bluuebunny/crossref_metadata_2025 huggingface dataset:
GENETIC SUSCEPTIBILITY TO EARLY ONSET OF TRANSFORMING GROWTH FACTOR-BETA DRIVEN CARDIAC REMODELING IN MICE IS ASSOCIATED WITH EGR1 AND STAT3
Authors: Kökény Gábor , Fazekas Krisztina , Popovics Helga , Mózes Miklós
Published: April 2021

Objective:

We have previously described that the severity of TGF-b induced cardiac remodeling was associated with genetic background differences in alb/TGF-b1 transgenic mice (with elevated plasma TGF-b1 levels) on B6 vs CBAxB6 strains. Early growth response factor-1 (EGR1) has been associated with kidney fibrosis, and we recently demonstrated non-canonical TGF-b induced STAT3 activation in vascular smooth muscle cells, but their role in cardiac fibrosis or hypertrophy was not yet elucidated. The present study investigated whether genetic susceptibility to TGF-b induced early cardiac remodeling is associated with transcription factors EGR1 and STAT3.

Design and method:

As the albumin promoter driven TGF-b1 transgene is expressed after birth only in males reaching early high plasma TGF-b1 levels, we investigated 14-day old male transgenic and wild type control mice. Blood pressure of TGF-b1 transgenic (B6-TGFb and CBAxB6-TGFb) mice, and wild type (B6 and CBAxB6) controls (n = 6–9/group) was assessed, then cardiac samples were harvested and analyzed for mRNA and protein expression. Data are presented as mean ± SD and evaluated using Kruskal-Wallis test with Dunn's post-hoc test.

Results:

Blood pressure was elevated in both transgenic strains as compared to controls (MAP mmHg, B6: 46 ± 3; CBAxB6: 48 ± 4; B6-TGFb:54 ± 9; CBAxB6-TGFb:68 ± 7, p < 0.01). Compared to B6-TGFb and wild type, CBAxB6-TGFb hearts showed 20-fold elevation in BNP mRNA relative expression (B6: 1.5 ± 0.9; CBAxB6: 2.3 ± 0.9; B6-TGFb:1.5 ± 1.0; CBAxB6-TGFb:23.5 ± 13,3 p < 0.001) associated with increased Collagen-I (B6: 1.3 ± 0.2; CBAxB6: 1.2 ± 0.1; B6-TGFb:1.2 ± 0.2; CBAxB6-TGFb:1.9 ± 0.6, p < 0.05) and EGR1 (B6: 0.9 ± 0.2; CBAxB6: 0.8 ± 0.3; B6-TGFb:0.9 ± 0.6; CBAxB6-TGFb:1.8 ± 0.5, p < 0.01) as well as STAT3 mRNA overexpression (B6: 0.8 ± 0.1; CBAxB6: 1.2 ± 0.2; B6-TGFb:1.1 ± 0.1; CBAxB6-TGFb:1.7 ± 0.6, p < 0.01) and STAT3 phosphorylation. Early cardiac remodeling was further associated with 12-fold and 2-fold overexpression of TIMP-1 (B6: 1.0 ± 0.4; CBAxB6: 0.8 ± 0.4; B6-TGFb:0.7 ± 0.3; CBAxB6-TGFb:12.2 ± 9.0, p < 0.01) and TIMP-2 (B6: 1.1 ± 0.1; CBAxB6: 1.2 ± 0.2; B6-TGFb:1.3 ± 0.4; CBAxB6-TGFb:2.1 ± 1.1, p < 0.05), respectively. Significant EGR1 immunoreactivity was detected only in cardiomyocytes of CBAxB6-TGFb hearts.

Conclusions:

We conclude that EGR1 and STAT3 might strongly contribute to the initiation and early progression of cardiac remodeling driven by high circulating TGF-b levels. We postulate that EGR1 and STAT3 could be potential targets to inhibit early cardiac remodeling.
POLYGENIC RISK SCORES PREDICT HYPERTENSION ONSET AND CARDIOVASCULAR RISK
Authors: Vaura Felix , Kauko Anni , Suvila Karri , Havulinna Aki , Mars Nina , Salomaa Veikko , Cheng Susan , Niiranen Teemu
Published: April 2021

Objective:

We aimed to quantify the predictive ability of polygenic risk scores in hypertension and demonstrate that they improve a gold standard clinical risk score of hypertension in the general population.

Design and method:

Our study sample comprised N = 218,792 FinnGen Study participants with lifetime follow-up (mean age 58 years, 56% women). We used recently developed Bayesian methodology and publicly available genome-wide association data to compute polygenic risk scores (PRS) for systolic (SBP) and diastolic blood pressure (DBP). Next, in a well-phenotyped subset of 22,624 FINRISK study participants, we calculated the 4-year clinical risk of hypertension and 10-year clinical risk of cardiovascular disease (CVD) using gold standard risk scores. Using time-to-event analysis, we then assessed (1) the association of blood pressure PRSs with hypertension, age of hypertension onset, and CVD in all FinnGen participants, and (2) the incremental improvement in model discrimination when combining blood pressure PRSs with the 4-year and 10-year clinical risk predictions of hypertension and CVD in the FINRISK cohorts.

Results:

Compared to having an average PRS, elevated PRS was associated with up to 2.3-fold risk of hypertension and an 11-year earlier disease onset (Figure). In subgroup analyses, the risk was only 1.6-fold for late-onset hypertension (age > = 55 years), whereas it was 2.8-fold for early-onset hypertension (age < 55 years). Elevated SBP PRS was also associated with up to 1.3-fold risk of CVD and a 4-year earlier disease onset. SBP and DBP PRSs improved clinical risk prediction for hypertension, increasing the C-statistic by 0.7% (0.3–1.1; P = 0.0017) and generating a category-free Net Reclassification Improvement of 9.3% (1.9–16.8; P = 0.014). Inclusion of blood pressure PRSs did not improve the clinical CVD risk score.

Conclusions:

We demonstrated that genetic information improves clinical risk prediction of hypertension. Blood pressure PRSs could be used together with traditional risk factors to improve prediction of hypertension and particularly early-onset hypertension, which confers substantially increased CVD risk. When used independently, PRSs offer a simple and increasingly affordable way to measure genetic predisposition to hypertension at any point in life. Individuals with elevated blood pressure PRSs could benefit from genetic counseling and intensive early intervention.
THE CAUSAL EFFECT OF ADIPOSITY MEASURES ON BLOOD PRESSURE TRAITS IN TWO URBAN SWEDISH COHORTS: A MENDELIAN RANDOMIZATION STUDY
Authors: Giontella Alice , A. Luca Lotta , D. John Overton , Melander Olle , Gill Depender , Fava Cristiano
Published: April 2021

Objective:

Different adiposity traits may be causally related to hypertension in different ways. By using genetic variants as randomly allocated proxies for studying the effect of modifying adiposity traits, the Mendelian randomization approach can be used to investigate this.

Design and method:

In this study, we used four different genetic risk scores (GRSs: GRS-BMI565, GRS-WHR324, GRS-VAT208, GRS-BF81) including hundreds of single nucleotide polymorphisms (SNPs) associated with Body Mass Index (BMI), Waist to Hip Ratio (WHR), Visceral Adipose Tissue (VAT), and Body Fat (BF), respectively, using risk alleles and weight from largest available GWAS meta-analyses. These were applied as instrumental variables (IVs) in Mendelian Randomization analyses. Two Swedish urban-based cohort studies, the Malmö Diet and Cancer (MDC) and the Malmö Preventive Projects (MPP; subjects evaluated both at baseline and after an average follow-up of 23 ± 4.7 years), were used to obtain genetic association estimates with blood pressure (BP).

Results:

In both the MPP and MDC, with the exception of that for BF, all the GRSs were significantly associated with systolic BP and diastolic BP, but with different magnitude.: In particular, each standard deviation (SD) increase in the GRS-WHR324 doubled the likelihood of hypertension prevalence at MDC or MPP baseline exam. However, only the GRS-BMI565 was significantly associated to BP and with hypertension incidence during 23.6 ± 4.3 years of follow-up in MPP.

Conclusions:

In conclusion, we have confirmed a causal link between genetically mediated adiposity, especially WHR and BMI, and BP-related traits including hypertension prevalence and, for the first time to our knowledge, hypertension incidence. The differences in magnitude between these associations might suggest different mechanisms by which different adiposity traits mediate their effect on BP/hypertension and consequently may indicate that tailored interventions are needed to reduce cardiovascular risk.
GENETIC ASSOCIATION STUDIES OF FIBROMUSCULAR DYSPLASIA IDENTIFY NEW RISK LOCI AND SHARED GENETIC BASIS WITH MORE COMMON VASCULAR DISEASES
Authors: Georges Adrien , Yang Min-Lee , Berrandou Takiy-Eddine , Bakker Mark , Dikilitas Ozan , Ma Lijiang , Satterfield Benjamin A. , Sengupta Sebanti , Hunker Kristina L. , Amar Laurence , Lorthioir Aurélien , Prejbisz Aleksander , Pappaccogli Marco , Ruigrok Ynte , Olin Jeffrey W. , Gornik Heather L. , Rietzschel Ernst R. , Celinska Ewa Warchol , Januszewicz Andrzej , Kullo Iftikhar J. , Azizi Michel , Jeunemaitre Xavier , Persu Alexandre , Kovacic Jason C. , Ganesh Santhi K. , Bouatia-Naji Nabila
Published: April 2021

Objective:

Fibromuscular dysplasia (FMD) is an arteriopathy that presents mainly by hypertension, stroke or dissection. Diagnosis is often made in middle-aged women with few cardiovascular risk factors. We aim at identifying common genetic variants associated to FMD.

Design and method:

We tested ∼6.5 million common genetic variants (MAF > 0.01) in 1962 cases and 7100 controls from 6 studies using variants and gene-based association analyses. Participants were of European ancestry, with similar characteristics (91% multifocal, 88% women), diagnosis methods and inclusion/exclusion criteria. Transcriptome-wide association (TWAS), eQTL, gene expression by sex and colocalization analyses used expression data in arteries from GTEx and/or FMD patients and matched controls. Open chromatin regions were defined using ATAC-Seq on primary human fibroblasts, smooth muscle and endothelial cells. Genetic correlations were assessed using summary statistics from UKBiobank and/or published studies by linkage disequilibrium score regression and multi-trait-based conditional and joint analyses (mtCOJO).

Results:

We confirmed the previously identified PHACTR1 locus and identified three new loci (LRP1, ATP2B1, and LIMA1) associated with FMD. TWAS in arteries identified one additional locus (SLC24A3). Through integration of annotation datasets, we provided prioritization of variants and genes. These are consistently and specifically expressed in fibroblasts, smooth muscle cells, and arterial tissues. PHACTR1 and SLC24A3 showed sex differences in gene expressions consistent with the direction of effects of FMD risk alleles. FMD genes are involved in regulatory mechanisms related to actin cytoskeleton and intracellular calcium homeostasis, two mechanisms central to vascular contraction. We found significant genetic overlaps between FMD and blood pressure traits, for the associated loci and globally at the genome level, but demonstrated that hypertension is not driving the genetic association with FMD. We also found positive genetic correlations with migraine and intracranial aneurysm, and an inverse correlation with coronary artery disease, independently from the genetics of blood pressure.

Conclusions:

We describe robustly associated loci and genes with FMD and provide several new leads toward understanding biological mechanisms of stenosis and dissection in young women in the absence of atherosclerosis, which shares part of its genetic basis with more common cardiovascular and neurovascular diseases.
PREVALENCE AND ASSOCIATED FACTORS OF HYPERTENSION AMONG RETIRED INDIAN ARMY IN POKHARA METROPOLITAN
Authors: Sapkota Abhishek , Neupane Dinesh , Adhikari Tara Ballav , Shrestha Aamod Dhoj , Shrestha Naveen
Published: April 2021

Objective:

To assess the prevalence and associated factors with hypertension among the retired Indian army living in a semi-urban area of Pokhara metropolitan.

Design and method:

The cross-sectional study was conducted among retired Indian army living in a semi-urban area of Pokhara metropolitan. Data on blood pressure (BP), anthropometric measurements, smoking, alcohol intake, physical activity, obesity and dietary factors were collected by face-to-face interview using WHO STEPwise approach to non-communicable disease risk factor surveillance (STEPS) questionnaire translated in Nepali language.

Results:

Among the 317 retired Indian army interviewed, the prevalence of hypertension was 68.1%. Mean blood pressure systolic was 144.48 mmHg, and diastolic was 89.3 mmHg. Prevalence of smoking any tobacco products was 12.9%, and consumption of alcohol products was 86.1%. One fourth (25.9%) of the respondents had a family history of hypertension. Over one half (51.4%) were classified as overweight (BMI), and 6.6% had central obesity. Respondents with age group (55–64) years were found more than three times (OR: 3.21, 95% CI: 1.91–8.68) likely to have hypertension. Alcohol consumers were 1.8 times more likely to have hypertension than non-consumers. Respondents with a family history of hypertension were found 2.57 folds to have hypertension.

Conclusions:

Hypertension among retired Indian army is comparatively much higher than the general population in the study area. The finding of the study calls for an immediate primary care to the high-risk occupation groups targeting prevention, screening and control measures for blood pressure and associated risk factors.
HYPERTENSIVE EMERGENCIES AND URGENCIES IN EMERGENCY DEPARTMENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Astarita Anna , Covella Michele , Vallelonga Fabrizio , Cesareo Marco , Totaro Silvia , Ventre Luca , Apra’ Franco , Veglio Franco , Milan Alberto
Published: April 2021

Objective:

The prevalence of hypertensive emergencies (HEs) and urgencies (HUs) and of acute hypertension-mediated organ damage (aHMOD) in emergency departments (EDs) is unknown. Moreover, the predictive value of symptoms, blood pressure (BP) levels and cardiovascular risk factors to suspect the presence of aHMOD is still unclear. The aim of this study was to investigate the prevalence of HEs and HUs in EDs and of the relative frequency of subtypes of aHMOD, as well as to assess the clinical variables associated with aHMOD.

Design and method:

We conducted a systematic literature search on Pubmed, OVID and Web of Science from their inception to August 22, 2019. Two independent investigators extracted study-level data for a random-effects meta-analysis.

Results:

Eight studies were analysed, including 1970 HEs and 4983 HUs. The prevalence of HEs and HUs was 0.3% and 0.9%, respectively (O.R.for HUs vs HEs:2.5 (1.4–4.3)). Pulmonary oedema/heart failure was the most frequent subtype of aHMOD (32%), followed by ischemic stroke (29%), acute coronary syndrome (18%), haemorragic stroke (11%), acute aortic syndrome (2%) and hypertensive encephalopathy (2%). No clinically meaningful difference was found for BP levels at presentations. HU patients were younger than HE patients by 5.4 years and more often complained of non-specific symptoms and/or headache, while specific symptoms were more frequent among HE patients.

Conclusions:

HEs and HUs are a frequent cause of access to EDs, with HUs being significantly more common. BP levels alone do not reliably predict the presence of aHMOD, which should be suspected according to the presenting signs and symptoms.
HOSPITAL-BASED INTERVENTION TO ENHANCE HYPERTENSION DIAGNOSIS IN HOSPITAL K, THAILAND, 2017–2019: A PRE-POST PILOT INTERVENTION STUDY
Authors: Yueayai Khaneungnij , Moran Andrew , Pratipanwat Piyanut , Chaisongkram Siwaboon , Anosri Ladda , Thitichai Phanthanee
Published: April 2021

Objective:

In Thailand 5.9 million individuals ?15 years old have undiagnosed hypertension. The intervention to reduce undiagnosed hypertension was piloted and aimed to compare pre? and post?intervention hypertension diagnosis rate and follow?up rate. A hospital?based pre? and post?intervention study was piloted in a general hospital in Thailand. The intervention included an electronic pop?up alert when raised blood pressure was observed and a follow?up protocol. The follow?up protocol entered patient information in a follow?up book that scheduled an appointment to recheck blood pressure. Statistical analyses compared the rate of hypertension diagnosis and follow?up between the pre? and post?intervention periods, adjusted for differences in baseline characteristics. A post?intervention, self?report survey among nurses and nurse?aids explored perceptions about raised blood pressure management and solicited suggestions to improve the intervention. 574 raised blood pressure patients visited the hospital in the pre?intervention period; 27.4% returned for follow??up; and hypertension diagnosis rate was 1.4%. Among 686 post?intervention raised blood pressure patients, overall hypertension diagnosis rate improved to 6.1%. In per?protocol patients, 81.9% were booked to follow?up, hypertension diagnosis rate was 18.6%, and the adjusted odds ratio of hypertension diagnosis was 4.5 times higher compared with the pre?intervention period. By self?report, 20% of health workers had no time to provide the follow?up book due to work overload, yet >57% reported that information technology improved detection of raised blood pressure and improved follow?up. The interventions significantly increased the hypertension diagnosis rate and follow?up among raised blood pressure patients in a single hospital but may benefit from incorporating an information technology?assisted follow?up protocol
KNOWLEDGE ABOUT ARTERIAL HYPERTENSION IN GENERAL POPULATION: RESULTS OF A COMMUNITY PHARMACY SCREENING PROGRAM
Authors: Fanelli Elvira , Ravetto Lorenzo Enri , Fasano Chiara , Di Monaco Silvia , Pappaccogli Marco , Irene Pignata , Elisabetta Eula , Guglielmo Masera , Franco Rabbia , Brusa Paola , Veglio Franco
Published: April 2021

Objective:

Hypertension is a cardiovascular and cerebrovascular risk factor. Prevention of hypertension mediated organ damage is a main health problem. Guidelines underlines the importance of screening and educational programs in general population and the role of non-medical sanitary subjects, particularly pharmacists. This study evaluated knowledge about hypertension in a population afferent to community pharmacies of Piedmont and Ligury.

Design and method:

A questionnaire about knowledge of hypertension has been collected from 2731 community pharmacy costumers, participating to an arterial hypertension screening program. It included three sections about prevalence of hypertension, hypertension-mediated organ damage and preventive lifestyle behaviour. Blood pressure was measured with an Omron HEM 1040-E device. Further information about home blood pressure levels, cardiovascular, metabolic and cerebrovascular comorbidity were collected.

Results:

57,5% of subjects were female and mean age was 58,3 ± 15,9 ys. 47% subjects declared a hypertensive status, 41% normotensive one and 12% didn’t know their pressure status. Mean systolic blood pressure was 130 ± 18 mmHg and diastolic blood pressure 79 ± 10 mmHg. 69% of hypertensive subjects was not controlled at pharmacy evaluation, on the base of guidelines office target values. 10% of subjects self-declared normotensive and 35% who didn’t know their blood pressure status had a blood pressure >= 140/90 mmHg. In the questionnaire only 15% of subjects knew hypertension prevalence; 23% had a poor knowledge about lifestyle prevention interventions and 36% have poor knowledge about hypertension mediated organ damage. The proportion of people with poor knowledge was particularly higher in people who didn’t know their pressure status (low level consciousness about lifestyle and consequences in 30% and 48% of subjects respectively). Subjects with a low global knowledge about hypertension had significantly higher blood pressure levels compared to those with a good consciousness.

Conclusions:

Many people have poor knowledge of hypertension as risk factor; this is the base of poor blood pressure control and non-adherence. Community pharmacies may represent an important resource for education and prevention among general population, including people not seeking medical care.
RELATIONSHIP BETWEEN 24-HOURS URINARY SODIUM EXCRETION AND ARTERIAL STIFFNESS IN CONTROLLED HYPERTENSIVE AND RESISTANT HYPERTENSIVE INDIVIDUALS
Authors: Zanatta João Marcos De M. , Ricardi Fábio Dos S. , Uyemura Jéssica R.R. , Cosenso-Martin Luciana N. , Yugar-Toledo Juan C. , Vilela-Martin José F.
Published: April 2021

Objective:

To compare the influence of dietary sodium intake through 24-hours urinary sodium excretion (Na + Ur24 h) on arterial stiffness markers in controlled and resistant hypertensive individuals.

Design and method:

126 patients were randomized in an observational and cross-sectional study, divided into two groups: 63 in the controlled hypertension group (CHTN) and 63 in the resistant hypertension group (RHTN). All were submitted to clinical evaluation, laboratory tests, Na + Ur24 h and non-invasive central hemodynamic evaluation by the SphygmoCor® and Mobil-O-Graph® system to determine arterial stiffness parameters.

Results:

Clinical characteristics and laboratory tests were similar in both groups. There was no statistical significance between CHTN and RHTN for Na + Ur24 h values (186.60 ± 92.15 vs.179.76 ± 66.91 mEq/L, respectively). The carotid-femoral pulse wave velocity (cfPWVc) showed no statistically significant difference between CHTN and RHTN (10.52 ± 2.47 m/s vs. 10.21 ± 2.27 m/s, respectively). Central hemodynamic parameters were statistically different between the groups assessed by 24-hour ambulatory blood pressure monitoring (ABPM - Mobil-O-Graph®). RHTN group had higher cardiac output during sleep and greater vascular resistance during wakefulness and 24 hours than CHTN group (p < 0.05) in ABPM.

Conclusions:

Na + Ur24 h excretion is similar between groups, but there is better adherence to dietary sodium intake restriction in the resistant hypertension group. Physiological hemodynamic parameters are altered in the RHTN group, such as cardiac output and peripheral vascular resistance, a fact that evidences their participation in the pathophysiological process of resistant hypertension.
ASSOCIATION OF CARDIOVASCULAR OUTCOME WITH THE SLOPE BETWEEN SYSTOLIC BLOOD PRESSURE AND PULSE RATE MEASURED BY AMBULATORY BLOOD PRESSURE MONITORING IN A JAPANESE GENERAL PRACTICE
Authors: Narita Keisuke , Satoshi Hoshide , Kazuomi Kario
Published: April 2021

Objective:

Blood pressure (BP) and pulse rate (PR) usually show a physiologically negative correlations in terms of keeping cardiac output consistent. The relationship between BP and PR is associated with sympathetic activity. The higher PR corresponding to elevated BP measured by home BP monitoring reportedly elevates cardiovascular disease (CVD) risks. However, it remains unclear whether the relationship between ambulatory BP and PR predicts incident of CVD. We aimed to assess the predictive ability of the correlations between BP and PR for incident of CVD in clinical practice.

Design and method:

This is a prospective study, which recruited patients with a history of or risk factors of CVD. Participants underwent ambulatory BP monitoring and followed-up incident CVD, including stroke and coronary artery disease. The relationship between BP and PR was evaluated by the slope of correlation line between systolic BP (SBP) and PR in 24-hour, daytime, and nighttime which were assessed by each participant's diary. The association of the slope between SBP and PR with incident of CVD was assessed using Cox proportional hazards models.

Results:

Among 1422 participants (age, 64.6 ± 11.6 [mean ± SD], 47.6% male, 92.8% hypertensives), During a follow-up of 6.8 ± 3.5 years (9670 person-years), 49 stroke, 53 coronary artery disease (CAD), and 125 various CVD events (stroke, CAD, hospitalization due to heart failure, and aortic dissection) occurred. Although the slope between SBP and PR in daytime did not associated with CVD risks after adjustments for covariates, the slope between SBP and PR in nighttime was associated with an increase risk of stroke and various CVD events after adjustments for covariates (hazard ratios [95%CIs] for stroke: 1st quartile as reference; 2nd quartile, 1.45 [0.57–3.72]; 3rd quartile, 1.50 [0.60–3.74]; 4th quartile, 2.53 [1.05–6.11]; for various CVD events: 1st quartile as reference; 2nd quartile, 1.43 [0.83–2.47]; 3rd quartile, 1.56 [0.91–2.70]; 4th quartile, 1.96 [1.13–3.38]) (Table).

Conclusions:

Based on the results of this study, the slope between SBP and PR in nighttime was suggested to be associated to CVD outcomes.
ROLE OF SACUBITRIL/VALSARTAN IN THE TREATMENT OF CHRONIC HEART FAILURE WITH REDUCED EJECTION FRACTION IN ELDERLY HYPERTENSIVES WITH COMORBIDITY: FROM CLINICAL TRIALS TO REAL WORLD
Authors: Mazza Alberto , Torin Gioia , Schiavon Laura , Rossetti Ciro , Cuppini Stefano
Published: April 2021

Objective:

Sacubitril/Valsartan (SV) has been shown to reduce cardiovascular mortality in ambulatory patients with chronic heart failure (CHF) and reduced left ventricular ejection fraction (HFrEF). However there are few real-word evidences about its efficacy in elderly hypertensives with HFrEF and comorbidities.

Design and method:

In this prospective open-label study, 54 subjects (mean age 78.6 ± 8.2 years, 75.0% men), with HFrEF (29.8 ± 4.3%), in New York Heart Association (NYHA) class II-III were assigned to receive SV twice daily at different dosage of 24/26, 49/51, 97/103 mg. These patients were gender and age-matched with a control group of patients with HFrEF receiving optimal standard therapy for CHF. The office blood pressure (BP), the NT-pro-BNP, eGFR, blood glucose and glycated haemoglobin (HbA1c), uric acid (UA), left ventricular ejection fraction (LVEF) and NYHA class were evaluated at a mean follow-up of 14-months. Mortality and re-hospitalisation for HF were collected. Categorical variables were compared with the Pearson's test and difference of continuous variables, were evaluated by the analysis of variance for repeated measures.

Results:

NYHA class significantly improved in the SV than control group (24.9 vs. 6.4% moved from III-- > II and 55.4 vs. 25.2% from II-- > I classes, p < 0.05). A significant improvement of LVEF and eGFR levels was found in the ARNIs than controls (42.4 vs. 34.2%, 73.8 vs. 61.2 ml/min for all p < 0.001, respectively). The NT-pro-BNP, systolic BP, diastolic BP, blood glucose, HbA1c and UA values were lower in SV than controls (3107 vs 4552 pg/ml, 112.2 vs. 120.4 and 68.8 vs 75.6 mmHg, 108.4 vs 122.6 mg/dl, 5.4 vs. 5.9% and 5.9 vs 6.4 mg/dl, p < 0.05). Mortality and re-hospitalisation for CHF was lower in the SV than controls (20.1 vs. 33.6 and vs. 27.7 vs. 46.3%, p < 0.05).

Conclusions:

In elderly hypertensives with HFrEF and comorbidities SV treatment seems effective and safe. The improvement of LVEF, BP, eGFR, serum glucose, UA and HbA1c could be the mechanisms by which SV plays a beneficial role on clinical outcomes
LEFT VENTRICULAR STRUCTURE AND FUNCTION ARE RELATED WITH THYROID FUNCTION AND ELECTROLYTE LEVELS IN TREATMENT-NAIVE ESSENTIAL HYPERTENSIVE PATIENTS
Authors: Catena Cristiana , Brosolo Gabriele , Da Porto Andrea , Colussi Gianluca , Vivarelli Cinzia , Desimini Angela , Sechi Leonardo A.
Published: April 2021

Objective:

Left ventricular mass index (LVMI) and LV systolic and diastolic function are affected by a number of metabolic variables. Only a few studies have examined the relationship between LV structure and function of treatment-naive essential hypertensive (EH) patients with thyroid function and plasma electrolyte levels.

Design and method:

In 466 never treated EH patients (age 49 ± 13 years; 254 males), we measured BMI, waist circumference (WC), systolic (SBP) and diastolic (DBP) blood pressure, alcohol intake, glomerular filtration rate (GFR), and plasma levels of glucose, magnesium, calcium, 25OH-Vit.D, PTH, Free-T3, and Free-T4. In these patients we examined the cardiac structure and function by two-dimensional and Doppler echocardiography and tissue-Doppler imaging (TDI).

Results:

LV ejection fraction was directly correlated with Free-T3 and Free-T4 and inversely correlated with WC and DBP. LVMI was directly correlated with age, BMI, WC, SBP, DBP, serum glucose, magnesium, and PTH and inversely correlated with serum calcium. Transmitral E/A ratio was directly correlated with GFR and inversely correlated with age, WC, SBP, DBP, and serum glucose and magnesium. TDI e’ wave was directly correlated with GFR and serum calcium, and inversely correlated with age, WC, SBP, DBP, serum glucose and PTH. LV ejection fraction was independently associated with Free-T3 and Free-T4 (B = 0.134, P = 0.017 e B = 0.143, P = 0.007, respectively). Transmitral E/A ratio was independently associated with serum magnesium (B = -0.137, P = 0.015), while other relationships were lost in the multivariate analysis.

Conclusions:

In treatment-naive EH patients, LV systolic function is independently associated with higher circulating levels of thyroid hormones. LVMI is associated with lower serum calcium and higher serum PTH suggesting subtle secondary hyperPTH, but this association is lost when other variables that affect LVMI are considered.
ASSOCIATIONS OF SODIUM INTAKE WITH CENTRAL HEMODYNAMICS AND CHANGES IN VASCULAR STRUCTURE AND FUNCTION AT HIGH ALTITUDE LOCALITIES
Authors: Zhipeng Zhang , Xiaoping Chen , Xin Zhang
Published: April 2021

Objective:

To investigate the associations of sodium intake with central hemodynamics and changes in vascular structure and function at high altitude localities.

Design and method:

From December 2018 to January 2019, a total of 383 monks who participated in cardiovascular risk factors screening were enrolled in four temples around Luhuo County, Ganzi Tibetan Autonomous Prefecture with an average elevation of 3,800 meters. Questionnaire, physical examination, blood and urine examination, electrocardiogram, echocardiography, intima-media thickness (IMT), Brachial ankle pulse wave velocity (BaPWV), Ankle brachial index (ABI), Central systolic blood pressure (CSBP), Central diastolic blood pressure (CDBP), Central pulse pressure (CPP), Central mean arterial pressure (CMAP), Augmentation pressure (AP), Augmentation index (AI) and other tests were performed on all participants. Estimated 24-hour urinary sodium excretion was measured by the Kawasaki formula using the urinary sodium/urinary creatinine ratio of the second morning fasting urine. Pearson correlation and multiple linear regression were used to analyze the associations between 24 h urinary sodium and central arterial hemodynamic parameters and BaPWV and IMT.

Results:

1. The estimated 24 h urinary sodium excretion in the temple was (5.26 ± 1.61)g, and the estimated salt intake was (13.36 ± 4.09)g. There was no significant correlation between 24 h urinary sodium and CDBP, AP and IMT (P > 0.05). After gender, age, CSBP, body Mass Index (BMI), fasting blood glucose (FBG), estimated glomerular filtration rate (eGFR), triglycerides (TG), high density lipoprotein (HDL) and low density lipoprotein (LDL) were adjusted, 24 h urine sodium was positively correlated with CSBP (P = 0.018) and CPP (P < 0.001). After adjusting for gender, age, CSBP, BMI, eGFR, FBG, TG, HDL, LDL, 24 h urinary sodium was significantly negatively correlated with AIX75 and BaPWV (P = 0.028,P < 0.001, respectively). The line graph of means across the 24 h urinary sodium quartiles and the cubic fitting curve showed that the associations between 24 h urinary sodium excretion with AIX75 and BaPWV presented an approximate ’J’ shape.

Conclusions:

24 h urinary sodium was positively correlated with CSBP and CPP in the monks in this region. The associations between 24 h urinary sodium with AIX75 and BaPWV resembled a ’J’ shape.
LEFT VENTRICULAR STRUCTURE AND FUNCTION IN CENTENARIANS
Authors: Eruslanova Kseniia , Kotovskaya Julia , Runikhina Nadezjda , Tkacheva Olga , Bazaeva Ekaterina
Published: April 2021

Objective:

Centenarians are still represented as underinvestigated population. There is a large proportion of studies showed the anatomical and functional changes of the heart with ageing, but very few data available for centenarians. The aim of the Moscow Centenarian Study (NCT02876809) was to perform a complex evaluation of centenarians living in Moscow. Preliminary results of the prevalence of arterial hypertension and echocardiography are reported in this abstract.

Design and method:

Echocardiography was performed with a portable device In 64 (8 male) aged from 97 to 105 years. Medical history, including the past medical history of arterial hypertension (AH), was collected during an interview with centenarians, their relatives/ carers, and from medical notes if available. The diameter of aorta, left atrium size and volume index (LAVI), systolic and diastolic dimensions and volumes of the left ventricle (LV), LV mass index (LVMI), ejection fraction (EF) and diastolic function were evaluated. LV hypertrophy was diagnosed if LVMI was > 95 g/m2 in females or > 115 g/m2 in males, concentric LV geometry if relative wall thickness (RWT) > 0,42. The data are presented as Mean+SD.

Results:

The prevalence of AH was 78% (n = 64). Mean aortic root diameter was 3,5 + 0,34 cm and in 8 subjects exceeded 3,8 cm. Mean LAVI was 41,8 + 14,3 ml/m2 and was > 28 ml/m2 in 57 subjects. Normal LVMI and RWT were found in 13 (20,3%) of centenarians. Concentric LV remodelling was observed in 15 (23,4%), concentric LVH 24 (37,5%), eccentric LVH in 12 (18,7%). Two subjects had EF < 40% (history of MI in both), 62 subjects had EF > 50%. Structural abnormalities typical for heart failure with preserved EF (LV end diastolic volume < 97 ml/m2 and LAVI > 34 ml/m2 or LVH) was observed in 46 (71,9%) centenarians.

Conclusions:

The prevalence of AH and the structural changes which are specific for elevated blood pressure are common in this age group, as well as diastolic dysfunction.
LEFT VENTRICULAR HYPERTROPHIE ASSOCIATED WITH HYPERTENSION: PREVALENCE, IMAGING AND FACTORS ASSOCIATED
Authors: Maaroufi Anass , Zahidi Hatim Amine , Mehdi Aqli , Hajar Bendahou , Salim Arous , Ghali Bennouna El , Drighil Abdenacer , Habbal Rachida
Published: April 2021

Objective:

The prevalence of LVH increases with age, the severity of hypertension, and duration of hypertension. So, the presence of LVH indicates a long run of uncontrolled hypertension associated with many parameters.

The objective of the study is to determine prevalence and factors associated with LVH in the setting of Hypertension.

Design and method:

100 patients attending the outpatient department and those who were admitted from January 2016 to June 2017 were the study subjects.

All cases of hypertension, irrespective of the duration of hypertension and type of treatment received were included in the study. Patients with secondary hypertension, ischemic heart disease/myocardial infarction, ischemic cardiomyopathy, congenital heart disease, and valvular heart disease were excluded.

Results:

Out of 100 patients, 59 (59%) were males and 41 (41%) were females. Among 59 males, 36 (61.01%) showed LVH and among 41 females, 24 (58.53%) showed LVH. The majority of cases was in the age group of 50–59 years (n = 48, 48%). The youngest patient was aged 40 years and the oldest patient was aged 87 years and the mean age was 56.4 years.

Sokolow-Lyon criteria identified LVH in 24 patients. Among them, 18 (75%) were males and 6 (25%) were females.

ECHO identified LVH in 60 patients. Among them, 36 (60%) were males and 24 (40%) were females.

Out of 60 patients, 29 had mild LVH, 16 had moderate LVH, and 15 had severe LVH.

Out of 24 patients with blood pressure (BP) < 140 mmHg, 6 (25%) had LVH. Eighteen (58.08%) out of 31 patients had LVH with BP of 140–159 mmHg. Twenty-eight (77.78%) out of 36 patients had LVH in the BP group of 159–180 mmhg.

Among the 60 patients who had LVH at the echo only 15 patients had LVH at Electrocardiogram

Conclusions:

Left ventricular hypertrophy is a serious condition, so while managing a patient with hypertension the goal should be regression of LVH along with reducing BP to target level. ECG is not as good as Echocardiography to detect LVH, so wider use of Echocardiography is advocated.
CD153 VACCINE IS A NOVEL SENOTHERAPEUTIC OPTION FOR REMOVING SENESCENCE-ASSOCIATED T CELLS
Authors: Nakagami Hironori , Yoshida Shota , Morishita Ryuichi , Rakugi Hiromi
Published: April 2021

Objective:

Senotherapy targeting for senescent cells is designed to attenuate age-related dysfunction and promote healthy aging. Senescence-associated T cells (SA-T cells), defined as CD4+ CD44high CD62Llow PD-1+ CD153+ cells, accumulate in visceral adipose tissues (VAT) in obese individuals. Here, we show the long-lasting effect of using CD153 vaccination to remove SA-T cells from high-fat diet (HFD)-induced obese C57BL/6J mice.

Design and method:

The peptide vaccines for mouse CD153 consisted of a short peptide sequence conjugated to KLH (keyhole limpet hemocyanin) as a carrier protein to induce the specific CD153 antibody, and knowing the CD153 epitope information allowed five candidate peptide to be selected as antigens. The five peptide vaccines (30 microg of the CD153 peptide per mouse) were conjugated to KLH and coadministered with the Alum adjuvant (Alhydrogel) to seven-week-old male C57BL/6J mice twice at two-week intervals. CD153#D vaccine-induced antibodies effectively recognize the rmCD153 protein, and we selected the CD153#D vaccine as a candidate for further experimental studies.

Results:

The number of CD153+ SA-T cells increases gradually and systemically with age. Indeed, more CD153+ SA-T cells were observed in the splenic tissues of male C57BL/6J mice at 20 months of age than at 3 months of age (18.7 ± 0.5% vs. 3.8 ± 0.2%; p < 0.0001; n = 3 in each group). In VAT (viceral adipose tissue), CD153+ SA-T cells tended to increase more in elderly mice than in young mice (8.2 ± 1.0% vs. 4.3 ± 1.4%; p = 0.08; n = 3 in each group). We administered a CD153 peptide-KLH conjugate vaccine with Alhydrogel (CD153-Alum) or CpG oligodeoxynucleotide (ODN) 1585 (CD153-CpG) and confirmed an increase in anti-CD153 antibody levels that was sustained for several months. After being fed a HFD for 10–11 weeks, adipose SA-T cell accumulation was significantly reduced in the VAT of CD153-CpG-vaccinated mice, accompanied by glucose tolerance and insulin resistance. A complement-dependent cytotoxicity (CDC) assay indicated that the mouse IgG2 antibody produced in the CD153-CpG-vaccinated mice successfully reduced the number of SA-T cells.

Conclusions:

These results suggest that the CD153-CpG vaccine might be an optional tool for senolytic therapy.
AMLOPIDINE AND DRESS SYNDROME: UP TO DATE WITH MY KNOWLEDGE?
Authors: Lopez-Sublet Marilucy , Magnan Benjamin , Le Jeune Sylvain , Rousset Laurie , Lazaridou Ingrid , Ghouiles Sabrina , Benramedane Ghouti , Lukina Elena , Leprieur Benedicte Giroux , Benainous Ruben , Suhl Jaehyo , Foudi Farid , Dhote Robin
Published: April 2021

Objective:

Drug hypersensitivity syndrome or “Drug Reaction with Eosinophilia and Systemic Symptoms” (DRESS) is a severe form of cutaneous drug eruptions that combines skin manifestations and systemic damage. More than 50 drugs have been associated with this syndrome. Amlodipine is a long-acting calcium channel antagonist of type L (DHP), used as an antihypertensive drug. Peripheral edema remains one of the most common side effects of this drug, while dermatological events are very rare (1/100,000). We report a patient with DRESS syndrome who appeared under amlodipine treatment.

Design and method:

An 84-year-old hypertensive patient with eradicated chronic hepatitis C, chronic renal failure, idiopathic thrombocytopenia and dyslipidaemia was hospitalized with a febrile rash.

Treatment with amlodipine 5 mg/d is prescribed for hypertension and then stopped by the patient after 15 days. Resumption of treatment is an accompanied at 4 weeks by a diffuse and infiltrated erythematous skin rash (initially suggestive of a large mesh livedo), associated with facial edema and fever at 39°. EKG is normal. The biological parameters: progressive hypereosinophilia up to 9 G/l, lymphopenia at 0,9 G/l with hyperbasophilic activated T lymphocytes (TL), hepatic cytolysis, HHV6 PCR is positive. The autoimmune test remains negative. The skin biopsy shows an inflammatory infiltrate, rich in eosinophils, with a few rare necrosis areas leading to cutaneous drug eruption. There is no vasculitis. The RegiSCAR score was 4. The discontinuation of amlodipine and high-dose dermocorticoids allowed the rash and hypereosinophilia is reduced within a few weeks until complete disappearance. The pharmacovigilance survey retained this diagnosis with proscription from this drug class.

Results:

The pathogenesis of DRESS syndrome is still very controversial. A hypersensitivity cytokine mediation of TL, and the reactivation of HHV6 are involved. The RegiSCAR score (European register of Serious Adverse Skin Reactions) is used to categorize the imputability to a drug. Amlodipine remains an exceptional cause but should be known because of the very common frequency of prescribing this treatment.

Conclusions:

DRESS syndrome is a rare but serious side effect of calcium channel blockers. Lack of knowledge can leaf to diagnostic errors and unnecessary additional examinations.
GINGIVAL BLEEDING: A POSSIBLE INDICATOR OF HIGH BLOOD PRESSURE?
Authors: Del Pinto Rita , Pietropaoli Davide , Monaco Annalisa , D’aiuto Francesco , Aguilera Eva Muñoz , Ortu Eleonora , Giannoni Mario , Czesnikiewicz-Guzik Marta , Guzik Tomasz , Ferri Claudio
Published: April 2021

Objective:

Cardiovascular disease (CVD) and related risk factors, including hypertension, are characterized by systemic inflammation. Periodontitis, a chronic inflammatory disease of the supporting tissues of the tooth, has recently been associated with hypertension. However, it is not clear whether the risk of hypertension can vary throughout the natural history of periodontal diseases, that is, if it is modified by gingival bleeding, an easily investigable indicator of local pathology.

Design and method:

Survey-based propensity score matching (PSM) incorporating major confounders shared between hypertension and periodontal diseases (age, gender, ethnicity, poverty, BMI, hypertension diagnosis and treatment, smoking habit, diabetic status, aspirin use) was applied to cross-sectional NHANES III data from adults > = 30 years who underwent BP measurement and periodontal examination, identifying two matched groups with/without gingival bleeding. The association of bleeding gums with systolic blood pressure (BP, mmHg) and high/uncontrolled BP according to the European Society of Hypertension (ESH) was then assessed with generalized additive models incorporating inflammatory markers (CRP, white blood cells, ferritin). Stratification by periodontal health status (healthy; gingivitis; stable/unstable periodontitis) was performed.

Results:

Gingival bleeding (gingivitis; unstable periodontitis) was independently associated with +2.6 mmHg (p < 0.001) systolic BP compared with no bleeding (healthy periodontium; stable periodontitis), and with greater odds (OR 1.42, p < 0.001) of high/uncontrolled BP. Participants with unstable periodontitis had higher systolic BP than those with stable periodontitis (+2.1 mmHg; p < 0.001) or gingivitis (+5.3 mmHg; p < 0.001). Unstable periodontitis and gingivitis, but not stable periodontitis, were associated with increased risk of high/uncontrolled BP (OR 1.29, p = 0.046; OR 1.98, p < 0.001 respectively).

Conclusions:

Gingival bleeding contributes to shaping the relationship between periodontal diseases and hypertension. Inflammatory pathways specific for acute and chronic settings and the immunological/metabolic effects of microflora fluctuations might explain differences among disease strata in the association. Guidelines now recommend oral and periodontal examination in patients with CVD, and warn of the increased cardiovascular risk in the presence of periodontitis. Whether periodontal treatment in hypertension is a cost-effective measure for CV prevention is still undetermined; our results add to the existing observational evidence in support of this possibility.
VIEWS AND PERSPECTIVES OF HYPERTENSION EXPERTS IN GREECE REGARDING THE EFFICACY AND SAFETY OR RENAL SYMPATHETIC DENERVATION
Authors: Doumas Michael , Andreadis Emmanouil , Davlouros Periklis , Dimitriadis Kyriakos , Gkaliagkousi Eugene , Grassos Harris , Hatzitolios Apostolos , Imprialos Konstantinos , Kalaitzidis Rigas , Kallistratos Emmanouil , Konstantinidis Dimitrios , Kotsis Vasilios , Makris Thomas , Manolis Athanasios , Marketou Maria , Papadakis Ioannis , Papadopoulos Dimitrios , Poulimenos Leonidas , Sanidas Ilias , Savopoulos Christos , Stavropoulos Konstantinos , Stergiou George S. , Thomopoulos Konstantinos , Triantafyllidi Helen , Triantafyllou Areti , Vlachakos Dimitrios , Zebekakis Pantelis , Ziakas Antonios , Tsioufis Costas
Published: April 2021

Objective:

The role of renal sympathetic denervation (RSD) in the management of arterial hypertension remains controversial, given the initial enthusiasm by the first studies, the great disappointment by the first sham-controlled randomized study and the current promising finding in recent randomized trials. Therefore, an uncertainty exists about the beliefs of hypertension specialists regarding RSD. This analysis presents the opinions of hypertension experts in Greece regarding the efficacy and safety of RSD.

Design and method:

Chairpersons of ESH Hypertension Excellence Centers in Greece and their senior clinical research fellows, were invited to participate in a meeting aiming to discuss the current evidence on the clinical utility of RSD. Individual responses were recorded and qualitatively analyzed, in order to reach consensus about the safety and efficacy of RSD.

Results:

Twenty-five experts participated in the meeting (cardiologists 52%, internists 40%, nephrologists 8%). Participants agreed upon the favorable results of three recent clinical trials and supported the view that RSD is an effective method. 44% believe that further technological development of the denervation catheter is expected to improve the results of the technique. Importantly, 22% of the experts highlighted the additional benefits of the method in regressing target organ damage and in patients with increased activity of the sympathetic nervous system. However, 44% of the experts underlined the lack of reliable predictive markers for the efficacy of RSD, while 32% highlighted the lack of long-term efficacy studies. Experts universally agreed on the safety of the method. However, 64% stated that the duration of the RSD trials was short, and thus there is lack of data on the long-term safety of RDS. Of note, 76% considered the method as easy to perform and minimally invasive.

Conclusions:

The majority of the hypertension experts in Greece agree upon the efficacy of RSD and all had minimal concerns of the safety of method. More data are needed to reveal the degree of confidence among hypertension experts regarding the efficacy and the safety of the whole procedure and its specific aspects.