bluuebunny/crossref_metadata_2025 huggingface dataset:
EPIDEMIOLOGICAL PROFILE OF HYPERTENSE PATIENTS IN PRIMARY CARE SETTING IN RIO DE JANEIRO CITY
Authors: Oliveira Monica Amorim De , Rey Helena Cramer Veiga , Ribeiro Antonio Luiz Pinho
Published: April 2021

Objective:

Observational study, to describe in the context of family medicine care, epidemiological data of a cohort of hypertensive patients.

Design and method:

Prospective cohort observational study of hypertensive patients selected from a randomized sample, conducted in primary care units in the city of Rio de Janeiro, where 1,000 patients aged over 18 years were allocated in 2016 and 2017 who were referred for electrocardiogram. Clinical evaluations were documented in a care form and recorded in a database. Follow-up by telephone following one year.

Continuous variables will be described as mean and standard deviation or median and interquartile difference. Categorical variables will be described as frequency and proportion, with their respective 95% confidence intervals. Statistical analyzes, to assess the significance of the differences found between the strategies, will be performed as recommended. The statistical program R was used.

Results:

In the selected sample of patients in basic health units, the prevalence of hypertension was 72.38%.

Of the total sample 35.6% were male, the average age was 57.75 years and the median age 59. Among the hypertensive 35.52% were male, the average The mean age was 60.97 years and the median age 61.5.

Most patients had primary education, 58.22%, and received less than 2 minimum wages, 78.69%.

In hypertensive patients the prevalence of risk factors was 64.35% of sedentary lifestyle, 25.63% of dyslipidemia, 24.51% of diabetes mellitus and 14.76% of smoking. And the prevalence of associated clinical conditions was 4.32% stroke, 1.53% chronic kidney disease, 2.3% heart failure and 1.25% atrial fibrillation. 5.71% of the patients had previous acute myocardial infarction (AMI), 2.65% had already undergone coronary angioplasty and 0.56% had myocardial revascularization surgery.

Among non-hypertensive, 36.03% were male, the average age was younger than hypertensive people, 49.12 years, even as the median age, 49. There were less people with some cardiovascular risk factors as dyslipidemia (11,4%) and diabetes (10.66%).

Conclusions:

Studies such as this are necessary to understand the population served and to implement strategies to improve the quality of the HA primary care program with measures to prevent or delay the onset of related complications.
CHARACTERISTICS OF DRAFT-AGE YOUTH WITH HYPERTENSION
Authors: Posokhov Igor , Uvarovskaya Basana , Melnik Maria
Published: April 2021

Objective:

Identification of draft-age youth with hypertension (HTN) is crucial, since these individuals

may experience an exacerbation of their illness during training with dire consequences for them.

HTN may disqualify conscripts for military service. We aimed to evaluate characteristics of HTN in pre-conscripts.

Design and method:

Making office and ambulatory blood pressure measurements (BP and ABPM) we selected 150 men aged 17–27 years with normotension (group I, n = 19), masked HTN (II, n = 16); white coat HTN (III, n = 24) and sustained HTN (IV, n = 91). Then we evaluated height, BMI, echo and laboratory tests.

Results:

Characteristics of pre-conscripts are represented in the table.

The pre-conscripts in groups I and III are of normal weight and in groups II and IV are overweight. According to generally accepted reference values, there are no signs of LV hypertrophy. However, participants in group IV are revealed to to be significantly (p < 0,05) different than those of group I.

Conclusions:

More than 45% of pre-conscripts with measured normotensive office BP are revealed to have a masked HTN. Young men with masked HTN and sustained HTN are overweight. In 20% of draft-age youth with office HTN increased BP is caused by white coat HTN. It seems HTN-mediated heart damage begins already in the very early stages of hypertension.
BLOOD PRESSURE CHANGES OVER 18 MONTHS AFTER INITIATION OF ANTIRETROVIRAL THERAPY IN HIV INFECTED PATIENTS IN LILONGWE, MALAWI
Authors: Steffen Hans-Michael , Phiri Sam , Kasper Philipp , Chaweza Tom , De Forest Andrew , Heller Tom , Tweya Hannock , Mwagomba Beatrice , Nhlema Angellina , Chiwoko Jane , Fätkenheuer Gerd , Neuhann Florian
Published: April 2021

Objective:

The improved survival of people living with HIV (PLHIV) and the economic and demographic changes in sub-Saharan Africa are accompanied by a rising number of patients suffering from cardiovascular disease. According to a recent meta-analysis hypertension prevalence is higher in PLHIV on antiretroviral therapy (ART) compared to ART-naïve patients. As part of the ongoing prospective LighTen Cohort Study (ClinicalTrials.gov NCT02381275) we examined blood pressure (BP) changes in ambulatory PLHIV who initiated ART in urban Lilongwe, Malawi.

Design and method:

Anthropometric measurements of adult study participants at baseline and during study visits after 1, 3, 6 and every 6 months thereafter were recorded in an electronic patient registry. For the present analysis we surveyed systolic and diastolic BP values (oscillometric measurements) and body weight (BW) from this data base for patients who were still alive and active study participants at month 18. Student's t-test was used to compare systolic and diastolic BP, BW and their changes between baseline and month 18. Pearson's r was calculated to test for correlations between changes in BW and BP.

Results:

Data from 995 (577 females, mean age 36.7 ± 9.2 years) of the originally included 1436 PLHIV were analyzed. BW (p < 0.001) and systolic BP (p < 0.01) differed significantly between baseline and month 18. The change in systolic and diastolic BP correlated with the change in BW (r = 0.312 and r = 0.220, respectively; p < 0.01). There were significant differences (p < 0.001) in the mean change of systolic/diastolic BP between the lowest (-9.6 ± 18.8/-3.8 ± 12.9 mmHg) and highest (6.8 ± 19.2/4.3 ± 13.9 mmHg) quartile of the distribution of BW changes (decrease >1.39 kg vs. increase >6.09 kg). Also, the mean change in BW for normotensive patients at baseline who still had a BP < 140/90 at month 18 (n = 722, 89.6%) compared to those whose BP values had increased to 140/90 mmHg or higher (n = 84, 10.4%) was significantly lower (2.3 ± 6.2 kg vs. 5.6 ± 7.6 kg, p < 0.001).

Conclusions:

Increasing body weight due to the improved health status after ART initiation was associated with hypertensive BP values. Counselling of PLHIV regarding measures to control body weight should be embedded into patient education programs at HIV centers in countries like Malawi.
COST-EFFECTIVENESS OF CARDIOVASCULAR RISK CLASSIFICATION BASED ON ANKLE-BRACHIAL INDEX TEST IN ASSOCIATION TO FRAMINGHAM RISK SCORE
Authors: Maloberti Alessandro , Cortesi Paolo , Micale M. , Mazzaglia G. , Occhi Lucia , Palazzini Matteo , Peretti Alessio , Cavasin Davide , Pansera Francesco , Grasso Enzo , De Chiara Benedetta , Vallerio Paola , Mantovani Lg , Giannattasio Cristina
Published: April 2021

Objective:

An individual patient-data meta-analysis conducted on 24,955 men and 23,339 women showed that Ankle-Arm Index (ABI) in combination with FRS classifies female subjects with higher accuracy with no difference for male. The objective of this analysis is assessing the cost-effectiveness of ABI combine with FSR in primary prevention.

Design and method:

A decisional analytical model was developed to simulate CV risk of asymptomatic female subjects, stratified in 3 CV risk categories. The model compares the primary prevention intervention (treatment of subjects at intermediate and high risk) based on the classification with FRS alone or in association with ABI<0.9 (FRS-ABI). The cost-effectiveness model used 10 years time-horizon and the point of view of the Italian National Health System. Results were presented as incremental cost-effectiveness ratios (ICERs) per QALY gained. Cost and outcomes were discounted at 3%.

Results:

FRS-ABI determined a reclassification to higher risks in 7% of the female population, with an increase in costs per patient (€3,373 vs €3,198) but also greater efficacy (8,683 vs 8,689 QALYs) over a 10 years time horizon, with an ICER of €47.065 per QALY gained. While using an ABI<1.10 cut-off we obtained an ICER of €28.688 per QALY gained over 10 years simulation. In the probabilistic sensitivity analysis, the FRS-ABI reported a 50% probability to be cost-effective with ABI<0.9 cut-off and 80% probability with ABI<1.1 at a willingness to pay threshold of €50,000 per QALY.

Conclusions:

Our study showed that FRS and ABI combination is a potentially cost-effective CV risk classification approach in female population. Our results can help the healthcare decision makers in implementing better strategies for primary CV diseases prevention in Italy.
SODIUM AND POTASSIUM INTAKE, AND KNOWLEDGE ATTITUDES AND BEHAVIOUR TOWARDS SALT CONSUMPTION: A NATIONAL SURVEY OF ADULTS IN THE SULTANATE OF OMAN
Authors: Cappuccio Francesco , Al-Mawali Adhra , D’elia Lanfranco , Jayapal Sathish K. , Morsi Magdi , Al-Shekaili Waleed N. , Pinto Avinash D. , Al-Kharusi Hilal , Bulushi Zainab Al , Idikula John
Published: April 2021

Objective:

High sodium (Na) and inadequate potassium (K) intake are important determinants of high blood pressure (BP) and cardiovascular diseases (CVDs). In Oman, CVD represents a common cause of morbidity and mortality, accounting for 33.0% of all deaths. However, there is no reliable measure of Na and K intake in the Sultanate of Oman. The aim of the present survey was to establish current baseline average consumption of Na and K, and explore knowledge, attitudes and behaviour (KAB) towards the use of salt, in a nationally representative random sample of Omani adult men and women living in Oman.

Design and method:

The study was a national cross-sectional population-based survey of proportional random samples, representative of Omani adults (18 yrs and older), obtained from all Governorates of Oman (Figure). Of the 999 who agreed to participate, after robust quality control, 569 (193 men, 376 women; response rate 57%; mean age 39.4 yrs [SD 13.1]) were included in the final analysis. The characteristics of those excluded were comparable to those included. Participants attended a screening including demographic, anthropometric and physical measurements by standardized methods. Dietary Na (salt) and K intakes were assessed by 24 h urinary Na (UNa) and K (UK) excretions. Urinary creatinine was also measured. KAB were assessed by questionnaire.

Results:

Mean UNa was 144.3 (78.8) mmoL/day, equivalent to 9.0 g of salt/day and potassium excretion 52.6 (32.6) mmoL/day, equivalent to 2.36 g/day. Men ate more sodium and potassium than women. Only 22% of the sample had a salt intake below the World Health Organization (WHO) recommended target of 5 g/day and less than a quarter met WHO targets for potassium excretion (>90 mmoL/day). Whilst 89.1% of those interviewed knew that consuming too much salt could cause serious health problems and only 6.9% felt they were using too much added salt, 1 in 2 participants use always or often salt, salty seasonings or salty sauces in cooking or when preparing food at home.

Conclusions:

In Oman, salt consumption is higher, and potassium consumption lower, than recommended by the WHO, both in men and in women.
SUB-CLINICAL DAMAGE TO THE TARGET ORGANS (TOD) IN HYPERTENSIVE PATIENTS, ABOUT 300 PATIENTS
Authors: Ouail Djamel Eddine , Tebbani Meriem , Ahmed Djamila Si , Bouali Fayçal
Published: April 2021

Objective:

HTA is considered to be a silent killer. TOD is an indicator of cardiovascular risk in people with hypertension.

The main objective of our study is to describe the sub-clinical TOD in hypertensive patients.

Design and method:

This is a descriptive study, conducted between October 2016 and October 2019. It included all asymptomatic hypertensive patients over the age of 35 of both sexes.

Screening for infraclinical cardiac, vascular and renal damage is carried out with; the evaluation of the left ventricular hypertrophy (LVH) ultrasound and electric. Intima media thickness measurement by 2D carotid ultrasound and screening and evaluation of plaques. The measurement of pulsed pressure. Measuring the ABI for obliterating arterial disease. And finally, the estimate of urinary albumin excretion (UEA) and creatinine clearance according to MDRD.

Results:

300 patients included in our series, these are 120 men and 180 women. The average age is 59.75 years. The prevalence of TOD is estimated at 72.3%, the prevalence of electrical LVH is 17.3%, the ultrasound LVH is 29%.

Carotid hypertrophy is observed in 34.9% and the presence of stenotic plaques affect 9.1% of patients

AOMI is found in 9%. Pathological pulsed pressure is found in 34.3%.

UAE is pathological in 23.30% of our patients for A2 and 5.7% for A3. The creatinine clearance is less than 60 ml / min in 11%.

The main independent risk factors associated with TOD are the value of SBP and Age.

Pulse pressure> 60 mmHg is associated with all TOD and the IMT is correlated with all screening tests for TOD.

The SCORE score is predictive only for carotid lesions, it is not predictive for LVH or albuminuria. The SCORE score is not very predictive for AOMI and renal failure.

Conclusions:

Subclinical TOD is frequent in our series.

The major modifiable independent risk factor is the value of SBP. Special attention to pulse pressure as a cardiovascular risk factor and marker of arterial stiffness

A strategy for screening for target organ damage coupled with effective therapy targeting SBP is the only way to prevent cardiovascular, neurovascular and renal complications.
FRANCE'S PARTICIPATION IN MAY MEASUREMENT MONTH 2019: THE WHOLE STARTING POINT OF A COLLECTIVE WORK WITHIN THE FRENCH SOCIETY OF HYPERTENSION (SFHTA)
Authors: Lopez-Sublet Marilucy , Halimi Jean Michel , Bouhanick Beatrice , Boivin Jean Marc , Denolle Thierry , Mourad Jean Jacques , Vaisse Bernard , Fauvel Jean Pierre , Pathak Atul
Published: April 2021

Objective:

May Measurement Month (MMM) is a global awareness campaign against hypertension launched by the International Society of Hypertension and supported by the World Hypertension League. In France, nearly 1 out of 3 people have hypertension, of which a large proportion remains undiagnosed. The aim of this work is to make data collected during MMM 2019 in France available for the global cohort and raise awareness through this screening action.

Design and method:

Screening was coordinated by each manager of the 7 different participating sites, while following the standardised MMM protocol. SFHTA (in partnership with Omron France) sponsored centres requesting blood pressure monitors, by offering Omron HEM-FL31/M3 Comfort® devices.

Results:

Baseline data for 818 subjects (including 66 teenagers) are summarized in joint table. Most participants reported having measured their BP at least once in the past year. 22% measured their BP at least a year ago or never. The number of patient with known hypertension was 208 (25.4%), 176 (21.5%) were treated, out of them 101 (57,4%) were controlled (BP < 140/90 mmHg).

In our cohort, 76 healthy subjects (9.2%) had unknown high normal BP and 109 healthy subjects (13.3%) have been screened as new hypertensive patients.

Conclusions:

Up to day, more than 2.7 million people have taken part in the MMM program worldwide. This first survey in France highlights how a scientific society, such as SFHTA, could beyond education and science also promote a non expensive hypertension screening program to support global awareness and local actions. A wider participation with ancillary studies are planned for 2020 with the need to clarify ethical issues, in order to use national data according to French legislation.

Thanks to all patients and the teams at each centre who took part in this campaign.
ACCESS TO SINGLE PILL COMBINATIONS IN NATIONAL HYPERTENSIVE CONTROL PROGRAMS: IS PRICING A BARRIER?
Authors: Negi Sagri , Sahoo Swagata Kumar , Mahajan Tanushree , Swaroop Kishan , Neupane Dinesh , Moran Andrew , Sharma Bhawna , Pathni Anupam Khungar
Published: April 2021

Objective:

Most patients with hypertension require two or more medicines to control their blood pressure. Single pill combination (SPC) antihypertensive medicines facilitate simpler dosing schedules, decrease pill burden, increase patient medication adherence, simplify procurement and distribution. This study uses a private sector pharmaceuticals database to explore whether prices are a barrier to access SPCs in hypertension control programmes.

Design and method:

Trends in sales of anti-hypertensive medications in India were analysed in private sector pharmaceutical sales dataset from IQVIA Consulting. Price information was collated for medicines that attributed to 70% of sales in terms of number of tablets sold. Maximum Retail Prices of 11 SPCs and their associated Fixed Dose Equivalents (FDEs; same medications and doses as separate pills) were gathered through a publicly available website called “1mg” between November 2019-January 2020.

Results:

In India, the market share of 2-drug-SPCs and 3-or-more-drug SPCs increased from 2016–2018 at a compounded annual growth rate of 5.5% and 16.1% respectively. In 2018, 2-drug-SPCs (36.3%) had the highest market share in terms of quantity of medicines followed by FDE of SPC components, such as calcium channel blockers (18.3%), beta blockers (16.3%), angiotensin receptor blockers (14.6%), diuretics (5.3%), and ACE-Inhibitors (3.6%). Share of 3-or-more-drug SPCs (2.0%) was very small. While nine of 11 SPCs had an average price higher than sum of the average price of their component FDEs (Range 2.6% - 45.9% higher), a comparison of SPCs and FDEs by the same manufacturer showed that for eight 2-drug-SPCs there was at least one company for each molecule whose SPC was priced lower than the sum of the price of FDEs (Range -71.47% -124.73%).

Conclusions:

SPCs are increasingly preferred for hypertension treatment in the Indian private sector. The World Health Organization recently included four SPCs for hypertension management in its Essential Medicine List. India has a vibrant and competitive hypertensive medicines market. Examples discovered in this dataset of minimal-to-no price difference suggest that price need not be a barrier to accessing SPCs, and that market forces can further drive down prices with substantial advantages for patients and hypertension control programmes.
UNDERSTANDING THE COMPLEXITIES OF THE PREVALENCE AND CONTROL OF TRANS FAT IN THE FOOD SUPPLY IN PAKISTAN
Authors: Mukhtar Omer , Al-Jawaldeh Ayoub , Nishtar Noureen , Masuood Khawaja , Achakzai Baseer , Gulzar Yahya
Published: April 2021

Objective:

Pakistan is among the nations that have a high intake of trans fatty acids (TFAs). TFAs are considered one of the major dietary risk factors of noncommunicable diseases (NCDs). Efforts are underway in the country to eliminate industrially-produced TFAs from the food supply in keeping with the priority targets of the World Health Organization (WHO) for 2019–2023. We reviewed the TFA content reported in industrially produced foods and discuss the regulatory landscape for TFAs, to facilitate the required policy changes in Pakistan and ultimately eliminate the TFA burden from industrial food products.

Design and method:

The study components included review of published research and product labels as well as review of prevailing food regulations for TFA-related information. A set of recommendations was also prepared to eliminate TFAs from Pakistan after national consultation workshops conducted in 2019.

Results:

Vanaspati ghee (partially hydrogenated oil), bakery shortening, hard margarines, and fat spreads were identified as the major sources of TFAs. Food products with partially hydrogenated vegetable oils or bakery margarine in their ingredients also contained high level of TFAs. Repeated use of oil for deep frying of potato and cereal products also caused an increase in TFA content. Federal and provincial food authorities have recently established the limits for TFAs in a few products; however, regulations do not include mandatory food labeling.

Conclusions:

A comprehensive national strategy for TFA elimination, based on knowledge of TFA prevalence associated regulatory control is suggested in this study. We recommend to: (1) promote actions towards replacement of traditional vanaspati ghee/bakery fats with healthier alternatives; (2) review national and provincial food standards to support development and implementation of legislative actions and their compliance; (3) amend food labeling laws so that clear information will be provided to inform consumers’ healthy food choices.
CROSSTALK BETWEEN INTRINSIC HEART RATE AND PULSE WAVE ANALYSIS IN SMOKERS
Authors: Mozos Ioana , Jianu Daniela , Mozos Costin , Gug Cristina , Stoian Dana
Published: April 2021

Objective:

Heart rate and pulse wave analysis provide useful information for cardiovascular risk. It was the aim of the present study to assess the relationship between heart rate and pulse wave variables in healthy smokers.

Design and method:

A total of 68 middle-aged, healthy smokers, underwent pulse wave analysis using an Arteriograph. Blood pressure variables, pulse wave velocity (PWV), brachial and aortic augmentation indices (AixBrach, AixAo), vascular (arterial) age (AA) and coronary perfusion indices (diastolic reflection area DRA, diastolic area index DAI) were assessed. Resting heart rate (HR) and intrinsic heart rate (IHR) were assessed for each patient. Data about smoking history were collected and smoking pack years (SPY) were calculated.

Results:

HR, IHR, SPY, pulse wave velocity (PWV), systolic blood pressure (SBP), mean arterial pressure (MAP), systolic blood pressure in the aorta (SBPAo), AixBrach, AixAo, were, as follows: 73 ± 11 beats/minute, 101 ± 13 beats/minute, 7.56 ± 9.31 pack years, 8.73 ± 5.06 m/s, 126 ± 15 mmHg, 91 ± 12 mmHg, 116 ± 16 mmHg, -42.27 ± 28%, 16 ± 14%, respectively. Significant correlations were obtained between HR and PWV, AA, DAI, DRA and between IHR and number of cigarettes smoked/day, SPY, AixBrach, AA, DAI, DRA, SBPAo, PPAo, AixAo, PWV and pulse pressure. Linear regression analysis revealed significant associations between IHR and AixBrach, SBPAo, PPAo, AixAo and AA. Multiple regression analysis revealed significant associations between IHR and SBPAo and AA, respectively (multiple R = 0.539, R square = 0.291, p = 0.006 and 0.013).

Conclusions:

IHR is significantly associated with brachial and aortic augmentation indices, central blood pressure and vascular age. Systolic blood pressure in the aorta and vascular age are independent predictors of IHR in healthy smokers.
EVALUATION OF CARDIOVASCULAR FUNCTIONAL RESPONSE TO ORTHOSTATISM IN TREATED HYPERTENSIVE PATIENTS: RESULTS OF THE IMPEDDANS STUDY
Authors: Leão Rodrigo , Janeiro Claudia , Silva Pedro
Published: April 2021

Objective:

Arterial Hypertension (AHT) is one of the main causes of morbidity and mortality in the world. Generally defined as an increase in blood pressure (BP), it is characterized by hemodynamic changes that have implications for diagnosis, risk stratification and therapy. In this study we intend to characterize the hemodynamic response to orthostatism in a group of treated hypertensive patients using impedance cardiography (ICG).

Design and method:

Resistant hypertensive patients without heart failure, ischemic heart disease, valvular heart disease or dysrhythmia were prospectively selected. All patients underwent ICG in the supine position and in orthostatism. After ICG, they were classified into patterns: vasoconstrictor (systemic vascular resistance (SVR) > 2500 dyn.s.cm-5.m2), hyperdynamic (cardiac index (CI) > 4.2 l / min / m2 and / or heart rate HR > 80 cycles / min), hypervolemic (thoracic fluid (CFT) > 34 1 / kOhm) or balanced (hemodynamic parameters below the established limit values). All patients underwent transthoracic echocardiography to exclude major morphologic changes.

Results:

We included 178 patients, 56.1% males, age 63 ± 11 years, medicated with 4 ± 1 antihypertensives. In ICG, 56.5% were vasoconstrictors, 11.8% hyperdynamic, 33.4% hypervolemic and 22.9% had a balanced hemodynamic profile. In the supine position the patients had systolic blood pressure 134 ± 18, diastolic blood pressure 79 ± 11, HR 69 ± 10, indexed ejection volume 42 ± 9, pre-ejection period 95 ± 15 ms, ejection time 333 ± 17 ms, systolic time ratio 0.28 ± 0.06, RVSI 2687 ± 621, cardiac index 2.8 ± 0.4 and CFT 32 ± 5. In the orthostatic position some of these values were significantly higher: diastolic blood pressure 82 ± 12 (p < 0.001), HR 73 ± 12 (p < 0.001), pre-ejection period 119 ± 23 (p < 0.001), systolic time ratio 0.41 ± 0.11 (p < 0.001). The indexed ejection volume 39 ± 9 (p < 0.001), ejection time 301 ± 46 (p < 0.001) and CFT 28 ± 3 (p < 0.001) were significantly lower.

Conclusions:

Although polymedicated, most patients had an unbalanced hemodynamic profile. The analysis of the impedance waveform with postural modification can be used to clarify the response to orthostatism and to better characterise the hemodynamic phenotype.
COMBINATION OF NON-DIPPING PROFILE WITH HIGH NIGHTTIME SYSTOLIC BLOOD PRESSURE IN RHEUMATOID ARTHRITIS IS ASSOCIATED WITH HIGHER CARDIOVASCULAR RISK
Authors: Troitskaya Elena , Velmakin Sergei , Kobalava Zhanna
Published: April 2021

Objective:

Non-dipping profile is an important predictor of adverse cardiovascular (CV) outcomes. Its associations with subclinical vascular damage in rheumatoid arthritis (RA) are not known yet. We aimed to assess dipping patterns and nighttime systolic blood pressure (SBPn) and their associations with CV risk in patients with RA.

Design and method:

The study group included 85 patients with RA (females 77.6%, aged 59.7 ± 14.3 years, HTN 65%, mean DAS-28 3.7 ± 1.1) and control group (40 patients matched by gender, age and risk factors). Office BP was measured with a validated oscillometric device, 24-hour ABPM by BPLab Vasotens. CV risk was calculated as mSCORE. 3 groups were formed after adjustment of dipping state by SBPn: dippers (G1), non-dippers with SBPn < 120 mmHg (G2), non-dippers with SBPn > 120 (G3). p < 0.05 was considered significant.

Results:

Rate of BP control was 58% in RA and 67% in the controls (p = 0.48). Patients with RA vs controls were characterized by higher mean SBPn (123 ± 17 vs 112 ± 10 mmHg, p = 0.002), lower diurnal index (DI) (median 4 vs 7.5%, p = 0.006), higher rate of night hypertension (49.4 vs 12.5% (χ2 = 17, p < 0.001)). RA patients more often had non-dipping profile (DI < 10%): 83.5 vs 62.5%, (χ2 = 7.4, p = 0.02). In RA group patients with SBPn > 120mmHg had higher age (64.8 ± 12.6 vs 54.8 ± 14.3 years), office BP (142 ± 19/82 ± 11 vs 121 ± 14/76 ± 9mmHg), HTN duration (med 5.5 vs 0 years), mSCORE (med 6.1 vs 2.5%), p < 0.001 for trend. Patients with DI < 10% had higher age (60.8 ± 14.8 vs54.1 ± 10 years, p = 0.04). SBPn significantly correlated with age (r = 0.5), office SBP (r = 0.6) and DBP (r = 0.3), mSCORE (r = 0.5);non-dipping pattern–with age (r = 0.2). After adjustment by SBPn, no differences were observed between G1 and G2. Patients in G3 vs G1 had higher CRP (med 16.6 vs 6.7 mg/l, p = 0.03), mSCORE (med 7.1 vs2.3%, p < 0.001 for both); in G3 vs G2–higher mSCORE (med 7.1 vs 2.1%), p < 0.001 for trend and ESR (med 46 vs 23 mm/h, p = 0.03).

Conclusions:

Patients with RA were characterized by higher incidence of non-dipping pattern, SBPn elevation. Combination of high SBPn and non-dipping pattern was associated with higher CV risk. These associations may be mediated by inflammation.

The publication was prepared with the support of the RUDN University Program 5-100.
GAMMA-DELTA T CELLS MEDIATE ALPHA-BETA T CELL ACTIVATION IN ANGIOTENSIN II-INDUCED HYPERTENSION
Authors: Caillon Antoine , Paradis Pierre , Schiffrin Ernesto L.
Published: April 2021

Objective:

Both innate and adaptive immune cells have been shown to play a role in hypertension and vascular injury. Recently, we demonstrated that a small subset of “innate-like” T lymphocytes, expressing the γδ T cell receptor (TCR) rather than the αβ TCR, plays a key role in hypertension and vascular injury. We demonstrated an increased number and activation (CD69+) of αβ and γδ T cells during the development of hypertension caused by angiotensin (Ang) II infusion, and that deficiency in γδ T cells prevented Ang II-induced hypertension, resistance artery endothelial dysfunction and spleen T-cell activation in mice. We hypothesized that γδ T cells mediate activation of other T cells in hypertension.

Design and method:

Fourteen to 15-week-old aged C57BL/6J male mice were infused or not with Ang II (490 ng/kg/min, SC) for 7 and 14 days (n = 5–7). γδ and αβ T cells were isolated from peripheral lymph nodes and spleen and αβ T cells were cultured alone or with γδ T cells (5:1) in presence of anti-CD3 antibodies plus or minus Ang II. T cell phenotype was evaluated by flow cytometry.

Results:

Close correlations were demonstrated between the number (#) of activated CD69 + γδ T cells and CD4 + CD69 + T cells (r2 = 0.74, P < 0.01) and CD8 + CD69 + T cells (r2 = 0.64, P < 0.01) after 7-day Ang II infusion. In vitro, Ang II increased the fraction of CD69 + αβ T cells when αβ T cells were co-cultured with γδ T cells isolated from control mice (% of αβ T cells: 19.9 ± 2.9 vs. 16.4 ± 2.6, P < 0.001) but not when cultured alone. The fractions of CD69 + (% of CD69 + αβ T cells: 35.7 ± 2.7 vs. 18.9 ± 1.5, P < 0.001) and CCR6 + αβ T cells (% of CCR6 + αβ T cells: 27.6 ± 2.4 vs. 19.2 ± 3.5, P < 0.05) were increased when αβ T cells were co-cultured with γδ T cells isolated from Ang II-infused compared to control mice.

Conclusions:

These results suggest that γδ T cells mediate activation of αβ T cells in Ang II-induced hypertension. Targeting γδ T cells may contribute to reduce the low-grade inflammation found in hypertension.
THE 10-YEAR RELATIONSHIP BETWEEN SUPAR AND CENTRAL SYSTOLIC BLOOD PRESSURE IN AN HIV INFECTED POPULATION
Authors: Le Roux Shani , Kruger Ruan , Schutte Aletta , Brits Sanette , Fourie Carla
Published: April 2021

Objective:

Inflammation plays a role in vascular wall changes which may lead to aortic stiffening. Soluble urokinase plasminogen activator receptor (suPAR), a low-grade inflammatory marker, is predictive of cardiovascular disease and mortality in the general and HIV infected populations. We determined the 10-year relationship between suPAR and central SBP in the HIV infected.

Design and method:

HIV uninfected and infected participants from the PURE study, conducted in the North West province, South Africa, were matched by age and sex and followed for a median of 9.87 years (HIV uninfected: baseline = 211 and follow-up = 159; HIV infected: baseline = 92 and follow-up = 144 of which 69% initiated antiretroviral treatment (ART)). We obtained demographic and cardiometabolic data and measured EDTA plasma suPAR with suPARnostic® ELISA kits at baseline and follow-up and measured central SBP at follow-up.

Results:

Median suPAR was higher in HIV infected (ART-naive) compared to uninfected participants at baseline (3.61 vs 3.26 ng/ml; p = 0.038) but not at follow-up (p = 0.45). Cox-regression analyses (Figure 1) showed that, in the HIV infected group only and independent of ART, suPAR predicted a higher central SBP (> = 118 mmHg) after 10 years, but only when lipids, glomerular filtration rate or gamma-glutamyl transferase were added to the model.

Conclusions:

The initiation of ART may contribute to lower inflammation (as measured with suPAR) in HIV infected compared to uninfected individuals. SuPAR associated with central SBP over 10 years, but only when metabolic markers or renal function were taken into account. This may suggest a significant mediating effect between inflammation and cardiometabolic risk markers in increasing central aortic pressure and therefore future cardiovascular risk in the HIV infected.
FEATURES OF THE BLOOD PRESSURE DYNAMICS AND PRO-INFLAMMATORY CYTOKINES IN PATIENTS WITH RESISTANT HYPERTENSION AND CORONARY ATHEROSCLEROSIS AFTER RENAL DENERVATION
Authors: Zyubanova Irina , Mordovin Viktor , Pekarskiy Stanislav , Tatyana Ripp , Falkovskaya Alla , Lichikaki Valeriya , Sitkova Ekaterina , Baev Andrey , Gusakova Anna
Published: April 2021

Objective:

Inhibition of sympathetic activity via renal denervation (RDN) is associated with a reduction of blood pressure and variety of inflammatory markers in patients with resistant hypertension (RH).

The purpose of this study was to investigate the effects of RDN on BP, TNF-alpha and hs-CRP in patients with confirmed atherosclerosis, to compare the studied parameters in revascularized and conservatively treated patients groups.

Design and method:

In 35 patients with RH associated with CAD and confirmed by coronary angiography atherosclerosis, levels of 24-h BP, TNF-alpha and hs-CRP analyzed by ELISA were identified before and 12 months after RDN. Baseline 24-h systolic (SBP), diastolic (DBP) and pulse (PBP) BP were 154 ± 12 mmHg, 82 ± 13 mmHg and 73 ± 13 mmHg respectively. Then patients retrospectively where divided into two groups according to the severity of coronary artery disease (CAD): the first group underwent coronary stenting or coronary artery bypass grafting, the second had no need for revascularization and was treated conservatively.

Results:

12 month after RDN all the patients had significant (p < 0,05) 24-h SBP (144 ± 15 mmHg), DBP (77 ± 11 mmHg) and PBP (67 ± 14 mmHg) and TNF-alpha from 7,0 ± 3,4 ng/ml to 6,6 ± 3,0 ng/ml, p = 0,03 reduction and downward trend in hs-CRP from 4,0 ± 3,5 ng/ml to 2,8 ± 2,4 ng/ml, p = 0,07, that correlated with PBP reduction (r = 0,47, p < 0,05).

It was no difference between SBP and hs-CRP levels in the two groups.

In the first group baseline levels of PBP and TNF-alpha where higher than in the second: 78,9 ± 12,8 mmHg vs 69,0 ± 12,1 mmHg, p = 0,03; 9,0 ± 1,2 ng/ml vs 5,7 ± 3,7 ng/ml, p = 0,01.

Downward trend in TNF-alpha and hs-CRP persisted in both groups.

In conservatively treated group there was significant 24-h SBP/DBP reduction 12 months after RDN (p < 0,05) on 15 (3; 23) / 7 (4; 16) mmHg, whereas in the revascularized group SBP, DBP and PBP did not change (p > 0,05).

Conclusions:

Patients with RH associated with CAD have significant TNF-alpha reduction, downward trend in hs-CRP 12 months after RDN. Patients with severe coronary atherosclerosis have higher levels of TNF-alpha and are non-responders for RDN.
EFFECT OF RENAL DENERVATION ON OFFICE BLOOD PRESSURE IN PATIENTS WITH UNCONTROLLED HYPERTENSION: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED, SHAM-CONTROLLED TRIALS
Authors: Stavropoulos Konstantinos , Imprialos Konstantinos , Patoulias Dimitrios , Katsimardou Alexandra , Koutsampasopoulos Konstantinos , Alataki Sofia , Kerpiniotis Georgios , Dimitriadis Kyriakos , Papademetriou Vassilios , Tsioufis Konstantinos , Doumas Michael
Published: April 2021

Objective:

Untreated and uncontrolled hypertension remain a significant global health problem and a major cardiovascular risk factor. The role of renal denervation (RDN) in the treatment of hypertension has been studied extensively at basic and clinical research level during the last decade. We aimed to provide precise effects estimates about the effect of RDN on office blood pressure levels in patients with untreated or uncontrolled hypertension.

Design and method:

PubMed and CENTRAL, along with grey literature sources, were searched from their inception to May 2019 for randomized, sham-controlled trials evaluating the efficacy and safety of RDN on the management of hypertension, irrespective of study blinding, setting and sample size.

Results:

Six randomized, sham-controlled trials were identified and included in the meta-analysis. In total, 981 patients with hypertension were randomized in all 6 trials to undergo either RDN (n = 585) or sham-procedure (n = 396). Compared to sham, RDN resulted in a significant decrease in office systolic blood pressure levels by 5.47 mmHg (95% CI: -8.10 to -2.84; I^2 = 0%) and in office diastolic blood pressure levels by 4.25 mmHg (95% CI: -6.16 to -2.33; I^2 = 0%), compared to sham procedure. No major safety issues were detected.

Conclusions:

RDN is associated with a significant reduction in both systolic and diastolic office blood pressure levels, confirming its promising role in the field of hypertension treatment.
PATIENTS WITH RESISTANT HYPERTENSION AND ATRIAL FIBRILLATION ARE THE BEST RESPONDERS FOR RENAL DENERVATION
Authors: Plashchinskaya Larisa , Goncharik Dmitry , Barsukevich Veronika , Chasnoits Alexandr , Rebeko Ekaterina , Persidskikh Yuliya , Podpalova Olga , Mrochek Alexandr
Published: April 2021

Objective:

The search for the ideal candidate for renal denervation (RDN) is one of the priority treatments of patients with resistant hypertention (RH). Our objective was to identify the predictors of the efficiency of renal denervation.

Design and method:

The study included 112 patients with RH. The average age of patients was 53 [19; 69] years. Twenty-four (21.4%) patients had atrial fibrillation (AF). Four (16.7%) patients had chronic AF, 8 (33.3%) patients had persistent AF, and 12 (50%) – paroxysmal AF. All patients underwent RDN. Procedure was performed by an experienced electrophysiologist at the renal arteries using specialized electrode Symplicity Flex (Medtronic): ablation power = 8 - 10 W at 55°C, 4 – 10 points for each renal artery (including brunches), 2 minutes per point. Office BP and 24-hour ambulatory BP, 24-hour ECG monitoring, arrhythmia chronocard diaries were measured before, at 6 and 12 months of follow-up. A logistic regression analysis included the following parameters: gender, age, body mass index, office and 24-hour ambulatory systolic blood pressure (SBP), diabetes mellitus and the AF presence.

Results:

baseline office SBP and DBP in patients with RH were 185.4 ± 29.19 and 109.96 ± 17.95 respectively. Office BP decreased by 29.8 /14.1 mmHg at 12 month after RDN (p < 0.001). 24-hour ambulatory SBP decreased from 161.3 ± 25.9 mm Hg to 148.1 ± 21.3 mm Hg at 12 months after the intervention, DBP from 94.3 ± 16.4 mm Hg to 87.2 ± 15.9 mmHg (p < 0,001). It was found that all patients (100%) with RH and AF were responders to renal denervation. This response is defined as a reduction of office SBP of less than 10 mmHg following RDN. Whereas 17.2% of non-AF group patients were non-responders. The number of symptomatic AF paroxysms significantly decreased from 9 [2; 11] to 2 [1; 3] one year after RDN (p = 0.001).

Conclusions:

Patients with RH and AF are among the best candidates for RDN. It may help to improve the selection of patients with arterial hypertension for the RDN.
THREE-YEAR RESULTS OF RENAL DENERVATION: PRESERVATION OF POSITIVE TRENDS
Authors: Zyubanova Irina , Falkovskaja Alla , Mordovin Viktor , Manukyan Musheg , Pekarskiy Stanislav , Lichikaki Valeriya , Baev Andrey , Gusakova Anna , Ryabova Tamara
Published: April 2021

Objective:

To assess the persistence of the beneficial effects of renal denervation (RD) over a three-year follow-up

Design and method:

The study included 42 patients, 27 women and 15 men (mean age 57,2 ± 7,9 years) with resistant hypertension. 24-hour blood pressure (24-h BP) monitoring, echocardiography with left ventricular mass (LVM) determination, and blood sampling from a peripheral vein for pro-inflammatory cytokines by ELISA and creatinine level determination with a calculation of the glomerular filtration rate (GFR) were performed at baseline and 3 years after RD

Results:

The number of antihypertensive drugs did not change significantly from 4,0 ± 0,9 to 4,3 ± 0,9 (p > 0.05). The studied indicators dynamics after 3 years was as follows: 24-h BP decreased from 159,9 ± 16,5 / 88,0 ± 13,4 mmHg to 143,3 ± 17,2 / 79,0 ± 13,5 mmHg (p = 0,000); LVM - from 251,9 ± 64,1 g to 229,7 ± 61,9 g (p = 0,015).

Tumor necrosis factor alpha changed from 4,1 ± 3,6 ng/ml to 2,5 ± 2,2 ng/ml (p = 0,042); interleukin-1 (IL-1) from 5,6 ± 4,4 ng/ml to 3,2 ± 2,1 ng/ml (p = 0,010); IL-6 from 3,6 ± 3,0 ng/ml to 2,7 ± 1,5 ng/ml (p > 0,05); IL-10 from 5,6 ± 3,6 ng/ml to 2,8 ± 0,7 ng/ml (p = 0,000).

The creatinine level did not change significantly over 3 years from 82,1 ± 18,2 mmol/l to 85,6 ± 23,1 mmol/l (p > 0,05). GFR, determined by the CKD-EPI, decreased from 78,8 ± 16,1 to 74,5 ± 20,2 ml/min/1,73m2 for 3 years mainly by the first year due to BP decrease.

No adverse events were registered

Conclusions:

RD is an effective and safe method for the treatment of resistant hypertension. We indicate target organ damage regression, including an LVM decrease and a slowdown in chronic kidney disease progression. There is a decrease in proinflammatory cytokines levels as well as in IL-10, probably by a feedback mechanism, which may also indicate a persistent sympathetic tone decline.
BLOOD PRESSURE DURING HEMODIALYSIS AS PREDICTOR OF MORTALITY IN END-STAGE RENAL DISEASE PATIENTS
Authors: Zakauskiene Urte , Vickiene Alvita , Vicka Vaidas , Sukackiene Diana , Rimsevicius Laurynas , Miglinas Marius
Published: April 2021

Objective:

High blood pressure (BP) and consequential cardiovascular complications remain the leading cause of death in hemodialysis (HD) patients. Aim of this study is to link BP variations during HD with a 1 year mortality.

Design and method:

We conducted a cohort study in tertiary reference dialysis center. Patients undergoing HD were enrolled. Systolic, diastolic and mean arterial BP were measured before, every hour during and after HD procedure. These patients were observed for 12 months and mortality rate was evaluated. Mean values of measurements were compared across the groups. Furthermore, these measurements were included in univariate and multivariate regression analysis, determining their potency to predict 1 year mortality.

Results:

Study enrolled 99 patients. Mean age of patients was 58.7 ± 14.4 years, more than a half of them were men 51 (51.5%) with median time on HD for 4,5 [2,0–8,5] years. Mortality rate was 15.2 % (n = 15). All of the BP measurements were significantly lower in deceased group, except of BP before HD. (Table 1). Univariate regression analysis revealed that all of these pressures were linked to 1 year mortality, however, after application of stepwise forward selection model in multivariate analysis the most potent predictor was eluded to be MAP of the 1st HD hour (OR CI95% p), tripling the risk of mortality per every decrease of 10mmHg. However, the difference in precipitated risk of mortality for 2nd h, 3rd h and post HD MAP was minimal.

Conclusions:

One year mortality in HD patients is substantial. Blood pressure during and post HD is a more potent predictor of mortality than a blood pressure measured before the procedure. Further studies should investigate the application of intradialytic BP for the timely intervention.
BILATERAL RENAL ARTERY EMBOLIZATION IN END-STAGE RENAL DISEASE AND RESISTANT HYPERTENSION
Authors: Vaclavik Jan , Kvapil Tomas , Cerna Marie , Prasil Vojtech , Kocianova Eva , Jelinek Libor , Kamasova Monika
Published: April 2021

Objective:

Some patients with end-stage renal disease present with resistant or refractory arterial hypertension despite dialysis and use of multiple antihypertensive drugs. Renal artery embolization is a rarely used minimally invasive interventional procedure which may provide improved blood pressure (BP) control in chronic renal parenchymal disease by eliminating renal function while avoiding the morbidity and mortality of a nephrectomy.

Design and method:

A 44-year old white male with chronic glomerulonephritis and stage 5 chronic kidney disease undergoing regular dialysis treatment was referred for refractory arterial hypertension. Despite treatment by 7 antihypertensive drugs and good therapeutic adherence his office and ambulatory BP remained very high. Plasma renin was markedly elevated and CT angiography found diffuse atherosclerotic changes of renal arteries. Sequential catheter-based renal artery embolization with application of a tissue glue was indicated.

Results:

In September 2019, catheter based embolization of right renal artery was performed in analgosedation, followed by the embolization of the left renal artery two weeks later. Because of the rapid antihypertensive effect of the procedure, antihypertensive medications were reduced at the time of the left-sided procedure (from 9 to 6 defined daily doses). One month after the renal artery embolization, despite reduced medication, office BP decreased from baseline 170/106 mmHg by 57/22 mmHg. Mean 24-hour, day-time and night-time ambulatory BP was reduced by 15/11 mmHg, 14/11 and 34/15 mmHg, respectively. The patient reported prolonged flank pain lasting approximately one week after the embolization, which responded well to conventional analgesics.

Conclusions:

Renal artery embolization lead to a marked improvement of BP control in a patient with end-stage renal disease, refractory arterial hypertension and high plasma renin. Further studies are warranted to assess the efficacy and safety of renal artery embolization in such patients.
HYPERTENSIVE PATIENTS WITH TYPE 2 DIABETES MELLITUS AND PROTEINURIC PHENOTYPE OF CHRONIC KIDNEY DISEASE ARE CHARACTERIZED BY WORSE PARAMETERS OF 24-H CENTRAL AORTIC BLOOD PRESSURE
Authors: Chernomorets V. , Troitskaya E. , Kobalava Z.
Published: April 2021

Objective:

The aim of the study was to evaluate the 24-h profile of peripheral and central blood pressure (BP) in hypertensive patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) according to the presence of proteinuria.

Design and method:

The study included 90 patients with HTN, T2DM and CKD with eGFR 30-<60 ml/min/1.73 m2 and urine albumin–creatinine ratio (UACR) <300 mg/g (66% females, median age 60 years, median duration of DM–7.5 years, median duration of HTN 18 years). All received antihypertensive therapy and antidiabetic drugs (insulin in 58%). The analysis was performed according to CKD phenotype: proteinuric (UACR 30-<300 mg/g) and non-proteinuric (UACR < 30 mg/g). Office BP was measured with a validated oscillometric device. Clinical central BP and 24-hour ABPM of brachial and central aortic BP were performed with BPLab Vasotens. All results are presented as median values. p < 0.05 was considered significant.

Results:

Office brachial BP was 156/83 mmHg, aortic – 139/90 mmHg, median UACR was 26.5 mg/g. Proteinuric phenotype was found in 78% and compared to non-proteinuric phenotype was characterized by higher rate of dyslipidemia (85% vs 45%, p = 0.0004), more frequent history of coronary artery disease (53% vs 10%, p = 0.001), longer duration of HTN and DM (19.5 vs 7.5 years and 8 vs 3 years respectively, p < 0.01), lower HDL-C (1.2 vs 1.9, p = 0.02) and higher office brachial DBP (83 vs 80 mmHg, p = 0.04) and central SBP (147 vs 137 mmHg, p = 0.007). Proteinuric phenotype compared to non-proteinuric was associated with worse 24-h profile of central SBP (daytime 147 vs 138 mmHg, p = 0.008; night-time 143 vs 130 mmHg, p = 0.04). HTN phenotypes according to diurnal index for proteinuric and non-proteinuric CKD were as follows: dippers 0 vs 10%, non-dippers 6 vs 5%, night-peakers 82 vs 70% over-dippers 12 vs 15% (all differences were non-significant). Presence of proteinuric phenotype positively correlated with daytime and night-time aortic SBP (r = 0.28 and 0.21 respectively, p < 0.05).

Conclusions:

Proteinuric phenotype of CKD in patients with HTN and T2DM is associated with worse 24-h profile of central BP.

The publication was prepared with the of the RUDN University Program 5-100