bluuebunny/crossref_metadata_2025 huggingface dataset:
INFLUENCES OF BEDREST DECONDITIONING ON ORTHOSTATIC HYPERTENSION RISK
Authors: Hönemann Jan -NIKLAS , Moestl Stefan , De Boni Laura , Hoffmann Fabian , Heusser Karsten , Mulder Edwin , Tank Jens , Jordan Jens
Published: May 2024

Objective:

Orthostatic hypertension defined as systolic blood pressure (SBP) increase of more than 20 mmHg when standing up with hypertensive upright SBP heralds increased cardiovascular risk. The phenomenon is caused by sympathetic overactivation and occurs in conditions associated with poor cardiopulmonary fitness or hypovolemia. We hypothesized that head-down tilt bedrest, which induces cardiopulmonary deconditioning, hypovolemia, and sympathetic activation increases the likelihood of experiencing orthostatic hypertension.

Design and method:

We pooled data from two strict head-down tilt bedrest studies, the 60 days AGBRESA study (n=24, 8 women/ 16 men, 33.3±9 years) and the 30 days SANS countermeasure study (n=47, 20 women/ 27 men, 35±9 years), which both included healthy persons on no medications. In both studies, participants were on controlled sodium diets and caloric intake was adjusted to maintain body weight. Before and immediately after bedrest, we measured supine and upright blood pressure and heart rate during head-up tilt testing. We measured plasma volume using carbon monoxide rebreathing before and after bedrest.

Results:

Supine SBP was 128±9 mmHg before and 133±10 mmHg after bedrest (p<0.0001). While 5 minutes standing, SBP changed 2±8 mmHg before and 3±8 mmHg after bedrest (p=0.5825). 1 out of 67 participants fulfilled diagnostic criteria of orthostatic hypertension before and 3 out of 57 after bedrest. Supine heart rate was 69±11 bpm before and 79±15 bpm after bedrest (p<0.0001). With standing, heart rate increased 21±12 bpm before and 39±16 bpm after bedrest (p<0.0001). Plasma volume decreased by 367±348 ml with bedrest (p<0.0001).

Conclusions:

We conclude that in most healthy persons, cardiovascular deconditioning and volume loss associated with long-term bedrest are not sufficient to elicit orthostatic hypertension. There may be a smaller subgroup of susceptible individuals.
LOW-RENIN VERSUS NON-LOW RENIN HYPERTENSION: A COMPARISON OF CONTROL IN A SPECIALIST CLINIC
Authors: Travis Reece , Keogh Morgan , Faconti Luca
Published: May 2024

Objective:

A significant proportion of hypertensive individuals display a low-renin profile and are commonly referred as subjects with low-renin-hypertension (LRH) phenotype. LRH is associated with a significant increase in cardiovascular events but it is debated whether it is more difficult to treat than non-low-renin hypertension (NLRH). Here, we investigated the prevalence of LRH and blood pressure (BP) control at 3 and 12 months in specialist centre in the UK.

Design and method:

Consecutive hypertensive subjects not on treatment with beta-blockers and centrally acting drugs were recruited from the hypertension outpatient service at Guy's and St. Thomas’ Hospital, London. Anthropometric variables, biochemistry assessment and BP measurement were evaluated in a baseline visit following which subjects were classified as LRH if renin concentration was < 5mU/L. Clinical data at 3 and 12 months were then used to assess BP control.

Results:

205 patients ((mean±SD) age 44±13 years, 61% male) of whom 92% on pharmacological treatment were recruited. Prevalence of LRH was 28% and the two groups (LRH/NLRH) were similar in age, gender, body mass index, prevalence of diabetes and dyslipidaemia. Subjects with LRH (n=59) had higher systolic BP values compared to NLRH (156±23 mmHg vs 147±20 mmHg, P=0.013) whilst the difference was non-significant for diastolic BP (94±14 mmHg vs 91±14 mmHg, P=0.175). Decrease in systolic BP values were greater in LRH compared to NLRH at 3 months and 12 months (10.8±2.9 mmHg vs 5.1±1.6 mmHg and 13.1±3.4 mmHg and 6.3 ±1.7 mmHg respectively, both P< 0.05). with BP values at 12 months similar between the two groups (144±20/88±11 mmHg vs 141±16/89±12 mmHg for LRH and NLRH respectively, P=0.375, Figure 1). Treatment at 12 months differed in the two groups, with LRH patients more likely to be prescribed diuretics (39% vs 25%) and less likely to be prescribed ACE-i/ARB (39.0% v 61.4%), both P<0.05.

Conclusions:

LRH phenotype is common among patients evaluated in a specialist centre for hypertension. Despite higher BP values at the time of the encounter, LRH patients achieve similar levels of BP control compared to NLRH at 3 and 12 months during the follow up.
IMPACT OF NON-DIPPER PATTERN ON LEFT VENTRICULAR GLOBAL LONGITUDINAL STRAIN, IN HYPERTENSIVE PATIENTS. NACIM DAHMANI1, NABILA SOUFI TALEB BENDIAB2, MOUHAMED SOUFIANE LOUNES1
Authors: Dahmani Nacim
Published: May 2024

Objective:

Several studies have shown that the non-dipper blood pressure pattern, defined by a nocturnal decrease in blood pressure (BP) of less than 10% at the 24-hour ambulatory blood pressure monitoring (ABPM), is associated with an increase in cardiovascular risk and risk of target organ damage, however, there are few data on the non-dipper effects on the longitudinal strain overall studied by 2D speckle tracking. The aim of this study is to evaluate the impact of nocturnal dipper/non-dipper pattern on the global longitudinal systolic (GLS) of left ventricle by means of two-dimensional speckle tracking echocardiography (2D STE), of hypertensive patients under treatment or not.

Design and method:

This is a cross-sectional descriptive study conducted over a period of 20 months, from November 2021 to June 2023. The study included a total of 382 patients with arterial hypertension, enrolled consecutively. All participants were subjected to clinical evaluation, biological examination, 24-hour ambulatory blood pressure monitoring and echocardiography with GLS. The patients were divided into dippers and non-dippers, according to the percentage reduction in systolic blood pressure (SBP) and diastolic blood pressure (DBP) at night. The study sought to analyze the relationship between these nocturnal profiles and GLS.

Results:

179 patients (46.90%) are non-dippers. The non-dippers had a significantly lower GLS value than the dippers (-19.45 ±2.03 vs -18.2 ±2.17, P < 0.001). The multivariate linear regression confirmed this independent relationship of the GLS and the non-dipping (β = -0.157, P=0.013), however, we do not find independent relationships between the non-dipping and the diastolic function on the one hand and the non-dipping and the LV geometry on the other hand.

Conclusions:

This study shows that non-dipping is associated with subclinical systolic dysfunction of the LV, as shown by the decrease in the GLS studied by 2D Speckle-Tracking, in hypertensive non-dippers patients.
THE PHENOTYPE OF ESSENTIAL HYPERTENSION WITH A HIGH LEVEL OF RENIN AND A HIGH LEVEL OF ALDOSTERONE
Authors: Cho Jungsun , Ihm Sang -Hyun , Kim Kyunghee
Published: May 2024

Objective:

Over the years, considerable efforts have been made to divide the large, heterogeneous groups of individuals with essential hypertension into smaller, homogeneous subgroups based on hormonal responses to biological stimuli. This classification has included low-renin hypertension and non-modulators, in which changes in sodium intake do not produce the expected reciprocal changes in the adrenal gland (aldosterone) with normal or high levels of renin. In never treated essential hypertensive patients, we aim to evaluate the hypertensive phenotype according to renin and aldosterone levels.

Design and method:

Consecutive patients (n=782) with never treated hypertension were enrolled between August 2009 and July 2021. All enrolled patients underwent ambulatory blood pressure monitoring and laboratory tests, including renin and aldosterone levels, and were evaluated for cardiovascular events during a median follow-up of 5 years, excluding patients with primary aldosteronism.

Results:

Patients were divided into four groups based on renin and aldosterone levels:

High renin and aldosterone (n=216), low renin and high aldosterone (n=161), high renin and low aldosterone (n=163), low renin and aldosterone (n=212). The high renin and high aldosterone group was younger and had lower urine Na/K ratio and higher heart rate than those of other groups in this study.

Conclusions:

Other than low-renin hypertension or nonmodulators, high renin and aldosterone hypertension could be one of the phenotypes of essential hypertension. In addition, renin and aldosterone levels could be helpful in understanding the phenotypes of essential hypertension.
RELATIONS BETWEEN WHITE COAT EFFECT OF BLOOD PRESSURE AND ARTERIAL STIFFNESS
Authors: Cao Rong , Sun Gang , Yang Xiaomin
Published: May 2024

Objective:

The aim of this study was to analyze the relationship between brachial-ankle pulse wave velocity (b-a PWV) and white coat effect (WCE), that is the difference between the elevated office blood pressure (BP) and the lower mean daytime pressure of ambulatory BP, in a mixed population of normotention, untreated sustained hypertension, sustained controlled hypertension, sustained uncontrolled hypertension, white coat hypertension, white coat uncontrolled hypertension.

Design and method:

A total of 444 patients with WCE for systolic BP (54.1% female, age 61.86±13.3 years) were enrolled in the study. Patients were separated into low white coat effect (< 9.5 mm Hg) and high white coat effect (>=9.5 mm Hg) according to the median of WCE.

Results:

The subjects with a high WCE showed a greater degree of arterial stiffness than those with a low WCE for systolic BP values (P< .05). The b-a PWV were 17.2±3.3m/s and 18.4±3.4 m/s in low WCE and high WCE, respectively. The b-a PWV increased with the increase of WCE, showing a positive correlation between them (P< .05 for non-linearity). The significant association between the high WCE and the b-a PWV was confirmed by the results of multiple regression analysis after adjusting for confounding factors (beta=0.78, 95% Cl 0.25-1.31, P=. 004). Similar results were observed in subgroups.

Conclusions:

In conclusion, WCE is significantly associated with arterial stiffness. More research is needed to determine the WCE and target organ damage.
PHENOTYPIC CHARACTERISTICS OF PATIENTS WITH INCREASED ARTERIAL STIFFNESS IN A HYPERTENSION UNIT
Authors: Camafort Miguel , Suarez Ana , Benitez Cristina , Fernández Carolina , Aldea Anna , Coloma Emmanuel , Torresa Manuel , Mayor Miriam , Viñas Esther , Guio Ana , Sepulveda Constanza , Coca Antonio
Published: May 2024

Objective:

Arterial stiffness is related to the increase in morbidity and mortality of patients with arterial hypertension (HTN). The characteristics of a sample of patients where PWV was performed.

Our goal was to look for differential characteristics among those with increased PVW.

Design and method:

Retrospective study of patients assessed in the hypertension unit of a tertiary hospital during 2019.

Patients were assessed through ABPM by Space labs(R), Ankle brachial index by ABI Huntleigh (R) and PWV measured by Sphygmocor®.

Characteristics of patients with High PWV are presented.

Results:

A total of 22 patients were included, mean age was 60 (± 18.1), average abdominal circumference was 99.3 cm (± 18) and average BMI was 28.55 kg/m2 (± 6.4). Office Blood pressure (BP): Mean systolic BP of 156mmHg (± 22), a mean diastolic BP of 76.58mmHg (± 10.89), a mean heart rate (HR) of 69bpm (± 10), mean central systolic BP of 135.66mmHg (± 10.76) and mean central diastolic BP of 81mmHg (± 12.4).

An ankle-brachial index (ABI) was performed on 9 patients, with a mean right ABI of 120 (± 11.87) with a mean intima media thickness (IMG) of 626 (± 206.1) and a mean left ABI of 118 (± 14.61) with an IMT of 631.7 (± 143.83).

Ambulatory blood pressure monitoring (ABPM) was performed in 11 of the patients, which showed a mean systolic BP of 138mmHg (± 17.57), mean diastolic BP of 75mmHg (± 11.65), and mean HR of 68bpm (± 11.94).

Regarding the correlation with the laboratory findings, a mean glucose value of 108 g/dL (± 29.9), mean triglycerides of 146.9mg/dL (± 54), mean cholesterol of 191.27mg/dL (± 40.94), mean LDL of 114mg/dL (± 36.57) and mean HDL of 48.7mg/dL (± 11.37), and a mean glomerular filtration rate of 64ml/min (± 14.25).

This sample was compared with patients with non-pathological PWV, with no significant differences between the groups.

Conclusions:

We did not find statistically significant associations, in our data, that would allow us to differentiate patients who had pathological OPV during the first visit. More studies are needed
EFFECT OF ALPHA GALACTOSIDASE ON ARTERIAL HYPERTENSION AND ITS COMPLICATIONS IN PATIENTS WITH FABRY DISEASE
Authors: Cherif Abdelghani Bachir , Bennouar Salam , Bellahmer Sihem
Published: May 2024

Objective:

Fabry disease (FD) is an X-linked lysosomal storage disease caused by alpha-galactosidase A deficiency. It leads to multi-systemic damage from a very young age. The diagnosis is mainly clinical and confirmed by the measurement of enzymatic activity. The objective of our study is to evaluated the blood pressure profile as well as the effect of enzymotherapy on the control of hypertension.

Design and method:

We studied 9 Fabry patients (5 male and 4 female) over a period of 1 years regarding disease progression and clinical outcome under enzyme replacement therapy. All Fabry cases benefited from a complete physical examination and additional tests to assess multi-system involvement. The diagnosis is mainly clinical and confirmed by the measurement of enzymatic activity. All patients received alpha galactosidase.

Results:

At baseline, 9 patients demonstrated at least 6 fibrotic left ventricular segments, 3 had 1 left ventricular segment affected (mild fibrosis). In patients without fibrosis, enzyme replacement therapy resulted in a significant reduction in left ventricular mass (232 ± 33 g at baseline, 215 ±26 g at 1 years; P <0.001). The prevalence of hypertension was 66%, whereas hypertension in patients with chronic kidney disease ranged 81%. A study using 24-hour ambulatory blood pressure monitoring (ABPM) to measure blood pressure (BP) indicated a high prevalence of uncontrolled hypertension in FD. Enzyme replacement therapy with recombinant alpha-galactosidase A reduces blood pressure and left ventricular hypertrophy in all patients. We found larger treatment effects in patients with baseline estimated glomerular filtration rates greater than 56 mL/min per 1.73 m2 (hazard ratio, 0.15 [CI, 0.03 to 0.71]; P 0.01) compared with 50 mL/min per 1.73 m2 or less (hazard ratio, 0.75 [CI, 0.28 to 2.1]; P 0.8) (formal test for interaction, P 0.07). Most treatment-related adverse events were mild or moderate infusion-associated reactions, reported by 55% of patients in the agalsidase-A group.

Conclusions:

Fabry disease is a rare and potentially serious disease because of its renal and cardiac complications. Early diagnosis is fundamental. Modern management of patients with FD must combine treatment of hypertension and enzyme therapy as early as possible.
NOCTURNAL HYPERTENSION: THE VEILED DARK SIDE OF HYPERTENSION MANAGEMENT IN A REAL WORLD
Authors: Liu Jing , Liu Jiahui ,   Nhig
Published: May 2024

Objective:

Nocturnal hypertension (NH) is highly prevalent among Chinese and Asian populations, while it is usually undetected and uncontrolled in real world clinical practice. This study is aimed to explore the status of nocturnal blood pressure (BP) control in subjects undergone 24h ambulatory blood pressure monitoring (ABPM) in China.

Design and method:

A nationwide 24h ABPM database was analyzed. NH was defined as average nighttime BP >=120/70 mmHg according to the recent Chinese and European hypertension guidelines.

Results:

A total of 210782 Chinese adult subjects undergone 24h ABPM between 2020-2022 with suspected and established hypertension were include in this preliminary analysis. Half of the participants was male, the mean age was 59.5(+/-15.3) years. The average nocturnal BP was 127.8/76.0 (+/- 20.0/ 12.9) mmHg. Overall, nocturnal BP was under controlled (<120/70 mmHg) among 23% of the participants, 20% in male, 26% in female, much less than the 45% of daytime BP control and 35% of 24h average BP control in the total subjects. Nighttime systolic BP <120 mmHg was found in 37% of the participants, while nighttime diastolic BP<70 mmHg was seen in 32% of the participants.

Conclusions:

NH was uncontrolled in about 3/4 of Chinese adults undergone 24h ABPM, indicating an urgent need for NH detecting and managing in practice.
THE ASSOCIATION BETWEEN HYPERTENSION SUBTYPES DEFINED BY HOME BLOOD PRESSURE IN HYPERTENSIVE PATIENTS AND INCIDENCE OF HYPERTENSION MEDIATED ORGAN DAMAGE
Authors: Phanmaneelux Nutthaphol , Buranakitjaroen Peera , Kunanon Sirisawat , Roubsanthisuk Weranuj , Chotruangnapa Chavalit
Published: May 2024

Objective:

To investigate the association between different hypertension subtypes, based on home blood pressure measurements, and new-onset hypertension mediated organ damage (HMOD).

Design and method:

A retrospective cohort study was conducted from January 2019 to March 2023. Patients, who aged at least 18 years and did not have HMOD, were categorized into normotension, isolated diastolic hypertension (IDH), isolated systolic hypertension (ISH), and combined systolic-diastolic hypertension (SDH) based on the average 7-consecutive-day home blood pressure. The primary outcome was a composite of the first following events of HMOD, including ischemic heart disease, heart failure, stroke, chronic kidney disease, new-onset proteinuria, and death. The secondary outcomes consisted of each HMOD and change of estimated glomerular filtration rate (eGFR).

Results:

The total of 2,351 patients were screened and the 1,314 patients were finally enrolled. The median follow-up period was 24.10 ± 12.54 months. Most of them were women (65.91%) and did not have diabetes mellitus (81.66%). The overall baseline eGFR was 87.75 ± 15.57 ml/min/1.73m2. The average home systolic and diastolic blood pressure were 121.76 ± 7.49/ 73.37 ± 7.10 mmHg in normotensive group, 127.84 ± 5.02/ 88.20 ± 3.48 mmHg in IDH group, 140.60 ± 6.14/ 74.79 ± 7.17 mmHg in ISH group, and 143.45 ± 9.09/ 91.74 ± 5.67 mmHg in SDH group. Multivariable Cox proportional analysis demonstrated that patients with IDH, ISH, and SDH had a similar risk of the composite primary outcome compared to normotensive individuals (adjusted HR of 1.12, 95% CI (0.52 to 2.45), p-value = 0.770 in IDH; adjusted HR of 1.25, 95% CI (0.74 to 2.10), p-value = 0.406 in ISH; adjusted HR of 0.81, 95% CI (0.34 to 1.91), p-value = 0.633 in SDH). However, ISH was significantly associated with an increased risk of slope of eGFR decline (mean change was -2.48 ml/min/1.73m2/year, 95% CI (-3.71 to -1.25), p-value < 0.001). No significant associations were observed for the other secondary endpoints.

Conclusions:

Although hypertension subtypes defined by home blood pressure might not increase the incidence of composite HMOD, patients with ISH had significantly higher rate of annual renal function loss.
VACUOLAR H+-ATPASE AND MEGALIN-MEDIATED PRORENIN UPTAKE: FOCUS ON ELEMENTS BEYOND THE (PRO)RENIN RECEPTOR
Authors: Wang Na , Lu Xifeng , Danser A.H. Jan
Published: May 2024

Objective:

Megalin is a multiple-ligand receptor that contributes to the reabsorption of filtered proteins (including albumin) in the kidney. Recently, megalin was found to act as a novel endocytic receptor for renin and prorenin. This internalization process depended on the (pro)renin receptor [(P)RR]. The (P)RR is an accessory protein of vacuolar H+-ATPase (V-ATPase), a structurally conserved multi-subunit complex, consisting of 14 subunits and two accessory proteins. Here we explored whether V-ATPase elements other than the (P)RR also affect megalin-mediated (pro)renin uptake.

Design and method:

Using RNAi technology, we inhibited each individual V-ATPase subunit in megalin-expressing BN16 cells. Subsequently, we quantified megalin expression and the uptake of prorenin and bovine serum albumin. Moreover, to unravel the underlying molecular mechanisms, we investigated adaptor proteins autosomal recessive hypercholesterolemia (ARH) and disabled-2 (Dab2), which are important for the endocytosis of megalin, and glycogen synthase kinase-3 beta (GSK-3 beta), a regulatory factor of megalin cell surface expression and recycling.

Results:

Silencing the subunit Atp6voa1 reduced prorenin and albumin uptake by 18.6 and 8.9%, while silencing the subunit Atp6ap1 increased prorenin and albumin uptake by 14.5 and 4.4%. Silencing the other subunits did not result in significantly altered prorenin uptake. Silencing Atp6voa1 reduced surface megalin density, without altering its mRNA and total protein levels, and this was associated with increased phosphorylation of GSK-3 beta. Silencing Atp6ap1 increased megalin mRNA and total protein expression and this was accompanied by ARH upregulation, while Dab2 expression was unaltered.

Conclusions:

V-ATPase units differently affect megalin-mediated reabsorption of prorenin, thereby offering novel pharmacological targets to not only affect renal renin-angiotensin system activity, but also to treat renal diseases that are associated with disturbed protein reabsorption, like Dent's disease.
48-HOUR AMBULATORY BLOOD PRESSURE MEASUREMENT AND VOLUME STATUS IN CHRONIC HEMODIALYSIS PATIENTS
Authors: Varda Luka , Piko Nejc , Petreski Tadej , Bevc Sebastjan , Hojs Radovan , Ekart Robert
Published: May 2024

Objective:

Both arterial hypertension and fluid overload present prevalent risk factors for cardiovascular morbidity and mortality in end-stage kidney disease patients. Bioelectrical impedance analysis (BIA) is a promising method to assess hypervolemia in hemodialysis (HD) patients. A consensus on how to correctly assess blood pressure (BP) values in HD patients remains to be reached. Ambulatory BP measurement (ABPM) has been found to closely correlate with end-organ damage and cardiovascular risk. Less is known about the significance of 48-hour ABPM and its correlation with overhydration in HD patients.

Design and method:

88 randomly selected chronic HD patients completed a 48-hour ABPM and BIA using a body composition monitor before the midweek HD session. Statistical analysis was performed using commercially available SPSS® (version 29.0; Chicago, IL, USA). Descriptive statistics and Pearson's parametric correlation test were performed. P-values of less than 0.05 were considered statistically significant.

Results:

Included patients were male in 61.4%, with a mean age of 63.7±13.1 years and median dialysis vintage of 47 (95% CI (48.4, 75.6)) months. 21 (23.9%) patients had a dipping pattern, 62 (70.5%) were overhydrated for more than 1 L, and 50% of those patients for more than 2.5 L. Patients’ antihypertensive therapy and their 48-hour ABPM are presented in Tables 1 and 2, respectively. We found a statistically significant and positive correlation between the average 48-hour systolic BP, day-time systolic BP, night-time diastolic BP and overhydration assessed by BIA (r=0.217; p=0.044; r=0.225, p=0.036; r=0.224, p=0.038, respectively) (Table 2).

Conclusions:

Increased average 48-hour systolic BP, day-time systolic BP and night-time diastolic BP directly correlate with overhydration measured by BIA in chronic HD patients.
SODIUM-MEDIATED BLOOD PRESSURE RISE IS ASSOCIATED WITH A LOWER VASODILATION RESPONSE TO NITROGLYCERIN IN HEALTHY CONTROLS, BUT NOT IN PATIENTS WITH CKD
Authors: Duin Robert Van , Oppelaar Jetta J. , Van Den Born Bert -Jan , Engberink Rik H. Olde , Vogt Liffert
Published: May 2024

Objective:

Chronic kidney disease (CKD) is characterized by endothelial dysfunction, that is partly caused by reduced bioavailability of NO. In addition to volume overload, endothelial dysfunction may contribute to hypertension in CKD. High sodium consumption affects NO levels, potentially leading to impaired vasorelaxation and a salt-sensitive blood pressure (BP) response. Whether salt-sensitivity in CKD is related to impaired NO bioavailability remains unknown. In this randomized-crossover-study, the vasoresponse to the NO donor nitroglycerin (NTG) during a high sodium diet in both CKD and healthy controls (HC) was assessed.

Design and method:

CKD patients (KDIGO stage G2-3A, proteinuria >0.5 g/d) and HC followed a 7-day low sodium control diet (LSD, <50mmol/d) and high sodium diet (HSD, >200mmol/d) in random order. After each diet, the hemodynamic profile was assessed by daytime BP and cardiac output (CO) measurements, by which systemic vascular resistance (SVR) was calculated. Nitroglycerin was administered to assess SVR changes.

Results:

We included 15 CKD patients (mean age, 49 yrs; median (IQR) proteinuria 0.7 (0.6-1.4) g/d; and plasma creatinine 129 (105-160) μmol/l) and 16 HC (41 yrs). Dietary salt intervention was comparable in the CKD and HC groups. After HSD, mean (SD) systolic BP increased in CKD by 9.7 mmHg (9.8; p<0.01) as compared to 3.1 mmHg ((6.0), p=0.07)) in HC (between-group difference p=0.04). After HSD, changes in body weight and CO did not differ between groups. Median (IQR) SVR change after HSD was 163.0 (-34.9-275.7) in CKD and -13.8 ((-299.4–61.4),p=0.03) dyn/sec/cm-5 in HC. In HC, salt-mediated blood pressure change was positively associated with a NTG-induced SVR change during HSD (r= 0.70, p= 0.01). This association was not present in CKD (r=-0.24, p=0.34) and significantly different from that in HC (p<0.01).

Conclusions:

CKD patients have a higher sodium-mediated BP response with comparable change of fluid status but a different SVR change as compared to HC. In HC, impaired sensitivity to the NO donor nitroglycerin associates with higher BP response to sodium. No such association was found in CKD patients, suggesting that persistent endothelial dysfunction is pivotal for salt sensitivity in CKD.
BLOOD PRESSURE CONTROL IN HEMODIALYSIS PATIENTS: CONTRIBUTION OF BIO -IMPEDANCEMETRY
Authors: Riguen Mouna , Fendri Beya , Kmicha Erij Ben , Abid Hanen , Dammak Najla , Agrebi Ikram , Chaker Hanen , Yaich Soumaya , Kammoun Khawla , Toumi Salma , Hmida Mohamed Ben
Published: May 2024

Objective:

Arterial hypertension is common in hemodialysis patients of which physiopathology is multifactorial. Moreover, it is associated with an increased risk of cardiovascular disease and a higher mortality. Fluid overload is the main contributing factor. Few studies have assessed the interpretation of parameters obtained through bioelectrical impedance (BIA) for the management of these patients.

Design and method:

we conducted a cross-sectional study at the Hemodialysis Center of Hedi Chaker in Sfax, Tunisia. Multifrequency bioimpedance analysis (BIA) was used to assess the hydration status which is performed at the end of the dialysis session.

Results:

Our study included 29 patients, with a mean age of 46.8 years (21-78 years) and an average dialysis vintage of 92.4 months. Male predominance was noted with a sex ratio of 1.06. Forty-eight percent of patients were hypertensive. Twenty-three percent of patients were on triple antihypertensive therapy, 13.3% were on dual therapy, and 16.7% were on monotherapy. Hypertension was essential in 64.2% of cases, renin-dependent in 14.2%, and volume-dependent in 21.6% of cases. Twenty-point seven percent (20.7%) of patients were in fluid overload, with an average overhydration of 0.9 liters. The impedance measurements were consistent with the data from cardiac ultrasound. The diameter of the inferior vena cava was significantly correlated with overload (p=0.01). However, there is no correlation between pulmonary arterial hypertension (HTAP) and the hyperhydration (p=0.4).

Conclusions:

Bio-impedancemetry is a valuable and simple tool at the patient's bedside for the dry weight estimation and the proper management of volume status in chronic hemodialysis patients, and consequently, blood pressure control.
FINERENONE TREATMENT PREVENTS GLOMERULAR DAMAGE AND RENAL INTERSTITIAL INFLAMMATION IN TYPE 1 DIABETIC RATS WITH CHRONIC KIDNEY DISEASE
Authors: Mateos Esther Durán , Palma-guzmán Paloma , Mercado-garcía Elisa , Ruíz-hurtado Gema , Kolkhof Peter , Plaza Adrián , Kreutz Reinhold , Fernández-alfonso Maria S.
Published: May 2024

Objective:

Finerenone (FIN), a non-steroidal mineralocorticoid receptor antagonist, has shown a protective effect on kidney and cardiovascular damage progression in type 1 diabetic Munich Wistar Frömter rats with established chronic kidney disease (CKD). The gradual decline in kidney function in diabetic CKD is due to a thickening of glomerular and Bowman capsule basement membranes, mesangial matrix expansion, and tubulointerstitial fibrosis. In this study we aimed to characterize whether the renal protection of FIN is related to a decrease in kidney damage through histomorphological changes in diabetic MWF rats.

Design and method:

Diabetes was induced by a streptozotocin injection (15 mg/Kg, i.p.) together with exposure to a high fat/high sucrose (HF/HS) diet (MWF-D) for 6 weeks. The MWF-D-FIN group was additionally treated with 10 mg/Kg/day of FIN included in the HF/HS diet (n = 6/group). Morphometrical analysis of renal structural changes was performed under hematoxylin and eosin staining, and light microscopy. Matrix metalloproteinases (MMP)-2 and MMP-9 activities were determined by zymography.

Results:

MWF-D and MWF-D-EP rats exhibited significantly elevated glycemia, water intake, urine volume, glucosuria, and kidney weight compared to control MWF. Histological examination of kidney samples of MWF and MWF-D rats showed hypertrophic glomeruli with an increase of the glomerular tuft and the Bowman's space. These pathological alterations were prevented by FIN treatment. The percentage of glomerulosclerosis was significantly higher in MWF and MWF-D rats and 59% lower in the MWF-D-FIN group (p<0.001) whereas the glomerulosclerosis index was reduced to 33% by FIN (p<0.001). Moreover, MWF-D rats showed an increased interstitial inflammation index compared to MWF rats (p<0.001) which was reduced to 44% (p<0.001) in the MWF-D-FIN group. Since an increase in MMP-2 and MMP-9 activities are associated with fibrosis development, these were determined by zymography in kidney samples of all groups. Both MMP-2 and MMP-9 were significantly higher in MWF-D compared to MWF and decreased by FIN treatment.

Conclusions:

In conclusion FIN prevents the development of diabetic kidney damage due to a reduction in glomerular alterations and interstitial inflammation associated to an inhibition of MMP-2 and MMP-9 activities.
THRESHOLDS AND PREVALENCE OF GLOMERULAR HYPERFILTRATION ACROSS BLOOD PRESSURE CATEGORIES IN LOW-RISK EUROPEAN POPULATION
Authors: Jelakovic Ana , Domislovic Marija , Kos Jelena , Josipovic Josipa , Gellineo Lana , Fucek Mirjana , Pecin Ivan , Bilajac Lovorka , Jelakovic Bojan
Published: May 2024

Objective:

Aims of this study were to define thresholds for GH in a healthy low-risk European population using an age and gender-specific 95th percentile cut-offs, and to determine the prevalence of GH based on various eGFR equations across blood pressure (BP) categories.

Design and method:

In cross-sectional survey we included 1105 apparently healthy untreated participants from general population. There were 294, 412, and 400 normotensive, prehypertensive, and untreated hypertensive participants, respectively. The eGFR was calculated using CKD Epi equations, absolute GFR equation, MDRD and Cockcroft-Gault equations. Subjects were divided into the age quintiles. Prevalence of GF was determined for each equation and differences among BP categories were calculated.

Results:

Highest prevalence was found when GFR was estimated with CKD EPI equations. The lowest prevalence was observed with absolute GFR and Cockcroft-Gault equations (Figure 1). We failed to find differences in the prevalence of GH among the BP categories with the CKD EPI equations. Significant positive trend in the prevalence of GH from subjects with normal BP to the subjects with untreated hypertension was found when we used absolute GFR and Cockcroft-Gault equations. Subjects with GH had more obesity, dyslipidaemia, inflammation and salt intake compared to subjects with normal eGFR. In multinominal logistic regression, among subjects with eGFR >60 ml/min/1.73 m2, PP > 60 mmHg, ACR and salt intake increases the risk for GH by 96.4%, 90% and 83.9%, respectively. In the group of subjects with eGFR < 60 ml/min/1.73 m2, PP > 60 mmHg, ACR and being obese vs. having normal BMI increases the risk for GH by 94.4%, 88.8% and 10.2%, respectively. Obesity, ACR, PP and salt intake are risk factors for GH in apparently healthy Caucasians.

Conclusions:

There is no unique threshold value for GH, and age-gender - 95th cut off values should be used. CKD-Epi equations overestimate the prevalence of GH compared to de-indexed and Cockcroft-Gault equations. Differences in GH prevalence among BP categories were observed only without indexation for 1.73.
NO DIFFERENCE IN RENIN BETWEEN NORMOTENSIVE AND HYPERTENSIVE PATIENTS WITH RENAL FIBROMUSCULAR DYSPLASIA
Authors: Kroon Abraham A , Schutten Monica Tj , Zelis Piet , Houben Alphons Jhm , De Leeuw Peter W
Published: May 2024

Objective:

Fibromuscular dysplasia (FMD) of the renal arteries is considered to be a cause of renovascular hypertension. However, a substantial portion of patients with renal FMD remains normotensive. We hypothesized that hypertensive patients with renal FMD secrete more renin than their normotensive counterparts.

Design and method:

In patients scheduled for renal angiography, we simultaneously collected blood samples for renin determination from the renal artery (A) and renal vein (V) of both kidneys. Renin was measured by a direct immunoradiometric assay. In each patient, we calculated the arterial-venous concentration increment in renin as (V-A)/A for both kidneys separately. In addition, we determined renin secretion rate as (V-A) times flow in those patients in whom we could measure renal blood flow by the xenon-washout technique.

Results:

A total of 132 FMD patients were studied of whom 62 (47%) were normotensive. There were no differences between the two groups in age (on average 54 years in both) and in the proportion of females (91%). Most patients had experienced a spontaneous coronary artery dissection earlier.

Arterial renin levels were 24.4+6.3 mIU/L in the normotensive group and 27.2+5.1 mIU/L in the hypertensive group (difference not significant). Likewise, no differences in renal venous renin from either kidney were apparent between the groups. The renin concentration increments across the kidney varied from 13 to 64% but again without a difference between normotensives (13-62%) and hypertensives (15-64%). Finally, in the 53 patients in whom renal blood flow was measured, no difference in renin secretion rate between normotensives and hypertensives was found.

Conclusions:

Although blood pressure may vary substantially between patients with renal FMD, there is no difference in renin release between the normotensive and the hypertensive ones. Thus, other factors besides renin must contribute to the development of high blood pressure in such patients.
HYPERTENSIVE NEPHROPATHY: TRANSCRIPTOMICS OF KIDNEY BIOPSIES PREDICTS LONG TERM OUTCOME AND IDENTIFIES THERAPEUTIC TARGETS
Authors: Chen Tony , Furriol Jessica , Landolt Lea Zoe , Hallan Stein Ivar , Øvrehus Marius Altern , Knoop Thomas , Scherer Andreas , Eikrem Øystein , Marti Hans -PETER
Published: May 2024

Objective:

Hypertensive nephropathy (HN) represents a major cause of chronic kidney disease, but it is incompletely understood why some patients show disease progression. Our project aim is to identify potential markers of disease progression and novel therapeutic targets.

Design and method:

Adult patients (n=43; n=16 females, mean age 53 years) with biopsy-verified HN were categorized as ’early’ (estimated glomerular filtration rate (eGFR) >45 ml/min/1.73m2) or ’late’ disease (eGFR <45 ml/min/1.73m2) at the time of biopsy. Patients were further divided into “stable” (eGFR decline <3 ml/min/year) or “progressive” (eGFR decline >3 ml/min/year or start of renal replacement therapy) after median follow-up of 10 years (5-22). TruSeq Exome sequencing was executed after RNA extraction (miRNeasy FFPE kit, Qiagen) at Novogene, Cambridge, UK. Quality control and data analysis was performed using R Studio (v4.2.0) and QIAGEN Ingenuity Pathway Analysis.

Results:

We analyzed the following subgroups of HN patients: early stable (ES, n=11), early progressive (EP, n=11), late stable (LS, n=9) and late progressive (LP, n=12). Differentially expressed genes (DEG, fold change (FC) >1.5 and p-value < 0.05) were identified, with n=265 in ES vs. EP, and n=674 in LS vs. LP.

Principal component analysis (PCA) showed separation of ES vs. EP and LS vs. LP, as depicted in Figure 1A and B. K-nearest neighbour (KNN) analysis of DEG identified a 6-gene classifier in LS vs. LP (19/21 samples correctly classified), while IER5L and CNTNAP5 were the top 2-gene classifier in ES vs. EP (20/21 samples). These classifiers, as well as other DEGs such as PER1, YB1, TIMP3, ADAMTS4, IGFBP5 and EGF could represent novel targets to inhibit disease progression.

Differentially regulated pathways were associated with regulation of TP53 activity and circadian rhythm involving melatonin metabolism in ES vs. EP, and metabolic processes related to water-soluble vitamins, glutathione and sphingolipids in LS vs. LP.

Conclusions:

Transcriptomic profiling from diagnostic kidney biopsies with HN can distinguish future disease progression from non-progression and may identify novel therapeutic targets.
HIGHER 24-HOUR URINE SODIUM-TO-POTASSIUM RATIO IS ASSOCIATED WITH WORSE RENAL OUTCOME, INDEPENDENT OF HYPERTENSION
Authors: Zwager Charlotte , Vliet Myrthe Van , Slagmolen Famke , Kwok Kevin , Vogt Liffert , Engberink Rik Olde
Published: May 2024

Objective:

Low sodium and high potassium intake are advised to control blood pressure and may improve long term cardiorenal outcomes. The optimal potassium intake for patients with chronic kidney disease remains to be defined. We investigated whether the 24-hour urine sodium-to-potassium ratio (Na/K-ratio), which incorporates estimates of both sodium and potassium intake, could predict long-term renal outcome.

Design and method:

We selected adult outpatients of a Dutch tertiary hospital who collected at least one 24-hour urine collection with available sodium and potassium measurements between 1998-2023. Patients with a history of dialysis or kidney transplantation were excluded. We examined the need for persistent renal replacement therapy (RRT), defined as dialysis or kidney transplantation, using Cox regression. The association between the 24-hour urine Na/K-ratio and the estimated glomerular filtration rate (eGFR) slope was assessed using linear regression in patients who had >2 eGFR measurements available in >2 years. The linear regression analysis was adjusted for age, sex, baseline eGFR, diabetes mellitus and hypertension. In the Cox regression analysis, we additionally adjusted for the interaction between the 24-hour urine Na/K-ratio and baseline eGFR. Hypertension was defined as a clinical diagnosis or an office blood pressure >139/89 mmHg.

Results:

We included 720 patients aged 50±15 years, of whom 52% were male, 58% had hypertension and 31% diabetes mellitus. The baseline eGFR was 64±34 ml/min/1.73m2. The 24-hour urine Na/K ratio was 2.5±1.2 in a median number of 1 (IQR=1-2) urine collection. During a median follow-up of 11.2 (14.0) years, 29% of patients needed RRT. In 575 patients with sufficient eGFR measurements (mean 12±8 measurements per subject) the median annual eGFR decline was 1.51(IQR=0.49-3.98) ml/min/1.73m2.

Every unit increase in the 24-hour urine Na/K-ratio was associated with a 19% higher risk for persistent RRT need (HR 1.19, 95% CI 1.03-1.39; p=0.02) and an additional 0.44 ml/min/1.73m2 (95% CI -0.83, -0.04; p=0.03) decline in eGFR.

Conclusions:

This study suggests that higher 24-hour urine Na/K-ratio is associated with faster kidney function decline and the need for RRT, independent of hypertension, in a selected group of outpatients.
INFLUENCE OF MULTIPLE RISK FACTOR CONTROL LEVEL ON CARDIOVASCULAR OUTCOMES IN HYPERTENSIVE PATIENTS
Authors: Zhuang Miaomiao , Peng Xinyi , Cai Jun
Published: May 2024

Objective:

The relationship between level of baseline risk factor control and cardiovascular outcomes in hypertensive patients with blood pressure intervention is not well understood.

It is unclear whether the level of baseline risk factor control is persuasively associated with cardiovascular outcomes in hypertensive patients with blood pressure lowering strategy.

Design and method:

We performed a post hoc analysis of the Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients (STEP) trial. 8337 participants with complete demographics and clinical data were involved in the analysis and analyzed for seven risk factors (BMI, low-density lipoprotein cholesterol, fast blood glucose, smoking, alcohol consumption, physical activity, and renal function). The primary outcome was a composite of cardiovascular events and death from any causes. Cox proportional hazards models were used to calculate hazard ratio and estimate association between risk factor control and cardiovascular outcomes.

Results:

A total of 8337 participants were involved in the analysis and the mean follow-up period of 3.19±0.66 years. Patients were categorized according to numbers of risk factors control: more than(or including) 6 risk factor control, 4 risk factor control, 5 risk factor control, and less than(or including) 3 risk factor control. Adjusted hazard ratio for patients in group with most risk factor control were1.95 (95% confidence interval [CI]: 1.37-2.77) compared with controls. In this analysis, protective effects of multiple risk factor control were not modified by systolic blood pressure (SBP) intervention (P for interaction=0.71).

Conclusions:

A stepwise association was observed between decreasing number of risk factor control and increasing risk of cardiovascular outcomes and all-cause mortality in hypertensive patients. Comprehensive risk factor control strategies are needed to reduce the risk of cardiovascular diseases and mortality.
WORLD HYPERTENSION DAY 2023 – THE PRO-HEALTH CAMPAIGN IN BIALYSTOK, POLAND
Authors: Piotrowska Weronika , Gawryluk Mateusz , Zbroch Aleksandra , Bazarewicz Jakub , Anikie Katarzyna , Malinowska Dominika , Skorulska Iwona , Siwik Marcin , Panas Zuzanna , Szczerbinska Natalia , Zdanska Adrianna , Wilk-sledziewska Katarzyna , Zbroch Edyta
Published: May 2024

Objective:

The study was based on a pro-health campaign of World Hypertension Day 2023.

The aim of the study was to evaluate the incidental blood pressure (BP), heart rate (HR), glycemia and electrocardiography (EKG) among residents of Bialystok, Poland and the surrounding region.

Design and method:

192 random participants were included (53.3% female). Each person completed a survey consisting of weight, height, age, education status, place of residence, smoking, physical activity, diagnosed cardiovascular disease and diabetes. BP, HR, glycemia and ECG were assessed by the medical team.

Data were analyzed by dividing by sex, age above 65 years or below, BP above 140/90 mmHg, body mass index (BMI) above 30, glycemia above 120 mg/dl and comorbidities.

Results:

Average systolic blood pressure (SBP) was 135.7 mmHg, diastolic blood pressure (DBP): 79.9 mmHg, HR: 76/min, glycemia: 99.3 mg/dl, BMI: 26.7. 85% of participants resided city. 30% were higher educated. 33.3% performed no physical activity.

Men had significantly higher SBP and DBP than women. Participants with BP above 140/90 mmHg presented significantly elevated BMI and HR. 63% of them were diagnosed with hypertension, and ECG abnormalities were 1.6 times more common here.

In the age above 65years vs. lower then 65 years group, SBP was not significantly different while DBP was lower (77.5 vs 83.1 mmHg, p-0.002). Diabetics had higher BMI and SBP compared to non-diabetics.

Participants diagnosed with hypertension had higher BMI, SBP and DBP.

BMI above 30 was not associated with higher BP or HR. No significant differences in BP and HR were found between smokers vs nonsmokers, physically active vs non-active, or according to place of residence. The awareness of prevention of hypertension was not satisfactory in all studied group.

Conclusions:

BP values of Bialystok's, Poland female residences were in satisfactory ranges while male had it in-creased, specially SBP. BP above 140/90 mmHg was related to higher BMI and HR as well as to abnormalities in ECG. Surprisingly, persons with diagnosed hypertension or diabetes had worse BP values.

There is a sustained need to increase a general awareness of hypertension prevention and a healthy lifestyle.
RENAL POTASSIUM EXCRETION IS NOT A FIXED PERCENTAGE OF INTAKE
Authors: Vliet Myrthe Van , Rauh Manfred , Vogt Liffert , Titze Jens , Engberink Rik Olde
Published: May 2024

Objective:

Because of its blood pressure lowering effects, high potassium intake could help to reduce cardiovascular events. As a significant amount of potassium is lost via stool, the World Health Organization advices to multiply 24-hour renal potassium excretion by 1.3 for estimation of dietary intake. We analyzed whether this 1.3 factor varies over time in healthy volunteers and tested whether factors associated with tissue cation storage, namely sodium intake, aldosterone, cortisol and urine volume, affect the renal potassium excretion.

Design and method:

We performed a post-hoc analysis of the Mars sodium balance studies in which ten healthy male participants consumed a fixed salt (6, 9 and 12 grams/day for periods >29 days) and potassium intake (4 grams/day) for 105 (n=4) and 205 days (n=6). For the entire study period, all urine was collected in 24-hour aliquots. We calculated the percentage of potassium intake that was excreted in the corresponding 24-hour urine collection during steady-state. Using a multivariable mixed-effects model, we assessed whether this percentage was associated with sodium intake, potassium intake, urinary aldosterone, urinary cortisol and urine volume.

Results:

Overall, the median renal potassium excretion was 80% of potassium intake, but percentages ranged from 24% to 304%. Within participants the interquartile range of renal potassium excretion was 25% and between participants 21%. Increased sodium intake was associated with a higher percentage of renal potassium excretion (P<0.05), whereas increased potassium intake was associated with a lower percentage of renal potassium excretion (P<0.001). There was a significant positive interaction between the effects of sodium and potassium intake (P<0.001; figure A). Additionally, urinary aldosterone (figure B), urinary cortisol (figure C) and urine volume (figure D) were associated with a higher percentage of renal potassium excretion (P<0.001).

Conclusions:

The percentage of ingested potassium that is excreted in urine varies considerably within and among subjects. Sodium intake, potassium intake, urinary aldosterone and cortisol levels, and urine volume independently affect the fraction of the ingested potassium that is excreted by the kidneys during steady-state. Our results suggest that the WHO's standard 1.3 conversion factor may lead to inaccurate estimation of potassium intake.