bluuebunny/crossref_metadata_2025 huggingface dataset:
HYPERTENSION IS A RISK FACTOR FOR ACUTE KIDNEY INJURY AND A PREDICTOR OF MORTALITY IN HOSPITALIZED PATIENTS WITH COVID-19
Authors: Khruleva Yulia , Mubayazvamba Tapiwa , Troitskaya Elena , Efremovtseva Marina , Kobalava Zhanna
Published: April 2021

Objective:

Initial reports indicate a high incidence of acute kidney injury(AKI) in the novel coronavirus infection (COVID-19). Hypertension(HTN) frequently coexists with COVID-19 and may be a possible risk factor for AKI. The aim of the study was to investigate the contribution of HTN for the AKI development in patients hospitalized with COVID-19.

Design and method:

A retrospective analysis of the register of patients with COVID-19 was performed. COVID-19 was defined as the laboratory-confirmed infection and/or presence of the typical CT picture. AKI definition was based on KDIGO criteria. P value < 0.05 was considered statistically significant.

Results:

The register included 721 patients(49.6% male, age 64 ± 15.7 years, HTN in 66%, controlled in 80%, obesity in 50.8%, diabetes mellitus(DM) in 24.2%, chronic kidney disease(CKD) in 6%). The median length of stay was 11[9;15] days, in the ICU – 4[2;9] days. 18.9% of patients died. Mean blood pressure at admission was 130 ± 17/80 ± 11 mmHg in the hypertensive group. 40.3% of patients received angiotensin-converting enzyme inhibitors(ACEi) or angiotensin II-receptors blockers(ARBs) regularly before admission. In 79% therapy was continued, in 21% - withdrawn. The AKI incidence in the register was 27.2%, in hypertensive patients– 30.1%. ACEi /ARBs intake wasn‘t associated with AKI. Hypertensive patients compared to normotensives were older (69 ± 12vs50 ± 15, p < 0.0001), more often had DM (31.7%vs10%, p < 0.0001), CKD (8%vs2%, p = 0.01). History of HTN was associated with higher mortality (23.6%vs10.7%, p = 0.001). HTN incidence was higher in patients with AKI (80%vs61%, p < 0.0001) and HTN was a risk factor for AKI development (OR 2.45, 95% CI 1.49–4.13, p = 0.0002). Hypertensive patients with AKI compared to patients without AKI had longer duration of hospitalization (13 ± 7vs12 ± 6 days, p = 0.003), were more likely to be treated with mechanical ventilation (50%vs13%, p < 0.0001), more often were in the ICU (46.5%vs16.4%, p < 0.001 and had higher in-hospital mortality (48%vs9.7%, respectively, p < 0.0001).The AKI development and history of HTN were predictors of mortality: OR 8.90 (95%CI 5.7–13.78, p < 0.0001) and OR 2.58 (95%CI 1.46–4.75, p = 0.0006), respectively.

Conclusions:

AKI is common among patients hospitalized with COVID-19 and is associated with the presence of HTN. HTN and AKI development are the significant predictors of in-hospital mortality in this population.
THE ASSOCIATION BETWEEN ARTERIAL STIFFNESS MARKERS AND THE SEVERITY OF CORONARY ARTERY DISEASE AS ASSESSED BY SYNTAX II SCORE IN HYPERTENSIVE PATIENTS WITH INSULIN RESISTANCE
Authors: Khalil Wael
Published: April 2021

Objective:

The Endothelial dysfunction and the arterial stiffness are the signs of cardiovascular diseases especially in the hypertensive patients with insulin resistance. The endothelial dysfunction were assessed by the brachial flow mediated dilatation. The arterial stiffness markers which are expected to be early increased in hypertensive patients with insulin resistance were assessed for detection of coronary artery disease. The aim of this study: to detect the association between arterial stiffness markers and the presence of coronary artery disease and the assessment of CAD severity by syntax II score in hypertensive patients with insulin resistance.

Design and method:

A total of 120 hypertensive patients who underwent coronary angiography in catheterization unit from January 2019 to October 2020 by using the (homesostatic model assessment of insulin resistance) were divided into (Group A) sixty patients with insulin resistance and CAD (Group B) sixty patients without insulin resistance and no CAD. The brachial flow mediated dilatation was measured. The Mobil O Graph blood pressure device was used to measure the PWV and Aix at rest and three min after isometric handgrip exercise at 40% of the maximal handgrip power. The inter-arm systolic blood pressure difference from both arms was calculated. The severity of the coronary artery diseases were assessed by the syntax II risk score.

Results:

In our study the predictive value of FMD for the detection of CAD in group A with a cutoff value >0.448 (P < 0.0001), (sensitivity of 88.9% and specificity of 91.8%). After isometric exercise handgrip for 3 min, the Aix was increased significantly in patients with CAD (before 16.7% vs. 3 min after 23.6%, P = 0.001). PWV was increased significantly in patients with CAD (before 11.5 vs. 3 min after 12.2 m/s,P = 0.001). The Inter Arm Blood Pressure Difference more than 10mmHg were associated with a high syntax II risk score compared to the patients with values less than 10 mmHg (p < 0.001).

Conclusions:

FMD and after isometric handgrip exercise (PWV and Aix), are independent predictors for CAD. The Inter Arm Blood Pressure Difference more than 10mmHg was associated with a higher syntax II risk score.
MICROVASCULAR DYSFUNCTION IN NON-DIABETIC HYPERTENSIVE PATIENTS IS RELATED TO DYSLIPIDAEMIA AND GLUCOSE INTOLERANCE: RESULTS FROM THE DOXAZOSIN RAMIPRIL STUDY
Authors: Jekell Andreas , Kahan Thomas
Published: April 2021

Objective:

Microvascular dysfunction relates to increased cardiovascular risk in type 2 diabetes and in the metabolic syndrome. Disturbances in microvascular function are multifactorial, and both low HDL-cholesterol (HDL) and glucose intolerance are important mediators. However, their importance in relation to microvascular function in non-diabetic hypertension is not well studied.

Design and method:

71 patients with untreated hypertension (mean BP 154/93 mm Hg) without coronary heart disease were included. The subendocardial viability ratio (SEVR) was calculated by pulse wave analysis (SphygmoCor). Skin microvascular function was assessed by laser Doppler fluxmetry and iontophoresis of acetylcholine (ACh) and sodium nitroprusside (SNP), and by local heating. Glucose tolerance was estimated by the triglyceride (TG) glucose index (TyG, ln [fasting plasma glucose (mg/dL) x triglycerides (mg/dL)/2]), and by the TG/HDL ratio.

Results:

Fasting LDL-cholesterol (LDL), HDL and TG 3.48 ± 0.92, 1.40 ± 0.40 and 0.96 [0.61–1.33] mmol/L, respectively. Mean glucose was 5.40 ± 0.55 mmol/L, TyG 6.74 ± 0.59, and median TG/HDL ratio 0.65 [0.43–1.18]. Ach peak flux (mean 42.4 ± 29.8 PU) related to HDL (r = 0.27, P = 0.025). Peak flux by local heating (85.4 ± 43.7 PU) related to HDL (r = 0.29, P = 0.017) and inversely to the LDL/HDL ratio (r = –0.29, P = 0.019). Ach peak flux was inversely related to log(TG/HDL) ratio (r = –0.29, P = 0.016) and tended to relate to TyG (r = –0.23, P = 0.065), while responses to SNP and local heating did not. SEVR (mean 169 ± 29 %) was inversely related to LDL (r = –0.25; P = 0.041), but not to HDL (r = –0.05; P = 0.69). SEVR did not relate to TyG or to log(TG/HDL) ratio.

Conclusions:

Skin microvascular dysfunction was related to low HDL and to glucose intolerance, whereas coronary microvascular dysfunction was related to increased LDL. Maximum reactive hyperaemia by local heating is a robust method to evaluate skin microvascular function in non-diabetic hypertension. As for patients with type 2 diabetes and the metabolic syndrome, early microvascular dysfunction can be detected in non-diabetic hypertensive patients, and predict cardiovascular risk.
PATIENTS’ PERCEPTIONS ON THE USE OF RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM INHIBITORS DURING THE FIRST WAVE OF THE COVID-19 PANDEMIC
Authors: Ioannidis Antonios , Paraskelidou Maria , Pechlevanis Apostolos , Fragkiskou Afroditi
Published: April 2021

Objective:

Since the outbreak of the SARS-COV-2 pandemic, concerns have been raised that renin-angiotensin-aldosterone system inhibitors (RAAS-i) may increase the susceptibility to the coronavirus and the likelihood of severe COVID-19 illness. Aim of this study was to assess the patients’ perceptions on the risk or benefit of RAAS-I use in the COVID-19 era.

Design and method:

Patients visiting the emergency (non-COVID) department or the outpatient clinics of a tertiary hospital in Northern Greece were invited to participate by completing a short questionnaire. This observational study was conducted during the first wave of the COVID-19 (April to June 2020) and would restart at an imminent second wave. Analyses included only questionnaires from the first wave (which was apparently well controlled in Greece) and were performed by IBM SPSS Statistics.

Results:

In total 178 patients (94 women, 52.8%) taking angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor type 1 blockers (ARBs) participated (mean age 63.8 ± 10.2 years). About half (97, 54.4%) were taking RAAS-i for hypertension, while the rest for other indications. The vast majority (160, 92.1%) were aware of the issue that some antihypertensive drugs might be harmful (mainly from TV reports), although almost one third (51, 31.9%) were not sure if they were prescribed such drugs. One fifth of the patients had contacted their doctor inquiring if they were taking such drugs and if, in that case, they could replace it. Only three patients altered their therapeutic regimen. Of note, the majority of patients (151, 84.8%) reported that the chances of getting COVID-19 were low or somewhat low, though they feel more susceptible to catch it (128, 65.7%) or that they will have a more severe disease course (136, 76.4%). Disturbingly, none of the patients had been informed of the position of major scientific societies that patients should not stop taking RAAS-i.

Conclusions:

Greek patients appear to be aware of the issue relating the RAAS-i with the COVID-19 pandemic. Nevertheless they seem lacking information from their healthcare providers or from scientific bodies. Further research is warranted to assess whether patient oriented informative campaigns could comfort the concerns.
RELATION BETWEEN AMBIANT TEMPERATURE AND BLOOD PRESSURE: A CROSS SECTIONNAL ANALYSIS FROM THE GUBBIO RESIDENTIAL COHORT STUDY
Authors: Humbert Xavier , Puddu Paolo -Emilio
Published: April 2021

Objective:

The aim was to investigate impact of ambient temperature (AT) on blood pressure (BP) in the Gubbio residential cohort.

Design and method:

Cross-sectional analyses were performed using data from 5 058 persons (45% men, 49 ± 18 years old). AT (indoor and outdoor) was collected at each inclusion. Three BP measurements were performed following a standard protocol. Linear regression was used to examine the relationships of AT with BP.

Results:

From June 1988 to July 1992, relationships of indoor temperature (r = -0.03 and r = -0.05 for systolic or diastolic BP respectively) and outdoor temperature outdoor temperature (r = - 0.05 and r = - 0.08 for systolic or diastolic BP respectively) with BP were inconsistent. The same relations were found in hypertensive subjects.

Conclusions:

In primary care, ambient (indoor and outdoor) temperature does not seem to influence blood pressure.
SEX DIFFERENCES IN LIFESTYLE FACTORS AND BLOOD PRESSURE: A CROSS-SECTIONAL ANALYSIS FROM THE GUBBIO STUDY, AN ITALIAN RESIDENTIAL STUDY
Authors: Humbert Xavier , Licaj Idlir , Puddu Paolo-Emilio
Published: April 2021

Objective:

Hypertension is a well-established major risk factor for cardiovascular disease. Lifestyle behaviors for its prevention and control are recommended within worldwide guidelines. Their relationship with blood pressure (BP), and particularly sex differences, need more investigations. The aim was to investigate impact of lifestyle factors on BP and sex differences in the Gubbio residential study.

Design and method:

Cross-sectional analyses were performed using data from Gubbio study. Information's concerning lifestyle factors were collected using self-reported questionnaire and were further completed with a baseline clinical examination and blood exams. Three BP measurements were performed following a standard protocol. Age-adjusted and multiple linear regressions were used to examine the relationships between lifestyle parameters and BP. We used heterogeneity test to observe sex differences.

Results:

In Gubbio residential study, 3,183 persons were included (48% men, 43 ± 17 years old). Mean systolic BP (SBP) was 119 ± 16 mmHg and 10.6% were hypertensives. In multivariable analysis, age, BMI, uric acid and fast blood glucose (FBG) were positively associated with SBP in both sexes. Alcohol was positively associated in women while coffee in women and education level in men were negatively associated with SBP. We observed sex differences concerning education level (high versus low education, p = 0.03), BMI (overweight versus normal, p = 0.04), age (p < 10-4) and coffee consumption (p = 0.04) associated to SBP.

Conclusions:

Many different factors influence differently SBP in men and women (age, education level, BMI, coffee and alcohol consumptions).
THE EFFECTIVENESS AND SAFETY OF ISOMETRIC RESISTANCE TRAINING FOR ADULTS WITH RAISED BLOOD PRESSURE: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Hansford Harrison , Parmenter Belinda , Wewege Michael , Mckleod Kelly , Smart Neil , Schutte Alette , Jones Matthew
Published: April 2021

Objective:

Isometric resistance training (IRT) has demonstrated anti-hypertensive effects, but safety data is limited. Determine the effectiveness and safety of IRT compared to non-exercising control in adults with raised blood pressure.

Design and method:

We conducted a systematic review of published and unpublished trials up to August 2020. We included randomised control trials comparing IRT conducted for at least 3 weeks to a non-exercising, sham or lifestyle modification control in adults with raised blood pressure (systolic greater or equal to 130 and/or diastolic greater than or equal to 85mmHg). The outcomes were office, ambulatory and central blood pressure, as well as safety (adverse events). We assessed risk of bias with the Cochrane risk of bias tool and strength of evidence with GRADE. We conducted random-effects meta-analyses in R.

Results:

24 trials of 1143 participants were included, mean age = 56 ± 9yrs, 56% female. IRT resulted in clinical and statistically significant reductions in both office systolic (-6.72 mmHg, 95% CI -8.64 to -4.79, p < 0.0001) and diastolic blood pressure (-3.80 mmHg, 95% CI -5.22 to -2.38, p < 0.0001) however, the results of studies differed significantly, with the overall quality being very low. IRT also resulted in clinical and statistically significant reductions in central systolic (-7.48mmHg, 95% CI -14.89 to -0.07, p = 0.035) and diastolic blood pressure (-3.75mmHg, 95% CI -6.38 to -1.12, p = 0.005), though the quality of evidence was low. 24hr ambulatory systolic (-2.77mmHg, 95% CI -6.80 to 1.25, p = 0.18) blood pressure did not see a significant reduction but diastolic blood pressure did (-2.39mmHg, 95% CI -4.28 to -0.40, p = 0.02), with very low-quality evidence. The findings of 964 participants with data for adverse events there were 8 events in the IRT group and one in the control group; equating to one adverse event per 28,428 bouts of IRT. There were no serious adverse events. All trials were at a high risk of bias.

Conclusions:

IRT reduces office and central blood pressure with clinical and statistical significance although the quality of evidence is very low and low respectively. IRT appears safe with few adverse events occurring. High-quality trials are required.
CUFF-BASED AND INTRAARTERIAL BRACHIAL BLOOD PRESSURE MISMATCH AND ITS POTENTIAL IMPACT ON ANTIHYPERTENSIVE TREATMENT AND ESTIMATION OF AORTIC BLOOD PRESSURE
Authors: Goupil Remi , Kowalski Cedric , Yang Katie , Charron Thierry , Doucet Michel , Hatem Raja , Kouz Remi , Palisaitis Donald , Schampaert Erick , Terriault Paul , Tessier Pierre , Agharazii Mohsen
Published: April 2021

Objective:

Cuff-based brachial blood pressure (BP) is universally used as a guide to treat hypertension, although it can differ from the intraarterial BP. In this study, we examine the potential impact of cuff-to-intraarterial brachial systolic BP (bSBP) mismatch phenotypes on BP treatment and its impact on determination of central BP.

Design and method:

In 379 hypertensive subjects undergoing cardiac catheterization through the radial artery, non-invasive brachial cuff and central BPs were measured using the Mobil-o-Graph device simultaneously to intraarterial brachial and aortic BP. According to the difference between cuff-based bSBP (CUFF-bSBP) and intraarterial bSBP (IA-bSBP), we identified three phenotypes: Underestimation Mismatch group (CUFF-bSBP < IA-bSBP by more than 10 mmHg); No Mismatch group (CUFF-bSBP within 10 mmHg of IA-bSBP); Overestimation Mismatch group (CUFF-bSBP > IA-bSBP by more than 10 mmHg). Influence on ACC/AHA BP categories was evaluated and accuracy was determined following ARTERY society recommendations (mean difference <=5 ± 8 mmHg).

Results:

The Underestimation (n = 190), No Mismatch (n = 155) and Overestimation (n = 34) groups, despite overall similar clinical characteristics, showed only minor differences in CUFF-bSBP (127 ± 17, 123 ± 15, 126 ± 19 mmHg) despite highly different IA-bSBP (147 ± 18, 126 ± 16 vs 108 ± 18 mmHg, p < 0.001) and aortic SBP (136 ± 20, 122 ± 16, 109 ± 18 mmHg, p < 0.001). ACC/AHA BP categories were concordant in 33%, 68% and 44% of the Underestimation, No Mismatch and Overestimation groups. The Underestimation Mismatch group had 64% of individuals at risk of undertreatment compared to 16% in the No Mismatch Group, while in the Overestimation Mismatch Group 50% were at risk of overtreatment compared to 17% in the No Mismatch group. Cuff bSBP accurately estimated the aortic SBP only in the No Mismatch Group (mean difference 1.7 ± 8.2 mmHg) whereas central BP with the Mobil-o-Graph device did not reach the strict ARTERY criteria for accuracy in any groups.

Conclusions:

Our study shows that the brachial cuff underestimates and overestimates intraarterial brachial BP in a significant proportion of hypertensive subjects, potentially leading to an increased risk of BP mismanagement, and inaccurate non-invasive estimation of central BPs. This underlines the importance of improving the accuracy of cuff-based brachial and central BP monitors, ideally taking into consideration invasive BP phenotypes.
CONTRIBUTING FACTORS OF INTRADIALYTIC HYPERTENSION IN MAINTENANCE HAEMODIALYSIS PATIENTS
Authors: Gathmyr Dewi , Nugroho Pringgodigdo , Awang Iqbal , Lydia Aida , Bawazier Lucky Azizah , Khumaedi Indri , Marbun Maruhum Bonar
Published: April 2021

Objective:

The objective of this study was to determine the proportion of IDH and to evaluate its association with fluid overload using Bioimpedance Analysis (BIA).

Design and method:

A cross-sectional study involving 130 chronic haemodialysis patients in Cipto Mangunkusumo hospital Jakarta. This study is conducted between September to November 2019. IDH was defined as an increase in Mean Arterial Pressure (MAP) of at least 15 mmHg within or after dialysis or an increase of systolic blood pressure more than 10 mmHg after dialysis.

Results:

The prevalence of IDH was 17,7% (n = 23). There was a trend towards predialysis excess fluid in the IDH group with 10 (45,5%) samples when compared with NIDH with 35 (32,7%) samples respectively; as measured by BCM (p = 0.184). A trend towards use of more than 3 antihypertensives was noted in the IDH group [12 (52,1%) samples versus <3 types was 11 (47.8%) samples; p > 0.000]. On bivariate analysis, post dialysis blood pressure and post dialysis MAP are significantly greater in IDH group, as expected. None of the predialysis blood pressure, BMI, ultrafiltration, and serum sodium were associated with incident of IDH

Conclusions:

The prevalence of IDH in our treatment centres is 17,7%. Subclinical fluid overload was found higher in IDH patients, although statistically non significant. The use of BIA identifies patients who may benefit from additional UF.
SERUM MAGNESIUM CONCENTRATION IS REVERSELY ASSOCIATED WITH ARTERIAL STIFFNESS IN YOUNG ADULTS WITH HYPERTENSION
Authors: Khomova Irina , Ilinskaia Sofia , Kirpichnikova Ekaterina , Ezhova Nadezhda , Shavarova Elena , Bazdyreva Elena , Kobalava Zhanna
Published: April 2021

Objective:

Magensium deficeincy is known as a risk factor for cardiovascular disease. However, the data on it's role in arterial stiffness developement is controversial. Our aim was to investigate the association of serum magnesium levels with arterial stiffness in young hypertensive patients.

Design and method:

We included 94 adults 18–45 years old with masked and sustained hypertension verified with 24-hours ambulatory blood pressure monitoring (ABPM). None of them were on blood pressure (BP) lowering treatment. We performed routine clinical investigation including anthropometry, biochemical blood assay, office BP measurement and ABPM. Atrerial stiffness was estimated with applanation tonometry and cardio-ankle vascular index (CAVI) measurement. To investigate the relationship between serum magnesium concentration and other variables we used Spearman's rank correlation coefficient.

Results:

Median age was 23[21–25] years, 79% were males, median body mass index - 24.9 [22.3;28.7].

Median serum magnesium level was 0,9 [0,84;0,94]. No significant associations were found for magnesium concentration and BP characteristics, neigher office, nor 24-hours. Pulse wave velocity was reversely associated with serum magensium level: (-0,184), p = 0,013. Magnesium concentration had also reverse significant correlation with CAVI (-0,300), p < 0,001. These findings were independent of blood pressure levels, body mass index and insulin resistance.

Conclusions:

Serum magnesium concentration is reversely associated with pulse wave velocity and cardio-ankle vascular index in young patients with hypertension.
LEFT VENTRICULAR GEOMETRY AND FUNCTION AND GLOMERULAR FILTRATION RATE DIFFERS IN YOUNG NEVER-TREATED PATIENTS WITH HIGH NORMAL AND NORMAL BLOOD PRESSURE
Authors: Ezhova Nadezhda , Kirpichnikova Ekaterina , Ilinskaia Sofia , Khomova Irina , Shavarova Elena , Bazdyreva Elena , Kobalava Zhanna
Published: April 2021

Objective:

While ESC define individuals with systolic blood pressure of 130–140 mm Hg or diastolic blood pressure of 80–89 mm Hg as normotensive, AHA classify them as hypertensive. Already sophisticated, clinical decision making in young hypertensives becomes really tricky, especially in patients of gray zone.

Design and method:

We recruited 127 adults 18–45 years old with BP 130/80 mm Hg or higher registered during check-up. All of them had never taken any BP-lowering medication. In all those out-patients we performed routine medical examination, including repeated measurements of office BP, 24-hours ambulatory BP monitoring, anthropometry, blood and urine tests and echocardiography. The participants were divided into 3 subgroups: normotensives (with SBP < 130 and/or DBP < 80mmHg, n = 64), hypertensives (SBP 140 mm Hg and/or DBP 90 mm Hg, n = 25), and intermediate group (SBP 130–139 and/or DBP 80–89 mmHg, n = 38).

Results:

Median age was 23[21–25] years; 81,1% were males, 90,6% were Caucasians. The subgroups were comparable in age and BMI. Patients had different glomerular filtration rate (GFR): 105,85[102,64;121,79] vs 103,02[91,61;109,73] vs 96,85[84,50;104,85] ml/min/1.73 m2 for normotensive (group I), intermediate (group II) and hypertensive (group III) patients respectively, p = 0,001. We observed difference in left ventricular mass index (LVMI): 80,32[68,34;87,06] vs 87,06[78,87;99,98] vs 92,31[85,15;107,55] g/m2 in groups I, II and III, respectively, p < 0,001. In pairwise comparison of LVMI we observed significant difference between I and II groups (p = 0,002) and I and III (p < 0,001). LV concentric remodeling was more prevalent in hypertensive patients (52%) than in normotensive (20%) or patients with intermediate BP (46%), p = 0,004. Incidence of LV hypertrophy didn’t significantly differ in groups: 3,6% vs 6,5% vs 12%, for I, II and III, respectively, p = 0,352. E/A ratio was 1,68[1,38;1,86] vs 1,55[1,3;1,9] vs 1,86[1,48;2,22] for I, II and III, respectively, p = 0,044. In the pairwise comparison the difference in E/A between normotensive and patients with intermediate level of BP was significant: p = 0,016.

Conclusions:

Rate and severity of abnormal LV geometry and function and GFR decline is higher in young patients with high normal BP than in those with normal and optimal BP.
THE PROGNOSTIC VALUE OF MARKERS OF MYOCARDIAL AND RENAL DYSFUNCTION IN OLDER HYPERTENSIVE PATIENTS WITH COMORBIDITY
Authors: Efremova Elena , Shutov Alexander , Podusov Alexander
Published: April 2021

Objective:

Comorbidity, including chronic kidney disease (CKD), chronic heart failure (CHF)and anemia, worsens the prognosis in older patients with arterial hypertension. Hypoxia is the leading link in pathogenesis. The aim of this study was to investigate the prognostic value of markers of myocardial and renal dysfunction in older hypertensive patients with CHF.

Design and method:

72 older hypertensive patients with CHF (27 males and 45 females, mean age 71.8 ± 8.4 years) were examined. Arterial hypertension was defined according to ESC Guidelines for the diagnosis and treatment of arterial hypertension, 2018. CKD was diagnosed and classified according to the KDIGO guidelines (2012). Serum levels of HIF-1, endogenous erythropoietin (eEPO), N-terminal propeptide of type B natriuretic hormone (NT-proBNP), cystatin C were assessed. The follow-up period was 12 months; the primary endpoint was total mortality.

Results:

CKD was diagnosed in 48 (66.7%) older hypertensive patientswith CHF. The HIF-1 levelwas significantly higher in the group of deceased patients than in the survivors (0.08 (IQR 0.06; 0.11) and 0.05 (IQR 0.04; 0.07) ng / ml, p = 0.02), as well as the level of NT-proBNP (1126.3 (IQR 551.8; 2750.0)and 164.4 (IQR 135.5; 1100.9) pg / ml, p < 0.0001), EPO(16.92 (ICR 5.43; 64.57) and 5.36 (IQR 1.65; 8.85) mIU / ml, p < 0.0001),cystatin C(1.49 (ICR 0.86; 2.13) and 0.99 (IQR 0.82; 1.32) Mg / l, p = 0.0005). Multivariate regression analysis showed an independent relationship between the eEPO level and patient survival (R = 0.61, ß = 0.49, p = 0.0037).

Conclusions:

The level of eEPOin older hypertensive patients with CHF has an independent and closer relationship with the mortality of patients than the traditional markers of myocardial and renal dysfunction.
A HIGHER FAT FREE MASS OF LEFT LEG WAS ASSOCIATED WITH AN INCREASED RISK OF CARDIOVASCULAR RISK FACTORS AMONG CHINESE CHILDREN AND ADOLESCENTS
Authors: Dong Yangyang , Cai Rongrong , Ma Ping , Yang Qingmei , Jia Leina , Ding Wenqing
Published: April 2021

Objective:

The relationship between lean body mass (LBM) and Cardiovascular risk factors (CVRFs) in children and adolescents remains unclear. This study aimed to examine the association between LBM and risk of CVRFs among Chinese children and adolescents.

Design and method:

In this cross-sectional study, a total of 1159 children and adolescents aged 10 to 18 underwent a comprehensive assessment of CVRFs, including questionnaire surveys, physical examination, and biochemical tests. Lean body mass analysis was performed with bioelectrical impedance analysis (BIA). The number of CVRFs clustering greater than or equal to 1 was defined as CVRFs > = 1.

Results:

The individuals with CVRFs > = 1 showed higher level for all LBM indexes than those with no CVRFs (CVRFs < 1). The prevalence of CVRFs > = 1 increased, with the level of all LBM indexes increased, all P < 0.001. For example, the prevalence of CVRFs > = 1 increased with the increase of fat free mass (FFM), from 25.3% to 48.1%, P < 0.001. Compared to the lowest LLFFM tertile group, the adjusted OR and 95% confidence interval (CI) for CVRFs > = 1 were 7.16 (1.13–45.45) and 5.49 (1.40–21.58) in the second and highest LLFFM tertile group, respectively, after adjusting sex and age.

Conclusions:

A higher LLFFM was associated with an increased risk of CVRFs among children and adolescents. It is essential for children and adolescents to keep LLFFM at a low level to prevent cardiovascular disease (CVD) and take LBM into account when assessing the risk of CVD.
WHEN NOT TO NEGOTIATE RHYMES WITH TAKING RISKS
Authors: Caruso Giuseppe , Ciarambino Tiziana , Ciaburri Filippina , Paoli Vera Delli , D’Avino Maria
Published: April 2021

Objective:

The ESH/ESC 2018 guidelines recommend lifestyle modifications in subjects with high-normal blood pressure (BP) values and low-moderate cardiovascular risk. The purpose of this study was to assess whether a population of subjects with high-normal BP could develop arterial hypertension or organ damage over a three-year follow-up.

Design and method:

In this study, 98 subjects (60 M), with mean age 42 ± 12.7 years, were randomized. In 34 subjects, silent signs of organ damage were highlighted, in the remaining 64 no anomalies were highlighted. ABPM (Ambulatory Blood Pressure Monitoring) was applied to the 64 subjects and, repeated annually.

Results:

Twelve of the 64 subjects, during the 3 years of follow up, became hypertensive grade 1, with no evidence of organ damage; 15 presented echography changes (rhythm disturbances, left anterior hemiblock, left axial deviation, left ventricular hypertrophy); 2 paroxysmal AF and only 1 subject, was subjected to tomography computerized investigations with evidence of adrenal adenoma. The remaining 34 subjects, with only lifestyle changes, presented, BP values controlled both by clinical measurement and by ABPM.

Conclusions:

Our results, in a small sample, show an evolution of high-normal BP in arterial hypertension grade 1, as well as the appearance of organ damage. The follow up of subjects with high-normal BP, must be constant over time, with visits, also carried out by dedicated nursing staff. In addition, a complete initial assessment would be desirable, for the exclusion of concomitant pathologies.
ISOLATED DIASTOLIC BLOOD PRESSURE AND RISK OF ATHEROSCLEROTIC CARDIOVASCULAR DISEASE IN A COMMUNITY DWELLING POPULATION
Authors: Cheng Di , Wang Qian , Tan Isabella , Butlin Mark , Avolio Alberto , Zuo Junli
Published: April 2021

Objective:

Although the threshold of blood pressure (BP) for hypertension was lowered to 130/80 mmHg in the 2017 American college of cardiology (ACC)/American Heart Association (AHA) guidelines, the threshold of >=140/90 mmHg was still recommended in both the 2018 European Society of Cardiology (ESC) and 2019 National Institute for Health and Care Excellence (NICE) guideline. This study was to explore the clinical significance of isolated diastolic blood pressure for cardiovascular risk based on the two hypertension thresholds.

Design and method:

6768 participants without antihypertensive treatment were included in the analysis of the association between isolated diastolic hypertension (IDH) and atherosclerotic cardiovascular risk. IDH was defined respectively by 2017 AHA/ACA guidelines (systolic BP < 130mmHg, diastolic BP >= 80mmHg) and by the ESC/NICE definition (systolic BP < 140mmHg, diastolic BP >=90mmHg). Arteriosclerotic cardiovascular disease (ASCVD) was determined by the 2013 ACC/ AHA recommended guidelines.

Results:

The estimated prevalence of IDH was 24.0% by the 2017 ACC/AHA definition and 10.85% by the 2018 ESC/ 2019 NICE definition. Compared with normotensive individuals, those with IDH by both the 2017 ACC/AHA definition and the 2018 ESC/ 2019 NICE definition did not show any significant difference for the prevalence of ASCVD risk [Odds Ratio (OR) of 2017 ACC/AHA definition: 0.56, 95% confidence interval (CI):0.3–1.01; OR of 2018 ESC/ 2019 NICE definition: 1.43, 95%CI: 0.83–2.44]. The diagnostic efficiency of diastolic blood pressure is not significant (Area Under the ROC Curve: 0.51, 95%CI: 0.48–0.55). The dose-response relationship was validated by restricted cubic spline analysis (P for overall association = 0.57, P for non-linear association = 0.50).

Conclusions:

In this Chinese population, IDH is more prevalent when defined by the 2017 AHA/ACC definition compared with the 2018 ESC/ 2019 NICE definition. However, IDH as defined by either threshold is not significantly associated with increased ASCVD risk and its diagnostic efficacy is poor.
EFFECTS OF ACE INHIBITORS AND ANGIOTENSIN TYPE-1 RECEPTOR BLOCKERS ON ACE-2 EXPRESSION IN HUMAN ALVEOLAR EPITHELIAL CELLS
Authors: Caputo Ilaria , Caroccia Brasilina , Seccia Teresa Maria , Domenig Oliver , Poglitsch Marko , Rossi Gian Paolo
Published: April 2021

Objective:

Angiotensin converting enzyme 2 (ACE-2) has regained widespread attention as the cellular receptor of SARS-CoV-2 virus that caused the COVID-19 pandemic. It was contended that ACE inhibitors (ACEis) and angiotensin type 1 receptor (AT1R) antagonists (ARBs) increase ACE2 expression in lung cells and their administration in Covid-19 patients could be detrimental and/or constitute a potential risk factor. As there were no evidences supporting this hypothesis we investigated the effect of ACEis/ARBs on ACE2 expression in lung cells.

Design and method:

Calu-3 cells, epithelial cells derived from lung adenocarcinoma, were treated with 10 μM irbesartan (ARB), or 10 μM ramipril (ACEi) alone or in the presence of 100 nM Angiotensin II (Ang II) for 12 hours in serum-free media. After 12 hrs ACE2 mRNA expression was evaluated by Digital droplet (dd)PCR.

Results:

We found that Ang II increased by two-fold ACE2 mRNA copies (vehicle 792.7 ± 161.3 vs Ang II 1475 ± 319.9; p < 0.001), while both irbesartan and ramipril did not affect ACE2 expression levels (722.3 ± 170.2 and 747.8 ± 313.8, respectively). Moreover, pretreatment with irbesartan abolished Ang II-induced ACE2 expression (722.3 ± 170.2 copies irbesartan vs 1046 ± 182.4 copies Ang II + irbesartan; p < 0.05), while pretreatment with rampiril had no such effect (1252 ± 246,4 copies Ang II + ramipril).

Conclusions:

ARBs and ACEis do not increase ACE2 expression at mRNA levels in human epithelial lung cells. Ang II increased ACE2 expression by acting via AT1R. Therefore, these results provided mechanistic support to a beneficial effect of both ACEi and ARB treatment in Covid19 patients with Sars-CoV-2 infection.
ASSOCIATION BETWEEN BODY FAT DISTRIBUTION AND BLOOD PRESSURE IN NORMAL-WEIGHT CHINESE CHILDREN AND ADOLESCENTS
Authors: Cai Rongrong , Dang Jie , Dong Yangyang , Zhang Hao , Yang Qingmei , Ma Ping , Ding Wenqing
Published: April 2021

Objective:

Body fat distribution is commonly considered as playing a significant role in blood pressure (BP), whether normal-weight children and adolescents whose body fat distribution confer BP risk that remains uncertain. Aim of this study was to assess the associations of body fat distribution with BP risk in normal-weight Chinese children and adolescents.

Design and method:

A cross-sectional study consisted of 898 normal-weight children and adolescents aged 10–18 years from China. Participants were selected using a cluster sampling method and underwent bioelectrical impedance analysis (BIA) for body fat distribution indexes.

Results:

Body fat distribution was related with an increased risk for BP in normal-weight children and adolescents. After adjustment for gender and age, visceral fat level(VFL) was positively associated with abnormal BP (OR:1.109 95%CI, 1.016–1.210; P < 0.05), and the same result also found when including fat mass percentage(FMP; P < 0.05). FMP, VFL and VFL/FMP ratio showed a positively association with abnormal BP in girls after adjustment for age, respectively (OR:1.08; 95%CI, 1.03–1.13; P < 0.01)(OR:1.22; 95%CI, 1.07–1.38; P < 0.01)(OR:1.08; 95%CI, 1.01–1.14; P < 0.05). However, when both FMP and VFL were adjusted for age, FMP but not VFL negatively associated with abnormal BP in boys (OR:0.94; 95%CI,0.88–1.00; P < 0.05), and the same result also found when additional including VFL/FMP ratio in the same model(P < 0.05).

Conclusions:

The body fat distribution (especially visceral fat) is associated with abnormal BP in normal-weight children and adolescents, especially in girls. Therefore, attention should be paid to the relative effect of body fat distribution (especially visceral fat) on BP in the prevention and treatment of hypertension in youths.
THE IMPACT OF HYPERGLYCEMIA FIRST DETECTED IN PREGNANCY ON OFFSPRING BLOOD PRESSURE IN SOWETO, SOUTH AFRICA
Authors: Boerstra Brittany , Soepnel Larskse M. , Nicolaou Veronique , Kolkenbeck-Ruh Andrea , Ware Lisa , Norris Shane A. , Klipstein Kerstin
Published: April 2021

Objective:

In South Africa, the prevalence of pediatric hypertension in 5-year-old children is 1 in 5. It has been estimated that 60% of South African children with elevated blood pressure maintain this status into adulthood, contributing to the highest prevalence of hypertension in adults aged 50+ globally. Recent literature suggests that pediatric hypertension may be influenced by maternal factors during pregnancy, including hyperglycaemia first detected in pregnancy (HFDP). The long-term consequences for offspring born to mothers with HFDP are not yet well understood and its impact on childhood blood pressure has not previously been assessed in sub-Saharan Africa. The objective of this study is to evaluate the association between HFDP and offspring blood pressure in 3–6-year-old children in Soweto, South Africa.

Design and method:

Oscillometric blood pressure was measured in 183 children born to mothers with and without HFDP using a 75-g 2-hour OGTT for diagnosis. Blood pressure was categorized into normotensive, elevated, Stage 1 and Stage 2 hypertension according to the 2017 American Academy of Pediatrics Hypertension Guidelines. The association between maternal hyperglycemia and offspring blood pressure was analyzed using multiple linear regression

Results:

In 48.6% of children, blood pressure was above the normotensive range. Prevalence of hypertension did not significantly differ between the exposed and control group. There was no significant association between maternal hyperglycemia and offspring systolic blood pressure when adjusted for offspring age, height, and sex, [-0.323, 95% CI (-3.126–2.480), P = 0.821). Early life factors, including child BMI age z-score [1.529, 95% CI (0.067–2.990), P = 0.041] and exposure to maternal smoking [5.460, 95% CI (0.182–10.739), P = 0.043], were significantly associated with offspring systolic blood pressure. Maternal hypertension was not a significant predictor for offspring blood pressure.

Conclusions:

Maternal HFDP was not associated with childhood blood pressure at 3–6 years, but the high prevalence of pediatric hypertension in this group of preschool-aged children is concerning. Future research should further evaluate offspring obesity and maternal smoking as potentially preventable risk factors that could be improved by public policy to reduce the cycle of hypertension and cardiovascular risk in an African setting.
EFFECTS OF METABOLIC SYNDROME ON BLOOD CELLS OF RATS
Authors: Birulina Julia , Petrova Irina , Ivanov Vladimir , Buyko Evgeniy , Trubacheva Oksana , Smagliy Ludmila
Published: April 2021

Objective:

The study is focused on the effects of metabolic syndrome induced by high-fat, high-carbohydrate diet on erythrocytes and platelets of rats.

Design and method:

The 6-week old Wistar rats (n = 23) were used for study. Rats were divided into control and experimental groups. The rats from the control group were fed standard rat chow. The rats from the experimental group had a high-fat, high-carbohydrate diet. Body weight, blood pressure (BP) were assessed. After 12 weeks of a diet load an oral glucose tolerance test was carried out. Hematological and biochemical parameters in plasma were analyzed. The conductivity of the KCa-channels of the erythrocyte membrane was measured by potentiometric method, and the platelet aggregation was determined by turbidimetric method.

Results:

High-fat, high-carbohydrate diet feeding in rats for 12 weeks led to obesity, BP elevation, hyperglycemia, impaired glucose tolerance, dyslipidemia with triglyceridemia. Elevation of number of leukocytes due to granulocytes and platelets were observed in the experimental group. The collagen-induced aggregation of platelets was elevated in rats with metabolic syndrome. Red blood cell count in rats of the experimental group did not significantly differ from the control group. The multidirectional changes in the membrane potential were observed in response to the stimulation of the KCa-channels of the erythrocyte membrane of the experimental group with the Ca2 + ionophore A23187 or the redox-system.

Conclusions:

The data obtained indicate that a high-fat, high-carbohydrate diet leads to metabolic and hemorheological disorders, that are characteristic of metabolic syndrome.
THE IMPACT OF COVID-19 PANDEMIC AND LOCKDOWN ON CARDIOMETABOLIC STATUS ON PATIENTS WITHOUT EVIDENCE OF SARS COV-2 INFECTION IN THREE REGIONS OF LATIN AMERICA. A SUB-STUDY OF THE CORCOVID LATAM STUDY
Authors: Camilletti Jorge , Renna Nicolas , Santi Ricardo Lopez , Erriest Juan , Siller Grecia Perez , Garcia Maria Isabel , Martinez Carlos Garcia , Baranchuk Adrian
Published: April 2021

Objective:

Background The purpose of the study was to evaluate regional related differences in Latin America on the impact of the pandemic in cardiometabolic patients without evidence of SARS-CoV-2 infection.

Methods:

A cross-sectional survey was conducted which included 38 questions about demography, clinical condition, change of health habits, medical treatments to cardio metabolic patients in outpatient follow-up. A total of 66 researchers from 13 Latin American countries enrolled patients from June 15 to July 15, 2020. The countries were divided into 3 geographic regions Region1 (NCCR) North, Central, and Caribbean Region; Region2 (AR) Andean Region; Region3 (SCR) Southern Cone Region. Isolation measures were estimated from national reports and correlated using the Spearman R coefficient.

Design and method:

4216 patients were analyzed, NCCR (33.82%); AR (32.23%) SCR (33.94%). Significant differences were found between regions in the AR, SCR and NCCR, in age, unemployment, CV risk, adherence, percentage of smokers, type of diet and vaccination coverage. This analysis of habitual medication showed, that discontinued medication was greater in AR, reaching almost 30% (1 in 3 patients), to a lesser extent in NCCR and ultimately less in SCR, showing a significant difference between zones (p < 0.001). The main finding of this study was the negative impact that restrictive measures have on adherence to medications and physical activity, Rs = 0.84 p = 0.0003 and Rs = 0.61 p = 0.0032, respectively.

Results:

Significant differences were found between regions, AR is the most vulnerable region, lower income, lower educational level, higher medication discontinuation. Restrictive measures imposed by the different countries (quarantine) showed a positive correlation with the discontinuation of medication and a negative correlation with the amount of physical activity. The impact of the consequences left by this pandemic will be very profound in most Latin American countries.
Prevalence of Depression or Anxiety During Antepartum Hospitalizations for Obstetric Complications
Authors: Toscano Marika , Royzer Rebecca , Castillo Daniel , Li Dongmei , Poleshuck Ellen
Published: April 2021

OBJECTIVE:

To systematically review the prevalence of antenatal depression and anxiety in women hospitalized in an antepartum unit for obstetric complications.

DATA SOURCES:

We searched PubMed, EMBASE, CINAHL, PsycINFO, and ClinicalTrials.gov for English-language articles published from database inception through March 2020.

METHODS OF STUDY SELECTION:

We included cross-sectional, cohort, case–control, quasi-experimental, and randomized controlled studies from any country that reported the proportion of pregnant women with an elevated depression or anxiety screening scale or diagnostic interview during antepartum hospitalization of any duration and at any gestational age.

TABULATION, INTEGRATION, AND RESULTS:

We identified 8,799 articles and reviewed 79, 39 of which were included in a systematic review and 18 in meta-analysis of the primary outcome. Two raters independently assessed quality of individual studies using a 14-question tool. A random effects meta-analysis model was used to estimate prevalence and 95% CI of depression or anxiety. Heterogeneity was examined with the I2 test, and funnel plots were used to assess publication bias. After meta-analysis, the estimated prevalence of depression was 34% (95% CI 27–41%) and of anxiety 29% (95% CI 16–43%). There was expected substantial clinical and methodologic heterogeneity between studies that persisted even after planned a priori subgroup analyses and meta-regression. Even so, the direction of effect was consistent across studies. No publication bias was found.

CONCLUSION:

The current meta-analysis suggests that one in three women hospitalized during pregnancy for obstetric complications report clinical levels of depression or anxiety symptoms, twice the reported prevalence of antenatal depression or anxiety in the general obstetric population.

SYSTEMATIC REVIEW REGISTRATION:

PROSPERO, CRD42020172111.
Uptake and Outcomes of Sentinel Lymph Node Mapping in Women With Atypical Endometrial Hyperplasia
Authors: Dioun Shayan , Chen Ling , Melamed Alexander , Gockley Allison , St. Clair Caryn M. , Hou June Y. , Tergas Ana I. , Khoury-Collado Fady , Hur Chin , Hershman Dawn L. , Wright Jason D.
Published: April 2021

OBJECTIVE:

To examine the utilization, morbidity, and cost of sentinel lymph node mapping in women undergoing hysterectomy for complex atypical endometrial hyperplasia.

METHODS:

Women with complex atypical endometrial hyperplasia who underwent hysterectomy from 2012 to 2018 in the Perspective database were examined. Perioperative morbidity, mortality, and cost were examined based on performance of sentinel lymph node mapping, lymph node dissection or no nodal evaluation.

RESULTS:

Among 10,266 women, sentinel lymph node mapping was performed in 620 (6.0%), lymph node dissection in 538 (5.2%), and no lymphatic evaluation in 9,108 (88.7%). Use of sentinel lymph node mapping increased from 0.8% in 2012 to 14.0% in 2018, and the rate of lymph node dissection rose from 5.7% to 6.4% (P<.001). In an adjusted model, residence in the western United States, treatment by high-volume hospitals and use of robotic-assisted hysterectomy were associated with sentinel lymph node mapping (P<.05 for all). The complication rates were similar between the three groups. The median cost for sentinel lymph node mapping ($9,673) and lymph node dissection ($9,754) were higher than in those who did not undergo nodal assessment ($8,435) (P<.001).

CONCLUSION:

Performance of sentinel lymph node mapping is increasing rapidly for women with complex atypical endometrial hyperplasia but is not associated with increased perioperative morbidity or mortality.