bluuebunny/crossref_metadata_2025 huggingface dataset:
DO INCREASED LEVELS OF TRIGLYCERIDES CONSIST AN INDEPENDENT RISK FACTOR DEFINING THE SEVERITY OF CARDIOMYOPATHY IN T2DM PATIENTS WITH KNOWN HYPERTENSION ?
Authors: Papazoglou Spyros , Toutouzas Konstantinos , Tsioufis Konstantinos
Published: June 2022

Objective:

The association of diabetes mellitus and heart disease is well established in evidence-based medical practice in our days. Diabetes Mellitus is also associated with various cardiovascular risk factors including hypertension and hypertriglyceridemia. Therefore, the severity of Cardiomyopathy in Diabetics is interdependent among these various risk factors. The aim of this study was to assess that hypertriglyceridemia is an independent risk factor of the severity of cardiomyopathy in T2DM patients with known Hypertension.

Design and method:

451 (249male, 202 female) T2DM Hypertensive patients participated on this study. Age range of the patients was between 48–79 years of age. All patients were assessed for cardiac functioning with Echocardiography and Ventriculographies. Severity of Cardiomyopathy was estimated measuring LVEDP with a borderline > 15 mm Hg. TGC were measured in serum blood analysis of patients in SI units. Data were analyzed using ANOVA and logistic regression analysis. Hypertriglyceridemia was analyzed as an independent risk factor. Data is presented as mean ± standard deviation and level of significance was accepted when p < 0.05.

Results:

Data were analyzed on 451(249 male, 202 female) hypertensive T2DM patients, 91 (20.2%) presented with TGC level of 2.9 ± 0.8 mmol/L, and a LVEDP of 16.2 ± 0.8 mm Hg. 109 patients (24.1 %) with TGC level of 3.6 ± 0.7 mmol/L, and a LVEDP of 17.8 ± 0.9 mm Hg. 132 (29.3%) TGC level of 4.1 ± 0.3 mmol/L, and a LVEDP of 19.4 ± 0.8 mm Hg and 119 (26.4%)patients with TGC level of 4.7 ± 0.6 mmol/L, and a LVEDP of 21.1 ± 0.8 mm Hg. Data Analysis revealed that hypertriglyceridemia p = 0.019 is an independent risk factor of cardiomyopathy in T2DM hypertensive patients and leads in markedly increased Left Ventricular End Diastolic Pressures p = 0.022.

Conclusions:

Hypertriglyceridemia is an independent risk factor of Cardiomyopathy in Hypertensive T2DM patients.
MANAGEMENT OF DYSLIPIDAEMIA AND HYPERTENSION BY GLYCAEMIC STATUS IN URBAN SOUTH AFRICANS
Authors: Kotze-Horstmann Liske , Hill Jillian , Kengne Andre Pascal , Peer Nasheeta
Published: June 2022

Objective:

To describe the prevalence and management of hypertension and dyslipidaemia in adults in Cape Town with 1) known diabetes, and those identified as high-risk for diabetes and subsequently diagnosed with 2) normoglycaemia, or 3) newly diagnosed diabetes, through oral glucose tolerance tests.

Design and method:

Cross-sectional data collection comprised administered interviews, clinical measurements, and biochemical analyses. Group differences between detection, treatment and control indices were calculated using univariate analyses (median and 25th 75th percentiles, or prevalence and percentage). Multiple logistic regressions described the association with sociodemographic, and cardiovascular risk factors (odds ratios and 95% confidence intervals).

Results:

This study included 618 participants (82% women) between 49–63 years of age. Known diabetes participants (n = 339) were significantly older and less obese (Body mass index < 30 kg/m2) compared to normoglycaemia (n = 212) or newly diagnosed diabetes (n = 70). Hypertension prevalence was lower in normoglycaemia (66%) and newly diagnosed diabetes (64%) compared to known diabetes (89%) (p < 0.001). Among normoglycaemia, newly diagnosed and known diabetes participants with hypertension, detection was 80%, 89% and 97%, with 60%, 68% and 88% taking medication, while hypertension control was 46%, 44% and 74%, respectively (p < 0.001 for all). Dyslipidaemia prevalence (low-density lipoprotein cholesterol > 3mmol/l or on treatment) was lower in normoglycaemia (43%) compared with newly diagnosed diabetes (74%) and known diabetes (83%) (p < 0.001). Among normoglycaemia, newly diagnosed and known diabetes participants with dyslipidaemia, 36%, 37% and 85% were detected, 22%, 23% and 73% were on lipid lowering treatment, and 14%, 10% and 49% were controlled, respectively (p < 0.001 for all). Regression analysis showed that having a pre-existing diabetes diagnosis was associated with higher odds for being detected, treated, and controlled for dyslipidaemia. However, the odds of attaining hypertension control in those taking medication were higher only in known diabetes who were uncontrolled (HbA1C > 7%).

Conclusions:

Hypertension and dyslipidaemia prevalence and management were higher in participants with known diabetes compared with their counterparts. Improved screening and management are required for high-risk individuals who were probably not in regular contact with healthcare services.
CENTRAL BLOOD PRESSURE ESTIMATION IN TYPE 1 DIABETES: IMPACT OF PERIPHERAL BLOOD PRESSURE CALIBRATION APPROACH
Authors: Helleputte Simon , Spronck Bart , Sharman James , Bortel Luc Van , Segers Patrick , Calders Patrick , Lapauw Bruno , de Backer Tine
Published: June 2022

Objective:

Pulse wave analysis (PWA) of peripheral arterial pressure waveforms is used for non-invasive estimation of central blood pressure (BP), which can assist in cardiovascular (CV) risk assessment in populations with a high CV burden such as patients with type 1 diabetes (T1DM). However, correct calibration of peripheral BP waveforms is important in order to accurately estimate central BP. The impact of peripheral BP waveform calibration on central BP is not investigated yet in T1DM. Therefore, this study aims first for the first time in a T1DM patient cohort, to examine differences in central BP parameters estimated by PWA of radial BP waveforms, depending on which brachial BP (SBP/DBP vs. DBP/MAP) is used for calibration of the radial BP waveforms.

Design and method:

Cross-sectional study, in which adult T1DM patients without known CVD were enrolled. Radial artery BP waveforms were acquired using applanation tonometry (SphygmoCorâ) for the estimation of central systolic BP (central SBP), central pulse pressure (central PP) and central augmentation pressure (central AP), using either brachial SBP/DBP or DBP/MAP for calibration of the radial pressure waveforms. Brachial MAP was calculated using a fixed form factor of 40% (MAP = brachial DBP + 0.40 × brachial PP).

Results:

54 patients (M/F: 32/22; age: 46 ± 9.5 yrs; T1DM duration: 27 ± 8.8 yrs) were evaluated. All three estimated central BP parameters were significantly higher when brachial DBP/MAP was used compared to SBP/DBP calibration (7.5 ± 5.04 mmHg, 7.5 ± 5.04 mmHg and 1.5 ± 1.36 mmHg higher central SBP, PP and AP, respectively, p < 0.001). Brachial-to-radial SBP amplification was estimated at 10 ± 7.1 mmHg (p < 0.001).

Conclusions:

This study confirms for the first time that in patients with T1DM there are significant differences in central BP parameters estimated with PWA, depending on the method used for calibration of the radial pressure waveforms. Brachial DBP/MAP calibration resulted in consistently higher central BP parameters as compared to using SBP/DBP. Hence, it seems that brachial-to-radial SBP amplification is important to take into account in the estimation of central BP parameters also in patients with T1DM.
CONCOMITANT USE OF SULFONYLUREAS AND BETA-BLOCKERS AND THE RISK OF SEVERE HYPOGLYCEMIA: POPULATION-BASED COHORT STUDY
Authors: Dimakos Jenny , Cui Ying , Platt Robert W. , Renoux Christel , Filion B. Kristian , Douros Antonios
Published: June 2022

Objective:

Evidence suggests that beta-blockers increase the risk of hypoglycemia. However, their effects among users of sulfonylureas, drugs that also cause hypoglycemia, are not well understood. Thus, our study assessed the potential association between concomitant use of sulfonylureas and beta-blockers and the risk of severe hypoglycemia.

Design and method:

This retrospective cohort study used the United Kingdom Clinical Practice Research Datalink linked to hospitalization and vital statistics data. It included patients with type 2 diabetes initiating sulfonylurea treatment between 1998 and 2020. Patients with use of beta-blockers in the 6 months prior to cohort entry were excluded. Time-dependent Cox proportional hazards models estimated confounder-adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) of severe hypoglycemia associated with concomitant use of sulfonylureas and beta-blockers compared to sulfonylurea use alone. To account for residual confounding, we also performed an analysis using an active comparator, where the reference category was current concomitant use of sulfonylureas and thiazide diuretics. To explore the role of cardioselectivity in the hypoglycemic risk of beta-blockers, we further compared head-to-head current concomitant use of sulfonylureas and non-cardioselective beta-blockers (i.e., propranolol, carvedilol, sotalol, labetalol) versus current concomitant use of sulfonylureas and cardioselective beta-blockers (i.e., acebutolol, atenolol, bisoprolol, metoprolol, nebivolol, esmolol).

Results:

Our cohort included 252,869 patients initiating sulfonylureas. During a mean (standard deviation) follow-up of 8.6 (5.7) years, there were 16,857 events of severe hypoglycemia (crude incidence rate, 7.8 [95% CI, 7.6–7.9] per 1000 person-years). Compared to sulfonylurea use alone, concomitant use of sulfonylureas and beta-blockers was associated with a 53% increased risk of severe hypoglycemia (adjusted HR, 1.53; 95% CI, 1.42–1.65). The use of an active comparator led to consistent findings (adjusted HR, 1.69; 95% CI, 1.42–2.01). When comparing concomitant use of sulfonylureas and non-cardioselective beta-blockers to concomitant use of sulfonylureas and cardioselective beta-blockers, we were not able to detect an increased risk of severe hypoglycemia (adjusted HR, 0.95; 95% CI, 0.74–1.24).

Conclusions:

Our population-based study showed an increased risk of severe hypoglycemia associated with concomitant use of sulfonylureas and beta-blockers. Cardioselectivity of beta-blockers did not seem to play a major role in this regard.
BLOOD PRESSURE-INDEPENDENT RENOPROTECTION IN DIABETIC RATS TREATED WITH SMALL INTERFERING RNA TARGETING LIVER ANGIOTENSINOGEN
Authors: Lopez Edwyn Omar Cruz , Ren Liwei , Uijl Estrellita , Clahsen-Van Groningen Marian C. , Van Veghel Richard , Garrelds Ingrid M. , Domenig Oliver , Poglitsch Marko , Zlatev Ivan , Rooney Timothy , Kasper Anne , Nioi Paul , Foster Don , Danser A.H. Jan
Published: June 2022

Objective:

Small interfering RNA (siRNA) targeting liver angiotensinogen (AGT) exerts beneficial effects on blood pressure and kidney function, but its effects in diabetes are still unknown.

Design and method:

To address this, TGR(mREN2)27 rats (a model of angiotensin II-dependent hypertension) were made diabetic with streptozotocin for 18 weeks and treated with vehicle, AGT siRNA, the angiotensin receptor blocker valsartan, the ACE inhibitor captopril, valsartan + siRNA, or valsartan + captopril for the final 3 weeks. Arterial pressure was measured via radiotelemetry.

Results:

Baseline mean arterial pressure (MAP) was 164 ± 1 mm Hg. Diabetes resulted in albuminuria, accompanied by glomerulosclerosis and podocyte effacement, without a further rise in MAP or a change in glomerular filtration rate. All treatments lowered MAP (by ~50 mm Hg) and cardiac hypertrophy identically. Treatment with siRNA resulted in the largest reduction in AGT, while in combination with valsartan AGT virtually disappeared. Only the dual treatment groups and captopril lowered circulating angiotensin II and aldosterone. No treatment affected renal AGT mRNA expression, confirming the liver-specificity of the siRNA. Yet, siRNA with or without valsartan, and valsartan + captopril, but not valsartan alone, or captopril alone, reduced renal angiotensin I and II. All treatments lowered albuminuria and proteinuria, while only siRNA with or without valsartan improved glomerulosclerosis and podocyte dysfunction. Multiple linear regression confirmed both mean arterial pressure and renal angiotensin II as independent determinants of albuminuria.

Conclusions:

In conclusion, AGT siRNA exerts renoprotection in diabetic TGR(mREN2)27 rats, and this relies, at least in part, on the suppression of renal angiotensin II formation from liver-derived AGT. Consequently, AGT siRNA may prove beneficial in human diabetic kidney disease.
PROGNOSTIC VALUE OF THE GLYCOSYLATED HEMOGLOBIN TO THE MACE IN HYPERTENSIVE NON DIABETIC PATIENTS
Authors: Papavasileiou Maria , Aravantinos Dionysios , Karamanou Alexandra , Moustakas Georgios , Patsianis Stylianos , Pittaras Andreas
Published: June 2022

Objective:

Of the study was the investigation of the association and the prognostic value of the level of serum glycosylated hemoglobin (HbA1c), with the MACE in hypertensive non diabetic patients

Design and method:

This is a prospective analysis including 174 hypertensive treated or newly diagnosed untreated, non diabetic patients (57,3% female) of mean age at the entry of the study: 59,4 ± 13,3 years, mean office systolic/diastolic blood pressure (S/DBPo): 147,9 ± 18,2/91,8 ± 11,0 mmHg, mean office heart rate (HRo): 75,0 ± 12,4 beats/min, MBMI: 28,5 ± 4,7 kg/m2 The median follow-up period was 7,5 years.

The MHbA1c (5,7 ± 0,92 %) was measured at the entry of the study. Major cardiovascular events (MACE) (myocardial infarction, unstable angina, transient ischemic attack or stroke, peripheral vascular intervention, heart failure events, cardiovascular death) were registered. We estimated the prognostic value of the HbA1c to the MACE.

Cox proportional hazard model were employed to determine the prognostic value of HbA1c.

Results:

The median follow-up period was 7,5 years.

There were 70 (40,2%) MACE at the end of the study and the cox regression analysis revealed that HbA1c was strong predictor factor for the MACE (HR: 1,32 95%cl: 1,093–1,599 p value 0.004)

Table 

HbA1c = glycosylated hemoglobin

Conclusions:

HbA1c levels have significant predictive value for MACE, in hypertensive non diabetic patients in a follow up of 7.5 years
MUSIC THERAPY WITH HYPERTENSIVE PATIENTS DURING THE PANDEMIC PERIOD - ONLINE MEETINGS AS PART OF MULTIPROFESSIONAL TREATMENT
Authors: Zanini Claudia , Teixeira Diana , Pereira Dalma , Sousa Ana Luiza L. , Souza Weimar K.S.B.
Published: June 2022

Objective:

This paper aims to report the participation of the music therapist in the care of hypertensive patients, using information and communication technology during the pandemic period in Brazil.

Design and method:

Before the pandemic, Music Therapy interventions took place mainly in the waiting room of the outpatient service and in meetings called Hypertensive’s Club. The main resources used were the voice and the guitar, more accessible instruments for care in a hospital environment. With the arrival of the Pandemic, in March 2020, during the period of social removal, there was an interruption of in-person calls. During this period, the patients were invited to meetings by Google Meeting and the music therapist conducted the interventions using the voice and instruments, such as the guitar, keyboard and/or drum. Online interventions lasted one hour. Interactive Music Therapy techniques were used, using singing as the main activity, in addition to music listening activities, with guided relaxation and breathing activities.

Results:

Interventions were carried out online, with the participation of hypertensive patients and, in some cases, family members who helped with the handling of cell phones/equipment, since most patients are elderly people with little experience in technology. Music Therapy had a humanistic approach and a look at the patient’s integrality, welcoming all feelings arising from anxiety, fear, stress and grief experienced in the pandemic period. The techniques used provided the self-perception of the body (breathing, heartbeat, posture, etc.) and the self-expression of feelings through songs chosen by the participants or improvised with the guidance of the music therapist. Spirituality and/or religiosity also emerged through the choices of songs, bringing to light the hope of better days and the strength needed to face the losses suffered by many of the participants.

Conclusions:

The music therapist’s action, through online consultations with hypertensive patients, helped to maintain the quality of life, to improve the individual’s entirety, to reduce stress and to express the patients’ subjectivity. Therefore, the music therapist in the multidisciplinary team contributed to the humanization of collective health care, in line with the National Policies of the Ministry of Health.
ADHERENCE AND BLOOD PRESSURE CONTROL IN PATIENTS WITH PRIMARY ALDOSTERONISM
Authors: Widimsky Jiri , Nikrynova Thi Minh Phuong , Strauch Branislav , Petrak Ondrej , Kratka Zuzana , Holaj Robert , Kurcova Ivana , Maresova Vera , Waldauf Petr , Zelinka Tomas
Published: June 2022

Objective:

To evaluate the adherence to MR antagonists and other antihypertensive therapy and blood pressure control in conservatively treated patients with primary aldosteronism.

Design and method:

We have consecutively investigated in an outpatient hypertension clinic conservatively treated subjects with previously confirmed primary aldosteronism (PA) (n- 50, 64,5 ± 9 years of age, 24% of women). The confirmation of PA was based on saline supression test in accordance with current guidelines. The PA patients were conservatively treated due to bilateral disease confirmed by adrenal venous sampling or refusal of the surgery. All subjects were regularly followed-up in our clinic. In addition to basic laboratory and clinical parameters, 24 hour ambulatory blood pressure monitoring (Spacelabs) was evaluated. Unplanned blood sampling for assesment of all serum antihypertensive drug concentrations by means of liquid chromatography-mass spectrometry was performed in all patients. The drug was considered positive when the concentration was at least at the lowest detectable level. Total noncompliance was defined as the absence of all measured antihypertensive drugs. Partial noncompliance was calculated as the absence of serum levels of at least one, but not all antihypertensive drugs apparently taken.

Results:

We have detected good blood pressure control (mean 24 h systolic/diastolic BP 130 ± 12/77 ± 9 mmHg). Average number of antihypertensive drugs was 3,9 ± 1,5. All subjects were treated by MR antagonists. 44% of patients received spironolactone (average daily dose 45 ± 20 mg) and in remaining 56% of subjects eplerenon was given (average daily dose 80 ± 30 mg) because of spironolactone side effects. Assesment of antihypertensive drug concentrations revealed full adherence in 80 %, partial nonadherence was noted in remaining 20 % of subjects. MR antagonists were detected in almost all subjects (49 out of 50).

Conclusions:

We have detected very good blood pressure control and adherence in conservatively treated patients with primary aldosteronism. Eplerenone had to be used due to spironolactone side effects quite often. Combination of MR antagonists with other antihypertensive drugs (mainly calcium channel blockers and thiazides) had to be used in majority of patients with PA.
RELATIONSHIP BETWEEN METABOLICALLY HEALTHY OBESITY AND THE DEVELOPMENT OF HYPERTENSION: A NATIONWIDE POPULATION-BASED STUDY
Authors: Yuan Yue , Sun Wei , Kong Xiangqing
Published: June 2022

Objective:

Metabolically healthy obesity (MHO), which does not have a general definition, has been recognized as a transient phenotype with few cardiometabolic diseases. This study aimed to assess the relationship between the development of hypertension and metabolically healthy abdominal obesity (MHAO) and metabolically healthy general obesity (MHGO) phenotype.

Design and method:

This was a retrospective cohort study of 4764 adults who were enrolled from the China Health and Nutrition Survey (CHNS) study from 2009 to 2015. Obesity was classified as abdominal obesity based on waist circumference and as general obesity based on body mass index. Logistic regression was used to analyze the relationship between metabolic health combined with obesity and prehypertension and hypertension.

Results:

There were 412 (37.9%) participants with prehypertension and 446 (41.0%) participants with hypertension with the MHAO phenotype. Subjects with the MHAO phenotype had significantly higher risks of prehypertension [risk ratio (RR) = 1.89 (1.51–2.36), P < 0.001] and hypertension [RR = 2.58 (2.02–3.30), P < 0.001] than subjects with the metabolically healthy nonabdominal obesity (MHNAO) phenotype. A similar trend existed with regard to the subjects with the MHGO phenotype, particularly in young individuals aged under 64 years. Men with the MHAO phenotype seemed to have higher risks of prehypertension [men: 2.42 (1.52–3.86) vs. women: 1.76 (1.36–2.29)] and hypertension [men: 3.80 (2.38–6.06) vs. women: 2.22 (1.64–3.00)] than women when compared with those with the MHNAO phenotype.

Conclusions:

The MHO phenotype, regardless of the presence of general or abdominal obesity, showed a worse effect on the development of prehypertension and hypertension, particularly in young adults. Abdominal adiposity with healthy metabolic status is more strongly associated with incident hypertension in men than in women, guiding decision-making for sex-specific and risk-stratified obesity treatment.
POOR HYPERTENSION CONTROL AND DISAPPEARANCE OF MEDITERRANEAN LIFE STYLE ON THE CROATIAN ADRIATIC ISLANDS. HUNT ON THE SILENT KILLER (HSK) – OPPORTUNISTIC PUBLIC HEALTH ACTION
Authors: Tarnovski Lorka , Frkanec Stjepan , Katic Luka , Strbac Tea , Susnjara Petar , Lovakovic Josip , Kolaric Melanija , Stupin Ana , Josipovic Josipa , Baretic Maja , Boljesic Marta , Begic Zvonimir , Barisic Klara , Bilajac Lovorka , Radunovic Danilo , Prelevic Vladimir , Jelakovic Ana , Gellineo Lana , Domislovic Marija , Jelakovic Bojan
Published: June 2022

Objective:

Mediterranean lifestyle is slowly disappearing along the Croatian coast and Croatian islands were supposed to be the last part of healthy living. Unfortunately, healthcare system is poorer on islands than in other parts of Croatia. Our aim was to analyse lifestyle and hypertension (HT) treatment and control among inhabitants of the Croatian islands.

Design and method:

HSK was organised by the Croatian Society of Hypertension and conducted by the WG- medical students in hypertension. A screening site was set up at the boat by which students traveled from island to island. Adult volunteers were recruited through opportunistic screening on five Adriatic islands. Trained medical students collected information through an extended questionnaire. HT was defined as blood pressure (BP) > 140/90mmHg (single occasion; an average of 2nd–3rd measurement; Omron M3) and/or self-reported use of drugs for HT. Results were compared with results from the general Croatian population (EHUH 2 cohort).

Results:

A total of 424 participants were included (196 men, average age 61 years). There were less obese and current smokers at islands than in the general Croatian population (26.5% vs. 33.1%; 21.5% vs. 25%, respectively, p < 0.05). Islanders were more physically active (> 1 time/week), eat more frequently fish (> 1 time/week), and use more frequently olive oil (daily basis) (44.1% vs. 26%, 79.9% vs. 32.5%, 72.6% vs. 14.9 %, respectively; p < 0.01). However, there were no differences in consumption of red meat, processed meat, cookies and cakes (p > 0.05). Less hypertensive patients were treated and control was achieved in less subjects on islands than in the general population (60.7% vs. 72.9%; 27.2% vs. 39.3%, respectively; p < 0.01).

Conclusions:

Some elements of Mediterranean life are still present on Croatian islands. However, several poor lifestyle habits are equally present on islands and in other Croatian regions. Treatment and control of HT are poorer on islands reflecting inadequate healthcare and lack of physicians. Public health authorities should reorganize health care on islands. In the meantime, such public health actions are warranted and must continue.
IMPACT OF PROTEINURIA ON LONG-TERM MORTALITY IN PATIENTS WITH HYPERTENSIVE CRISIS VISITING THE EMERGENCY DEPARTMENT
Authors: Shin Jeong-Hun , Kim Byung Sik , Kim Hyung-Jin , Yu Mi-Yeon
Published: June 2022

Objective:

Hypertensive crisis is associated with poor clinical outcomes. Proteinuria, frequently observed in hypertensive crisis, is a risk factor for cardiovascular and all-cause mortality in patients with hypertension. However, in patients presenting with hypertensive crisis and proteinuria, the impact of proteinuria on long-term mortality are unknown. We investigated the association of proteinuria with all-cause mortality.

Design and method:

This retrospective study at a tertiary referral center conducted with adult patients who were admitted to the ED between 2016 and 2019 with hypertensive crisis, which was defined as systolic blood pressure > = 180 mmHg and/or diastolic blood pressure > = 100 mmHg. Of 10,219 patients with hypertensive crisis, 5,421 patients with an assay for proteinuria were enrolled in this study. Proteinuria was defined as a trace or more of protein on a urine dipstick test performed at ED.

Results:

Proteinuria was present in 2,855 (52.7%) of the 5,421 patients. At 3 years, crude all-cause mortality rates were 9.6% for patients who were negative proteinuria, 17.9% for those with trace proteinuria, 25.7% for those with proteinuria (1+), 28.9% for those with proteinuria (2+), 33.6% for those with proteinuria (> = 3+). After adjusting for sex, age, blood pressure, and comorbid condition, the hazard ratio (95% CI) for dipstick proteinuria was 1.74 (1.44–2.10) for those with trace proteinuria, 2.24 (1.84–2.72) for those with proteinuria (1+), 2.21 (1.76–2.78) for those with proteinuria (2+), 2.30 (1.75–3.01) for those with proteinuria (> = 3+) compared with the reference of negative proteinuria.

Conclusions:

Proteinuria, which was detected on a urine dipstick test, was a significant predictor of all-cause mortality in patients with hypertensive crisis.
LIPIDS’ METABOLISM AND ANGIOTENSINOGEN GENE (AGT, RS699) POLYMORPHISM ASSOCIATION IN PATIENTS WITH ESSENTIAL ARTERIAL HYPERTENSION
Authors: Repchuk Yuliya , Sydorchuk Larysa
Published: June 2022

Objective:

The study purpose was to analyze the association of angiotensinogen AGT (rs699) gene polymorphism with lipids` metabolism in patients with essential arterial hypertension (EAH).

Design and method:

The study involved 72 patients suffering from EAH with target-organ damaging, moderate, high or very high cardiovascular risk. Among them, 70.84% (51) women and 29.16% (21) men, mean age 59.87 ± 7,98 y o. The control group involved 50 practically healthy persons, matched by age and sex distribution. To examine polymorphism of AGT (rs699) gene a qualitative polymerase chain reaction was made in real-time regimen. The state of lipids` metabolism was studied by means of determination of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TGs) content in the blood plasma using diagnostic standard sets produced by „ACCENT-200” firm (Poland).

Results:

The genotypes distribution of the AGT (rs699) gene in patients vs control group did not differ reliably and was as follows: TT- genotype - 13.89% vs 16.67%, TC- genotype - 59.72% vs 54.17% and CC-genotype - 26.39% vs 29.17%, that was corresponded to the Hardy-Weinberg Equilibrium (p > 0.05).

Mean values of TC were higher than that of the normal ones practically in all the groups. The highest parameters were found among TC-genotype carriers, especially among men – 6,14 ± 0,34 mmol/l in the control group and 5,79 ± 0,14 mmol/l in the group of patients with EAH, though there was no reliable difference found between the groups. The level of TGs was higher among T-allele (especially TC-genotype) carriers in comparison with the control group by 50% among men (p = 0,03) and by 25,6% among women. The HDL-C levels were higher than threshold among men-carriers of TT-genotype in both groups, while the carriers of C-allele (especially CC-genotype) had 26,4% (p = 0,01) and 40,2% (p = 0,03) higher values in comparison with TT-genotype carriers. The LDL-C levels were the highest among TC-genotype carriers, but in comparison with other genotype carriers there was no reliable difference found.

Conclusions:

Thus, T-allele of AGT (rs699) gene is associated with a lower HDL-C level in men and a higher level of TGs in women.
ARTERIAL HYPERTENSION (HT) IS ONE OF THE MOST PREDICTIVE RISK FACTORS FOR TYPE 2 DIABETES (DM2). THE FINDRISC IS VALIDATED FOR THE EARLY DETECTION OF SUFFERING FROM DM2
Authors: Mirada Micaela , Pessana Franco , Acuña Maria Isabel Rodriguez , Ramirez Agustin , Sanchez Ramiro
Published: June 2022

Objective:

To investigate in patients with hypertension the risk of DM 2 according to the criteria of the FINDRISC score

Design and method:

Cross-sectional epidemiological study. 659 subjects between 18–65 years of age, 210 (32%) female and 449 (68%) males were selected. The parametric variables under the studio were: Age, Weight, Height, Central Abdominal Perimeter, Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), HDL, LDL, Total cholesterol, triglycerides, Basal blood glucose and the dichotomous variables: Sex, Diet, Exercise, antihypertensive drugs, historical hyperglycemia, family history of DM to evaluate the FINDRISC score. Two multivariate analysis model was used: linear and potential regression, together with logical tests. Excel and JMP were used for the statistical analysis.

Results:

From the group studied, 71% of them were at risk of developing type 2 diabetes mellitus. Among them, 16.2% (107 subjects) presented high and very high FINDRISC score values (15–20 and greater than 20). 25.8% were hypertensives (131 patients), and 36% of them present a high and very high risk FINDRISC score value, compared with only 11% of the normotensive group. When analyzing the population of hypertensive subjects and high risk for diabetes, no differences were observed between male and female (37% male men and 33% female.

Conclusions:

With FINDRISK score, Hypertension is one of the most relevant risk factors to develop diabetes in our population. This makes it possible to plan individual actions in order to achieve a reduction in cardiovascular complications.
THE PREVALENCE OF WHITE-COAT EFFECT AND REVERSE WHITE-COAT EFFECT IN TREATED HYPERTENSIVE PATIENTS
Authors: Lewandowska Katarzyna , Lipski Dawid , Pawlak-Chomicka Regina , Uruski Pawel , Tykarski Andrzej
Published: June 2022

Objective:

In hypertensive population are patients whose office blood pressure measurements differ from those in 24-hour ambulatory blood pressure measurements. They are patients with the white-coat effect (office blood pressure is higher than office measurements) and with the reverse white-coat effect (ambulatory measurements are higher than office blood pressure measurements). The cardiovascular risk and the prevalence of organ damages in both phenomena are unclear. There are studies showing that these phenomena could be clinically significant. The aim of the study was to assess the prevalence of white-coat effect and reverse white-coat effect in treated hypertensive patients, depending on gender and age.

Design and method:

The office and 24-hour ambulatory blood pressure measurements data were collected from 1465 hypertensive patients (771 men) with mean age 55.9 ± 15.2. The reverse white-coat effect was defined as: office systolic blood pressure – daytime systolic blood pressure mean < -10 mmHg. The white-coat effect was defined as: office systolic blood pressure – daytime systolic blood pressure mean > = 20 mmHg and/or office diastolic blood pressure – daytime diastolic blood pressure mean > = 10 mmHg. Patient data were sorted in accordance with gender and divided into age decades every 10 years. Statistica software (StatSoft) and Microsoft Excel were used to calculate phenomena prevalence.

Results:

300 (20.5%) patients met the reverse and 286 (19.5%) white-coat effect criteria. The prevalence of both phenomena was similar in the treated hypertensive population. The white-coat effect was more common in older patients, with the highest prevalence in the 65–74 age decade (26.3%). The reverse white-coat effect referred to younger patients - predominating was 25–34 age decade (31.9%). Depending on gender, the white-coat effect was dominant among women aged 75–84 (27.4%) and among men aged 65–74 (27.1%). The reverse white-coat effect was dominant among women and men aged 25–44 (appropriate 43.5% and 26.1%).

Conclusions:

The reverse white-coat effect occurs the most often in women and men in the 25–34 age decade. The white-coat effect is the most common among women in 75–84 and among men in the 65–74 age decade.
PREVALENCE AND CONTROL OF HYPERTENSION IN DIABETIC PATIENTS WITH VERSUS WITHOUT CHRONIC KIDNEY DISEASE
Authors: Georgianou E. , Markakis K. , Georgianos P. , Zografou I. , Sachinidis A. , Sabanis C. , Doumas M.
Published: June 2022

Objective:

Adequate control of hypertension is a guideline based strategy to retard the progression of kidney injury in patients with diabetes. The aim of this cross-sectional study was to compare the prevalence and control rates of hypertension in diabetic patients with versus without chronic kidney disease (CKD).

Design and method:

In 483 outpatients with type 1 or type 2 diabetes from a tertiary university hospital of the region of Thessaloniki, office blood pressure (BP) was recorded under standardized conditions (triplicate recordings after a 5-minute seated rest period) using the validated automated device HEM-705 (Omron, HealthCare). Hypertension was defined as office BP equal as or higher than 140/90 mmHg or current use of at least 1 antihypertensive drug.

Results:

The prevalence of hypertension was 69.8% in diabetic patients with estimated-glomerular-filtration-rate (eGFR) > 90 ml/min/1.73m2, 79.6% in patients with eGFR 60–90 ml/min/1.73m2 and 91.4% in those with eGFR < 60 ml/min/1.73m2 (P< 0.001 for the trend across eGFR strata). Despite the fact that 69.6% of the overall population was being treated with an average of 2.2 antihypertensive drugs daily, the control rates of hypertension were 41.8%, 40.0% and 34.5% in patients with eGFR > 90, 60–90 and < 60 ml/min/1.73m2, respectively (P = 0.245). The decline in eGFR was accompanied by a parallel rise in systolic BP, decline in diastolic BP, and widening of pulse pressure (51.5 ± 14.8 vs. 55.5 ± 16.5 vs. 65.9 ± 17.3 mmHg in the eGFR strata of > 90, 60–90 and < 60 ml/min/1.73m2, respectively, P < 0.001). A similar distribution of the severity of hypertension was observed when the patients were stratified by level of albuminuria.

Conclusions:

The present study shows that among patients with diabetes, the severity of hypertension increases in parallel with the decline in eGFR and rise in albuminuria. The widening of pulse pressure is possibly reflecting the more severe arteriosclerosis in patients with diabetes and established CKD.
EPIDEMIOLOGY OF HYPERTENSION IN CROATIA (EHUH STUDY) -ECG FINDINGS AND CARDIOVASCULAR MORTALITY DATA AFTER 17 YEARS OF FOLLOW-UP
Authors: Frkanec Stjepan , Katic Luka , Strbac Tea , Tarnovski Lorka , Boban Marin , Sekulic Mislav , Stojic Vana , Trobonjaca Adrian , Begic Zvonimir , Barisic Klara , Jelakovic Ana , Blagus Luka , Bosnjak Vito , Gellineo Lana , Stevanovic Ranko , Rak Benedict , Jelakovic Bojan
Published: June 2022

Objective:

Our aim was to association of ECG findings and mortality data in random sample of Croatian population, an original cohort from the EHUH study after 17 years of follow up.

Design and method:

EHUH study is nation-wide survey on prevalence, treatment and control of hypertension in Croatia. In 2001–2003 a random sample of 1267 subjects were enrolled. Mortality data were analyzed after average period of 17 years. Office blood pressure (BP) was measured in sitting position using mercury sphygmomanometer three times at two visits and once at home visit: total 9 measurements -average BP values were calculated. Mortality data were collected from National Public Health Institute records. ECG scans were taken 17 years ago in 162 subjects and scans were analyzed by 2 different examiners manually, regardless one of another. In this group there were 17 deaths. Heart rate, intrinsic heart rate, RR interval, QT, TPe and QRS times, QTc and TPe/QTc ratios were analyzed across the groups.

Results:

Statistically significant differences were observed in distributions of intrinsic heart rate (p < 0.001) and QTc (p < 0.05) between subjects who died and survivors. Higher values of intrinsic heart rate were linked with lower mortality (B = -0.361, (p < 0.001). A smaller, but statistically significant difference was observed for QRS time (B = -0.045, p < 0.05) suggesting longer QRS times are linked with lower mortality.

Conclusions:

Our results which are not in line with other reports could be explained with small group, small number of events and most probably it is the case of reverse epidemiology.
IMPACT OF COMBINED TREATMENT WITH ACE INHIBITORS AND STATINS ON CARDIOVASCULAR OUTCOMES IN THE BRISIGHELLA HEART STUDY: A 8-YEAR FOLLOW-UP
Authors: Cicero Arrigo F.G. , Fogacci Federica , Rizzoli Elisabetta , Giovannini Marina , D’Addato Sergio , Borghi Claudio
Published: June 2022

Objective:

The aim of this analysis was to comparatively evaluate the long-term effect of combining treatment with statins and angiotensina-converting enzyme (ACE) inhibitors on hemodynamic and laboratory parameters and on the incidence of major cardiovascular events (MACE) and other clinical outcomes in a well characterized Italian cohort.

Design and method:

We considered data from a subset of Brisighella Heart Study (BHS) participants who were consecutively evaluated in three epidemiological surveys between 2012 and 2020. For the purpose of this analysis, we excluded normotensive subjects and individuals with a low calculated 10-year CVD risk, hypertensive patients treated with antihypertensive drugs different from ACE inhibitors and patients who changed antihypertensive medications during follow-up. The remaining participants were divided into four groups depending on whether they were treated with (I) perindopril +/- amlodipine without statin treatment, (II) perindopril +/- amlodipine and atorvastatin, (III), an ACE inhibitor other than perindopril without statin therapy, (IV) an ACE inhibitor other than perindopril and statin therapy. The long-term (8 years) effects of the different combined treatment were compared among the pre-defined groups.

Results:

Over the follow-up period of 8 years, the proportion of subjects who developed MACE, type 2 diabetes mellitus and hyperuricemia, and the proportion of subjects who had a need for the intensification of antihypertensive treatment to improve blood pressure control were statistically different among the predefined groups (P < 0.05).

Conclusions:

Based on our observations, the combined treatment with ACE inhibitors and statins in hypertensive patients seems to significantly reduce the risk of developing CVD in comparison with treatment with ACE inhibitors alone. This effect seems to be particularly impressive when treatment with perindopril (+/- amlodipine) is as-sociated to atorvastatin.
LONG-TERM EFFECT OF DIFFERENT TRIPLE COMBINATION ANTIHYPER-TENSIVE MEDICATIONS: DATA FROM THE BRISIGHELLA HEART STUDY
Authors: Cicero Arrigo F.G. , Fogacci Federica , Rizzoli Elisabetta , D’Addato Sergio , Borghi Claudio
Published: June 2022

Objective:

The aim of this study was to comparatively evaluate clinical, laboratory and hemodynamic effects on the long term of different triple combination antihypertensive medications in a well-characterized population cohort.

Design and method:

We considered data of a subset of Brisighella Heart Study (BHS) participants who were consecutively evaluated in three epidemiological surveys between 2012 and 2020. For the current analysis, we excluded normotensive subjects, patients treated with < 3 or 3 or more high blood pressure (BP) medications without taking angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), calcium-channel blockers (CCB) and/or thiazide/thiazide-like diuretics. The remaining participants were divided into three groups depending on whether they were treated with ACE-inhibitors/CCBs/Thiazide, ARBs/CCBs/Thiazide or Perindo-pril/Amlodipine/Indapamide, either with separate drugs or fixed pill combinations. A further group of age- and sex-matched volunteers was selected as control and included patients receiving other antihypertensive medications. The long term effects of the different antihypertensive medications were compared among the pre-defined groups.

Results:

On the long-term, combination treatment with renin-angiotensin system (RAS) modulators, CCBs and thiazide/thiazide-like diuretics was associated with better control of diastolic BP and lipid pattern than other triple combination antihypertensive medication. Patients treated with Perindopril/Amlodipine/Indapamide did not experience any age-related increase in serum levels of total cholesterol. Moreover, during the follow-up they neither developed type 2 diabetes nor had a need for a greater number of antihypertensive drugs to improve BP control.

Conclusions:

Based on our observations, combination treatment with RAS modulators, amlodipine and thiazides/thiazide-like diuretics is more effective than other combination antihypertensive medications for lowering the diastolic BP and has a better impact on serum lipids. Perindopril/amlodipine/indapamide is associated with better lipids’ profile than any other considered combination antihypertensive medication.
PREVALENCE, TREATMENT AND CONTROL OF ASYMPTOMATIC HYPERURICAEMIA IN THE GENERAL CROATIAN POPULATION (EH UH 2 STUDY)
Authors: Bukal Nikolina , Domislovic Marija , Gellineo Lana , Fucek Mirjana , Begic Zvonimir , Frkanec Stjepan , Jelakovic Ana , Radunovic Danilo , Prelevic Vladimir , Dika Zivka , Karanovic Sandra , Stevanovic Ranko , Jelakovic Bojan
Published: June 2022

Objective:

Hyperuricemia is acknowledged cardiovascular risk factor and determination of uric acid is a routine laboratory test in arterial hypertension. Debate is going on whether asymptomatic hyperuricemia should be treated or not, and what should be the targets. Our aim was to analyze prevalence of asymptomatic hyperuricemia, treatment and control in general Croatian population.

Design and method:

EHUH -2 study is nation-wide survey (Croatian Science Foundation) on hypertension and numerous cardiovascular risk factors in Croatia. In 2018–2021 a random sample of 1321 subjects were enrolled. Extended questionnaire was applied and subjects were clinically examined. Office blood pressure (BP) and heart rate were measured in sitting position using Omron 3 device three times and average BP values were calculated. Fasting blood sample was drawn after measurements and all lab data including uric acid were determined in a central laboratory. Hyperuricemia was defined as uric acid > 428 umol/l for men and > 357 umol/l for women

Results:

Prevalence of asymptomatic hyperuricemia was 12.6% without difference between men and women. Only 14.2 % of patients with asymptomatic hyperuricemia was treated with xanthine oxidase inhibitors. Normal values of uric acid were achieved in 71.5%. However, it means that in the entire group of patients with asymptomatic hyperuricemia only 10.1 % were under control.

Conclusions:

Prevalence of asymptomatic hyperuricemia is in line with reports from some countries (Italy 9–12%, Spain 5.11% and Sweden 10.16%), but lower than in North America, Russia, Japan and China. Small number of patients is treated and majority were not controlled. This therapeutic inertia should be improved by increasing awareness among physicians.
MORPHOFUNCTIONAL ABNORMALITIES WITHIN THE AORTA AS A PREDICTOR OF ARTERIAL HYPERTENSION IN METABOLIC SYNDROME
Authors: Birulina Yuliya , Buyko Evgeniy , Ivanov Vladimir , Dzyuman Anna , Grigoreva Anna
Published: June 2022

Objective:

Arterial hypertension is an important component of the metabolic syndrome, the development of which is caused by the occurrence of endothelial dysfunction and impaired contractile activity of vascular smooth muscle cells. In the presented work, the morphological basis of an increase in blood pressure under the influence of a high-fat high-carbohydrate diet in rats was investigated.

Design and method:

A study was carried out in male Wistar rats weighing 250–320 g, 140 days old at the end of research. The rats from the control group were fed standard rat chow. The rats from the experimental group had a high-fat high-carbohydrate diet (proteins 16%, fats 21%, carbohydrates 46%, including 17% fructose, 0.125% cholesterol, 90 days). Body weight, blood pressure were assessed. It was determined the morphological changes in the aortic wall. Mechanical tension of isolated aortic rings was measured by Myobath Tissue Bath System II. Sections of aorta were stained with hematoxylin and eosin, sudan III.

Results:

It was found that blood pressure increases in animals kept on a high-carbohydrate high-fat diet. The high-carbohydrate high-fat diet causes endothelial vascular dysfunction, impaired contractile activity of vascular smooth muscles. In the rats the experimental group a changes in the activity of calcium and potassium channels, Na +, K +, 2Cl - cotransporter and chlorine conductivity was found. In the aortic wall of the animals of the experimental group, there are signs of elastolysis (initial remodeling of the media), accumulation of lipids in the interstitial cells of the media, hyperplasia of fat cells in the adventitia.

Conclusions:

Functional and morphological abnormalities in the vascular wall in metabolic syndrome can be the basis for an increase in blood pressure and arterial hypertension.
THE INTERRELATION OF HYPERTENSION AND HYPERURICEMIA THE PRISM OF SCORE2
Authors: Ruf Ruslan , Grinshtein Yuri , Shabalin Vladimir
Published: June 2022

Objective:

Hyperuricemia increases the risk of hypertension. At the same time, hypertension is a part of the SCORE2 model, which assesses the total cardiovascular risk. In the present study, we analyzed the interrelation between the prevalence of hyperuricemia and the cardiovascular risk calculated with the SCORE2 model.

Design and method:

A total of 1603 Krasnoyarsk Krai inhabitants were recruited in the ESSE-RF study. The study protocol provided a standard questionnaire, anthropometry, office blood pressure measurement, and biochemical blood analyses to find the prevalence of known cardiovascular diseases and their risk factors. These data allowed us to calculate an individual cardiovascular risk with the SCORE2 model for each study participant. After that, we compared the prevalence of hyperuricemia (uric acid levels higher than 360 micromole/l in females and 400 micromole/l in males) in the low, medium, and high cardiovascular risk subgroups.

Results:

We found 30.7% (95% CI = 28.4%-33.0%) of the study participants having hyperuricemia. In persons aged 40 and older, 10.8% had a low risk, 37.0% had a medium risk, and 52.2% had a high cardiovascular risk, according to the SCORE2.

In the low-risk subgroup, the prevalence of hyperuricemia was at 11.3% (95% CI = 5.3%-17.4%). At a medium risk, 27.0% (95% CI = 22.4%-31.6%) of people had hyperuricemia. Finally, in the subgroup of high risk, hyperuricemia was found in 37.0% (95% CI = 32.8%-41.2%) of people. Chi-square was for trend at p < 0.001.

Conclusions:

Due to the interrelations between hypertension and hyperuricemia, the higher is the SCORE2-calculated cardiovascular risk of a patient, the higher is the probability that this patient also has hyperuricemia.