bluuebunny/crossref_metadata_2025 huggingface dataset:
A META-ANALYSIS ASSESSING THE EFFECT OF SODIUM-GLUCOSE CO-TRANSPORTER-2 INHIBITORS ON SURROGATE ENDPOINTS IN PATIENTS WITH HEART FAILURE WITH REDUCED EJECTION FRACTION
Authors: Patoulias Dimitrios , Katsimardou Alexandra , Stavropoulos Konstantinos , Imprialos Konstantinos , Toumpourleka Maria , Kalogirou Maria -Styliani , Koutsampasopoulos Konstantinos , Tegou Zoi , Mavridou Maria , Siskos Fotios , Papadopoulos Christodoulos , Doumas Michael
Published: April 2021

Objective:

Heart failure (HF) is a main contributor of cardiovascular morbidity and mortality among patients with type 2 diabetes mellitus (T2DM), while T2DM among patients with HF with reduced ejection fraction (HFrEF) represents an independent risk factor for 1-year all-cause mortality and HF re-admission.

Design and method:

For this meta-analysis, we identified the hallmark cardiovascular outcome trials (CVOTs) and we searched the two major electronic databases, PubMed and Cochrane Central Register of Controlled Trials (CENTRAL), for sub-analyses of these trials according to HF status of enrolled participants at baseline.

Results:

Besides the dedicated HFrEF trials (DAPA-HF and EMPEROR-Reduced), only researchers of the DECLARE-TIMI 58 trial provided data regarding the effect of dapagliflozin on “hard” outcomes in patients with HFrEF. Therefore, we pooled data in a total of 9,145 patients with HFrEF. SGLT-2 inhibitor treatment resulted in a significant decrease in the odds for HF hospitalization compared to placebo, equal to 31% [OR = 0.69, 95% confidence interval (CI); 0.61 to 0.78, I2 = 0%]. In addition, SGLT-2 inhibitor treatment decreased the odds for cardiovascular death by 18% (OR = 0.82, 95% CI; 0.68 to 0.99, I2 = 40%). Odds for the composite outcome of cardiovascular death or HF hospitalization was significantly decreased by 28% with SGLT-2 inhibitor treatment (OR = 0.72, 95% CI; 0.65 to 0.80, I2 = 0%). Finally, SGLT-2 inhibitor treatment resulted in marginally non-significant decrease in the odds for all-cause death by 17% (OR = 0.83, 95% CI; 0.68 to 1.00, I2 = 53%).

Conclusions:

SGLT-2 inhibitor treatment provides substantial cardiovascular benefits in patients with HFrEF, decreasing the odds for HF hospitalization and cardiovascular death, while it might reduce the odds for all-cause death, compared to placebo.
THE USE OF ARTIFICIAL INTELLIGENCE TO CAPTURE READINGS ON TRADITIONAL BLOOD PRESSURE DEVICES. A SHOWCASE FROM OFFLINE READINGS TO ONLINE HEALTH MANAGEMENT
Authors: Tsoi Kelvin , Chu Christopher , Yiu Karen , Chow Yuk , Ip Kc
Published: April 2021

Objective:

Cloud-based blood pressure (BP) monitoring devices can improve the data accuracy for better health management. However, it may not be affordable for those from low income families. Image processing with artificial intelligence on the screen image of BP devices is almost at no cost to save data on the cloud. The aim of this study is to investigate the accuracy of image recognition with deep learning techniques.

Design and method:

A total of 1,000 screen capture images on different BP devices were collected from a group of healthy subjects who regularly marked their BP levels on excel files. Data augmentation technique was used to manipulate a set of 20,000 screen capture images, where noise of image was introduced, such as lighting and contrast adjustment, shift of numerical readings. Deep learning algorithm with ResNet-50 architecture was used to detect numerical readings on the devices on 15,000 images (75%), and the prediction accuracy was verified by another 5,000 images (25%). Clustering algorithm for grouping the numbers into meaningful data, including the readings for systolic and diastolic blood pressure. Each number was estimated with a probability function, and the one with highest probability value was selected. True positive (TP) and false positive (FP) were used to derive the testing precision, i.e. TP/(TP+FP), on the correctness of image recognition.

Results:

A raw image of a screen capture on a BP device was used to demonstrate the performance of deep learning algorithm for image recognition (Figure 1). All numbers were automatically identified in each green box where showed a probability function for the prediction accuracy. Final readings were captured and combined according the numbers with highest accuracy (Table 1). In the validation set of 5,000 images, testing precision was 98.5%.

Conclusions:

The use of artificial intelligence to capture readings on traditional blood pressure devices is a feasible option for those who cannot afford a new cloud-based BP machine. Subjects with detailed BP records on the cloud can, in fact, help physician to make better diagnosis on hypertension.
COMPARISON OF STATISTICAL AND MACHINE LEARNING APPROACHES IN A SURVEY FROM THE EPIDEMIOLOGY OF NON-COMMUNICABLE DISEASES
Authors: Vladimir Kutsenko , Pereverdieva Ksenia , Balanova Yulia , Imaeva Asiia , Shalnova Svetlana , Yarovaya Elena
Published: April 2021

Objective:

To determine if the disuse of basic machine learning approaches may cause a significant loss of predictive power in the epidemiology study.

Design and method:

A cross-sectional study «Epidemiology of Cardiovascular Diseases in the Russian federation (ESSE-RF)» was performed in 13 regions in 2012–2013. ESSE-RF included randomly selected 21768 participants aged 25–64 with a response rate > 80 %. Standard epidemiology methods and criteria were used. The current sub-study included 13912 participants. We chose lasso regression (L1Regression) and random forest (RF) as basic machine learning methods and logistic regression (LogRegression) as a basic statistical method. We compared these algorithms on predicting arterial hypertension (AH) from 18 clinical, demographic, and social risk factors from international AH guidelines. We fitted the models on the training sample and assessed their quality on the holdout sample with an AUC metric. We used 1000 random train-holdout splits to exclude randomness. We studied the RF feature impacts with model-agnostic techniques: partial dependence plots (PDPs), feature importances, and feature interaction measures. Statistical analysis was performed using R 3.6.1.

Results:

LogRegression had better performance (82.11 ± 0.42) than L1Regression (81.90 ± 0.40) and RF (81.60 ± 0.43) respectively. Nine out of the top ten important variables in LogRegression were in the top ten important variables of RF, and vice versa. However, RF feature importance was more compatible with the risk guidelines than the LogRegression one (fig. 1A). In particular, LDL and HDL levels were insignificant in the LogRegression but significant in the RF. PDPs of RF were strictly monotonous and close to linear (fig. 1B). There were no features with an interaction measure greater than 35 % except for age. Using the previous analysis information, we constructed new interpretable features, which improved the AUC of basic LogRegression by 0.21.

Conclusions:

Data from the ESSE-RF study is homogeneous. Associations between features and AH are approximately linear and non-interactive. Therefore, it is correct to adhere to the basic interpretable statistical algorithms. However, machine learning methods can provide additional information that can improve understanding of risk factors influence.
QUANTIFICATION OF CARDIAC KINETIC ENERGY AND ITS CHANGES DURING TRANSMURAL MYOCARDIAL INFARCTION ASSESSED BY MULTI-DIMENSIONAL SEISMOCARDIOGRAPHY
Authors: Morra Sofia , Pitisci Lorenzo , Su Fuhong , Hossein Amin , Rabineau Jérémy , Racape Judith , Gorlier Damien , Migeotte Pierre -François , Creteur Jacques , Van De Borne Philippe
Published: April 2021

Objective:

Seismocardiography (SCG) records cardiac and blood-induced motion transmitted to the chest surface as vibratory phenomena. Evidences demonstrate that acute myocardial ischemia (AMI) profoundly affects the SCG signals. Multidimensional SCG records cardiac vibrations in linear and rotational dimensions and scalar parameter of kinetic energies can be computed. We speculate that AMI and revascularization profoundly modify cardiac kinetic energy as recorded by SCG.

Design and method:

Under general anesthesia, 21 swines underwent 90 minutes myocardial ischemia induced by percutaneous subocclusion of proximal left anterior descending (LAD) coronary artery and subsequent revascularization. Invasive hemodynamic parameters were continuously recorded. SCG was recorded during the baseline (BSL); immediately and 80 min after LAD subocclusion (AMI t0; AMIt80, respectively); immediately and 60 min after LAD reperfusion (RE t0, RE t80, respectively). iK was automatically computed for each cardiac cycle (iK_CC) in linear (iK_Lin) and rotational (iK_Rot) dimensions. iK was calculated during systole and diastole (iK_Sys and (iK_Dia, respectively).

Results:

Compared to baseline, troponins increased from 13.0 [6.5; 21.3] ng/dL to 170.5 [102.5; 475.0] ng/dL and LVEF dropped from 65.0 ± 0.0% to 30.6 ± 5.7% at the end of revascularization (both p < 0.0001).

In the linear dimension, iK_Lin-CC, iK_Lin-Sys, iK_Lin-Dia dropped by 43%, 52%, 53% respectively (p < 0.0001, p < 0.0001, p = 0.03, respectively) from baseline to the end of reperfusion. In the rotational dimension, iK_Rot-CC and iK_Rot-Sys dropped by 30% and 36% respectively (p = 0.0006, p < 0.0001), but iK_Rot-Dia did not change (p = 0.41).

The figure below represents the evolution of waveforms of iK computed from the SCG signals during the experimental procedure, specifically during BSL, AMIt0, AMIt80, REt0, REt60. Linear (B) and rotational (C) iK drop at AMIt0 compared to BSL, remain below baseline values during the all duration of AMI and returns to normal level during reperfusion.

The hemodynamic parameters, except the pulmonary artery pulse pressure, were significantly correlated with parameters of iK.

Conclusions:

Multidimensional SCG can detect changes in myocardial contractility during experimental AMI, providing information on the cardiac contractile status expressed in term of iK.

This automatic system may empower health care providers and patients to remotely monitor cardiovascular status in the near future.
CONTRIBUTION OF ARTIFICIAL INTELLIGENCE TO THE DECISION-MAKING PROCESS WHEN PERFORMING A HOME BLOOD PRESSURE MONITORING
Authors: Asmar Roland , De Buyer Paul , Boualit Robert , Girerd Xavier
Published: April 2021

Objective:

Analyze home blood pressure monitoring data with the help of algorithms used in artificial intelligence and compare this method to traditional statistical analysis to categorize a subject with respect to its blood pressure status.

Design and method:

From an anonymized database of self-measurements performed in hypertensive patients followed in a hypertensive specialist center, artificial intelligence algorithms were used (logistic regression, gradient boosting tree, neural network) and compared with usual statistical methods. The self-measurement protocol consisted of 6 sequences over 3 days with 3 measurements per sequence, and 2 sequences per day. The mean of the 18 measures was used as a baseline to categorize the decision-making process with the thresholds SBP > = 135 or DBP>= 85 to define hypertension status.

Results:

The data base included 3910 HBPM which generated over 110,000 values to enter the analysis model. The figure shows that the AI allows to confirm or deny ‘hypertension’ in 46% of the subjects, as soon as sequence 2 is performed and that 82% of the subjects have a definite diagnosis after 4 sequences. In addition, AI is systematically more efficient than the statistical method whose performance, at 70% of patients with a definite diagnosis, remains at a plateau after sequence 4.

Conclusions:

Artificial intelligence algorithms are more efficient than conventional statistical methods to categorize the blood pressure status of a subject after only 2 sequences of a Home Blood Pressure Monitoring. From this hospital database it appears that 4 sequences performed over 2 days are sufficient to confirm or deny the diagnosis of hypertension in more than 80% of subjects.
ARTIFICIAL INTELLIGENCE FOR HYPERTENSION MANAGEMENT: A SYSTEMATIC REVIEW OF MEDICAL AND ENGINEERING LITERATURES
Authors: Tsoi K. , Lee H. W. Y. , Yiu K. K. L. , Leung C. L. T. , Wong S. Y. S.
Published: April 2021

Objective:

The present study aims to review and clarify the current evidence on AI applications for hypertension management from medical and engineering perspectives.

Methods:

A literature search was conducted on major electronic databases: Embase, MEDLINE, CINAHL with keywords ‘artificial intelligence’, ‘hypertension’, and ‘blood pressure’. The quality of included studies was assessed with PROBAST tool. Included studies were categorised into (i) software and hardware development, (ii) disease prediction, and (iii) treatment recommendation. Results of individual studies were summarized for comparison.

Design and method:

A total of 92 articles were included for study, with more than half originated in Asia. Most studies involved blood pressure (BP) measurement with studies in engineering journals concerning the development of hardware and software, whereas medical researchers largely focused on the clinical use of these AI solutions. Electronic signals are the mainstay of BP measurement, although attempts were also made to extract useful information from health records. About a third of the studies were devoted to the identification of, and predicting the incidence and outcomes of hypertension using AI. In particular, studies that aimed to identify hypertension based on electronic signals achieved an AUC between 0.7 and 0.9, very similar to those concerning the incidence and prognosis of hypertension, despite different types of data and algorithms used. Studies on BP profiling and treatment with AI remained scant yet insightful.

Conclusion:

While a number of novel solutions have been invented for BP measurement and management, closer interdisciplinary collaboration between clinicians and engineers should further be encouraged to streamline BP profiling and treatment, personalised treatments with the aid of AI for example.
AMBULATORY BLOOD PRESSURE IN RELATION TO PLASMA AND URINARY MANGANESE
Authors: Zhang Zhen-Yu , Carmeli Cristian , Ponte Belen , Pruijm Menno , Ackermann Daniel , Ehret Georg , Guessous Idris , Petrovic Dusan , Pechère-Bertsc Antoinette , Vogt Bruno , Martin Pierre -Yves , Burnier Michel , Lenglet Sébastien , Augsburger Marc , Thomas Aurelien , Bochud Murielle
Published: April 2021

Objective:

The association of blood pressure (BP) with manganese, an essential trace element required for human health, remains poorly studied.

Design and method:

In 734 randomly recruited Swiss participants (mean age, 47.5 years; 51.4% women), we related ambulatory BP to two biomarkers, plasma manganese (pMn) and the urinary manganese excretion (uMn). To allow for diurnal variation, we assessed BP and uMn over 24 h and during wakefulness and sleep, using split urine samples.

Results:

24 h, day- and night-time systolic/diastolic BPs averaged 119.8/78.1, 123.8/81.2 and 107.0/68.3 mm Hg; the corresponding medians uMn were 199.5, 83.0, 51.5 umol and median pMn 0.52 ug/L. In analyses dichotomized by the median of the biomarkers, greater pMn was associated with higher 24 h systolic/diastolic BP (+4.1/+ 2.3 mm Hg; P<= 0.0003), greater daytime uMn with lower daytime BP (3.5/ 1.9 mm Hg; P<= 0.0067) and greater nighttime uMn with higher nighttime BP (+2.9/+ 1.2 mm Hg; P<= 0.046). In multivariable-adjusted analyses, significance (P<= 0.030) was retained for the positive association of 24 h and daytime diastolic BP with pMn and for systolic BP in relation to uMn at night. The association sizes for a twofold increment in the biomarkers amounting to 0.77 mm Hg (95% confidence interval [CI], 0.08–1.47 mm Hg), 0.97 (CI, 0.20–1.76) and 1.33 (CI, 0.20–2.50 mm Hg), respectively.

Conclusions:

In conclusion, there were positive associations between diastolic BP and pMn over 24 h and during daytime and between systolic BP and uMn at night.
THE PROLACTIN MAY BE A SENSITIVE MARKER FOR MENOPAUSAL HYPERTENSIVE WOMEN WITH LEFT VENTRICULAR HYPERTROPHY
Authors: Wang Hongxing , Yu Jing
Published: April 2021

Objective:

This study aimed to explore the relationship between the level of prolactin (PRL) and left ventricular hypertrophy (LVH) in postmenopausal women with hypertension.

Design and method:

A total of 128 menopausal women with hypertension were divided into hypertension with LVH group (n = 63, group 1) and hypertension without LVH group (n = 65, group 2). Selected healthy people matched the age, menopausal time with group 1 and group 2 as a control group (n = 57, group 3). Blood pressure, blood biochemistry, sexual hormones, including PRL were measured in these three groups. At the same time, echocardiography recorded the parameters including left atrial diameter (LAD), left ventricular end diastolic diameter (LVEDd), interventricular septal thickness (IVST), left ventricular posterior wall thickness (LVPWT), left ventricular ejection fraction (LVEF), and early diastolic mitral flow velocity (E) and systolic mitral flow velocity (A) ratio (E /A). central artery blood pressure and cervical -femoral pulse wave velocity (cf-PWV) were also measured. A statistical analysis was performed to compare the differences in these parameters among the three groups.

Results:

There was no significant difference in age and menopausal time among this three groups (P > 0.05). The body mass index (BMI) in the hypertension with LVH group was significantly higher than that of hypertension without LVH group (P < 0.05). There was no significant difference in estradiol, testosterone and progesterone among three groups (P > 0.05), but the PRL in the hypertension with LVH group was lower significantly than those of without LVH group (P < 0.05). In hypertension with LVH group, there were significantly higher in LAD, IVST and LVPWT compare with hypertension without LVH group. The cf-PWV in hypertension with LVH group were significantly higher than that of hypertension without LVH (P < 0.05). It was shown that the degree of decline in PRL was positively correlated with LVH in menopausal hypertensive women (P < 0.05).

Conclusions:

After menopause, the decline in PRL may be a more sensitive marker rather than other sexual hormones for menopausal hypertensive women with LVH.
INFLAMMATORY BIOMARKERS AND OBESITY IN RESISTANT HYPERTENSION
Authors: Vallaperde João Gabriel , Alves Hugo Farrah Afonso , Santo Bruno Dussoni Moreira Dos , Silva Joao Gabriel Bezerra Da , Gonçalves Larissa De Oliveira , Kimura Lucca Hiroshi De Sá , Nolasco Vitor De Melo , Carvalho Fernanda Oliveira De , Cortez Arthur Fernandes , Chedier Bernardo , Muxfeldt Elizabeth
Published: April 2021

Objective:

To evaluate the relationship between inflammatory biomarkers and obesity in a large cohort of patients with resistant hypertension (RHT).

Design and method:

This cross-sectional study evaluated 423 subjects with RHT (30.5% male; 63.9 ± 10.8 years old), 215 (50,8%) of whom are obese. In all subjects the inflammatory biomarkers, TNF-alfa, MCP-1, E-Selectin and PAI-1, were dosed. Socio-demographic characteristics, anthropometric measurements and cardiovascular risk factors were recorded. Variance analysis compared the serum levels of 4 biomarkers inflammatory and the bivariate analysis compared resistant hypertensives with and without obesity.

Results:

Obese subjects are younger, with a higher prevalence of peripheral obstructive arterial disease. No difference was found concerning to the blood pressure, neither to subclinical lesions. The values of PAI-1 (123 [107–164] vs 113 [89–138] and E-Selectin (53.2 [34.2–68.6] vs 44.6 [20.8–62.0] were significantly higher in patients with obesity. The other biomarkers evaluated did not evidence association with obesity.

Conclusions:

Among the inflammatory biomarkers evaluated, which was most strongly correlated with obesity was PAI-1 and E-Selectin. According to literature PAI-1 is tightly linked to metabolic disorders, such as insulin resistance and central obesity, while E-Selectin has an important role on atherosclerosis's development.
RED BLOOD CELL DISTRIBUTION IS INDEPENDENTLY ASSOCIATED WITH DAILY DIASTOLIC BP VARIABILITY
Authors: Torbas Olena , Kushnir Svitlana , Rekovets Oksana , Sirenko Yuriy
Published: April 2021

Objective:

Previously it was shown that in a large cohort of unselected outpatients there was a strong independent association between elevated red blood cell distribution width (RDW) and increased incidence of cardiovascular events which may be associated with inflammation. The aim of our analysis was to evaluate whether RDW was independently associated with any of proven cardiovascular diagnostic markers.

Design and method:

We included 171 patients with arterial hypertension who had underwent all diagnostic procedures: office BP measurement, ambulatory BP monitoring (ABPM), carotid-femoral pulse wave velocity (cfPWV), cardio-ankle vascular index (CAVI), haematology test with RDW, vascular ultrasound and echocardiography. The results of Spearman correlation was after that tested in a multivariant regression model.

Results:

Results. Mean age of our patients was 52,9 ± 1,1 y/o, mean BP was 154,4 ± 2,4/93,3 ± 1,3 mmHg, mean hear rate (HR) 78,3 ± 1,3 bits per min, 37% men and 63% women, mean RDW was 14,8 ± 0,7%. Among all the parameters we have obtained, RDW was significantly inversely associated only with office systolic and diastolic BP (r = -0,189, p = 0,023 and r = -0,206, p = 0,013 respectively), daily diastolic BP (DBP) variability (r = -0,270, p = 0,02) and daily HR variability (r = -0,314, p = 0,027). Moreover, the association RDW with DBP variability remained significant even after the adjustment for office DBP, hemoglobin and erythrocytes level (beta = -0,587, p = 0,022), but correlation of RDW with HR variability after the adjustment for office HR and hemoglobin was not significant (beta = -0,437, p = 0,116) which underlines that HR variability is more associated with blood hemoglobin level. Also we did not find any significant correlations of RDW with any of arterial stiffness, vessel wall thickness, echocardiographic left ventricle mass index and other parameters.

Conclusions:

A significant correlation of RDW with office systolic and diastolic BP, but more an independent correlation of RDW with DBP variability may demonstrate is role as a potential interesting biomarker which may be used in future studies.
ARTERIAL HYPERTENSION IN POSTMENOPAUSAL WOMEN WITH ABDOMINAL OBESITY: ROLE OF INFLAMMATORY RESPONSE MARKERS, LEPTIN AND SEX HORMONES IN PATHOGENESIS OF VASCULAR WALL STIFFNESS
Authors: Petelina Tatiana , Avdeeva Ksenia , Gapon Lyudmila , Musikhina Natalia , Suplotov Sergey , Zyeva Ekaterina , Gorbatenko Elena
Published: April 2021

Objective:

Arterial hypertension (AH) with abdominal obesity, especially during postmenopause, remains one of the most serious medical and social problems. The objective was to study features of AH in postmenopausal women with abdominal obesity and to assess the role of markers of inflammatory response, leptin and female sex hormones in the pathogenesis of vascular wall stiffness.

Design and method:

The study included 164 patients randomized into 3 groups. Group 1 (control) consisted of 42 healthy women aged 44.43 ± 14.26 years, group 2 - 62 women aged 60.69 ± 7.09 years with AH and group 3 included 60 women aged 57.24 ± 7.4 years with AH and abdominal obesity. Parameters of 24-hour ambulatory blood pressure monitoring; sphygmography - pulse-wave velocity (PWV); lipid profile parameters, inflammatory markers (high-sensitivity C-reactive protein, TNF-alpha, homocysteine, interleukin-1 beta, -6, -8); endothelial dysfunction markers (endothelin-1, nitrites) and hormonal profile (sex hormone levels, cortisol and testosterone), leptin were measured.

Results:

Analysis results revealed that systolic and diastolic blood pressure indices were significantly higher in group 3 in comparison with group 2. An excess of the variability of systolic blood pressure at night was recorded in group 2 and 3 (p < 0.017). Higher PWV values were registered in group 2. Lower levels of sex hormones and significant increase in the level of inflammatory markers were found in groups 2 and 3 compared to the control group. We revealed multiple multidirectional correlations between the studied parameters. Logistic regression method detected the main biochemical markers that affect increase in stiffness of the vascular wall, such as leptin (odds ratio (OR): 1.021, 95% confidence interval (CI): 1.004–1.039, p = 0.018), high-sensitivity C-reactive protein (OR: 1.300; 95% CI 1.091–1.549, p = 0.003) and endothelin-1 (OR: 1.0242; 95% CI 1.042–1.794, p = 0.024). Rise of each marker by unit of measurement leads to increase in PWV by 2.1%; 1.3 times by 2.4%, respectively.

Conclusions:

Features of AH in postmenopausal women with abdominal obesity are systolic-diastolic AH with increase in variability of systolic blood pressure at night. The main markers determining the state of elastic properties of the vascular wall are leptin, high-sensitivity C-reactive protein and endothelin-1.
LINKS BETWEEN VITAMIN D, C REACTIVE PROTEIN, LDL, OXIDIZED LDL AND ECG VARIABLES IN HYPERTENSIVE PATIENTS
Authors: Mozos Ioana , Jianu Daniela
Published: April 2021

Objective:

The present paper aimed to assess the relationship of electrocardiographic variables with vitamin D, C reactive protein (CRP), LDL and oxidized LDL level, respectively, in hypertensive patients.

Design and method:

A total of 40 hypertensive patients underwent standard 12-lead ECG, which enabled measurement of P wave, PR and QT interval and QRS duration, as well as R wave in V5 and V6 and S wave in V1, V2. The following laboratory tests were performed: vitamin D (25-hydroxycholecalciferol: liquid chromatography method), CRP (immunophelometry), LDL (photometric method) and oxidized LDL (ELISA method).

Results:

QRS complex and heart rate corrected QT interval (QTc) duration were prolonged in 27.5% and 25%, respectively, of the patients. Vitamin D was less than 20 microg/l (D20) in 35% of the patients, and less than 30 microg/l (D30) in 77.5%. Significant correlations were found between vitamin D level and QRS duration (rS = −0.334, p = 0.035), QT (rS = 0.383, p = 0.015), QTc (rS = 0.366, p = 0.020), RV5 (rP = 0.682, p less than 0.001), RV6 (rP = 0.573, p less than 0.001), SV2 (rP = 0.356, p = 0.024). QRS duration correlated with CRP exceeding 0.300 mg/dl (rK = 0.423, p = 0.008). LDL level was significantly associated with a prolonged P wave duration (P120) (rP = −0.327, p = 0.039). No correlation was found between oxidized LDL level and ECG variables.

Conclusions:

Vitamin D level can provide valuable information about QRS duration, QT interval, R in V5 and V6 and S in V2, CRP about QRS duration, and LDL level about P wave duration. Vitamin D, CRP and LDL level may inform about ventricular arrhythmia and atrial fibrillation risk, respectively, in hypertensive patients.
LIPOCALIN-2 CORRELATES WITH ARTERIAL STIFFNESS IN OBESE PATIENTS
Authors: Aguayo Ana Karen Guzmán , Lista Francisco Javier Manzano , Herrera Miguel Ángel Rubio , Hernández Beatriz Somoza , Ortega Marta Gil , Rizo Valeria Díaz , Martín Elena Vega , Trujillo X , Nava Ji Gamez , Muñoz Eg Cardona , Alfonso Marisol Fernández
Published: April 2021

Objective:

Increased arterial stiffness, as reflected by an increased pulse wave velocity (PWV), is independently associated with a higher risk of cardiovascular morbidity and mortality in obese patients. Obesity is a low grade chronic inflammatory process due to the increase of visceral fat and adipokine overproduction. One of these adipokines, lipocalin-2, is an important biomarker in processes dealing with inflammation and oxidative stress. The hypothesis of this study is that arterial stiffness is increased in obesity, associated with the elevation of lipocalin-2 in plasma.

Design and method:

The association between lipocalin-2 and PWV was analyzed in 84 subjects (74 women and 10 men) with or without obesity. Subjects were classified according to the body mass index (BMI) in normal weight (18.5 - 24.9 kg/m2, n = 43) or obesity (> 30 kg/m2, n = 41). In addition, 55 morbid obese patients (grade IV) were studied before and one year after bariatric surgery (BS). Intrinsic arterial stiffness was analyzed in omental arteries dissected from omental adipose tissue from patients undergoing BS with a pressure myograph.

Results:

Lipocalin-2 levels were higher in the obesity group than in the normal weight group (85.6 ng/mL vs 66.29 ng/mL, p < 0.05). Lipocalin-2 levels correlated significantly with PWV, indicative of the presence of arterial stiffness. In morbid obese patients, elevated levels of lipocalin-2 were observed prior to surgery (113.1 ± 5.0 ng/mL) and significantly decreased after surgery (94.3 ± 6.2ng/mL). Mechanical studies performed in omental arteries from these patients evidenced a stiffness index B of 13.9 ± 2.5, as an index of intrinsic arterial stiffness.

Conclusions:

From these results we can conclude that lipocalin-2 levels correlate with the degree of obesity and, in turn, with intrinsic arterial stiffness and pulse wave velocity.
INFLAMMATORY MARKERS AND CHRONIC KIDNEY DISEASE
Authors: Alves Hugo Farah Affonso , Santo Bruno Dussoni Moreira Dos , Vallap João Gabriel Rega Do Nascimento , Silva João Gabriel Bezerra Da , Gonçalves Larissa De Oliveira , Kimura Lulcca Hiroshi De Sá , Nolasco Vitor De Melo , Carl Fernanda Oliveira De Carvalho , Cortez Arthur Fernandes , Chedier Bernardo , Muxfeldt Elizabeth
Published: April 2021

Objective:

Background: Resistant hypertension (RHT) defined as an uncontrolled blood pressure (BP) despite the use of 3 or more antihypertensives presents a high cardiovascular (CV) morbidity and mortality and high prevalence of chronic kidney disease (CKD). High BP levels and kidney injury appear to be strongly associated with inflammatory biomarkers.

Objective:

To evaluate the relationship between inflammatory markers and subclinical and established CKD in a large cohort of patients with RHT

Design and method:

Cross-sectional study that evaluated 423 resistant hypertensives (30.5% male, mean age 64.0 ± 10.8 years) submitted to renal function assessment (albuminuria dosage and evaluation of glomerular filtration rate calculated from the CKD-EPI formula) and dosage of inflammatory markers: TNF-alpha, MCP-1, E-selectin and PAI-1. Socio-demographic characteristics, anthropometric measurements and CV risk factors were recorded. We considered subclinical CKD those patients with moderately high albuminuria (30–300 mg/g) and/or GFR between 30 and 60 ml/min/1.73m2 and established CKD those who presented albuminuria > 300 mg/g and/or TFG < 30 ml/min/1.73m2. Variance analysis compared serum levels of the 4 inflammatory markers and bivariate analysis compared patients with and without subclinical and established chronic kidney disease.

Results:

The prevalence of established CKD was 7.3% (31 patients) and subclinical CKD was 47% (187 patients). Patients with subclinical CKD were older and with higher arterial stiffness (higher pulse wave velocity). TNF-alpha (7.1 [4.4–8.6] vs 51, [3.2–7.5]) and MCP-1(284 [220–379] vs 260 [185–359] were significant higher in this group of patients. When we analyzed patients with established CKD, we observed that they have higher BP levels and that TNF-alpha values (7.8 [5.6–14.0] vs 5.6 [3.5–8.3]) and E-selectin (54.4[41.2–61.3] vs. 47.8 [32.0–65.3]) were significantly higher in this group.

Conclusions:

Among the inflammatory markers evaluated, which was most strongly correlated with subclinical CKD were TNF-alpha and MCP-1, while those with established CKD have higher TNF-alpha and E-selectin levels, possibly pointing out that the MCP-1 is an earlier marker of kidney injury.
PLASMA N-GLYCOME AS INCIDENCE HYPERTENSION PREDICTOR
Authors: Cvetko Ana , Kifer Domagoj , Deris Helena , Cindric Ana , Spector Tim D. , Padmanabhan Sandosh , Lauc Gordan , Menni Cristina
Published: April 2021

Objective:

N-glycosylation, one of the most complex co- and post-translational modifications, is a highly regulated process influenced by many diseases. There is evidence that N-glycosylation could be a marker of hypertension. The aim of this study was to determine if plasma N-glycome is predictor of incident hypertension (HTN).

Design and method:

We selected 271 unrelated cases with incident hypertension and 271 controls matched for age, BMI and follow-up time from the TwinsUK cohort (mean follow-up time was 8.5 years). Longitudinal plasma N-glycome (39 directly measured traits) was measured by ultra-performance liquid chromatography (HILIC-UPLC).

Logistic regression with elastic net penalty (a = 1 and l = 10e-2) and 10-fold cross validation was implemented on this subset fitting two models: null, with baseline age, BMI and follow-up time, and glyco, with null + baseline plasma N-glycans as predictors. Models were evaluated by comparing their area under the curves using bootstrap test.

Most important glycans contributing to prediction of incident HTN in elastic net were further assessed by Cox survival analysis to estimate their effect on the risk of incident HTN. Cox models were fitted using the whole dataset, with baseline BMI and age as covariates and Family ID as random effect.

Results:

Glyco model (AUC = 0.628, 95%CI = 0.582–0.675) was significantly better in prediction of incident HTN in contrast to null model (AUC = 0.524, 95%CI = 0.475–0.570; p < 0.001) explaining an extra 10%. The glyco model identified 6 plasma glycans mostly contributing to the prediction. These include four high branched structures with two to four sialic acids (GP25, GP27, GP31, GP32) originating from a-1-acid glycoprotein, one structure with two branches and one sialic acid (GP15), and one glycan peak (GP2) without sialic acid, related to high mannose structure or structure ending with a bisecting N-acetylglucosamine residue. Cox survival analysis showed that only GP32 significantly increased risk (log(HR) = 0.253, 95%CI = 0.075–0.432; p = 0.006) of incident hypertension.

Conclusions:

Baseline plasma N-glycome is associated with incident hypertension in our cohort of adult female subjects. N-glycome of a-1-acid glycoprotein appears to contribute the most to hypertension risk and merits further validation studies in independent cohorts.
BNP LEVELS AND LEFT VENTRICULAR MORPHOLOGY AND FUNCTION IN HYPERTENSIVE PATIENTS BEFORE AND AFTER AN INTRAVENOUS SALINE LOAD
Authors: Bulfone Luca , Catena Cristiana , Da Porto Andrea , Colussi Gianluca , Cecotti Alessandra , Scandolin Laura , Cavarape Alessandro , Sechi Leonardo
Published: April 2021

Objective:

Previous studies have reported a relationship between BNP levels and left ventricular (LV) morphology and function in essential hypertension (EH), but results are conflicting. The aim of the study was to investigate the relationships between BNP levels measured before and after a standard saline load (SLT), plasma aldosterone (PA), active renin (AR), and LV variables in EH patients without heart failure or valvular disease.

Design and method:

In 155 EH patients (age 48 ± 12 years, 92 males, 64 treatment-naïve, the remaining 91 after drug wash-out), a SLT (0.9% saline, 2 L in 4 hours) was performed with baseline and post-SLT measurement of PA, AR, BNP pre- and post-test (pre-BNP, post-BNP). Echocardiography with Tissue Doppler Imaging (TDI) was performed, with measurement of indexed LV mass (LVMI), ejection fraction (EF), TDI-S velocity, E/A and E/e’ ratios, and TDI-e’ velocity.

Results:

Pre-BNP level was higher in females than males, and in patients with previous antihypertensive treatment than in naive patients. Pre-BNP level was significantly and directly related to age, LVMI, E/e’, and inversely related to glomerular filtration (GFR), AR, TDI-S, E/A, and TDI-e’. Post-BNP levels was higher in females and in previously treated patients, and it was positively related to age, E/e’ ratio, and inversely related to GFR, AR, TDI-S, E/A, and TDI-e’. At multivariate analysis pre-BNP level was independently associated with age, female gender, GFR, and AR, while post-BNP level was independently associated with age, AR, and previous antihypertensive treatment.

Conclusions:

In EH patients, plasma BNP is related with LVMI and LV systolic and diastolic function before and after a SLT, but this relationship seems to be limited to female sex and older subjects. Measurement of BNP might be useful for identification and follow-up of subclinical LV abnormalities in these patients.
PROGNOSTIC VALUE OF MID-REGIONAL PROADRENOMEDULLIN (MR-PROADM) IN PATIENTS WITH CHRONIC KIDNEY DISEASE AND HYPERTENSION
Authors: Czajkowska Katarzyna , Zbroch Edyta , Bielach-Bazyluk Angelika , Koc-Zorawska Ewa , Kakareko Katarzyna , Rydzewska-Rosolowska Alicja , Hryszko Tomasz
Published: April 2021

Objective:

Adrenomedullin (ADM) is a peptide hormone with an antihypertensive effect. ADM plasma concentration is elevated in hypertension, heart failure and chronic kidney disease (CKD). Unfortunately, ADM is an unstable peptide, therefore the stable MR-proADM protein, produced in the course of ADM synthesis in a 1:1 ratio, maybe used as a biomarker in diagnostic procedures. The aim of the study was to assess the MR-proADM plasma concentration in conservatively treated patients with CKD and hypertension comparing to healthy volunteers in regard to kidney function, blood pressure control and cardiovascular parameters.

Design and method:

The plasma concentration of MR-proADM was evaluated in 80 patients with chronic kidney disease conservatively treated and hypertension (median age 76 years) and in 27 healthy volunteers using ELISA test. The blood pressure control and echocardiography were assessed. The statistical analysis included the stages of CKD, the degree of hypertension and the presence of cardiovascular complications.

Results:

The plasma MR-proADM concentration was higher in patients with CKD comparing to the control group (247.32 pg / ml vs 65.20 pg / ml; p < 0.001). There was a significant positive correlation between MR-proADM and the dimensions of the left ventricle (p = 0.0039, r = 0.33) and left atrium (p = 0.026, r = 0.26), and a negative correlation between MR-proADM and the ejection fraction rate (p = 0.043 r = -0.23). There were no significant differences in the plasma concentration of MR-proADM depending on the degree of hypertension and CKD stages.

Conclusions:

Chronic kidney disease is associated with an increased level of plasma MR-proADM similarly to abnormal volume of heart cavities and reduced left ventricular ejection. However, the usefulness of MR-proADM protein as a biomarker of CKD and increased cardiovascular risk requires further research.
PERIOSTIN AS A POTENTIAL BIOMARKER FOR PREDICTORS OF CARDIOVASCULAR RISK IN SUBJECTS WITH TYPE-2 DIABETES MELLITUS: EVIDENCE FROM A CROSS-SECTIONAL STUDY
Authors: Azharuddin Md Azharuddin , Kapur Prem , Sharma Manju
Published: April 2021

Objective:

Periostin may be playing a central role in the pathogenesis of heart failure and myocardial infraction among patients with diabetes, and therapies targeting the periostin pathway may represent a novel treatment strategy. The unmet need of early detection and diagnosis of cardiovascular (CV) risk in patients with type 2 diabetes mellitus (T2DM) is required to ensure adequate prevention to delay the diabetic complications.

Therefore, the aim of this study is to find out the association between periostin level, anthropometric measurements, and inflammatory biomarkers in patients with T2DM.

Design and method:

A cross-sectional study included a total of 130 Indian T2DM patients and 40 healthy control. All anthropometric measures and biochemical parameters including periostin, high sensitivity C-reactive protein (hsCRP), and leukocyte count were estimated. Pearson's correlation analysis was performed to assess the significant association between periostin level and other biochemical parameters. p-values <0.05 were considered statistically significant.

Results:

The mean age of the included participants were 52.42 years. Serum periostin levels were higher among obese T2DM patients. Correlation analysis showed positive correlation between serum periostin levels and waist circumference (WC), BMI, waist-hip ratio (WHR), fasting plasma glucose (FPG), postprandial glucose (PPG), glycated hemoglobin (HbA1c), triglyceride (TG), total cholesterol (TC), hsCRP, leukocyte count (p < 0.05) however, negative correlation was observed with high-density lipoprotein cholesterol (HDL-C) (p < 0.05). After adjustment, regression model showed hsCRP, BMI, TG were independent predictors of elevated serum periostin (p < 0.05).

Conclusions:

Evidence from the current study suggested that periostin levels were higher among patients with higher BMI groups and it is significantly associated with lipid profile, anthropometric measures, and inflammatory biomarkers. periostin may consider as a novel biomarker to measure the early cardiovascular risk. However, lacking follow-up it further creates room for future investigation. Therefore, further real-world studies warrant to robust the present findings.
NON-DIPPING ASSOCIATED PARAMETERS IN SINUS RHYTHM INDIVIDUALS
Authors: Zhemanyuk Svitlana , Syvolap Vitaliy
Published: April 2021

Objective:

The aim of the study was to evaluate the association between non-dipping pattern of systolic BP (SBP) in sinus rhythm individuals.

Design and method:

We studied 145 individuals (mean age, 60 [95% CI, 59–62] years, 54% men), 92% was essential hypertension patients, who underwent 24-h ABPM and 24-h ECG. Averages were measured for SBP, diastolic (DBP), pulse pressure (PP), mean arterial pressure (MAP) and 24-h ambulatory arterial stiffness index (AASI) calculated. According to the degree of nocturnal SBP fall (according to the 24-hour-clock-based definition of night from 1 am to 6 am), patients were sub-classified as dippers (39%) and non-dippers (61%), which included mild dippers (60/89), extreme dippers (6/89), reverse dippers (23/89). A bivariate multivariate logistic regression analysis (Stata 15) was performed to evaluate the value of ABPM parameters for non-dipping status.

Results:

Comparisons between groups showed no differences in age, sex, as well as in SBP, DBP, PP, MAP. The best fitting model for explanatory non-dipping pattern (log likelihood = -97.82; AUC ROC = 0.6372) after adjustment for age, sex (male vs female), SBP, DBP, PP, MAP with ORs included AASI (11.57 [CI 95%, 1.02–130.47], p = 0.048).

Conclusions:

24-h AASI is the only one ABPM parameter that associated with non-dipping pattern in individuals with sinus rhythm.
COMPARATIVE ANALYSIS OF THE RESULTS IN ARTERIAL STIFFNESS BETWEEN TWO ASSESSMENT METHODS – SPHYGMOCOR AGAINST MOBIL-PULSE WAVE VELOCITY – IN HYPERTENSIVE PATIENTS
Authors: Zanatta João Marcos De M , Ricardi Fábio Dos S , Rubio Tatiana De A , Cestário Elizabeth E S , Cosenso-Martin Luciana N , Yugar-Toledo Juan C , Vilela-Martin José F
Published: April 2021

Objective:

To compare the pulse wave velocity (PWV) results obtained by Sphygmocor AtCor Medical, by radial tonometry, and Mobil-Ambulatory Blood Pressure Monitor-Pulse Wave Velocity (Mobil-ABPM-PWV) 24 hours, an oscillometric method.

Design and method:

Sixty-three controlled hypertensive (41 female and 22 male) and sixty-three resistant hypertensive (36 female and 27 male) patients were recruited and submitted to evaluation of arterial stiffness by the SphygmoCor (radial tonometry) and by Mobil-ABPM-PWV (oscillometric method). Linear regression and Bland-Altmann test were used to statistics analysis.

Results:

The correlations of the PWV as assessed with Mobil-ABPM-PWV 24 hours with the values obtained using the SphygmoCor radial tonometry were significant (controlled hypertensive patients: r = 0.54, P < 0001; resistant hypertensive patients: r = 0.48, P < 0.001). Comparison Bland-Altman plot showed concordance correlation coefficient (controlled hypertensive patients = 5.0, P < 0.0001 and resistant hypertensive patients = 4.8, P < 0.0001). Figures 1–4.

Conclusions:

The oscillometric method Mobil-ABPM-PWV is an easy-to-use and time-effective method for assessing arterial stiffness compared with the SphygmoCor AtCor radial tonometry.
MEASUREMENT OF BLOOD PRESSURE IN THE ARM AND FOREARM: IS THERE A DIFFERENCE?
Authors: Zanatta LóSo Marcos De Menezes , Yugar Lucy Toledo , Cestari Elizabeth Do Espirito Santo , Souza Maira Regina De , Mello Priscilla Galisteu De , Rubio Tatiane De Azvedo , Gonzales Elizangela Gianini , Costa Larissa Morete Caieiro Da , Martin Luciana Neves Cosenso , Tacito Lucia Helena Bonalumi , Ferreira-Melo Silvia Elaine , Moreno Heitor , Vilela-Nartin José Fernando , Yugar-Toledo Juan Carlos
Published: April 2021

Objective:

Obtain an accurate measurement of blood pressure (BP) is of fundamental importance for the diagnosis and follow-up of hypertensive patients. It is known that in some patients, such accuracy is not possible due to the anatomical changes in the musculature of the arm, obesity, and dysmorphisms. Objective: To evaluate and compare blood pressure values using the traditional method of measuring blood pressure in the arm with the values measured in the forearm in hypertensive patients for validation of this technique in obese patients and/or with the arm dysmorphisms.

Design and method:

Were included 70 patients of both sexes, aged between 30 and 90 years of hypertension outpatient clinic of the State Medical School of São José doRio Preto FAMERP - SP. The BP was measured by the oscillometric method using two electronic devices, with clamp standard for adults with arm circumference between 220 mm and 420 mm and automatic inflation and deflation of air, with pressure variation of 0–280 mmHg (appliance, MICROLIFE BP3AC1–1 model PC) obeying the VII Brazilian Guidelines for the treatment of hypertension. The anthropometric data were obtained at the beginning of the research for sample characterization, as well as information on gender and age.

Results:

In accordance with the statistical analysis of the data measured blood pressure could observe that the linear correlation values are >80%, which corresponds to an excellent correlation between the measurements of arm and forearm for both systolic and diastolic BP, me, an BP and pulse pressure.

Conclusions:

Both measurements of systolic and diastolic blood pressure were equivalent in arm and forearm, in such a way that can be considered effective measurement of BP in the forearm in hypertensive patients being of particular usefulness in obese patients or who present arms dysmorphisms.