bluuebunny/crossref_metadata_2025 huggingface dataset:
CLINICAL EFFECTS OF SINGLE PILL COMBINATION THERAPY OF ANTIHYPERTENSIVES AND STATIN ON BLOOD PRESSURE, LIPID, AND CARDIOVASCULAR RISK PROFILES IN PATIENTS WITH NEWLY DIAGNOSED HYPE
Authors: Park Sang Min , Cho Eun Jeong
Published: June 2023

Objective:

Hypertension and dyslipidemia are the major risk factors for athersclerotic cardiovascular disease (ASCVD). The single pill combination (SPC) covering these risk factors are commonly used but has little data. The clinical effect of these SPCs on blood pressure and lipid profile with ASCVD risk change were evaluated in middle aged borderline risk group.

Design and method:

Seventy-two patients (age: 53.6±10 years) who were simultaneously diagnosed with hypertension and dyslipidemia were randomized to the two SPC groups: amlodipine 5 with atorvastatin 20 (AA) versus (vs.) olmesartan20 with rosuvastatin 10mg (OR). Before and after medication for six months under the active life style change, 24-hour ambulatory blood pressure (BP) monitoring (ABPM), lipid profile, carotid ultrasonography, ankle-brachial index (ABI), and ASCVD risk parameters including glucose profiles were also compared.

Results:

Baseline 24-hr mean systolic BP were higher in OR group (AA vs. OR: systolic BP 142.8±8.9 vs. 148.3±8.8mmHg, p = 0.039). The level of LDL cholesterol were slightly higher without significance in OR group (LDL 121.3±31.2 vs. 136.4±26.6mg/dL, p = 0.091). Follow-up mean BP were similar on 24-hr ABPM (systolic BP 127.3±9.4 vs. 125.1±7.3mmHg, p = 0.416; diastolic BP 85.6±6.6 vs. 81.4±7.8mmHg, p = 0.083). The changes in reduction of mean systolic BP markedly greater in OR group (systolic BP -15.1±11.5 vs -22.8±11.7, p = 0.048). Reduction of LDL cholesterol were similar (-53.1±24.7 vs. -62.5±29.1 mg/dL, p = 0.331). The level of fasting glucose was increased in only OR group and those of hemoglobin A1c were increased at both group and its changes were greater in OR group (0.12±0.30 vs. 0.23±0.28%, p = 0.048). The carotid intima-media thicknesses were slightly reduced in both group while ABI were not changed. ASCVD risk score were decreased after treatment (5.3 to 2.9 vs. 6.9 to 3.8%) with its similar rate between both group (45.3 vs 45.6%).

Conclusions:

In treating the middle aged patients with newly diagnosed hypertension and dyslipidemia using SPCs of AA and OR, OR is beneficial in blood pressure control while AA is advantageous to glucose control. After 6-months simultaneous treatment of hypertension and dyslipidemia, their grades of ASCVD risks were shifted from borderline to lower group.
INFLUENCE OF CHRONIC AT1 RECEPTOR BLOCKADE ON GASTRIC BARRIER FUNCTION IN MICE
Authors: Nickel Laura , Rawish Elias , Suenderhauf Annika , Sina Christian , Raasch Walter
Published: June 2023

Objective:

The AT1 receptor blocker Telmisartan (TEL) is beneficial for the treatment of individuals suffering the Metabolic Syndrome as TEL reveals not only antihypertensive effects but also improves the glucose and lipid control and lowers body weight. As we have recently shown that TEL has impact on gut microbiota and brain barrier function we here investigated whether TEL influences gut barrier function which may participate in decrease of energy intake.

Design and method:

BL6 mice were fed with chow or high fat diet (45% fat) and were additionally treated with vehicle (CONchow or CONHFD) or TEL (8 mg/kg/d, 12 w, TELchow or TELHFD). Visceral and subcutaneous fat mass was quantified by MRI. Segments of large intestine were Canoy fixed to determine thickness of mucus by immunohistochemistry. PAS staining was performed for depicting goblet cells. The signalling pathway being involved in necroptosis was investigated by Western blots and qPCR.

Results:

Compared to chow feeding, gain in body weight increased by HFD (3.4±0.5 vs. 14.4g±1.2 g) and was reduced by TEL (1.7±0.5 vs. 2.8±0.5g). Visceral fat and liver mass was higher in CONHFD than CONchow but remained normal by TEL treatment. The mucus thickness was lower in CONHFD than CONchow. Independent on feeding, TEL additionally reduced mucus thickness. Numbers of goblet cells were not affected by HFD feeding and TEL treatment. RIP3 was particularly increased in TELHFD mice, while muc2 and ki67 almost remained unaffected by TEL.

Conclusions:

In contrast to our expectation, the antiobese effect of TEL was associated with a decrease in mucus thickness. Increase in RIP3 indicates that necroptosis may be enhanced by TEL. Further studies have to be performed to elucidate whether this detrimental TEL effect is true and be relevant for gastrointestinal function.
DIABETES MELLITUS AND ASSOCIATED HYPERTENSION, A TOXIC COMBINATION FOR CARDIOVASCULAR RISK
Authors: Nelaj Ergita , Gjata Margarita , Kecaj Irida , Gjermeni Ilir , Tase Mihal
Published: June 2023

Objective:

The coexistence of hypertension in diabetic patients greatly enhances their likelihood of developing CVD. Other important risk factors for CVD in these patients include the following: obesity, atherosclerosis, dyslipidemia, microalbuminuria, inflammation, retinopathy, and “diabetic cardiomyopathy”. We aimed to assess the impact of type 2 diabetes mellitus associated with high blood pressure over these cardiovascular risk factors.

Design and method:

We performed a transversal study, lasting 12 months, in which 100 patients with essential hypertension, and type 2 diabetes, with medium age 60.7 ± 9.3 years were evaluated in comparison with 100 patients with only hypertension. We evaluate these patients for: BMI; waist circumference; IMT by carotid ultrasonography; microalbuminuria in a spot morning urine; fundus oculi, LVMI for left ventricular hypertrophy by echocardiography. Serum PCR and lipid concentrations were measured.

Results:

The diabetic hypertensive subjects significantly had higher BMI (p = 0.01) and waist circumference statistically significant (p = 0.005). Patients with hypertension and diabetes had a greater left ventricular mass index (66% vs 51%, P = 0.04). Mean value for IMT was 1.1 ± 0,3 mm for diabetic patients and 0.93 ± 0,2 mm for the other group (P < 0.001) and its prevalence was high in diabetics (75% vs 64%, P = 0.1). Prevalence of microalbuminuria was significantly high in diabetics (44% vs 14%, P < 0.001). PCR as marker of inflammation was prevalently high in people with diabetes and hypertension (32% vs 16%, P = 0.013) Also, prevalence of retinopathy was significantly high in people with diabetes and hypertension compare to other group (27% vs 12%, P = 0.012). There was strong relation between LVMI, microalbuminuria, IMT and PCR. Waist circumference had correlation with IMT and microalbuminuria.

Conclusions:

DM is an independent risk factor for the increased LV mass and impaired diastolic function regardless of association with hypertension or not. Central obesity is associated with an increased risk for cardio metabolic diseases such as atherosclerosis and diabetic nephropathy. Atherosclerosis is characterized by chronic inflammation affecting the arterial intimae. Thus, individuals with type 2 diabetes and hypertension had increased risk for CVD.
THE NEW PCSK9-INHIBITOR INCLISIRAN: AN EXCEPTIONAL REDUCTION IN LDL CHOLESTEROL FROM THE FIRST PATIENTS OF THE NIGUARDA HOSPITAL
Authors: Merlo Anna , Maloberti Alessandro , Ossola Paolo , Caccia Andrea , Busti Andrea , Garofani Ilaria , Fabbri Saverio , Senni Michele , Giannattasio Cristina
Published: June 2023

Objective:

Dyslipidemia is one of the most prominent risk factors in coronary artery disease. With the new strict target of Low Density Lipoprotein (LDL) cholesterol in secondary prevention in some patients oral medication may not be sufficient. Inclisiran is a small interfiring RNA that inhibits the hepatic PCSK-9 synthesis inducing a reduction in low-density lipoprotein levels up to 50%. Conveniently, it only requires one administration every six months.

Design and method:

A 53-year-old man, with no previous cardiologic history, presented to our emergency department reporting acute chest pain and left arm paresthesia developed after an emotional stress. Electrocardiogram was normal with a slightly and stable increased of high sensitivity troponin T levels (18 ng/l). The patient had the following cardiovascular risk factors: type 2 diabetes mellitus, dyslipidemia, obstructive sleep apnea syndrome, obesity (body mass index 30), sedentary lifestyle. Taking into consideration his clinical presentation and his cardiovascular risk, a coronary computer tomography was performed showing severe stenosis in Left Anterior Descending (LAD) and right coronary arteries. The subsequent coronary angiography confirms the severe stenosis in the proxymal LAD and the mild stenosis (30%) in the right coronary artery. The LAD was treated with a drug eluting stent. At the time of the event the patient was already on therapy with rosuvastatina/ezetimibe 10/10 mg that we increased to a dosage of 20/10 mg. At the first medical examination after the hospitalization, his blood tests showed uncontrolled LDL cholesterol (70 mg/dl). We therefore decided to try lowering his cholesterol levels with addition of inclisiran.

Results:

After 3 months of inclisiran therapy, his blood test showed a surprisingly decrease in cholesterol levels (total cholesterol 78 mg/dl and LDL 11 mg/dl) reaching the desirable target.

Conclusions:

Inclisiran is a valid therapeutic strategy for reaching the desiderable cholesterol target in patient at high cardiovascular risk. In our first patients inclisiran, added to statin and ezetimibe therapy, successfully lowered LDL to the desirable target. Surprinsigly, it lowered LDL up to 85%, much more than expected. Further studies will be needed to identify which patients may be super responders to Inclisiran.
ASSOCIATION OF SERUM RETINOL CONCENTRATION WITH CARDIOVASCULAR DISEASES IN THE US NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY (NHANES) 2001-2006
Authors: Liang Xiaopeng , Chou Oscar Hou In , Cheung Bernard Man Yung
Published: June 2023

Objective:

The association between serum retinol concentration and cardiovascular disease is controversial. This study aimed to investigate the relationship between serum retinol concentration and cardiovascular diseases.

Design and method:

This cross-sectional study included 8240 non-pregnant participants aged over 20 in the National Health and Nutrition Examination Survey (NHANES) 2001-2006. Cardiovascular diseases were defined as a self-reported history of coronary heart diseases, heart attacks, angina pectoris, and stroke. Restricted cubic spline and logistic regression were employed to examine the association of serum retinol concentration with cardiovascular diseases with adjustments for potential confounders (i.e., demographics, socioeconomic status, body mass index, physical activity, alcohol, smoking, medical history, and use of vitamin A supplements).

Results:

6.8% (95% CI, 6.0-7.6) of the participants had cardiovascular diseases. The mean (±standard error) serum retinol concentration was 2.06±0.13 μmol/L. Serum retinol concentration had a J-shaped relationship with cardiovascular diseases, with the lowest risk observed between 0.82 and 1.20 μmol/L. Stratified by gender, the serum retinol concentration with the lowest odds ratio was 0.99 μmol/L in men and 1.07 μmol/L in women. The lower and upper tail of serum retinol concentrations (< 0.82μmol/L or >1.20μmol/L) were associated with cardiovascular diseases [OR = 1.70, 95%CI (1.23-1.85), P<0.01] after adjusting for covariates.

Conclusions:

Serum retinol concentration has a J-shaped association with cardiovascular diseases. While serum retinol may be an independent predictor of cardiovascular diseases, further studies are needed to determine if this is a causal relationship.
POSSIBLE PREDICTORS CONTRIBUTING TO ATRIAL FIBRILLATION OCCURRENCE IN HYPERTENSIVE PATIENTS
Authors: Grigoryan Svetlana , Zelveian Parunak , Hazarapetyan Lusine
Published: June 2023

Objective:

Arterial hypertension (HT) and atrial fibrillation (AF) are two important public health problems. Their prevalence is increasing worldwide, and often coexist in the same patient. HT and AF are strikingly related to an excess risk of cardiovascular disease and death. HT ultimately increases the risk of AF and several factors underlying the higher risk of AF in patients with HT are still incompletely known. HT is one of the main reasons for the remodeling process in and makes a significant contribution to the development of structural changes of the heart.

The aim of this study is to identify possible predictors of paroxysmal/persistent AF occurrence and progression in hypertensive patients.

Design and method:

In this study where enrolled 219 hypertensive patients with non-valvular paroxysmal/persistent AF (mean age 63.6±7.4). As a control group 94 patients with HT and without AF were also examined. Echocardiography examination and 24-hour ambulatory Holter monitoring ECG were registered in each patient. The database consisting of 19 indicators that characterize the clinical, hemodynamic and structural-functional state of the heart, as well as markers of inflammation and fibrosis was created. Data were analyzed by SPSS 13 program using logistic analysis by odds ratio (OR).

Results:

The obtained results showed that in hypertensive patients with paroxysmal/persistent AF, OR of more episodes of hypertensive crises, deterioration of electrical remodeling and left ventricular (LV) diastolic function, as well as a significant increase in the levels of concentrations of inflammatory and fibrosis markers in comported with hypertensive patients without AF were detected.

Conclusions:

The multifactorial analysis revealed significant impact of LA and LV dysfunction, inflammation and fibrosis as well as hypertensive crises on the possible risk of AF occurrence and progression in hypertensive patients.
ASSOCIATION OF CAROTID-FEMORAL PULSE WAVE VELOCITY AND RISK THRESHOLDS OF INDEX OF ATHEROSCLEROTIC CARDIOVASCULAR DISEASE (ASCVD) IN HYPERTENSION
Authors: Chang Guili , Hu Yueliang , Ge Qian , Chu Shaoli , Avolio Alberto , Zuo Junli
Published: June 2023

Objective:

As index of arterial stiffness, carotid-femoral pulse wave velocity (cfPWV) is strongly associated with cardiovascular risk. This study aimed to assess association of cfPWV and cardiovascular disease (CVD) in a Chinese hypertensive cohort and determine the cfPWV threshold value for assessment of future risk of CVD.

Design and method:

This cross-sectional study was conducted in hospital in-patients with multiple CVD risk factors or complications due to target organ damage. cfPWV was measured with the Complior device (Alam Medical, France) and central aortic pressure (cAP) with the SphygmoCor device (AtCor Medical [CardieX], Sydney) giving cAP indices: augmented pressure (AP), augmentation index (Aix), aortic pulse pressure, (aPP) aortic systolic pressure (aSBP). Framingham Risk Scores (FRS) were computed for all participants. Criteria specified by American College of Cardiology and American Heart Association were used to calculate atherosclerotic cardiovascular disease (ASCVD) risk scores. Patients were stratified by ASCVD risk threshold of 10% and divided into two groups: ASCVD >10% or ASCVD<10%. cfPWV cut-off value associated with or without ASCVD risk was obtained by receiver operating characteristics (ROC) curve.

Results:

All participants (n = 630; age 63.6 ± 8.6 years, 61.7% male) had primary hypertension. aAP, AIx, aPP, aSBP and were greater in females than in males (p < 0.001); ASCVD risk scores and brachial diastolic pressure (DBP) were higher in males (p<0.05). All hemodynamic indices showed significant correlation with ASCVD and FRS, except for AIx with no correlation with ASCVD. In multivariate logistic analysis, cfPWV was significantly associated with ASCVD risk (OR: 1.324, [1.119–1.565], p < 0.001) after adjusting for age, gender, smoking, body mass index, total cholesterol, fasting blood glucose, antihypertensive treatment, statin treatment, DBP. Area under the ROC curve was 0.758 and 0.672 for cfPWV and aortic SBP (p < 0.001 and p < 0.001, respectively); the critical value of cfPWV and aSBP was 12.5 m/s (sensitivity 63.2%; specificity: 77.8%) and 124.5 mmHg (sensitivity 63.9%; specificity: 65.3%). cfPWV significantly correlated with the ASCVD risk.

Conclusions:

The optimal cut-off value of cfPWV for assessing future CVD risk in the hypertensive population in China is 12.5 m/s.
PREVALENCE, AWARENESS AND TREATMENT OF CARDIOVASCULAR RISK FACTORS IN HEALTH PROFESSIONALS IN THE CARDIOVASCULAR FIELD: AN ITALIAN PILOT STUDY
Authors: Rosei Claudia Agabiti , Pinto Rita Del , Mengozzi Alessandro , Bressa Stefano , Malerba Paolo , Cacciatore Marco , Ghignatti Simone , Fama’ Francesca , Arenare Giulia , Curcio Rosa , Muiesan Maria Lorenza , Grassi Guido , Ferri Claudio
Published: June 2023

Objective:

Physicians and researchers in the cardiovascular (CV) field are constantly engaged in the promotion of guidelines-directed preventive measures, but whether they are themselves adherent to the same recommendations was only sporadically assessed.

Design and method:

During the annual meeting of the Italian Society of Hypertension (October 2022), a pilot observational study on consecutive volunteer health professionals was conducted. Participants underwent three standard sitting and two standing (1-3 minutes) blood pressure (BP) measurements and answered a questionnaire regarding modifiable/not modifiable CV risk factors and related treatments. Hypertension was defined as BP more then 140 and/or 90 mmHg or as a pre-existing diagnosis. Orthostatic hypotension was defined as a decrease of systolic BP more then 20 mmHg or of diastolic BP more then 10 mmHg; orthostatic hypertension was defined as an increase of systolic BP more then 20 mmHg or of diastolic BP more then 11 mmHg.

Results:

In total, 62 participants (30F, mean age 43.2±14.8 years; 74.2% non-smokers) were enrolled; 79% reported regular physical activity; 53% of women and 38% of men were on a low-salt diet. Dyslipidemia was the most common risk factor (17.7%), but only 63.3% were on a statin; 22.6% had high BP, of whom 50% were unaware; 1.6% and 16.4% had orthostatic hypo- and hypertension, respectively.

Conclusions:

Despite the specific professional involvement, room for improvement in self CV risk factors awareness and management was detected in the examined exploratory sample of health professionals. This pilot research anticipates forthcoming, larger studies during national and international meetings.
EARLY MORNING HEMODYNAMIC CHANGES AND LEFT VENTRICULAR HYPERTROPHY AND MORTALITY IN HEMODIALYSIS PATIENTS
Authors: Mallamaci Francesca , Tripepi Rocco , Torino Claudia , Tripepi Giovanni , Sarafidis Pantelis , Zoccali Carmine
Published: June 2023

Objective:

Amplified early morning increase in BP, a phenomenon accompanied by a parallel rise in heart rate (HR), is a marker of high cardiovascular risk in the general population. The early morning changes in these parameters have not been investigated in the hemodialysis population.

Design and method:

In a pilot, single center, study including a series of 58 hemodialysis patients we measured the pre-awakening BP and HR surges and the nocturnal dipping of the same parameters as well as other established indicators of autonomic function (weighted 24h systolic BP and HR variability) and tested their relationship with the left ventricular mass index (LVMI) and with the risk of death over a median follow up of 40 months.

Results:

The pre-awakening HR surge (r = -0.46, P = 0.001) was inversely associated with LVMI and the risk of death [HR (1 unit): 0.89, 95% CI: 0.83-0.96, P = 0.001] while the corresponding BP surge largely failed to associate with these outcomes. The link between the pre-awakening HR surge with LVMI and death was robust and largely independent of established risk factors in the hemodialysis population, including the nocturnal dipping of BP. Weighted 24h systolic BP and HR variability did not correlate with LVMI (all P>0.11) nor with the risk of death (P>0.11) and these parameters were also independent of the nocturnal dipping of systolic BP and HR.

Conclusions:

This pilot study suggests that the low early morning changes in HR, likely reflecting enhanced sympathetic activity, entail a high risk for LVH and mortality in the hemodialysis population.
COMPARING THE CARDIOVASCULAR RISK ESTIMATION IN YOUNG ADULT PATIENTS WITH TYPE 1 DIABETES: STENO F1RISKENGINE VS. ESC-EASD 2019 RISK TABLE
Authors: Kuzior Agnieszka , Rios-Gomez Carlos , Ojeda Borja Santana- , Leon-Durango Ricardo Jose De , Hernandez-Lazaro Alba , Arnas-Leon Claudia , Acosta-Calero Carmen , Ortiz-Hernandez Catherine Pino , Perez-Rivero Jennifer Maria , Martinez-Martin Francisco Javier
Published: June 2023

Objective:

Adult patients with type 1 diabetes (T1DM) have very high cardiovascular risk, which is typically underestimated in daily clinical practice. The ESC-EASD risk table (2019) for both type 1 and type 2 diabetes is based on categorical variables, ignores specific variables such as HbA1c and yields an imprecise risk estimation (moderate, high or very high). The rarely used Steno T1RiskEngine predicts the 5-year and 10-year risks of a cardiovascular event and of terminal kidney disease, both absolute and relative to the reference population. We undertook to compare the results of both cardiovascular risk calculations in a group of young adult patients with T1DM.

Design and method:

Retrospective analysis of the data from consecutive patients with a sufficient collection of clinical data was performed. Informed consent was obtained from all patients. The ESC/EASD 2019 risk table is available at doi:10.1093/eurheartj/ehz486; the Steno T1RiskEngine is described in doi:10.1161/CIRCULATIONAHA.115018844 and the calculator is available online: (https://steno.shinyapps.io/T1RiskEngine1)

Results:

30 patients were included, 18 women (60%), aged 32±9 years. According to the ESC/EASD table, 2 (6.7%) had moderate risk, 16 (53.3%) had high risk and 12 (40%) had very high risk. With the Steno T1RiskEngine the median risk of cardiovascular event was 6.4% (IQR 2.7-9.3%) at 5 years and 12.4% (IQR 5.9-17.6%) at 10 years, with medians of 1.7% and 3.4% in the reference population (relative risks 376% and 365% at 5 and 10 years); the median risk of terminal kidney disease was 2.9% (IQR 1.2-6.7%) vs. 0.8% in the reference population (relative risk 362%). By cardiovascular risk categories, with the Steno T1RiskEngine we obtained 3 patients (10%) with moderate risk, 13 (43.3%) with high risk and 14 (46.7%) with very high risk, without significant difference vs. the ESC/EASD categorization (Chi2 p = 0.72).

Conclusions:

The cardiovascular and renal risk of our adult patients with T1DM is very high (>3.5x the reference population risk); the ESC/EASD categorisation of cardiovascular risk does not significantly differ from that of the T1RiskEngine. However, the Steno T1RiskEngine yields a more precise estimation of the individual risks and should be used more frequently.
VALIDATION OF AN OSCILLOMETRIC DEVICE FOR BRACHIAL-ANKLE PWV: PRELIMINARY RESULTS
Authors: Jadoon Maryam , Khettab Hakkim , Justin Junior , Boutouyrie Pierre , Bruno Rosa Maria
Published: June 2023

Objective:

Arterial stiffness is independent and clinically relevant prognostic biomarker, which can be measured by different techniques, including carotid-femoral Pulse wave velocity (cfPWV), Branchial-ankle PWV baPWV. The aim of this study is to investigate if there is an agreement between ankle-branchial and Carotid-femoral pulse wave velocity.

Design and method:

The carotid- femoral and Branchio-ankle Pulse wave velocity of 30 patients coming for routine clinical checkup of cardiovascular risk evaluation were measured with SphygmoCor CVSM (Atcor Medical, Australia) and WatchBP Office Vascular (Microlife, Widnau, Switzerland). The mean of left and right leg measurements was used for calculating baPWV, whereas the mean of two measurements on the right side (median for 3) was used for cfPWV. The Bland-Altman Analysis was used for finding the agreement between the two types of pulse wave velocities.

Results:

30 patients (63% men, age 66.89 ± 12.75 years, BMI 25.73 ± 3.84 kg/m2, MBP 92.866 ± 10.13 mmHg). CfPWV was 9.80 ± 2.56 m/s and baPWV was 14.24± 2.37 m/s. cfPWV and baPWV were linearly correlated with each other (r = 0.598, p = 0.0005). Both were positively correlated with age (cfPWV: r = 0.6083, p = 0.0004; baPWV r = 0.4716, p = 0.0103). The two metrics showed significant bias (bias CI95% 4.836, 95.0% lower confidence limit 0.901, 95.0% upper confidence limit 8.77).

Conclusions:

In a population of individuals undergoing cardiovascular screening, a significant bias between Cf-PWV and Ba-PWV was found, in accordance with previous studies. cfPWV and baPWV are correlated each other and showed a similar correlation with age. Larger head-to-head studies are needed to explore differences in relationship with risk factors.
DAYTIME SUPINE BLOOD PRESSURE NORMALIZED BY 24-HOUR VALUES INDEPENDENTLY PREDICTS FUNCTIONAL OUTCOME AFTER ISCHEMIC STROKE
Authors: Gasecki Dariusz , Kowalczyk Kamil , Kwarciany Mariusz , Botouyrie Pierre , Laurent Stephane , Narkiewicz Krzysztof , Karaszewski Bartosz
Published: June 2023

Objective:

Blood pressure (BP) after ischemic stroke (IS) may follow various patterns. Post-event acute BP alterations mirror both stroke and patient characteristics, and resolve over time, yet their clinical significance is low or uncertain. Whether individual BP variations, based on a single standardized measurement normalized by a background BP course, have a distinct significance for stroke outcome remains unknown. We hypothesized that the BP difference index (BPD) between daytime supine resting and a series of surrounding BP values (daytime, 24-hour (24h)) in the subacute phase of IS is associated with functional outcome.

Design and method:

we included 131 IS patients [age 60.8 ± 12.5 years, median (NIHSS) score 5 (3-8)]. Office BP measurements and continuous 24-hour BP monitoring were performed on day 7 after stroke onset. The daytime period was defined as the interval from 6 a.m. to 10 p.m. Functional outcome was evaluated 90 days after stroke using the modified Rankin Scale (mRS) with an mRS score of 3 to 6 (dependency or death) considered as a poor outcome.

Results:

In a univariate analysis, high BPD was significantly associated with a poor stroke outcome (p = 0.001, 0.003, and 0.002 for systolic, diastolic, and mean BP, respectively, irrespective of the normalization subperiod (daytime, 24h). In a multivariate analysis, the predictive value of BPD remained significant only for systolic BP [SBP] normalized by daytime or 24h mean (OR, 1.06; 95% CI, 1.01-1.11; p = 0.02) after adjustment for covariates. Moreover, the relationship was stronger in a subgroup of patients able to walk independently (mRS 0-2) on day 7 after stroke onset (adjusted OR, 1.08; 95% CI, 1.01-1.17; p = 0.049 for SBP normalized by daytime or adjusted OR, 1.09; 95% CI, 1.01-1.18; p = 0.03 for SBP normalized by 24h mean).

Conclusions:

We found that the higher difference between supine resting and daytime or diurnal mean BP in patients in the subacute phase of ischemic stroke is independently associated with a poor outcome. This BP index might be useful in clinical practice, including therapeutic decisions, but needs broader studies in patient populations of stroke subtypes.
RELATIONSHIP BETWEEN SKELETAL MASS INDEX AND DIFFERENT OBESITY METABOLIC PHENOTYPES AMONG ADOLESCENTS IN CHINA
Authors: Tong Lingling , Ma Xiaoyan , Tian Mei , Ding Wenqing
Published: June 2023

Objective:

To explore the relationship between skeletal mass index (SMI) and different obesity metabolic phenotypes among adolescents,and to provide a theoretical basis for the prevention and control of obesity and related metabolic diseases in adolescents.

Design and method:

A total of 1352 adolescents aged 12-18 were randomly selected for questionnaire survey,physical measurements,body composition determination and laboratory testing. Multiple logistic regression analysis was used to analyze the correlation intensity between SMI and different metabolic phenotypes of obesity.

Results:

The metabolically unhealthy normal weight (MUNW) phenotype, metabolically healthy obesity(MHO) phenotype and metabolically unhealthy obesity(MUO) phenotype had lower levels of SMI compared to the metabolically healthy normal weight(MHNW) phenotype among adolescents,with all differences being statistically significant(P-values were all less than 0.001). Similar results were found after stratification by sex. Multiple logistic regression analysis showed that after adjusting for sex, SMI were protective factors for MUNW phenotype, MHO phenotype and MUO phenotype in adolescents(P-values were all less than 0.001),with the 0.86(95%CI:0.85,0.92),0.78(0.75,0.82) and 0.73(0.70,0.76) increased risks of MUNW phenotype, MHO phenotype and MUO phenotype associated with each unit rise in SMI, similar results were found after stratification by sex.

Conclusions:

SMI were protective factors for MUNW phenotype, MHO phenotype and MUO phenotype among adolescents. Attention should be paid to the assessment and supervision of adolescent skeletal muscle quality when prevented obesity and related metabolic risks,reducing the risk of abnormal cardiovascular metabolism in adolescents.
MEDIATING EFFECTS OF MUSCLE MASS ON THE ASSOCIATION BETWEEN FAT MASS AND BONE MINERAL CONTENT IN CHINESE ADOLESCENTS AGED 12-18 YEARS
Authors: Tong Lingling , Ma Xiaoyan , Tian Mei , Ding Wenqing
Published: June 2023

Objective:

To explore whether muscle mass (MM) is a mediator in the pathway of fat mass (FM) on bone mineral content (BMC) and determine the proportion of the mediation effect.

Design and method:

A total of 1852 adolescents (1130 boys, 61.02%) aged 12 to 18 years in China were randomly selected through a stratified cluster sampling. BMC, FM and fat free mass (FFM) were assessed using bioelectrical impedance analysis (BIA), and calculated MM. Mediation analysis was applied to determine direct and indirect effects of FM on BMC through MM.

Results:

Mediation analysis results showed that,after controlling for gender and age, MM can partially explain the association of FM on BMC( = 0.028,95%CI: 0.025,0.030;P<0.001) and its proportion of mediation effect was 75.7%. Stratified by gender,after adjusting for age,indirect effects through MM on the FM-BMC association were estimated at 0.030(mediation effect = 73.2%) in boys and 0.027(mediation effect = 84.4%) in girls (P<0.001 for both).

Conclusions:

The association between fat mass and bone mineral content is in part mediated through increasing in muscle mass. Muscle mass mediates the effect of fat mass on bone mineral content.
THE ASSOCIATION OF CIRCULATING SERUM IRISIN LEVELS WITH GLUCOSE AND LIPID METABOLISM IN CHINESE ADOLESCENTS AGED 12∼18 YEARS
Authors: Tong Lingling , Ma Xiaoyan , Tian Mei , Ding Wenqing
Published: June 2023

Objective:

Irisin is an exercise-regulated myokine inducing browning of white adipose tissue and has gained interest as a potential new strategy to combat type 2 diabetes mellitus and dyslipidemia. The aim of this study was to evaluate the possible relationships between circulating serum irisin levels with glucose and lipid metabolism in Chinese adolescents.

Design and method:

This cross-sectional study included 1219 adolescents aged 12 to 18 years. Serum irisin levels were evaluated by enzyme-linked immunosorbent assay and all participants’ fasting blood glucose (FBG) and lipids,including totalcholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C) and high-density lipoprotein cholesterol(HDL-C) were measured. Multiple linear regression was used to study the effect of irisin on glucose and lipid metabolism.

Results:

There were several significant negative correlations between circulating irisin and FBG (r = -0.120, P<0.001), TC(r = -0.091, P<0.001), LDL-C(r = -0.088, P = 0.002) and HDL-C(r = -0.094, P<0.001) across the study. In multivariate linear regression analysis, after controlling for potential confounders such as gender, age and BMI, irisin levels were independently associated with FBG( = -0.115, P<0.001), TC( = -0.078, P = 0.003), LDL-C( = -0.073, P = 0.005) and HDL-C(r = -0.087, P = 0.001).

Conclusions:

We found that serum irisin levels were inversely correlated with glucose and lipid metabolic parameters including FPG, TC, LDL-C and HDL-C,suggesting that irisin may play a crucial role in glucose and lipid metabolism from an early age.
OFFICE BLOOD PRESSURE VARIABILITY AND INSTABILITY IN CHILDREN, ADOLESCENTS AND YOUNG ADULTS: ASSOCIATION WITH PRECLINICAL ORGAN DAMAGE
Authors: Theodosiadi Aikaterini , Ntineri Angeliki , Kollias Anastasios , Kyriakoulis Konstantinos , Menti Ariadni , Ntousopoulos Vasileios , Stathopoulou Panagiota , Zeniodi Maria , Stambolliu Emelina , Servos George , Moysakis Ioannis , Destounis Antonios , Vazeou Andriani , Stergiou George S.
Published: June 2023

Objective:

To evaluate the association of systolic blood pressure (SBP) variability and instability within a single office visit with preclinical target organ damage in young individuals.

Design and method:

Apparently healthy individuals aged 6-25 years referred for elevated blood pressure (BP) were subjected to triplicate office BP measurements in a single visit and 24h ambulatory BP monitoring. SBP variability and instability were quantified using (i) standard deviation (SD) (ii) coefficient of variation (CV) (iii) average real variability (ARV) (iv) maximum office SBP (v) maximum-minimum office SBP difference (MMD) (vi) ratio of difference between 1st-3rd measurement to the average office SBP (Relative change). Preclinical organ damage was evaluated by (i) carotid intima-media thickness (cIMT), (ii) carotid-femoral pulse wave velocity (PWV; Complior device), and (iii) echocardiographic left ventricular mass index (LVMI).

Results:

301 individuals were analyzed (mean age 13.8±3.7 years, 66.8% males, BMI z-score 1.12±0.95, average office BP 122.6±16.9/72.5±10.7 mmHg, 24h ambulatory BP 119.1±11.4/67.8±6.8 mmHg). LVMI measurements were available in 258 participants, IMT in 208 and PWV in 60. LVMI, IMT and PWV were associated with office SBP (r = 0.30/0.23/0.42, respectively, p< = 0.001), 24h ambulatory SBP (r = 0.35/0.33/0.48, p< = 0.001) and maximum office SBP (r = 0.31/0.30/0.41, p< = 0.001). LVMI and IMT were associated with SD (r = 0.14/0.15, p<0.05) and MMD (r = 0.13/0.15, p<0.05), while IMT and PWV with age (r = 0.31/0.38, p<0.001). Other indices of variability were not associated with indices of organ damage. In stepwise multivariable linear regression models (independent variables: age, sex, BMI z-score, office SBP, 24h ambulatory SBP, maximum office SBP, SD, MMD), LVMI was determined by BMI z-score and 24h ambulatory SBP, IMT by age, male sex and 24h ambulatory SBP, and PWV by 24h ambulatory SBP.

Conclusions:

These results suggest that in young individuals the variability and instability of office SBP within a single visit are not associated with preclinical organ damage.
IMPACT OF THE NUMBER OF OFFICE VISITS ON DIAGNOSING HYPERTENSION PHENOTYPES IN YOUNG INDIVIDUALS
Authors: Stathopoulou Panagiota , Kollias Anastasios , Menti Ariadni , Ntineri Angeliki , Zeniodi Maria Elena , Theodosiadi Aikaterini , Ntousopoulos Vasileios , Kyriakoulis Konstantinos , Vazeou Andriani , Stergiou George S.
Published: June 2023

Objective:

To investigate the impact of measuring office blood pressure (BP) in an increasing number of visits on diagnosing hypertension phenotypes in young individuals.

Design and method:

Young individuals referred for elevated BP and healthy volunteers aged 6-25 years were evaluated with office BP measurements (3 visits; triplicate measurements; average of the last 2) and 24-hour ambulatory BP monitoring (ABP). Normotension (NT) was defined as normal office and ABP; Sustained hypertension (HT) as elevated office and ABP; White-coat hypertension (WCH) as elevated office but normal ABP; Masked hypertension (MH) as normal office with elevated ABP.

Results:

Analysis included 273 individuals (mean age 13.9±3.8 years, 69.6% males, BMI 24.6±4.8 kg/m2). Average office BP at 1st visit was 122.0±16.4/72.9±10.7 mmHg, systolic/diastolic, average of first 2 visits 120.6±15.4/72.3±10.2 and average of 3 visits 119.8±15.1/72.0±9.7 mmHg. The prevalence of NT, HT, MH and WCH was: 1st visit 55/17/8/20% respectively; average of first 2 visits 61/16/10/13%; average of 3 visits 63/15/11/11% respectively. The agreement between the 1st and the average of 1st-2nd visit was 92% for NT diagnosis (kappa = 0.83), 98% for HT (kappa = 0.92), 98% (kappa = 0.87) for MH and 92% for WCH (kappa = 0.70). The agreement between the 1st visit and the average of all 3 visits was 91% for NT (kappa = 0.81), 97% for HT (kappa = 0.89), 97% for MH (kappa = 0.83) and 91% for WCH (kappa = 0.64). Last, the agreement between ABP and office BP measurements for BP elevation was 72% for the 1st visit (kappa = 0.35), 77% for the average of the 1st-2nd visit (kappa = 0.41) and 78% for the average of 3 visits (kappa = 0.44).

Conclusions:

These findings suggest that in young individuals at least 2 office visits are required for optimal office BP evaluation which has reasonable agreement with ABP.
RELATIONSHIP BETWEEN CAROTID INTIMA MEDIA THICKNESS AND PHENOTYPES OF HIGH BLOOD PRESSURE IN ADOLESCENTS
Authors: Silva Egle , Bermudez Greily , Chacin Lisbeth , Bracho Mayela , Madueño Freddy
Published: June 2023

Objective:

The aim of this study was to investigate the relationship between the Carotid Intima Media Thickness (cIMT) and high blood pressure phenotypes (HBPP) in a population of Hispanic adolescents.

Design and method:

It was conducted a cross-sectional study in Maracaibo, Venezuela that included 616 adolescents, 289 males and 327 females, selected from high school institutions (age: 13-18 years old). An ultrasonic study was carried out through high resolution B-mode ultrasound examinations for the measurement of the c-IMT. Also, 24-hs ambulatory blood pressure (ABPM) monitoring was performed to obtain ambulatory BP during 24-hs, awake and asleep periods. Demographic (age, gender), anthropometric data [weight, height, hip circumference, waist circumference (WC)] and office BP were recorded. The HBPP included were: true normotension (TN), sustained (SH), white coat (WCH) and masked (MH) hypertension according the new American Heart Association recommendations. Spearman Correlation was used to estimate the association between c-IMT and HBBPP.

Results:

The mean c-IMT value was 0.42 mm in all adolescents, 0.43 in males and 0.41 in females (p = 0.01). The HBPP prevalence in all adolescents was: 4. % (n = 26) for SH, 21.6 % (n = 133) for MH, 1.0 % (n = 6) for WCH and 73.2 % (n = 451) for TN. Males showed statistically significant high prevalence of MH and SH than female group [(28.4% vs. 15.6% for MH) and (8.3% vs. 0.6%) for SH. The adolescents with SH showed statistically significant higher values than those with TN in c-IMTI values [0.45±0.05 vs. 0.41.2±0.061 mm, p = 0.01]. There were statistically significant associations between c-IMT values with HBPP (Sperman rho = 0.115, p = 0.01).

Conclusions:

This study showed important associations between c-IMT values and HBPP in adolescents. Also, there is a very high prevalence of MH and SH; this condition appears to be associated with male gender. It should be important to evaluate c-IMT in those adolescents with office or ambulatory high BP values to investigate possible vascular changes induced by hypertension.
EFFECTS OF BLOOD PRESSURE ON THE HEALTH STATUS AMONG ADOLESCENTS 12-13 YEARS
Authors: Ospanova Ainur , Kerimkulova Aiman.S. , Rymbaeva Tamara.H. , Markabaeva Akbayan.M. , Nurpeissova Riza.G. , Idrissov Alisher.S.
Published: June 2023

Objective:

To investigate the effects of blood pressure (BP) on health status, the appearance of complaints in adolescents

Design and method:

The results of a single-step cross-sectional study of teenagers aged 12-13 years studied in secondary schools in Semey city (Kazakhstan) are presented. The study included adolescents in the amount of 1519 (average age, standard deviation 12.3 + 0.46 years). For representing the outcomes there were used data from the conducted survey, the measurement of blood pressure of adolescents. Criteria for BP: normal BP (SBP and DBP <89 percentile); high normal BP (SBP and DBP < 90 and 94 percentile); arterial hypertension (SBP and DBP> 95 percentile). The criterion for the statistical significance of the obtained results was considered the value of p <0.05.

Results:

From studied teenagers, boys were 49.1% (n = 745), girls 50.9% (n = 774) respectively. Population with normal BP composed 62.7%, normal raised BP - 24.8%, hypertension -12.4%. Adolescents with normal blood pressure levels rated their health as poor 31, with elevated blood pressure 12 adolescents (p = 0.198). According to cardiovascular disease complaints, no statistically significant differences were found in adolescents (p = 0.66). Complaints with normal blood pressure - 198, with high blood pressure - 113.

Conclusions:

Most adolescents with hypertension complaints from the cardiovascular disease do not show and assess their health as good. That requires screening among adolescents
ASSOCIATION OF DEPRESSION AND ANXIETY WITH HYPERTENSIVE CRISIS. A CROSS SECTIONAL STUDY FROM A HOSPITAL SETTING IN KARACHI, PAKISTAN
Authors: Yousuf Fatimah Sireen , Arif Aiman , Bibi Raheela , Almas Aysha
Published: June 2023

Objective:

Hypertension, a leading risk factor for cardiovascular death has been closely linked with depression and anxiety. The aim of this study was to examine the association of depression or anxiety with hypertensive crisis in patients from a hospital setting and also see if the association is affected by age groups or gender.

Design and method:

This cross-sectional study was conducted between July 2019 and March 2022 on 290 patients admitted at the Aga Khan University Hospital (AKUH). All adult patients of more than 18 years of age admitted with uncontrolled hypertension with systolic blood pressure of > 140 and diastolic blood pressure > 90 admitted through emergency were included. Hypertensive crisis was defined as systolic blood pressure more than 180mm Hg or a diastolic blood pressure more than or equal to 120mm Hg, with or without accompanying end organ damage. Depression and Anxiety were evaluated using the Hospital Anxiety and Depression Scale (HADS), with a cut-off score of greater than 8.

Results:

Of the patients identified with uncontrolled hypertension, a total of 140 (48.3 percent) of the patients presented with a hypertensive crisis, while 150 (51.3 percent) did not have a hypertensive crisis at presentation. In the hypertensive crisis group, 60 (49. percent) had HADS scores consistent with depression, while 83 (59.3 percent) had HADS scores consistent with anxiety. In patients with hypertensive crisis, HADS depression and anxiety were most prevalent in the 61-75 age group (39.7 percent). In the comparison of gender, it was found that males and females with hypertensive crisis had an almost equal prevalence of anxiety (49.4 percent in males versus 50.6 percent in females). A slightly higher prevalence of depression was seen in females with hypertensive crises when compared to males.

Conclusions:

We found no association between depression or anxiety with hypertensive crisis, and the association is not affected by age group or gender. However, do note that half of the patients with hypertensive crises had depression or anxiety. Future large multicentered studies are required to study the link in greater detail.
EFFECTS OF HYPERTENSION ON TAVI OUTCOMES
Authors: Sener Yusuf Ziya , Ates Ahmet Hakan , Sahiner Mehmet Levent , Kaya Ergun Baris , Aytemir Kudret
Published: June 2023

Objective:

Severe aortic stenosis (AS) is the most common valvular disease in elderly and transcatheter aortic valve implantation (TAVI) is the standard of care treatment for AS in patients with high surgical risk. Hypertension accompanies with AS in this population in general. We aimed to evaluate the impact of hypertension on TAVI related outcomes.

Design and method:

All of the patients who underwent TAVI procedure between January 2010 and March 2020 were screened and patients with eligible datas were included. Datas were obtained from hospital electronic database.

Results:

A total of 306 cases were enrolled. Mean age of the population was 76.0 ± 10.4 61.4% of the cases were female. Median follow-up was 28.4 (13.0-49.5) months. Age was significantly higher (77.0 ±8.2 vs. 72.7± 14.8; p = 0.018) and diabetes was more frequent (37.6% vs. 16.9%; p = 0.001) in hypertensive patients. Use of RAS blockers (62.0% vs 28.6%; p<0.001) and calcium channel blockers (34.5% vs. 3.9%; p<0.001) were more frequent in hypertensive cases as expected. Baseline characteristics and outcomes were summarized in Table-1.

Left ventricular mass index was similar between the two groups (129.5 ± 32.8 vs. 132.7 ± 39.3; p = 0.502). Rates of contrast induced nephropathy, insertion site complications and need of de novo pacemaker implantation due to advanced heart block were not different between the two arms. Stroke rates were distinctly higher in patients with hypertension (7.4% vs 0%; p = 0.009), while all-cause mortality during follow-up was similar between patients with and without hypertension.

Conclusions:

Left ventricular mass index increases in patients with severe AS and hypertension also leads left ventricular hypertrophy by raising afterload. However, LVMI values were similar between patients with and without hypertension contrary to as expected. Higher proportion of RAS blocker use that has favorable effects on cardiac remodelling can explain this finding. Significantly increased risk of stroke in patients with hypertension is another attractive finding that should be kept in mind.
IMPACT OF DIABETES MELLITUS ON ARTERIAL STIFFNESS, AND PULSATILE HEMODYNAMICS IN HEART FAILURE WITH PRESERVED EJECTION FRACTION
Authors: Postadzhiyan Arman , Andreeva Lora , Tochev Sotir , Velchev Vassil , Finkov Bojidar
Published: June 2023

Objective:

The aim of the current study was to characterize different parameters of arterial stiffness and pulsatile hemodynamics in patients with arterial hypertension and metabolic syndrome according the presence of diabetes mellitus and diastolic dysfunction.

Design and method:

121 consecutive patients with left ventricular ejection fraction > 40% were included in the study. LV diastolic function was assessed using pulsed wave Doppler on transthoracic echocardiography. Brachial-ankle pulse wave velocity (baPWV) and the cardio-ankle vascular index (CAVI) was measured using a VaSera VS-1500® device (Fukuda Denshi). Ambulatory BP monitoring over 24 hours was performed using the Mobilograph device (IEM, Stolberg, Germany) which measures brachial and central (aortic) BP, as well as time-resolved waveforms, allowing for ambulatory pulse wave analysis (including wave separation into forward and backward waves and reflection magnitude)

Results:

Among 121 patients included, diabetes mellitus was present in 55 (54.5%) and diastolic dysfunction in 54 (45.4%). The presence of impaired myocardial relaxation on echocardiography was associated with markedly increase of arterial stiffness parameters – CAVI (8.7 vs 8.1, p = 0.03), PWV (8.8 vs 7.9, p = 0.001), central hemodynamics - central SBP (129.4 vs 114 mmHg, p<0.001), cardiac output and total peripheral resistance (1.34 vs 1.25, p = 0.001) and pulsatile hemodynamics - with reduced reflection magnitude (60.7 vs 63, p = 0.04). Diabetic subjects with HFpEF exhibited a markedly greater left ventricular wall thickness and left atrium size on echocardiography. Pronounced aortic stiffening was also observed in the diabetic group (pulse wave velocity, 8.7 vs 7.9, p, 0.001; cardio-ankle vascular index, 9.1 vs 7.8, p<0.001), with an adverse pulsatile hemodynamic profile characterized by increased forward and backward wave amplitude and reduced reflection magnitude (61 vs 64.8, p = 0.05).

Conclusions:

The presence of diastolic dysfunction is associated with changes of arterial stiffness and pulsatile hemodynamics. Diabetes mellitus is a key determinant of left ventricular remodeling, arterial stiffness, adverse pulsatile hemodynamics, and ventricular-arterial interactions in HFpEF.