bluuebunny/crossref_metadata_2025 huggingface dataset:
RELATIONSHIP BETWEEN CLINIC AND AMBULATORY BLOOD PRESSURE AND MORTALITY IN PATIENTS WITH PREVIOUS STROKE
Authors: Armario Pedro , Gomez-choco Manuel , Garcia-sanchez Sonia , Ruilope Luis M , Williams Bryan , De La Sierra Alejandro
Published: May 2024

Objective:

The aim of this study was to evaluate the association between clinic and ambulatory BP and mortality in patients with a previous stroke

Design and method:

Observational cohort study from the Spanish Ambulatory Blood Pressure Registry. Mortality data (date and cause) were ascertained by a computerized search of the vital registry of the Spanish National Institute of Statistics. For each study participant, follow-up was from the date of his or her recruitment to the date of death, or December 31st, 2019, whichever occurred first. Cox models were used to estimate associations between clinic and ambulatory BP and mortality, adjusted for clinical confounders (age, sex, BMI, smoking, diabetes, and dyslipidemia), and additionally for alternative measures of BP.

Results:

From the 59 124 individuals included in the Registry, we selected 2,183 with a previous stroke. Mean age was 67.5 ± 11.8 years, 43.6% were female. During a median follow-up of 9.7 years (IQR 7.7–11.3), 632 (29.5%) participants died, including 236 from cardiovascular causes (62 ischemic heart disease deaths, 83 stroke deaths, and 28 heart failure deaths). In the confounder-adjusted model, clinic systolic BP was not associated with the risk of all-cause or cardiovascular mortality. In contrast, systolic BP indices obtained through ABPM (24h, day and night) were all associated with all-cause and cardiovascular mortality. In the simultaneous adjustment of daytime and night-time systolic BP, only night-time systolic BP remained significantly associated with all cause and cardiovascular death: OR 1.36 (1.21-1.52) and 1.45 (1.21-1.73), respectively. For diastolic BP, only night-time BP was associated with all-cause and cardiovascular mortality: OR 1.33 (1.18-1.49) and 1.58 (1.32-1.89), respectively. Reverse dipper pattern (risers) was also associated with all-cause mortality: OR 1.56 (1.18-1.86) and cardiovascular mortality: OR 1.81 (1.27-2.57).

Conclusions:

In patients who have suffered a previous stroke, night-time blood pressure is the BP estimate most closely associated with all-cause and cardiovascular mortality.
SEVERE COURSE OF PARAGANGLIOMAS IN CHILDREN WITH SUCCINATE DEHYDROGENASE MUTATIONS – A REPORT OF TWO CASES
Authors: Skrzypczyk Piotr , Soltyski Jaroslaw , Bujanowicz Adam , Ambroziak Urszula , Grat Michal , Toutounchi Sadegh , Niemczyk-cieslak Elzbieta , Niemczyk Kazimierz , Furmanek Mariusz I. , Panczyk-tomaszewska Malgorzata
Published: May 2024

Objective:

Paragangliomas and pheochromocytoma (PPGL) are rare causes of arterial hypertension (AH) in children. This study aimed to present the clinical course in two adolescents with PPGL tumors due to succinate dehydrogenase mutations.

Design and method:

We analyzed age, gender, clinical manifestations, laboratory findings, including plasma methoxycatecholamines, genetic and imaging findings, pharmacological and surgical treatment, and outcome.

Results:

Case 1: A 14-year-old boy presented with tinnitus, dizziness, and balance disorders. A computed tomography (CT) revealed a paraganglioma in the area of the left internal jugular vein bulb, causing ear and bone destruction. The boy was diagnosed with AH; his plasma normetanephrine was 343pg/mL (normal range: 18-138), metanephrine and 3-methoxytramine were normal. The patient was started on doxazosin, and the tumor was removed. A genetic study showed a pathogenic variant in the SDHD gene (c.33C>A). PET/CT showed another tumor between the inferior vena cava and diaphragm. A successful tumor resection was performed. Currently, the boy is 17 years old, methoxycatecholamine levels are normal. The patient has AH (primary hypertension) and is treated with rampiril and amlodipine.

Case 2: A 17.5-year-old girl was admitted to the hospital due to headaches and AH lasting about six months. Laboratory tests revealed a markedly elevated plasma normetanephrine - 8734.59pg/mL (normal range: 16-142) and a slightly elevated 3-methoxytramine - 25.52pg/mL (normal range < 14). CT showed a large tumor (11x7x7cm) at the level of the diaphragm, modeling the heart, liver, and inferior vena cava. Whole-body PET/CT and MIBG scintigraphy did not detect other tumors. A genetic test showed a pathogenic variant in the SDHB gene (c.181dupT). The girl was treated with doxazosin. Surgical treatment included two transarterial embolizations, followed by surgical removal of the tumor. Currently, the patient is 18 years and 2 months old, has normal methoxycatecholamines, and does not require antihypertensive drugs. The same variant of the SDHB gene was found in the patient's father and older brother.

Conclusions:

1.PPGL can have an unusual clinical course in children, and patients may present with a variety of symptoms

2.Pediatric patients with PPGL require genetic tests and individualized, multidisciplinary medical care.
THE SUBCLINICAL INFLAMMATION IN PEDIATRIC PATIENTS WITH PRIMARY HYPERTENSION AND WHITE COAT HYPERTENSION
Authors: Dziedzic-jankowska Katarzyna , Bujanowicz Adam , Szyszka Michal , Stelmaszczyk-emmel Anna , Skrzypczyk Piotr
Published: May 2024

Objective:

Adult and experimental data indicate the vital role of inflammation in the pathogenesis of primary hypertension. The study aimed to evaluate subclinical inflammation in patients with primary hypertension (PH) and white coat hypertension (WCH).

Design and method:

In 56 untreated pediatric patients with PH, 40 with WCH, and 30 healthy individuals (CG – control group), we evaluated high sensitivity C-reactive protein (hsCRP), interleukin 18 (IL18) concentrations, complete blood count-derived markers of inflammation, office and ambulatory blood pressure, and selected clinical and biochemical parameters.

Results:

hsCRP was significantly higher in PH patients compared to CG (PH vs. CG: 4.9±5.2 vs. 2.8±5.4 [mg/dL], p=0.002), and neutrophil and monocyte counts were significantly higher in PH and WCH patients compared to CG (PH vs. WCH vs. CG, neutrophils: 3.89±1.44 vs. 3.40±1.75 vs. 2.63±0.96 [∗10^3/μL], p=0.001, monocytes: 0.56±0.17 vs. 0.53±0.18 vs. 0.46±0.14 [∗10^3/μL], p=0.026). Receiver operating characteristic analysis revealed good prognostic profiles for hsCRP (area under curve [AUC]=0.668, p=0.0005), neutrophil (AUC=0.691, p=0.0001), lymphocyte (AUC=0.615, p=0.0230), monocyte (AUC=0.622, p=0.0148), and platelet counts (AUC=0.606, p=0.0364), as well as the neutrophil-to-lymphocyte ratio (AUC=0.619, p=0.0181), monocyte-to-neutrophil ratio (MNR) (AUC=0.617, p=0.0204), and platelet-to-mean platelet volume ratio (AUC=0.606, p=0.0370) as predictors of the presence of primary hypertension. In multivariate analysis monocyte-to-lymphocyte ratio (MLR) and platelet count (beta=0.217, p=0.011; beta=0.191, p=0.036) were significant predictors of office diastolic blood pressure Z-score, neutrophil count predicted 24h systolic blood pressure Z-score (beta=0.365, p=0.005); MLR, lymphocyte count, IL-18, and MNR predicted 24 h diastolic blood pressure Z-score (beta=0.305, p=0.002; beta=0.253, p=0.010; beta=-0.197, p=0.019; beta=-0.189, p=0.029), and neutrophil count together with IL-18 predicted 24h mean arterial pressure Z-score (beta=0.210, p=0.027; beta=-0.209, p=0.012).

Conclusions:

1.Patients with primary hypertension and white coat hypertension are characterized by similar levels of subclinical inflammation, significantly higher compared to healthy peers. 2. Complete blood count-derived indices, especially neutrophil count and MLR, can be an important adjunct to the clinical evaluation of pediatric patients with primary hypertension.
ASSOCIATION BETWEEN SINGLE POINT INSULIN SENSITIVITY ESTIMATE AND METABOLIC PHENOTYPE IN CHINESE ADOLESCENTS AGED 12–18 YEARS OLD
Authors: Tian Mei , Ma Xiaoyan , Liu Jianxi , Tong Lingling , Ding Wenqing
Published: May 2024

Objective:

To study the relationship between single-Point Insulin Sensitivity Estimator (SPISE) and metabolic phenotypes of obesity in adolescents in Yinchuan City, and to provide a basis for the prevention and control of adolescent obesity and related metabolic diseases.

Design and method:

A total of 1 573 adolescents aged 12 to 18 years were randomly selected by stratified cluster sampling in Yinchuan City from 2017 to 2020, and they were surveyed using questionnaires, physical measurements, body composition measurements, and laboratory tests. According to the diagnostic criteria for metabolic abnormalities and the definition of obesity based on the body mass index, the subjects were divided into four metabolic phenotypes: metabolically healthy normal weight, metabolically healthy obesity, metabolically unhealthy normal weight, and metabolically unhealthy obesity. The association between SPISE and the metabolic phenotypes was analyzed using multivariate logistic regression.

Results:

The SPISE levels in the metabolically unhealthy normal weight,metabolically healthy obesity, and metabolically unhealthy obesity groups were all lower than those in the metabolically healthy normal weight group (P<0.001). Multivariate logistic regression analysis showed that after adjusting for gender and age, higher SPISE levels were protective factors for adolescents to develop metabolic unhealthy normal weight, metabolically healthy obesity, and metabolically unhealthy obesity phenotypes (OR=0.89, 0.04, and 0.04, respectively; P<0.001).

Conclusions:

Increasing SPISE can reduce the risk of the development of metabolic unhealthy/obesity. In the prevention of adolescent obesity and related metabolic diseases, attention should be paid to the monitoring of SPISE index, so as to reduce the risk of adolescent obesity and cardiovascular and metabolic abnormalities.
ANALYSIS OF THE MEDIATING EFFECT OF NONTRADITIONAL LIPID PARAMETERS IN THE RELATIONSHIP BETWEEN BODY MASS INDEX AND BLOOD PRESSURE IN CHINESE ADOLESCENTS
Authors: Ma Xiaoyan , Tian Mei , Liu Jianxi , Tong Lingling , Ding Wenqing
Published: May 2024

Objective:

To analyze the mediating role of non-traditional lipid parameters in the relationship between body mass index (BMI) and blood pressure in children and adolescents, and to provide a reference basis for the development of hypertension prevention and treatment strategies in children and adolescents.

Design and method:

A stratified whole-group random sampling method was used to select 1796 children and adolescents aged 12 to 18 years from middle and high schools in Ningxia for physical examination and laboratory testing, and a mediating effect model was used to analyze the mediating effect of nontraditional lipids on the relationship between BMI and blood pressure.

Results:

Among the nontraditional lipid parameters, all of them were significantly associated with blood pressure except Non-HDL-C (all P<0.001); three of them, Remnant Cholesterol (RC), TG/HDL-C and RC/HDL-C, had significantly higher effects on blood pressure than the others (all P<0.001). HDL-C, RC and RC/HDL-C partially mediated the relationship between BMI and blood pressure, with the three mediating effects accounting for 5.2%, 6.9%, and 7.5% of the relationship between BMI and diastolic blood pressure and 4.4%, 3.0%, and 3.8% of the relationship between BMI and systolic blood pressure, respectively (all P<0.001).

Conclusions:

Nontraditional lipid parameters are associated with blood pressure and partially mediate the relationship between BMI and blood pressure, and more attention should be paid to the role of monitoring nontraditional lipid parameters in the management of blood pressure in children and adolescents.
WHITE COAT HYPERTENSION IN EX-PRETERM CHILDREN ASSOCIATES WITH HIGHER NGAL LEVELS
Authors: Chainoglou Athanasia , Sarafidis Kosmas , Taparkou Anna , Farmaki Evangelia , Chrysaidou Katerina , Gidaris Dimos , Kollios Konstantinos , Kotsis Vasilios , Stabouli Stella
Published: May 2024

Objective:

As preterm birth is a risk factor for hypertension (HTN), biomarkers for early detection of HTN in childhood is an emerging need. The aims of the study were to evaluate serum biomarkers in ex-preterm children and examine for associations with blood pressure (BP) phenotypes using both office BP and ambulatory BP monitoring to classify BP levels.

Design and method:

This prospective case-control study included 52 children and adolescents born prematurely (ex-preterms) and 22 ones born at full term (controls). All participants underwent office and ambulatory BP monitoring, and assessment of serum biomarkers at the same clinic visit. Neutrophil gelatinase-associated lipocalin (NGAL), matrix metalloproteinase-2, -9 (MMP-2, -9), and Cystatin C (CysC) were measured using enzyme-linked immunosorbent assay.

Results:

Mean age of the population was 10.74±3.55 years. 31% of the ex-preterm children and 23% of the controls had white-coat hypertension (WCH). Among ex-preterm children and adolescents 17% had ambulatory HTN and 31% had white-coat HTN. Among controls 23% had WCH while none of the children and adolescents in the control group had ABP HTN. NGAL, CysC, MMP -2, and -9, levels did not differ between BP phenotypes in the study population. When ex-preterm group was analyzed separately, NGAL levels were found higher in ex-preterm children with WCH compared to children with normal BP in the ex-preterm group [57.89 (IQR 50.79) versus 34.58 (IQR 46.22), p=0.018}. Receiver operator curve analysis showed that NGAL could be a significant predictor of WCH in the ex-preterm group with area under the curve (AUC) of 0.718 (95% CI 0.56-0.87, p = 0.005) (Figure).

Conclusions:

As WCH is common in ex-preterm children and adolescents and is associated with higher NGAL levels, regular BP measurement in children with history of prematurity or low weight at birth is recommended because of their increased risk of HTN and cardiovascular disease in the future.
FIBROSIS AS AN ADDITIONAL RISK FACTOR FOR STROKE DEVELOPMENT IN HYPERTENSIVE PATIENTS WITH ATRIAL FIBRILLATION (RETROSPECTIVE STUDY)
Authors: Hazarapetyan Lusine , Zelveian Parounak , Grigoryan Svetlana
Published: May 2024

Objective:

Atrial fibrillation (AF) is a common issue that is increasingly prevalent, particularly in hypertensive patients and leads to severe complications, notably stroke. Several prothrombotic factors are elevated in AF, contributing to an increased risk of stroke. Tissue factor (TF) is the main initiator of the blood coagulation cascade, also involved in inflammation and fibrogenesis. Atrial fibrosis plays a central role in creating the substrate for AF, with the Transforming Growth Factor (TGF-B1) identified as a key cytokine involved in the pathogenesis of atrial fibrosis. The aim of this study is to investigate the relationship between atrial fibrosis and the risk of developing transient ischemic attack (TIA) or stroke in hypertensive patients with AF (retrospective study).

Design and method:

We observed 445 hypertensive patients with nonvalvular AF over three years (2017-2019). Clinical examination included a study of complaints, physical, laboratory, and instrumental examination, along with additional biochemical blood tests, such as TF, hsCRP, IL-6, and TGF-B1. Blood tests were determined using the ELISA method. Treatment regimens for all patients included standard therapy (anticoagulants, antiarrhythmic, and symptomatic medication). Studies were conducted based on open-label protocols, using the universal statistical packages SPSS 13.0.

Results:

The obtained results have shown that among the 445 hypertensive patients with AF within three years, TIA or stroke was detected in 128 patients (28.8%). We found that in these patients, the level of TF is statistically elevated compared to other patients with AF (1350±65 vs. 850±33 pg/ml). Hypertensive patients undergoing TIA or stroke exhibited a significant increase in levels of inflammatory and fibrosis markers compared with other hypertensive patients with AF. Significant differences between hsCRP levels were observed (8.6±1.4 vs. 4.2±1.6, p=0.002); IL-6 levels (6.4±0.8 vs. 3.6±1.2 pg/ml, p=0.043); and TGF-B1 levels (1240±75 vs. 900±43 pg/ml, p=0.02). Moreover, plasma levels of hs-CRP were higher among AF patients at high risk of stroke (3 or more) according to CHA2DS2-VASc (p=0.002).

Conclusions:

We have demonstrated that fibrosis and inflammation markers, along with coagulation cascade markers, are additional prognostic criteria contributing to the development of TIA or stroke in hypertensive patients with AF.
DEVELOPMENT AND INTERNAL VALIDATION OF A PREDICTION MODEL TO PREDICT THE PROBABILITY OF FUTURE RECURRENCE OF HYPERTENSION IN PATIENTS WITH HYPERTENSIVE DISORDERS OF PREGNANCY
Authors: Sun Yancui
Published: May 2024

Objective:

This study aimed to obtain a clinical prediction model for the future recurrence of hypertension in women with a history of gestational hypertension or Preeclampsia-Eclampsia by analyzing the basic data and laboratory indicators in their pregnancy.

Design and method:

We retrieved hypertensive disorders of pregnancy (HDP) patients of the First Affiliated Hospital of Dalian Medical University and the Second Affiliated Hospital of Dalian Medical University from 2001 to June 2021. After telephone follow-up, a total of 605 pregnant women with previous HDP were followed up. The baseline data of the cases were followed by binary logistic regression analysis according to the follow-up hypertension outcome, Nomogram plotted according to independent risk factors, and the model discrimination was tested by operating characteristic curve (ROC), The reproducibility of the model was verified by internal validation on the development dataset (Bootstrap self-sampling method, internal cross-validation and Jackknife validation), verify the calibration of the model through the calibration curve (Hosmer-Lemeshow goodness of fit test), and Validation of clinical predictive value by Decision Curve Analysis (DCA).

Results:

data analysis showed that A total of 200 (33.06%) pregnant women with a previous history of HDP had recurrent hypertension during follow-up (median follow-up time was 5 years). The predictors in the Nomogram were the highest diastolic blood pressure (DBP) during pregnancy, the highest systolic blood pressure (DBP) during pregnancy, peak Alkaline phosphatase value, age at delivery, peak uric acid value, and positive urine protein, Contrary to the remaining 5 predictors, a low level of peak alkaline phosphatase value predicted a high risk of postpartum hypertension. the Area Under Curve (AUC) of ROC about the nomogram was 0.797, and a similar C-index was obtained in the internal validation, and this model show a high fitting degree in the calibration curve and show clinical predictive value.

Conclusions:

The results of this study can provide predictive indicators for women with HDP to suffer from hypertension after delivery, which can be used for clinical decision-making, and aid with follow-up blood pressure monitoring and the selection of primary prevention treatment groups.
THE EFFECTS OF OLMESARTAN/AMLODIPINE ADMINISTERED IN THE MORNING OR AT NIGHT ON NOCTURNAL BLOOD PRESSURE IN CHINESE PATIENTS WITH MILD-MODERATE ESSENTIAL HYPERTENSION (OMAN TRIAL)
Authors: Ye Runyu , Zhang Xin , Liu Xueting , Sun Lirong , Chen Xiaoping
Published: May 2024

Objective:

The clinical evidence of antihypertensive chronotherapy remains controversial. This study aimed to compare the effects of morning and bedtime antihypertensive administration on the nocturnal blood pressure (BP) reduction and the circadian rhythm of hypertensives.

Design and method:

A randomized, multicenter, open-label clinical trial was conducted in China from March, 2022. Patients aged 18-75, not taking or stopped using antihypertensive drugs for 2 weeks, were recruited. At baseline, all patients received 24-h ambulatory BP measurement (ABPM) and office BP measurement (OBPM), and were randomized to the morning (06:00-10:00 AM, group 1) or the bedtime dosing group (6:00-10:00 PM, group 2). Each patient received one tablet of olmesartan/amlodipine (OA) (20/5 mg) daily for 4 weeks, and then followed up every 4 weeks for 12 weeks. The OA dosage was adjusted based on the ABPM and OBPM. Patients with uncontrolled BP at the first follow-up received an increased dosage to 1.5 tablets, and increased to 2 tablets if BP was uncontrolled after 4 weeks of dosage increase.

Results:

700 patients were recruited (mean age 56.54±10.52 years; 45.5% female), with 382 finished the 12-week follow-up and were included in the analysis (follow-ups are continuing). At week 4, the mean BP differences of ABPM and OBPM did not differ significantly between groups. At week 12, compared with group 1, patients in group 2 showed significantly greater reductions from baseline in nighttime systolic BP (SBP) (between-group difference -5.04mmHg, 95% confidence interval (CI): -8.38 to -1.70), and diastolic BP (DBP) (-3.03mmHg, 95% CI -5.08 to -0.97); with better nocturnal SBP control (67.4% vs. 76.7%, P=0.04), and decrease in nocturnal BP load. The proportion of non-dipper or reverse dipper increased from 52.3% to 54.4% in group 1 (P=0.64), and dropped from 57.9% to 45.5% in group 2 (P<0.01). The incidence of nocturnal hypotension (SBP/DBP<100/90mmHg) did not differ.

Conclusions:

Compared with morning dosing, bedtime dosing can better control nocturnal BP, and improve the circadian rhythm without increasing the risk of nocturnal hypotension. It represents a reasonable strategy to optimize BP control, especially nocturnal BP control.
CHARACTERISTICS OF DIFFERENT HYPERTENSION STAGES IN CHINA —RESULTS FROM A NATIONAL CROSS-SECTIONAL UPPDATE STUDY
Authors: Xie Kun , Gao Xiufang , Bao Liwen , Shan Ying , Li Yong
Published: May 2024

Objective:

We sought to investigate the prevalence and characteristics of patients with hypertension stage 1, 2, and 3 according to 2023 ESH guidelines for the management of hypertension.

Design and method:

A cross-sectional study was carried out in 90 centers from 15 cities in China from 2017-2018. Patients aged over 18 years with essential hypertension were investigated. Hypertension stage 1 was defined as uncomplicated hypertension without hypertension-mediated organ damage (HMOD), diabetes, cardiovascular disease (CVD) and without chronic kidney disease (CKD) >=stage 3. Hypertension stage 2 was defined as presence of HMOD, diabetes, or CKD stage 3. Hypertension stage 3 was defined as presence of CVD or CKD stage 4 or 5.

Results:

A total of 4286 patients were included, 56% of whom were male. Hypertension stage 1, 2, and 3 account for 28%, 50%, and 22% respectively. Ninety-three % of the total patients were having antihypertensive therapy. The average BP was 133±12/85±11 mmHg, 146±17/83±12 mmHg, and 143±19/84±13 mmHg in hypertension stage 1, 2, and 3 respectively. Lipid lowering therapy accounted for 40%, 49%, and 71% respectively, which was relatively low. The average LDL-C level was 3.0±1.0mmol/L, 2.9±1.0mmol/L, and 2.6±1.4mmol/L respectively, which was far from the goal of LDL-C management. Homocysteine was 11.2±9.6 μmol/L, 13.6±9.1 μmol/L, and 19.0±11.2 μmol/L, which increased from stage 1 to stage3.

Conclusions:

Hypertension stage 2 accounted for half of the patients with hypertension in China. The average blood pressure was much higher in stage 2 and stage 3. Only 71% of hypertension stage 3 were having lipid lowering therapy and LDL-C levels were far from the recommended goal. Homocysteine was positively associated with hypertension stage.
RATIONALE AND DESIGN OF THE PROSPECTIVE IN-HOSPITAL DETECTION OF ELEVATED BLOOD PRESSURE STUDY (INDEBP)
Authors: Vischer Annina , Hausknecht Katharina , Socrates Thenral , Mayr Michael , Breidthardt Tobias , Burkard Thilo
Published: May 2024

Objective:

There is a large gap in evidence on how to handle asymptomatically elevated blood pressure (BP) values during non-cardiac hospitalization. Recent data suggests that initiation or up-titration of antihypertensive drugs during hospitalization poses a risk of adverse events, possibly due to over-diagnosis and treatment. The aim of the study is to elucidate the prevalence of new persistent or uncontrolled arterial hypertension (AHT) four weeks after hospital discharge in patients with elevated BP values during hospitalization and to demonstrate safety of postponement of treatment.

Design and method:

This is a single-center, open-label, prospective, two-phase observation-intervention study. Patients with asymptomatically elevated BP values during non-cardiac hospitalization will be included. The study contains two subsequent periods. In a first control phase, adjustment of BP treatment will be at the discretion of the treating physician without any interference by the study physicians. In the second intervention phase, the patients’ pre-hospital antihypertensive treatment will not be changed during hospitalization. Only bail out medications for safety reasons will be permitted. Four weeks after hospital discharge, all patients will receive a 24h BP measurement (ABPM) (Figure). Patients with new or uncontrolled AHT on ABPM will be offered treatment recommendations according to current guidelines. We plan to enroll 400 participants in each phase. The primary endpoint will be the proportion of new persistant or uncontrolled AHT according to mean ABPM. Furthermore, prevalence of adverse events consisting of intracerebral bleeding, ischemic stroke, myocardial infarction, cardiovascular death or cardiovascular re-hospitalization, falls, acute kidney injury, or electrolyte disturbances will be analyzed.

Results:

Study received Ethical Committee approval by October 2023 with the first-patient-in November 16th 2023. During the first week we screened 21 patients with enrolment of 6. Main reason not to participate is the lack of consent to attend the ABPM installation due to their poor health.

Conclusions:

This is the protocol of a new study assessing the outcome of postponement of antihypertensive treatment in patients and adding new insights into the management of asymptomatic BP elevations during non-cardiac hospitalizations.
EVALUATING THE IMPACT OF OMEGA-3 FATTY ACID SUPPLEMENTATION ON LIPID PROFILES IN ADULTS WITH PPARG POLYMORPHISMS: A RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED TRIAL
Authors: Pokushalov Evgeny , Ponomarenko Andrey , Bayramova Sevda , Garcia Charlotte , Pak Inessa , Shrainer Evgenya , Johnson Michail , Miller Richard
Published: May 2024

Objective:

To assess the effects of fish oil supplementation on cardiovascular markers among adults with PPARG gene polymorphisms in a randomized, double-blind, placebo-controlled trial.

Design and method:

A cohort of 102 individuals, aged 40-75 with LDL-C 70-190 mg/dL, was randomized to receive either 2000 mg of omega-3 fatty acids or a placebo daily for 90 days. Adherence, dietary and lifestyle constancy were monitored, and lipid and metabolic panels were evaluated at baseline and study conclusion.

Results:

Ninety-nine participants completed the trial. In the omega-3 group with PPARG polymorphisms, LDL-C was reduced by 15.4% (95% CI: -19.8% to -11.0%), compared with a 2.6% decrease in the placebo group (95% CI: -4.1% to -1.1%; p<0.01). In the omega-3 group without PPARG polymorphisms, LDL-C was reduced by 3.7% (95% CI: -6.9% to -0.6%), not significantly different from the placebo group's reduction of 2.9% (95% CI: -5.1% to -0.8%; p=0.28). The reduction in LDL-C was notably 11.7% greater in those with PPARG polymorphisms than in those without (95% CI: -19.3% to -4.0%; p<0.01). Triglycerides decreased by 21.3% in omega-3 recipients with PPARG polymorphisms (95% CI: -26.5% to -16.2%; p<0.01), with no significant changes in HDL-C, total cholesterol, or hsCRP levels in any groups. Minor allele frequencies and baseline characteristics were comparable, ensuring a balanced genetic representation.

Conclusions:

Our study provides robust evidence supporting the modulatory role of PPARG polymorphisms in lipid metabolism in response to omega-3 fatty acid supplementation. The data obtained from this randomized, double-blind, parallel-group clinical trial unequivocally demonstrate that individuals with PPARG polymorphisms, who are at low-to-moderate cardiovascular risk and present with elevated cholesterol levels, benefit significantly from the introduction of omega-3 fatty acids into their diet. These benefits are manifested in substantial reductions in LDL-C, total cholesterol, and serum triglycerides over a three-month period.

Importantly, the findings highlight the potential for personalized nutrition strategies, suggesting that genetic profiling could be an invaluable tool in optimizing lipid-lowering interventions. Patients carrying PPARG polymorphisms showed greater improvements in lipid profiles, indicating that genetic predispositions should be considered when prescribing omega-3 fatty acid supplementation.
EFFECT OF METHYLFOLATE, PYRIDOXAL-5’-PHOSPHATE, AND METHYLCOBALAMIN SUPPLEMENTATION ON HOMOCYSTEINE AND LDL-C LEVELS IN PATIENTS WITH MTHFR, MTR, AND MTRR POLYMORPHISMS
Authors: Pokushalov Evgeny , Ponomarenko Andrey , Bayramova Sevda , Garcia Charlotte , Pak Inessa , Shrainer Evgenya , Johnson Michael , Miller Richard
Published: May 2024

Objective:

To assess the effects of methylfolate, pyridoxal-5’-phosphate (P5P), and methylcobalamin on homocysteine and lipid levels in patients with MTHFR, MTR, and MTRR gene polymorphisms linked to CVD.

Design and method:

In a thorough randomized, double-blind, placebo-controlled study design, 54 patients between the ages of 40-75, with elevated homocysteine levels and moderate LDL-C levels, were enrolled. Stratified by their genetic makeup concerning MTHFR, MTR, and MTRR polymorphisms, participants received either an intervention comprising methylfolate, P5P, and methylcobalamin or a placebo over a 6-month period. The primary endpoint was the percent change in serum homocysteine levels, while secondary endpoints included the assessment of LDL-C, HDL-C, total cholesterol, serum triglycerides, and hsCRP.

Results:

The trial concluded with 51 participants, demonstrating high adherence and consistent dietary habits. At 6-month follow-up, the treatment group demonstrated a significant reduction in homocysteine levels by 30.0% (95% CI: -39.7% to -20.3%) and LDL-C by 7.5% (95% CI: -10.3% to -4.7%), compared to the placebo (p<0.01 for all). Changes in HDL-C and other lipid markers were not statistically significant.

In the subgroup analysis, homozygous minor allele carriers showed a more significant reduction in homocysteine levels (48.3%, 95% CI: -62.3% to -34.3%, p<0.01) compared to mixed allele carriers (18.6%, 95% CI: -25.6% to -11.6%, p<0.01), with a notable intergroup difference (29.7%, 95% CI: -50.7% to -8.7%, p<0.01). LDL-C levels decreased by 11.8% in homozygous carriers (95% CI: -15.8% to -7.8%, p<0.01) and 4.8% in mixed allele carriers (95% CI: -6.8% to -2.8%, p<0.01), with a significant between-group difference (7.0%, 95% CI: -13.0% to -1.0%, p<0.01).

Conclusions:

Methylfolate, P5P, and methylcobalamin supplementation tailored to genetic profiles effectively reduced homocysteine and LDL-C levels in patients with specific MTHFR, MTR, and MTRR polymorphisms, particularly with homozygous minor allele polymorphisms. These findings underscore the potential for personalized nutrition in the management and prevention of CVD, emphasizing the role of genotype-guided therapy in clinical practice.
TO EXPLORE THE CLINICAL FRAILTY SCALE IN PREDICTING THE LONG TERM PROGNOSIS OF PATIENTS WITH ACUTE MYOCARDIAL INFARCTION AFTER IN-HOSPITAL CARDIAC REHABILITATION
Authors: Liu Yuting , Yu Wanqi , Hong Wen , Kang Sang , Li Xinni , Xiao Huoyan , Pan Jingwei
Published: May 2024

Objective:

Patients successfully revascularized after acute myocardial infarction (AMI) underwent in-hospital cardiac rehabilitation (CR) and were assessed for their state by the clinical frailty scale (CFS) to investigate the predictive value of the CFS score on the incidence rate of major cardiovascular events within one year.

Design and method:

A graded CR scheme was developed in a total of 501 patients with AMI, who were treated in the cardiology center of Shanghai Sixth People’s Hospital from May 2020 to May 2022, and the CFS score was assessed based on the CR condition of the patients before discharge. Patients were then categorized into three groups (norm group, vulnerable group, and frail group) according to their CFS score. The difference in one-year major cardiovascular event (all-cause death and re-hospitalization for heart failure) rates among these groups was compared. Logistic regression analysis was performed to explore risk factors affecting cardiovascular events, and an ROC curve was generated to analyze the risk factors in predicting one-year cardiovascular event rates. Finally, an optimal prediction model was developed.

Results:

The CFS score in AMI patients was positively correlated with age and peak proBNP and inversely correlated with gender difference (P <= 0.001). There were significant differences in the incidence of all-cause death between the frail group and the norm group (P = 0.002), whereas there was no significant difference between the vulnerable group and the norm group (P > 0.05). There was no significant difference in re-hospitalization for heart failure among the three groups (P = 0.710). The CFS score could sensitively predict the 1-year risk of all-cause death in AMI patients (β = 1.89, OR = 6.61, P = 0.001), and the risk model combined with the CFS score had the best predictive effect (AUC = 0.845, P = 0.000).

Conclusions:

In-hospital CR along with assessment using the CFS score can effectively identify AMI patients with a high risk of death.
ACHIEVED SYSTOLIC BLOOD PRESSURE BELOW 130 MMHG PRESERVES KIDNEY FUNCTION IN DIABETIC AND NON-DIABETIC HYPERTENSIVE PATIENTS WITHOUT CARDIAC HYPERTROPHY
Authors: Olsen Eirik , Soraas Camilla L. , Schmieder Roland E. , Jamerson Kenneth , Macdonald Thomas , Mancia Giuseppe , Heimark Sondre , Mehlum Maria H. , Mariampillai Julian , Liestol Knut , Larstorp Anne C , Hoieggen Aud , Kjeldsen Sverre E. , Rostrup Morten , Mo Rune , Julius Stevo , Weber Michael A.
Published: May 2024

Objective:

Kidney function is preserved by achieving systolic blood pressure (SBP) primarily <140mmHg and possibly <130mmHg in hypertensive patients. We aimed to investigate kidney function when achieving SBP 130-139 and <130mmHg in type-2 diabetic and non-diabetic hypertensive patients without cardiac hypertrophy who participated in a major prospective hypertension outcome trial.

Design and method:

Of the 15,245 study participants, 13,803 patients were without cardiovascular events during the first six months after randomization with roll-over from previous medications to blinded study drugs and had a minimum of 3 subsequent BP visits during 4-6 years. Of these, 2,458 patients with cardiac left ventricular hypertrophy (LVH) by ECG were not included in the present analysis because, as previously reported, they had increased cardiac and all-cause mortality at average achieved SBP <130mmHg. Of the remaining 11,345 patients, 3932 had diabetes. Cox analyzes adjusted for baseline covariates compared the pre-specified kidney endpoints 50% rise of se-creatinine (worsening kidney function, WKF) and end-stage renal disease (ESRD, dialysis and/or transplantation) for patients who achieved average SBP 130-139 and <130mmHg with those who remained with SBP >=140mmHg.

Results:

Patients with diabetes had less WKF at SBP 130-139mmHg (HR=0.50, 95% CIs 0.34-0.72, n=1605, p<0.001) and at SBP <130mmHg (HR=0.43, CIs 0.23-0.80, n=599, p=0.008). They also had less ESRD at SBP 130-139mmHg (HR=0.32, CIs 0.12-0.88, p=0.03) with similar trend at SBP <130mmHg (HR=0.21, CIs 0.03-1.65) which was significant for the 3rd quartile of SBP (135mmHg) (HR=0.09, CIs 0.01-0.71, p=0.02) and for the 4th quartile of SBP (126mmHg) (HR=0.12, CIs 0.02-0.92, p=0.04). Patients without diabetes (n=7413) also had less WKF at SBP 130-139mmHg (HR=0.58, CIs 0.40-0.83, n=3258, p=0.003) and at SBP <130mmHg (HR=0.38, CIs 0.21-0.68, n=1542, p<0.001). For ESRD the trend was similar as for diabetes at 3rd quartile of SBP (135mmHg) (HR=0.37, CIs 0.14-1.00, p=0.05) and at 4th quartile of SBP (126mmHg) (HR=0.23, CIs 0.07-0.75, p=0.02).

Conclusions:

In high-risk hypertensive patients above 50 years, with and without type-2 diabetes, but without cardiac hypertrophy, we found stepwise less worsening of kidney function and end-stage renal disease with lower average achieved systolic BP from >=140mmHg to 130-139mmHg to <130mmHg.
OBSTRUCTIVE SLEEP APNEA AND AUTONOMIC DYSFUNCTION
Authors: Berger Abel , Caruso Gustavo , Sivori Martin , Iriarte Javier , Sanchez Ramiro , Ramirez Agustin
Published: May 2024

Objective:

To investigate 1) the relationship between sympathetic nervous system activity and the Apnea Hypopnea Index (AHI), a simplified outpatient OSA identifier.

Design and method:

A cross-sectional, observational analytical study including patients with suspected OSA were invited to participate.

The office blood pressure (BP) measurement was performed thrice automatically (Omron Hem 742). After, the respiratory evaluation was performed (Apnealink plus) and patients with AHI >5 were identified having OSA and included in the study.

Finally, a 2h continuous beat-to-beat BP recording was carried out (FINAPRES device) 1h at rest and 1h behaving quiet activities. Then, BP and PI (Pulse Interval) mean values and respective variabilities were calculated SBPvar, DBPvar and Pivar.

From the original beat to beat recording, a frequency analysis (Fast Fourier Analysis) was performed and the power of the High (HF) and Low (LF) Frequency components calculated, as representatives of the vagal and sympathetic activity, respectively. A similar protocol was followed with 50 normotensive subjects without OSA (NT).

Results:

A total of 23 patients with OSA were enrolled (Mean age 49.17±2.93 years; 42.8% women)

OSA patients showed a higher BMI (37.6±1.66) and BP (135.4±3.18 / 86.1±2.2mmHg) than NT (BMI: 26.74±0.56 Kg/m2, p=0.02; BP: 126.82±1.25 / 72.95±1.43 mmHg; p=0.05).

In OSA patient higher SBPvar and PI (Systolic Blood Pressure variability, Pulse interval variability).only when performing quiet activities (12.1±0.79 / 6.9±0.61mmHg and 71.0±7.37msec) than in NT subjects (11.4±0.30 / 6.4±0.25mmHg; p=0.004 62.6±3.11msec; p=0.02).

Instead higher BPvar or PIvar values were observed at rest, only during quiet activity, OSA patients showed higher SBPvar (13.9±0.81mmHg, p=0.004) and PIvar (90.4±8.82msec, p=0.002) when compared to NT subjects (11.4±0.30).

Finally, the AHI showed a significant correlation with SBPvar (r=0.593, p=0.01), DBPvar (r=0.655, p=0.01, and PI var (0.535, p=0.02). A significant negative correlation was found between AHI and the HF/LF relationship at rest (r=-0.0.26) and when standing up (Physiological Tilting; r=-0.27).

Conclusions:

Compared to normotensive subjects, OSA patients showed an altered autonomic activity represented by an increase in BP and PI variabilities. This was associated with an increased OSA prevalence in patients with increased sympathetic activity.
IMPACT OF IRON DEFICIENCY ON CLINICAL,BIOCHEMICAL AND ECHOCARDIOGRAPHIC PARAMETERS IN HEART FAILURE PATIENTS
Authors: Siddiqi Zeba , Rao Nidhi , Wani Irshad
Published: May 2024

Objective:

Iron deficiency (ID) is prevalent in HF irrespective of the presence of anemia. Objective was to study the impact of iron deficiency on clinico- biochemical and echocardiographic parameters of heart failure patients.

Design and method:

Sixty adult heart failure patients were included in observational study with consent.

Excluded were anemia not attributed to ID,IV iron or blood transfusion administered in last 3 months,Oral iron supplements in previous 4 weeks, dyspnea of non cardiac origin,clinical evidence of ACS, TIA or stroke within the last 30 days,CABG, PTCA, cardiac device implant/resynchronisation therapy or any other cause leading to significant blood loss within the last 30 days.

Demographic information and medical history including NYHA grade of Dyspnea at presentation were noted. Iron studies,Nt proBNP levels and echocardiography were performed and appropriate statistical tests were applied.

Results:

Mean Age of cases was 57 (+/-5) years. Most common presenting symptom was breathlessness in 49(81.7%)patients followed by leg swelling in 46 (76.7%) and chest pain in 34 (56.7%)where as among the signs on examination; raised JVP was recorded in 18 (30%),hepatomegaly in 30(50%), splenomegaly in 17(28.3%),ascites in 19(31.7%),S3 gallop rhythm and basal lung crepitations in 10(16.6%) and 47(78.3%)patients respectively.

Majority of patients were in grade2 NYHA.

Iron Deficiency as determined by serum ferritin of <100 μg/mL or ferritin 100-300 μg/ml but transferrin saturation less than 20% was present in 43(71.7%)patients whereas in 17 patients(28.3%) it was not observed. Mean serum Iron was 36.417μg/dl,mean serum ferritin was 242.89 μg/ml and mean transferrin saturation was 17.25%.

Mean Hb was 10 gm% and mean NTProBNP was 11,324.65 picogm/ml.Mean Ejection fraction was 38%(+/- 12.75%).NtProBNP levels did not show any correlation with iron profile whereas LVEF showed a significant correlation with serum Iron as well as transferrin saturation (p <0.001). Serum iron and Transferrin saturation were significantly reduced with the progression of severity grade (p<0.006&0.001 respectively).

Conclusions:

Targeting iron deficiency in HF can improve outcomes as it targets mitochondrial dysfunction. This makes ID stand out as a therapeutic target in HF since it is relatively easy to diagnose and treat.
SYSTEMIC DISEASES ARE A GROUP OF INFLAMMATORY ILLNESSES THAT CAN DAMAGE THE ARTERIAL WALL ASSESSED ACCORDING TO NON-INVASIVE ARTERIAL TONOMETRY
Authors: Paterno Carlos Alberto
Published: May 2024

Objective:

Objective: Hypertensive Cardiovascular Disease is a complex, multifactorial, and chronic illness, frequently beginning during childhood or adolescence, could develop functional and/or structural organ damage by the increase of arterial stiffness and the curve volume/pressure that in turn can raise the stress into the ventricular-arterial coupling and the appearance of arrhythmias. The aim of this study was to assess systemic inflammatory diseases according to non-invasive arterial tonometry and their possible complications.

Design and method:

Design & Method: This cross-sectional study registered 339 patients, women 77%, both sexes, presented various systemic inflammatory diseases such as Psoriasis (123), Rheumatoid Arthritis (26), Celiac disease (13), Sjögren's disease (9), Crohn's disease (7), Ulcerative colitis (10), Endometriosis (10), Polycystic Ovary Syndrome (141). Anthropological data, Systolic/Diastolic Blood Pressure, and Heart Rate were measured. Central Hemodynamic Parameters (Central Aortic Pressure, End-Systolic Pressure, Mean Arterial Pressure, Pulse Pressure, Augmentation Pressure) and the difference between the maximum normal level and the observed value of the Augmentation Index (Diff-AIx), the surrogated value of arterial stiffness, were assessed with the SphygmoCor System-PVX, according to established protocols by sex and age.

Results:

Results: The mean age of women and men was 45-51 years. The mean of Systolic/Diastolic Blood Pressure among women and men was 132.5/81.6-135.2/85.9 mmHg, respectively. The Diff-AIx among women was 4.8 and among men was 5.4. The most important finding of the assessment of the systemic inflammatory diseases was the presence of hypertensive cardiovascular disease, considering the measurements of high systolic and diastolic blood pressure, and the abnormal Central hemodynamic parameters. The most important complication observed was the brief phases of atrial fibrillation during the 24-hour Holter monitoring (7.4%), the mean age of patients was 64.2 years, range of 44-88 years, and the highest percentage of each group were Ulcerative colitis (20.0%), Rheumatoid Arthritis (15.4%), and Crohn's disease (14.3%), Psoriasis (10.6%), Endometriosis (10.0%).

Conclusions:

Conclusions: The systemic diseases can damage the arterial wall and contribute to the development of Hypertensive Cardiovascular Disease. Cardiologists and clinical physicians, in the anamnesis, should include the search for inflammatory systemic diseases for a more complete clinical evaluation and therapeutic guidance.
G-PROTEIN-COUPLED RECEPTORS ANTIBODIES HAVE SUBSTANTIAL VASOREGULATIVE IMPLICATIONS IN LONG-COVID
Authors: Seibert Felix , Wiemers Lea , Stervbo Ulrik , Sander Oliver , Seidel Maximilian , Bertram Sebastian , Babel Nina , Westhoff Timm
Published: May 2024

Objective:

The Long-COVID syndrome is associated with the generation of autoantibodies to vasoregulative G-protein coupled receptors (GPCR), playing a potential key role in this disease. How far GPCR are related to vascular dysfunction in this context remains elusive.

Design and method:

We performed a cross-sectional study, enrolling 80 patients with Long-COVID. GPCR antibodies encompassed autoantibodies against Angiotensin-II-Receptor-1 (AGTR2), Beta-1 Adrenergic Receptor (ADRB1), Beta-2 Adrenergic Receptor (ADRB2), Endothelin Receptor (EDNRA), Muscarinergic Choline Receptor 3 (CHRM3), and Muscarinergic Choline Receptor 4 (CHRM4), all measured by ELISA. Vascular endothelial function was assessed by flow mediated dilation (FMD). We checked for vascular and systemic inflammation by measuring lipoprotein-associated phospholipase A2 (Lp-PLA2) and high-sensitive C-reactive protein (hsCRP). We performed a non-invasive pulse wave analysis to investigate central aortic blood pressure as well as nailfold capillaroscopy.

Results:

52 (65%) patients had positive antibody findings above previously established cut-off values. The median concentrations for AGTR2, ADRB1, ADRB2, EDNRA, CHRM3 and CHRM4 were 13.21 (interquartile range [IQR] 11.57-18.51) U/ml, 19.12 (IQR 16.03-27.54) U/ml, 14.18 (IQR 10.83-31.26) U/ml, 14.07 (IQR 11.30-25.19) U/ml, 13.73 (IQR 12.04-25.30) U/ml and 9.27 (IQR 7.15-13.02) U/ml, respectively. Correlation analysis showed strong and significant negative correlation of several GPCR antibodies with aortic systolic blood pressure (AGTR2 p=0.026, ADRB1 p=0.001, ADRB2 p=0.012) and aortic diastolic blood pressure (ADRB1 p=0.005, CHRM4 p=0.046). High EDNRA antibodies titers were associated with increasing FMD (p=0.038). ATGR2, ADRB2 and EDNRA had substantial negative correlation with inflammation as seen by lower hsCRP concentrations (p=0.025, p=0.001, p=0.017, respectively). None of the above mentioned antibodies were associated with Lp-PLA2 (p>0.05 each). None of the investigated subentities of nailfold capillaroscopy were significant for GPCR-antibodies.

Conclusions:

GPCR antibodies are present in Long-COVID and show various vascular implications in terms of vasorelaxation as seen in lower aortic systolic and diastolic blood pressure as well as in an amelioration of FMD. If this is the result of anti-inflammatory properties remains elusive.