bluuebunny/crossref_metadata_2025 huggingface dataset:
WHAT IS IN THE SHADOW – A CASE OF SECONDARY HYPERTENSION
Authors: Mihailescu Anamaria , Balahura Ana Maria , Weiss Emma , Mehic Florentina , Bartos Daniela , Badila Elisabeta
Published: April 2021

Objective:

To present a case of secondary hypertension, to rule the importance of having evidence based recommendations.

Design and method:

We describe the case of a diabetic, dyslipidemic 63 years old man, with coronary artery disease-percutaneous coronary intervention (PCI) of right coronary artery (RCA) and of circumflex coronary artery(CCA) in 2016, hypertensive (ambulatory treatment: angiotensin-enzyme inhibitor, a calcium channel blocker, beta blocker and alpha2 central receptors) admitted in internal medicine ward with fronto-occipital headache, dizziness, hypertension (with a blood pressure value of 170/110 mmHg), hypokalemia (K 1.76 mmol/l). Taking into consideration the characteristics of the particularly case presented above, the patient is considered to meet the admission criteria. The abdominal CT scan revealed adrenal gland adenoma (1.8/1.4 cm). The diagnose of primary hiperaldosteronism is confirmed by the value of aldosteron/renine ratio (ARR 17). The patient's blood pressure and hypokalemia was influenced by the dose adjustment to the patient's ambulatory treatment and the administration of antimineralocorticoid and potassium supplement.

Results:

The new regimen reduced the blood pressure values, normalized the blood pressure and partially increased the potassium level (K 2.82 mmol/l).

Conclusions:

Although the prevalence of secondary hypertension is approximately 10 % the risks associated with are significantly higher. We reported a case of secondary hypertension with a good outcome despite it's severity.
EVALUATION OF A NEW DIAGNOSTIC TEST FOR PRIMARY ALDOSTERONISM
Authors: Rusev Rosen , Matrozova Joanna , Vasilev Vladimir , Elenkova Atanaska , Kalinov Krasimir , Zacharieva Sabina
Published: April 2021

Objective:

Primary aldosteronism (PA) is the most common form of endocrine hypertension. Currently, diagnosis comprises a screening test based on the aldosterone –to-renin ratio (ARR), followed by a confirmatory test to verify autonomous aldosterone secretion. However, available confirmatory tests (fludrocortisone, saline infusion) are laborious or relatively expensive. For this reason, the non-invasive Captopril test has been widely used despite its lower specificity. Recently, a new overnight screening test (DCVT) has been proposed, using oral administration of combined blockers of RAAS (renin–angiotensin–aldosterone system). The aim of the study was to assess the performance of DCTV in the diagnosis of PA in patients in whom the diagnosis was confirmed by the established Captopril test.

Design and method:

A total of 94 subjects with hypertension were investigated over a 2-year period. To confirm PA diagnosis all the patients underwent the Captoptil challenge test, as previously described. In addition, in all participants the DCVT was performed (patients received 2 mg Dexamethasone, 50 mg Captopril and 320 mg Valsartan at midnight and an extra dose of 50 mg Captopril 1 h before blood sampling in the next morning).

Results:

In the whole group of patients, 37 were diagnosed with PA on the basis of Captopril test cut-offs. The remaining 57 patients were considered to have essential hypertension. There was no significant difference in the main characteristics (age, sex, BMI, blood pressure, fasting blood glucose, lipids) between the two groups, except for potassium which was lower in patients with PA (p < 0.001). The areas under the receiver–operator characteristics curves for the post DCTV-aldosterone and post-DCVT ARR were 0.88 and 0.82, respectively. The optimal cutoff value for post DCTV- aldosterone was 262 pmol/l, which yielded a sensitivity and specificity of 83% and 75% respectively.

Conclusions:

In conclusion, DCVT is an reasonable alternative to the more complex invasive confirmatory tests in the PA diagnosis. Similarly to Captopril test, DCVT is safe and much easier to perform, so it may serve as a feasible alternative, despite slightly lower performance indices. When interpreting the results of DCVT, post- DCTVT aldosterone is recommended compared to post-DCVT ARR.
GLUCOCORTICOID EXCESS INDUCES NON-DIPPING BLOOD PRESSURE AND RENAL VASCULAR DYSFUNCTION
Authors: Costello Hannah , Jones Natalie , Grenier Celine , Stewart Kevin , Holmes Megan , Livingstone Dawn , Dhaun Neeraj (Bean) , Bailey Matthew
Published: April 2021

Objective:

Blood pressure (BP) abnormalities such as loss/attenuation of nocturnal BP dip (non-dipping) increase cardiovascular risk. The mechanisms underlying non-dipping are not clear, but renal and vascular dysfunction has been implicated. People with abnormal glucocorticoid (GC) homeostasis, such as in Cushing's syndrome, often display non-dipping BP therefore, here we investigated the contribution of GCs to BP rhythmicity.

Design and method:

The effect of GC excess, driven by ACTH infusion, on BP and plasma GC rhythmicity was examined in adult male C57BL/6J mice. Radiotelemetry was used to measure BP longitudinally before and after ACTH infusion (2.5 mg/day for 14days via minipump). Diurnal plasma GCs was measured by ELISA. Diurnal renal vascular function was investigated ex vivo by wire myography in isolated renal arteries from separate cohorts of mice either control or ACTH-treated collected between 7–8AM (day) or 7–8PM (night). Vascular reactivity to vasoconstrictor phenylephrine (PHE), endothelium-dependent acetylcholine (ACh) and endothelium-independent sodium nitroprusside (SNP) vasodilators was assessed. Data are mean ± SD.

Results:

After 5days of baseline measurements, 24-hour systolic BP (SBP) was 123.8 ± 4.2 mmHg and 24-hour diastolic BP (DBP) was 96.2 ± 5.6 mmHg. The day:night SBP and DBP variation was 12.8 ± 4.5 mmHg and 12.3 ± 4.8 mmHg, respectively. ACTH-excess increased 24-hour SBP to 133.8 ± 1.7 mmHg and 24-hour DBP to 101.4 ± 2.1 mmHg. The day:night SBP and DBP variation was reduced to 0.6 ± 7.2 mmHg (p = 0.0166) and 2.4 ± 9.6 mmHg (p = 0.0235), respectively. Day:night activity count during BP measurements was similar before and after ACTH infusion. Diurnal plasma GCs was increased following ACTH infusion, compared with baseline (p < 0.0001). Furthermore, ACTH-excess flipped the diurnal rhythm of GC, so the day plasma GC concentration is higher than the night. Day control renal arteries showed a trend for an increase in sensitivity to PHE (p = 0.0578) and SNP (p = 0.0795), with no changes in ACh (p = 0.1299), compared with night control renal arteries. ACTH-excess caused no differences in day and night responses to PHE (p = 0.5526), ACh (p = 0.1169), and SNP (p = 0.9466). ACTH-excess caused renal vascular dysfunction, compared with controls, causing a significant reduction in sensitivity to PHE (p = 0.0005), ACh (p = 0.0128) and SNP (p = 0.0002).

Conclusions:

These data show that chronic GC induces non-dipping BP and renal vascular dysfunction.
THE EFFECT OF AGE, BMI, AND SEX ON ALDOSTERONE, RENIN AND THE ALDOSTERONE-TO-RENIN RATIO IN ESSENTIAL HYPERTENSIVES
Authors: Alnazer Rawan , Veldhuizen Gregory , de Leeuw Peter
Published: April 2021

Objective:

The aldosterone-to-renin ratio (ARR) is widely used as a screening test for primary aldosteronism (PA) in patients with hypertension. The purpose of the present investigation is to identify the impact of age, body mass index (BMI) and sex on renin, aldosterone, and the ARR, when measured under strictly standardised conditions.

Design and method:

We measured plasma aldosterone, plasma renin concentration and the ARR in 190 essential hypertensive patients (120 males, 70 females). All measurements were taken in the supine position at 9am. A low sodium diet (55mmol/day) was in place for no less than two weeks prior to screening. In those who were receiving antihypertensive medications, all medications were discontinued at least 2 week before testing.

Results:

Renin and aldosterone were significantly higher in men, and remained so when controlling for BMI and age. However, the ARR was not significantly affected by sex.

Aldosterone was not significantly influenced by age but renin correlated inversely with age, with and without controlling for BMI (r = -0.285, p < 0.001). The ARR was positively correlated with age (r = 0.236, p < 0.001), with and without controlling for BMI. Subgroup analysis demonstrated a significant effect on the ARR in males only, with and without controlling for BMI (p < 0.001 and p0.004, respectively).

Although renin and aldosterone individually were not significantly influenced by BMI, the ARR showed a positive correlation (p = 0.022). However, this effect was not seen when age was controlled for nor was it seen in the subgroup analysis of males and females (p = 0.125, p = 0.515, p = 0.207, respectively)

Conclusions:

Under strictly standardized conditions, advanced age is associated with an increased ARR in male essential hypertensives. BMI when controlling for age does not influence the ARR. The impact of sex on the ARR appears negligible.
ADDED VALUE OF CATECHOLAMINE PHENOTYPING AND GENETIC SCREENING FOR THE CHARACTERIZATION OF PHEOCHROMOCYTOMA: A BELGIAN MULTICENTRE COHORT
Authors: Courcelles Louisiane , Gruson Damien , Evenepoel Lucie , Maiter Dominique , Persu Alexandre
Published: April 2021

Objective:

Pheochromocytomas/paragangliomas (PPGL) are rare neuroendocrine tumors arising from chromaffin cells of the adrenal medulla or from neural-crest derived sympathetic tissue. They secrete catecholamines in varying amounts, which accounts for their symptomatology. Hypertension is the most common sign, found in approximately 95% of patients. Nowadays, biochemical testing remains the simplest and most widely available method to assess PPGL in first intention. Identification of mutations in known susceptibility genes may help further refining tumor characterization and prognosis assessment. The objective of this study was to analyze clinical characteristics of PPGL from Belgium according to their secretory and genetic profiles.

Design and method:

We retrospectively analyzed a cohort of 120 cases of non-syndromic PPGL diagnosed in 19 Belgian centres. Clinical characteristics were correlated with three catecholamine phenotypes based on urinary metanephrines (noradrenergic, adrenergic and silent) and with the results of genetic screening.

Results:

Our cohort included a majority of women (59%). The mean age at diagnosis was 47 ± 7 years. We documented the prevalence of pediatric (7.5%), extra-adrenal (13.3%), bilateral (2.9%), multifocal (5.1%), recurrent (8.5%), metastatic (7.6%) and familial (5.9%) cases. While the yield of positive genetic screening was low (15%), the presence of at least one of these criteria was associated with a 4-fold increased prevalence of mutation (30.3 vs 8.5%; p = 0.03). In the subset in whom metanephrines values were available (n = 62), the prevalence of adrenergic, noradrenergic and silent phenotypes was 58%, 34% and 8% respectively. Patients belonging to these three subsets differed by age at diagnosis (51 ± 14; 38 ± 17; 42 ± 13 years; p = 0.009), the proportion of extra-adrenal tumors (2.8%; 9.5%; 40%; p = 0.016), pediatric (2.8%; 19%; 0%; p = 0.074) and familial (0%; 18.8%; 0%; p = 0.041) cases. Finally, an excess of dopamine secretion was associated with a higher prevalence of metastatic disease (25% vs 1.9%; p = 0.005).

Conclusions:

Secretory phenotypes and genetic profiles deserve to be integrated in the preoperative characterization of PPGL and may help orienting management and follow-up. Simple clinical features are associated with an increased probability of inherited tumor. Identification of an increased dopamine secretion should raise the suspicion of metastatic PPGL.
THE EFFECT OF THE MENSTRUAL CYCLE ON RENIN, ALDOSTERONE AND ALDOSTERONE-TO-RENIN RATIO IN FORMERLY PREECLAMPTIC AND HEALTHY WOMEN
Authors: Alnazer Rawan , Veldhuizen Gregory , Spaanderman Marc , De Leeuw Peter
Published: April 2021

Objective:

The aldosterone-to-renin ratio (ARR) is widely used as a screening test for primary aldosteronism (PA) in patients with hypertension. The purpose of the present original investigation is to identify the impact hormonal changes have on renin, aldosterone, and the ARR during the menstrual cycle of premenopausal women when measured in strict standardised conditions.

Design and method:

We analysed 59 women with a history of preeclampsia and 6 healthy parous controls. Blood values were determined during both follicular and luteal phases of the menstrual cycle (days 1 and 14 respectively). Plasma aldosterone, active plasma renin concentration (APRC) and the ARR were measured under standardised conditions. All measurements were taken in the supine position at 9am, all patients maintained a standardised sodium diet (100 mmol/day) for no less than two weeks. In those who were receiving antihypertensive medications (n = 2), all medications were discontinued at least 1 week prior to screening.

Results:

When performing the Friedman's Test and the Wilcoxon signed rank test in formerly preeclamptic women (n = 59), aldosterone and renin were both significantly elevated in the luteal phase (mean rank aldosterone 1.2 and 1.8 p0.000 Z-4.7, mean rank renin 1.23 and 1.77 p0.000 Z -4.5, respectively), however the ARR values did not significantly differ between phases (mean rank 1.53 and 1.47 p0.7 Z-0.14). When performing the Friendman's Test in the control group (n = 6), the difference in aldosterone, renin and the ARR between the follicular and luteal phase was not significant (p0.059 for all parameters). Wilcoxon signed test revealed a significant difference in aldosterone (Z-2.02 p0.04), but the difference in renin and the ARR remained insignificant (p0.06).

Conclusions:

In this study of premenopausal women we found that both renin and aldosterone are significantly affected by the menstrual cycle. However the resulting ARR was not statistically significantly altered. Our study indicates that it is not necessary to take the menstrual phase of patients into account when performing and interpreting the ARR as a screening test for PA in patients with a history of preeclampsia.
FOLLOW THE HEART OR THE GUT?
Authors: Munteanu Alice Elena , Diaconescu Corina , Casian Mihnea , Ionita Iulia
Published: April 2021

Objective:

This case underlines the importance of thoroughly investigating alternative causes for hypertension in patients with atypical presentations, regardless of their age and risk factors.

Design and method:

Clinical case.

Results:

We present the case of a 68 year old woman without known cardiovascular diseases who came to the ER complaining of headaches, palpitations and chest pain of two hours duration. Upon admission, her blood pressure was 300/150 mmHg - overlapping values in all limbs with no asymmetric pulse. Heart rate was 140 bpm, rhythmic and without heart murmurs, abdomen without murmurs or palpable masses. Her ECG showed diffuse ST segment depression and high sensitivity troponin level at 0 h was 258 ng/L. Cardiac echo showed no wall motion abnormalities and no hypertrophy of the left ventricle. Her BP was acutely controlled with ACEi and iv nitroglycerin. Two hours after admission her BP returned to normal and remained within normal range without medication. Her ECG showed normal sinus rhythm with no other pathological findings. Coronary angiography was performed the next day and showed no atherosclerotic lesions. At this stage, her diagnosis was type 2 MI caused by severely elevated BP. Blood and urine tests revealed high levels of serum catecholamines and urinary normetanephrines - over 4000 micrograms/24 h. Abdominal ultrasound found a mass near her right kidney. Abdominal CT confirmed the presence of a nodular 5 × 3 cm mass in the right adrenal gland, compatible with a pheochromocytoma. She was submitted to laparoscopic adrenalectomy with normalization of her BP after the surgery. During follow-up, the patient presented with persistently normal blood pressure and normal ECG aspect without any chronic medication.

Conclusions:

Pheochromocytoma is a rare neuroendocrine tumour originating in the adrenal gland medulla. Sustained or paroxysmal arterial hypertension is sometimes associated with the classic triad: episodic headaches, profuse sweating and tachycardia. A timely diagnosis and an effective therapeutic strategy are important, as this is a potentially fatal disease with a very good prognosis if discovered and treated early. It should be excluded in patients with high paroxysmal BP, especially if under 20 or over 50 years old.
HDL CHOLESTEROL LEVELS AND ENDOTHELIAL GLYCOCALYX INTEGRITY IN TREATED HYPERTENSIVE PATIENTS OVER 40 YEARS OLD
Authors: Triantafyllidi Helen , Benas Dimitrios , Schoinas Antonios , Mpirmpa Dionyssia , Ikonomidis Ignatios , Iliodromitis Efstathios
Published: April 2021

Objective:

Endothelial dysfunction indicates target organ damage in hypertensive patients. The integrity of endothelial glycocalyx (EG) plays a vital role in vascular permeability, inflammation and elasticity and finally to cardiovascular disease. We aimed to investigate the role of increased HDL cholesterol levels (HDL-C), which usually are considered protective against cardiovascular disease, in EG integrity in middle aged hypertensive patients.

Design and method:

We studied 186 treated hypertensive patients, apparently healthy and older than 40 years. They were divided regarding sex distribution in two groups. In males’ group, HDL-C was 48 + 19 mg/dl (n = 77, mean age 51 + 11 years) while in females’ group, HDL-C was 67 + 16 mg/dl (n = 109, mean age 63 + 12 years). Increased perfusion boundary region (PBR) of the sublingual arterial microvessels (ranged from 5–9 micrometers) using Sideview Darkfield imaging (Microscan, Glycocheck) was measured as a non-invasive accurate index of reduced EG thickness.

Results:

Females were older (p = 0.04) with fewer smokers (p = 0.04), higher levels of office SBP (148 + 19 mmHg vs. 139 + 15 mmHg, p < 0.001) as well as higher HDL levels (p < 0.001). No differences were found within groups regarding BMI, DBP, total Cholestelol and PBR 5–9. In males, HDL-C was inversely related with PBR 5–9 (r = -0.29, p = 0.01). In a multiple linear regression analysis model, using smoking habit and office SBP levels, as independent variables, we found that HDL-C independently predicted PBR 5–9 (Beta = 0.25, p = 0.006) in male hypertensives.

Conclusions:

In middle-aged, apparently healthy, hypertensive patients, higher HDL-C levels protect EG and subsequently endothelial function. However, the role of EG as a novel index regarding cardiovascular risk in essential hypertension needs to be extensively investigated in future studies.
CIGARETTE SMOKE EXTRACT INDUCES DNA DAMAGE AND ACCELERATES CELLULAR SENESCENCE IN HUMAN ENDOTHELIAL CELLS
Authors: Ishida Mari , Ueda Keitaro , Sakai Chiemi , Yoshizumi Masao , Ishida Takafumi
Published: April 2021

Objective:

Elevated blood pressure and tobacco smoking are causes of preventable mortality. The effects of tobacco smoking on blood pressure are complex and chronic effects of tobacco smoking are inconsistent. We reported that DNA damage was increased in smokers’ blood cells compared to non-smokers. Recently, it has been reported that DNA damage is involved in cellular senescence. In this study, we investigated whether cigarette smoke extract (CSE) exerts DNA damage and cellular senescence in endothelial cells and the physiological influence of DNA damage.

Design and method:

The effect of CSE extracted from tobacco smoke was examined in human umbilical vein endothelial cells (HUVEC). CSE was added to HUVEC and DNA damage formation was quantified by fluorescence immunostaining; DNA single strand breaks (SSBs) with RPA 2 and double-strand breaks (DSBs) with phosphorylated histone H2AX as indices. Cellular senescence was quantified by senescence-associated -b galactosidase activity. The mRNA expression of inflammatory cytokines was quantified by real-time RT PCR.

Results:

SSBs increased at 24 hours after CSE stimulation, and DSBs increased significantly at 72 hours after stimulation. Continuous stimulation with CSE for 7 days resulted in an accumulation of cytosolic DNA (percentage of cells with cytosolic DNA; control: 3.4 ± 1.1, 7 days stimulation: 11.8 ± 1.8, p < 0.01)and accelerated cellular senescence (percentage of senescent cells; control: 32.5 ± 3.4, 7 days stimulation: 61.5 ± 5.2, p < 0.01). The mRNA expression of inflammatory cytokines, such as IL-6 and IL-1a was increased and prolonged by continuous CSE stimulation.

Conclusions:

CSE was shown to induce DNA damage, accumulation of cytosolic DNA, cellular senescence and inflammation of vascular endothelial cells.
THE IMPACT OF ISCHEMIA-REPERFUSION ON LANGENDORFF RABBIT HEART WITH EXPERIMENTAL ATHEROSCLEROSIS
Authors: Revnic Cristian Romeo , Sonea Cosmin , Revnic Flory
Published: April 2021

Objective:

To examine the effect of hypercholesterolemia (HC)on cardiac function in rabbit model.

Design and method:

12 adult rabbits divided into 2 groups of 6 rabbits each:Control(C) fed on normal chow, and (HC) fed on 2% cholesterol (Iard mixed with chow) for 16 weeks. After treatment, rabbits from (C) and (HC) groups were sacrificed and hearts were quicky removed, and perfused with standard Krebs Hanseleit buffer at a rate of 10 ml/minute at 37°C, pH 74 in Langendorff retrograde perfusion system at a constant pressure.45 minutes ischemia was followed by 120 minutes reperfusion and parameters of cardiac function: coronary flow (HC), Heart rate (H.R.) and left ventricle developed pressure (LVDP) of hearts from (C) and (HC) groups were measured. TACS DNA laddering kit was used to assess left ventricle cardiomyocytes from group (HC) for apoptosis, also fragments of left ventricle from (HC) were processed for Electron Microscopy (EM).

Results:

Evaluation of (C.F.), (H.R.) and (LVDP) in (C) and (HC) groups have pointed out a 50% reduction in (C.F). in (HC) group versus (C) during stabilization period In (HC) group, LVDP was depressed during the whole experiment, while in (C) group is was almost constant. Protection of myocardium against oxidative stress was significantly depressed following (HC) treatment, synthesis and utilization of GSH was limited versus (C). Cardiac hypertrophy experimentally induced with (HC) was related with a decrease in (C.F.) and LVDP associated with an increase in lipid peroxidase, in LDH and CK as markers of myocardial lesion and GGT activity in myocardial tissue. Myocyte apoptosis was present in (HC) group, pointed out by DNA laddering pattern on gel electrophoresis. (E.M.) studies have pointed out perinuclear edema of myocytes, dilated sarcoplasmic reticulum and swollen mitochondria.

Conclusions:

High cholesterol diet in (HC) rabbits induces cardiac hypertrophy and changes in physiological parameters of heart with a negative impact upon synthesis of antioxidant enzymes as well as changes in ultrastructure of heart muscle and at the molecular level (DNA laddering is present as a sign of apoptosis in ventricular myocytes).
HEMODIALYSIS AND PERITONEAL DIALYSIS PATIENTS HAVE SEVERELY IMPAIRED ENDOTHELIAL POST-OCCLUSIVE FOREARM VASODILATORY RESPONSE ASSESSED WITH LASER SPECKLE CONTRAST IMAGING
Authors: Alexandrou Maria-Eleni , Gkaliagkousi Eugenia , Loutradis Charalampos , Dimitriadis Chrysostomos , Mitsopoulos Efstathios , Lazaridis Antonios , Nikolaidou Varvara , Dolgiras Panagiotis , Papadopoulou Dorothea , Douma Stella , Papagianni Aikaterini , Sarafidis Pantelis
Published: April 2021

Objective:

Endothelial dysfunction is associated with cardiovascular events and mortality in various disease states, including end-stage-renal-disease (ESRD). Novel technological approaches have emerged for real-time assessment of endothelial reactivity. This study examined forearm skin microcirculation using Laser Speckle Contrast Imaging (LSCI) before and after arterial occlusion in ESRD patients undergoing hemodialysis (HD) or peritoneal dialysis (PD).

Design and method:

Thirty-eight patients undergoing HD were matched in a 1:1 ratio with 38 PD patients (for age, sex and dialysis vintage) and 38 controls (for age and sex). Skin microvascular reactivity parameters assessed with LSCI included baseline perfusion, occlusion perfusion, and peak perfusion during post-occlusive reactive hyperemia (PORH); time to peak perfusion; proportional change from baseline to peak perfusion; baseline and peak cutaneous vascular conductance (CVC); proportional change from baseline to peak CVC; and the amplitude of the PORH response (calculated as the difference between peak and baseline CVC).

Results:

Baseline perfusion [HD: 46.97 ± 14.6; PD: 49.32 ± 18.07; controls: 42.02 ± 11.94 Laser-Specle-Perfusion-Units (LSPU), p = 0.097] and peak post-occlusion perfusion (104.77 ± 28.68 vs 109.04 ± 40.77 vs 116.96 ± 30.96 LSPU, p = 0.238) did not differ between groups. However, the post-occlusive vascular response was completely different, since time to peak response (HD: 7.24 ± 6.99; PD: 10.68 ± 9.45; controls: 11.11 ± 5.1 sec, p = 0.003) and the (%) increase from baseline to peak perfusion (HD: 133% ± 66; PD: 149% ± 125; controls: 187% ± 61, p = 0.001) was significantly lower in ESRD patients. ESRD patients had also lower levels of peak CVC, indicating the maximum capillary recruitment (HD: 1.05 ± 0.3; PD: 1.07 ± 0.44; controls: 1.57 ± 0.52 LSPU/mmHg, p < 0.001), lower % increase of CVC at peak (p = 0.001), and lower amplitude of the PORH response (p = 0.001) (a measure of the difference between baseline and maximum capillary recruitment).

Conclusions:

Using this novel non-invasive technology endothelial post-occlusive skin vasodilatory response was found to be similar between HD and PD patients and significantly impaired compared to controls. Future studies are needed to assess the prognostic implications of this microcirculatory functional defect.
THE EFFECT OF ELEPHANTOPUS SCABER EXTRACT ON HISTOPATOLOGY OF AORTA SECTION IN SPRAGUE-DAWLEY RATS WITH HYPERCHOLESTROLEMIA DIET MODEL
Authors: Kresna Deva Bayu , Ardiansyah Rizki , Imani Namira Putri , Budiani Dyah Ratna
Published: April 2021

Objective:

This study was designed to evaluate the antihypercholesterolemic effect of Elephantosus scaber on histopatology of Sprague-Dawley rat's aorta with hypercholesterolemia diet model.

Design and method:

This is an Experimental study with post test only control group design. Twenty-one (21) Sprague-Dawley rats of about 2–3 months old, weighing between 150–200 g body weight, were used for the study with incidental sampling. The rats were divided into three groups (3) of seven animals in each cage. First group (G1) was the normal control administered standard meal. Positive control group (G2) and Treatment group (G3) were administered with high fat diet. Administration of 400 mg/kg body weight of Elephantopus scaber extract was given to the third group in 7–11 weeks after induced by high fat diet. Termination was done after last feed administration. Aorta section was done with Hematoxylin eosin stain. Data analysis used Kruskal-wallis followed by Mann-Whitney test.

Results:

Proximate measurement was carried out on the Sprague-Dawley rat's aorta section with the following results: wall thickness in normal control group 85.19 ± 8.35 mm; positive control group 95.78 ± 17.64 mm and treatment group 80.50 ± 8.41 mm. Data analysis of Kruskal-Wallis was obtained P = 0.018, a > P. The results obtained from the analysis of Mann-Whitney test are significant difference between normal control group (G1) and positive control group (G2). And non-significant difference between normal control group (G1) and treatment group (G3).

Conclusions:

Elephantosus scaber extract has antihypercholesterolemic potential effect that could reduce atherosclerosis on histopatology of aorta section in Sprague-Dawley rats with hypercholesterolemia diet model.
COMPARISON OF WHITE COAT AND MASKED HYPERTENSION IN AN OUTPATIENT CARDIOLOGY POPULATION
Authors: Victor Andrew , Kumar Nikhil , Sheriff Rebecca , Kumar Naresh
Published: April 2021

Objective:

White coat hypertension and masked hypertension are two diagnoses that have opposite defining characteristics. White coat hypertension is defined as having an abnormally elevated blood pressure reading at the doctor's office however it is normal otherwise. Masked hypertension is defined as having a normal blood pressure reading in office while being hypertensive otherwise. White coat hypertension is well understood to be provoked by anxiety and stress when visiting a doctor's office. Masked hypertension is frequently under-diagnosed as patients with normal blood pressure readings likely do not have further investigations where masked hypertension can be identified. According to current literature, masked hypertension can be present in as much as 20% of the population. This study analyzes a sample of patients in an outpatient setting to determine the prevalence of such conditions in a typical Canadian population.

Design and method:

500 patients from a single outpatient cardiology practice were screened with a 24 hour ambulatory blood pressure monitor and results were analyzed the following day. Patients were diagnosed as having masked hypertension, white coat effect/hypertension or having normal blood pressures.

Results:

Of the 500 patients analyzed, 6.2% of the cohort was diagnosed as having masked hypertension. 23.6% of the cohort was diagnosed as having white coat effect. 60% of the screened patients were normotensive whereas the remaining 40% had some degree of hypertension, including masked hypertension.

Conclusions:

The data obtained from the analysis shows that in this typical segment of Canadian population, the diagnosis of masked hypertension is well below the current expected prevalence for this condition. This is noted as only 6% of the population was diagnosed as having masked hypertension. Almost 1/4 of the patients were appropriately shown to have white coat effect on their blood pressure recordings. The majority of the patients were identified as having normal blood pressure. The data suggests that masked hypertension may not be as significant a condition as previously suspected. White coat hypertension is especially prevalent and should be followed up on as white coat hypertension can sometimes turn into permanent hypertension.
UNSUPERVISED CLUSTER ANALYSIS OF HYPERTENSIVE INDIVIDUALS IDENTIFIES A ROBUST HIGH-RISK SUBGROUP
Authors: Vaura Felix , Salomaa Veikko , Kaaja Risto , Lahti Leo , Niiranen Teemu
Published: April 2021

Objective:

Despite hypertension being a crucial risk factor for cardiovascular disease, the current classification of hypertension does not reflect the heterogeneity or the wide variation in cardiovascular outcomes of hypertensive individuals. Our objective was therefore to identify subgroups of hypertensive individuals with distinct cardiovascular outcomes using data-driven cluster analysis.

Design and method:

To identify phenotypically distinct subgroups of hypertensive individuals, we performed unsupervised hierarchical clustering in participants with grade 2 hypertension from two population cohorts (FINRISK 2002 and 2012; n = 1971, mean age 59.8 years, 49% women) with up to 16 years of follow-up for incident cardiovascular events (n = 260). We defined hypertension as either systolic blood pressure (SBP) over 160 mmHg, diastolic blood pressure (DBP) over 100 mmHg, or use of antihypertensive medication. We computed the clusters separately for men and women based on eight factors related to hypertension and cardiovascular outcomes: mean arterial pressure (MAP; steady state pressure), pulse pressure (PP; pulsatile pressure), non-high-density lipoprotein cholesterol (non-HDLc), glycated hemoglobin (HbA1c), body-mass index (BMI), C-reactive protein (CRP), estimated glomerular filtration rate (eGFR), and alcohol consumption (rAlcohol). In analyses with men and women combined, we used Cox regression models adjusted for age and sex to assess the risk of cardiovascular outcomes between the resulting clusters.

Results:

We observed two comparable clusters for both sexes (Figure). These clusters had significantly different patient characteristics. Notably, mean HbA1c (5.5 ± 0.4 vs. 7.6 ± 0.9 in men; 5.5 ± 0.3 vs. 7.7 ± 0.8 in women) and BMI (29.0 ± 4.5 vs. 31.1 ± 4.3 in men; 29.4 ± 5.4 vs. 33.3 ± 5.5 in women) were higher in Cluster 2 than in Cluster 1. Individuals in Cluster 2 had 2.1-fold greater risk (95% CI 1.4–3.1, p < 0.001) of cardiovascular disease than individuals in Cluster 1.

Conclusions:

Using unsupervised hierarchical clustering, we stratified patients into two subgroups with differing disease progression and risk of complications. Substratification of hypertensive patients by low vs. high blood glucose and BMI could help to tailor and target early treatment to patients who would benefit most from it.
EFFECTS OF SMOKING ON CENTRAL BLOOD PRESSURE
Authors: Takase Hiroyuki , Machii Masashi , Nonaka Daishi , Ohno Kazuto , Takayama Shin , Sugiura Tomonori , Ohte Nobuyuki , Dohi Yasuaki
Published: April 2021

Objective:

Smoking is known to induce systemic vascular damage, leading to cardiovascular diseases. Recent studies demonstrated that central blood pressure has a greater impact on cardiovascular events than brachial blood pressure. We investigated effects of habitual smoking on central systolic blood pressure (CSBP) in the general population.

Design and method:

A total of 5630 subjects (male = 2622, 51.7 ± 12.0 year-old at baseline), who visited our hospital for a physical check-up at least twice during the last 10 years and underwent CSBP measurement at each visit, were enrolled, and effects of smoking on the average and yearly changes of CSBP (median follow-up 5 years) were analyzed. Brachial blood pressure (oscillometer) and radial artery pressure waveforms (tonometer) were recorded using an automated device, and the pressure corresponding to the second systolic peak of radial pressure waveforms was taken as CSBP (HEM-9000AI, Omron Healthcare, Kyoto). Hypertension was defined as brachial BP > = 140/90mmHg or the use of antihypertensive medications. A yearly change in CSBP was calculated in each subject by linear regression analysis using longitudinal data.

Results:

The average CSBP during the follow-up was higher in habitual smokers than in non-smokers when analyzed in normotensive (n = 4634, 109.1 ± 11.7 vs. 107.6 ± 12.8 mmHg, p < 0.001) and non-treated hypertensive subjects (n = 91, 150.7 ± 14.8 vs. 142.8 ± 16.7 mmHg, p < 0.05), whereas in hypertensive subjects under medication the average CSBP was lower in smokers than in non-smokers (n = 905, 124.6 ± 12.4 vs. 127.8 ± 13.6 mmHg, p < 0.01). Although smoking status did not affect yearly changes of CSBP in both normotensive (habitual smokers vs. non-smokers; 1.38 ± 6.00 vs. 1.44 ± 6.04 mmHg/year) and treated hypertensive subjects (-0.16 ± 7.08 vs. -0.66 ± 8.24 mmHg/year), the unfavorable effect of smoking on yearly increase of CSBP was found in non-treated hypertensive subjects (4.09 ± 15.1 vs. -0.53 ± 10.3 mmHg/year).

Conclusions:

Habitual smoking increases CSBP especially in subjects with hypertension, however, antihypertensive medications counteract the unfavorable effects of smoking on CSBP. These results imply a new pathway underlying the development of cardiovascular diseases in smokers. Unfavorable changes in the cardiovascular system caused by smoking may quite slowly progress that short period of observation in the present study could not have detected enhanced yearly increases of CSBP by smoking.
OPPORTUNISTIC SCREENING FOR HYPERTENSION VERSUS NATIONAL MULTISTAGE STRATIFIED HEALTH SURVEY: 2019 ISH/MMM IN GREECE VERSUS NATIONAL SURVEY EMENO
Authors: Stergiou George , Menti Ariadni , Papadakis Ioannis , Kalpourtzi Natasa , Doumas Michael , Kalaitzidis Rigas , Krokidis Xenophon , Chatzopoulos Michail , Marketou Maria , Gkaliagkousi Eugenia , Kallistratos Manolis , Katsi Vasiliki , Manios Efstathios , Papadopoulos Dimitrios , Sarafidis Pantelis , Touloumi Giota , Zebekakis Pantelis
Published: April 2021

Objective:

In 2019 the International Society of Hypertension screening project May Measurement Month (MMM) for hypertension collected data from 5,727 adults in 5 large cities in Greece. This analysis assessed the reliability of the MMM in reflecting the true prevalence and control of hypertension, by comparing its findings with those of a national health survey (National Morbidity and Risk Factors Survey EMENO 2013–16).

Design and method:

The 2019 MMM estimates were compared with those of EMENO 2013–16, in which a representative sample of 4,704 adults in Greece (> = 18 years) was selected. Both projects obtained blood pressure (BP) measurements and information on antihypertensive drug treatment. The prevalence of hypertension (BP > = 140/90 mmHg and/or use of antihypertensive drugs), awareness, treatment and control were compared.

Results:

In the MMM and EMENO participants’ mean age was in 52.7 ± 16.6 (SD) and 49.0 ± 18.5 years (p < 0.001) respectively, BMI 27.1 ± 5 and 28.1 ± 5.7 kg/m2 (p < 0.001) and men 46.5% and 48.5% (p < 0.001). The prevalence of hypertension was 41.6% in the MMM versus 40.5% in the EMENO (p = NS) (in men 51% vs. 44.6%, p < 0.001 and women 33.6% vs 36.6%, p < 0.05). Among hypertensive subjects, unaware were 21.3/33.6% in MMM/EMENO (p < 0.001), aware untreated 5.6/2.9%, treated uncontrolled 24.8/36.1% and treated controlled 48.3/27.5% (p < 0.001 for difference in control rate among treated subjects).

Conclusions:

These data suggest that the MMM opportunistic screening gave a reliable estimate of hypertension prevalence in Greece. However, the MMM largely underestimated the true prevalence of undiagnosed hypertension and overestimated the control rates.
HYPERTENSION AND POST-TRAUMATIC STRESS DISORDER: A STRONG ASSOCIATION IN AN AFRICAN POPULATION EXPOSED TO FREQUENT VIOLENCE
Authors: Bapolisi Achille , Maurage Pierre , Pappaccogli Marco , Georges Coralie , Petit Géraldine , Bisimwa Ghislain , De Timary Philippe , Persu Alexandre
Published: April 2021

Objective:

Our interdisciplinary team has recently documented a high prevalence of Post-Traumatic Stress Disorders (PTSD) in patients with treatment-resistant hypertension, altogether with emotion regulation deficits and a psychopathological expression. The objective of the current study was to look for the prevalence and nature of psychological abnormalities and PTSD in hypertensive patients from Bukavu, a city located in South-Kivu (Democratic Republic of Congo) and at war for the last 20 years.

Design and method:

We compared the levels of trauma exposure, psychiatric disorders including PTSD, emotion regulation strategies and social support of hypertensive patients vs. normotensive controls enrolled at the Internal Medicine Department of Bukavu General Hospital.

Results:

We compared 47 patients with hypertension (62% women, age: 41 ± 13 years, BMI: 24.5 ± 3.5 kg/m2, BP: 139 ± 12/83 ± 7 mmHg on a median of 1.7 antihypertensive drugs) with 55 normotensive subjects (73% women, age: 43 ± 14 years, BMI: 22.4 ± 3.5 kg/m2, BP: 122 ± 10/76 ± 8 mmHg) without cardiovascular or renal disease. Compared with normotensive controls, hypertensive patients had been exposed to more severe traumas (p < 0.001), more frequently due to physical aggression (p < 0.001), developed more frequent PTSDs (68% vs. 4%, p < 0.001), Major Depressive Disorders (60% vs. 27%, p = 0.001), and Alcohol Use Disorders (49% vs. 2%, p = 0.006). Hypertensive patients also presented with less adaptive emotion regulation strategies (more tendencies for anger in (p = 0.01), emotional suppression (p = 0.043), self-blame (p = 0.04), rumination (p = 0.012) and catastrophizing (p = 0.029) contrasting with less tendencies for acceptance (p = 0.017) and emotional reappraisal (p = 0.024)). Finally, hypertensive patients received less social support from companion, friends and the community (p < 0.05).

Conclusions:

Altogether, this study shows a striking association between trauma exposure, various psychopathological disorders, in particular PTSD and hypertension. Psychological and traumatic factors may be an important but underestimated contributor to the increasing prevalence of hypertension in Subsaharan African populations.
CONTROL OF HYPERTENSION BY ETHNICS IN COLOMBIA, A SECONDARY ANALYSIS OF COLOMBIA PURE STUDY
Authors: Parra-Gómez Laura Alejandra , Camacho Paul Anthony , Lopez-Lopez Jose Patricio , Gallo-Marín Grecia , Rangarajan Sumathy , Yusuf Salim , Lopez-Jaramillo Patricio
Published: April 2021

Objective:

Hypertension is the main cardiovascular risk factor and its prevalence varies among the countries according to their economic income and ethnicity. Colombia is a middle-high income country, with a variety of ethnic groups among the national territory. We aim to describe the prevalence and control of hypertension by ethnics in Colombia and its associated factors.

Design and method:

Prospective Urban Rural Epidemiology (PURE) study - Colombia is a prospective, population-based cohort study on persons aged 35–70 years. Ethnic group was assessed by phenotypic characters (skin, eyes and hair color) and self-definition of white, mestizo (mixture of white and indigenous) and afro-descendant. Descriptive and analytic analysis was performed, using STATA V.11.

Results:

4457 individuals were included, of those 73.5% (N = 3275) where mestizos, 14.1% (N = 626) white and 12% (N = 535) afro-descendant. The prevalence of hypertension was, (34.9%; CI 33.2–36.5) in mestizos, (37.3%; IC 33.5–41.1) in whites, and (43.5%; CI 39.3–47.7) in afro-descendant. The afro-descendant have the lower percentage of awareness (43.5%; CI 37.3–50.0) compared with (51.5%; CI 48.6–54.4) in mestizos and (52.3%; CI 45.9–58.7) in whites. The percentage of treatment was lower (43.1%; IC 36.9–49.6) in the afro-descendant in relation to (45.2%; CI 42.3–48.1) in mestizos and (47.2%; CI 40.8–53.6) in whites, but only (13.8%; CI 9.9–18.8) of afro-descendant have hypertension controlled in relation to (18%; CI 13.5–23.5) in whites and (17.9%; CI 15.7–20.2) in mestizos. On the univariate analysis we found that being afro-descendant is a risk factor to hypertension against being white 1.30 (CI 1.02–1.64). In the multivariate analysis it was maintained after adjustment by age, education level, socio-economic income, urban/rural and muscle strength 1.57 (IC 1.20–2.06).

Conclusions:

Afro-descendants have a higher risk of hypertension in Colombia. Moreover, the percentage of awareness, treatment and control of hypertension are lower in this ethnic group. The association with socio-economic or genetic factors remains to be determinate.
THE ASSOCIATION BETWEEN N-TERMINAL PRO-BRAIN NATRIURETIC PEPTIDE AND CARDIOVASCULAR DISEASE IS CONDITIONED BY PRESENCE OF INCREASED ARTERIAL STIFFNESS
Authors: Blicher Marie Kofoed , Olesen Thomas Bastholm , Pareek Manan , Rasmussen Susanne , Vishram-Nielsen Julie , Olsen Michael Hecht
Published: April 2021

Objective:

The aim of this study was to evaluate whether the cardiovascular risk associated with increased N-terminal pro-brain natriuretic peptide (NT-proBNP) is modified by arterial stiffness assessed as carotid to femoral pulse wave velocity (PWV) in apparently healthy individuals.

Design and method:

This was a population-based cohort study comprising of 1858 healthy subjects included in the 10-year follow-up of the MONItoring of trends and determinants in CArdiovascular disease (MONICA) study. The primary outcome was major adverse cardiovascular events (MACE) after 16 years of follow-up. MACE was defined as cardiovascular death, sudden death, heart failure, arrhythmia, myocardial infarction, chronic ischemic heart disease, cerebrovascular disease, peripheral or central arterial disease. The association between NT-proBNP and MACE was evaluated with Cox proportional-hazards regression stratified for presence of increased arterial stiffness (PWV > 12m/s) and adjusted for traditional risk factors for cardiovascular disease. NT-proBNP was evaluated both as a continuous variable (log transformed) and dichotomously using the 90th percentile as cut-off (110pg/ml) allowing for group-wise comparisons.

Results:

314 events were recorded during a median follow-up of 16.0 years (interquartile range: 14.7–16.0).

In multivariable regression with both log (NT-proBNP) and log (PWV) included in the model, we found that log (NT-proBNP) was associated with MACE: HR = 1.28 [1.13–1.45] (P < 0.001). There was a significant positive interaction between log (NT-proBNP) and log (PWW): HR = 1.53 [1.02–2.29] (P = 0.042). In subjects with PWV < 12m/s, log (NT-proBNP) was not associated with MACE: HR = 1.07 [0.91–1.26] (P = 0.429). In subjects with increased PWV, log (NT-proBNP) was associated with MACE, HR = 1.68 [1.39–2–04] (P < 0.001).

In multivariable categorical analysis using subjects with PWV < 12m/s and NT-proBNP < 110pg/ml as reference group we found: 1) Increased NT-proBNP without increased PWV was not associated with MACE: HR 0.92 [0.52–1.64] (P = 0.790). 2) Increased PWV and normal NT-proBNP showed borderline significant association with MACE HR 1.35 [0.99–1.84] (P = 0.052). 3) Increased PWV and increased NT-proBNP was associated with MACE: HR 3.21 [2.14–4.80] (P < 0.001).

Conclusions:

The association between increased NT-proBNP and MACE was positively modified by increased arterial stiffness. NT-proBNP was only associated with MACE in subjects with simultaneously increased arterial stiffness.
STUDY FOR BETTER BLOOD PRESSURE AND CARDIOVASCULAR RISK CONTROL IN A RURAL AREA OF RWANDA
Authors: Muggli Franco , Parati Gianfranco , Suter Paolo , Bianchetti Mario , Muvunyi Bienvenu , Ntaganda Evariste
Published: April 2021

Objective:

Also in Sub-Saharan Africa (SSA), the burden of hypertension and related cardiovascular (CV) complications is an health threat. Between October and November 2017 blood pressure (BP) was assessed in 372 subjects (>18y) at the Health Centre of Nyamyumba, a village of the rural District of Nyaruguru (Rwanda), where the MABAWA Association is active for more than 15 years as an integrated development project (www.mabawa.org). BP was determined by mean of oscillometric device. Systolic BP 140mmHg or more was detected in 136 subjects (68 females and 54 males). Hence we decided to perform a local study with the aim to exactly determine the prevalence of hypertension and to improve its control.

Design and method:

Phase 1 of the study aims to assess the incidence of hypertension and other CV risk factors. Phase 2 will focus the control of hypertension and associated CV risk factors with the aim of providing improved CV protection. The aim will be achieved by establishing a clinical consultation module which will be culturally and risk pattern adapted. The protocol of the project has the approval of the Rwanda National Ethic Committee and the endorsement of the World Hypertension League.

Subjects living in Nyamyumba will be visited at home by instructed health care providers and BP will be measured using a validated oscillometric device (OMRON HEM-7322U) according to a standardized protocol. Subjects with elevated BP will be asked to participate to the project. Those with confirmed hypertension will undergo a clinical examination including anthropometric measurements, electrocardiogram and laboratory test (blood count, creatinine, potassium, total-/, HDL-/ and LDL-cholesterol, triglyceride, HbA1c and microalbuminuria). Finally, they will be taught in a culturally adapted way to understand the risk associated with high BP and start appropriate life style and medical intervention.

Results:

expected for 2021

Conclusions:

High BP likely affects millions of people in Africa. It is the most important cause of heart disease and stroke. Only few SSA countries have a clear hypertension management strategy. Our purpose is to identify practical and feasible solution to improve control of BP and associated risk factors in Rwanda.