bluuebunny/crossref_metadata_2025 huggingface dataset:
Ethnic Disparities in Obstetric Anesthesia Care in England: Parallels and Paradoxes With Care in the United States
Authors: Lee A.J. , Palanisamy A.
Published: May 2024

(Anaesthesia. 2023;78:799–802)

The majority of studies on ethnic disparities in health care environments originate in the United States, where access to care and other factors make the health care experience different for every individual. It has been unclear whether these disparities exist in countries with a more consistently available health care system, such as the United Kingdom. This article comments on a recent study about ethnic disparities in the obstetric anesthesia population in the United Kingdom.
Obstetric Anesthesia Manpower and Service Provision Issues: Introduction and European Perspective
Authors: Guasch E. , Ioscovich A. , Brogly N. , Orbach-Zinger S. , Kranke P. , Morau E. , Gilsanz F.
Published: May 2024

(Int J Obstet Anesth. 2023;55:103647)

The global perspective on obstetric anesthesia emphasizes the critical role of universal health coverage, particularly during the COVID-19 pandemic. The United Nations prioritizes achieving 80% global universal health coverage by 2030, recognizing the substantial gaps in emergency and essential surgical and anesthesia care. The shortage of health care workers, especially in low-income and middle-income countries (LMIC), is evident, focusing on the lack of anesthesia physicians. In Europe, standards for physician anesthesia providers are currently achieved, but concerns persist about workforce challenges. Obstetric anesthesia practices vary globally, and efforts to address shortages include fellowship programs to enhance competency and efficiency. Examples from European countries, such as Israel, demonstrate diverse approaches to training obstetric anesthesiologists, aiming to ensure quality care amid workforce challenges. The Israel Obstetric Anesthesia Society actively contributes to education and training, highlighting the ongoing need for improvement in aligning standards with daily practice.
High-Volume Patient-Controlled Epidural Versus Programmed Intermittent Epidural Bolus for Labor Analgesia: A Randomized Controlled Study
Authors: Roofthooft E. , Filetici N. , Van Houwe M. , Van Houwe P. , Barbé A. , Fieuws S. , Rex S. , Wong C.A. , Van de Velde M.
Published: May 2024

(Anaesthesia. 2023;78(9):1129–1138)

Neuraxial labor analgesia is a well-established and effective method for managing pain during labor. The initiation of analgesia through epidural or combined spinal-epidural methods can be followed by various maintenance techniques, including continuous epidural infusion, manual intermittent boluses, patient-controlled epidural analgesia (PCEA), programmed intermittent epidural bolus (PIEB), or a combination of these approaches. Adding PCEA to a continuous infusion was long-favored, demonstrating benefits such as reduced breakthrough pain incidents, lower local anesthetic consumption without compromising efficacy, and heightened patient satisfaction compared with continuous epidural infusion.
ASSESSMENT OF HYPERTENSIVE PATIENTS’ COMPLEX METABOLIC STATUS IN THE NORTHEASTERN REGION OF HUNGARY USING DATA MINING METHODS
Authors: Kovacs Beata , Nemeth Akos , Daroczy Balint , Karanyi Zsolt , Maroda Laszlo , Zrinyi Miklos , Dioszegi Agnes , Nadro Biborka , Szabo Tamas , Harangi Mariann , Pall Denes
Published: May 2024

Objective:

Previously, the metabolic status of Central and Eastern European hypertensive adult patients has not been thoroughly explored. Therefore, we aimed to identify the prevalence of hypertension and its associated metabolic abnormalities in a relatively large adult population using data mining methods.

Design and method:

We analyzed the data of adults who visited the University of Debrecen Clinical Center’s hospital (n = 937,249) by evaluating a period of 20 years (2001-2021).

Results:

We identified a total of 292,561 adults with hypertension (male/female: 45.4/54.6%), with a 31.2% calculated prevalence of hypertension in the whole study population and a higher prevalence in males (33%) compared to females (29.9%). We found an increasing prevalence in consecutive age groups both in males and females up to the age of 80. The ratio of males with hypertension was higher from 18 to 65 years of age. Markedly higher body mass index (BMI) values were found in hypertensive patients as compared to non-hypertensives (29.5±6.3 vs. 26.57±5.6 kg/m2, p<0.001). A significantly higher triglyceride level was found in hypertensive adults compared to non-hypertensives (1.46 (1.06–2.07) vs. 1.19 (0.82–1.73 mmol/L, p<0.001). We could not find significant differences in total cholesterol and LDL-C levels in the entire patient population (5.1±1.2 vs. 5.0±1.2 mmol/L and 3.1±0.99 vs. 3.1±1.0 mmol/L, respectively). Significantly higher serum glucose levels (5.8 (5.2–6.9) vs. 4.7 (4.6–5.8) mmol/L, p<0.001) were found in subjects with hypertension. Significantly higher urea and creatinine levels were found in hypertensive patients compared to normotensives (5.78 (4.6–7.5) vs. 4.6 (3.7–5.7) mmol/L, p<0.001 and 76 (64–92) vs. 69 (59–81) μmol/L, p<0.001, respectively). Furthermore, we also assessed the rate of significant concomitant diseases in our hypertensive population.

Conclusions:

The results proved that data mining is an excellent yet not-too-widespread method used to define prevalence in large patient cohorts. This novel way of statistical analysis could be beneficial not only for regional clinical practice but nationwide strategies as well.
ASSOCIATION OF CARDIOVASCULAR RISK AMONG DIFFERENT COMMON OFFICE BLOOD PRESSURE MEASUREMENT PROTOCOLS IN COMMUNITY-BASED CHINESE POPULATION
Authors: Yong Jingwen , Fan Fangfang , Li Jianping , Zhang Yan
Published: May 2024

Objective:

The office blood pressure (BP) measurement protocols recommended by the guidelines is inconsistent. We aim to investigate the relationship between different office BP measurement protocols and cardiovascular risk in Chinese community population.

Design and method:

A total of 6098 participants without cardiovascular disease history were included in our study from the community atherosclerosis cohort conducted in Beijing, China, from December 2011 to April 2012. We conducted three measurements using the standard calibration method of Omron HEM-7117 electronic blood pressure monitor, with intervals between consecutive readings exceeding 1 minute. Four common office BP measurement protocols included: the average of the first two BP values; the average of the last two times; triple average value; and if BP fluctuation eceeds 10mmHg, take the average of the last two times; otherwise, take the average of the first two times. The primary endpoint is defined as the major adverse cardiovascular events (MACE) before December 31th, 2021, including acute myocardial infarction, stroke, and cardiovascular death. Cox proportional hazard regression models was used to examine the relationship between BP measurement protocols and MACE. Likelihood ratios and receiver operating characteristic curve (ROC) were also compared, and concordance of models assessed with Harrell C statistic.

Results:

Of all subjects, the mean age was 54.99 (8.41) years old, and 2126 (34.9%) were males. After a mean 9.86-year follow-up, a total of 486 (6.99%) participants experienced MACE. After adjusting for covariates, no difference of events predicted by different office BP measurement protocols was found in the COX analysis. The ROC curves for the different BP measurement protocols also did not show any significant differences (Figure1). There were no differences in the C-index among the different BP models (all P>0.05). These findings were consistent across subgroups stratified by age, gender, and hypertension grades (all P>0.05).

Conclusions:

The performance of all prediction models using four different BP measurement protocols is the same. All four blood pressure measurement protocols can accurately predict prognosis.
OUTCOME-DERIVED DIAGNOSTIC THRESHOLD FOR CENTRAL BLOOD PRESSURE BASED ON CARDIOVASCULAR RISKS USING UK BIOBANK
Authors: Wang Shuqi , Wong Samuel Ys , Yip Benjamin Hk , Lee Eric Kp
Published: May 2024

Objective:

This study aimed to establish the diagnostic threshold for central blood pressure (BP) and evaluate its clinical usefulness in risk stratification for cardiovascular diseases (CVD).

Design and method:

A cohort study of 34,289 adults without prior CVD was conducted using the UK Biobank dataset. The primary endpoint was a composite of cardiovascular mortality and non-fatal cardiovascular events. The diagnostic threshold was determined by using current brachial BP cutoff with bootstrap and approximation methods. Cox regression models were constructed to evaluate the clinical utility of diagnostic thresholds for central BP in CVD prediction.

Results:

Over a median follow-up of 40 months, 809 composite cardiovascular events occurred. A diagnostic threshold of 135 mmHg for central systolic BP (SBP) corresponded to the threshold of 140 mmHg for brachial SBP. Concurrent assessment of brachial and central BP identified brachial and central normotension (49.84%), isolated brachial hypertension (HT) (2.23%), isolated central HT (3.65%) and concordant brachial and central HT (44.28%). Compared to concordant normotension, hazard ratios for cardiovascular events were 0.81 (0.45, 1.44) for isolated brachial HT, 1.70 (1.23, 2.35) for isolated central HT and 1.51 (1.30, 1.76) for concordant HT. Inclusion of central BP improved model fit and discrimination for predicting CVD beyond brachial BP alone.

Conclusions:

The study determined a diagnostic threshold of 135 mmHg for central SBP. Individuals with central HT had elevated risks of CVD, regardless of brachial HT status. Incorporating central BP enhanced the prediction of CVD risk beyond traditional BP measurement.
APPLICATION OF PHOTO RECOGNITION TO ENCOURAGE PARTICIPATION IN HOME BLOOD PRESSURE MONITORING: A COMMUNITY COHORT OF 18,867 USERS IN HONG KONG
Authors: Tsoi Kelvin Kf , Hao Ziyu , Chen Yize , Chan Howard H , Tsang Davie Mt , Yiu Karen Kl
Published: May 2024

Objective:

Manual blood pressure recording is still common among the elderly who do not have a blue-tooth measurement device. A mobile application was developed with photo recognition techniques, named HealthCap, to capture blood pressure data from a photo of the measurement device. This study aimed to investigate the acceptance of new technologies for blood pressure data collection among the elderly in Hong Kong.

Design and method:

HealthCap can be downloaded after health talks and other publicity events. Participants aged over 18 years with at least 10 blood pressure records were included. A specific elderly cohort was recruited from elderly centres. Personal interviews were conducted to assess the demographic and health conditions. Nursing calls and social worker engagement were offered for those with suboptimal blood pressure levels. The logistic regression models were used to investigate the acceptance of photo recognition techniques for regular blood pressure monitoring.

Results:

A total of 2,284,026 blood pressure records were collected from 18,867 participants in Hong Kong from June 2018 to November 2023. Among the 8,970 participants who met the inclusion criteria, blood pressure records collected by manual input, photo recognition and a mixture of both methods were 2,621 (29%), 2,475 (28%), and 3,892 (43%) respectively. The mean frequency of blood pressure measurement was 4.2±7.9 times per week. Among a subgroup of 1,321 elderly participants with a mean age of 71 years, blood pressure records collected by manual input, photo recognition, and a mixture of both methods were 386 (29%), 199 (15%) and 736 (56%) respectively. Logistic regression was applied to compare the users of photo recognition and manual input (Table 1). Younger age, lower education levels, elderlies living with children, and those with self-reported memory complaints were shown to have a better usage of the photo recognition technique.

Conclusions:

The general population is welcome for the new technology application for blood pressure management. The participation rate of using photo recognition among the elderly is comparable to the general population. It also engages the participation of those living with family members.
REPRODUCIBILITY OF NIGHT-TIME BLOOD PRESSURE PHENOTYPES. RESULTS FROM THE HARVEST
Authors: Palatini Paolo , Saladini Francesca , Mos Lucio , Vriz Olga , Mazzer Adriano , Zanata Giuseppe , Fania Claudio , Rattazzi Marcello
Published: May 2024

Objective:

Night-time blood pressure (BP) assessed with ambulatory monitoring has a greater prognostic value than daytime BP but whether this is due to night-time hypertension being more reproducible than daytime hypertension is unclear. The aim of the study was to investigate the reproducibility of ambulatory BP subperiods and nocturnal dipping phenotypes assessed twice 3 months apart in young-to-middle-age untreated subjects screened for stage 1 hypertension.

Design and method:

We investigated 1096, 18-to-45-year old subjects from the HARVEST. Their office BP was 145.8±10.5/93.7±5.8 mmHg. Office BP and 24h BP were measured at baseline and after 3 months. Office, 24-h, daytime and night-time hypertensions, and nocturnal dipping patterns were defined according to the 2023 ESH guidelines. Definitions were based on systolic BP (SBP), diastolic BP (DBP) or either pressure. Agreement was evaluated with Kappa statistics.

Results:

Correlation coefficients between baseline and repeat measurements were 0.44 and 0.45 for office SBP and DBP, 0.68 and 0.66 for 24h, 0.65 and 0.65 for daytime, and 0.59 and 0.57 for nigh-time BPs, respectively. Reproducibility evaluated with weighted Kappa (K) was moderate for 24h hypertension (0.54 for SBP, 0.58 for DBP, 0.48 for either pressure), was lower but still moderate for daytime hypertension (0.42, 0.45, and 0.43, respectively), and was fair to moderate for night-time BP (0.41, 0.37, and 0.36, respectively). Between-measurement agreement was even worse for isolated night-time hypertension (K=0.20), and poor for office hypertension (K=0.14). Non-dipping was present in 31.8%, 31.2%, and 45.0% of participants, respectively, when based on SBP, DBP or either pressure, and showed a fair agreement (K=0.26, 0.23, and 0.30, respectively). Poorer agreement was shown by extreme dipping (K=0.18) and by reverse dipping (K=0.07).

Conclusions:

These data show that within the ambulatory sub-periods, 24h hypertension has the best and night-time hypertension the worst reproducibility. Thus, the better association with adverse outcomes shown by night-time hypertension compared to daytime hypertension in observational studies is not due to a better reproducibility of the former. The agreement was even worse for dipping phenotypes, especially for extreme and reverse dipping. Thus, dipping patterns should be confirmed with repeat ambulatory BP monitoring.
ASSESSMENT OF THE CART-I PLUS FOR CUFFLESS BLOOD PRESSURE MONITORING: A COMPARATIVE STUDY WITH STANDARD ABPM ACROSS DIVERSE PATIENT SUBGROUPS
Authors: Lee Huijin , Lee Hae -YOUNG
Published: May 2024

Objective:

This study aimed to assess the accuracy of the CART-I Plus device, a novel ring-type cuffless blood pressure (BP) measuring device, across various ages, genders, and medication statuses, in comparison with standard ambulatory blood pressure monitoring (ABPM).

Design and method:

Design and Method: Forty patients were enrolled in the study, with thirty-three completing it. They were asked to simultaneously wear the CART-I Plus device, which measures blood pressure using photoplethysmography, and a standard ABPM device for about 24 hours. To assess the accuracy of the CART-I Plus, we conducted subgroup analyses based on age, gender, and medication status, comparing these specific groups to see how well the device performed across different patient profiles.

Results:

The CART-I Plus demonstrated strong correlation with the ABPM across various patient subgroups divided by age, sex, and medication use. For individuals under 52, Pearson’s correlation coefficients ranged from 0.81 to 0.93. The correlation was similarly robust in participants aged 52 and over (ranging from 0.83 to 0.95), with the highest observed in nighttime diastolic readings (r=0.95). Gender-specific analyses revealed very high correlations in males (up to r=0.98 for nighttime systolic readings) and strong correlations in females, albeit slightly lower. Medication status also showed strong correlations, with those on treatment displaying coefficients from 0.83 to 0.94, and those without from 0.80 to 0.90.

Conclusions:

The CART-I Plus device displays a high degree of concordance with ABPM, suggesting its potential utility for reliable, cuffless BP monitoring across diverse patient populations. The significant correlations in all subgroups, especially in nighttime readings and among those not on medication, underscore its promise for continuous, non-invasive BP measurement in various clinical scenarios.
BLOOD PRESSURE CONTROL WITH APROCITENTAN IN RESISTANT HYPERTENSION
Authors: Narkiewicz Krzysztof , Danaietash Parisa , Kania Grzegorz , Kantola Ilkka , Martinez-garcia Fernando , Sassi-sayadi Mouna , Schlaich Markus P , Toursarkissian Nicole , Wang Ji -GUANG , Weber Michael A , Gimona Alberto
Published: May 2024

Objective:

The results of the phase 3 PRECISON study demonstrated that in patients with resistant hypertension, aprocitentan in addition to a fixed-dose combination of amlodipine, valsartan, hydrochlorothiazide was well tolerated and superior to placebo in lowering blood pressure at week 4 with a sustained effect at week 40. This pre-planned analysis evaluates the % of subjects with controlled blood pressure according to hypertension guidelines at different timepoints during the study.

Design and method:

In PRECISION, the mean SiSBP and SiDBP were 153 mmHg and 88 mmHg at baseline, across groups. In the 4-week DB part 1, patients were randomized to aprocitentan 12.5 mg, 25 mg and placebo. Thereafter all patients received 25 mg aprocitentan during the SB part 2. At week 36, subjects were re-randomized to 25 mg or placebo up to week 48. The primary endpoint was at week 4 and the key secondary endpoint at week 40. Control was defined as SiSBP <140 or <135 and/or SiDBP < 90 or <85 mm/Hg (trough unattended office BP). The % of patients achieving control was calculated at the end of part 1 (week 4, primary end point), end of part 2 (week 36) and at the timepoint of the key secondary endpoint (week 40).

Results:

At week 4, more patients had SiSBP below 140 mmHg with 12.5 mg (56%) and 25 mg (57%) compared to placebo (44%). The % of patients with controlled SiSBP increased to 64% at the end of part 2 and reached 67% of patients treated with 25 mg during part 3. The % of patients achieving control decreased in those re-randomized to placebo (48%). A similar trend was observed when the threshold of 135 mmHg was considered, with 56% of patients achieving control at week 40 with 25 mg, while in patients re-randomized to placebo the control rate was 35%. 52 to 65% of patients had both SiSBP and SiDBP controlled with aprocitentan 25 mg at week 40.

Conclusions:

Aprocitentan controlled systolic and diastolic blood pressure in up to 67% and 90% respectively, of patients with resistant hypertension.
CARDIAC TROPONIN-T AND N-TERMINAL PRO-B-TYPE NATRIURETIC PEPTIDE RELATED TO OTHER CLINICAL HIGH-RISK FACTORS IN PATIENTS ON AT LEAST TWO ANTIHYPERTENSIVE AGENTS
Authors: Larstorp Anne Cecilie , Halvorsen Lene V. , Hoff Oliver F. , Soraas Camilla L , Kjaer Vibeke N , Aune Arleen , Olsen Eirik , Brobak Karl Marius , Bergland Ola U , Rognstad Stine , Gerdts Eva , Mo Rune , Solbu Marit , Opdal Mimi S , Kjeldsen Sverre E , Rostrup Morten , Hoieggen Aud
Published: May 2024

Objective:

Cardiac biomarkers are useful in identifying patients with high risk of cardiovascular events. We aimed to identify how cardiac troponin T (cTnT) and N-Terminal Pro-B-Type Natriuretic Peptide (NT-pro-BNP) relate to other clinical high-risk markers in patients with treated essential hypertension in a national multicenter study.

Design and method:

We performed a cross-sectional study of patients with hypertension treated with > =2 antihypertensive agents. Cardiovascular risk factors were identified by interview, blood and urine tests, and physical examination. Ambulatory (ABPM) and office BP were measured with validated devices. High-sensitive cTnT and NT-pro-BNP were measured from stored serum samples at a core laboratory using Elecsys Troponin T Gen 5 STAT and Elecsys pro-BNP II (Roche Diagnostics, Basel, Switzerland). Continuous variables are presented as median (interquartile ranges [IQR]) and categorical variables as percentages. Multivariable logistic regression models were used to test for associations between risk factors and elevated cTnT > =14 ng/L or elevated NT-pro-BNP > =125 ng/L.

Results:

In 550 patients (36.5% women) aged 64 years (IQR 57-72) with daytime ABPM of 143/84 mmHg, 199 patients (36.2%) had high cTnT > =14 ng/L and 138 (25.1%) patients had high NT-pro-BNP > =125 ng/L. Elevated cTnT was independently associated with higher HbA1c (p=0.045) and history of diabetes (p<0.001) when adjusting for age, sex, estimated GFR and pulse pressure. Elevated NT-pro-BNP was independently associated with higher pulse pressure (p=0.008), number of antihypertensive agents (p<0.001), aldosterone/renin ratio (p<0.001), lower HDL (p=0.02), use of antithrombotic (p=0.002) and lipid-modifying (p=0.02) drugs and a history of coronary heart disease (p=0.02) when adjusting for age, sex and estimated GFR.

Conclusions:

We found that elevated cTnT and NT-pro-BNP were independently associated with several clinical markers of increased risk for cardiovascular events in patients with hypertension treated with > =2 antihypertensive drugs, when adjusting for age, sex and estimated GFR. Prospective studies should further explore the potential of these cardiac biomarkers to individualize risk assessment in patients with uncontrolled hypertension.
ANTIHYPERTENSIVE TREATMENT OF MASKED HYPERTENSION GUIDED BY AMBULATORY BLOOD PRESSURE MONITORING: A DOUBLE-BLIND, PLACEBO-CONTROLLED TRIAL
Authors: Huang Jian -Feng , Zhang Dong -Yan , An De -Wei , Li Ming -Xuan , Liu Chang -Yuan , Feng Ying -Qing , Zheng Qi -Dong , Chen Xin , Staessen Jan , Wang Ji -Guang , Li Yan
Published: May 2024

Objective:

Masked hypertension, office normotension combined with out-of-office hypertension, is associated with target organ damage (TOD), but whether antihypertensive treatment guided by out-of-office blood pressure (BP) would reduce TOD is unproven. We aimed to assess TOD change on antihypertensive treatment guided by ambulatory BP monitoring.

Design and method:

Double-blind, placebo-controlled randomized trial at 15 Chinese hospitals. Enrolment started on February 14, 2017 and follow-up ended on October 31, 2021. Patients of either sex, aged 30-70 years, not on antihypertensive drugs were eligible, if at two screening visits 1-week apart office BP was <140/<90 mmHg and the 24-hour, daytime or nighttime ambulatory BP was >=130/>=80, >=135/>=85, or >=120/>=70 mmHg, respectively. Patients had >=1 sign of TOD: ECG left ventricular hypertrophy (LVH), brachial-ankle pulse wave velocity (baPWV) >=1400 cm/s, or urinary albumin-to-creatinine ratio (ACR) >=3.5 mg/mmol in women and >=2.5 mg/mmol in men. Active antihypertensive treatment consisted of allisartan starting at 80 mg/day to be increased to 160 mg/day at month 2 and to be combined with amlodipine 2.5 mg/day at month 4, if the ambulatory BP remained uncontrolled. Matching placebos were used likewise in the control group. The primary endpoint included normalization of baPWV, ACR or LVH or >=20% reduction in baPWV or ACR.

Results:

Of 320 patients (43.1% women; mean age 54 years), 153 were randomized to active antihypertensive treatment and 167 to placebo. At baseline, office BP averaged 130/81 mm Hg and the 24-hour BP 136/84 mm Hg. The prevalence of elevated baPWV, ACR and LVH was 97.5%, 12.5%, and 7.8%. At 1 year, the 24-hour systolic/diastolic decreased by 9.0/5.6 mm Hg (95% CI: 7.5-10.5/4.8-6.5 mmHg) on active treatment and by 1.4/1.0 mm Hg (-0.1-2.8/0.2-1.8 mm Hg) on placebo. Regression of TOD occurred more frequently in patients randomized to active treatment than in those assigned to placebo with 1 year rate of 45.8% (95% CI: 37.9-53.7%) and 25.8% (19.1-32.4%), respectively (P<.001 for between-group differences in BP and TOD). Per-protocol and subgroup analyses were confirmatory.

Conclusions:

Masked hypertensive patients require antihypertensive treatment guided by out-of-office BP monitoring before subclinical TOD progresses to major cardiovascular complications.
RENAL DENERVATION AT THE GEORGES-POMPIDOU EUROPEAN HOSPITAL IN PARIS: THE TRANSITION FROM RESEARCH TO STANDARD CARE IN HYPERTENSIVE PATIENTS
Authors: Gebara Nicole , Al Ahmar Marc , Lorthioir Aurelien , Mallart-riancho Julien , Amar Laurence , Sapoval Marc , Azizi Michel
Published: May 2024

Objective:

Renal Denervation (RDN) is a minimally invasive intervention for resistant primary hypertension or medication-intolerant patients, transitioning from research to standard care. This prompts our forward-thinking initiative to facilitate this shift.

Design and method:

The approach undertaken in this project is comprehensive and multidimensional, encompassing the definition, assessment, and analysis of various pivotal dimensions in hypertensive patients’ management, focusing on patient’s pathway, legal considerations, RDN techniques and expertise, internal visibility, and cost analysis.

Results:

The patient pathway involves eligibility criteria-based selection, with an interventional radiologist assessing renal artery anatomy. A multidisciplinary meeting validates the procedure’s indication, and with patient consent, the 3-days hospitalization for the procedure is followed by a rigorous 5-years follow-up.

Legally, healthcare professionals consider good clinical practice and liability, implementing proactive measures for compliance and safety. Patient-related legal considerations focus on obtaining informed consent and protecting personal data.

In human resources (HR), a strategy adapts to Generations Y and Z, addressing upcoming changes. Training initiatives encourage professional involvement and reveal potentials. HR management during shortages focuses on optimizing existing staff for quality care. Stakeholders express satisfaction with the training, demonstrating its effectiveness in strengthening skills and confidence in managing RDN patients.

In the marketing aspect, an observational study targeted potentially eligible RDN patients in our Hypertension Unit. Efforts aim to emphasize the uniqueness of the RDN implementation approach to strengthen internal recognition. Due to the lack of social security coverage, limited availability of RDN probes, and logistical constraints, external recruitment remains restricted.

Financially, annual hypertensive patient treatment costs are 422 EUR, with uncomplicated follow-up at 135 EUR per patient. Managing cardio-neurovascular complications costs at least 12,647 EUR per patient in the first year. While the financial benefit of RDN for complicated hypertension is evident, the comparison with uncomplicated cases is subtle and considers the reduction in cardiovascular events and improvement in quality of life. Our registry supports RDN probe reimbursement requests.

Conclusions:

This managerial approach reinforces the belief in the effectiveness of a strategic and systematic method to successfully implement RDN into standard care highlighting the inherent complementarity between management and medicine.
VASCULAR AGEING MANIFESTATIONS AND RISK OF HYPERTENSION IN THE COMMUNITY. A CLUSTERING ANALYSIS OF CAROTID ECHO-TRACKING DATA ON 10,157 PARTICIPANTS
Authors: Alanis Guillermo Adrian , Boutouyrie Pierre , Bruno Rosa Maria , Abouqateb Mouad , Climie Rachel , Van Sloten Thomas , Danchin Nicolas , Laurent Stéphane , Jouven Xavier , Empana Jean -Philippe
Published: May 2024

Objective:

To investigate the association between patterns of vascular ageing (VA) manifestations, and risk of hypertension in the community.

Design and method:

We used baseline (2008-2012) and follow-up data (up to 2020) from the Paris Prospective Study III, a French community-based prospective cohort including 10,157 volunteers. Baseline hypertension was defined as blood pressure equal or >140/90 mmHg or antihypertensive treatment use. Incident hypertension was defined as self-reported antihypertensive treatment at 2, 4, 6, 8, 10 years of follow-up. VA manifestations were assessed at baseline via echo-tracking in the right common carotid artery. Patterns of VA manifestations were identified using hierarchical clustering analysis. Associations between clusters of VA manifestations (main exposure) and prevalent and incident hypertension (outcomes) were assessed on separate logistic regression analysis.

Results:

The cross-sectional analysis included 8,839 study participants (mean age of 59±6 years, 39% female) without cardiovascular disease, among whom 3,129 (35.3%) were diagnosed with hypertension (74.8% with blood pressure equal or >140/90 mmHg and 40.8% under treatment). Three clusters of VA manifestations were identified. Cluster 1 (n=4,216;47.7%) was characterized by healthy vascular ageing (HVA) (low arterial stiffness and low prevalence of atherosclerosis). Cluster 2 (n=2,218;25.0%) was characterized by arterial stiffness (high local pulse wave velocity, beta stiffness index, pulse pressure, Young’s elastic modulus, and low distensibility coefficient). Cluster 3 (n=2,405;27.2%) was characterized by atherosclerosis (relative high prevalence of carotid plaques and high IMT). Compared to the HVA cluster, arterial stiffness (adjusted odds ratio [aOR]: 4.02; 95% CI 3.56;2.70) and atherosclerosis clusters (aOR 2.70; 95% CI 2.39;3.05) were associated with baseline hypertension independently of traditional risk factors. The longitudinal analysis included 5,384 normotensive participants (untreated blood pressure <140/90 mmHg) among whom 588 (10.9%) reported being under treatment after a median follow-up of 8.0 years (range: 7.9-9.4). In multivariate analysis, both arterial stiffness (aOR 1.45; 95% CI 1.15-1.82) and atherosclerosis (aOR 1.61; 95% CI 1.29-1.99) clusters were associated with anti-hypertensive treatment initiation.

Conclusions:

Vascular ageing manifestations reflecting carotid stiffness and carotid atherosclerosis are related to both prevalent and incident hypertension in the community.
DEFICIENCY OF THE COMPLEMENT RECEPTOR C5AR2 HAS NO EFFECT ON BLOOD PRESSURE AND END ORGAN DAMAGE IN ANGIOTENSIN II INDUCED HYPERTENSION
Authors: Dreher Leonie , Bode Marlies , Ehnert Nicolas , Herrnstadt Georg R. , Meyer-schwesinger Catherine , Köhl Jörg , Huber Tobias B. , Wenzel Ulrich O.
Published: May 2024

Objective:

Complement activation plays an important role in development of hypertension and hypertensive end organ damage by affecting immunity and tissue integrity. The anaphylatoxin C5a, a key inflammatory mediator of the complement system, binds to the anaphylatoxin receptors C5aR1 and C5aR2. Recently we and others could demonstrate that C5aR1 knockout mice show reduced hypertensive renal end organ damage. However, the role of C5aR2 in hypertension remains unclear.

Design and method:

First, we investigated the expression of C5aR2 on infiltrating and resident renal and cardiac cells, using a tandem dye (td) tomato-C5aR2 knock-in reporter mouse. Flow cytometry analysis of leukocytes isolated from the kidneys of td tomato-C5aR2 reporter mice showed that dendritic cells were the major population expressing C5aR2 (34%), followed by monocytes/macrophages (30%) and neutrophils (14%). Confocal microscopy did not detect expression of C5aR2 in resident renal or cardiac cells.

Results:

Next, we examined the influence of C5aR2 deficiency on Ang II-induced hypertension and hypertensive end organ damage. To assess the role of C5aR2 deficiency in hypertensive injury, we used an aggravated model of hypertension including unilateral nephrectomy followed by infusion of Angiotensin (Ang) II (0.75 ng/g/min) and a high salt diet in both wildtype (n=12) and C5aR2 knockout mice (n=18). 9 normotensive mice served as controls.

No significant differences were observed regarding blood pressure, renal injury (albuminuria, glomerular filtration rate, glomerular and tubulointerstitial injury, inflammation), or cardiac injury (cardiac fibrosis, heart weight, gene expression) between hypertensive wildtype and hypertensive C5aR2-deficient mice.

Conclusions:

In summary, our findings showed that while C5aR2 is predominantly expressed on myeloid cells in the kidney, its deficiency does not appear to have an impact on Ang II-induced hypertensive injury.
THE INTERACTION BETWEEN GLOMERULAR FILTRATION RATE (GFR)-ADJUSTED URICEMIA AND INSULIN RESISTANCE IN PREDICTING MORTALITY: THE URRAH PROJECT
Authors: Russo Elisa , Viazzi Francesca , Pontremoli Roberto , Casiglia Edoardo , Desideri Giovambattista , D’Elia Lanfranco , Ferri Claudio , Galletti Ferruccio , Masulli Maria , Muiesan Maria Lorenza , Tikhonoff Valerie , Virdis Agostino , Grassi Guido , Borghi Claudio , Group Siia Working
Published: May 2024

Objective:

Uric acid (UA) and insulin resistance (IR) are interlinked: UA contributes to adversely affect the insulin signaling pathway, while IR predicts the development of hyperuricemia. Both UA and IR are related to metabolic syndrome, which is nowadays one of the most prevalent risk factors for mortality. In the clinical scenario, the triglyceride (TG) to high-density lipoprotein cholesterol (HDL-C) ratio (TG/HDL-C) has been proved to have a high correlation with IR. The aim of the research was to explore the interplay between IR and GFR-adjusted uricemia (UA/GFR) in determining mortality risk in a large study cohort.

Design and method:

Data from 18,694 subjects were included from Uric acid Right foR heArt Healt (URRAH) database. Differences between TG/HDL-C quintiles were evaluated by t-test or chi-square test. We evaluated the association between TG/HDL-C and UA/GFR, and the development of outcomes during the follow-up study period. The primary endpoint was all-cause mortality. The Kaplan-Meier method and Cox proportional hazard regression models were used to analyze the prognosis.

Results:

After a mean follow-up of 124±64 months, there were 2,665 (14.2%) deaths for all causes. The incidence of fatal, non-fatal cardiovascular events, and all-cause mortality increased in parallel with the increase of TG/HDL-C quintiles. In both diabetic and non-diabetic patients, TG/HDL-C showed a positive association with UA/GFR, and TG/HDL-C and UA/GFR significantly interact in determining all-cause mortality. Along with the increase of TG/HDL-C quintiles, we observed a statistically significant increase in the rate of mortality (P <0.0001), independently by uricemia, GFR, body mass index (BMI) and the presence of diabetes (Figure 1).

Multivariate analysis showed that the TG/HDL-C increases the risk for mortality even after adjustment for potential confounding factors included age, diabetes, UA/GFR, BMI and statins treatment (Table 1).

Conclusions:

TG/HDL-C and UA/GFR interact in the prediction of death. Both IR and UA/GFR impact on all-cause mortality, independently of age, gender, diabetes, hypertension and statins. These findings provide evidence of the interactive relationship between hyperuricemia and the impairment in insulin sensitivity in their contribution to the mortality risk, independently by renal function.
RESTING HEART RATE AND MORTALITY RISK IN HYPERTENSIVE PATIENTS WITH NO ATRIAL FIBRILLATION
Authors: Pittaras Andreas , Kokkinos Peter , Faselis Charles , Grassos Charalampos , Doumas Michael , Kallistratos Emmanouil , Manolis Athanasios , Samuel Immanuel Babu
Published: May 2024

Objective:

The recent ESH Guidelines include elevated resting heart rate (RHR) as an independent risk factor among the established and suggested novel risk factors that influence cardiovascular risk in patients with hypertension, indicating sympathetic overdrive. Increased fitness affects both mortality and RHR. However, the association between RHR and mortality risk, adjusted for cardiorespiratory fitness, age, comorbidities and medication has not been fully explored.

Design and method:

We evaluated the association between RHR and mortality in 422,702 hypertensive patients (mean age 62.5 ± 8.6 years) with no evidence of atrial fibrillation during the entire follow-up. All completed a standardized exercise treadmill test (ETT), with no evidence of overt heart disease prior to and at the time of the ETT. To assess the risk in a wide and clinically relevant spectrum, we established 6 RHR categories per 10 heartbeat intervals ranging from <=60 to >100 beats. We used multivariable Cox regression to assess the RHR-mortality association. We adjusted the models for age, body mass index, cardiac risk factors, exercise capacity, and medications (including b-blockers).

Results:

During the median follow-up of 10.6 years, providing 4,551,327 person-years, there were 107,863 deaths with an average annual rate of 23.7 events per 1,000 person-years. We noted approximately 7% increase in risk for each 10 heart beats. Mortality risk was significantly elevated at a RHR of >80 beats/min (HR; 1.15, CI; 1.12 - 1.17; p <0.006) and increased progressively to 41% (HR; 1.41, CI; 1.36 - 1.45; p <0.001) for those with a RHR of >100 beats/min. Similar trends were noted for subjects aged <60; 60-69; and >=70 years and those treated with b blockers. In all assessments, mortality risk was consistently overestimated when fitness was not considered.

Conclusions:

We noted a progressive increase in mortality risk with increased RHR at >80 bpm in hypertensive patients with no AF. The association was independent of comorbidities, and medications.
LONG-TERM CLINICAL OUTCOME OF PHYSIOLOGY-GUIDED RENAL ARTERY STENTING WITH ZETAROLIMUS ELUTING STENTS IN PATIENTS WITH UNCONTROLLED RENOVASCULAR HYPERTENSION
Authors: Galli Verdiana , Trento Laura , Salfa Federica , Fezzi Simone , Trevisanello Aurora , Galuppi Enrico , Casal Matteo , Piscopo Matteo , Scarsini Roberto , Pesarini Gabriele , Gambaro Alessia , Ferrero Valeria , Tavella Domenico , Ribichini Flavio Luciano
Published: May 2024

Objective:

Randomized clinical trials (RCTs) failed to demonstrate the superiority of renal artery stenting (RAS) on optimal medical therapy (OMT) alone in terms of blood pressure (BP) control, renal function stabilization and cardiovascular events in patients with renal arteries stenosis (SRA). Main limitations of these trials are the lack of clear diagnostic criteria to identify hemodynamically significant SRA and the use of bare metal stents. Aim of the study was to assess safety and efficacy of RAS with new-generation zotarolimus-eluting stents in uncontrolled renovascular hypertension, after hemodynamic flow-limitation assessment by invasive pressure-wire (PW).

Design and method:

From 2012 to 2022, patients with suspected renovascular uncontrolled hypertension despite OMT and rapid renal function decline were enrolled. Lesions of at least intermediate angiographical significance were analyzed with PW measurements. A pressure ratio between the distality of the diseased vessel and the aortic pressure without hyperemia (Pd/Pa) below 0.9 was considered as potentially responsible of renal ischemia. In 21 patients out of 40 interrogated, 25 SRA yielded a Pd/Pa<0.9 and therefore treated with ZES implantation. Primary endpoint of the study was systolic and diastolic office blood pressure (OBP) variation at 2 years. Secondary endpoints included the impact of RAS on renal function and cardiovascular events.

Results:

Baseline average OBP was 160.0±22.4/84.7±9.8mmHg. At a median follow-up of 17 months, a significant OBP reduction was observed, respectively by -16,7±23.7mmHg (systolic, p=0.006) and -9,7±14.7mmHg (diastolic, p=0.01). Glomerular filtration rate confirmed to be stable with a trend towards improvement by +2.87±10.44 ml/min/1.73m2. No procedure-related complications were reported. During the follow-up period, two episodes of hypertensive crisis, two myocardial infarction and three admissions for acute renal impairment were reported.

Conclusions:

SRA is one of the most frequent causes of secondary hypertension, with high rates of clinical events. Previous RCTs yielded negative results in demonstrating benefits either on BP control or renal function. Our experience suggests that functional guidance to identify appropriate candidates for RAS can be effective. Moreover, this is the first cohort of RAS implanted with new-generation ZES, that may have further improved clinical results because of the reduced risk of restenosis.
CAROTID-FEMORAL PULSE WAVE VELOCITY PROGRESSION IN HYPERTENSIVE PATIENTS IS ASSOCIATED WITH SUBSEQUENT CV OUTCOMES
Authors: Maloberti Alessandro , Rebora Paola , Occhino Giuseppe , Andreano Anita , Intravaia Rita Cristina My , Tognola Chiara , Toscani Giorgio , Morelli Martina , Pezzoli Stefano , D’Oro Luca Cavalieri , Russo Antonio , Giannattasio Cristina
Published: May 2024

Objective:

Arterial stiffness (Pulse Wave Velocity-PWV) is associated with CV events and mortality. However, little is known on the relationship of its progression (δ PWV) over time with CV outcomes. The aim of our study was to evaluate the relationship between PWV progression and all-cause mortality and CV events in hypertensive subjects.

Design and method:

We enrolled 402 consecutive hypertensive outpatients. At baseline anamnestic, clinical, BP, laboratory data and PWV were assessed. We performed a PWV follow-up examination at a median time of 3.7±0.5 years. Patients were subsequently followed for a median time of 10.1 (IQR 9.5-10.5) years recording all-cause mortality and CV events.

Results:

At baseline the mean age was 53.2±13.0 years, SBP and DBP were 141.8±17.5 and 86.8±10.5 mmHg and PWV was 8.5±1.9 m/s. Despite an improvement in BP control (-9.2±19.5 and -8.0±12.3 for SBP and DBP respectively), at follow-up the population showed a PWV increase (δPWV +0.6±1.9 m/s). Progressors (δ PWW > 0.5 m/s, 204 patients, 50.7%) had a significantly lower survival probability and higher cumulative incidence of composite events, while no differences were seen for CV events (unadjusted analysis). At cox multivariable analysis neither δ PWV > 0.5 m/s (progressors) nor δ PWV (as a spline function) were associated with CV events and with all-cause mortality. However, the association with survival probability and cumulative incidence of CV events, as a composite outcome, was significant (HR = 2.32, 95% CI: 1.33 – 4.04, p=0.003).

Conclusions:

In conclusion, our study shows that PWV progression of at least 0.5 m/s is frequent in hypertensive patients and that it is associated with a significantly higher risk of developing CV events or dying (composite outcome).
ASSOCIATION OF HYSTERECTOMY WITH HYPERTENSION INCIDENCE IN KOREAN WOMEN: A NATIONWIDE COHORT STUDY
Authors: Kim Byung -GYU , Yuk Jin -Sung , Kim Gwang Sil , Byun Young Sup , Kim Myoung -Hwan , Yoon Sang -Hee
Published: May 2024

Objective:

Although several observational studies have reported a higher risk of cardiovascular events in women who underwent hysterectomy, the underlying mechanism is unclear, and limited data exist regarding the effect of hysterectomy on the incidence of hypertension. We sought to evaluate the association between hysterectomy and the development of hypertension in Korean women aged 40–59 years.

Design and method:

In this Korean nationwide cohort study, 803,255 women aged 40-59 years were selected for analysis from January 1, 2002, to December 31, 2011. In total, 13,650 pairs were included in the hysterectomy and non-hysterectomy groups after 1:1 propensity score matching for age at 5-year intervals, year of inclusion, socioeconomic status, body mass index, residential region, Charlson comorbidity index, menarcheal age, menopause, diabetes, dyslipidemia, physical activity, smoking history, alcohol consumption, menopausal hormone therapy before inclusion, adnexal surgery history, uterine leiomyoma, and endometriosis. The primary outcome was the development of hypertension during follow-up. The participants were followed-up until December 31, 2020. Data analysis was performed from July 16, 2022 to January 07, 2023.

Results:

During median follow-up periods (10.6 years [IQR 9.2-12.6]; 10.9 years [IQR 9.2-12.7]), the incidence of hypertension was 22/1,000 person-years and 20/1,000 person-years for the hysterectomy and non-hysterectomy groups, respectively. The hysterectomy group had a significantly higher rate of development of hypertension than that of the non-hysterectomy group (hazard ratio [HR], 1.11; 95% confidence interval [CI], 1.05-1.17). The risk was prominent in women whose hemoglobin level increased by >2g/dL post-hysterectomy. In women who had an adnexa-sparing hysterectomy, the incidence of hypertension was higher (HR, 1.15; 95% CI 1.08-1.23, P <0.001) than that in the non-hysterectomy group.

Conclusions:

In this nationwide cohort study of Korean women revealed that hysterectomy was independently associated with an increased risk of hypertension among women aged 40 to 59. In particular, this risk elevation was prominent when the hemoglobin level increased by >2g/dL after hysterectomy, suggesting that hemorheologic changes following hysterectomy may have an impact on the occurrence of hypertension.
USING A MULTI-OMICS LANDSCAPE OF THE MATERNAL-FETAL INTERFACE TO MODEL THE LONGITUDINAL PATHOGENESIS OF EARLY-ONSET PRE-ECLAMPSIA
Authors: Nonn Olivia , Debnath Olivia , Valdes Daniela , Frolova Alina , Haider Sandra , Verlohren Stefan , Thilaganathan Basky , Kaituu-lino Tuuhevaha J , Tong Stephen , Staff Anne Cathrine , Coscia Fabian , Müller Dominik N. , Dechend Ralf , Gauster Martin , Ishaque Naveed , Herse Florian
Published: May 2024

Objective:

Pre-eclampsia (PE) is a syndrome that affects multiple organ systems and is the most severe hypertensive disorder in pregnancy. It frequently leads to preterm delivery, maternal and fetal morbidity and mortality and life-long complications. We currently lack efficient screening tools and early therapies to address PE.

Design and method:

To identify candidate biomarkers and operative pathways in early onset PE (eoPE, severe PE with onset before week 34), we performed spatio-temporal multi-omics profiling of human eoPE placentae and healthy controls, and validated targets in early gestation in a longitudinal clinical cohort. We used a single-nuclei RNA-sequencing combined with spatial proteo- and transcriptomics and mechanistic in vitro signalling analyses to bridge the gap from late pregnancy disease to early pregnancy pathomechanisms.

Results:

We discovered a key disruption in villous trophoblast differentiation, which is driven by the increase of transcriptional coactivator p300, that ultimately ends with a senescence-associated secretory phenotype (SASP) of trophoblasts in eoPE. We found a significant increase in the senescence markers in preeclamptic maternal serum in early gestation and late gestation, before the development of clinical symptoms, indicating that the placental syndrome drives systemic maternal syndrome, even before clinical manifestation of eoPE.

Conclusions:

Our work describes a new disease progression model, starting with dysregulated transition in villous trophoblast differentiation. Our study identifies potential pathophysiology-relevant biomarkers for the early diagnosis of the disease as well as possible targets for interventions, which would be crucial steps toward protecting the mother and child from gestational mortality and morbidity and an increased risk of cardiovascular disease later in life.