bluuebunny/crossref_metadata_2025 huggingface dataset:
INTERACTION OF COMORBID HYPERTENSION AND SEX ON OCCURRENCE OF MILD COGNITIVE IMPAIRMENT IN OUTPATIENTS WITH DIABETES MELLITUS: A 6-YEAR FOLLOW-UP STUDY
Authors: Miyamatsu Naomi , Kiyohara Maiko , Kawahara Mizuki , Morino Katsutaro , Miyazawa Itsuko , Fujita Yukihiro , Shima Azusa , Maegawa Hiroshi , Ogita Mihoko
Published: June 2023

Objective:

Hypertension and diabetes are known as a risk factor for impaired cognitive function among general population. And there are some sex-differences in prevalence/incidence of dementia and/or MCI and its related risk factors. We therefore examined the interaction of sex and hypertension comorbidity on MCI occurrence in diabetic patients.

Design and method:

Six-year follow-up study was conducted. A total of 308 without MCI out of 461 outpatients with diabetes mellitus assessed MMSE in 2014 were included. Blood pressure (BP) was evaluated twice after 5-muinite rest in the baseline survey. Comorbidity of hypertension was defined by prescription of antihypertensives. The follow-up assessment of MMSE were performed in 2019. A total of 155 patients were consequently used for the analysis (follow-up rate: 50.3%; 105 men and 50 women; age[years]: mean 63.9, SD 11.7, range 31-84). Participants were divided into four categories, men without hypertension(Mw/oHTN, reference), men with hypertension(MwHTN), women without hypertension(Ww/oHTN), women with hypertension(WwHTN) by baseline assessment. The odds ratios(ORs) and 95% confidence intervals(CIs) of MCI occurrence at the follow-up survey by sex and HTN category were calculated by multivariate logistic regression analyses after stratification by age.

Results:

Among 155 patients, 43 MCI was observed (case/n: 7/53 in Mw/oHTN, 18/52 in MwHTN, 9/23 Ww/oHTN, 9/27 WwHTN) at all ages during follow-up. After stratified by age, in patient aged under 65, age-adjusted ORs[95%CIs] of MCI were 9.85[1.08-89.49] for MwHTN, 13.33[1.10-162.10] for Ww/oHTN, 15.94[1.30-195.50] for Ww/oHTN. These results remained after adjusting SBP, BMI, HbA1c at baseline. Any significant increase on MCI occurrence by sex and HTN comorbidity was not observed in elderly diabetic patients.

Limitations: We could not identify whether hypertension or diabetes occurred first. Due to the low follow-up rate, especially in higher BP levels, the sample size and the number of events were insufficient to consider all possible confounders.

Strength: MMSE and other measures were assessed by well-trained researchers or research nurses with strict protocols.

Conclusions:

Comorbid hypertension in men with diabetes may cause MCI in adulthood. Further research focusing on risk factors for MCI in women with diabetes is needed.
RENIN-ANGIOTENSIN SYSTEM INHIBITOR IS BETTER IN SLOWING PROGRESSION OF MILD COGNITIVE IMPAIRMENT (MCI): A META-ANALYSIS ON ANTIHYPERTENSIVE DRUG AND RISK OF DEMENTIA IN MCI PATIENT
Authors: Lam Amy , Ip Roy , Chan Aaron , Yiu Karen , Tsoi Kelvin
Published: June 2023

Objective:

Antihypertensive drugs has been known to reduce risk of mild cognitive impairment (MCI) and dementia in hypertensive patients. The current meta-analysis aims to assess association of antihypertensive drugs and risk of dementia in MCI patients.

Design and method:

PubMed, Embase and Web of Science were searched for articles from database inception until October, 2022. Longitudinal cohort studies in subjects aged 18 or above with MCI at baseline involving (1) comparison of use of antihypertensive drugs and non-user, or (2) comparison among classes of antihypertensive drugs were included. Primary outcome was risk of dementia. Reported risk of dementia was extracted as hazard ratio or odds ratio. Peto fixed effects meta-analysis was performed to estimate the pooled effect size of antihypertensive drugs on risk of dementia.

Results:

Eight studies were included in current analysis. One was post-hoc analysis of randomised controlled trial, while the others were observational cohort study. A total number of 1,107 dementia cases were identified. Use of antihypertensive drugs, regardless of therapeutic class, reduced risk of dementia by 27% (Peto odds ratio (OR) 0.73, 95% confidence interval (CI) 0.62-0.86). Use of renin-angiotensin system (RAS) inhibitor, including angiotensin-converting enzyme inhibitor (ACEI) and angiotensin II receptor blocker (ARB), reduced risk of dementia by 47% (Peto OR 0.53, 95% CI 0.39-0.72), while use of non-RAS antihypertensives reduced risk of dementia by 28% (Peto OR 0.72, 95% CI 0.57-0.91). When directly comparing use of RAS and non-RAS antihypertensives, RAS inhibitor further reduced 20% risk of dementia (Peto OR 0.80, 95% CI 0.68-0.94). Among RAS inhibitor, ARBs showed trend of reducing dementia risk but could not achieve statistical significance (Peto OR 0.85, 95% CI 0.69-1.06).

Conclusions:

Antihypertensive drug reduced risk of dementia in MCI patients. Among different classes of antihypertensive drugs, RAS inhibitor performed better than other non-RAS antihypertensive drug in slowing progression of mild cognitive impairment to dementia, while ARB and ACEI were comparable in this aspect.
COGNITIVE FUNCTION IN HYPERTENSIVE PATIENTS WITH DIFFERENT TYPES OF CAROTID LESIONS
Authors: Kadanina Kseniia , Bragina Anna , Podzolkov Valeriy , Druzhunina Natalia , Mohammadi Leila , Shakhmagomedov Rustam , Tyulin Maxim , Kartashov Ioann
Published: June 2023

Objective:

The aim of our research was to study the cognitive function and its relation with the types of carotid arteries lesions (CL) in patients with hypertension.

Design and method:

67 hypertensive patients (35 men and 32 women) were examined (median age 51 [45;55] y., hypertension duration 3 [2;5] y). Cognitive function was assessed by the Montreal Cognitive Rating Scale (MoCA). The subjects underwent duplex scanning of the carotid arteries on a Samsung HS50 2021. The results were statistically processed using Statistica 10 program.

Results:

The patients included in the study were divided into 4 groups according to the type of CL: group 1 (n = 39) without pathological carotid tortuosity (PCAT) and atherosclerotic plaques (AP); group 2 (n = 11) with PCAT, but without AP; group 3 (n = 11) with AP<70% stenosis and without PCAT, and group 4 (n = 6), which has both PCAT and AP<70% stenosis. The groups did not differ significantly in gender and age (p>0.05). Cognitive function levels were significantly higher in group 1 (28[26;29] points) when compared with group 2 (20[19;20] points, p = 0.000001), with group 3 (24[20;26] points, p = 0.00004), and

with group 4 (19[19;23] points, respectively, p = 0.00009). In group 2 the MoCA level was significantly lower than in group 3 (p = 0.019). The lowest MoCA level was in group 4, though but because of the small sample of patients, the differences did not reach the level of statistical significance (p>0.05, when compared with group 2). The MoCA level was in negative correlation with the presence of CL (PCAT + AP) (r = -0.77; p<0.05). A similar correlation between the MoCA level and PCAT was in group 2 (r = -0.81; p<0.05).

Conclusions:

In patients with hypertension, there is a negative correlation between the cognitive function and the presence of different variants of carotid lesions. The most severe decline of cognitive function was observed in hypertensives with both atherosclerotic plaques and pathological carotid tortuosity.
SINGLE-CELL TRANSCRIPTOMIC PROFILING OF THE HYPERTENSION MOUSE BRAIN
Authors: Huang Jun , Dingli Liqiang , Gui Menglu , Zhao Bing , Gao Pingjin
Published: June 2023

Objective:

Chronic hypertension has devastating effects on the brain, being the major cause of stroke and a leading cause of dementia. The alterations of cerebral blood vessels structure and vasoregulatory mechanisms leading by hypertension have been recognized for decades. However, the specific cellular and molecular mediators that drive these alterations remain unclear.

Design and method:

After 4 weeks of continuous administration of angiotensin II, we performed a single-cell transcriptomic analysis of brain cellulome. The brain cellular ecosystem in response to angiotensin II was analyzed, the network of cells that forms the mouse brain was profiled after a proinflammation stimulus that drives pathological brain vascular remodeling.

Results:

We analyzed the transcriptomes of 52,856 single cells (28,078 normal and 24,778 angiotensin II) derived from the brains of 10 normal and 12 angiotensin II mice, and compared all the cellular composition and transcriptomes of the whole brain cells.

For all the major cell populations, we provide comprehensive datasets of genes and pathways whose transcriptional profiles change with hypertension. To reveal heterogeneity within each population, we grouped the cells into 14 classes based on the expression profile, lineage, function and anatomical organization. Of the 20718 total detected genes, 800 were significantly affected by hypertension in at least one cell type. Hypertensive- related cellular pathways and processes were also investigated, and we highlight changes in EC and EPC. Furthermore, the cellular responses to angiotensin II and the changes in intercellular communication were identified.

Conclusions:

These large-scale datasets provide a valuable resource for exploring the brain cellular landscape in health and after chronic cerebral vascular stress. These data provide insights into the cellular and molecular mechanisms that afford an additional discoveries of directed towards understanding the mechanisms by which hypertension disrupts cerebral blood vessels.
PREVALENCE AND DISEASE SPECTRUM OF FIBROMUSCULAR DYSPLASIA IN PATIENTS WITH SPONTANEOUS CEREBROVASCULAR ARTERY DISSECTION
Authors: Pappaccogli Marco , Mangeruga Martina , Eula Elisabetta , Bosco Giovambattista , Verzini Fabio , Cerrato Paolo , Paoli Alessandro De , Guarnaccia Carla , Rabbia Franco , Veglio Franco
Published: June 2023

Objective:

Spontaneous cervical artery dissection (sCeAD) is the most frequent cause of ischemic stroke in young adults and has been associated to various arteriopathies, such as fibromuscular dysplasia (FMD). The aim of this study was to assess the prevalence of both cervical and extra-cervical FMD in patients with a diagnosis of CeAD.

Design and method:

All patients discharged from the Stroke Unit of A.O.U. Città della Salute e della Scienza of Turin from 2016 to 2020 with a diagnosis of CeAD underwent a contrast-enhanced CTA from chest to pelvis to look for FMD-related lesions (multifocal stenosis, aneurysms, dissections, arterial tortuosity). FMD diagnosis was assessed in the presence of at least a multifocal stenosis in one of the vascular beds explored.

Results:

Among 56 patients with spontaneous CeAD, 72.7% were male of middle age (52±8.5 y.o.). According to radiological findings, 43.2% of patients showed extra-cervical arterial lesions, with a prevalence of overall FMD (defined as the presence of at least a multifocal stenosis) reaching 47.3% of the studied sample and affecting carotid (36.4%), renal (18.9%), visceral (16.2%), iliac (22.2%) and coronary arteries (2.7%) respectively. Renal involvement included multifocal renal stenosis (13.5%) and arterial aneurysms (5.4%). Visceral involvement included multifocal stenosis (13.5%), visceral aneurysms (2.7%) and silent mesenteric artery dissection (5.4%). Iliac involvement included multifocal stenosis (2.7%), silent artery dissection (2.7%) and tortuosity (16.7%). Furthermore, two spontaneous dissections, one of the left external iliac artery and the other of the coeliac trunk, clinically asymptomatic, were reported in two males with no multifocal stenosis. Two women suffered also from SCAD. Multivascular extra-cervical involvement was observed in almost one third of the patients (27.0%) with sever lesions (multifocal high degree stenosis and/or arterial dissections) affecting 13.5% of the population.

Conclusions:

According to our results, we demonstrated that FMD is frequently associated to CeAD and that silent FMD-related lesions, even severe as arterial dissections, may coexist in such patients. Therefore, FMD should always be taken in consideration in the differential diagnosis of spontaneous arterial dissection, especially in young subjects without major cardiovascular risk factors.
DETERMINANTS OF ADOLESCENT OBESITY: PARENTAL INFLUENCE AND REGION OF RESIDENCE IN ITALY
Authors: Pellegrino Alessio , Bacci Samuele , Guido Francesco , Zoppi Andrea , Toncelli Loira , Stefani Laura , Boddi Maria , Modesti Alessandra , Modesti Pietro Amedeo
Published: June 2023

Objective:

Childhood obesity is on the rise globally, and family environment and socio-economic factors can play a relevant role. In Italy, regional differences in the prevalence of childhood obesity are observed. This study aimed to investigate the interaction between geographical region of residence, family environment and obesity among Italian adolescents.

Design and method:

Students of primary or secondary schools and their parents, residing in Calabria (South Italy) and Tuscany (Central Italy), were enrolled in a cross-sectional study. All participants were asked to fulfill a questionnaire composed of four sections. First section investigated demography and anthropometry, while General and Sport Nutrition Knowledge questionnaire (GeSNK), Mediterranean Diet Score, and International Physical Activity Questionnaire (IPAQ) assessed nutritional knowledge, dietary habits and physical activity levels respectively. BMI was calculated and students were classified using WHO BMI-for-age charts. Determinants of students’ habits and BMI were investigated with multivariate regression analyses.

Results:

179 students and 113 parents from Tuscany, 247 students and 185 parents from Calabria participated in the study. Obesity prevalence was higher in Calabria than in Tuscany among both students and parents, however multivariate regression analysis showed that geographical region of residence was not in itself a determinant of the BMI of students. Although transmission of eating and physical activity habits from parents to sons appears to occur, parental BMI was the only parental characteristic identified as an independent determinant of the students’ BMI at multivariate regression analysis (adjusted for geographical area, students’ age and gender, parental BMI and education level, parents’ and students’ habits and nutritional knowledge).

Conclusions:

Prevention strategies oriented to reduce childhood obesity should also involve parents.
IMPACT OF DIFFERENT GUIDELINES ON THE PREVALENCE OF HYPERTENSION IN CHILDREN AND ADOLESCENTS
Authors: Calderon Jose Miguel , Ponce Francisco , Deutsch Christine , Alvarez Julio , Aguilar Francisco , Redon Josep , Lurbe Empar
Published: June 2023

Objective:

To assess the prevalence of hypertension (HTN) in youth according to the criteria of the European Society of Hypertension (ESH) (Lurbe, 2016), the American Academy of Pediatrics (AAP) (Flynn, 2017), and the Canadian Guidelines (Rabi 2020).

Design and method:

Four thousand nine hundred and forty evaluations in 2957 Caucasians of both sexes (1459 females), of European origin, from 5 to 18 years of age (mean age 11.0 ±3.2) were included and grouped in 5-12 yr, 13-15 yr and 16-18 yr. Blood pressure (BP) was measured in the non-dominant arm with cuff and bladder size adjusted to upper-arm girth. The three measurements of each office visit were averaged for analysis. Subjects were qualified as hypertensive (SBP and/or DBP) based on the thresholds defined by ESH, AAP and Canadian guidelines and differences among them were calculated.

Results:

According to the ESH, Canadian and AAP criteria, the percentage of hypertensives was 6.2%, 6% and 9.9%, respectively. The percentages in boys were 7.2%, 8.2% and 12.3%, while in girls were 5.1%, 3.6% and 7.4%. According to age, between 5-12 yr the prevalence of HTN was 6.2%, 5.2% and 10%. In those with 13-15 yr, HTN ranged at 7.3%, 6.8% and 8.6%, while in those with 16-18 yr, HTN was observed in 1.6%, 9.2% and 13.2%. The graphic expression of the different prevalence is shown in the Figures. Significant differences were observed for the total and male prevalence between ESH and Canada with AAP (p<0.05). For girls, differences were observed among the 3 Guidelines.

Conclusions:

Overall, there are differences in the prevalence of HTN applying different Guidelines. Differences were largely dependent on age and sex.
THE PROFILE OF HYPERTENSION IN TYPE 2 DIABETICS PATIENTS
Authors: Rihab Zouaoui , Mariem Khadhar , Sarra Haddad , Mouna Jerbi , Hanen Gaied , Raja Trabelsi , Rim Goucha
Published: June 2023

Objective:

Hypertension (HT) is associated with type 2 diabetes (T2D) in 80% of cases.

This association is explained by the same risk factors shared by these two pathologies, essentially obesity, lack of physical activity and smoking.

The aim of our work is to study the epidemiological, clinical and therapeutic characteristics of hypertension in type 2 diabetes patients at the first nephrology consultation.

Design and method:

It's a retrospective study of 42 patients with type 2 diabetes followed at the nephrology consultation of Mongi Slim Hospital over a period of three years (January 2013 - December 2016). HT was classified according to the ESH / ESC recommendations of 2021.

Results:

The study included 25 men and 17 women with a mean age of 63.3 [31-80].

At the first consultation, 88% of our patients had hypertension with a sex ratio M/F of 1.3.

The duration of the HT was 98 months [0-300] and that of the T2D was 170 months [2-480].

The diagnosis of HT and T2D was made at the same time in 7 patients (16.6%). In 8 patients (19.04%), HT preceded T2D.

HT was classified as grade 1 in 8 patients (19%), grade 2 in 12 patients (28.6%), grade 3 in 6 patients (14.3%) and systolic HT in 9 patients (21.4%).

Fourteen patients were on dual therapy, 12 patients were on triple therapy including a renin angiotensin system blocker and 2 were on quadruple therapy including a loop diuretic.

The mean systolic blood pressure was 161.78 mm Hg, 152.91 mm Hg and 175 mm Hg respectively and the mean diastolic pressure was 80.35 mm Hg, 68.75 mm Hg and 85 mm Hg respectively.

Conclusions:

Hypertension is frequently associated with type 2 diabetes. It increases the cardiovascular risk of type 2 diabetes patients. Thus, early diagnosis and good control of hypertension are of paramount importance.
HIGH BLOOD PRESSURE IN THE NEWLY DIAGNOSED TYPE 2 DIABETES PATIENTS
Authors: Nelaj Ergita , Gjata Margarita , Kecaj Irida , Gjermeni Ilir , Tase Mihal
Published: June 2023

Objective:

Type 2 diabetes mellitus and hypertension often coexisted in type 2 diabetes patients. Hypertension is often present at the time of diagnosis of type 2 diabetes. Our study aim to evaluate the prevalence of arterial hypertension in newly diagnosed type 2 diabetics and to evaluate the comorbidities associated with hypertension at the time of diagnosis of diabetes.

Design and method:

Is a prospective study based on 126 newly diagnosed type 2 diabetics, 66 men, and 60 women, aged 45 to 70, hospitalized in Internal Medicine. Blood pressure is taken in consultation according to the recommendations of the ESH, based at least in two consecutive consultations. All patients underwent the assessment of the impact on the target organs, as well as a systematic evaluation for micro and macro-vascular complications.

Results:

At the time of diagnosis of type 2 diabetes mellitus, the prevalence of arterial hypertension is 56.2%. The patients were already followed for arterial hypertension in 24% of the cases, among them, only 11% considered for therapeutic objectives, and 3% presented with ketosis. Hypertensive diabetics are on average 61.2 years old and have metabolic syndrome in 81.1%. Women are more obese and have a significantly higher waist circumference. Men have higher blood sugar, lower HDL, higher coronary risk, and more frequently present with albuminuria. The level of blood pressure, both systolic and diastolic, rises significantly with the number of metabolic syndrome criteria, and the number of cardiovascular risk factors. We find microangiopathy in 59.1% of cases, and cardiovascular disease in 65.2% of cases. The association of microangiopathy with cardiovascular disease is significantly more frequent in hypertensive diabetics than in non-hypertensives (58% vs 31%, p = 0.005).

Conclusions:

High blood pressure is very prevalent in newly diagnosed diabetics. The hypertensive diabetic has a higher degree of morbidity, and presents a cardiometabolic profile with a very high cardiovascular risk compared to the non-hypertensive diabetic at the time of diagnosis of diabetes mellitus.
THE COURSE OF CHRONIC HEART FAILURE IN PERSONS WITH POST-INFARCTION CARDIOSCLEROSIS WITH ARTERIAL HYPERTENSION AND TYPE 2 DIABETES MELLITUS AND OBESITY ACCORDING TO A NUMBER OF MET
Authors: Dunaieva Inna , Kravchun Nonna , Kravchun Pavlo
Published: June 2023

Objective:

To investigate the effect of lipid metabolism, biomarkers of fractalkin and clusterin inflammation on the development and progression of chronic heart failure (CHF) in patients with post-infarction cardiosclerosis, type 2 diabetes and obesity.

Design and method:

A retrospective analysis of a comprehensive examination of 67 patients with postinfarction cardiosclerosis with concomitant type 2 diabetes and obesity. All patients were divided into 3 groups depending on the functional class (FC) of CHF: 1 group (n = 22) - patients with CHF II FC; Group 2 (n = 23) - patients with CHF III FC; Group 3 (n = 22) - patients with CHF IV FC. All patients were examined clinically, they underwent instrumental, biochemical and hormonal examinations.

Results:

With the progression of CHF from FC II to FC III there is a deterioration of lipid metabolism: a significant increase in cholesterol levels by 5.5%, TG – by 15.7%, LDL cholesterol – by 74.4%, VLDL cholesterol – by 15.9%, reduction of HDL cholesterol by 27.6% (p<0,05). An analysis of the fractal equation showing that ailing on CHF is advised by FC; and the level of clusterine - on the contrary decreases. Classical changes in patients with postinfarction cardiosclerosis with CHF and concomitant type 2 diabetes mellitus and obesity, which are the formation of atherogenic lipid metabolism disorders associated with body weight, as well as changes in the latest indicators such as fractalkin and clusterin, indicating the role of these molecules in the progression of CHF.

Conclusions:

Due to the progression of chronic heart failure in patients with postinfarction cardiosclerosis and AH concomitant type 2 diabetes and obesity, an increase in all fractions of lipoproteins at stage III functional class was diagnosed, and then their decrease, which may indicate a deterioration in this category of patients, due to the progression of metabolic shifts, stagnation, dysfunction of the main parenchymal organs. Increased circulatory levels of fractalkin and decreased clusterin content in patients with postinfarction cardiosclerosis with concomitant type 2 diabetes mellitus and obesity is accompanied by an increase in the functional class of chronic heart failure.
PARAMETERS OF LEFT VENTRICULAR DIASTOLIC DYSFUNCTION IN PATIENTS WITH HYPERTENSION DISEASE WITH CONCOMITANT TYPE 2 DIABETES MELLITUS
Authors: Dunaieva Inna , Bilovol Olexandr
Published: June 2023

Objective:

To conduct analyzes of the peculiarities of left ventricular (LV) diastolic function in patients with hypertension disease with concomitant T2DM and without it before and after complex treatment with the inclusion of Eplerenone 50 mg per day and Trimetazidine 80 mg per day.

Design and method:

The study examined 25 patients with HT and DM in a subcompensated state, with an HbA1c level of 7.6±0.34% (main group) and 25 patients with HT stage II (HbA1c level of 5.01±0.13%), without T2DM aged 35 to 65 years, who were being treated at the clinic of the GI “L.T. Malaya Therapy National Institute of the NAMS of Ukraine”. The control group consisted of 20 healthy individuals (HbA1c level of 4.68±0.49%).

Results:

The data in Table 1 suggest that in patients with HT and HT with comorbid T2DM, the mean kinetics of diastolic flow of the fibrous ring was significantly lower in comparison with the control group. While the e`mean level in patients with T2DM and HT was significantly lower in comparison with patients with HT. Thus, the findings indicate that aggregate hemodynamic and metabolic alterations adversely affect the kinetic capabilities of the myocardium. Moreover, the lowest rates of the myocardial diastolic relaxation rate were probably found in patients with HT with T2DM. The latter proves that the comorbidity of these negative factors significantly reduces the functional capacity of the myocardium.

Conclusions:
P2Y12 INHIBITOR MONOTHERAPY OR DUAL ANTIPLATELET THERAPY AFTER PERCUTANEOUS CORONARY INTERVENTION IN PATIENTS WITH HYPERTENSION
Authors: Pil-Sang Song , Jin-Ok Jeong
Published: June 2023

Objective:

P2Y12 inhibitor monotherapy after a brief period of dual antiplatelet therapy (DAPT, a combination of aspirin and a P2Y12 inhibitor) can reduce bleeding without increasing ischemic harm after percutaneous coronary intervention (PCI). The impact of this approach among patients with hypertension remains unknown. We sought to examine the effect of P2Y12 inhibitor monotherapy versus DAPT among patients with hypertension undergoing PCI.

Design and method:

This is a post-hock analysis of the hypertension cohort in the SMART-CHOICE trial. The SMART-CHOICE trial was a randomized trial that compared P2Y12 inhibitor monotherapy after 3 months of DAPT with prolonged DAPT (12 months or longer) in patients who underwent PCI. The primary endpoint was Bleeding Academic Research Consortium (BARC) 2 to 5 bleeding. The composite ischemic endpoint was all-cause death, myocardial infarction, or stroke. Treatment effects were estimated according to presence of hypertension with formal interaction testing to assess for effect modification.

Results:

Patients with hypertension comprised 61.5% (n = 1,840) of the randomized cohort and were characterized by more frequent comorbidities. At 3 years after randomization, patients with hypertension experienced higher rates of all-cause death (3.9% vs 2.5%; p = 0.039), stroke (1.6% vs 0.6%; p = 0.014), or MACCE (6.8% vs 3.8%; p<0.001) but similar BARC types 2 to 5 bleeding (5.4% vs 4.9%; p = 0.601) compared with patients without hypertension. The incidence of BARC 2 to 5 bleeding was 2.9% and 7.8% among patients with hypertension randomized to P2Y12 inhibitor monotherapy versus DAPT [hazard ratio (HR): 0.382; 95% confidence interval (CI): 0.243 to 0.600; p<0.001]. However, P2Y12 inhibitor monotherapy was not associated with an increase in ischemic events compared with DAPT (7.2% vs. 6.5%; HR: 1.135; 95% CI: 0.767 to 1.679; p = 0.527) in patients with hypertension. In the overall trial population, there was no significant interaction between hypertension status and treatment group for the primary bleeding (adjusted p for interaction 0.835) or ischemic endpoints (adjusted p for interaction 0.707).

Conclusions:

P2Y12 inhibitor monotherapy is associated with significantly lower risk for bleeding events compared with DAPT, without any compromise in ischemic prevention, among patients with history of hypertension undergoing PCI.
THE IMPACT OF HYPERTENSION ON IN-STENT RESTENOSIS IN POST-STEMI REVASCULARIZED PATIENTS
Authors: Munteanu Alice Elena , Ispas Irina , Ionita Iulia Theodora , Casian Mihnea
Published: June 2023

Objective:

The current picture of cardiology is the result of great therapeutic advances and large clinical trials. Perhaps the most spectacular impact seen in recent decades has been among patients with coronary artery disease, whose life expectancy and quality of life have been profoundly altered by the introduction of percutaneous myocardial revascularization into practice.

Design and method:

The study was carried out in the Carol Davila Central Military Emergency University Hospital in Bucharest, on a group of patients with acute coronary syndrome with ST segment elevation, treated interventionally in our center through the RO-STEMI program. In the period 2015-2018, 1316 STEMI procedures were performed, of which 107 presented stent restenosis of various degrees, visually quantified by the angiographer.

The presented study is observational, analytical, retrospective. This study can be considered a real world one, because the phenomenon of stent restenosis was studied and objectively correlated with clinical practice, reflecting the experience of our center.

Results:

HT represented an indicator present in the current study in a significant proportion - 80% of the patients in the study, being more frequent in men. A higher prevalence of arterial hypertension was observed in smoking patients. It has been noted that the presence of HT in overweight or HT associated with dyslipidemia increases the risk of AMI or other acute events (stroke). In the hypertensive patients studied, the percentage of major events was 20% higher, but without a statistically significant influence. The main risk factor incriminated in the determination and occurrence of the process of intraluminal proliferation resulting in intrastent restenosis was diabetes mellitus. In patients with DM, the percentage of events was 20% higher than in patients without DM. Diabetes, dyslipidemia, stent characteristics were independent risk factors for in-stent restenosis (p <0.05).

Conclusions:

In conclusion, for patients with risk factors indicating PCI, identification and personalized patient management are warranted to prevent in-stent restenosis. Long-term follow-up of patients with STEMI is essential both for their prognosis and for the individualization of this population through studies.
LACK OF CARDIOVASCULAR EVENTS AFTER ONE YEAR FOLLOW-UP IN PATIENTS FOLLOWED HOSPITAL ADMISSION FOR MODERATE TO SEVERE COVID-19 PNEUMONIA
Authors: Cattaneo Chiara , Salvotti Francesca , Leidi Francesca , Pellegrinelli Riccardo , Geroldi Veronica , Cherubini Fabio , Vaccarello Paola , Napoli Federico , Reale Scilla , Loro Giorgia , Turini Daniele , Malerba Paolo , Viola Sara , Pasini Giancarlo , Ferrari-Toninelli Giulia , Guarinoni Vittoria , Brami Valeria , Bonzi Bianca , Rizzoni Damiano , Boari Gianluca E.M.
Published: June 2023

Objective:

There is increasing evidence that SARS-CoV-2 infection may involve many organs, including cardiovascular system, possibly causing not only acute but cardiovascular events in the long term.

In this retrospective analysis we investigated cardiovascular events during a long time span since hospitalization (384 days and 848) on two different groups of patients.

Design and method:

This study considers two different groups: the first included 43 patients from the second-third wave (October 2020-May 2021), hospitalized in our Internal Medicine ward for moderate to severe SARS-CoV2 related pneumonia treated with high-flow oxygen support that accepted to be re-evaluated after an average period of 324 days by quality-of-life questionnaire, standard laboratory tests, chest computed tomography, spirometry with evaluation of DLCO. Mean age was 63 years, 28% (12/43) were female and 72% (31/43) were male.

The second group included 82 patients from the first wave (February 2020-May 2022) over 94 that underwent a similar follow-up protocol after a mean of 4 month (no CV events at that time) and were contacted with a phone interview assessing quality of life and cardiovascular event after a mean of 848±16 days. Mean age was 66 years, 37% (30/82) were female and 63% (52/82) were male.

Results:

None of the first group of 43 patients had major cardiovascular events: coronary heart disease, cerebrovascular disease, peripheral arterial disease, deep vein thrombosis and pulmonary embolism.

Of them, 35% suffered from heart diseases, 56% of them were hypertensives and 23% had type-2 diabetes; 12% had chronic kidney disease and 49% was obese;

In the second group one patient underwent a PTCA and another had an apparently non-provoked pulmonary embolism, but no other major cardiovascular events were reported

Among second group, 18% had heart diseases, 51% hypertension, 17% type 2 diabetes; 6% chronic kidney disease and 39% were obese

Conclusions:

This study has some limitations, anyway, failed to demonstrate a higher new-onset CV events compared with normal population. Il is plausible that longer follow-up studies with much higher numbers or more detailed analyses are needed to better define cardiovascular risk following SARS-CoV-2 infection.
EFFECTS OF SARS-COV-2 INFECTION ON THE CARDIORESPIRATORY PERFORMANCE BY HYPERTENSION STATUS
Authors: Kariori Maria , Fragoulis Christos , Chrysochoou Christina , Tsioufis Panagiotis , Grigoriou Kalliopi , Papakonstantinou Panteleimon , Mageiras Nikolaos , Manta Eleni , Nikolopoulou Lefki , Siafi Eirini , Mantzouranis Emmanouil , Tatakis Fotios , Konstantinidis Dimitrios , Thomopoulos Costas , Tsioufis Konstantinos
Published: June 2023

Objective:

Few data have been published regarding the holistic approach of patients with history of arterial hypertension after Sars-Cov-2 infection. The purpose of our study was to examine the impact of Covid-19 in the cardiopulmonary status of hypertensive patients 3 months after the first day of infection.

Design and method:

All participants who recovered Covid-19 infection underwent cardiorespiratory exercise test using either Bruce or modified Bruce protocol and transthoracic echocardiogram where all parameters were evaluated. The population was separated into two groups based on history of hypertension. Group I included 62hypertensives and Group II included 134normotensive subjects.

Results:

A total of 198 patients (51±15 years, 44.4% males, 6.6% history of coronary heart disease) were assessed. Hypertensives had higher BMI (30.47±4.68 vs. 26.20 ±5.36 kg/m2, p<0.001) and BSA (2.03±0.24 vs. 1.91±0.45, p<0.001). They were hospitalized in higher percentage comparing to normotensives(54.8% vs. 35.8%, p<0.01). Out of echocardiographic parameters, diastolic dysfunction parameters including left atrial diameter(40 ±6 vs. 35±5mm, p<0.001) and E/A ratio (0.95±0.34 vs. 1.22±0.43, p<0.001) differed significantly between two groups. LVEF(%) was also significantly impaired (56±10% vs. 58±9%, p:0.04) in hypertensives. This finding was depicted in lower oxygen consumption (VO2 (ml/kg/min)) both maximum (22±4 vs.28±7, p<0.001) and during the 1st minute of recovery (19±18 vs.21±23, p<0.006), metabolic equivalents (METS) at peak, 10±13 vs. 10±3, p<0.001) and HR1st minute recovery (124±23 vs. 138±21 bpm, p< 0.001) comparing to normotensives. Systolic blood pressure(mmHg) at rest (132±13 vs. 125±16, p: 0.002), maximum (189±28 vs. 177±26, p: 0.01) and during the 1st minute of recovery (179±29 vs. 162±25, p: 0.001) was higher while the exercise duration was significantly lower (8±3 vs. 9±3 min, p<0.001) in patients with hypertension. Finally, hypertensive subjects reported higher scores in Borg scale for dyspnea (7±2 vs. 6±2, p:0.02) comparing to normotensives.

Conclusions:

Current study highlighted the negative impact of Sars-Cov-2 infection in the ability of patients with hypertension to exercise. Therefore, the need for a more comprehensive approach for rehabilitation including the modification of risk factors like hypertension and obesity in post-covid patients is mandatory
UNCONTROLLED BLOOD PRESSURE BEFORE COVID-19 IS ASSOCIATED WITH ELEVATED SERUM IL-17 AND LONG-COVID SEQUELAE IN HEMODIALYSIS PATIENTS
Authors: Stepanova Natalia , Driianska Victoria , Rysyev Andriy , Ostapenko Tetyana , Kalinina Nataliia , Savchenko Victoria , Kolesnyk Mykola
Published: June 2023

Objective:

Hypertension, a nearly ubiquitous complication in hemodialysis (HD) patients, has been identified as a risk factor for COVID -19 and its associated adverse outcomes. In turn, both hypertensive and COVID-19-infected patients with long- COVID sequelae have been reported to have elevated serum interleukin-17 (IL-17) levels. Although HD patients belong to the high-risk group for long COVID sequelae, the association between pre-infection blood pressure (BP) control, serum IL-17 levels, and long COVID sequelae has never been investigated in this cohort.

Design and method:

A total of 80 HD patients aged 56 (44-63.2) years with a dialysis vintage of 40 (23-74) months who had experienced COVID-19 before enrollment were included in this cross-sectional cohort study. Controlled BP was defined as a 3-month average pre-dialysis BP < 140/90 mmHg and post-dialysis < 130/80 mmHg. IL-17 was measured at least 5 months after acute COVID-19 by ELISA assay. Data were expressed as proportion or median (Me) and interquartile ranges (Q25-Q75) and compared with the Chi-squared test or the Mann-Whitney test as appropriate.

Results:

Of the 80 patients included, 46 (57.5%) had uncontrolled BP and 34 (42.5%) had controlled BP before infection with COVID -19. Long-term COVID sequelae were observed in 26/46 (56.5%) patients with uncontrolled BP and 11/34 (32.4%) of the BP -controlled group (⇙2 = 4.6, p = 0.03). Serum levels of IL-17 ranged from 0.01 to 15.14 pg/ml and were significantly higher in patients with uncontrolled BP than in the controlled BP group [0.34 (0.08-0.98) vs 0.06 (0.03-0.14) pg/mL, p = 0.001]. In addition, IL-17 was also higher in patients with long-COVID sequelae than in fully recovered patients [0.43 (0.07-1.58) vs 0.08 (0.02-0.16) pg/mL, p = 0.0003], while those with long-COVID sequelae and preinfection uncontrolled BP had the highest value IL-17 (p = 0.04) (Fig. 1).

Conclusions:

Uncontrolled BP before COVID-19 is associated with increased serum IL-17 levels and long-COVID sequelae in HD patients. Further studies are needed to understand the role of IL-17 in BP control and long-term COVID sequelae in HD patients.
EFFECT OF THE PERIOD OF THE COVID-19 PANDEMIC ON HYPERTENSIVE PEOPLE: A PROSPECTIVE COHORT STUDY
Authors: Guimarães Mayra Cristina Luz Pádua , Santos Juliano , Coelho Juliana Chaves , Campos Cassia Lima De , Silva Giovanio Vieira da , Drager Luciano Ferreira , Pierin Angela Maria Geraldo
Published: June 2023

Objective:

To analyze the influence of the COVID-19 pandemic period on habits and lifestyles, adherence to antihypertensive treatment, control of blood pressure and comorbidities, in hypertensive patients followed in a specialized outpatient clinic of high complexity.

Design and method:

Prospective longitudinal study that evaluated hypertensive patients treated at the hypertension outpatient clinic of a tertiary teaching hospital, in São Paulo - SP, Brazil before and during the covid-19 pandemic. The following were included: older than 18 years old and being followed up for at least six months. Pregnant women were excluded. In the pre-pandemic period, the interview and assessments were carried out between March and May 2019, in person (face to face). During the pandemic, assessments were carried out between March and August 2020, by telephone. Biosocial data, habits and lifestyles and disease history were evaluated. The study was approved by the Research Ethics Committee. Values of p less or equal 0.05 were considered significant.

Results:

111 hypertensive patients were evaluated, the majority (61.3%) women, with a mean age of 66.0 (SD = 12.6) years, 66.7% white, 56.8% married, with an average schooling of 10.5 (SD = 4.2) years. When comparing before and during the pandemic, statistically significant differences (p less or equal 0.05) were observed, respectively, for the variables: monthly income (R$2,362.98 vs R$1,924.88); in the number of widowed (16.2% vs 19.8%) and divorced people (8.1% vs 22.5%), smoking habits (8.1% vs 7.2%), alcoholism (45.0% vs 21.8%) and physical inactivity (97.3% vs 89.2%); glycemia [116.1 (SD = 33.2) vs 129.6 (SD = 57.3) mg/dL] adherence to antihypertensive drug treatment (89.2% vs 54.9%), increase in diabetics ( 48.6% vs 52.2%) and chronic kidney patients (18.9% vs 28.8%). Despite the decrease in blood pressure control, there was no significant difference (67.6% vs 56.9%).

Conclusions:

The findings indicate that there were favorable influences for habits and lifestyles in hypertensive people in the period of the COVID-19 pandemic, but there was a compromise in income, comorbidities, and especially in adherence to antihypertensive treatment.
FEATURES OF THE COURSE OF ATRIAL FIBRILLATION IN PATIENTS WITH CORONAVIRUS DISEASE
Authors: Stasyshena Oksana , Sychov Oleg , Romanova Olena , Marchenko Olena
Published: June 2023

Objective:

The aim of our study was to study the course of the most common and potentially dangerous arrhythmia - atrial fibrillation (AF) in patients within 6 months after infection with COVID-19 (CI).

Design and method:

The study included 187 pts aged 62.5±0.9 years (47% men, 53% women). The first three groups formed 116 pts who had AF and underwent coronavirus infection (CI). The first group (G1) consisted of 36 patients who did not have AF before CI. The second group (G2) was represented by 25 patients in whom the transition of the paroxysmal form of AF into persistent, or persistent AF into its permanent form occurred. The third group (G3) consisted of 55 patients in whom the form of AF did not change.

Results:

Older age, female gender, hypertension, and coronary heart disease were clinical factors associated with the occurrence of AF or the worsening of the course of previously diagnosed AF in patients who underwent COVID-19. In addition, there were more pronounced signs of damage to the functional properties of the endothelium, the severity of systemic insufficient content in the blood of total cholesterol and TG, proatherogenic fractions of blood lipoproteins, which can be the cause of more clinically pronounced arrhythmias.

Conclusions:

A proportion of COVID-19 patients with newly diagnosed AF may have a pre-existing substrate for AF, and acute COVID-19 infection may be a trigger for the initiation of AF, consistent with a temporal relationship between new-onset AF and COVID-19 infection.
POST HOC ERGO PROPTER HOC? NOT EVERYTHING THAT HAPPENS AFTER COVID-19 IS LONG COVID. OR, THE MANY MASQUERADES OF PHEOCHROMOCYTOMA
Authors: Kuzior Agnieszka , Rios-Gomez Carlos , Ojeda-Santana Borja , Leon-Durango Ricardo Jose de , Hernandez-Lazaro Alba , Arnas-Leon Claudia , Acosta-Calero Carmen , Ortiz-Hernandez Catherine Pino , Perez-Rivero Jennifer Maria , Rodriguez-Escobedo Raul , Gonzalez-Martinez Silvia , Martinez-Martin Francisco Javier
Published: June 2023

Objective:

A seemingly endless list of symptoms and conditions are being labeled as long COVID or post-COVID syndrome, but not everything that happens after a COVID-19 episode can be attributed to it. We hereby present a clinical case in which pheochromocytoma was masquerading as long COVID.

Design and method:

Review of the patient's clinical record and the relevant literature.

Results:

A previously healthy, non-smoker, 57-year-old woman was admitted in October 2020 with fever, dyspnea and asthenia. She was diagnosed with SARS-CoV-2 bilateral bronchopneumonia and required oxygen therapy but not assisted ventilation or intensive care. Three months after discharge the patient was asymptomatic but in the two following years she progressively developed symptoms of confusion, dizziness, inability to concentrate, gait instability, tachycardia, palpitations, anxiety and insomnia. The syndrome was labeled as post-COVID and in March 2022 began treatment with alprazolam and propranolol. Subsequently she complained of severe non-pulsatile holocranial headache accompanied by vertigo, nausea and skin pallor. In October 2022 she was admitted in Emergency Care with a BP reading of 226/118 mmHg, HR 132 bpm, ECG: sinus rhythm without repolarization anomalies. She was referred to our Outpatient Hypertension Clinic for workup of suspected secondary hypertension.

Physical exam: BMI 27.3 kg/m2, BP 156/94 mmHg, FC 112 lpm, normal cardiopulmonary auscultation, no murmurs or oedema.

Lab: Plasma glucose, ionogram, lipid profile, blood count, free T4, TSH, aldosterone, renin, ARR, NT-pro-BNP: normal, metanephrines 876/1238 pg/mL, albuminuria 56 mg/g Cr.

Echocardiography: slight LVH (13 mm septum and posterior wall) with preserved function.

Abdominal CT: Left adrenal mass, 54 mm, hyperdense, heterogeneous.

MIBG scintigraphy: hyperintense left adrenal uptake without additional anomalies.

After standard presurgical conditioning the patient underwent laparoscopic adrenalectomy, uneventfully. Pheochromocytoma was pathologically confirmed, without suggestion of malignancy (Ki-67 <2%). Three months afterwards the patient is normotensive and asymptomatic without medication, with normal plasma metanephrines.

Conclusions:

The clinical presentation of pheochromocytoma may be atypical and sometimes bizarre. Sustained hypertension may be absent, but the paradoxical hypertensive response to beta-adrenergic blockade is highly suggestive. Anyhow, a ‘post-COVID syndrome’ label may be masking unrelated and solvable serious diseases.
CARDIAC REMODELING IN HYPERTENSIVE PATIENTS WITH COVID-19: PRE-DISCHARGE ASSESSMENT AND A 1-MONTH FOLLOW-UP
Authors: Honchar Oleksii
Published: June 2023

Objective:

To study the impact of hypertension on the formation of structural and functional cardiac changes during hospitalization for COVID-19 and the dynamics of detected changes in the early post-discharge period.

Design and method:

212 hospitalized COVID-19 patients (mean age 53.4+-13.6 years, 53% female) underwent comprehensive transthoracic echocardiographic examination and the 6-minute walk test at the baseline 1-2 days prior to discharge and after 31 days of follow-up, being compared to 88 matched controls.

Results:

COVID-19 patients had increased absolute (10.1 ± 1.5 vs 9.1 ± 0.9 mm, p < 0.001) and relative LV walls thickness (0.45 ± 0, 07 vs 0.39 ± 0.04, p < 0.001), LV myocardial mass index (38.1 ± 8.9 vs 33.9 ± 5.8 g/m2.7, p < 0.001) and left atrial volume index (28.6 ± 6.6 vs 25.1 ± 4.9 ml/m2, p < 0.001), as well as decrease in LV global longitudinal strain (-17.5 ± 2.4 vs -18.6 ± 2, 2%, p < 0.001) and diastolic filling parameters (e’ 9.2 ± 2.2 vs 11.3 ± 2.6 cm/s, p < 0.001; E/e’ 7.5 ± 1.8 vs 6.8 ± 1.7, p = 0.002). The observed changes were more pronounced in the cohort of hypertensive participants, but also persisted among normotensive patients, resulting in a high prevalence of concentric LV geometry (78% and 43%, respectively, p < 0.001 between groups and vs control), predominantly grade I diastolic dysfunction (51% and 25%, p < 0.001 between groups and vs control), and abnormal values of global longitudinal strain (32% and 19%, p = 0.027 between groups, p < 0.001 vs control), all of which persisted throughout 1-month follow-up. The increase in the % of predicted 6-minute walk distance was 11.2 ± 7.5 in hypertensives vs 12.8 ± 7.6 in non-hypertensive participants, p > 0.05.

Conclusions:

Hospitalised COVID-19 patients at the pre-discharge period were characterized by the high prevalence of LV concentric geometry and diastolic dysfunction, as well as the minor decrease of its longitudinal contractility, which were more pronounced in the presence of concomitant hypertension and did not improve during 1 month of follow-up.