bluuebunny/crossref_metadata_2025 huggingface dataset:
24-H-AMBULATORY BLOOD PRESSURE IN SUB-SAHARAN AFRICA: PREVALENCE OF WHITE COAT OR MASKED HYPERTENSION AND DISRUPTED DIPPING PATTERNS IN HIV+ PATIENTS ON ANTIRETROVIRAL THERAPY
Authors: Kasper Philipp , Phiri Sam , Chaweza Tom , Tweya Hannock , Mwagomba Beatrice , Muula Adam , Nhlema Angellina , Chiwoko Jane , Neuhann Florian , Steffen Hans-Michael
Published: April 2021

Objective:

Background: Cardiovascular disease and especially hypertension are a growing problem among people living with HIV (PLHIV) on antiretroviral therapy (ART) in sub-Saharan Africa. As robust data on hypertension phenotypes associated with distinct cardiovascular risks among PLHIV are limited, we aimed to assess the frequency of white-coat (WCH) or masked (MH) hypertension and blood pressure dipping-patterns in a group of Malawian PLHIV.

Methods:

As part of the prospective Lighthouse-Tenofovir-Cohort-Study, we analyzed clinical, laboratory and 24-h-ambulatory blood pressure monitoring (ABPM) data of PLHIV from urban Lilongwe with known treated or untreated hypertension or raised office blood pressure (OBP) during routine study-visits (hypertension unknown and untreated).

Design and method:

118 PLHIV were included and data of 117 participants could be analyzed. 24-h ABPM-normotension was found in 14/37 PLHIV with known treated hypertension (37.8%), 19/24 with known untreated hypertension (79.2%) and 40/56 with raised OBP (unknown/untreated hypertension; 71.4%). Using the strict definition of controlled hypertension or true normotension, i.e. normal OBP plus normal mean BP for all periods of ABPM the corresponding rates were 10.8%, 41.7%, and 39.3%. WCH with normal BP during all periods of 24-h-ABPM was identified in 12/64 OBP-hypertensive PLHIV (18.8%), primarily in patients with grade 1 hypertension (11/41 patients; 26.8%). MH was found in 17/53 PLHIV with OBP-normotension (32.1%), predominantly in patients with high normal BP (11/20 patients; 55%). The estimated glomerular filtration rate was significantly lower in MH compared to strictly defined normotensive PLHIV (92.0 ± 20.4 vs. 104.8 ± 15.7 ml/min/m2, p = 0.031). 64.1% of PLHIV (59.5% with 24-h hypertension and 66.7% with 24-h normotension) had abnormal systolic dipping.

Conclusion:

The high prevalence of WCH and MH with early signs of renal end-organ damage and an abnormal dipping in approximately 2/3 of PLHIV warrants further confirmation as these factors may contribute to the increased cardiovascular risk of PLHIV in resource-limited settings like Malawi.
STRIDE BP REVIEW OF PUBLISHED EVIDENCE ON ACCURATE BLOOD PRESSURE MEASURING DEVICES
Authors: Stergiou George S. , O’Brien Eoin , Myers Martin , Palatini Paolo , Menti Ariadni , Kollias Anastasios , Parati Gianfranco
Published: April 2021

Objective:

STRIDE BP has systematically reviewed PubMed publications reporting validation data of BP measuring devices using an established protocol. Lists of accurate devices for clinical use are available on the STRIDE BP website (www.stridebp.org) and are circulated to hypertension societies. This report presents the results of the STRIDE BP review.

Design and method:

The STRIDE BP Advisory Board reviewed 446 validation studies of 287 BP measuring devices reported in 294 PubMed publications up to Nov. 2019. Using an online review system each study is evaluated independently by 2 reviewers experienced in validation studies using a structured checklist which is specific for each protocol and a final internal review is developed. This is reviewed by 2 members of the STRIDE BP Advisory Board and a final decision is taken to approve or reject the study.

Results:

220 devices were approved (77%) and 115 (52%) were ‘Preferred’ according to predefined criteria (specific device features depending on its use; recent validation study). The numbers of approved office, home and ambulatory BP monitors for general population, children and pregnancy/preeclampsia are shown in the Table. Of 446 validations 390 (87%) were published as device ‘Pass’ and 56 (13%) ‘Fail’. Of 390 validations published as ‘Pass’, 95 (24%) were rejected in the STRIDE BP review process. The latter studies were rejected because of major protocol violation (single observer 22%, inadequate sample size 13%, BP measurement protocol violation 36%, inappropriate data analysis 31%, validation criteria not reported 32%).

Conclusions:

Using a standardised review process STRIDE BP provides independent evaluation of the accuracy of BP measuring devices that are available in various countries. The STRIDE BP review process by international experts, which examines validation studies using a structured and detailed process, is more critical than the classic review process of PubMed journals, which often miss important methodological issues in the validation studies. By widely circulating this information, STRIDE BP encourages health care professionals and the public to use only accurate devices for the evaluation of BP.
ARTERIAL HYPERTENSION RISK PREDICTION IN CONDITIONS OF ROTATIONAL SHIFTWORK IN THE ARCTIC
Authors: Shurkevich Nina , Vetoshkin Aleksandr , Gapon Lyudmila , Simonyan Ani
Published: April 2021

Objective:

To study features and dynamics of chronostructure of circadian blood pressure (BP) rhythm in normotensive patients and define their prognostic value with respect to arterial hypertension (AH) within prospective observation in conditions of Arctic rotational shiftwork.

Design and method:

During the prospective one-year study, in conditions of rotational shiftwork in the Arctic, 173 men with normal BP and with negative history of AH (mean age 40.2 ± 4.1 years) were examined. Work experience in the Arctic was 16.5 ± 6.8 years; work experience in rotational shifts was 11.2 ± 3.8 years and office BP was 123.4 ± 7.5/80.5 ± 5.5. All patients underwent ambulatory blood pressure monitoring (ABPM) 1 time in 3 months; individual cosinor-data analysis was carried out to determine circadian rhythm chronotypes.

Results:

According to the classification of P. Cugini, true normotension (50%) and atypical chronotypes: allonormotension (22%) and isonormotonia (28%) were revealed in individuals with normal BP. The prognostic value of circadian BP rhythm disturbances was explained by high frequency of atypical normotensive chronotype transformation into hypertensive ones. During the year of observation, AH developed in 26% of normotonics with atypical chronotypes.

Based on results of the study of chronobiological parameters in individuals with normal BP, the role of autonomic nervous system in the formation of chronotypes of circadian BP rhythm in normotensive patients was assessed. Moreover, atypical chronotypes of BP highlighted as main disturbances of circadian rhythm in the conditions of the Arctic region. Atypical normotensive chronotypes were characterized by more evident structural changes of the heart and vessels. In conditions of the Arctic, chronobiological approach in comparison with standard analysis of ABPM indicated higher diagnostic sensitivity, specificity and efficiency. Logistic regression revealed prognostic significance of normotensive atypical chronotypes compared to main risk factors (smoking, low physical activity, body mass index, dyslipidemia, age, duration of work in the Arctic and rotational shiftwork experience, the mode and type of rotational shiftwork).

Conclusions:

Using multivariant analysis, there was received the model for determining a diagnostic indicator showing risk for AH development during one-year observation in normotensive individuals in condition of rotational shiftwork in the Arctic.
DIRECT COMPARISON OF HOME VERSUS AMBULATORY DEFINED NOCTURNAL HYPERTENSION FOR PREDICTING CARDIOVASCULAR EVENTS: THE J-HOP STUDY
Authors: Mokwatsi Gontse , Hoshide Satoshi , Fujiwara Takeshi , Negishi Keita , Schutte Alta , Kario Kazuomi
Published: April 2021

Objective:

The home blood pressure monitoring (HBPM) method that measures blood pressure during sleep hours was reported to be comparable to ambulatory blood pressure monitoring (ABPM) in measuring night-time blood pressure and detecting nocturnal hypertension. The aim of this study was to directly compare the prognostic power of nocturnal hypertension detected by HBPM versus ABPM for predicting future cardiovascular events.

Design and method:

We analyzed night-time blood pressure (measured by HBPM and ABPM) data of 1005 participants who were included in the Japan Morning Surge-Home Blood Pressure (J-HOP) study.

Results:

During a follow-up period of 7.6 ± 3.4 years, 80 cardiovascular disease events occurred. The majority (91.8%) of our study population were hypertensive and 80.7% participants were using antihypertensive medication. Night-time home systolic blood pressure (SBP) was higher compared to night-time ambulatory SBP (123.0 ± 14.6 versus 120.3 ± 14.4, p < 0.001). Nocturnal hypertension was defined as night-time home or ambulatory SBP of 120 mmHg or more. The number of participants with nocturnal hypertension defined by HBPM and ABPM was 564 (56.1%) and 469 (46.7%), respectively. Nocturnal hypertension defined by HBPM was associated with increased risk of future cardiovascular events; total cardiovascular events (coronary artery disease and stroke events) [1.83 (1.00; 3.37)] and stroke [2.87 (1.17; 7.03)], independent of office SBP and night-time ambulatory SBP. These results were absent with nocturnal hypertension defined by ABPM.

Conclusions:

This is the first comparison prospective study illustrating that uncontrolled nocturnal hypertension defined by HBPM (independent of office SBP and night-time ambulatory SBP) is a predictor of future cardiovascular events.
ASSOCIATION OF FATAL AND NONFATAL CARDIOVASCULAR OUTCOMES WITH 24 HOUR MEAN ARTERIAL PRESSURE
Authors: Melgarejo Jesus , Yang Wen-Yi , Thijs Lutgarde , Li Yan , Asayama Kei , Hansen Tine , Kikuya Masahiro , Ohkubo Takayoshi , Dolan Eamon , Stolarz-Skrzypek Katarzyna , Huang Qi-Fang , Tikhonoff Valérie , Malyutina Sofia , Casiglia Edoardo , Lind Lars , Sandoya Edgardo , Filipovský Jan , Gilis-Malinowska Natasza , Narkiewicz Krzysztof , Kawecka-Jaszcz Kalina , Boggia José , Wang Ji-Guang , Imai Yutaka , Vanassche Thomas , Verhamme Peter , Janssens Stefan , Brien Eoin O. , Maestre Gladys E. , Staessen Jan A. , Zhang Zhen-Yu
Published: April 2021

Objective:

Automated oscillometric devices are increasingly replacing auscultation for assessment of systolic (SBP) and diastolic (DBP) blood pressure, but determine mean pressure (MAP) and extrapolate SBP and DBP. Major adverse cardiovascular events (MACE) are closest associated with 24 H blood pressure levels. We determined outcome-driven 24 H MAP thresholds and assessed association of MAP, SBP and DBP with MACE.

Design and method:

In a population-based cohort (n = 11,596), blood pressure and risk factors were measured at baseline. Office MAP, computed from SBP and DBP, was categorized according to the 2017 American guideline. 24 H MAP was recorded oscillometrically. Statistics included multivariable Cox regression and the log-likelihood ratio test.

Results:

Baseline office and 24 H MAP averaged 97.4 and 90.1 mm Hg. Over 13.6 years (median), 2034 MACE occurred. 24 H MAP levels of < 90, 90–92, 93–96 and = > 96 mm Hg yielded equivalent 10 year MACE risks as the office MAP standard and delineated normotension (n = 6304), elevated 24 H MAP (n = 1074), and hypertension stages 1 (n = 1732) and 2 (n = 2484). MACE rates per 1000 person-years increased (P < 0.001) with higher 24 H MAP category from 11.9 (95% CI, 11.1–13.2) to 12.5 (10.7–14.7), 16.2 (14.6–18.1) and 22.0 (20.4–24.1). Compared with 24 H MAP normotension, the corresponding hazard ratios were 1.06 (0.88–1.25), 1.43 (1.26–1.63) and 1.78 (1.59–2.00). Adding 24 H MAP to covariables, SBP and DBP improved the model fit (P < 0.001). On top of MAP, higher SBP increased, whereas higher DBP attenuated risk (P < 0.001).

Conclusions:

The oscillometrically determined 24 H MAP used in conjunction with SBP and DBP substantially refined estimates of MACE risk.
MORNING BLOOD PRESSURE SURGE POWER IS A BETTER PREDICTOR OF CARDIOVASCULAR DEATH OR EVENTS IN THE OHASAMA POPULATION THAN PRE-AWAKE VERSUS POST-AWAKE MEASURES
Authors: Head Geoffrey , Sata Yusuke , Ohkubo Takayoshi , Kikuya Masahiro , Imai Yutaka , Lukoshkova Elena
Published: April 2021

Objective:

The morning surge in blood pressure has been associated with increased cardiovascular risk. However, there has been no direct comparison to determine which method has the best prognostic value. The Ohasama study with 1522 participants, 126 cardiovascular deaths and 165 events was used to compare different methods of calculating the morning blood pressure surge (MBPS).

Design and method:

After adjustment for age, mean 24-hr mean BP, smoking, body mass index, sex and antihypertensive therapy, we calculated i) Cosinor curve amplitude ii) Day-night difference iii) MBPS 1 (2 hours Post-awake minus pre-awake) iv) MBPS 2 (2 hours post awake minus night minimum) v) morning rate of rise (RoR) and vii) morning surge power (rate x amplitude). The latter 2 are calculated using a logistic equation (Am Hypertens 2010;23:1074–1081). The outcome of combined cardiovascular events including death and non-fatal events were distributed into quintiles according to each MBPS measure and linear and quadratic trends determined as an indicator of a predictive ability.

Results:

Cosinor curve amplitude for between quintiles, linear and quadratic trends were P = 0.036,P = 0.122 and P = 0.257. Day-night difference for between quintiles, linear and quadratic trends were P = 0.113, P > 0.5 and P = 0.087. MBPS 1for between quintiles, linear and quadratic trends were P = 0.083, P > 0.5 and P = 0.074. MBPS 2 for between quintiles, linear and quadratic trends were P = 0.013, P = 0.34 and P = 0.068. Morning Power for between quintiles, linear and quadratic trends were P = 0.001, P = 0.244 and P = 0.035. MBPS1 and day night difference did not predict cardiovascular events. Cosinor amplitude and MBPS 2 showed differences between quintiles mainly due to high risk in the lowest quartile in which participants had little nocturnal dipping. By far the strongest predictor was morning BP power which showed a U-shaped relationship with combined cardiovascular events. We also observed a high correlation between adjusted morning power and MBPS1 (r = 0.50) and also with MBPS2 (r = 0.45) suggesting that these measures are reflecting some similar aspects of the morning surge.

Conclusions:

We conclude however, that the morning BP power is a superior and valuable predictive measure of cardiovascular risk even after adjustment for cofounders.
ABDOMINAL AORTIC CALCIFICATION IN ALDOSTERONE PRODUCING ADENOMA AND IDIOPATHIC HYPERALDOSTERONISM
Authors: Shibayama Yui , Wada Norio , Baba Shuhei , Obara Shinji , Sakai Hidetsugu , Usubuchi Hiroaki , Terae Satoshi , Kameda Hiraku , Nakamura Akinobu , Atsumi Tatsuya
Published: April 2021

Objective:

Aldosterone promotes vascular calcification, which leads to atherosclerosis and eventually cardiovascular disease via enhancing vascular osteoinductive signaling, oxidative stress, inflammation and apoptosis. As an independent prediction of coronary artery disease (CAD), abdominal aortic calcification has been useful as well as coronary artery calcification. It has been shown that patients with aldosterone producing adenoma (APA) have higher rate of CAD comparing patients with idiopathic hyperaldosteronism (IHA) at the diagnosis of primary aldosteronism (PA). However, no data have shown whether the degree of abdominal aortic calcification is different between APA and IHA. We aimed to clarify the degree of abdominal aortic calcification in each subtype of PA.

Design and method:

This retrospective observational study comprised 170 patients diagnosed with PA. We divided participants into APA (n = 48) and IHA (n = 132), according to the results of adrenal venous sampling (AVS) and pathological findings. Aortic calcification index (ACI) was evaluated by unenhanced abdominal computed tomography, focusing around the left renal artery and scanning 10 times at 10-mm intervals.

Results:

Age was not different between the two subtypes (p = 0.47). Duration of hypertension and plasma aldosterone concentration were significantly higher in APA than IHA (p < 0.001, p < 0.001, respectively). Neither smoking ratio, HbA1c, LDL-cholesterol, nor eGFR was different between the two subtypes (p = 0.86, p = 0.49, p = 0.20, p = 0.47, respectively). The percentage of patients with ACI > 1 was significantly higher in APA than IHA (APA vs. IHA; 17/48 (35.4%) vs. 25/132 (18.9%), p = 0.03). In patients with ACI > 1, ACI was correlated with duration of hypertension in both subtypes of PA (APA; r = 0.62, p = 0.01, IHA; r = 0.49, p = 0.02).

Conclusions:

Abdominal aortic calcification was progressed in APA than IHA. This result was concordant with higher rate of CAD in APA than IHA. In both subtypes of PA, patients with longer duration of hypertension tended to coexist abdominal aortic calcification, demonstrating an importance of early diagnosis and treatment before developing to aortic calcification in either subtype of PA.
HIGH LEVEL OF PLASMA ALDOSTERONE AFTER SALINE INFUSION TEST IN COMBINATION WITH FINDING OF ADRENAL NODE ON CT SCAN CAN PREDICT ALDOSTERONE-PRODUCING ADENOMA MORE PRECISE THAN FINDING OF NODE ALONE
Authors: Holaj Robert , Kvasnicka Jan , Rosa Jan , Zelinka Tomas , Petrak Ondrej , Strauch Branislav , Kratka Zuzana , Indra Tomas , Forejtova Lubomira , Kavan Jan , Waldauf Petr , Widimsky Jiri
Published: April 2021

Objective:

Idiopathic aldosteronism due to bilateral hyperplasia and unilateral aldosterone-producing adenoma of adrenal gland are two main forms of primary aldosteronism. The discrimination between unilateral and bilateral aldosterone overproduction is crucial for an appropriate management of patients with primary aldosteronism. This study tests the reliability of plasma aldosterone after the postural stimulation test and after the saline infusion test in combination with finding of adrenal node on CT scan for the identification of these two common forms of primary aldosteronism.

Methods:

One hundred and fifty patients with laboratory diagnosis of primary aldosteronism (96 patients with confirmed diagnosis of aldosterone producing adenoma and 54 patients with idiopathic aldosteronism were enrolled into the study. All of patients underwent CT scan, the postural stimulation test, the saline infusion test and adrenal venous sampling.

Design and method:

Plasma aldosterone concentration in the supine or in the standing position and after the saline infusion were higher in patients with aldosterone-producing adenoma than in those with idiopathic aldosteronism (P < 0.001; P < 0.01 and P < 0.001, respectively). The largest area under the curve = 0.83 (for a cut-off of 165 ng/l) suggesting the diagnosis of unilateral aldosterone overproduction was found for finding of adrenal node on CT scan in combination with plasma aldosterone concentration after the saline infusion test with a sensitivity of 83%, specificity of 61%, positive-predictive value of 79% and negative-predictive value of 67%.

Results:

The study found that the value of plasma aldosterone concentration ?165 ng/l after the saline infusion test in combination with finding of node on CT scan can predict aldosterone-producing adenoma more precise than finding of node alone, nevertheless, results of adrenal venous sampling remain to be crucial in the identification of two common forms of primary aldosteronism. The study found that the value of plasma aldosterone concentration ?165 ng/l after the saline infusion test in combination with finding of node on CT scan can predict aldosterone-producing adenoma more precise than finding of node alone, nevertheless, results of adrenal venous sampling remain to be crucial in the identification of two common forms of primary aldosteronism.
ADDITIONAL VALUE OF OXIDATIVE STRESS-RELATED SKIN CHANGES IN CARDIOVASCULAR RISK MANAGEMENT
Authors: Voicehovska Julija , Janovska Jana , Skesters Andrejs , Voicehovskis Vladimirs , Silova Alise , Kisis Janis , Lejnieks Aivars
Published: April 2021

Objective:

Oxidative stress (OS) associated with Metabolic syndrome (MetS) is one of the important focuses of recent research related to pre-diabetes, diabetes and cardiovascular diseases (CVD) risk prediction. OS supports a chronic inflammatory reaction in the skin. Associations among OS biomarkers, malondialdehyde (MDA) and superoxide dismutase (SOD) levels, as well as skin alterations

Design and method:

The prospective study of random, age- and sex-stratified population sample was conducted during 2017–2018 at the Department of Internal Medicine, Riga Stradins university, Latvia. Detailed examination of the skin for the presence of acanthosis nigricans, Lentigines, Seborrheic keratosis, Actinic keratosis, Aging wrinkles, Gravity wrinkles, Teleangiectasias was performed. Skin biopsy assessment has been performed as well. Serum MDA and SOD were measured by RANSOD, Randox

Results:

Statistical analysis (SPSS 21.0 for Windows) showed a direct linear relationship (Positive Pearson correlation, Chi-square test, p < 0.05) between skin alterations and intensity of MDA and SOD. Increased MDA(p < 0.05) was associated with Lentigines, Seborrheic keratosis, Actinic keratosis, Aging wrinkles, Gravity wrinkles. tracellular matrix degradation correlates with increased MDA activity.

MDA and SOD levels appear to be linked to several skin manifestations of MS

Increased SOD was associated with Lentigines and Seborrheic keratosis.

Conclusions:

Skin alterations associated with elevated MDA and SOD levels could become a convenient characteristic additionally to routine cardiovascular risk assessment. Clinical add-on value of MDA and SOD as early biomarkers seems to be relevant significant in individualized CVD risk management. Such approach could help to identify apparently healthy patients among those who already have clinical damages caused by metabolic disorders, whilst prevention is still effective.

We believe that our clinical study will contribute to the essential process of evidenced based practice and would help to guide anti-aging treatment decisions for both health care professionals and patients.
ASSOCIATION RELATIVE TELOMERE LENGTH AND TELOMERASE ACTIVITY WITH LIFESTYLE RISK FACTORS IN HYPERTENSIVE PATIENTS
Authors: Pavlova Olga , Ogurtsova Svetlana , Karabko Irina , Barbuk Olga , Liventseva Maria , Mrochek Alexander
Published: April 2021

Objective:

To determine association relative telomere length (RTL) and telomerase activity with lifestyle risk factors in hypertensive patients (pts) and normotensive individuals.

Design and method:

80 people (34 hypertensive patients and 46 normotensive individuals) were examined. Mean age of hypertensive pts was 55.5 ± 8.7 and of normotensives was 49.7 ± 9.9 years. Smoking status, alcohol abuse, level of physical activity, body mass index, waist circumference, presence of obesity, dietary habits, blood pressure (BP), glucose and cholesterol levels, depressive episodes and psychological stress were evaluated. Arterial stiffness performed by volume sphygmography with assessing cardio-ankle-vascular index (CAVI) and ankle-brachial index. The RTL of peripheral blood leukocytes performed by previously validated real-time PCR. Telomerase activity was determined by enzyme immunoassay.

Results:

The association was found between RTL and CAVI (r = −0.414; p = 0.021) in the group of hypertensive pts. However, there were no association with age, levels of glucose and cholesterol, BP, obesity, diet and psychological risk factors. Sedentary work was related with shortening RTL in hypertensive patients (p = 0.043) and in normotensives (p = 0.003). Telomerase activity was related with fruit consumption (r = 0.520; p = 0.004) in hypertensive patients. Among normotensives telomerase activity was associated with consumption of fish (r = 0.344; p = 0.024) and vegetables (r = 0.302; p = 0.004). In hypertensive patients and in normotensives also was found trend toward relation between telomerase activity with dietary salt (r = −0.312; p = 0.08 and r = −0.270; p = 0.07, accordingly).

Conclusions:

The data suggests that lifestyle risk factors such as sedentary work and rare fruit consumption can influence on RTL and telomerase activity in hypertensive pts as well as sedentary work, low intake of fish and vegetables in normotensive people.
THE POSITIVE EFFECT OF MOXONIDINE ON TELOMERASE ACTIVITY
Authors: Eruslanova Kseniia , Dudinskaya Ekaterina , Bazaeva Ekaterina , Tkacheva Olga
Published: April 2021

Objective:

To estimate the effect of moxonidine versus bisoprolol on cellular senescence processes in postmenopausal women with arterial hypertension (AH).

Design and method:

There was an open randomized control study. The study group was represented by 56 women with AH and a mean age of 63 ± 9.217 years, with SBP of 146.72 ± 7.127 mm Hg and DBP of 84.38 ± 7.941 mm Hg, who received moxonidine treatment (average dose 0.515 mg/day [0.4; 0.6]) for 12 months. The control group was comprised of 59 female patients with AH and a mean age of 61 ± 9.117 years, with SBP of 145.59 ± 6.102 mm Hg and DBP of 86.18 ± 6.682 mm Hg, who received treatment with bisoprolol (average dose 5.0 mg/day [5.0; 7.5]) for 12 months. For all patients, the measurement of telomerase activity was performed using genomic DNA real-time PCR at baseline and after 12 months of treatment. Statistical analysis was carried out using the SPSS/PASW Statistics software (version 18, SPSS Inc., Chicago, Illinois, USA).

Results:

In both groups there was a substantial and significant BP reduction, in the moxonidine treatment group: SBP – 126.93 ± 8.086 mm Hg (p < 0.001), DBP – 73.64 ± 7.522 mm Hg (p < 0.001); in the bisoprolol treatment group: SBP – 125.83 ± 8.097 mm Hg (p < 0.001), DBP – 73.31 ± 7.964 mm Hg (p < 0.001). Patients from the moxonidine treatment group demonstrated a significant reduction of body weight, on average, by 1.89% (from 75.7 ± 12.77 kg to 74.5 ± 11.7 kg,p < 0.001) and of BMI (from 29.359 ± 4.7 kg/m2 to 28.6 ± 4.4 kg/m2, p < 0.001). By contrast, in the bisoprolol treatment group patients’ average body weight increased by 2.22% (from 76.655 ± 13.754 kg to 78.13 ± 13.728 kg, p < 0.001) as well as BMI (from 29.037 ± 4.6 kg/m2 to 29.609 ± 4.7 kg/m2, p < 0.001).

TA in the moxonidine treatment group increased from 0.87 [0.16; 1.18] to 1.1 [0.74; 1.5] (p < 0.001), and, conversely in the bisoprolol treatment group TA decreased from 1.1 [0.5; 1.6] to 0.94 [0.56; 1.5] (p < 0.001).

Conclusions:

The preliminary data suggests that moxonidine can be used as telomerase activator and effective geroprotective agent. Increased TA against the backdrop of moxonidine treatment may be explained by increased insulin sensitivity, decreased body weight, and, consequently, lower intensity of chronic inflammation.
ATRIAL FIBRILLATION INFLUENCE ON LEFT VENTRICULAR FUNCTION IN HYPERTENSIVE PATIENTS WITH PRESERVED EJECTION FRACTION
Authors: Petre Ioana , Diaconeasa Alexandra , Onciul Sebastian , Iancovici Silvia , Zamfir Diana , Onut Roxana , Stoian Monica , Scarlatescu Alina , Vijiiac Aura , Fronea Oana Gheorghe , Dorobantu Maria
Published: April 2021

Objective:

Atrial fibrillation(AF) may affect left ventricular function, causing abnormal diastolic filling and variable degrees of systolic abnormality. We tried to find the influence of AF on left ventricular function in a group of hypertensive patients with preserved ejection fraction.

Design and method:

108 subjects were prospectively enrolled. All had a history of essential hypertension(HTN), without any other important comorbidity and with preserved ejection fraction(LVEF>50%). 67 patients without any history of arrhythmia formed group one(group HTN) and 41 subjects with a recent AF episode, but in sinus rhythm at the enrollment, group two(group HTN and AF). By performing a standard echocardiography, we evaluated LV mass, LV ejection fraction, diastolic function and LA maximal volume. Also, global longitudinal strain of left ventricle(GLS) was analyzed, using the current recommendations of speckle tracking method.

Results:

In arrhythmia group, we observed a longer history of HTN diagnosis(62.2 versus 40.4months, p = 0.04) and a more severe form of HTN(grade 3 HTN for 48.8 % patients). LV ejection fraction, though normal, was lower in group2 (58.44% versus 60.75% in HTN group, p = 0.02). Also, GLS was more affected in group2 in comparison with group1, suggestive for a mild myocardial dysfunction(-16.71% in group 2 versus -18.85% in group1, p = 0.02). We found a greater diastolic dysfunction in AF patients based on mitral E/A ratio(p = 0.04) and smaller values of A’ septal and lateral velocity(p < 0.0001 and p = 0.002) in this group.

Conclusions:

Even paroxysmal or persistent types of AF can cause an incipient form of LV systolic dysfunction and diastolic dysfunction in asymptomatic hypertensive patients with preserved left ventricular ejection fraction.
IS TAILORED ANTICOAGULATION MANAGEMENT FEASIBLE IN PATIENTS WITH ARTERIAL HYPERTENSION AFTER THEIR FIRST CLINICAL ECG-DOCUMENTED PAROXYSMAL ATRIAL FIBRILLATION EPISODE?
Authors: Papakonstantinou Panteleimon , Simantirakis Emmanuel , Kanoupakis Emmanuel , Parthenakis Frangiskos , Vardas Panos
Published: April 2021

Objective:

Long-term anticoagulation therapy is usually recommended for most of the patients with hypertension as the CHA2DS2-VASc score is at least 1. However, this is to some extent arbitrary, because it is not known if these patients will continue to present AF episodes. Furthermore, recent data showed that only AF episodes with a duration >24 hours increased significantly the risk of ischemic stroke. We tested the hypothesis whether the identification of the exact natural course of AF would have a favorable impact on AF-personalized anticoagulation, by facilitating the selection of patients in need of antithrombotic treatment on the basis of their AF recurrence profile.

Design and method:

Consecutive patients who received an implantable loop recorder-ILR (Reveal XT 9529; Medtronic, Minneapolis, Minnesota, USA) after their first ECG-documented symptomatic episode of paroxysmal AF were enrolled. Low recurrence rate and short durations episodes of the arrhythmia was defined as <5 AF episodes/year and </=24 h AF episodes respectively.

Results:

Thirty (30) consecutive patients (mean age 66.9 +/− 10 years; 14 men); 25/30 (83.3%) with arterial hypertension, were included in the study. The follow-up period lasted for 34,63 +/− 2,96 months after the implantation of the ILR. The mean CHA2DS2-VASc score was 2.83 ± 1.66. Three patients (10%) had no AF recurrence, while 4 patients (13.3%) presented only one episode during the three-year follow-up period. Almost half of the patients (46.7%) had a low recurrence rate (<5 episodes/year), while the majority of patients (19/30) suffered from episodes with maximum duration of </=24 h. Eleven patients (36.7%) presented either no episode or a low recurrence rate with episodes lasting </=24 h.

Conclusions:

A significant percentage of patients either suffer 0–1 AF recurrence (23.3%) after their first episode or show a low recurrence rate (46.7%). Most patients present episodes of short duration (<24 h). If these findings are confirmed by larger studies, they could have an impact in the strategy towards a more personalized approach, in the long-term AF anticoagulation management, especially in the era of non-Vitamin K antagonists and devices that provide long-term cardiac rhythm monitoring.
BLOOD PRESSURE AT ADMISSION PREDICTS SHORT-TERM AND LONG-TERM CLINICAL OUTCOMES IN PATIENTS HOSPITALIZED FOR HEART FAILURE
Authors: Huang Xinghe , Liu Jiamin , Hu Shuang , Li Jing
Published: April 2021

Objective:

Hypertension is the leading risk factor for the development of heart failure (HF). However, the association between admission blood pressure (BP) and clinical outcomes in patients hospitalized for HF remains uncertain. The study aimed to investigate the association between BP at admission and 1-month, 6-months and 1-year clinical outcomes in patients hospitalized for HF.

Design and method:

This study was based on the China PEACE Prospective Heart Failure Study, which prospectively enrolled 4,930 patients hospitalized primarily for HF in 52 hospitals from 20 provinces in China. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) at admission were categorized by 10 mmHg increments. The outcomes were the composite of all-cause death or HF readmission within 1 month, 6 months and 1 year after admission. The association between BP at admission and the outcomes was estimated with Cox proportional hazards models, adjusted by age, gender, insurance type, etiology, cardiovascular risk factors, comorbidities, clinical presentation, patient reported health status and medications during hospitalization.

Results:

We included 4,841 HF patients with available admission BP and 1-year follow up data. The mean age was 65.1 ± 13.5 years, 37.4% were female, and the mean admission BP was 133.2 ± 24.6/81.0 ± 16.0 mmHg. Compared to patients with SBP of 120–129 mmHg, patients in the lower SBP groups had higher risk of 1-year outcome (the adjusted HR 1.41, 95% confidence interval (CI) 1.19–1.66 for SBP< 110 mmHg and HR 1.29, 95% CI 1.09–1.54 for SBP of 110–119 mmHg) (Table 1). A significant decrease in the risk of 1-year outcome was observed for DBP of 80–89 mmHg (HR 0.87, 95% CI 0.76–0.99), 90–99 mmHg (HR 0.83, 95% CI 0.71–0.98) and > = 100 mmHg (HR 0.71, 95% CI 0.59–0.85) compared with DBP of 70–79 mmHg (Table 1). Similar results for SBP and DBP for outcomes at 1 month and 6 months have been observed in Table 1.

Conclusions:

In patients hospitalized for HF, admission SBP and DBP predict 1-month, 6-month, and 1-year clinical outcomes after adjusting for known confounders.
IMPACT OF CHRONIC KIDNEY DISEASE ON HEART FAILURE SEVERITY IN HYPERTENSION AND ATRIAL FIBRILLATION PATIENTS
Authors: Tatar Maria Cristina , Husariu Madalina , German-Sallo Marta , Tilea Ioan
Published: April 2021

Objective:

Given the frequent association of chronic kidney disease (CKD) to cardiovascular disorders and the coexistence of heart failure (HF) with atrial fibrillation (AF), especially in elderly, hypertension being a contributor, our main objective was to assess the effect of kidney dysfunction on the heart failure progression in hypertension and atrial fibrillation patients.

Design and method:

We conducted a retrospective analytic-observational study that included 258 AF patients, mean age 73.48 yr (SD = 10.4), 51.6% females. In order to classify the CKD, we divided the study population in two groups based on the estimated glomerular filtration rate (eGFR): higher or equal than 60, respectively below 60 ml/min/1.73 square meters, comparing the estimations of Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. We used the NYHA classification to identify the HF severity.

Results:

Of all patients, according to the presence or absence of the hypertension, 210 patients (81.4%) presented high blood pressure values. In terms of the eGFR using the MDRD equation, 117 patients presented a value higher or equal than 60 ml/min/1.73 square meters, while 93 had an eGFR below 60 ml/min/1.73 square meters. The median value of NYHA class was 3 in both groups (SD = 1.03; 0.96) and there was no statistical significance (p = 0.13) between them. By comparison, estimation using the CKD-EPI equation, indicated a statistically significant difference (p = 0.03), 109 patients presented higher than 60 ml/min/1.73 square meters and 101 patients were below this cut off value even though the median NYHA class was 3 as well (SD = 1.04; 0.94).

Conclusions:

These results reinforce the well-known superiority in the accuracy of the CKD-EPI equation. But, in terms of the influence of renal dysfunction severity on the heart failure severeness, our results suggest that decreasing in the eGFR is not correlated with the progression of the heart failure in AF patients. However, given the severity of complications and importance of proper treatment in atrial fibrillation, the development of an estimation equation that relates to the presence of atrial fibrillation should be considered.
SURROGATE CARDIOVASCULAR OUTCOMES WITH SODIUM-GLUCOSE CO-TRANSPORTER-2 INHIBITORS IN WOMEN: AN UPDATED META-ANALYSIS
Authors: Patoulias Dimitrios , Katsimardou Alexandra , Imprialos Konstantinos , Stavropoulos Konstantinos , Toumpourleka Maria , Koutsampasopoulos Konstantinos , Tegou Zoi , Mavridou Maria , Siskos Fotios , Papadopoulos Christodoulos , Doumas Michael
Published: April 2021

Objective:

Women with type 2 diabetes mellitus (T2DM) experience an increased risk for cardiovascular disease development compared to men. However, they are usually underrepresented in clinical trials assessing treatment strategies to ameliorate excess cardiovascular risk. Previous meta-analyses of cardiovascular outcome trials (CVOTs) demonstrated that sodium-glucose co-transporter-2 (SGLT-2) inhibitors do not decrease the risk for major adverse cardiovascular events (MACEs) among women participants.

Design and method:

We searched PubMed from its inception to 2 October 2020. We sought to determine the effect of SGLT-2 inhibitors on cardiovascular outcomes of interest in women utilizing data from the “hallmark” CVOTs and the recently published trials enrolling patients with heart failure with reduced ejection fraction (HFrEF), extracting data concerning female patients, as reported across the selected studies. We set as primary efficacy outcome the composite of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke and as secondary efficacy outcome the composite of hospitalization for heart failure (HF) worsening and cardiovascular death.

Results:

SGLT-2 inhibitor treatment resulted in a non-significant decrease in the risk for MACEs (RR = 0.91, 95% CI; 0.80 to 1.04, I2 = 0%). Regarding the secondary efficacy outcome, it was shown that SGLT-2 inhibitor treatment led to a significant decrease equal to 21% (RR = 0.79, 95% CI; 0.69 to 0.91, I2 = 8%), which was primarily driven by the results observed in the dedicated HFrEF trials. More specifically, we demonstrated that SGLT-2 inhibitor treatment did not induce a significant decrease in the risk for heart failure hospitalization or cardiovascular death across the cardiovascular outcome trials (RR = 0.87, 95% CI; 0.73 to 1.03, I2 = 0%), while it produced a significant result when we pooled the data from the DAPA-HF and the EMPEROR-Reduced trials (RR = 0.71, 95% CI; 0.58 to 0.88, I2 = 15%).

Conclusions:

SGLT-2 inhibitors do not confer significant decrease in the risk for MACEs among women; however, they provide significant results in terms of reduction in the risk for cardiovascular death or hospitalization for heart failure in the HFrEF population. Better representation of women in future trials will provide further insights.
CIRCULATING CERAMIDE AS A POTENTIAL BIOMARKER FOR ISOLATED NOCTURNAL HYPERTENSION
Authors: Zhang Dongyan , Guo Qianhui , Cheng Yibang , Wang Jiguang , Li Yan
Published: April 2021

Objective:

Isolated nocturnal hypertension (INH) is a subtype of hypertension characterized as an elevated blood pressure (BP) at nighttime only. To identify potential new biomarkers related with INH, we compared serum metabolite profiles between INH and normotensive controls.

Design and method:

Twenty-four-hour ambulatory BP monitoring was performed with Mobil-O-graph (IEM, Germany) monitors in untreated outpatients. INH was defined as a nocturnal BP greater or equal to 120/70 mmHg and daytime BP less than 135/85 mmHg at both two visits within a month. Age-sex matched normotensives (NT) were included as controls. We applied untargeted liquid chromatography tandem mass spectrometry (LC-MS) to detect serum metabolites. Multiple algorithms were first run in a training set (40 INH and 40 NT) and then in a test set (22 INH and 19 NT) to select and verify potential biomarkers. We computed student's P-values corrected by multiple comparison and VIP (Variable Importance in the Projection) score. Based on the results of untargeted LC-MS, we quantified 8 circulating sphingolipids, including sphingomyelin (SM) (d18:1/16:0), SM (d18:1/18:0), SM (d18:1/24:1), ceramide (Cer) (d18:1/16:0), Cer (d18:1/18:0), Cer (d18:1/24:1), sphingosine and sphingosine-1-phosphate in the test set by a targeted LC-MS method.

Results:

Orthogonal partial least squares-discriminant analysis (OPLS-DA) demonstrated a clear separation of metabolite profiles of INH patients from NT controls (R2 = 0.747, Q2 = 0.672). Cer (d18:1/16:0) had significant association with INH (odds ratio (OR) = 0.290 per SD, 95% confidence interval (CI), 0.125–0.715, P trend = 0.0027). The ceramide score, calculated as a sum of concentrations of the three ceramides, was associated with a lower risk of INH across extreme quartiles (OR = 0.592, 95% CI, 0.400–0.875, P trend = 0.0085). Moreover, Cer (18:1/16:0) significantly improved the diagnostic prediction of INH (P = 0.04).

Conclusions:

Our study illustrated a novel association between plasma ceramide concentration and INH. More research on ceramides in hypertensive pathobiology might be warranted.
CORRELATION OF NT-PROBNP CONCENTRATION WITH THE CONDITION OF BLOOD MICROCIRCULATION IN PATIENTS WITH CONTROLLED AND UNCONTROLLED ARTERIAL HYPERTENSION
Authors: Podshibiakina Elizaveta , Nebieridze Natiya , Safronova Tatyana , Podzolkov Valerij
Published: April 2021

Objective:

To study the relation between NT-proBNP and the condition of blood microcirculation in patients with controlled (CAH) and uncontrolled (UAH) course of hypertension.

Design and method:

A cross-sectional study included 27 patients with essential hypertension: group I (CAH) - 12 patients, group II (UAH) - 15. The average age was 59.6 ± 9.5 years, the average duration of hypertension was 13.6 ± 10.2 years, the function of the left ventricle was normal. The criteria for inclusion in group I were the constant use of correct therapy for hypertension, 24-hour BPM indicators within the reference values, the absence of hypertensive crises over the last year. All patients underwent measurement of NT-proBNP concentration, laser Doppler flowmetry of microvasculature vessels.

Results:

The concentration of NT-proBNP exceeded normal values in 4 patients (14.8%) in group I and in 1 patient (3.7%) in II, in group I this indicator was lower - 27.6 [21.4; 47.9] pg/ml than in group II - 45.15 [36.2; 102.0] pg/ml (p < 0.05).

According to the 24-BPM, the average daily (119.5 [112.0; 123.5]) and nocturnal (105.0 [99.5; 108.0]) SBP, as well as daily DBP (76 [64; 83]) in group I was lower than the similar indicators (136.0 [125.0; 164.0]), (122.5 [107.0; 144.0]) and (81 [75; 90]) in group II (p < 0.05). During the study of the microvasculature state, there was found an improvement in the microcirculation index (MI) in group I (30.55 [26.64; 34.37] compared to group II (22.19 [18.25; 26.05] (p < 0.05).

During the correlation analysis, the concentration of NT-proBNP in group I was correlated with the coefficient of variation of MI (r = 0.6; p < 0.05), the indicator of blood shunt (r = 0.59; p < 0.05), the maximum amplitude of the pulse factor regulating microcirculation (r = 0.71; p < 0.05), the contribution of the pulse factor to the total perfusion of tissues (r = 0.68; p < 0.05). In group II, the concentration of NT-proBNP had correlation with pulse BP (r = 0.54; p < 0.05).

Conclusions:

In patients with CAH there was detected a lower concentration of NT-proBNP along with lower values of SBP and DBP and better indicators of the state of blood microcirculation as compared with patients with UAH.
LOWER CIRCULATING MIR-191-5P AND LET-7G-5P ARE INDEPENDENT BIOMARKERS OF RENAL INJURY
Authors: Paradis Pierre , Berillo Olga , Huo Ku -Geng , Fraulob-Aquino Julio C. , Richer Chantal , Briet Marie , Boutouyrie Pierre , Lipman Mark L. , Sinnett Daniel , Schiffrin Ernesto L.
Published: April 2021

Objective:

Hypertension is associated with subclinical target organ damage including cardiac, vascular and kidney injury. Circulating microRNAs have been investigated as biomarkers of cardiovascular disease, but few studies have examined them as target organ damage biomarkers in hypertension. We aimed to identify circulating microRNAs that could serve as biomarkers of hypertension-induced target organ damage using an unbiased approach.

Design and method:

Normotensive subject, hypertensive patients (HTN) and patients with HTN associated with at least 2 other features of the metabolic syndrome (MetS) or with chronic kidney disease (CKD) grades 3–4 were studied (n = 15–16). Blood pressure was determined by automated office measurement (AOBP). Blood and urine were collected for determination of blood cell count, blood biochemistry and urinalysis. Platelet-free plasma (6 mL) was isolated from blood collected on EDTA, and RNA extracted for small RNA deep sequencing using Illumina HiSeq-2500. Differentially expressed (DE) genes were identified with a threshold of false discovery rate < 0.1. The most abundant DE miRNAs were confirmed by reverse transcription-quantitative PCR (RT-qPCR). Right common carotid artery remodeling and stiffness were assessed by ultrasound and aorta stiffness by carotid to femoral pulse wave velocity.

Results:

We found 4 up-regulated and 4 down-regulated miRNAs uniquely associated with the HTN group, 1 up-regulated uniquely associated with the MetS group, 1 up-regulated and 12 down-regulated miRNAs uniquely associated with the CKD group and 8 were found similarly DE in different groups (P < 0.01 and q < 0.1). Two down-regulated miRNAs, let-7g-5p and miR-191–5p of 11, the most abundant DE miRNAs, were validated by RT-qPCR. Correlation analysis revealed that let-7g-5p was associated with large vessel stiffening, miR-191–5p with diabetes, and both microRNAs with estimated glomerular filtration rate (eGFR) and inflammatory markers. Using let-7g-5p and miR-191–5p and parameters that correlated with eGFR as candidate variables, stepwise multiple linear regression generated a model showing that let-7g-5p, miR-191–5p and urinary albumin/creatinine ratio predicted eGFR with an adjusted R2 of 0.40 (P = 1.1e-5).

Conclusions:

Circulating let-7g-5p and miR-191–5p were identified as independent biomarkers of chronic kidney disease among patients with hypertension, which could have pathophysiological and therapeutic implications.