BP (SBP) and diastolic BP (DBP), psychological outcomes (depression/anxiety/stress) and dropout rate were compared between the MBSR arm and the control arm by random effect model. Quality assessment was conducted based on the Cochrane risk-of-bias tool.

Results:

12 studies were included and only one was considered at low risk of bias. MBSR decreased office SBP and DBP by 6.64mmHg (95% confidence interval (CI): 1.53–11.74mmHg; I2:86.7%) and by 2.47mmHg (95%CI: 0.89–4.06mmHg, I2:14.8%) at post-intervention; the reduction in DBP was sustained at 3–6 months after recruitment. Although one study suggested reduced 24-h SBP and DBP by MBSR at 1 year, our meta-analyses did not find significant reduction of out-of-office BP by MBSR at post-intervention. MBSR reduced depressive, anxiety and stress symptoms. The drop-out rate from MBSR arm was 15% (95%:9–22%), which was not different from that of control arm.

Conclusions:

MBSR is acceptable to patients and can reduce office BP and mood symptoms. The current evidence is limited by lack of high-quality and adequately powered trials with long-term follow-up. Furthermore, out-of-office BP was only reported by few trials.
ACCURATE ESTIMATION OF INDIVIDUAL SODIUM INTAKE WITH REPEATED SPOT URINE SAMPLING
Authors: Ginos Bigina , Vogt Liffert , Frings-Meuthen Petra , Heer Martina , Engberink Rik Olde
Published: April 2021

Objective:

In clinical practice, individual sodium (Na+) intake is estimated by measuring Na+ excretion in one 24-h urine collection (UC), whereas long-term Na+ balance studies indicate that 7 consecutive 24-h UCs may be needed. In this study, we investigate whether the use of repeated spot UCs is an appropriate alternative for multiple 24-h UCs to estimate Na+ intake.

Design and method:

We performed a post-hoc analysis of a metabolic ward study in 8 healthy male adults who consumed a 7-d diet with a fixed amount of 200 mmol/d Na+. Urine was collected in 4 daily intervals (7–13 h, 13–19 h, 19–23 h and 23–7 h). After reaching steady state, we estimated Na+ intake by single and repeated 24-h UCs and repeated spot UCs, using the Kawasaki formula with measured 24-h urine creatinine excretion.

Results:

At day 5, mean 24-h Na+ excretion matched intake, indicating that steady state was achieved (Fig 1A). Mean absolute differences (δ) between measured Na+ intake and 3-d spot UC estimates were 18.8 (SD 14.6), 32.3 (SD 18.7), 74.6 (SD 30.0) and 28.2 (SD 19.8) mmol for interval 7–13 h, 13–19 h, 19–23 h and 23–7 h, respectively (Fig 1B). With the exception of samples collected between 19–23 h, Na+ intake estimates by 3-d spot UCs did not significantly differ from Na+ intake estimates by single (δ 29.8 mmol; SD 23.9) and three 24-h UCs (δ 22.9 mmol; SD 11.4).

Figure 1. (A) Mean 24-h Na+ excretion during 7-d diet. (B) Comparison of the performance of three consecutive spot UCs (blue), single 24-h UC (green) and three consecutive 24-h UCs (red) for estimating Na+ intake (200 mmol/d). Absolute differences (δ) between estimated and measured Na+ intake. Data are mean and SD.

Conclusions:

In this 7-d Na+ balance study, repeated spot UCs performed similar to a single and repeated 24-h UCs in estimating Na+ intake. Adequately powered studies need to confirm whether repeated spot UCs are an accurate and low burden alternative to 24-h UCs.
IMPACT EVALUATION OF SOUTH AFRICA'S MANDATORY SALT LEGISLATION
Authors: Charlton Karen , Kowal Paul , Ware Lisa , Schutte Alta , Corso Barbara , Minicuci Nadia
Published: April 2021

Objective:

South Africa implemented legislation in June 2016 mandating maximum sodium (Na) levels in a range of processed foods. A pre-post impact evaluation was undertaken to assess whether the legislative approach reduced salt intake and blood pressure in South Africans.

Design and method:

Baseline sodium intake was assessed in a nested cohort of the WHO Study on global AGEing and adult health (WHO-SAGE) Wave 2 (W2; 2014–2015). From 4030 randomly selected households, 24 h urine samples were collected in a random subsample (n = 1200) for Na potassium (K), creatinine and iodine analysis, alongside blood pressure (BP) and anthropometric measures. Follow-up in Wave 3 (W3; 2018) included replacements in the case of non-compliance or loss to follow-up. Complete urine collections were determined as volume > 300 mL and creatinine excretion > = 4 mmol/day (women) or > = 6 mmol/day (men).

Results:

Median salt intake indicated a slight downward trend between W2 (median 6.6 (IQR 6.1) g salt/day; n = 408) and W3 (6.3 (5.4) g/day; n = 392); with borderline significance (P = 0.0924). Proportion meeting the salt target of < 5 g/day remained similar (33.3 vs 34.7%; P = 0.685). In n = 48 paired subjects with complete urine and survey data in both waves, a non significant downward trend in salt intake was observed (median 6.7 (4.3) to 6.1 (5.4) g/day); P = 0.644). Significant predictors for increased systolic BP pressure between W2 and W3 were hypertension status (p < 0.0001) and age (p = 0.002).

Conclusions:

Complexities of obtaining repeat measures in the same individuals over 3 years of follow-up prevents determination of the magnitude of change in salt intake. These first results of salt intake following implementation of South Africa's mandatory sodium legislation, using valid 24hr urinary Na concentrations in a national sample suggest that the phased approach whereby stricter Na levels were enforced from June 2019 is necessary to achieve predicted population salt reduction of 0.85 g salt/person.
INCREASED EXPRESSION OF EPITHELIAL SODIUM CHANNEL AFFECTS MECHANICAL PROPERTIES OF ENDOTHELIAL CELLS BY REORGANISING THE F-ACTIN CYTOSKELETON
Authors: Shah Vikash Kumar , Fronius Martin
Published: April 2021

Objective:

Epithelial sodium channel (ENaC) in the kidney maintain body salt/water balance and regulate blood pressure. Recent finding suggests that endothelial cells express ENaC. Here elevated ENaC contributes to increased endothelial cell stiffness (ECS) that associates with endothelial dysfunction and hypertension. dysfunction and hypertension. However, the mechanism how ENaC influence ECS remains unknown. This study aims to investigate the potential role of ENaC subunits in mediating ECS by cytoskeletal changes. I hypothesize ENaC mediated ECS via an increased expression of F-actin. To challenge our hypothesis, ENaC protein expression was quantified by Western blot in human umbilical vein endothelial cells (HUVECs) treated with aldosterone under static condition (0 dyn/cm2) and under laminar shear stress (LSS, 10 dyn/cm2, 24 h). Atomic Force Microscopy (AFM) was used to measure cell stiffness and changes of F-actin were assessed by immunofluorescence microscopy. Under static condition, aldosterone significantly increased ?-, and ?-ENaC protein levels. On the other hand, under LSS conditions aldosterone increased ?-, and ?-ENaC protein levels. Also under static condition, a significantly increased Young's modulus was determined in both fixed and live HUVEC cells treated with aldosterone. Furthermore, the increased stiffness in aldosterone treated cells revealed increased F-actin levels. Overall, these findings indicate that aldosterone has different effects on ENaC subunit expression in HUVECs grown under static and LSS conditions. The increased ENaC expression does increase ECS. This seems to involve an increased F-actin expression as a major determinant of ECS. Therefore, this study may provide a new mechanism for ENaC-mediated ECS and blood pressure regulation.
SKIN MICROVASCULAR REACTIVITY AND SUBENDOCARDIAL VIABILITY RATIO IN RELATION TO LIPID PROFILE AND METABOLIC STATUS, IN PRIMARY HYPERTENSION: THE DOXAZOSIN RAMIPRIL STUDY
Authors: Jekell Andreas , Kalani Majid , Kahan Thomas
Published: April 2021

Objective:

Skin and coronary microvascular dysfunction both relate to increased cardiovascular risk in type 2 diabetes and in the metabolic syndrome. Disturbances in microvascular function are multifactorial, and both low HDL-cholesterol (HDL-C) and glucose intolerance are important mediators. However, their importance in relation to microvascular function in primary hypertension is not well studied.

Design and method:

We included 71 patients with untreated hypertension (55 ± 13 years, 34% women) but no coronary artery disease, dyslipidaemia, or diabetes. Subendocardial viability ratio (SEVR) as a measure of coronary microcirculation was calculated by pulse wave analysis (SphygmoCor). Skin microvascular function was assessed by laser Doppler fluxmetry and local iontophoresis of acetylcholine (ACh) and sodium nitroprusside (SNP), and by maximum reactive hyperaemia by local heating. Glucose tolerance was estimated by the triglyceride (TG) glucose index (TyG, ln[fasting plasma glucose (mg/dL) x triglycerides (mg/dL)/2]), and by TG/HDL-C ratio.

Results:

Mean office BP was 154/93 mmHg, fasting LDL-C, HDL-C and TG 3.48 ± 0.92, 1.40 ± 0.40 and 1.16 ± 0.86 mmol/L, respectively. Mean glucose was 5.40 ± 0.55 mmol/L, TyG 6.74 ± 0.59, and median TG/HDL-C ratio 0.65 [0.43–1.18]. SEVR (mean 169 ± 29%) was inversely related to LDL (r = –0.25; P = 0.041), but not to HDL-C (r = –0.05; P = 0.69). SEVR did not relate to TyG or TG/HDL-C ratio. Ach peak flux increase (mean 483 ± 380%) was related to HDL-C (r = 0.28, P = 0.021), whereas SNP (679 ± 395%) and heat induced maximum reactive hyperaemia (906 ± 491%) peak flux increase did not. Ach peak flux increase tended to relate inversely to TyG (r = –0.22, P = 0.069) and to TG/HDL-C ratio (r = –0.19, P = 0.12), while responses to SNP and local heating did not.

Conclusions:

Different mechanisms mediate skin and coronary microvascular dysfunction. In the coronary microcirculation LDL-C was associated with endothelial dysfunction, suggesting atherosclerotic disease to be an important factor, whereas skin microvascular reactivity was reduced by dyslipidaemia with low HDL-C in combination with impaired glucose tolerance. Our results are, in consort with observations in type 2 diabetes and in the metabolic syndrome, and suggest that early signs of skin and coronary microvascular dysfunction can be detected in uncomplicated hypertension and predict different aspects of cardiovascular risk.
NAIL CAPILLARY DENSITY DURING POSTOCCLUSIVE REACTIVE HYPEREMIA AND VENOUS CONGESTION IS MORE IMPAIRED IN DIABETIC COMPARED TO NON-DIABETIC CKD PATIENTS
Authors: Schoina Maria , Loutradis Charalampos , Memmos Evangelos , Triantafillidou Eva , Pagkopoulou Eleni , Dimitroulas Theodoros , Garyfallos Alexandros , Papagianni Aikaterini , Sarafidis Pantelis
Published: April 2021

Objective:

Alterations in endothelial function and capillary circulation have been associated with increased cardiovascular events and overall mortality. Both diabetes mellitus (DM) and chronic kidney disease (CKD) have been associated with microcirculatory damage. Nailfold video-capillaroscory can provide a thorough assessment of capillary density and microcirculation changes. This is the first study examining in comparison microcirculatory function parameters in diabetic and non-diabetic patients with CKD.

Design and method:

We included 48 diabetic and 48 non-diabetic adult patients (>18 years) with CKD (eGFR: < 90 and > 15 mL/min/1.73m2), matched in a 1:1 ratio for age, sex and eGFR within each CKD stage (2, 3a, 3b and 4). All participants underwent nailfold video-capillaroscopy, during which capillary density was measured at normal conditions (baseline), after a 4-minute arterial occlusion (postocclusive reactive hyperemia) and at the end of a 2-minute venous occlusion (congestion phase).

Results:

Baseline demographic, anthropometric and laboratory characteristics were similar between patients with and without diabetes in total and in CKD stages. Overall, no significant differences at baseline capillary density were observed between groups; however diabetic patients presented significantly lower capillary density during reactive hyperemia (36.3 ± 3.8 vs 38.3 ± 4.3 capillaries/mm2, p = 0.022) and at venous congestion (37.8 ± 4.0 vs 39.8 ± 4.2 capillaries/mm2, p = 0.015). When stratified according to CKD stages, the between-group differences in parameters of interest were not significant in stages 2, 3a and 4. In stage 3b, capillary density was significantly lower in diabetic compared to non-diabetic subjects at baseline (31.1 ± 2.8 vs 33.4 ± 3.4 capillaries/mm2, p = 0.044), during postocclusive hyperemia (36.8 ± 2.7 vs 40.0 ± 4.3 capillaries/mm2, p = 0.037) and venous congestion (38.3 ± 2.8 vs 41.5 ± 3.5 capillaries/mm2, p = 0.022).

Conclusions:

Capillary density during postocclusive reactive hyperemia and after venous congestion is lower in diabetic compared to non-diabetic CKD patients, a finding indicative that diabetes is an additional factor contributing to microcirculatory functional impairment in CKD. These differences are more prominent in CKD stage 3b, and less prominent in earlier and later stages.
SEVERE HYPOURICEMIA IMPAIRS ENDOTHELIUM-DEPENDENT VASODILATATION: A RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED, 3-WAY CROSSOVER STUDY
Authors: Benjamin De Becker , Martin Chaumont , Philippe Van De Borne
Published: April 2021

Objective:

Assess UA depletion through xanthine oxidase inhibition with febuxostat (FX) and recombinant uricase (rasburicase, R) on endothelial function.

Design and method:

Microvascular function, blood pressure, renin-angiotensin system activity measured (n = 17).

Results:

Hypouricemia alters heating-induced hyperemia in the presence of nitric oxide synthase inhibition (figure). Blood pressure, angiotensin II (P < 0.03 versus FX) and aldosterone decreased (FX-R, P = 0.01).

Conclusions:

UA depletion alters heat-induced endothelium-dependent microvascular vasodilation.
RESISTANT HYPERTENSION AND METABOLIC SYNDROME –A TWO-WAY RELATIONSHIP
Authors: Manta E. , Tsioufis K. , Konstantinidis D. , Kouremeti M. , Iliakis P. , Papakonstantinou P. , Tatakis F. , Anastasiou A. , Dimitriadi M. , Mourtzoukou D. , Zamanis I. , Karaminas N. , Tousoulis D.
Published: April 2021

Objective:

Resistant hypertension is often accompanied by sympathetic hyperactivity, arterial stiffness and metabolic syndrome. Moreover, the idea of metabolic syndrome increasing the effect of resistant hypertension in sympathetic nervous system and vascular wall is under examination. The aim of this study was to appraise the effect of the metabolic syndrome on sympathetic drive, as it was assessed by MSNA estimations, and arterial stiffness in patients with resistant hypertension.

Design and method:

We studied 34 patients with resistant hypertension (age: 57 ± 11 years, 22 males, office blood pressure (BP): 157/93 ± 13/11 mmHg, 24-hour BP: 138/83 ± 14/10 mmHg, under 3.2 ± 0.5 antihypertensive drugs) who underwent anthropometric measurements, blood examinations and transthoracic echocardiographic study, for assessment of the metabolic profile. In all participants, MSNA was evaluated based on established methodology (microneurography) and arterial stiffness on the basis of carotid to femoral pulse wave velocity (PWV). Metabolic syndrome was defined according to the Adult Treatment Panel III criteria.

Results:

Patients with resistant hypertension and metabolic syndrome (n = 14), compared to those without metabolic syndrome (n = 20) were characterized by higher levels of office systolic BP (166 ± 15 vs 151 ± 15 mmHg, p < 0.001), fasting glucose (132.7 ± 2.7 vs 94.7 ± 2.2 mg/dl, p < 0.05), waist circumference (109.1 ± 5.3 vs 94.8 ± 9.3 cm, p = 0.002), as well as left ventricular mass index (124.2 ± 16.2 vs 114.4 ± 16.2 g/m2, p = 0.001). Furthermore, metabolic syndrome patients exhibited greater levels of MSNA (84.8 ± 2.5 vs 74.2 ± 2.4 bursts per 100 heart beats, p < 0.001) and greater levels of carotid to femoral PWV (11.5 ± 0.8 vs 9.1 ± 1.3m/sec, p < 0.001). In all participants, sympathetic nerve traffic as assessed by resting MSNA was related to office systolic BP (r = 0.38, p < 0.05) and waist circumference (r = 0.33, p = 0.002), but there was no association with PWV values (p = NS).

Conclusions:

In patients with resistant hypertension, metabolic syndrome is associated with high MSNA and PWV levels. These results suggest thatthe presence of metabolic syndrome can exacerbate the setting of resistant hypertension, through sympathetic overdrive and vascular abnormalities, conditions that can be the subject of therapeutic interventions.
NOVEL ANTHROPOMETRIC INDICES WERE BETTER ASSOCIATED WITH HYPERTENSIVE TARGET ORGAN DAMAGES IN THE COMMUNITY-DWELLING ELDERLY CHINESE: THE NORTHERN SHANGHAI STUDY
Authors: Tang Jiamin , Zhao Song , Yu Shikai , Chi Chen , Ji Hongwei , Xiong Jing , Teliewubai Jiadela , Zhang Yi , Xu Yawei
Published: April 2021

Objective:

Body mass index (BMI), the most commonly used body composition assessing indice, has recently been challenged by two novel anthropometric indices, a body shape index (ABSI) and body roundness index (BRI), in arterial stiffness predicting capacity[1,2]. The purpose of this study was to detect and compare the different predictive capacities of the four anthropometric indices (ABSI, BRI, waist-hip ratio (WHR) and BMI) in predicting hypertensive target organ damages (HTODs).

Design and method:

Overall, 3077 community-dwelling elderly Chinese (age > 65 years, 1329 men and 1748 women) in northern Shanghai were enrolled prospectively from June 2014 to August 2019. ABSI and BRI were calculated with validated formula. HTODs were defined as three levels: (1) left ventricular hypertrophy (LVH), (2) arterial stiffness (AS) and lower limb atherosclerosis (LLA), (3) micro-albuminuria (MAU). Multivariate linear and logistic regression were performed to detect the relations between anthropometric indices and HTODs.

Results:

Spearman correlation analysis revealed that all anthropometric indices were correlated with HTODs indices (all P < 0.001). In multivariate logistic regression models, compared to the lowest quartiles, participants with the highest quartiles of ABSI, BRI and WHR all exhibited a significantly higher risk of LVH, AS and MAU independent of confounders and BMI (all P for trend < 0.01). Results of receiver operator characteristic (ROC) analysis performed within the female subgroup demonstrated that BRI and WHR were the better anthropometric indices in predicting HTODs compared to BMI. However, similar trend disappeared in the male subgroup. Further comparison analysis about the predictive priorities in the female subgroup were tested with stepwise logistic regression, after all anthropometric indices were put into models, only BRI stayed and was significantly associated higher prevalence of LVH (OR = 1.42, 95%CI 1.30∼1.55) and LLA (OR = 1.48, 95%CI 1.23∼1.77) together with WHR stayed to predict higher risks of AS (OR = 1.30, 95%CI 1.18∼1.43) and MAU (OR = 1.48, 95%CI 1.28∼1.72, all P < 0.01).

Conclusions:

Novel anthropometric indices, especially BRI and WHR, compared to the conventional indice BMI, have the superior capacities in predicting HTODs in the elderly female Chinese population.
L-GLUTAMINE IMPROVES ADIPOSE FUNCTION AND AMELIORATES EXCESS HEPATIC LIPID IN ESTROGEN-PROGESTIN ORAL CONTRACEPTIVE-TREATED FEMALE RATS
Authors: Olaniyi Kehinde , Olatunji Lawrence
Published: April 2021

Objective:

Adipose dysfunction and inflammation with or without hepatic defects underlie metabolic obesity. Glutamine (GLU) improves glucoregulation and metabolic indices but its effects on adipose function and hepatic lipid deposition in estrogen-progestin oral contraceptive (EPOC) users are unknown. We therefore hypothesized that GLUT supplementation would protect against adipose dysfunction and excess hepatic lipid influx and deposition in animals treated with EPOC by suppressing adenosine deaminase (ADA) activity and improving glucose-6-phosphate dehydrogenase (G6PD)-dependent antioxidant defense.

Design and method:

Female Wistar rats weighing between 150–180 g were allotted into control, GLUT, EPOC and EPOC + GLUT groups (six rats per group). The groups received vehicle (distilled water, p.o.), GLUT (1 g/kg), EPOC containing 1.0 μg ethinylestradiol plus 5.0 μg levonorgestrel and EPOC plus GLUT respectively, daily for 8 weeks. Glucoregulatory parameters were determined by homeostatic model of assessment (HOMA-IR) and quantitative insulin sensitivity check index (QUICKI), while metabolically-induced obesity was determined using triglyceride-glucose index. Plasma and tissue biochemical analysis were estimated with enzyme-linked immunosorbent assay kits or fluorescence assay as appropriate

Results:

Results showed that the administration of EPOC caused glucose dysregulation and increased triglyceride-glucose index and visceral adiposity, but the body weight and liver weight were not affected. However, EPOC significantly decreased adipose lipid, G6PD and glutathione, and increased glycogen synthesis, ADA, XO, uric acid, lipid peroxidation, lactate production and Gamma-glutamyl transferase activity (GGT). On the other hand, EPOC significantly increased hepatic lipid, ADA, XO, uric acid, lipid peroxidation and lactate production, and decreased glycogen synthesis, G6PD and glutathione. Nevertheless, supplementation with glutamine attenuated these alterations.

Conclusions:

Collectively, the present results indicate that EPOC causes metabolically-induced obesity which is associated with adipose dysfunction and hepatic metabolic defection. The findings also suggest that glutamine confers metabo-protection with corresponding improvement in adipose and hepatic metabolic function by suppression of ADA activity and enhancement of G6PD-dependent antioxidant defense (Figure 1).
NICOTINE AVERTS CARDIORENAL DYSFUNCTION BY MITIGATING ESTROGEN-PROGESTIN-INDUCED IMPAIRED NA+/K+-ATPASE ACTIVITY AND TRIGLYCERIDE ACCUMULATION IN INSULIN RESISTANT FEMALE RATS
Authors: Michael Olugbenga , Areola Emmanuel , Dibia Chinaza , Adeyanju Oluwaseun , Olatunji Lawrence
Published: April 2021

Objective:

Roughly fifty percent of premenopausal women who smoke cigarettes are also on hormonal contraceptives, especially oral estrogen-progestin therapy. Oral estrogen-progestin therapy has been reported to promote insulin resistance (IR), a major risk factor for the development of cardiometabolic dysfunction. Impaired Na+/K+ -ATPase activity has also been associated with cardiometabolic disturbances. The effects of nicotine on cardiorenal metabolic dysfunctions during estrogen-progestin therapy have not been fully elucidated. It is therefore hypothesized that nicotine would ameliorate IR that is accompanied by improved cardiorenal Na+/K+-ATPase activity, uric acid, oxidative stress and lipid accumulation in estrogen-progestin-treated rats.

Design and method:

Female Wistar rats (n = 6/group) aged 10 weeks were given (po) vehicle, nicotine (1.0 mg/kg) with or without estrogen-progestin steroids (1.0 μg ethinylestradiol and 5.0 μg levonorgestrel) daily for 6 weeks. The insulin resistance was estimated using the homeostasis model assessment for insulin resistance (HOMA-IR).

Results:

Data showed that estrogen-progestin treatment or nicotine exposure led to insulin resistance, hyperinsulinemia, increased cardiac and renal uric acid, malondialdehyde, triglyceride, glycogen synthase kinase-3, plasminogen activator inhibitor-1, alkaline phosphatase, aspartate transaminase, alanine transferase activity and reduced bilirubin. Estrogen-progestin treatment led to decreased cardiac Na+/K+-ATPase activity while nicotine did not alter the activity. Renal Na+/K+-ATPase activity was not altered by the treatment. However, these alterations were ameliorated by nicotine exposure plus estrogen-progestin treatment

Conclusions:

The results showed that oral nicotine enhanced cardiorenal Na+/K+-ATPase activity and suppressed lipid accumulation, oxidative stress, inflammation and thrombotic tendency in estrogen-progestin-induced insulin resistance. Therefore, the findings of the present study imply that oral nicotine may be cardiorenal protective especially during estrogen-progestin therapy.
THE INFLUENCE OF OBESITY ON INTERRELATION BETWEEN ADROPIN AND PULSE WAVE VELOCITY IN HYPERTENSIVE PATIENTS
Authors: Kobets Alla , Shelest Borys
Published: April 2021

Objective:

The pulse wave velocity (PWV) is one of the most important marker of the hypertensive patient's state. The adropin levels is diminished in patients with essential hypertension, but it is not investigated the association between this peptide and pulse wave velocity in hypertensive patients and in hypertensive patients under the influence of concomitant obesity.

The objective was to investigate the influence of concomitant obesity on the interrelation between adropin level and PWV in hypertensive patients.

Design and method:

93 patients were under supervision in our study, 63 females, and average age 57.8 ± 8.3 years. 47 patients with essential hypertension associated with obesity formed the first group and 46 subjects of the second group had only hypertension. ELISA was used to measure the serum level of adropin. We used the applanation tonometry to estimate the carotid-femoral PWV. Obesity was considered as body mass index over 30 kg/m2.

Results:

The mean serum adropin level and PWV levels were 2.75 [2.08–4.21] pg / ml, 9.71 [7.01–10.36] m/s, in the first group and 3.51 [2.47–3.91] pg/ml, 8.53 [6.73–9.74] m/s in the second group respectively. There were significant differences between the groups in both adropin level and PWV (p < 0.01). The multivariate regression analysis did not showed that low adropin level was associated with increased values of PWV (p = 0.09) in hypertensive patients with concomitant obesity. In contrast, it was revealed significant association between PWV and adropin in the second group - (odds ratio 0.41, 95% confidence interval 0.021–0.64, p = 0.003).

Conclusions:

Conclusions: It was found that the presence of additional comorbid obesity in hypertensive patients lead to perversion of adropin and PWV interrelation. In obese hypertensive patients adropin did not evince its predictive role in PWV value but, in contrast, in hypertensive patients without obesity adropin is associated significantly with PWV, but further studies with larger amount of patients are needed to confirm these findings.
POPULATION ATTRIBUTABLE FRACTIONS OF CARDIOVASCULAR BURDEN ASSOCIATED WITH ABDOMINAL OBESITY IN CHINA-BASED A NATIONAL SURVEY
Authors: Kang Yuting , Wang Zengwu , Chen Zuo , Zhang Liinfeng , Wang Xin , Zheng Congyi , Jiang Linlin , Shao Lan , Tian Ye
Published: April 2021

Objective:

To provide updated and accurate provincial estimates of the burden of cardiovascular diseases attributable to abdominal obesity and to estimate the geography heterogeneity on cardiovascular diseases (CVD) burden.

Design and method:

The multivariable-adjusted RRs by cox regression using cohort study with more than 30,000 individuals, along with the national BP level from national study, were used to calculate the population attributable fractions (PAF). China Hypertension Survey, involving 458,273 participants from 262 selected counties by stratified multistage random sampling method was used to calculate the prevalence of abdominal obesity. CVD events were defined as the incidence of fatal and non-fatal stroke, fatal and non-fatal coronary heart disease (CHD), heart failure, and other causes from CVD.

Results:

Of more than 30,000 individuals aged 35 years or older in the current study, over a mean of 143,314.6 person-years years of follow up, we documented 571 cardiovascular events. Nationally, the CVD events attributable to abdominal obesity was 34.85%. The PAFs for abdominal obesity ranged from 16.86% in Tianjin to 4.21% in Hainan. In 2016, about 420.95 thousand (95%CI: 410.68–431.65) cardiovascular deaths were derived from abdominal obesity, with PAF of 10.95%. The provinces with high socio-demographic Index (SDI), such as Shanghai, Beijing and Tianjin, all had relative lower CVD death numbers for hypertension.

Conclusions:

Abdominal obesity were related with excess CVD deaths. Geography heterogeneity exited among 31 provinces, with lower excess CVD deaths in high SDI provinces.
COMBINED EFFECT OF BODY MASS INDEX AND SYSTOLIC BLOOD PRESSURE ON DIASTOLIC FUNCTION AND EXERCISE CAPACITY
Authors: Ihm Sang-Hyun , Jung Mi-Hyang
Published: April 2021

Objective:

We aimed to characterize the combined effect of obesity and prehypertension on the left ventricular diastolic function and exercise capacity.

Design and method:

From health check-up data, we extracted those without known cardiovascular disease or hypertension (n = 736). The subjects were classified as 4 groups according to their body mass index (BMI) and systolic blood pressure (BP) level: non-obese individuals with an optimal BP (n = 279), non-obese individuals with prehypertension (n = 224), obese individuals with an optimal BP (n = 80), and obese individuals with prehypertension (n = 153). We defined obesity as a BMI equal to or greater than 25 kg/m2 and prehypertension as a systolic BP of 120–139 and/or diastolic BP of 80–89 mmHg. Diastolic dysfunction was defined as an E/e’ equal to or greater than 10 and exercise intolerance as a percent-predicted peak VO2 of < 80%.

Results:

Across the BP/BMI strata, a gradual increase in the E/e’ ratio was demonstrated even after an adjustment for the age and sex. A gradual decrease in the percent-predicted peak VO2 was observed. Obese individuals with prehypertension had the highest risk for diastolic dysfunction (OR 5.69, 95% CI 3.17–10.22), followed by obese individuals with an optimal BP (OR 3.26, 95% CI 1.61–6.59) and non-obese individuals with prehypertension (OR 3.26, 95% CI 1.61–6.59) compared with the reference group (non-obese group with optimal BP) after an adjustment for the age and sex. A similar risk gradient was also observed with regards to the exercise intolerance (corresponding HRs [95% CIs] were 3.58 [2.34–5.47], 3.30 [1.96–5.55], and 1.36 [0.91–2.04], respectively).

Conclusions:

Both obesity and prehypertension adversely affected the diastolic function and exercise capacity, suggesting possible targets for primary prevention of heart failure.