bluuebunny/crossref_metadata_2025 huggingface dataset:
SUB-OPTIMAL HEALTH SYSTEM CAPACITY TO EFFECTIVELY MANAGE HYPERTENSION IN RURAL INDIA
Authors: Mohan Sailesh , Jarhyan Prashant , Sv Nikhil , Kumar Ganesh , Prabhakaran Dorairaj
Published: April 2021

Objective:

Despite the high burden of hypertension in rural India, limited information is available on the primary health system's capacity for its management. We aimed to determine the burden of hypertension and the health system's capacity to manage it in rural India.

Design and method:

We implemented a comprehensive diabetes and hypertension prevention and management program entitled “UDAY” in epidemiologically transitioning rural areas of North (Sonipat) and South (Vizag) India. Rural areas comprised a population of 200,000 and were being provided primary healthcare through six public primary healthcare facilities. A representative population based cross-sectional survey, using a multistage cluster random sampling technique among 6173 participants aged 30 years and above was done to determine the prevalence, awareness, treatment and control of hypertension. In addition, all the public primary healthcare facilities and all primary care providers (including private) were surveyed to assess the health system's capacity to manage hypertension according to the Indian Public Health Standards (IPHS) and other international/national standard guidelines. Data were obtained using an interviewer administered questionnaire, anthropometry, biosample collection, health facility survey and provider survey. Hypertension was measured using standard definitions and protocols.

Results:

The mean age was 48.0 (SD ± 12.7) years. Age-standardized prevalence of hypertension was 23.5% [95% CI: 22.5–24.6]. Among those with hypertension, awareness rate was 46.4% [43.8–49.0], treatment rate 35.3% [32.9–37.8] and control rate 26.3% [24.1–28.7]. Of all the public primary healthcare facilities (n = 6), none had the full sanctioned number of health staff, two did not have functional BP equipment, and no facility had all six classes of antihypertensive medicines available as recommended by the IPHS. Among 41 providers, only 9 (29%) reported using any standard guidelines for managing hypertension.

Conclusions:

Despite the high hypertension burden, public primary healthcare facilities relied upon by rural population, are inadequately equipped in terms of diagnostics, therapeutics, equipment and workforce to effectively manage hypertension. Health system strengthening along with providers’ training in guideline based hypertension management is imperative to improve management.
CARDIOVASCULAR DISEASES AND HYPERTENSION: A POPULATION-BASED OBSERVATIONAL STUDY
Authors: Rigon Giulio , Albrigi Martina , Tebaldi Giacomo , Giontella Alice , Fava Cristiano , Minuz Pietro
Published: April 2021

Objective:

Overt cardiovascular diseases and diabetes mellitus occuring in the population of hypertensive subjects may be a related to the effectiveness of antihypertensive treatment. Aim of the study was to obtain information concerning drug utilisation, the clinical characteristics of hypertensive patients and blood pressure control in a large population.

Design and method:

We performed ad observational study aimed at defining prevalence of diabetes mellitus, heart failure, chronic kidney disease, atrial fibrillation previous myocardial infarction among hypertensive patients living in the province of Verona (approximately one third of the estimated total number). Information concerning antihypertensive treatment (the number of different drugs concomitantly prescribed over a period of 12 months among 13 drug categories), age, sex, blood pressure (categorical variable, cutoff 140/90 mmHg) was collected from their electronic records (database MySQL, Centro Studi FIMMG) by the 150 General Practitioners taking part in the study. Chi-square test was used in the subgroup analysis. Logistic regression analysis was performed to define which variables were independent predictors of blood pressure control.

Results:

The total number of studied hypertensives was 43526 (females 52.7%), 19.3% of them also had diabetes mellitus, 9.4% atrial fibrillation, chronic kidney disease, 2.9% heart failure and 2.2% a previous myocardial infarction. Data concerning blood pressure control in the previous 12 months was available for 26949 patients (females 51.%). By logistic regression analysis, predictors of inadequate blood pressure control were, not being treated (n = 2013), female sex, coexistent diabetes mellitus and chronic kidney disease (P < 0.0001). When only patient that could ben defined as resistant to medication were considered (uncontrolled blood pressure control with 3 drugs or treated with 4 drugs or more, n = 6472), the prevalence of diabetes mellitus (32.8%), atrial fibrillation (20.1%), heart failure (9.1%), chronic kidney disease (7.8%) myocardial infarction (4.4%) was higher than in patients treated (P < 0.0001).

Conclusions:

In a large part of the population of hypertensives blood pressure control is not achieved. Overt cardiovascular diseases or diabetes mellitus in hypertensive patients are associated with poor blood pressure control, independently of the number of prescribed drugs, suggesting a vicious circle that could result in worsening of organ damage.
HYPERTENSION- A REAL WORLD SETTING ANALYSIS
Authors: Mihailescu Anamaria , Balahura Ana Maria , Japie Cristina , Weiss Emma , Bartos Daniela , Badila Elisabeta
Published: April 2021

Objective:

Hypertension (HTN) represents a public health problem and blood pressure (BP) control rates have remained poor worldwide leading to an increasing number of hospital admission. The purpose of the current study is to describe the pattern of anti-HTN drug therapy in the Department of Internal Medicine of a tertiary care emergency hospital.

Design and method:

We retrospectively analysed all the charts of patients admitted for HTN in the Internal Medicine department of a tertiary care emergency hospital during 3 months (August-October 2019). We retrieved demographic, clinical and treatment approach data from the charts of patients presenting for HTN defined as

JOURNAL/jhype/04.03/00004872-202104001-00695/inline-graphic1/v/2024-05-29T151720Z/r/image-tiff

. We compared different characteristics between female patients (FM) and male (ML) patients.

Results:

69 patients admitted for HTN in 3 months (4.64% from all admissions), 43 female patients (62.3%) mean age 65.51±1.41. The FM, when compared with ML, were more frequently older, with a higher mean systolic BP with the same mean diastolic BP. The calcium channel blockers were more frequently use in female than in their male counterparts, the same use of angiotensin-converting-enzyme inhibitors (ACEi), angiotensin -receptor-blockers (ARB), Loop diuretics and beta blocker was preferred as antihypertensive drug medication in male. See table.

Conclusions:

Hypertensive disease remains one of the main causes for hospital admission. Patients are more frequently women, have an advanced age, a higher systolic blood pressure making them more likely to have a more severe clinical picture. ACEI, CCB, and beta blocker are the preferred antihypertensive therapy. The number of patients with HTN is the expected to rise with the increase life expectancy if a correct antihypertensive therapy is not applied.
DYSLIPIDEMIA IN TREATED AND UNTREATED PATIENTS WITH HYPERTENSION, DIABETES OR BOTH
Authors: Miao Chaoying , Zhang Wei , Liu Changyuan , Wang Jiguang
Published: April 2021

Objective:

We investigated the prevalence of dyslipidemia in patients with hypertension and diabetes mellitus alone or both and the association between dyslipidemia and the use of antihypertensive and antidiabetic agents.

Methods:

Our study participants were treated and untreated hypertensive and diabetic patients enrolled in a China nationwide registry. Dyslipidemia was defined as a serum concentration of triglycerides ?2.3 mmol/L, total cholesterol ?6.2 mmol/L, low-density lipoprotein (LDL) cholesterol ?4.1 mmol/L and high-density lipoprotein (HDL) cholesterol ?1.00 mmol/L.

Design and method:

Serum triglycerides and HDL cholesterol, but not total and LDL cholesterol were significantly different between patients with hypertension alone (n = 860), diabetes alone (n = 473) or both (n = 1090). The prevalence of dyslipidemia was not significantly different between patients with hypertension and diabetes or both for either component or overall (P = 0.34), except that in the subgroup younger than 50 years of age. It was higher in patients with hypertension and diabetes than those with either disease alone. However, treated, compared with untreated hypertensive patients had significantly lower serum total, LDL and HDL cholesterol, and similar serum triglycerides. And treated, compared with untreated diabetic patients had significantly lower serum triglycerides, total and LDL cholesterol but similar HDL cholesterol. The result remained similar for various forms of dyslipidemia. After adjustment for confounding factors, the results were confirmatory, with a significantly odds ratio of 0.76 (95% CI 0.58 - 0.997, P = 0.048) for hypercholesterolemia and 1.56 (95% CI 1.19 - 2.03, P = 0.001) for low HDL cholesterol associated with antihypertensive treatment, and of 1.50 (95% CI 1.18 - 1.89, P = 0.0008) for low HDL cholesterol associated with antidiabetic treatment. Further analyses showed that the odds for low HDL cholesterol was significantly (P?0.02) higher with the use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (n = 927), diuretics/?-blockers (n = 547) and insulin (n = 460).

Results:

The prevalence of dyslipidemia was only sightly different between patients with hypertension and diabetes mellitus alone or both, but differed significantly between treated and untreated hypertension and diabetes in favour of treatment in spite of some compromise in HDL cholesterol with the use of some of medications.
NEGLECT OF HYPERTENSION AND HYPERLIPEMIA DURING MEDICAL HISTORY INQUIRY NEED MORE CONCERN
Authors: Ma Zhiyi , Chen Yuanyuan , Sun Ningling
Published: April 2021

Objective:

The neglect of hypertension and hyperlipemia is a further question while their awareness rates are increasing. Our observation is to estimate the neglect rate of hypertension and hyperlipemia for diagnosed patients during outpatient service.

Design and method:

In 2019, from May 06th to Nov 19th, we collected medical history inquiry information during outpatients service in cardiovascular department in our hospital. Patients inclusion criteria: those for symptoms or diseases. Patients exclusion criteria: those only for routine prescription. Initiative-providing-hypertension-history patients (IPHH) were defined as initiatively providing hypertension history during disease history inquiry. Passive-providing-hypertension-history patients (PPHH) were defined as providing antihypertension therapy during medication history inquiry without providing hypertension history. Initiative-providing-hyperlipemia-history patients (IPLH) were defined as initiatively providing hyperlipemia history during disease history inquiry. Passive-providing-hyperlipemia-history patients (PPLH) were defined as providing lipid-lowering therapy during medication history inquiry without providing hyperlipemia history. (see Table)

Results:

1. There were 459 hypertension patients among total 883 patients. IPHH patients were 412 and the complaints of 198 patients among them were hypertension unrelated. All the complaints of 47 PPHH patients were hypertension unrelated. The percentage of PPHH patients among hypertension patients without hypertension related complaints was 19.18%. 2. There were 245 hyperlipemia patients among total 883 patients. IPLH patients were 122 and the complaints of 92 patients among them were hyperlipemia unrelated. All the complaints of 123 PPLH patients were hyperlipemia unrelated. The percentage of PPLH patients among hyperlipemia patients without hyperlipemia related complaints was 57.21%. 3. The percentage of PPLH patients among hypertension patients without hyperlipemia related complaints was 19.73% (89/451). 4. The age of PPHH patients was significantly younger than that of IPHH patients without hypertension complaints (p = 0.023322). 5. PPHH patients had a higher female percentage than IPHH without hypertension complaints, but there was no statistical significance (p = 0.05365). (see Table)

Conclusions:

We need pay more attention to medication history inquiry to avoid omitting hypertension and hyperlipemia history. Particularly for application in artificial intelligence, man-machine conversation in the area of medicine should design the feedback from medication history inquiry to disease history inquiry.
HIGH BLOOD PRESSURE SCREENING DURING MAY MEASUREMENT MONTH (MMM) 2019: TIME FOR ADOLESCENTS?
Authors: Lopez-Sublet Marilucy , Ghouiles-Zeblah Sabrina , Benramedane Ghouti , Hahashy Jean -Kyrellos , Rouabhi Aicha , Gourara Helene , Mouterde Anne Laure , Benainous Ruben , Leprieur Benedicte Giroux , Suhl Jaehyo , Foudi Farid , Litout Marylene , Le Jeune Sylvain , Dhote Robin
Published: April 2021

Objective:

Every year, may 17th is dedicated to the World Hypertension Day (WHD). This is an initiative of the World Hypertension League, an affiliate of the International Society of Hypertension. These united forces have expanded to make May Measurement Month (MMM), a month of campaigning to raise awareness against hypertension. The objective of this study was to introduce the data obtained from a sample of adults and adolescents during the 2019 WHD.

Design and method:

Screening was conducted at a French hospital (Hôpital Avicenne) with the voluntary and volunteer assistance of physicians, interns, pharmacy and nursing students of our service, while following the standard MMM protocol. The support of the French Society of Hypertension (in partnership with Omron France) has been proposed to provide our centre with blood pressure (BP) monitors (Omron HEM-FL31/M3 Comfortâ).

Results:

Anonymous general data for this population of 140 subjects, including 66 adolescents, are summarized in the table. The majority of adult participants reported that their last BP measurement was more than a year ago, or was never even taken. All adolescents had measured their BP for the first time during this campaign. The number of known hypertensive adults 15 (20,3%). No adolescents were known to have high BP.

In this population, 10 (13,5%) adults and 3 (4,5 %) adolescents have an unknown high normal BP. As for new hypertensive patients, there are 6 adults (8,1%) and 4 adolescents (6,1%) broken down as follows: Grade 1 hypertension: 4 adults and 4 adolescents, Grade II: only 2 adults, and Grade III: no one.

Conclusions:

Hypertension in children and adolescents is underestimated and under-diagnosed in clinical practice. European and American guidelines tend to simplify adult hypertension classifications to apply it in adolescents, but data from intervention and screening trials are not yet available. Although our screening approach remains modest in France (or at the European level), it aims to place young people at the centre of screening actions. A sustainable and methodical model for hypertension screening campaigns must make it possible to involvement the future generations in the fight against cardiovascular risk.
PREVALENCE AND PREDICTION OF SECONDARY HYPERTENSION IN YOUNG MALE MILITARY PERSONNEL
Authors: Kim Kihyun , Kim Jong-Youn , Choi Eui-Young , Kwon Hyuck Moon , Rim Se-Joong
Published: April 2021

Objective:

Current guidelines suggest screening for secondary causes in the early onset of hypertension (HTN) before 30 years. However, there have been few studies on secondary HTN in young adults. We aimed to investigate the prevalence and predictors of secondary HTN in young male military personnel.

Design and method:

This study used data from the Defense Medical Information System (DEMIS) database between January 2011 and June 2017. Of 6373 hypertensive males (19–29 years) from 19 military hospitals in South Korea, we comprehensively reviewed the medical records of 638 cases with any diagnosis associated with secondary HTN.

Results:

Secondary HTN was confirmed only in 140 subjects (2.2%) as a final diagnosis through detailed chart review. The most common causes were polycystic kidney disease (0.74%) and renal parenchymal diseases (0.38%). Other endocrinologic causes were very rare. The independent predictors for secondary HTN were abnormal thyroid function test (odds ratio [OR], 9.50; 95% confidence interval [CI], 4.84 to 19.45; P < 0.001), proteinuria (> trace) (OR, 6.13; 95% CI, 2.97 to 12.99, P < 0.001), hematuria (> trace) (OR, 4.37; 95% CI, 2.15 to 9.01; P < 0.001), severe HTN (>180/110 mmHg) (OR, 3.07; 95% CI, 1.42 to 6.65; P = 0.004), and overweight (body mass index > 23 kg/m2) (OR, 0.33; 95% CI, 0.19 to 0.59; P < 0.001). However, there were no significant differences in the family history of HTN, headache, total cholesterol level and diabetic state between primary and secondary HTN.

Conclusions:

Secondary HTN is very rare in young male military personnel. To ensure cost-effectiveness, screening for secondary HTN should be performed selectively considering various predictive factors.
GENETICALLY, DIETARY SODIUM INTAKE IS CAUSALLY ASSOCIATED WITH SALT-SENSITIVE HYPERTENSION RISK IN A COMMUNITY-BASED COHORT STUDY: A MENDELIAN RANDOMIZATION APPROACH
Authors: Choi Jung Ran , Jeong Seongmun , Kim Jae-Yoon , Cho Youngbum , Kim Namshin
Published: April 2021

Objective:

Excessive dietary salt intake is associated with an increased risk of hypertension. Salt sensitivity, i.e., an elevation in blood pressure in response to high dietary salt intake, has been associated with a high risk of cardiovascular disease and mortality. We investigated whether a causal association exists between dietary sodium intake and hypertension risk using Mendelian randomization (MR).

Design and method:

We performed an MR study using data from a large genome-wide association study comprising 15,034 Korean adults in a community-based cohort study. A total of 1,282 candidate single nucleotide polymorphisms associated with dietary sodium intake, such as rs2960306, rs4343, and rs1937671, were selected as instrumental variables. The inverse variance weighted method was used to assess the evidence for causality.

Results:

Higher dietary sodium intake was associated with salt-sensitive hypertension risk. The variants of SLC8E1 rs2241543 and ADD1 rs16843589 were strongly associated with increased blood pressure. In the logistic regression model, after adjusting for age, gender, smoking, drinking, exercise, and body mass index, the GRK4 rs2960306TT genotype was inversely associated with hypertension risk (OR = 0.356, 95% CI = 0.236–0.476). However, the 2350GG genotype (ACE rs4343) exhibited a 2.11-fold increased hypertension risk (OR = 2.114, 95% CI = 2.004–2.224) relative to carriers of the 2350AA genotype, after adjusting for confounders. MR analysis revealed that the odds ratio for hypertension per 1 mg/day increment of dietary sodium intake was 2.24 in participants with the PRKG1 rs12414562 AA genotype.

Conclusions:

Our findings suggest that dietary sodium intake may be causally associated with hypertension risk.
DETERMINANTS FOR THE DEVELOPMENT OF HYPERTENSION AMONG INDONESIAN ADULTS: A PROSPECTIVE COHORT STUDY
Authors: Mashuri Yusuf Ari , Ng Nawi , Santosa Ailiana
Published: April 2021

Objective:

Hypertension is one most important contributors to disability, morbidity and all-cause mortality. The prevalence of hypertension is predicted to increase over time, not least in Indonesia. However, there is no longitudinal study investigating the factors determined the incidence of hypertension in Indonesia. This study aimed to assess the factors associated with the development of hypertension among adult Indonesian population.

Design and method:

This study used longitudinal data from the Indonesian Family Life Survey study (IFLS-4 and IFLS-5) consisting of individuals aged 15 years and over. We followed respondents who did not have hypertensive at the baseline during a 7-year follow-up period. Mixed method analysis was used to examine the determinants associated with the development of hypertension, controlling for sociodemographic, smoking behaviour, body mass index, and mental health status and socioeconomic status. The principal component analysis was conducted to construct the socioeconomic index

Results:

Out of the total 18,342 individuals who were followed up, 5,449 individuals (29.7%) were developed hypertension. The annual incidence rate of hypertension was 235.9 per 10,000 individuals. Being older, widow/divorcee, former smoker and had BMI > 25 kg/m2 were significantly associated with the development of hypertension (p < 0.05). Men had higher odds of developing hypertension compared to women (OR = 1.17, 95% CI = 1.02–1.34). In contrast, BMI < 18.5 kg/m2 (OR = 0.62, 95% CI:0.51–0.75) and in the 2nd tertile of mental health (OR = 0.83, 95% CI: 0.75–0.92) were protective factors for developing hypertension. While socioeconomic status, education level, working status, and residence area were not significantly associated with the development of hypertension.

Conclusions:

This study highlights the high burden of hypertension among Indonesian adults. Understanding factors associated with the development of hypertension in Indonesia setting helps to create a comprehensive preventive health program. Findings from this study suggest the need for strategic programmes and health policies for reducing the burden of hypertension regardless of any socioeconomic condition.
STUDY OF THE EUROPEAN SOCIETY OF HYPERTENSION ON BLOOD PRESSURE CONTROL IN ESH EXCELLENCE CENTERS (BP CON ESH) - THE FIRST PRELIMINARY REPORT
Authors: Jelakovic Bojan , Triantafyllou Areti , Doumas Michael , Kalaitzidis Rigas , Protogerou Athanase , Kallistratos Emmanouil , Stergiou George , Moloberti Alessandro , Giannattasio Cristina , Marketou Maria , Papadakis Ioannis , Papadopoulos Dimitrios , Pengo Martino , Parati Gianfranco , Sarafidis Pantelis , Stojanov Vesna , Triantafyllidi Eleni , Manta Eleni , Tsioufis K. , Agabiti-Rosei Enrico , Kreutz Reinhold , Polonia Jorge , Januszewicz Aandrzei , Mancia Giuseppe
Published: April 2021

Objective:

To determine the BP control and identify associated global and local risk factors in ESH Excellence centers.

Design and method:

The first 4 consecutive adult patients coming to the visit in an Excellence center on a particular day who fulfill inclusion/exclusion criteria and singed informed consent were enrolled. Structured questionnaire was applied, BP and heart rate were measured using the same validated device with appropriate cuff. In centers with capability to perform unattended BP measurements (Omron HEM-907 XL) both methods were done in a random sequence. Body weight, height and waist circumference, laboratory data, ABPM and ECG done in past 3 months and BP values from medical records were entered into the eCRF.

Results:

After the start in 12/2018 from overall 189 ESH Excellence centers, 80 centers (42.3%) from 24 different countries agreed to participate. Currently, 29 centers (36.3%) from 11 countries (45.8%) enrolled their patients. Patients’ demographics and clinical characteristics are shown in Table 1, and average BP and heart rate values are presented in Table 2.

Conclusions:

This first interim analyses confirmed the feasibility of conducting BP CON ESH study among ESH Excellence centers. The preliminary data for attended BP measurements indicated mean BP values above the recommended targets in the 2018 ESC/ESH guidelines.
IMPACT OF INTERVENTIONAL TECHNIQUES IN HYPERTENSIVE PATIENTS
Authors: Ali Muhammad , Shaheen Sumera
Published: April 2021

Objective:

These co morbidities such as metabolic diseases and kidney problems could not only alter the course of circulatory system but also may be the major reason behind the epidemiological association with hypertension because of systemic changes leads to potential nephropathic toxic risk which directly relate to hypertension. Proper identification of metabolic disorder is very important for suitable management and treatment of hypertension and its related disease. Heart problem, obesity and unhealthy diet and life style also contribute in high prevalence of hypertension in Pakistan. Social habits also link to high prevalence of hypertension. There for, current study based on different factors which associate to hypertension and their treatment.

Design and method:

The descriptive, interventional study was carried out at various hospitals and clinics. The samples were enrolled via purposive sampling method. The duration o f study was 02 years. The total number of control patients were 500 and 500 were of case patients in which interventional techniques were applied based on JNC VIII guidelines.

Results:

Out of total patients, 78.4% of the patients were under the category of sedentary lifestyle. 22.8% hypertensive patients with 30–39 kg/m2 were observed. The interventional technique was applied and results were assessing based on JNC VIII guidelines. In adding, contribution through patients, query along with follow up calls, recommend some additional education, and varying of therapy or dose, can be assist out the Patient as well as ultimately direct to an add to in drug compliance and disease situation upgrading. The significant value were come less than 0.5.

Conclusions:

Post interventions results show that patients upgraded their practice significant improvement of positive attitudes by intermittently checking their blood pressure level, lipid profile, control smoking habit, maintain their life styles and disease management of hypertension in patients.
FIXED-DOSE COMBINATIONS IN THE TREATMENT OF HYPERTENSION IN THE RUSSIAN FEDERATION
Authors: Vladimir Kutsenko , Balanova Yulia , Shalnova Svetlana , Imaeva Asiia , Kapustina Anna , Muromtseva Galina , Evstifeeva Svetlana , Karamnova Natalya , Maksimov Sergey , Yarovaya Elena
Published: April 2021

Objective:

To estimate the frequency of fixed-dose combinations (FDC) of antihypertensive medications (AHM) in the hypertension treatment in the population of the Russian Federation (RF).

Design and method:

A cross-sectional study ‘Epidemiology of Cardiovascular Diseases in the RF (ESSE-RF)’ was performed in 13 regions (2012–2013). Randomly selected males (N = 8304) and females (N = 13464) aged 25–64 were included (response rate>80%). Standard epidemiology methods and criteria were used. Hypertension defined as a measured blood pressure (BP) of 140/90 mm Hg or greater and/or treatment with AHM. The structure of FDC in AHM was investigated. AHM have been analyzed by the following classes: diuretics (D), betablockers (BB), calcium antagonists (CA), angiotensin converting enzyme inhibitors (ACEi), angiotensin II receptor blockers (ARBs), and «other». In addition, FDC of AHM have been studied. Statistical data was processed using R 3.6.1 (R Foundation for Statistical Computing, Vienna, Austria).

Results:

Results The prevalence of hypertension and treatment in the RF was 45,7% and 51.8%. Among hypertensive patients who were receiving treatment, 65.6% were taking 1 AHM, 2 – 23.1%, 3 and more – 6.7%, whereas 4,6% were taking non-AHM. The most commonly taken medications were ACEi (58.4%), BB (34.9%), and D (32.4%)

The frequency of taking an FDC of AHM was 15.6%. Among those taking FDC the most frequently employed were D+ACEi (49.3%), D+ARBs (24.8%), and D+BB (17.2%) fig 1.

Conclusions:

Despite the importance of BP control in preventing cardiovascular and cerebrovascular events, only 1/3 of hypertensive patients in the RF have their BP under control. Prescription frequency of an FDC of AHM remains low – only every sixth patient with hypertension taking medications applied the FDC.
OUTCOMES OF PATIENTS WITH ST SEGMENT ELEVATION MYOCARDIAL INFARCTION AND LEFT VENTRICULAR HYPERTROPHY: 25-YEAR POPULATION-BASED STUDY
Authors: Ghrab Aiman , Chamtouri Ikram
Published: April 2021

Objective:

Left ventricular hypertrophy is a common finding in hypertensive patients. The increase in myocardial masse is accompanied with an elevation of oxygen demand. The occlusion of a coronary artery in ST-segment elevation myocardial infarction (STEMI) leaves the myocardium without oxygen supply. This depletion is harmful to myocardial cells and its effect could be more important in left ventricular hypertrophy patients.

Aim:

To evaluate the effect of left ventricular hypertrophy on Stemi outcomes.

Design and method:

Patients with STEMI underwent an echocardiographic exam within two days from the event and left ventricular hypertrophy (LVH) was evaluated using the left ventricular mass calculated using echocardiography.

The primary endpoints were in-hospital and 1-year cardiovascular events. The secondary endpoints were left ventricular ejection fraction.

Results:

In total, 1605 patients were admitted for STEMI. There were 489 hypertensive patients. 28% had LVH.

There was no difference in risk-adjusted in-hospital mortality between patients with and without LVH (p = 0,149). Both groups showed the same risks of developing life threatening arrythmias (p = 0,287).

Left ventricular ejection fraction was evaluated in both groups. Patients with LVH did not have more risk of systolic dysfunction than the other group of patients (p = 0,098).

Conclusions:

Patients with left ventricular hypertrophy undergoing STEMI had similar outcomes compared to patients without LVH.
WHAT IS THE MAJOR FACTOR ON THE KIDNEY INJURY INDUCED BY HYPERTENSION OR HYPERHOMOCYSTEINEMIA
Authors: Xu Rui , Gao Ning
Published: April 2021

Objective:

As we all know kidney injury could be induced by hypertension or hyperhomocysteinemia (HHcy). What is the major factor? HHcy plays a synergistic role with hypertension in vascular injury; however, the relationship between HHcy and hypertension in renal injury remains unclear. Here, we sought to evaluate the relationship between HHcy and hypertension in the context of renal injury and to elucidate the mechanism of action underlying this relationship.

Design and method:

Wistar Kyoto (WKY) and spontaneously hypertensive (SHR) rats were randomized into WKY, WKY+HHcy, SHR, and SHR+HHcy groups. Blood pressure, plasma homocysteine, creatinine, serum malondialdehyde (MDA), serum superoxide dismutase (SOD), and urinary albumin creatinine ratio (UACR) were measured. mRNA and protein expression levels of NOX2, NOX4, and nephrin in the kidneys were also examined.

Results:

The WKY+HHcy group exhibited lower serum SOD levels, relative to the WKY group, along with higher levels of both serum MDA and UACR. Similar effects were observed in the SHR+HHcy group, relative to the SHR group. Moreover, compared with the levels in the WKY+HHcy group, mean SOD levels in the SHR+HHcy group were lower, while mean MDA and UACR levels were higher. Higher mRNA and protein expression levels of NOX2 and NOX4, along with lower mRNA and protein expression levels of nephrin, were observed in the kidneys of WKY+HHcy and SHR+HHcy rats, relative to SHR and WKY controls, respectively. Furthermore, the mRNA and protein levels of NOX2 and NOX4 were higher and the mRNA and protein levels of nephrin were lower in the SHR+HHcy group than in the WKY+HHcy group. In addition, compared with WKY+HHcy group, the UACR level of SHR group was higher.

Conclusions:

HHcy appears to synergistically increase hypertensive renal damage by enhancing oxidative stress. However, hypertension remains a major risk factor for renal impairment compared to HHcy.
RESVERATROL PROTECT AGAINST HOMOCYSTEINE-INDUCED RENAL DAMAGE THROUGH ANTIOXIDANT ACTION IN SPONTANEOUS HYPERTENSIVE RATS
Authors: Xu Rui , Hui Qingchen , Zhao Xuan
Published: April 2021

Objective:

The aim of this study was to investigate the effect of resveratrol in renal damage and the underlying mechanism induced by Hhcy in SHRs.

Design and method:

Twenty-four SHRs were divided into control group, Hhcy group, Hhcy + resveratrol (Hhcy+Res) group. Hhcy groups were given intraperitoneal injection of homocysteine. In addition, the Hhcy + Res group was given resveratrol by gavage. The Systolic blood pressure (SBP), diastolic blood pressure (DBP), plasma Hcy, serum malondialdehyde (MDA), superoxide dismutase (SOD) and the urinary microalbumin (UACR) were measured. To quantify RNA and protein expression levels, the mRNA and the protein expression of nephrin and NADPH oxidase subunits NOX2 and NOX4 in the kidney were examined by quantitative Real-time PCR and western blot. Renal histological or pathological changes were observed under light and electron microscope.

Results:

There was no difference in blood pressure before and after Hcy or Res intervention among groups. The homocysteine levels in Hhcy and Res group were significantly higher than that in control group, which showed that the model was successfully built by intraperitoneal injection. The serum SOD level was significantly decreased in Hhcy group, while it was increased in Res group. On the contrary, the serum MDA and UACR levels of model group were significantly increased. after the intervention of resveratrol, the MDA and UACR levels were reduced. Furthermore, the expression levels of mRNA and the protein of NOX2 and NOX4 were elevated while those of the nephrin were reduced in Hhcy group. Resveratrol significantly reduced the expressions of NOX2 and NOX4, and increased the expression of nephrin in renal tissue of SHRs with Hhcy.

Conclusions:

These results suggested that resveratrol may improve renal damage in hypertensive rats with Hhcy by exerting oxidative stress beyond blood pressure.
DIFFERENT FORMS OF AFFERENT NERVE INPUT IN CARDIAC AND RENAL DISEASE IN RATS?
Authors: Rodionova Kristina , Ditting Tilmann , Pickny Lisa , Ott Christian , Schmieder Roland , Schiffer Mario , Amann Kerstin , Veelken Roland
Published: April 2021

Objective:

Afferent nerve pathways form kidney and heart are said to control sympathetic renal nerve activity. In a renal disease model the responsiveness of afferent renal nerve units was shifted from units with highly active primary neurons (tonic response pattern) to units with neurons of very low activity upon stimulation (phasic response pattern). Afferent renal nerve activity was likely decreased. Likewise, afferent vagal nerve activity in congestive heart failure (CHF) had a lower frequency at saturation than controls. Hence we wanted to test the hypothesis that CHF the vagal afferent nerve pathway consists of a decreased number of highly active tonic sensory neurons in the nodose ganglion.

Design and method:

CHF was induced by coronary artery ligature, nephropathy by injections of an anti Thy1.1 antibody (OX7, 1.2 mg/kg). After a respective time (CHF 21 days, nephropathy 7 days after induction) nodose ganglion neurons with cardiac vagal afferents from CHF rats or neurons form dorsal root ganglia with renal afferents from rats with nephropathy were cultured. Current clamp was used to characterize neurons as tonic, i.e. sustained action potential (AP) firing or phasict, i.e. <5 APs upon current injection. More than 100 neurons were investigated.

Results:

In CHF rats, the number of neurons with a tonic response pattern did not differ from controls (64% vs. 70 %, ns). However, tonic cardiac neurons from CHF rats exhibited an increased production of action potentials compared (24.4+/-5.0 vs. 14.7+/-1.8 APs/10 s; p < 0.05; mean+/-SEM). In nephropathic rats, the number of neurons with a tonic response pattern decreased significantly (43% vs. 64 %, p < 0.05), but there was no difference in action potential production between groups.

Conclusions:

In congestive heart failure the number of afferent neurons with a tonic response pattern was not significantly altered. However, the action potential production of these neurons even significantly increased upon stimulation. Hence, in congestive heart failure vagal afferent neurons increase their sensitivity in the presence of impaired intracardiac receptors whereas in renal disease the responsiveness of the first part of the afferent pathway is impaired as a whole.
DIFFERENTIAL EXPRESSION OF VASCULAR DYSFUNCTION OF SMALLER DIAMETER ARTERIES IN A RODENT MODEL OF METABOLIC SYNDROME
Authors: Salman Ibrahim , Ameer Omar , Alwadi Aiman
Published: April 2021

Objective:

Metabolic syndrome, driven by obesity and diabetes, is a major contributor to cardiovascular disease. While large arteries vascular dysfunction is a well-documented phenomenon of metabolic syndrome, vascular disease of smaller diameter arteries, which are key contributors to peripheral vascular resistance and blood pressure control, remains uncertain. Using in-vitro organ-bath preparation, this study, therefore, investigated functional responses of the superior mesenteric and right iliac arteries in a high fat diet (HFD)/streptozotocin-induced diabetes mellitus rat model.

Design and method:

Five-week-old male Wistar Albino rats (n = 24) were fed with either HFD (45 kcal% fat) or control diet (10 kcal% fat) for 10 weeks. At 10 weeks of age, 40 mg/kg streptozotocin and saline were injected intraperitoneally into the HFD and control groups, respectively.

Results:

Diabetic HFD rats displayed a time-dependent increase (p < 0.01) in water intake, urine output, fasting blood glucose and tailcuff systolic blood pressure compared to controls (154 ± 6 vs. 110 ± 4 mmHg). Both mesenteric and iliac vasoconstrictor responses (N/g) to norepinephrine (1E-9 – 3E-5 M), but not to the depolarizing signals of high potassium (5 – 120 mM), were greater (p < 0.01) in the HFD group relative to controls. Mesenteric, but not iliac, endothelium-dependent vasorelaxation to acetylcholine (1E-10 – 1E-5 M) was blunted (p < 0.05) in the HFD rats compared with controls. In contrast, mesenteric and iliac endothelium-independent vasorelaxation responses to sodium nitroprusside (1E-11 – 1E-6 M) remained comparable between groups.

Conclusions:

Vascular functional responses in smaller diameter arteries are differentially expressed in metabolic syndrome, demonstrating upregulated vasoconstriction to adrenergic stimuli and/or impaired endothelium-dependent relaxation. These vascular abnormalities align with those previously described in larger arteries and could therefore further promote the development of cardiovascular disease in metabolic syndrome.
CENTRAL INTEGRATION OF LEFT VERSUS RIGHT BARORECEPTOR AFFERENT INPUT IN FEMALE SPONTANEOUSLY HYPERTENSIVE RATS
Authors: Salman Ibrahim , Ameer Omar , Mcmurray Sheridan , Sridhar Arun , Lewis Stephen , Hsieh Yee-Hsee
Published: April 2021

Objective:

Neuromodulation of blood pressure using baroreflex activation therapy is an effective means to control hypertension in resistant hypertensive patients. In a genetic rat model of essential hypertension, the spontaneously hypertensive rats (SHRs); we were able to demonstrate in male rats that preferential central integration of left baroreceptor afferent input exists relative to that of the right afferents. It remains unknown whether laterality also influences baroreflex responses in female SHRs. Accordingly, the differences in cardiovascular responses triggered by stimulation of the left and right baroreceptor afferents, as assessed by direct electrical stimulation of the aortic depressor nerve (ADN), were studied in female SHRs.

Design and method:

Pentobarbital-anesthetized female SHRs (25–29 weeks, n = 6–8) were instrumented for left and right ADN stimulation (1–40 Hz, 0.2 ms, 0.4 mA for 20 s) and recording of mean arterial pressure (MAP), heart rate (HR) and mesenteric (MVR) and femoral (FVR) vascular resistance. Female rats were also matched for the diestrus phase of the estrus cycle.

Results:

Both left and right ADN stimulation resulted in frequency-dependent reductions (P < 0.001) in MAP, HR, MVR and FVR. Reflex reductions in MAP, HR, MVR and FVR were comparable for both left-sided and right-sided stimulation.

Conclusions:

Unlike males, female SHRs express no differential central modulation of baroreceptor afferent input as evidenced by the comparable left versus right baroreflex-mediated depressor responses. Similar depressor responses in the left versus right stimulation may have been contributed to by the lack of differences in baroreflex-driven changes in HR and vascular resistance. Clinically, targeting either the left or right aortic nerves may equally provide adequate reductions in blood pressure in female hypertensive subjects. Future studies should elucidate the mechanisms responsible for sex differences in the central processing of baroreflex between male and female SHRs.
EFFECTIVE AND SAFE COMBINATION OF ATORVASTATIN AND EZETIMIBE THERAPY IN PATIENTS WITH ISCHAEMIC HEART DISEASE
Authors: Gamage Nadun Danushka Pitiduwa , Samarasekara Tharanga , Kottage Menaka , Muthumudalige Emashi
Published: April 2021

Objective:

Dyslipidaemia (DL) is a well-known risk factor for Cardiovascular disease(CVD). Literature suggests combined therapy of Atorvastatin and Ezetimibe (A&E) is beneficial than Atorvastatin therapy alone. Objective of the study is to determine the effective and safe dose combination of A&E in patients with Ischaemic heart disease (IHD) in patients attending to the cardiology clinic.

Design and method:

Four separate treatment regimens were administered in randomly assigned 4 groups of patients. Each group was given same dose of Ezetimibe (10 mg). Atorvastatin doses were given as 10 mg (G1), 20 mg (G2), 30 mg (G3), 40 mg (G4) etc. After baseline investigations, patients were followed up for 6 months and reevaluation was done. Non parametric tests were used for data analysis. Ethical clearance was obtained prior to the study.

Results:

Overall 110 patients were recruited. Mean age was 60.1 ± 9.4 years and female predominance (62.7%) was observed.

Significant reduction of total cholesterol (TC), low density lipoprotein (LDL) were observed in G2 (p = 0.009 and p = 0.003 respectively) and G4 (p = 0.006 and p = 0.001). However, no statistically significant change was observed in high density lipoprotein (HDL) and triglyceride (TG). No significant rise in serum creatinine (p = 0.08) and liver function tests were observed. And it is not found any statistically significant change of FBS before and after the treatment

Conclusions:

Combined therapy of Ezetimibe 10 mg with Atorvastatin 20 mg or 40 mg would be significantly reduce the TC and LDL in the patients with IHD. But it does not the improve HDL and TG levels. Use of Atorvastatin 10 mg and 30 mg did not show any significant improvement of entire lipid profile.
EFFECTS OF A GLUCAGON LIKE PEPTIDE-1 AGONIST AND RHO-KINASE INHIBITOR ON PULMONARY AND RIGHT VENTRICLE FUNCTION IN PULMONARY HYPERTENSIVE RATS WITH AND WITHOUT INSULIN RESISTANCE
Authors: Pearson James , Jin Huiling , Waddingham Mark , Sonobe Takashi , Maeda Hisashi , Ngo Jennifer , Ow Connie , Sukumaran Vijayakumar , Ogo Takeshi , Shirai Mikiyasu , Tsuchimochi Hirotsugu , Ueda Hatsue-Ishibash
Published: April 2021

Objective:

Insulin resistance is now recognized as an important factor in the development of pulmonary hypertension (PH). Increased activation of RhoA/Rho-kinase (ROCK) inhibits the protective actions of endothelial nitric oxide (NO) synthase (eNOS) signaling in diabetes and PH. Glucagon like peptide-1 (GLP-1) agonists were shown to reverse these pathological changes. We investigated how liraglutide (GLP-1 agonist) and fasudil (ROCK inhibitor) treatments affect the progression of pulmonary and right ventricle (RV) dysfunction in PH rats with insulin resistance.

Design and method:

SU5416 (20 mg/kg) was administered to male Wistar and prediabetic Goto-Kakizaki (GK) rats followed by 3 weeks of chronic hypoxia (SuHx) or normoxia exposure. Osmotic pumps delivered a continuous infusion of liraglutide (1 mg/kg/d) or fasudil (100 mg/kg/d) for the final 3 weeks in some SuHx rats. Synchrotron microangiography of the left lung was performed in vivo.

Results:

During chronic hypoxia 30% mortality occurred due to RV failure associated with thrombosis in GK rats. Systolic RV pressure was 74 mm Hg and 128 mm Hg in GK and Wistar SuHx rats respectively. Prediabetes exacerbated pulmonary arteriole-artery rarefaction (two-fold occlusion increase) and pulmonary vasoconstriction, with acetylcholine (ACh)-mediated constriction at 3 weeks and loss of NO donor mediated dilation at 6 weeks SuHx. Wistar SuHx maintained ACh-mediated dilation in resistance vessels despite pronounced overall vasoconstriction of all branching orders. Neither strain differed in ROCK1/2 protein expression. Notably, liraglutide and fasudil improved pulmonary vasodilation, but only liraglutide halted vascular remodeling. Fasudil increased phosphorylation of eNOS at Ser1177 in the RV of GK SuHx. Liraglutide reduced RV systolic pressure and Fulton indices, while fasudil elevated RV pressure to 104 mm Hg in the GK SuHx.

Conclusions:

Reduced NO bioavailability contributes to exacerbated pulmonary arterial rarefaction and depressed RV contractility associated with prediabetes in SuHx rats. GLP-1 agonist treatment did not ameliorate endothelin-1/ROCK- mediated suppression of eNOS phosphorylation in the RV as observed with fasudil. While liraglutide intervention prevented pulmonary microvessel occlusion, inhibition of both ROCK1/2 isoforms with fasudil increased occlusion formation suggesting that ROCK1 might act to inhibit pulmonary microvessel muscularization.
COMPARISON OF INHIBITORY EFFECTS EVOKED BY OLMESARTAN AND ENALAPRIL ON CATECHOLAMINE SECRETION
Authors: Lim Dong Yoon , Koh Young Youp
Published: April 2021

Objective:

The present study was designed to compare enalapril, an angiotensin converting enzyme inhibitor (ACEI) with olmesartan an angiotensin II receptor blocker (ARB) in the inhibitory effects on the secretion of catecholamines (CA) from the perfused model of the rat adrenal gland.

Design and method:

The adrenal gland was isolated and perfused with Krebs-bicarbonate. CA was measured directly by using the fluorospectrophotometer.

Results:

Both enalapril (50 microM) and olmesartan (50 microM) during perfusion into an adrenal vein for 90 min inhibited the CA secretory responses evoked by ACh (5.32 microM), DMPP (a selective neuronal nicotinic Nn receptor agonist, 100 microM), high K+ (a direct membrane-depolarizer, 56 mM), and McN-A-343 (a selective muscarinic M1 receptor agonist, 100 microM) in a time-dependent manner. Also, in the presence of enalapril or olmesartan, the secretory responses of CA evoked by veratridine (an activator of voltage-dependent Na+ channels, 100 microM), Bay-K-8644 (a L-type dihydropyridine Ca2+ channel activator, 10 microM), and cyclopiazonic acid (a cytoplasmic Ca2+-ATPase inhibitor, 10 microM) were significantly reduced. Based on the same concentration (50 microM) of enalapril and olmesartan, for the CA release evoked by Ach, high K+, DMPP, McN-A-343, angiotensin II, veratridine, Bay-K-8644 and cyclopiazonic acid, the following rank order of inhibitory potency was obtained: olmesartan> enalapril. In the simultaneous presence of enalapril and olmesartan, Ach-evoked CA secretory responses were more strongly inhibited in comparison with that of enalapril- or olmesartan-treated alone.

Conclusions:

Collectively, these results demonstrate that both enalapril and olmesartan inhibit the CA secretory responses evoked by activation of both cholinergic and angiotensin II receptors stimulation as well as by direct membrane depolarization in the perfused model of the isolated rat adrenal medulla. When these two drugs were used in combination, their effects were enhanced, which may also be of clinical benefit. Based on concentration used in this study, it seems that the inhibitory effect of olmesartan on the CA secretion is more potent than that of enalapril.