bluuebunny/crossref_metadata_2025 huggingface dataset:
CARDIOVASCULAR OUTCOMES AT RECOMMENDED BLOOD PRESSURE TARGETS IN MIDDLE AGED AND ELDERLY PATIENTS WITH TYPE 2 DIABETES MELLITUS AND HYPERTENSION
Authors: Olsen Eirik , Holzhauer Björn , Julius Stevo , Kjeldsen Sverre , Larstorp Anne , Mancia Giuseppe , Mehlum Maria , Mo Rune , Rostrup Morten , Søraas Camilla , Zappe Dion , Weber Michael
Published: April 2021

Objective:

The optimal blood pressure (BP) target for patients with type-2 diabetes mellitus (DM) and hypertension has been set at < 130/80 mmHg in guidelines. However, available data of event-based clinical outcomes trials show that little evidence supports these guideline recommendations.

Design and method:

We addressed this issue by post-hoc analyzing the risk of cardiovascular (CV) events in mostly elderly high-risk hypertensive patients with type-2 DM participating in the Valsartan Antihypertensive Long-term Use Evaluation (VALUE) trial.

Patients (n = 5250) were divided into 4 groups according to the proportion of on-treatment visits before the occurrence of an event (< 25%, 25%-49%, 50–74%, 75% -100%) in which BP was reduced to < 140/90 or < 130/80 mmHg.

Results:

After adjustment for baseline demographic differences between groups, a reduction in the proportion of visits in which BP achieved < 140/90 mmHg accompanied a progressive increase in the risk of CV mortality and morbidity as well as of cause-specific events such as stroke, myocardial infarction and heart failure (Figure, upper panel). A progressive reduction in the proportion of visits in which BP was reduced < 130/80 mmHg did not have any effect on CV risks (Figure, lower panel).

Conclusions:

In mostly elderly high-risk hypertensive patients with type-2 diabetes mellitus participating in the VALUE trial, achieving more frequently BP < 140/90 mmHg showed a marked protective effect on overall and all cause specific cardiovascular outcomes. This was not the case for a more frequent achievement of the more intensive BP target, i.e. < 130/80 mmHg.
THE MAIN FACTORS INFLUENCING PHARMACOTHERAPY IN PATIENTS OVER 60 YEARS OLD WITH ARTERIAL HYPERTENSION
Authors: Avdeeva Irina , Borisova Natalia , Burko Nadezhda , Oleynikov Valentin
Published: April 2021

Objective:

To assess the significance of the main factors influencing the pharmacotherapy performed in patients over 60 years old with arterial hypertension (AH) 1–2 grade.

Design and method:

The study included 50 persons over 60 years old with AH 1–2 grade. Office BP on pharmacotherapy was 136.7 ± 13.5 and 81.8 ± 7.7 mmHg, mean age - 71.7 ± 4.9 years. According to the questionnaires, the following factors were assessed: cost of drugs (less and more than 5 euros), frequency of administration, presence of disease symptoms before taking the drug, influence of awareness of the disease on interest in treatment, self-control over the treatment process, quality of medical care

Results:

The cost of drugs, if it was up to 5 euros, for the majority of patients (64%) had an average significance, while at a cost over 5 euros this factor acquired a high and very high value (50 and 26%, respectively). The frequency of drug intake was of average significance (16%) and higher (high - 22%, very high - 30%). The factors associated with communication with a doctor had a high and very high value for more than 50% of patients: the accuracy of the recommendations was 38 and 30%, the satisfaction from communication with the doctor was 41 and 22%, respectively. The speed of medical care and the doctor's control were predominantly very low (22 and 24%), low (24 and 32%) and medium (24 and 14%) significance. The presence of symptoms for taking drugs increased the significance of receiving treatment by more than 50% (high significance 18%, very high - 46%). The majority of the respondents assessed the disease awareness and interest in treatment as high (34%) and very high (34%). Self-control over the treatment process in half of the patients was rated high (22%) and very high (28%).

Conclusions:

Along with the high cost of drugs, the effectiveness of treatment in patients over 60 years old with hypertension 1–2 grade was significantly influenced by the frequency of drug intake, the presence of symptoms and awareness of the disease, self-control for most people was more important than the doctor's control.
DYNAMICS OF ARTERIAL STIFFNESS IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION IN LONG-TERM EFFECTIVE LIPID-LOWERING THERAPY
Authors: Matrosova Irina , Borisova Natalia , Babina Anastasia , Oleynikov Valentin
Published: April 2021

Objective:

To assess the dynamics of regional arterial stiffness by volume sphygmography in patients with primary myocardial infarction with ST segment elevation (STEMI) and without ST segment elevation (NSTEMI) on the background of long-term effective lipid-lowering therapy.

Design and method:

A total of 24 people with acute coronary syndrome were examined: 18 men (75%) and 6 women (25%). The diagnosis was confirmed by biomarkers of myocardial necrosis, electrocardiography, coronary angiography. STEMI was diagnosed in 91.6% of individuals. The average age was 52.88 ± 9.55 years; weight - 81.1 ± 12.6 kg; height 169.7 ± 8.9 m; BMI - 28.4 ± 4.1 kg/m2. Office pressure indicators: SBP –116.7 ± 12.23 mm Hg. and DBP –74.94 ± 8.74 mm Hg; heart rate -68.05 ± 5.16 bpm. On 7–9th day from the disease onset and after 48 weeks, the patients underwent an assessment of regional arterial stiffness using volume sphygmography (VaSera-1000, Fukuda Denshi, Japan). The following indicators were determined: the pulse wave velocity in the arteries of muscle type (B-PWV), in the arteries of elastic type on the right and left (R / L-PWV), cardio-ankle vascular index - CAVI1, which characterizes the true arterial stiffness, independent of the blood pressure level and the reflected wave. All patients were prescribed with atorvastatin 80 mg/day during the first 24–96 hours of acute myocardial infarction in addition to standard therapy. The duration of therapy was 48 weeks. If the target LDL-C level of < 1.5 mmol/L was not achieved 5–6 weeks after AMI, patients were additionally prescribed with ezetimibe 10 mg daily.

Results:

Against the background of lipid-lowering therapy, a statistically significant decrease in PWV was observed: R-PWV decreased from 14.3 ± 2.4 to 13.2 ± 1.8 m/s (p = 0.04), L-PWV decreased from 13.8 ± 1.8 to 13.0 ± 1.4 (p = 0.04). Significant dynamics of the average R/L-PWV indicator was from 14.1 ± 2.0 to 13.0 ± 1.6 m/s (p = 0.03). There were no significant changes in CAVI and B-PWV.

Conclusions:

48-week therapy with atorvastatin 80 mg in patients with primary myocardial infarction with ST segment elevation and without ST segment elevation leads to an improvement in the structural and functional properties of elastic type arteries.
ADHERENCE TO 48-WEEK THERAPY WITH ATORVASTATIN AT VARIOUS DOSES IN PATIENTS WITH PREVIOUS MYOCARDIAL INFARCTION
Authors: Oleynikov Valentin , Salyamova Lyudmila , Kvasova Olga , Khromova Angelina , Fadeeva Svatlana , Burko Nadezhda
Published: April 2021

Objective:

To study adherence to treatment with atorvastatin at various doses for 48 weeks in patients with STEMI.

Design and method:

The study included 117 STEMI patients mean age 52.1 ± 8.4 years in the first 24–96 hours from the disease onset. In accordance with the lipid-lowering therapy, the patients were divided into two groups. The first group included 39 people taking atorvastatin 40 mg/day. The second group consisted of 78 patients who received atorvastatin 80 mg/day. On 7–9th day from the STEMIt, after 24 and 48 weeks of follow-up, treatment adherence was assessed using the Morisky-Green questionnaire. In addition, compliance was determined based on the number of dispensed and returned drugs.

Results:

After 48 weeks of follow-up, pharmacotherapy was continued in the 1st group of 30 people (76.9%), in the 2nd group - 73 (93.6%) patients (p = 0.008); 9 patients (23.1%) from group 1 and 5 people (6.4%) from group 2 (p = 0.008) independently discontinued treatment.

After 48 weeks of follow-up, 17 patients (43.6%) in the 1st group were assigned to the number of compliant patients, and 39 people (50%) in the 2nd subgroup (p = 0.54). Ten patients (25.6%) in group 1 and 15 patients (19.2%) in group 2 (p = 0.39) turned out to be insufficiently adherent. There were 3 people not adhering to treatment in the 1st group (7.7%), in the 2nd group - 19 people (24.4%) (p = 0.03). In group 1, the mean score was initially 4 (4;4) points, after 24 weeks - 4 (3;4) points (p = 0.96), after 48 weeks - 4 (3;4) points (p = 0.87). In the group 2 - 4 (4;4) points, after 24 weeks - 4 (3;4) points (p = 0.99), after 48 weeks - 4 (2;4) points (p = 0.34).

According to the number of issued and returned drugs, the average amount of drugs taken in group 1 was 91.8 (79;99)%, in the 2nd group - 96.9 (82.8; 100)% (p = 0.23). The correct drug intake (>80% compliance) in group 1 was observed in 21 patients (76.7%); in group 2 - 57 (78.1%).

Conclusions:

in STEMI patients, 48-week atorvastatin treatment was characterized by good adherence and did not depend on the dose of the drug taken
STUDY OF THE ECONOMIC EFFICIENCY OF PROJECTS FOR DIGITAL TRANSFORMATION OF THE BP MONITORING MODEL
Authors: Oleynikov Valentin , Dzhazovskaya Irina , Salyamova Lyudmila , Shigotarova Ekaterina , Burko Nadezhda
Published: April 2021

Objective:

To investigate the economic efficiency of business models for a project for BP monitoring in patients with hypertension in the context of digital transformation of medical services.

Design and method:

Applied functional, structural and business modeling of design options, methods for assessing market capacity, competition analysis, financial modeling, project sensitivity analysis, analysis of regulatory constraints.

Results:

We studied two business models - implemented in commercial medicine and in a budgetary healthcare institution. Common in the models is the patient service scheme (supplying it with a certified tonometer with a built-in GSM or Bluetooth module - measuring BP - transmitting encrypted data to the remote monitoring center - storing it in a cloud database and the patient's electronic medical record - monitoring BP indicators - doctor's response to critical deviations in measurement results — patient feedback through the messenger). The difference in models is related to the sources and form of payment. In a private clinic, it is possible to use the patient's personal funds, voluntary medical insurance schemes, compulsory medical insurance (CMI), in a budgetary healthcare institution - payment at the CMI rate. The considered options turned out to be cost-effective (NPV > 0) with a discounted payback period from 2.8 (option 1) to 3.35 years (option 2). In case of state insurance system, the time for launching a project is lengthened due to the agreeing period on the telemonitoring tariff; the methods of stimulating the medical personnel participating in the RMBP are different. The sensitivity analysis showed that the most critical factor is the tariff level for the service (the acceptable range is 4.84 -8.81 euros for the telemedicine component), investments vary in the range from 225988.7 to 293785.3 euros. IRR of the project - 38% -45%, PI - 1.6 -1.75.

Conclusions:

The use of telemedicine technologies is economically feasible in both commercial and budgetary institutions. An increase in the project's efficiency indicators is possible due to the coverage of large regions. The accumulation and analysis of big data as a result of monitoring will create conditions for the chronopharmacology of antihypertensive drugs.
DYNAMICS OF INDICES OF LEFT VENTRICULAR-ARTERIAL COUPLING IN PATIENTS WITH HYPERTENSION AFTER ACUTE MYOCARDIAL INFARCTION
Authors: Oleynikov Valentin , Salyamova Lyudmila , Kvasova Olga , Galimskaya Vera , Fadeeva Svetlana
Published: April 2021

Objective:

To study the dynamics of left ventricular-arterial coupling (LVAC) indices in patients with arterial hypertension (AH) after STEMI, depending on the presence or absence of rapidly progressing left ventricular (LV) remodeling.

Design and method:

The study included 71 patients (mean age 51.4 ± 8.4 years) with hypertension after STEMI. Echocardiography was performed at the 7–9th day and 24th, 48th weeks after STEMI (MyLab, Esaote, Italy) with the determination of EDV, its index (EDVi) and calculation of LVAC indices: arterial elastance (Ea), LV elastance (Ees), LVAC index (Ea/Ees). All patients received STEMI treatment for 48 weeks.

Results:

According to the EDVi dynamic during the 24 weeks, the patients were divided into two groups: group 1 - 30 people with rapidly progressive LV remodeling (increase in the EDVi > 20%); group 2 - 41 people without LV remodeling (EDVi dynamics < 20%). The following dynamics of LVAC indices was revealed: in group 1 Ea initialy was 2.0[95%CI 1.8;2.2], after 24 weeks - 1.6 [95%CI 1.4;1.8] (p = 0.0003), 48 weeks - 1.8[95%CI 1.5;2.0] (p = 0.0007); in group 2, respectively, 1.9[95%CI 1.7;2.1], 1.9[95%CI 1.7;2.0] (p = 0.46), 1.8[95%CI 1.7;1.9] (p = 0.27). Ees in the 1st group initially 1.8[95%CI 1.4;2.3], after 24 weeks - 1.2[95%CI 0.9;1.6] (p = 0.0002), 48 weeks - 1.3[95%CI 1.1;1.6] (p = 0.0001); in group 2 - 2.0[95%CI 1.9;2.2], 2.2[95%CI 2.0;2.4] (p = 0.08), 2.3[95%CI 2.1;2.5] (p = 0.009). In the 1st group the Ea/Ees index initially corresponded to normal values: 1.2[95 CI 1.0;1.4], followed by an increase after 24 weeks to 1.4 [95% CI 1.1; 1.6] (p = 0.007) and after 48 weeks - 1.4[95%CI 1.2;1.7] (p = 0.002). In the 2nd group, a decrease of Ea/Ees was revealed: initially - 1.0[95%CI 0.9;1.1], after 24 weeks - 0.9[95%CI 0.8;0.9] (p = 0.02), 48 weeks - 0.8[95%CI 0.7;0.9] (p = 0.002).

Conclusions:

In the group of patients, against the background of the development of rapidly progressive LV remodeling after STEMI in combination with hypertension, a pathological increase in the LVAC index was revealed due to a more pronounced decrease in left ventricular elastance, which reflects impaired homeostasis of the cardiovascular system.
OBSTRUCTIVE SLEEP APNEA SYNDROME AS CARDIOVASCULAR RISK FACTOR ASSOCIATED WITH HYPERURICEMIA
Authors: Skvortsova Ruth , Anisimova Kristina , Pavlova Viktoria , Obukhova Anna , Popova Kristina , Vaulina Daria , Razumovskaya Tatiana , Rabik Ulia , Kazachenko Alexander , Balandov Stanislav , Vasilevsky Dmitry , Kulikov Alexander
Published: April 2021

Objective:

To assess the relationship between OSAS and uric acid levels.

Design and method:

54 patients with a BMI of more than 30 kg/m2, mean age 44.8 ± 11.4 years, men 14 and women 40 were examined. All patients underwent polysomnography with registration of apnea/hypopnea index (AHI) and mean saturation (SpO2m) and were evaluate for uric acid levels in the blood.

Results:

Patients were divided into 2 groups depending on AHI: 1) gr_1 (n = 33) with AHI < 15/hour, which corresponds to the norm and mild OSAS; gr_2 (n = 21) with AHI > / = 15 / hour, which corresponds to the middle-severe OSAS. In patients gr_1 AHI 4.1/hour ± 3.7 and in patients gr_2 - 50.5/hour ± 31.1, respectively. BMI was not associated with AHI. The level of uric acid was significantly higher in gr_2 - 481 ± 81 μmol/L than in gr_1 - 390 ± 84 μmol/L (p < 0.001). In addition, a correlation was found between the level of SpO2m and uric acid (p < 0.01).

Conclusions:

Hyperuricemia is an independent risk factor for hypertension and cardiovascular events.

According to the results of our examination, patients with OSAS have a more frequent development of hyperuricemia. Respectively, OSAS, adjusted for BMI, can be considered as an independent adverse risk factor for the development of cardiovascular events. Timely detection of OSAS will allow to start specialized treatment on time, improve the cardiovascular prognosis of this group of patients and, thus, reduce overall health care costs.
EXPOSURE TO CHILDHOOD ABUSE IS ASSOCIATED WITH HYPERTENSION IN SOUTH AFRICAN WOMEN
Authors: Nguyen Kim , Kengne Andre , Abrahams Naeemah , Jewkes Rachel , Mhlongo Shibe , Peer Nasheeta
Published: April 2021

Objective:

Childhood abuse (CA), which affected at least half of the children globally, has increasingly been shown to adversely impact physical health in adulthood. We investigated the associations of CA with hypertension in 18–40-year-old South African women in the Kwazulu-Natal Province of South Africa, using the baseline data of the Rape Impact Cohort Evaluation study.

Design and method:

In this cross-sectional study, CA was defined as sexual, physical and emotional abuse, and/or parental neglect. Hypertension was defined as blood pressure equal or above 140/90 mmHg or known hypertension on treatment. Logistic regression models examining the associations between childhood abuse and hypertension adjusted for traditional hypertension risk factors, rape exposure, HIV-infection, other traumatic exposures, depressive symptom scores and post-traumatic stress disorder (PTSD) scores. The mediating effects of hypertension risk factors on the associations were also explored.

Results:

Among 1797 women, median age 24 years (25th-75th: 21–29 years), the prevalence of exposure to CA was significantly higher in those with compared to without hypertension: any CA: 70.9% vs 57.2%, sexual abuse: 20.9% vs 12.4%, physical abuse: 51.8% vs 41.5%, emotional abuse: 40% vs 27.6% and parental neglect: 35% vs 25.7%. In the regression analyses, exposures to any CA (adjusted odds ratio: 1.04; 95%CI: 1.01–1.07; p = 0.014), sexual abuse (1.05; 1.01–1.10; p = 0.026) and emotional abuse (1.05; 1.01–1.08; p = 0.009) were associated with hypertension. The associations of physical abuse (1.03; 1.00–1.06; p = 0.074) and parental neglect (1.03; 0.99–1.06; p = 0.132) with hypertension were borderline to non-significant. Increasing frequency of CA and exposure to multiple types of CA were associated with higher odds of hypertension. The observed associations were partially mediated by alcohol consumption, other trauma experienced, depression and PTSD.

Conclusions:

The associations of CA with hypertension highlight that, while CA must be prevented, effective mental health interventions are needed to prevent hypertension in women exposed to CA.
FIRST RESULTS OF THE NEW HUNGARIAN HYPERTENSION REGISTRY: NUMBER OF DAILY MEASUREMENTS AND PROPORTION OF PATIENTS IN DIFFERENT BLOOD PRESSURE CATEGORIES
Authors: Nemcsik János , Habony Norbert , Ábrahám György , Farsang Csaba , Simon Attila , Benczúr Béla , Páll Dénes , Járai Zoltán
Published: April 2021

Objective:

Hypertension is a major public health problem and its proper diagnosis and treatment are crucial points of cardiovascular morbidity and mortality reduction. The aim of the new Hungarian Hypertension Registry is to evaluate the features of blood pressure measurement practice of family physicians and hypertension care specialists and to overview the blood pressure values measured during everyday practice.

Design and method:

Omron M3 IT devices are located for four months periods in repeated times between October 2018 and October 2023 to family physician practices and to hypertension outpatient clinics. Blood pressure values are transmitted online to an evaluating center using the Medistance system of Omron.

Results:

Until now 1,691 family physicians, 111 internists, 112 cardiologists and 12 hypertension specialists were being involved into the study. During 4 four-months long evaluation periods between October 2018 and October 2020, 1 701 927 blood pressure measurements were registered. The daily average number of the measurements in the three periods were 3.5, 4.8, 5.4 and 3.6, respectively. Following the ESH diagnostic criteria, the proportion of subjects in optimal, normal and high-normal blood pressure categories were 13.4%, 13.4% and 17%, respectively. The proportion of patients in stage 1, stage 2 and stage 3 hypertension categories were 32.1%, 17% and 7.1%, respectively. The average systolic blood pressure values in family physician practices with more than 2500 patients were higher compared with practices with less, than 1500 patients (141.8 mmHg versus 139.84 mmHg, respectively).

Conclusions:

In conclusions, the low daily average number of blood pressure measurements refers for limited blood pressure screening capacity of the Hungarian family physicians. In practices with more patients the blood pressure is generally less controlled. These results suggest the need for reconsideration of the blood pressure measurement guidelines and the further promotion of home blood pressure measurement.
IMPROVED PREGNANCY OUTCOME IN WOMEN WITH GESTATIONAL HYPERTENSION AS A RESULT OF OBSTETRICIAN AND CARDIOLOGIST TEAMWORK
Authors: Neagu Manuela , Patrascu Natalia , Vintila Ana Maria , Vintila Vlad
Published: April 2021

Objective:

Gestational hypertension remains the leading cause of maternal, fetal and neonatal morbidity and mortality worldwide.

In spite of ESH and ESC guidelines (2011–2013) regarding the use of low-dose aspirin for preventing poor obstetric outcome due to preeclampsia and in spite of the many studies involving aspirin published by FMF our national obstetrical guidelines didn’t mentioned aspirin prophylaxis until 2018. So for many years the first to recommend aspirin to a pregnant women was the cardiologist and not the obstetrician.

To asses the outcome of the second pregnancy in women of high risk for early onset/sever preeclampsia after introducing low dose aspirin in early gestation.

Design and method:

A case series of secundiparous women (2017–2019), with history of poor maternal and fetal outcome because of sever preeclampsia (2014–2015), was assessed after starting 150 mg of aspirin daily from the onset of the second gestation until week 36. In this retrospective study no women with diabetes, chronic hypertension, obesity, any type of autoimmune disease, kidney disease or multiple gestation were included. The followed-up of these patients was done both by the obstetrician and cardiologist. The evaluation criteria for assessing the obstetrical outcome were: gestational age at onset of hypertension, Doppler velocity indices and non-stress test results, time and mode of delivery, birth weight, Apgar score, length of hospitalization; all compared to the outcomes of the first pregnancy.

Results:

None of the patients developed severe preeclampsia or early onset hypertension, but all of them de late onset gestational hypertension or mild preeclampsia needing antihypertensive therapy. There were no preterm babies, all women delivered at term, week 38–39, by elective C-section or after induced labor. There were no cases of intrauterine growth restriction, no signs of fetal distress according to Doppler ultrasound examination or on CTG monitoring. The Apgar score was no lower than 8 and there was no NICU admission. Antihypertensive therapy was no longer required after birth and all mothers began brestfeeding.

Conclusions:

This improved obstetrical outcome was the result of team approach in the management of pregnant women with high risk of hypertensive disorders.
SERVICE AVAILABILITY, AND READINESS OF PRIMARY CARE HEALTH FACILITIES TO OFFER HYPERTENSION DIAGNOSIS SERVICES IN WAKISO DISTRICT – UGANDA
Authors: Nanono Jackline , Kasujja Francis Xavier , Rutebemberwa Elizeus
Published: April 2021

Objective:

To determine the availability of hypertension diagnostic services, the readiness of health center IIs, health-facility associated factors, facilitators and the barriers in provision of hypertension diagnosis services.

Design and method:

A cross sectional study design was used, 79 health facilities were sampled randomly. Health facility checklists were administered to the health facility in-charges, individual semi-structured questionnaires to health workers and key informant interview guides to a purposive sample of health workers and personnel at Wakiso district. Chi-square and the Fisher's exact test were used to assess associations between categorical variables. Service availability was measured by assessing the provision of blood pressure (BP) measurements, weight measurements and the scheduling of regular check-ups. Readiness was measured by assessing the availability and functional status of the BP apparatus and other hypertension diagnostic equipment and supplies, and yet also the presence of a trained health care provider.

Results:

The majority (86%) of the primary care health facilities offered all the hypertension diagnosis services and 13% of the health centre IIs were ready to offer comprehensive hypertension diagnosis services. There were significant associations between the level of the health facility; BP measurements (P = 0.005), managing newly diagnosed cases of hypertension (P = 0.001), and scheduling of regular check-ups (P = 0.003). The health workers were facilitated by the availability of equipment, primary health care funds and implementing partners, whereas the barriers faced were the lack of equipment, availability of non-functional equipment, delays in receiving trainings’ and inadequate staffing.

Conclusions:

The study showed that the majority of the health facilities offered hypertension diagnosis services including the Health Centre IIs which are lowest in the tier. There were gaps in the readiness to offer hypertension diagnosis services, thus equipment should be routinely calibrated, replaced and routine continuous medical education sessions should be provided to the health workers.
CONTENT, STRUCTURE AND DELIVERY CHARACTERISTICS OF YOGA INTERVENTIONS FOR MANAGING HYPERTENSION: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMISED CONTROLLED TRIALS
Authors: Nalbant Gamze , Lewis Sarah , Chattopadhyay Kaushik
Published: April 2021

Objective:

The objective of the systematic review was to synthesise the content, structure and delivery characteristics of yoga interventions used for managing hypertension.

Design and method:

The Joanna Briggs Institute guidelines were followed in conducting the systematic review. This systematic review included randomised controlled trials (RCTs) conducted among adults (18 years and older) with hypertension. Studies in line with the classification of hypertension by the International Society of Hypertension/American Society of Hypertension were eligible. RCTs reporting at least one of the major components of yoga (i.e., asana (yogic poses), pranayama (breathing practices), and dhyana (meditation) and relaxation practices) and comparing them with no intervention or any intervention (e.g., lifestyle modification and pharmacotherapy) were eligible. Nineteen databases were searched for published and unpublished studies without any date and language restrictions.

Results:

The literature search yielded 11,629 records. Thirty-one RCTs (evaluating 35 yoga interventions) met the inclusion criteria, and 2837 participants were included. Overall, the methodological quality of these studies was found to be low. Yoga interventions improved systolic and diastolic blood pressure (SBP, DBP) compared to control group (mean difference -6.69 and -2.68; 95% CI -9.32 to -4.07 and -4.11 to -1.24, respectively). Sixteen, 13 and 18 interventions were effective in improving SBP, DBP or either, respectively. Twelve out of 18 interventions incorporated all the three major components of yoga and allocated similar durations to each component. The most common duration and frequency of effective interventions was 45 min/session (in 5 interventions), 3 or 6 or 7 days/week (in 12 interventions) and 12 weeks (in 10 interventions). Eleven were centre-based, seven were both centre- and home-based, and 15 were supervised.

Conclusions:

Yoga interventions seem to be effective in managing hypertension. High-quality RCTs, utilising the synthesised content, structure and delivery characteristics of effective yoga interventions, should be conducted.
DEVICE-SPECIFIC EMPIRICAL CORRECTION EQUATIONS FOR ACCURATE NON-INVASIVE ESTIMATION OF CENTRAL SYSTOLIC BLOOD PRESSURE IN CHILDREN AND ADOLESCENTS
Authors: Mynard Jonathan , Harrington Hilary , Smolich Joseph , Avolio Alberto , Cheung Michael
Published: April 2021

Objective:

Central systolic blood pressure (cSBP) represents the load experienced by the heart and other central organs, and differs from brachial blood pressure due to pulse pressure amplification (PPA). Two widely-used automated devices (SphygmoCor XCEL and Mobil-O-Graph) incorporate algorithms to estimate cSBP and PPA, but in the recent KidCoreBP study, neither passed validation against invasively-measured cSBP in children and adolescents (J Hypertens 38:821–828, 2020). We investigated whether empirical correction equations, using information provided by these automated devices and basic demographics, could provide cSBP and PPA estimates with acceptable accuracy (error mean < 5 mmHg) and precision (error standard deviation < 8 mmHg).

Design and method:

Using data from the KidCoreBP study (n = 62, SphygmoCor; n = 52, Mobil-O-Graph), stepwise linear regression was used to identify empirical correction equations for predicting cSBP and PPA. Input variables included all blood pressures and pulse wave analysis indices provided by the device, as well as age, sex, height and weight. A leave-one-out cross-validation was then conducted to quantify accuracy and precision.

Results:

The empirical equations substantially improved estimation of cSBP (–0.1 ± 5.1 corrected vs 7.9 ± 6.8 mmHg uncorrected, SphygmoCor; and 0.03 ± 7.6 vs 5.7 ± 10.3 mmHg, Mobil-O-Graph) and PPA (0.0 ± 4.5 vs 4.2 ± 5.1 mmHg; and 0.0 ± 4.7 vs 6.8 ± 8.4 mmHg).

Conclusions:

This is the first study to demonstrate acceptable accuracy and precision of cSBP and PPA estimated using automated devices in children and adolescents, when compared to high fidelity invasive measurements. Device-specific empirical correction equations may overcome the present inaccuracy and/or imprecision of available devices.
INTEGRATED HYPERTENSION AND DIABETES MELLITUS TYPE II TREATMENT AND CARE AMONG PEOPLE LIVING WITH HIV/AIDS ATTENDING CARE AND TREATMENT CENTER IN DAR ES SALAAM, TANZANIA IN 2020
Authors: Musyani Atuganile , Mosi Grace , Kinyenje Erik , Mizinduko Mucho , Kishimba Rogath , Shimwela Meshack , Thomson-Paul Angela
Published: April 2021

Objective:

Persons living with HIV/AIDS (PLHIV) now live longer due to the advancement of HIV care rendering them at increased risk of developing Non-Communicable diseases (NCDs). Despite having strong HIV/AIDS care programs, Tanzania lacks effective integration of NCDs care among PLHIV. This project aimed at implementing and evaluating hypertension (HTN) and Type-2 diabetes mellitus (T2DM) prevention, treatment, and care efforts among PLHIV attending care and treatment clinic.

Design and method:

The project was a facility-based intervention that included a collection of demographic, clinical, and laboratory data. A STEPwise approach of the STEPS surveillance tool for NCDs from the WHO was used to collect information from participants. A cohort of patients diagnosed with HTN and T2DM was created and followed up for four months to ascertain for disease control rates. Patient follow-up included health education, medical checkup, and consultation. Descriptive, bivariate, and multivariate logistic regression analyses were done to determine the association between hypertension and risk factors. A paired t-test was done to see the significance of the intervention.

Results:

A total of 335 patients were included in the assessment for the risk factors for hypertension and T2DM in which the prevalence was found to be 21.32% and 2.70% respectively. With multivariate analysis, obesity (AOR = 4.04 95%CI 1.72–9.52) and diabetes (AOR 5.58 95%CI 1.05–29.53) were the risk factors for having hypertension. Being employed in private or government organization and Stage 4 four of HIV disease at diagnosis were found to be at reduced risk of getting hypertension. A paired T-test showed significance difference in mean systolic blood pressure (t = 3.07 w/df = 81, p < 0.01) and diastolic blood pressure (t = 2.91 w/df = 81, p < 0.01) while there was no difference in mean fasting blood glucose level (p = 0.82) and body mass index p = 0.08).

Conclusions:

The magnitude of NCD risk factors is significantly higher among PLHIV and there was a significant change in HTN after three months of project implementation. NCDs integration among PLHIV is possible and should be initiated and strengthened.
BLOOD PRESSURE IN A POPULATION OF A RURAL AREA OF RWANDA: PRELIMINARY DATA
Authors: Muggli Franco , Parati Gianfranco , Suter Paolo , Bianchetti Mario , Radovanovic Dragana , Umulise Alice , Muvunyi Bienvenu , Ntaganda Evariste
Published: April 2021

Objective:

Arterial hypertension likely affects millions of people in Africa and is the most important cause of heart disease and stroke. In Sub-Saharan Africa, the burden of hypertension is a rapid growing health threat. The objective of our study was to perform a screening of the local population living in the rural area of the District of Nyaruguru (Rwanda) to determine the prevalence of high blood pressure (BP).

Design and method:

Between February and July 2020, instructed health care workers collected some anthropometric data (such as height and weight) and measured BP three times in sitting position with validated oscillometric device (OMRON HEM-7322U).

Results:

A total of 7336 subjects participated to the screening, with median age of 32 (IQR 21,47) years; 4053 (55%) were female, age 35 (23, 49) years; 3283 (45%) were male, age 30 (20, 44) years (p < 0.001). Body Mass Index was 20.7 (19.0, 22.3) in males and 21.8 (20.0, 23.8) in females (p < 0.001). The mean of the last two BP measurements were 119.5 ± 15.2 mm Hg. Males had a higher systolic blood pressure (SBP) 120.1 ± 14.0 mm Hg comparing to female 118.6 ± 16.1 (p < 0.001.) Considered SBP equal or more than 140 mm Hg for the diagnosis of hypertension 642 subjects (8.8%) had high BP values, without differences between males (8.4%) und female (9.0%); p = 0.36.

Conclusions:

Surprisingly, in a very rural peripheral region where the average age of the inhabitants is relatively low, about 9% of the subjects examined have abnormal BP values. These data confirm the need to implement also in rural areas of Rwanda an adequate strategy for the prevention, diagnosis and treatment of hypertension.
INFLUENCE OF ANTIHYPERTENSIVE MEDICATION STATUS ON THE BLOOD PRESSURE RESPONSES TO DYNAMIC EXERCISE IN HYPERTENSIVE INDIVIDUALS
Authors: Ramirez-Jimenez Miguel , Morales-Palomo Felix , Moreno-Cabañas Alfonso , Alvarez-Jimenez Laura , Ortega Juan F. , Mora-Rodriguez Ricardo
Published: April 2021

Objective:

To investigate if the blood pressure (BP) response to a maximal graded exercise test (GXT) is influenced by antihypertensive medication (AHM) in monotherapy or in combination.

Design and method:

Thirty-one hypertensive individuals with obesity under AHM treatment targeting the renin-angiotensin-aldosterone system (RAAS) were divided into 3 groups depending on the number of AHM taken: monotherapy (MONO, n = 15), two drugs (DUAL, n = 8) or 3 drugs (TRIPLE, n = 8). By using a randomized, double-blind, placebo-controlled, crossover design, participants completed two trials (i.e. AHM vs PLAC). In each trial, 24-h ambulatory blood pressure (ABP), plasma renin activity (PRA), aldosterone concentration and the BP responses to a GXT were measured and compared among groups.

Results:

In AHM trials, 24-h ABP was significantly lower (127 ± 12 vs 134 ± 10 mmHg, P < 0.001) and PRA higher (4.0 ± 2.7 vs 1.9 ± 1.8 ng/mL/h, P < 0.001) in comparison to PLAC, without differences between groups in any variable (P > 0.05). There was not any group nor trial effect on plasma aldosterone concentration (P > 0.05). During incremental exercise, there were no differences between trials nor among groups in the BP response to incremental exercise, reaching similar peak systolic BP (211 ± 25 vs 206 ± 25 mmHg in AHM and PLAC, respectively, P = 0.118). Regarding the heart rate (HR) response to exercise, the TRIPLE group showed a higher HR at submaximal intensities in AHM vs PLAC (+7 ± 4 bpm, P < 0.005).

Conclusions:

Antihypertensive medication reduces ABP but does not have any effect on systolic BP during exercise, independently of the number of drugs taken. Our data suggest that in chronically treated hypertensives AHM does not reduce the BP response to exercise.
MMP-2 INHIBITION ATTENUATES HYPERTENSIVE ECCENTRIC CARDIAC HYPERTROPHY AND DYSFUNCTION BY PRESERVING TROPONIN I AND DYSTROPHIN
Authors: Parente Juliana Montenegro , de Mello Marcela Maria Blascke , da Silva Pedro Henrique Leite , Omoto Ana Carolina Mieko , Pernomian Laena , de Oliveira Isadora Sousa , Mahmud Zabed , Fazan Rubens , Braga Eliane Candiani Arantes , Schulz Richard , de Castro Michele Mazzaron
Published: April 2021

Objective:

To verify wether increased matrix metalloproteinase (MMP)-2 activity contributes to the proteolysis of troponin I and dystrophin in the left ventricle (LV) of two kidney-one clip (2K1C) rats thus favoring the transition from concentric (C-LVH) to eccentric hypertrophy (E-LVH) and cardiac dysfunction.

Design and method:

Male 7-week old Wistar rats were sham or 2K1C operated and treated with water or doxycycline (MMP inhibitor, 15 mg/kg/day) by gavage from the tenth to the sixteenth week post-surgery. To establish this aim, tail-cuff plethysmography, echocardiogram, morphological analysis (collagen deposition and cardio myocyte hypertrophy assay), gelatin and in situ zymography, confocal microscopy of MMP-2 and troponin I, troponin I western blotting and mass spectrometry, and dystrophin in silico analysis and immunofluorescence were performed. Results were analyzed by two-way ANOVA or unpaired t test (Ethics Committee approval number: 023/2015-1).

Results:

All 2K1C rats had increased systolic blood pressure when compared to controls (p < 0.05) and doxycycline did not decrease it (p > 0.05). About 25% of 2K1C rats had E-LVH followed by reduced ejection fraction and fractional shortening (p < 0.05). The remaining had C-LVH with preserved cardiac function (p < 0.05). Doxycycline prevented the transition from C-LVH to E-LVH. Both C-LVH and E-LVH rats had cardio myocyte hypertrophy (p < 0.05) and doxycycline reverted it (p < 0.05). E-LVH was the only group who had more collagen deposition in the LV (p < 0.05). MMP-2 activity increased in C- and E-LVH hearts when compared to controls (p < 0.05) and doxycycline inhibited it (p < 0.05). MMP-2 and troponin I co-localize in the LV of control rats (p < 0.05). This was associated with an increase in troponin I cleavage products in E-LVH when compared to C-LVH (p < 0.05) confirmed by western blotting and mass spectrometry. Moreover, about ten putative MMP-2 cleavage sites in rat dystrophin were found and, in fact, a decline in dystrophin levels was observed in E-LVH when compared to controls (p < 0.05) which was prevented by doxycycline (p < 0.05).

Conclusions:

Hypertension causes increased cardiac MMP-2 activity which reduces both troponin I and dystrophin levels and contributes to the transition from C-LVH to E-LVH.
CARBOXYLATED OSTEOCALCIN LEVELS CORRELATE WITH EARLY CHANGE OF ARTERIAL STIFFNESS PARAMETERS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS
Authors: Marinova Elena , Dimova-Mileva Maria , Gancheva Silviya , Boyadzhieva Mila , Kanazirev Branimir
Published: April 2021

Objective:

Osteocalcin (OC) is a bone derived protein with a recently discovered hormonal nature with a putative target organ the arterial wall. Under pathological conditions, OC synthesized locally by vascular smooth muscle cells. Arterial stiffness measurement is a modern method for diagnosing subclinical atherosclerosis. Of particular importance is to find a biomarker for early vascular damage in patients with Type 2 diabetes (T2DM).

Aim:

To evaluate the correlation of carboxylated (cOC) and uncarboxylated (ucOC) osteocalcin levels with parameters of arterial stiffness (AS) in patients with T2DM without cardio-vascular diseases.

Design and method:

46 patients with T2DM (mean age 58 ± 7.6 men 45.6%) and 18 healthy age- and sex-matched controls were included in the study and examined for cOC and ucOC with ELISA kits (Takara Bio, Japan). One-point Echo-tacking measuring by Aloka Hitachi were performed on the common carotid artery (CA) with measuring Pulse Wave Velocity (PWV), Beta-stiffness index (BSI) and Modulus of elasticity (Ep).

Results:

We found significant correlations of cOC with the BSI (r = 0.31; p = 0.03) and the Ep (r = 0.29; p = 0.05), and lack of correlation with PWV (r = 0.23; p = 0.12). After adjusting confounding factors such as blood pressure, waist circumference, cOC significant and independently correlated with BSI (B = -0.34; P = 0.04). No correlations were found for ucOC. We additionally established correlations of cOC with HDL (r = 0.3; p = 0.01), BMI (r = -0.32; p = 0.007) and waist (r = -0.4; p = 0.0009). cOC were lower in patients with T2DM 7.84 ± 2.41 ng/ml than in controls 10.05 ± 4.57 ng/ml (p = 0.01). unOC levels were lower in patients with T2DM without significance 3.81 ± 5.12 ng/ml vs. 4.37 ± 3.0 ng/ml (p = 0.08).

Conclusions:

Our patients with T2DM had lower unOC and cOC levels. For cOC were observed a significant correlation with the arterial stiffness parameters BSI and Ep and therefore with subclinical atherosclerosis. Osteocalcin is involved in the process of vascular calcification and can be considered as a potential biomarker for vascular damage.
PULSE PRESSURE SIGNIFICANTLY AND INDEPENDENTLY CORRELATES WITH CAROTID PULSE WAVE VELOCITY AND BETA-STIFFNESS INDEX IN PATIENTS WITH TYPE 2 DIABETES MELLITUS
Authors: Marinova Elena , Dimova-Mileva Maria , Kanazirev Branimir
Published: April 2021

Objective:

Introduction: Pulse wave velocity (PWV) and beta-stiffness index (BSI) are the most popular echo-tracking parameters indicating increased carotid stiffness. Pulse pressure (PP) values turns out to be higher in patients with increased indices of arterial stiffness and is an independent predictor of cardiovascular disease and mortality. This is of greater importance for patients with type 2 Diabetes Mellitus (T2DM).

Aim:

To find out correlation between the pulse pressure and carotid stiffness indices.

Design and method:

100 patients with T2DM without overt cardio-vascular diseases and 30 healthy age and sex matched controls were included in the study. All participants underwent carotid examination of PWV and BSI, by echo-tracking method with Aloka Hitachi Prosound alfa-7. Patients with uncontrolled blood pressure and history of CV diseases were excluded from the study.

Results:

Pulse pressure significantly correlated with left carotid artery PWV (r = 0.43; p = 0.0001) and BSI (r = 0.44; p = 0.001) and right carotid artery PWV (r = 0.38; p = 0.001), BSI (r = 0.39; p = 0.001). Multivariate regression analysis with independent variable PWV, revealed that PP remained a significant and independent determinant (B = 5.78; p < 0.0001), similar to systolic blood pressure (B = 2.97; p = 0.003).

Conclusions:

PP is among the most important independent determinants associated with increased carotid stiffness in patients with T2DM without cardiovascular complications and with well controlled blood pressure. PP may serve as an early marker of increased cardiovascular risk in patients with T2DM.
PREDIALYSIS SYSTOLIC PRESSURE AND MORTALITY
Authors: Hajri Malika , Mannai Khouloud , Jbeli Hela , Khedher Rania , Smaoui Wided , Krid Madiha , Ghabi Hiba , Mami Insaf , Kaab Badr , Fatma Lilia Ben , Raies Lamia , Beji Soumaya , Zouaghi Mohamed Karim
Published: April 2021

Objective:

This study aimed to verify the impact of predialysis systolic pressure (PDSP) on patients’ mortality.

Design and method:

We reviewed files of incident patients, in one reference center of hemodialysis, between January 2009 and June 2010. Arterial pressure was measured by sphygmomanometer before initiating the patient's first dialysis session. We considered: as “high PDSP” a SP equals or over 180 mmHg; as “low PDSP” a PS equals or less than 100 mmHg. Univariate and multivariate analysis were performed to study PDSP association with absolute mortality at five years. Odds ratio (OR) was subject to a 95% confidence interval. We used Kaplan Meier method for survival curves.

Results:

One hundred eleven patients were included. Sex ratio was 1.7 M/W. At dialysis initiation: mean age was 55 ± 14.9 years. Sixty nine patients (62%) were hypertensive; all of them were under antihypertensive agents. MAP, SP and DP were respectively 98.8 ± 16.3 mmHg, 139.4 ± 25.4 mmHg and 79.1 ± 14 mmHg. Mean urinary output was 1156 ± 542 ml/day and initial serum creatinine 887 ± 271 μmol/l.

In univariate analysis, absolute mortality at five years was associated with low PDSP (p = 0.001, OR = 4.8). This association was pronounced among orderlies (p = 0.001) and diabetic patients (p = 0.001). High PDSP was also associated with absolute mortality at five years (p = 0.03; OR = 1.67). In multivariate study, neither low nor high PDSP were associated to mortality.

Survival was decreased for patients with low PDSP (log-rank p = 0.001) (Figure 1) and high PDSP (log-rank p = 0.03) (Figure 2).

Conclusions:

These results suggest the presence of a “U” curve relationship between PDSP and mortality. Further studies, with larger populations, are needed to determine the potential use of low PDSP as a mortality risk factor.
COMPARISON OF PARTIAL SEATED SALINE INFUSION TEST AND SEATED SALINE INFUSION TEST FOR THE DIAGNOSIS OF PRIMARY ALDOSTERONISM
Authors: Li Keli , Qin Luo , Li Nanfang
Published: April 2021

Objective:

Seated saline infusion test (SSIT) has proved to be much more sensitive to recumbent saline infusion test (RSIT) in confirmation of primary aldosteronism (PA), highly specific, much cheaper and less complicated than fludrocortisone suppression testing (FST). However, SSIT requires the subjects to keep sitting position for 4.5 h, which is not comfortable for all patients, especially for the elderly. The purpose of this study was to explore the diagnostic consistency between more free and comfortable partial seated saline infusion test (PSSIT) and SSIT.

Design and method:

The current study involved 89 hypertensive patients who had positive results in the screening test and underwent both PSSIT and SSST for the confirmation of PA. For SSIT, patients remained sitting posture for 4.5 hours (0.5 h before the basal measurement of PAC at 9am local time and during the whole process of saline infusion). For PSSIT, patients remained sitting posture for 0.5 h before the measurement of basal PAC and 0.5 h before the completion of saline infusion, for the rest of the time in the process of infusion, subjects were permitted to adopted more free and comfortable posture. Two liters of 0.9% NaCl was administered intravenously over 4 h during SSIT or PSSIT. The diagnostic consistency between PSSIT and SSIT was analyzed.

Results:

The plasma aldosterone concentration (PAC) after PSSIT was significantly lower than that of SSIT (6.06 vs 7.07ng/dL, P < 0.001). Eight patients (9%) who had post-PSSIT PAC less than 10ng/dl had post-SSIT PAC greater than 10ng/dl. The two saline infusion tests had lower correlation coefficient (r = 0.246, P = 0.02) and intra group correlation coefficient (ICC = 0.194, P = 0.015). ROC analysis predicted optimal cut-off aldosterone levels of 5.385 ng/dl for PSSIT with high sensitivity (80%) but low specificity (50%) when use 6 ng/dl for SSIT according to the Endocrine Society Guideline.

Conclusions:

The optimal cut-off values of PAC for PSSIT were lower than that of SSIT with high sensitivity but low specificity, which need to be noted in clinical application.