bluuebunny/crossref_metadata_2025 huggingface dataset:
REGIONAL VARIATION OF AGE-RELATED BLOOD PRESSURE TRAJECTORIES AND THEIR ASSOCIATION WITH BLOOD PRESSURE CONTROL RATES, DISABILITY-ADJUSTED LIFE YEARS AND DEATH
Authors: Nolde Janis , Beaney Thomas , Carnagarin Revathy , Stergiou George , Poulter Neil , Schutte Aletta , Schlaich Markus
Published: May 2024

Objective:

Age-related BP trajectories may vary substantially across different populations and associated with differential CV risk and outcomes. The dataset of the May Measurement Month (MMM) campaigns enables a investigation of regional, socio-economic and sex differences in age-BP trajectories and their association with major public-health outcomes.

Design and method:

Global BP data from more than 4,5 million adult screenees obtained during the cross-sectional MMM campaigns in 2017, 2018, 2019, and 2021 were analysed. Average BP and slopes of BP changes across age groups were calculated within regional, socio-economic and sex strata. BP slopes of individuals between 30 and 70 years of age were derived from adjusted linear regression models, along with baseline BP estimates at young age. These BP slopes were correlated in regression models adjusted for baseline BP at young age with country-specific all-cause rates of DALYs (Disability-Adjusted Life Years), death (both from Global Burden of Disease Study 2019), life expectancy (World Bank data SP.DYN.LE00.IN 2019) and BP control rates (NCD Risk Factor Collaboration).

Results:

Age-related BP changes differed distinctly across global geographic regions, income levels, and between sexes. The steepest increase in BP with age was observed in populations from Africa and Europe, whereas a more gradual rise in BP with increasing age was seen in South-East Asian populations. Women had lower BP levels than men at younger ages (twenties and thirties), but subsequently experienced a more pronounced age-related BP increase resulting in diminishing sex differences across older age groups. Geographically divergent age-related BP trajectories were significantly associated with major national public health indicators. Globally, the steeper the age-related BP slope, the stronger the association with poor BP control (coef = -0.46 [95% CI: -0.74; -0.19], p=0.001), increased DALY's (coef = 66155.68 [95% CI: 44847.0; 87464.36], p<0.001) and death rates. (coef = 1017.3 [95% CI: 351.72; 1682.89], p=0.003).

Conclusions:

Age-related BP trajectories vary considerably across global populations and contribute considerably to the variability in BP-related risks and adverse outcomes across regions. Effective public health strategies may require region-specific targeting of lifestyle and other factors contributing to adverse BP trajectories to improve health outcomes.
ASSOCIATION OF RS6817105 POLYMORPHISM OF THE PITX2 GENE WITH ATRIAL FIBRILLATION IN PATIENTS WITH ARTERIAL HYPERTENSION IN THE UZBEK POPULATION
Authors: Radjabova Guliruh , Abdullaeva Guzal , Zakirova Dasha , Pulatova Muazzam , Sherbadalova Nigora , Mashkurova Zarina , Abdullayev Alisher
Published: May 2024

Objective:

Determine the influence of the rs6817105 polymorphism of the PITX2 gene on the risk of developing atrial fibrillation (AF) in patients with arterial hypertension (AH) in the Uzbek population.

Design and method:

Included 142 patients who were initially diagnosed with paroxysmal (n=15), persistent (n=43) and permanent (n=84) forms of AF. Control group (n=88) hypertensive patients without AF. Echocardiography evaluate the indexed left atrial volume (LAVI). Genotyping of samples for carriage of allelic variants rs6817105 by polymorphism of the PITX2 gene was carried out using the RFLP-PCR method. Relative risk (OR) was calculated using genetic models.

Results:

Patients with hypertension and AF,the following distribution of genotypes of rs6817105 polymorphism of the PITX2 gene was revealed: CC genotype -72(50.7%) patients, CT genotype-in 60 (42.3%), TT genotype-10(7.0%), χ2=68.535,p=0.000. The allelic distribution showed a predominance of carriage of the C allele:C allele–71.8%, T allele–28.2%, χ2=106.542, p=0.000. Patients with AH without AF,the C allele also prevailed:59.7% and 40.3%, respectively, χ2=12.375,p=0.000. Ratio of CC:ST:TT genotypes:38.6%:42.1%:19.3%, χ2=12.375, p=0.000. Multiplicative model of inheritance,a significant accumulation of the C allele was demonstrated among 142 patients AH with AF in 71.8% (χ2=7.30;p= 0.007;OR=1.72,95%CI 1.16-2.56),while the T allele was less common in 28.2% cases.General model demonstrated the association of the CC genotype with the risk of developing AF in patients with hypertension,CC genotype was more common in 50.7% (χ2=8.69;P=0.01;OR=1.63,95%CI 0.95-2.81), while CT genotype was found in 42.3% of cases and TT genotype in 7.0%.Group of patients without AF there was a different distribution of CC:CT:TT genotypes:38.6%:42.0%:19.3%,respectively.It is important to note that in hypertensive patients with AF-carriers of the CC genotype rs6817105 polymorphism of the PITX2 gene,the LAVI indicator was significantly higher in comparison with carriers of the CT and TT genotypes:46.8±14.9 ml/m2 versus 40.4±13.0 ml /m2 and 36.5±11.6 ml/m2, respectively(p=0.020).

Conclusions:

CC genotype and the C allele of the rs6817105 polymorphism of the PITX2 gene with the risk of developing AF in patients with hypertension in the Uzbek population. It was noted that in carriers of the CC genotype rs6817105 polymorphism of the PITX2 gene, the LAVI indicator was significantly higher in comparison with carriers of the CT and TT genotypes.
PREVALENCE AND ASSOCIATED PROGNOSIS OF ELECTROCARDIOGRAPHIC FINDINGS IN HYPERTENSIVE PATIENTS. AN ANALYSIS OF A 5-YEAR FOLLOW-UP STUDY
Authors: Stathoulopoulou Maria , Kasiakogias Alexandros , Tsoumpou Ioanna , Siafi Eirini , Tatakis Fotis , Konstantinidis Dimitrios , Leontsinis Ioannis , Fragoulis Christos , Fillipou Christina , Kakouri Niki , Karaminas Nikos , Drogkaris Sotiris , Polyzos Dimitrios , Iliakis Panagiotis , Liatakis Ioannis , Tsioufis Konstantinos
Published: May 2024

Objective:

Various electrocardiographic abnormalities may be identified in hypertensive patients, but their prognostic significance has not been sufficiently studied. We investigated the presence of diverse ECG findings in a hypertensive population and their predictive ability for cardiovascular disease.

Design and method:

We studied 1851 white Caucasian hypertensive patients (age 58±12years, 51% females) free of cardiovascular disease for a mean period of 5.3±3.4 years. At baseline, all patients underwent standard 12-lead electrocardiography. Left ventricular hypertrophy (LVH) criteria were assessed using both the Sokolow and the Cornel-Voltage formulas. An interventricular conduction delay (IVCD) was defined as a QRS >110msec in the absence of a bundle branch block (BBB). QRS fragmentation was identified as notches in the QRS complex not related to BBB. The QTc interval was considered prolonged if > 440ms in men and >460ms in women. ST depression was defined as >1 mm in depth. The outcome studied was the incidence of cardiovascular morbidity set as the composite of non-fatal coronary artery disease and stroke.

Results:

LVH criteria were fulfilled in 7% with the Sokolow formula and in 5.3% with Cornell Voltage criteria. A prolonged PR was evident in 6.3%. An IVCD, a left BBB and a right BBB were observed in 9%, 4.1% and 1% of the population respectively. QRS fragmentation was identified in 18% of the study population. An early transition zone was found in 30% of the population and a late transition zone in 19%. QTc was prolonged in 9.8% of cases. Prevalence of TWI was 3.8%, of which 39% was anterior TWI, 73% was lateral TWI and 11% was inferior TWI. Incidence of the composite endpoint during follow-up was 4%. Cox regression analysis revealed that only prolonged QTc (HR: 1.86, 95% CI: 0.97-3.54, p=0.06) and presence of TWI (HR: 2.6, 95% CI: 1.1-5.9, p=0.025) were associated with the composite endpoint. In multivariate models controlling for standard confounders the association with TWI was overall sustained.

Conclusions:

Among hypertensive patients without cardiovascular disease, ECG abnormalities are frequent. A prolonged QTc and T wave inversion seem to exhibit prognostic significance for cardiovascular events.
CHANGES IN THE THICKNESS OF THE WALLS OF THE LEFT AND RIGHT VENTRICLES DEPENDING ON THE CAUSE OF DEATH IN PATIENTS WITH ARTERIAL HYPERTENSION ACCORDING TO AUTOPSY STUDY
Authors: Kerimkulova Aiman , Veber Viktor , Markabayeva Akbayan , Nurpeissova Riza , Ospanova Ainur , Adiyeva Madina
Published: May 2024

Objective:

To explore the relationship between changes in the thickness of the walls of the left and right ventricles according to causes of death among people with arterial hypertension according to autopsy data.

Design and method:

A retrospective study was conducted based on autopsy reports over a period of 16 years. 643 data from autopsy reports were selected for analysis of patients who suffered from arterial hypertension during their lifetime and died suddenly. They did not have any other concomitant diseases leading to cardiac remodeling. The normal wall thickness of the left ventricle was taken as 0.7-1.2 cm, the right ventricle 0.2-0.3 cm.

Results:

The mean age (Me, IQR; 25th to 75th centiles) was 56 (49-63) years, for men - 54 (48-61, n=372); in women - 59 (50-69, n=255, p<0.001) for 643 autopsy reports submitted from patients with hypertension. The main causes of death among patients with arterial hypertension were acute heart failure, myocardial infarction, acute cerebrovascular accident, which was 98.9% (n=636), and they were taken into account in subsequent calculations when comparing groups. Thus, the groups were divided by cause of death: cardiac and cerebral. In the group, there were 62.5% (n=402) cases of cardiac death and 37.5% (n=241) of cerebral death, age was 58 (50-67) and 52 (46-61), respectively, p<0.001. The thickness of the ventricular wall was determined was determined for cardiac and cerebral causes of death, respectively, for the left ventricle 2.5 (2.0-2.5) and for 1.8 (1.6-2.0) cm and for the right ventricle 0.9 (0.6-1.2) and 0.4 (0.3-0.6) cm. The cardiac death case prevailed over the cerebral one with a more pronounced degree of left ventricular hypertrophy (Chi-square 125.2, df=1, p <0.001), and in the presence of right ventricular hypertrophy 25.6 times higher (95% CI 11.6-52.4), the differences in the group were statistically significant (Chi-square 124.2, df=1, p <0.001).

Conclusions:

The main cause of death in people with hypertension was the development of heart failure and myocardial infarction. Cardiac causes of death predominated among individuals with more pronounced changes in the left ventricle and in the presence of hypertrophy of the right ventricle.
REGIONAL CARDIAC PROTEOME ALTERATIONS IN A HYPERTENSION-INDUCED RAT MODEL FOR CHRONIC HEART FAILURE
Authors: Kedziora Sarah Michelle , Popp Oliver , Fahjen Pauline , Kräker Kristin , Mertins Philipp , Müller Dominik Nicolas , Haase Nadine
Published: May 2024

Objective:

Development of chronic heart failure is promoted by hypertension-induced ventricular stiffening and remodelling. Cardiovascular morbidity and mortality result from a constant rising prevalence in heart failure worldwide. A valuable measure to diagnose heart failure with preserved ejection fraction is speckle-tracking echocardiography to assess cardiac strain. Functional differences in specific cardiac regions can be investigated here. The role of the proteome in these regions remains elusive. Here we hypothesize a distinct proteome signature in intracardiac regions that could explain cardiac functional alterations in different regions of the failing heart.

Design and method:

Double-transgenic rats, expressing the human renin and angiotensinogen (dTGRs) were included in the study at the age of four weeks. Sprague Dawley wild-type (WT) rats served as controls. Echocardiography and speckle tracking echocardiography were used to evaluate cardiac function. In a label-free mass spectrometry approach, the proteome was analysed from six left-ventricular, intracardiac regions: posterior and anterior/septal base, mid and apex.

Results:

Vehicle-treated dTGR presented hypertrophy with an increased echocardiographically measured wall thickness of left-ventricular posterior wall in systole and diastole. Speckle tracking echocardiography indicated a diminished global longitudinal strain in vehicle-treated dTGR compared to WT rats. This indicates a reduction of myocardial movement along the longitudinal dimension. Strain analysis in distinct cardiac regions revealed that the myocardial performance of the posterior apex was most affected, followed by posterior base and mid, as well as anterior/septal apex and base. The anterior/septal mid was not significantly different between the groups. Label-free proteomics approach identified 661 and 789 proteins to be significantly different between posterior apex compared to anterior mid or anterior base, respectively. These differences were diminished in the dTGR heart. All six intracardiac regions displayed an altered protein profile in hearts from dTGR compared to WT, with alterations in proteins such as atrial natriuretic peptide, Serpin B3, Xin-Actin-Binding-Repeat-Containing 1 and pyruvate-dehydrogenase-kinase 4.

Conclusions:

Investigating the shift in cardiac proteome profile can improve our understanding of chronic heart failure and identify potential target proteins. Within this study, we highlight the relevance of intracardiac regions in proteome analysis with respect to chronic heart failure.
CHARACTERISTICS OF A SAMPLE OF ELDERLY HYPERTENSIVE INDIVIDUALS WITH INCREASED RELATIVE WALL THICKNESS (RWT) ON ECHOCARDIOGRAPHY
Authors: Camafort Miguel , Suárez Ana , Benítez Cristina , Fernández Carolina , Aldea Anna , Coloma Emmanuel , Torres Manuel , Mayor Miriam , Viñas Esther , Guio Ana , Sepulveda Constanza , Coca Antonio
Published: May 2024

Objective:

Arterial hypertension (HTN) is a prevalent disease with relevant morbidity and mortality due to the hypertension mediated organ damages (HMOD). Myocardial HMOD is very frequent. We describe the characteristics of a sample of patients with hypertension who underwent echocardiograms, showing a relative parietal thickness >0.42.

Design and method:

Retrospective review of older patients from the Hypertension clinic of a tertiary hospital during 2019 who underwent an echocardiogram. Anthropometric and analytical variables, vital signs and complementary tests performed on patients with a relative parietal thickness (GPR) value greater than 0.42 were collected.

Results:

From 50 patients included 36 patients had an increased RWT (17 men and 19 women). Mean age was 67 years (± 11.83) with a mean abdominal circumference of 104 cm (± 12.94).

Office Blood pressure (BP) was a mean systolic BP of 140mmHg (± 21.89), a mean diastolic BP of 73.08mmHg (± 13.79). Ambulatory blood pressure monitoring (ABPM) showed 24-hour systolic BP of 136mmHg (±13.57), 24-hour diastolic BP of 73.03mmHg (12.53), daytime systolic BP (±15.39), daytime diastolic BP 76.1mmHg (±14.4), nocturnal systolic BP 127mmHg (±13.31) and nocturnal diastolic BP 66.79 (±10.24).

Regarding personal history, 11% had active smoking and up to 22% had moderate alcoholism; 30% said they were active in physical exercise.

As with other antecedents, half of the patients were also diagnosed with dyslipidemia (PLD), 20% with diabetes mellitus (DM) and 16% with obstructive sleep apnoea (OSA). Up to 36% of the total had had previous cardiovascular events, and 77% were already undergoing antihypertensive treatment at the time of the echocardiogram.

Mean values of glucose 104.39 g/dL (± 24.11), triglycerides 146.24mg/dL (± 75.19), total cholesterol 188.58mg/dL (± 41.67), LDL cholesterol 117.23mg/dL (± 32.49), HDL cholesterol 50.57mg/dL (± 13.1) were observed.

2 patients presented cardiovascular event at one year in the form of coronary artery disease and arrhythmia, respectively). Mortality at 12 months was 0%.

Conclusions:

RWT is very frequent in older hypertensives in our sample. Our patients presented BP levels above guidelines recommended goal. A comprehensive approach to search for HMOD is recommended
CARDIAC AND HEPATIC DYSFUNCTION IN HYPERTENSIVE PATIENTS BY ASSOCIATION OF LIVER FIBROSIS INDICES 4 AND 5
Authors: Tatar Maria Cristina , German-sallo Marta , Runcan Dan Petrisor
Published: May 2024

Objective:

To study heart failure in close relation with left ventricular ejection fraction, NT-proBNP, as well as hepatic impairment by calculating liver fibrosis index (FIB-4 and FIB-5) in hypertensive patients admitted to our internal medicine clinic.

Design and method:

We studied 500 patients diagnosed with heart failure (HF), admitted to our internal medicine clinic between 2022-2023 with a mean age of 72.12 years. We selected 460 patients previously diagnosed with hypertension out of 500 (92% with hypertension) of which 46.09% were female and 53.91% male. Left ventricular ejection fraction (LVEF) was analysed by echocardiographic determination in different types of HF. Liver function was assessed based on the formulas of FIB-4 [Age (year) × AST (IU/l)]/[platelet count (× 109/l) × ALT (IU/l)1/2] and FIB-5 [albumin (g/l) × 0. 3 + platelet count (109/l) × 0.05 - alkaline phosphatase (IU/l) × 0.014 + AST/ALT ratio × 6 + 14], and data were taken from inpatient analyses. Correlations between FIB-4, FIB-5 and LVEF, respectively NT-proBNP were analysed using Spearman's nonparametric test. A p-value less than 0.05 was considered statistically significant.

Results:

The mean value of FIB-4 parameter was 1.80 ±0.42 while the mean of FIB-5 parameter was -11.6 ± 5.61. EF had a mean value in the whole studied group patients of 42.9 ± 2 towards 10.2. A significant correlation was demonstrated between LVEF in patients included in the entire group and the parameters FIB-4 (p=0.0008, 95% CI) and FIB-5 (p=0.0098, 95% CI). The same results were observed in patients previously diagnosed with hypertension regarding LVEF and FIB-4 (p=0.0016) as well as FIB-5 (p=0.0276). No significant correlation (p>0.05) was found between the mean value of NT-proBNP (5890.94 pg/mL) and FIB-4/FIB-5 indices in patients with HF regardless the presence of hypertension.

Conclusions:

In HF patients previously diagnosed with hypertension, decreasing EF will result in a significant increase in liver fibrosis risk, but we didn’t observed the same trend regarding the biomarkers for HF. Further research is needed in order to analyse the link between LVEF, NT-proBNP and liver fibrosis indices
INAPPROPRIATE PULSE WAVE VELOCITY TO BLOOD PRESSURE LEVEL: DEFINITION AND CLINICAL DETERMINANTS
Authors: Setjiadi Dellaneira , Delles Christian , Boutouyrie Pierre , Bruno Rosa -MARIA
Published: May 2024

Objective:

This study aims to quantify the proportion of population with inappropriate arterial stiffness measured by pulse wave velocity (PWV) and BP level including its associated characteristics.

Design and method:

This observational monocentric cohort study utilised data from Hôpital européen Georges-Pompidou (HEGP), Assistance Publique-Hôpitaux de Paris (APHP) that includes 5,186 (57.2% male, mean age 53 years) participants. 1,203 participants had a second PWV measurement. Residuals from log-transformed piecewise regression model for PWV prediction based on mean BP values were employed to define participants with inappropriate PWV. A multinomial regression analysis was conducted to find the associated clinical characteristics.

Results:

There are 522 participants with inappropriately high PWV and 517 participants with inappropriately low PWV, defined as 10th and 90th percentile of residuals. In the multinomial analysis, younger age, higher body mass index (BMI), and presence of diabetes mellitus (DM) are associated with inappropriately high PWV group. In participants with follow-up visit (n = 1,203), we found that classification into groups of inappropriate PWV was consistent, with 78% concordance.

Conclusions:

This study generates a classification method to define inappropriate HMOD compared to BP levels. Screening especially of younger patients for HMOD irrespective of their BP level may lead to early detection of organ damage and identifications of patients for targeted preventive strategies.
ARTERIAL HYPERTENSION IN CHRONIC HEMODIALYSIS
Authors: Riguen Mouna , Fendri Beya , Kmicha Erij Ben , Abid Hanen , Dammak Najla , Agrebi Ikram , Chaker Hanen , Yaich Soumaya , Kammoun Khawla , Toumi Salma , Hmida Mohamed Ben
Published: May 2024

Objective:

High blood pressure is widespread among individuals undergoing hemodialysis and is considered a significant contributor to the elevated cardiovascular mortality observed in this population. The aim of our study was to assess the prevalence of HTN and investigate its contributing factors.

Design and method:

This is a retrospective descriptive and analytic study conducted within our hemodialysis unit, including 70 patients. For each participant, the following clinical data were collected: age, gender, personal medical history, initial nephropathy, dialysis vintage, and evolution

Results:

Our study revealed a hypertension (HTN) prevalence of 51,4%. Among them, 63,9% were male, resulting in a sex ratio of 1,76. The mean age was 49.1 years (range: 21-86 years). undetermined nephropathy was the predominant initial nephropathy (39%). The average blood pressure of hypertensive patients was 159 mmHg for systolic (142-189 mmHg). Diabetic patients were more hypertensive with no statistically significant difference. Hypertensive patients exhibited a larger waist circumference, lower hemoglobin levels, and a lower left ventricular ejection fraction (LVEF) with no statistically significant difference. hypertensive patients were more prone to cardio vascular events such Cerebrovascular Accidents (2% of patients), transient ischemic attacks (2% of patients), and coronary artery disease (11% of patients).

Conclusions:

In summary, our study emphasizes the importance of investigating hypertension and its related factors, aiming to contribute insights for better cardiovascular health management.
VASCULAR FUNCTION CHANGES IN NONALCOHOLIC FATTY LIVER DISEASE (NAFLD)/ NONALCOHOLIC STEATOHEPATITIS
Authors: Jafari Kaveh , Paquet Véronique , Addour Saliha , Fortie Catherine , Trépan Gabrielle , Ferlan Stéphanie , Agharazii Mohsen , Carre Anne -MARIE
Published: May 2024

Objective:

The main cause of death among patients with NAFLD is cardiovascular disease. It is firmly established that NAFLD is major risk factors for cardiovascular diseases and Aortic stiffness is an independent predictor of cardiovascular events. Understanding this relationship aids in identifying potential risks and developing targeted interventions, ultimately improving preventive care strategies for individuals with NAFLD. Through the global approach, we investigate to examine the link between the severity of metabolic steatosis and the various indices of vascular function.

Design and method:

Patients followed consecutively at the University Hospital of Quebec were recruited to participate. We assessed aortic stiffness, brachial stiffness, Global stiffness, Intima-Media Thickness and the flow-dependent vasodilation (FMD). The participants were divided according to the stage of hepatic steatosis, either early or advanced.

Results:

In this study, we had 50 patients. Thirteen of them were in the early NASH group, with an average age of 65.1 ± 11.0, and 37 patients were in the advanced NASH group, with an average age of 54.0 ± 12.4. According to the classification into early and advanced NASH, there was a significant difference in brachial diastolic pressure between the two groups (69.2 ± 8.7 vs. 75.3 ± 8.0; P = 0.02). Regarding carotid artery remodeling parameters, static circumferential wall stress was higher in the advanced NASH group (69.2 ± 15.1 vs. 86.4 ± 20.5; P < 0.01), while the Wall-to-Lumen Ratio was lower among the advanced NASH patients (0.095 ± 0.02 vs. 0.078 ± 0.01; P < 0.01). Patients in the advanced stage had smaller intima-media thickness, and the artery diameter became wider (0.652 ± 0.169 vs. 0.555 ± 0.097; P < 0.05).

Conclusions:

In this preliminary analysis, there were no associations between the severity of NASH and markers of arteriosclerosis, atherosclerosis and endothelial dysfunction. However, advanced NASH was associated with a hypotrophic remodeling of the common carotid artery (large elastic vessel), even after adjustment for age, diastolic BP, and sex. In a similar manner, the diameter of the brachial artery (medium-sized muscular vessel) seemed to be higher with advanced NASH.
THE INFLUENCE OF EXTREME DIPPING PRESSURE ON LEFT VENTRICULAR HYPERTROPHY IN GENERAL POPULATION
Authors: Zou Hang , Diao Jiayu , Yan Ju , Gou Qiling
Published: May 2024

Objective:

Extreme dipping pressure, characterized by a nighttime decrease of over 20% compared to daytime levels, lacks consensus regarding its influence on cardiac structure and function. Particularly in the general population, there's limited research on this common blood pressure pattern. This study aims to investigate the relationship between extreme dipping pressure and cardiac structure and function in a general population.

Design and method:

We conducted 24-hour ambulatory blood pressure monitoring in 673 individuals without hypertension to assess blood pressure patterns. We analyzed the association between extreme dipping pressure and left cardiac structure, left ventricular hypertrophy (LVH), and left ventricular diastolic function.

Results:

Using a criterion of a nighttime decrease of over 20% in systolic and/or diastolic blood pressure, extreme dipping pressure was observed in 15.8% (107/673) of the general population. LVH prevalence in this study was 18.9% (127/673), with extreme dipping, non-dipping, and dipping patterns observed in 12.6%, 39.4%, and 48.0%, respectively, in the LVH group. In the non-LVH group, these patterns were observed in 16.5%, 47.8%, and 35.7%, respectively. A significant difference in distribution between different blood pressure patterns existed between the LVH and non-LVH groups (p=0.19). Univariate analysis indicated that, compared to the non-dipping pattern, extreme dipping was a protective factor for LVH occurrence (p=0.045, OR 0.173, 95%CI 0.031-0.959). Even after adjusting for factors such as gender, age, BMI, left ventricular size, interventricular septum thickness, left ventricular posterior wall thickness, and overall blood pressure, extreme dipping remained a protective factor for LVH occurrence (p=0.019, OR 0.187, 95%CI 0.046-0.756).

Conclusions:

Our study indicates that extreme dipping pressure is relatively common in the general population and is closely associated with LVH occurrence. In the general population, extreme dipping independently reduces the occurrence of LVH.
EARLY RESULTS OF THE PROSPECTIVE MULTIDISCIPLINARY HAMA COHORT: DESCRIPTION OF THE FIRST 302 PATIENTS, COMPARISON WITH ALREADY PUBLISHED COHORT AND NOVEL INSIGHTS
Authors: Boulestreau Romain , Lorthioir Aurélien , Dreau Hervé , Persu Alexandre , Halimi Jean Michel , Rubin Sebastien , Tharaux Pierre Louis , Mazighi Mikael , Maier Benjamin , Michel Paques , Bonnin Sophie , Cremer Antoine , Debeugny Stephane , Gosse Philippe
Published: May 2024

Objective:

Malignant hypertension has not disappeared and remains the most severe form of hypertension. More than 100 years after its description, many points remain unanswered. Mechanisms, definition and optimal treatment are still discussed. In 2019 we decided to launch a prospective multicenter multidisciplinary cohort in France try filling these gaps. Thjs study aims to describe the baseline characteristics of the first 302 included patients and compare these data to already published cohorts.

Design and method:

We included patient with severe hypertension and severe hypertensive retinopathy and patients filling the HYP MOD definition from a broad range of department (cardiology, nephrology, neurology intensive care unit, emergency department, internal medicine). We collected clinical data at admission, biological, imaging and target organ damage along with social and demographic data. We also recorded diagnostic and therapeutic management, adverse events during hospitalization and characteristics at discharge.

Results:

We recruited 302 patients in 32 month (105 / year) among 40 centres and different specialities. They are mostly young men (68%, mean age 48.7 +/- 14.5 years), with several interesting subgroups. Around one third of our patients were less than 40 years old, one third were from non-European origin, 13.6% were included through the multiorgan damage definition, without fundus severe injuries. Target organ damage involves the eye in 86% of patients, kidney in 54%, heart in 56%, brain in 33% and Thrombotic Microangiopathy in 13%. Our patients with severe retinopathy are very similar with those included in the most important cohorts already published. Interestingly, 22.8% of patients were treated without use of IV therapy, most patients were untreated or showed poor observance of treatments and a significant proportion had normal or low renin level.

Conclusions:

These preliminary findings already challenge long standing dogma, raise many questions and provide a strong basis to address them in ancillary studies of the cohort.
THE PRESENCE OF PROTEINURIA IS ASSOCIATED WITH IMPAIRED CEREBRAL OXYGENATION DURING EXERCISE IN CHRONIC KIDNEY DISEASE
Authors: Theodorakopoulou Marieta , Dipla Konstantina , Zafeiridis Andreas , Faitatzidou Danai , Koutlas Aggelos , Devrikis Nikolaos , Georgiou Areti , Karkamani Eleni , Doumas Michael , Papagianni Aikaterini , Sarafidis Pantelis
Published: May 2024

Objective:

Cognitive impairment and reduced exercise tolerance are common in patients with chronic kidney disease (CKD), in part due to reduced brain function. Cerebral perfusion and oxygenation are significant determinants of brain activation and have been shown to be significantly impaired in CKD. This analysis aims to examine the impact of proteinuria on cerebral oxygenation during a mild physical stress in patients with pre-dialysis CKD.

Design and method:

66 patients with CKD stage 2-4 were included in this post-hoc analysis; 24-h urine samples were used for evaluation of proteinuria. All participants underwent a 3-min intermittent handgrip exercise (HG) at 35% of their maximal voluntary contraction. Changes in cerebral oxygenation (oxyhemoglobin-O2Hb) and deoxyhemoglobin-HHb) and regional blood volume (total hemoglobin-tHb) were continuously recorded during HG-exercise by near-infrared spectroscopy (NIRS).

Results:

No significant differences between the 2 groups were detected in age (proteinuric vs nonproteinuric: 68.4±10.6 vs 67.2±10.8; p=0.676), eGFR (41.3±18.9 vs 46.3±14.8; p=0.248) and BMI (28.4±4.9 vs 28.1±4.8; p=0.803). The MMSE score (proteinuric vs nonproteinuric: 28.0±1.6 vs 28.0±1.7; p=0.938) and MVC (22.3±7.0 vs 23.9±7.5; p=0.416) were not significantly different between groups. The average response in cerebral oxygenation during exercise was lower in patients with proteinuric CKD (O2Hb: 1.02±0.87 vs 1.61±0.95; p=0.018 and diffO2Hb 1.53±.97 vs 2.07±1.25; p=0.065). The average tHb response (index of regional-blood-volume) was also lower in patients with proteinuria (0.51±1.08 vs 1.16±0.92 p=0.013); however, no differences in HHb (-0.50±0.55 vs -0.45±0.54; p=0.717) –an index of oxygen extraction capacity- among groups were detected. In univariate linear analysis the level of proteinuria did not show significant correlations with NIRS parameters.

Conclusions:

The presence and not the level of proteinuria is associated with impaired brain activation during a mild physical task in patients with predialysis CKD. Future studies evaluating the role of proteinuria in the decline of cerebral function and cognitive impairment are needed.
RENOPROTECTIVE EFFECTS OF DAPAGLIFLOZIN IN NON-DIABETIC CKD PATIENTS
Authors: Spanos Georgios , Vagopoulou Anastasia , Bakou Marianna , Giannakidis Ioannis , Atalla Alexandos , Serif-damadoglou Ahmed , Fragkidis Stylianos , Bantis Christos , Armentzoiou Livia -KARMEN , Bamichas Gerasimos
Published: May 2024

Objective:

Sodium-glucose co-transporter 2 inhibitors (SGLT2i) have demonstrated significant cardiorenal protection benefits in recent years, irrespective of the presence of diabetes mellitus (DM). These agents have emerged as pivotal in reducing albuminuria and impeding chronic kidney disease (CKD) progression. This study aimed to evaluate the renal effects of dapagliflozin, an SGLT2i, in in non-diabetic proteinuric patients with CKD.

Design and method:

In this retrospective observational study we analyzed medical records of adult non-diabetic patients with CKD, in our outpatient department over the period of one year. exhibiting albuminuria, and under stable renin-angiotensin system blockade. The primary objectives were to assess dapagliflozin's impact on estimated glomerular filtration rate (eGFR) within the first month and changes in 24-hour proteinuria from baseline.

Results:

Between November 2022 and December 2023, dapagliflozin was prescribed to 37 patients (8 women) with a mean age of 59.8±11.6 years. Primary diagnoses of CKD included IgA Nephropathy (7/37), other glomerulonephritis (9/37), hypertension (6/37), unknown (9/37), and other (6/37). Baseline median creatinine was 1.60±0.6 mg/dL, eGFR was 54.1±21.6 mL/min/1.73m2, and proteinuria was 1047 mg/24h (IQR 420-2170), serum potassium 4.77±0.41mEq/L blood pressure 130±15 / 82±9 mmHg, body weight 85.1±16.8 kg. After the first month, median creatinine was 1.75±0.7 mg/dL (p=0.02 vs baseline), eGFR was 50,7±21,3 mL/min/1.73m2 (p=0.006 vs baseline). Two patients experienced >30% serum creatinine increase within 4 weeks, leading to SGLT2i discontinuation. After a median follow-up of 233 days (IQR 80-284), creatinine was 1.71±0.75 mg/dL (p=0.067 vs baseline), eGFR was 51.6±23.6 mL/min/1.73m2 (p=0.019 vs baseline), and proteinuria decreased by 33,7% from baseline (450, IQR 270-1110). One patient stopped SGLT2i due to recurrent urinary tract infection. No change was observed in serum potassium, body weight and blood pressure throughout the study period.

Conclusions:

Treatment with dapagliflozin in non-diabetic patients with CKD reduced effectively proteinuria with an initial, reversible, decline in serum creatinine.
THE PREVALENCE AND RISK FACTORS FOR ARTERIAL HYPERTENSION IN CHILDREN WITH IDIOPATHIC NEPHROTIC SYNDROME
Authors: Skrzypczyk Piotr , Wabik Anna Maria , Deja Anna , Ofiara Anna , Szyszka Michal , Panczyk-tomaszewska Malgorzata
Published: May 2024

Objective:

Arterial hypertension (AH) is claimed to be an uncommon finding in children with idiopathic nephrotic syndrome (INS). The study aimed to analyze blood pressure, prevalence, and risk factors of AH in children with INS.

Design and method:

In 153 children with INS (9.32±3.84 years, 100 boys), we evaluated systolic and diastolic blood pressure (mm Hg, Z-scores), age at onset of the disease, anthropometric data, response to steroids, results of kidney biopsy, number of INS relapses, and medications.

Results:

The mean age at disease onset was 4.39±2.38 years; 67 patients had steroid-sensitive nephrotic syndrome (SSNS), 12 frequently relapsing nephrotic syndrome (FRNS), 58 steroid-dependent nephrotic syndrome (SDNS), and 16 steroid-resistant nephrotic syndrome (SRNS). Kidney biopsy was performed in 26: 5 – minimal change disease, 11 – mesangial proliferation, 10 – focal and segmental glomerulosclerosis. AH at disease onset was found in 10 (6.5%) patients in the following 11 (7.2%) after corticosteroid initiation. The observation period was 4.93±3.80 years, and AH was found in 31 (20.3%) – in 3 (4.5%) patients with SSNS, 2 (16.7%) with FRNS, 20 (34.5%) with SDNS, and 6 (37.5%) with SRNS. Patients with AH had lower height Z-score (-0.46±1.20 vs. 0.18±1.15, p=0.006), higher BMI Z-score (1.15±1.10 vs. 0.41±1.09, p<0.001), number of INS relapses (8.32±6.78 vs. 4.41±3.82, p<0.001), and current prednisone dose (0.49±0.67 vs. 0.18±0.29 [mg/kg/24h], p<0.001). Systolic blood pressure Z-score at the end of observation correlated with age (r=-0.192, p=0.017), BMI Z-score (r=0.368, p<0.001), and present prednisone dose [mg/kg/24h] (r=0.186, p=0.021), diastolic blood pressure Z-score with BMI Z-score (r=0.231, p=0.004), and number of INS relapses (r=0.163, p=0.044). In Cox Proportional Hazard presence of SDNS and SRNS were the only predictors of AH (SDNS: HR=4.80, 95CI(1.30-17.75), SRNS: HR=4.77, 95CI(1.06-21.53)).

Conclusions:

1. Approximately one-third of patients with SDNS and SRNS develop arterial hypertension in the course of the disease. 2. Steroid dependence and steroid resistance are the strongest predictors of AH in children with INS. Other determinants of blood pressure elevation in this group of patients are high BMI and a high number of relapses.
RISK FACTOR TO DEVELOP CKD IN GENERAL POPULATION: IMPACT OF HYPERTENSION
Authors: Redon Josep , Sauri Inma , Lidon Laura , Diaz Javier , Martinez Fernando , Fernandez Antonio , Grau Maria , Forner Maria J
Published: May 2024

Objective:

The aim of the present study was to assess the impact of hypertension in the incidence of Chronic Kidney Disease (CKD) in a general population.

Design and method:

The study analyzed the EHR of a community of 1,450.000 adult subjects >23 years of age. eGFR was calculated using the CKD-EPI formula. Lipid and uric acid was obtained at the beginning of the observational period. HTN was considered when it was recorded in the EHR (CIE9 and 10). Cox hazard ratio of risk to develop. CKD was calculated and plotted.

Results:

The main characteristics of the study population in the absence of CKD was 53.9 year old, male 56.5%, obese 422,114 (29.1%), diabetes 198242 (13.7%) and 508,477 (35%) hypertensives. The HR of each of the factors analysed is in the Table and the Cox plot in the figure.

Conclusions:

Hypertension independent of other risk factors increases rate of progression to CKD in general population.
STUDY OF CIRCADIAN RHYTHM OF BLOOD PRESSURE IN KIDNEY TRANSPLANT RECIPIENTS DURING THEIR FIRST YEAR
Authors: Rabhia Mehdi , Arzour Hind , Benkari Atika , Taibi Fatma , Khemri Dalila , Haddoum Farid
Published: May 2024

Objective:

There is a marked diurnal variation in blood pressure (BP), relative to these values, BP in most subjects is physiologically lower during the night and a no-drop BP profile is usually defined as a fall in blood pressure (BP). Nocturnal PAS less than 10%.

A non-dipper circadian pattern is often observed in renal transplant recipients and is linked to poor allograft function.

The primary objective of this study is to evaluate nighttime blood pressure variations in patients after kidney transplantation during their first post-operative year.

Design and method:

In this prospective study, 24-hour ambulatory BP monitoring (ABPM) was performed in 116 post-kidney transplant patients, aged > 18 years, with a serum creatinine level < 2 mg/dl after one month of transplantation. According to the nocturnal reduction in systolic BP (SBP), a profile of dipper (SBP > 10%), non-dipper (0 < SBP < 10%) and reverse dipper (SBP nocturnal increase) was defined.

Results:

We collected 116 kidney transplant patients (mean age 36 years, 66% men, all patients are treated with anti-calcineurins including 54% on Tacrolimus, with a pre-transplant dialysis duration ranging from 2 to 144 months), we note 14 preemptive transplants.

The nighttime reduction in SBP pattern among participants with respect to gender was not significant (p = 0.794). The mean age of patients with a non-dipper profile was significantly lower than that of patients with an inverse dipper profile (p = 0.009), but the mean age of patients with a dipper profile was not significantly different from patients with a non-dipper or inverted profile (p = 0.368, p = 0.605).

There was no significant correlation between dipper, non-dipper and inverse profile with immunosuppressive drugs (cyclosporin, tacrolimus), duration of dialysis before transplantation and time since transplantation (p = 0.194, p = 0.252 and p = 0.392, respectively).

Conclusions:

The inverse dipper profile was observed more frequently in older patients than in younger patients, and there was no significant correlation between the dipper, non-dipper, and inverse profile with immunosuppressive drugs, dialysis duration before transplantation and time since transplantation.
DEGREE OF JOINT RISK FACTOR CONTROL AND ONSET AND PROGRESSION OF CHRONIC KIDNEY DISEASE IN PATIENTS WITH HYPERTENSION
Authors: Peng Xinyi , Zhuang Miaomiao , Song Qirui , Cai Jun
Published: May 2024

Objective:

There is a reciprocal relationship between hypertension and chronic kidney disease. We aimed to determine if controlling multiple risk factors in combination could decrease the risk of chronic kidney disease in hypertensive patients.

Design and method:

The study was performed using data from the Kailuan cohort. We investigated the association between the degree of control of multiple risk factors on development of chronic kidney disease and the risk of progression in multivariable-adjusted Cox proportional hazards regression analysis.

Results:

Development of chronic kidney disease was investigated in 73,256 participants with a mean of 11.80 ± 4.50 years. A significant inverse association was found between the degree of risk factor control and the risk of developing chronic kidney disease in the population with hypertension. Each additional risk factor controlled was correlated with a 12% decline in the risk of incident chronic kidney disease (HR 0.88, 95% CI 0.86–0.90). The risk was higher in women and older individuals with hypertension than in their matched controls. Analysis of progression of chronic kidney disease found a similar inverse association between severity of chronic kidney disease and the degree of risk factor control. Each additional risk factor controlled contributed to a 13% reduction in the risk of progression (HR 0.87, 95% CI 0.84–0.90).

Conclusions:

This study found a significant inverse relationship between the degree of risk factor control and the risk of development and progression of chronic kidney disease in patients with hypertension. Modification of multiple risk factors had an additive effect in protecting kidney function. The results suggest that stronger preventive strategies are needed in hypertensive populations to alleviate kidney dysfunction.
APOLIPOPROTEIN-L1 RISK GENOTYPES ARE ASSOCIATED WITH CHRONIC KIDNEY DISEASE REGARDLESS OF HYPERTENSION STATUS IN A TRYPANOSOMA BRUCEI GAMBIENSE ENDEMIC AREA
Authors: Mupepe Dominique , Buila Nathan , Ekulu Pépé , Wameso Marie -Noelle , Nkoy Agathe , Van Den Heuvel Lp , Levtchenko Elena , Mumba Dieudonné , M’Buyamba Jean -René
Published: May 2024

Objective:

this study assessed the frequency of Apolipoprotein-L1 high-risk genotypes in an African rural endemic area to Trypanosoma Brucei Gambiense, and evaluated their association with arterial hypertension according to human African trypanosomiasis infection status.

Design and method:

The study enrolled 94 human African trypanosomiasis-infected and 144 non–infected participants in Masimanimba, the Democratic Republic of the Congo. Apolipoprotein-L1 high-risk genotype was the presence of two variants (G1G1, G2G2, or G1G2), and low-risk genotype the presence of 0 or 1 variant. Albuminuria was an albumin/creatinine ratio greater than or equal to 30 mg/g on freshly voided urine. We evaluated the association between Apolipoprotein-L1 risk genotypes and hypertension in human African trypanosomiasis-infected and non-infected participants.

Results:

The study population was aged 39.7 ± 17.1 years (females 62.2%). The frequency of high-risk genotypes among hypertensive participants was 14.3% in both human African trypanosomiasis - infected and uninfected individuals. Albuminuria (100% vs. 38.9%; p=0.09) was higher and estimated Glomerular Filtration Rate lower (88.5 vs. 106 ml/min/1.73 m2, p =0.066) in high-risk genotypes than low-risk carrying hypertensive participants. The respective values in non-hypertensive individuals were 100% vs. 37.5% (p=0.002) and 83 vs. 109.5 ml/min/1.73 m2 (p <0.001) for albuminuria and estimated Glomerular Filtration Rate.

Conclusions:

Apolipoprotein-L1 high-risk genotypes are associated with Chronic Kidney Disease regardless of the hypertension status in Human African Trypanosomiasis endemic area
ACUTE VASCULAR RESPONSE TO HEMODIALYSIS AS MEASURED BY SERUM SYNDECAN-1 AND ENDOTHELIN-1 LEVELS, AS WELL AS VASCULAR STIFFNESS
Authors: Csiky Botond , Sagi Balazs , Kun Szilard , Jakabfi-csepregi Rita Klaudia , Sulyok Endre
Published: May 2024

Objective:

End-stage kidney disease (ESKD) patients on chronic hemodialysis (HD) have very high cardiovascular risk. Acute vascular changes during dialysis mediated partially by factors of the endothelium may have a crucial role in the cardiovascular (CV) disease of HD patients.

Aim: To study acute vascular changes during HD measured by applanation tonometry and to assess the role of syndecan-1 (SDC-1), endothelin-1 (ET-1), and traditional and non-traditional CV risk factors in these changes.

Design and method:

Patients and methods. 29 consecutive chronic HD patients (median age: 65.6±10.4 years; 52% men) were included in the study. Pre-, mid-, and post-HD plasma SDC-1 and ET-1 levels and routine biochemical parameters were measured. Applanation tonometry (SphygmoCor, AtCor Medical) was performed before HD.

Results:

As assessed by trend analysis SDC-1 levels increased significantly during HD (p=0.004). ET-1 levels were decreasing during HD. Male patients had significantly higher ET-1 levels than women. Patients were divided into 2 groups based on their pulse wave velocity (PWV), PWV>=12 m/s and PWV<12 m/s). Pre-HD and mid-HD SDC-1 levels were significantly higher in the group with PWV>=12 m/s (10.174±2.568 vs. 7.928±1.794 ng/ml, p = 0.013, and 10.319±3.482 vs. 8.248±1.793 ng/ml, p = 0.044, respectively). Post-HD ET-1 levels were significantly higher in the patient group having PWV>=12 m/s (10.88±3.00 vs. 8.05±3.48 pg/l, p = 0.027). Patients having PWV>=12 m/s had significantly higher pre-HD peripheral and aortic systolic blood pressure than the patients having lower PWV (147.4±73.3 vs. 134.1±72.2 mmHg, p = 0.038, and 130.7±16.6 vs. 122.5±14.9 mmHg, p = 0.016, respectively). Mid-HD and post-HD blood pressures were not different. We found a positive correlation between total cholesterol and the decrease in SDC-1 levels during HD (r = 0.539; p = 0.008). Pre-, mid-, and post-HD SDC-1 correlated significantly with the ultrafiltration volume during HD (r = 0.432, p = 0.019; r = 0.377, p = 0.044; and r = 0.401, p = 0.012, respectively).

Conclusions:

SDC-1 and ET-1 may contribute to the vascular changes observed during HD, and they have correlations with some traditional and non-traditional CV risk factors.