bluuebunny/crossref_metadata_2025 huggingface dataset:
METABOLIC PROFILE OF SUBJECTS WITH NAIVE ISOLATED SYSTOLIC HYPERTENSION
Authors: Papadakis Ioannis , Theodorakopoulou Vasiliki , Vougiouklakis George , Petrakis Emmanouel , Spentzouri Despoina , Mathioudaki Anna
Published: June 2023

Objective:

Even though hypertension is an important contributor to cardiovascular disease (CVD), and its treatment has established mortality benefits, uncertainty lies in the management of isolated systolic hypertension (ISH). Although the association of ISH with CVD and mortality has been established, the metabolic characteristics of this population have not been adequately described. The aim of this study was to describe the metabolic profiles of patients with isolated systolic hypertension.

Design and method:

An observational study of patients attending the Hypertension Unit of the University Hospital of Heraklion, Heraklion, Greece, was performed.

Results:

In total, 809 hypertensive patients not on any anti-hypertensive treatment were identified. Among them, 44.7% were men; age was 55.6±12.5years, while 29.7% were smokers. Systolic blood pressure was 161.3±15.8mmHg and diastolic blood pressure was 96.1±11.3mmHg. Body mass index (BMI) was 31±5.3kg/m2, while 9.6% had type 2 diabetes mellitus (DM).

A comparison of subjects with ISH with the rest hypertensives, revealed that persons with ISH were older, had lower SBP and higher pulse pressure, while they also had lower total cholesterol and LDL, and were more likely to have DM even though they had a slightly lower BMI. On the other hand, they did not have any difference in terms of gender, smoking status, HDL, triglycerides, liver biochemistry, uric acid or prevalence of impaired fasting glucose.

Conclusions:

Subjects with ISH were older, with lower SBP, total cholesterol and LDL and higher pulse pressure and higher prevalence of DM.
ASSESSMENT OF MACROPHAGE INFLAMMATORY ACTIVITY ON VISCERAL ADIPOSE TISSUE IN HIGH-FAT DIET-INDUCED OBESE MICE BY 18F- FDG PET/CT
Authors: Pahk Kisoo , Kwon Hyun Woo , Yeo Jeong Seok , Kim Sungeun
Published: June 2023

Objective:

Obesity induced inflamed visceral adipose tissue (VAT) secretes pro-inflammatory cytokines thereby promoting systemic inflammation and insulin resistance which further exacerbate obesity-related cardiovascular disease (CVD). Macrophages are the key players in the development of obesity-associated VAT inflammation. Extensive clinical studies have reported that 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) can be used to evaluate the macrophage inflammatory activity on VAT in human beings. However, due to difficulty in human VAT biopsy, pathologic correlations were lacking and there was a few study on preclinical animal models. Here, we investigated whether 18F-FDG PET/CT could reflect the macrophage inflammatory activity on VAT in high-fat diet-induced obese mice.

Design and method:

Obese animal models were induced by a high-fat diet (60% fat) for 20 weeks using the male C57BL/6 mice. Insulin tolerance test was performed to evaluate the status of insulin resistance and C-reactive protein (CRP) was measured to assess the status of systemic inflammation. All animals underwent 18F-FDG PET/CT before sacrifice. Macrophage inflammatory activity was evaluated using the maximum standardized uptake value (SUVmax). Flow cytometry-, histological-, and molecular analyses were performed on harvested VAT.

Results:

All obese animals showed insulin resistance which resembled the human metabolic syndrome, a key pathophysiological process that contributes to increase CVD risk. VAT SUVmax was increased in obese mice and significantly correlated with the levels of CRP. Furthermore, VAT from obese mice showed increased macrophage infiltration, compared to normal mice.

Conclusions:

18F-FDG PET/CT could visualize and evaluate the macrophage inflammatory activity on obesity-driven inflamed VAT in obese mice model. Our preclinical study strongly supports the clinical application of 18F-FDG PET/CT in the assessment of VAT inflammation to patients who are vulnerable to CVD.
PRE-DIABETES AND ASYMPTOMATIC HYPERTENSION-MEDIATED ORGAN DAMAGE IN PATIENTS WITH ARTERIAL HYPERTENSION AND OBESITY
Authors: Koval Sergiy , Mysnychenko Olga , Penkova Marina , Lytvynov Vadim , Lytvynova Olga
Published: June 2023

Objective:

Patients with arterial hypertension (AH) and abdominal obesity (AO) are characterized by a high risk of developing type 2 diabetes mellitus, the addition of which significantly worsens the prognosis. One of the early disorders of carbohydrate metabolism, which has been subclinical for a long time and remains undiagnosed, is pre-diabetes. The aim of our study was to evaluate the frequency of pre-diabetes in patients with AH and AO and its relationship with asymptomatic hypertension-mediated organ damage (HMOD).

Design and method:

The survey included 87 patients (50 men) with essential AH of 2-3 degrees with AO of I-II degrees, aged 40 to 59 years. Patients were examined using standard clinical, laboratory and instrumental methods. Pre-diabetes was diagnosed in accordance with the recommendations of the European Society of Cardiology and the European Association for the Study of Diabetes (2019). Diagnosis of HMOD was also carried out in accordance with the recommendations of the European Society of Cardiology and the European Society of Hypertension (2018). Insulin resistance (IR) was determined by HOMA-IR.

Results:

The frequency of pre-diabetes among AH patients with AO in the whole group was 40.3%. A significant increase in the subgroup of patients with pre-diabetes compared with the subgroup of patients without pre-diabetes was found in the frequency of more severe AH of the 3rd degree (71.4% and 50.0%, P<0.05), more pronounced obesity-AO of the 2nd degree (68.6% and 32.7%, P<0.05), IR (88.6% and 40.4%, P<0.05) and dyslipidemia (94.3% and 76.9%, P<0.05). The subgroup of patients with pre-diabetes differed from the subgroup of patients without pre-diabetes by a significantly higher incidence of such HMOD as: left ventricular hypertrophy (97.1% and 75.0%, P<0.05), increased pulse pressure (48.6% and 25.0%, P<0.05) and microalbuminuria (42.9% and 23.1%, P<0.05).

Conclusions:

Pre-diabetes in AH patients with AO is associated not only with a significantly more severe course of hypertension and obesity, more pronounced metabolic disorders, but also with a higher incidence of asymptomatic HMOD such as heart, vascular, and kidney damage.
STUDY OF C-786T POLYMORPHISM IN THE NOS3 GENE IN THE DEVELOPMENT OF PREECLAMPSIA
Authors: Kurbanov Bakhodir
Published: June 2023

Objective:

Given the importance of endogenous NO in maintaining normal endothelial function, it is possible that polymorphisms in the gene encoding the enzyme that synthesizes NO may contribute to the development of preeclampsia. The purpose of the work was to determine the role of the C-786T polymorphism in the NOS3 gene in the development of preeclampsia.

Design and method:

We conducted a study of 90 pregnant women in the II-III trimester, which were divided into two groups: The main group of 53 pregnant women with severe preeclampsia. Control group - 47 pregnant women with a physiological course of the gestational period. The age of the examined women ranged from 19 to 41 years. Samples of pregnant women served as the material for the study. We have identified gene polymorphism - C-786T in the NOS3 gene. Isolation of DNA from blood and PCR analysis were carried out using kits of reagents and test systems from Ampli Prime Ribo-prep. Statistical processing of the results was carried out using statistical programs EpiCalc 2000.

Results:

There was a trend towards the prevalence of the heterozygous C/T genotype in the group of patients with severe preeclampsia, where it was detected with a frequency of 39.5% (x2-2.23; p-0.15; RR-1.46; 95% CI: 0.54-3.91; OR -1.76.; 95% CI: 0.84-3.69), relative to 27.1% in the control group.

The T/T genotype was slightly more common – in 11.6% of cases it was detected among patients with severe preeclampsia (x2-1.08; p-0.30; RR-1.78; 95%CI:0.43-7.32; OR-1.88; 95%CI:0.57- 6.19), while in the control group - with a frequency of 6.5%.

The C/C genotype was found in 59.8% of patients with severe preeclampsia (x2-1.04; p-0.31; RR-0.81; 95% CI: 0.37-1.74; OR-0.62)

The T allele among patients with severe preeclampsia was detected in 31.4% of cases, which was statistically significantly higher (x2-4.38; p-0.04; RR-1.17; 95%CI:0.79-1.73; OR-1.82; 95%CI:1.04- 3.19) than in the control group.

Conclusions:

Thus, the results of our study allow us to conclude that the adverse genotypic variants of the C-786T polymorphism of the NOS3 gene (associated with vascular endothelial dysfunction) contribute significantly to the mechanism of preeclampsia.
DISTURBED ASSOCIATION BETWEEN PLACENTAL SODIUM CONTENT AND GLYCOSAMINOGLYCANS IN GESTATIONAL HYPERTENSION BUT NOT IN PRE-ECLAMPSIA
Authors: Oppelaar Marjet , Vriend Esther , Lens Laura , Wijland Martine , Salik Priyaashri , Berg Romy Van Den , Vaz Frédéric , Dijk Marie Van , Bugiani Marianna , Boer Marjon De , Pampus Mariëlle Van , Ganzevoort Wessel , Engberink Rik Olde , Born Bert -Jan Van Den , Vogt Liffert
Published: June 2023

Objective:

Glycosaminoglycans (GAGs) facilitate tissue sodium accumulation which plays an important role in regulation of sodium homeostasis, water balance and blood pressure. During pregnancy, GAGs are also highly expressed in placental tissue. We studied placental sodium concentration and GAG content from normotensive and hypertensive pregnancies to explore a link between placental sodium and blood pressure during pregnancy.

Design and method:

We performed a prospective case-control study in singleton pregnancies with normal blood pressure (nBP, n = 22), gestational hypertension (GH, n = 12) and pre-eclampsia (PE, n = 10). Two full thickness placental biopsies (central [near umbilical cord insertion] and peripheral) were collected after delivery for analysis of placental electrolyte concentration (ICP-OES) and GAG content (UPLC-MS/MS). Linear associations were explored with a linear regression analysis with correction for gestational age, mode of delivery and treatment with antihypertensive drugs.

Results:

Placental sodium concentration in GH was 10.1% (p = 0.01) lower in central and 9.4% (p = 0.04) lower in peripheral biopsies compared to nBP. Total peripheral heparan sulfate (HS) expression was 32.3% lower in GH compared to nBP (p = 0.04). Also, di-sulfated HS as percentage of total HS was lower in peripheral biopsies of GH compared to nBP (11.0% [IQR 10.0-11.4] vs 12.3% [IQR 11.3-14.5], p = 0.02). In PE, placental GAG and sodium content were not significantly different from nBP. Placental sodium concentration was linearly associated with percentage of di-sulfated HS (Fig A), while in central biopsies it was negatively associated with systolic BP (Fig B).

Conclusions:

We show that GH is accompanied by lower placental sodium content when compared to pregnancies with normal blood pressure. Also, lower placental sodium content during pregnancy is associated with lower placental GAG content and higher BP. This indicates that placental sodium homeostasis might be involved in chronic maternal blood pressure regulation.
BLOOD GLUCOSE CONTROL DURING PREGNANCY IN GESTATIONAL DIABETES MELLITUS RESULTS IN A LOWER RISK OF PREGNANCY INDUCED HYPERTENSION (PIH) & BETTER MATERNAL-FETAL OUTCOMES
Authors: Jain Rajesh , Shoghli Mohammadreza , Seshiah Veeraswamy , Agarwal Shally , Tiwari Sadhna , Bhavatharini Natarajan , Saxena Pikee , Yadav Akshama , Kirubanidhi Vidyaa , Singh Mamta , Jain Rachna
Published: June 2023

Objective:

In Gestational Diabetes Mellitus GDM, pregnancy-induced hypertension PIH and low birth weight of newborns <2.5 kg are major and significant causes of maternal and fetal morbidity & mortality in developing worlds with low resource settings. Can we reduce these risks by Controlling Blood sugar and resulting in better maternal-fetal outcomes?

Design and method:

A prospective cohort study was done for one year from October 1, 2013, to September

31, 2014, at 198 diabetic screening units as a part of the Project

approved by the Indian Government in Kanpur, state of Uttar Pradesh district. 57,108 pregnant

women were screened during their 24–28th weeks of pregnancy by impaired oral glucose test OGTT Single Test Procedure with 2 Hour Post Blood glucose 140 mg/dl after 75 gm of Glucose load irrespective of non-fasting approved by, Govt of India.

Maternal and perinatal outcomes were followed up in GDM who have controlled Blood glucose value postprandial 2 hours of <140 mg/dl and those with uncontrolled GDM Group with >140 mg/dl between 2013 and 2014 in public health facilities with low resource settings.

Results:

Out of the Total number of Gestational Diabetes Mellitus cases followed up in this study, 5043; out of them, 4589 GDM women's blood Glucose was mild to moderately controlled < 140 mg/dl throughout pregnancy by Medical Nutrition therapy MNT & Insulin use and 454 GDM blood Glucose were not the well-controlled groups for not following MNT strictly and low insulin use 1.1%

Pregnancy-induced hypertension PIH and low birth weight of newborns <2.5 kg are major significant causes of maternal and fetal morbidity & mortality in developing worlds with scarce resource settings. We found that Pregnancy Induced Hypertension in GDM cases with <140 mg/dl Control was 2.98% compared to 9.3% in Blood glucose >140 mg/dl GDM women; low birth weight was 15.6% in an uncontrolled group compared to 8.9% in the control group.

Conclusions:

Blood Glucose control, in public health facilities, may result in better outcomes, specially pregnancy-induced hypertension, and low birth weight risk, which contribute significantly to morbidity and mortality of mothers and infants with GDM
INHIBITION OF AT1 RECEPTOR PARTIALLY PREVENTS ENDOVASCULAR ETHANOL INJECTION INDUCED ACUTE PULMONARY HYPERTENSION AND SECONDARY PULMONARY ARTERY REMODELING
Authors: Shen Yuchen , Su Lixin , Fan Xindong , Wang Deming
Published: June 2023

Objective:

Ethanol can induce acute pulmonary hypertension (APH) during endovascular sclerotherapy and embolization. We aimed to examine whether the inhibition of the AT1 receptor can prevent this pathological phenomenon and assess its related mechanisms.

Design and method:

A total of 40 male swine (age, approximately six months) were selected and performed with absolute ethanol endovascular injection (jugular vein). Saline was used as the negative control. Preventive administration of losartan was conducted orally for 3 consecutive days before operations. Pulmonary arterial pressure (PAP), femoral arterial pressure (FAP), and heart rate (HR) were monitored during procedures. Venous plasma and fresh pulmonary artery (PA) tissue of 32 swine were harvested immediately after the operation. The remaining eight swine were kept and sacrificed one-month after the operations, and PA tissues were harvested for paraffin embedding procedures. Protein level was detected by Western blotting and ELISA, whereas qRT-PCR was used in mRNA detection. H & E staining and immunohistochemistry (IHC) were conducted to evaluate histopathology.

Results:

Ethanol injection elevated PAP in all swine. The concentration of renin-angiotensin system (RAS) ligands was elevated in plasma (all P < 0.0001) but not in PA. The level of oxidative stress increased in both plasma and PA. MRNA level of AT1R (P < 0.01, 95% CI: 0.251 to 1.006), not AT2R increased in PA. Losartan failed to inhibit APH after all sessions of ethanol injection, and partially reversed the ethanol-induced PA remodeling (1. H & E staining presented abnormal morphology of PA; 2. CD31 IHC staining indicated the intimal hyperplasia; 3. a-SMA IHC staining suggested the pathomorphology of smooth muscle cells; 4. TNF-a IHC staining showed the infiltration of immune cells). The P38 MAPK was activated after ethanol injection and could be inhibited by losartan (P < 0.01, 95% CI: -0.391 to -0.164). Ethanol also promoted the translocation of the P40-PHOX/P47-PHOX/P67-PHOX complex and the activation of NOX, which was independent from RAS.

Conclusions:

Endovascular ethanol injection can induce AEPAP mainly by activating RAS and P38 MAPK signaling. Losartan can partially prevent AEPAP and vascular remodeling owing to the promotion of NOX activity by ethanol.
ANGIOTENSIN-(1-7) FORMATION UPON FLUID FLOW SHEAR STRESS IN HUMAN PODOCYTES
Authors: Kaiser-Graf Debora , Domenig Oliver , Poglitsch Marko , Kreutz Reinhold , Bolbrinker Juliane
Published: June 2023

Objective:

Glomerular hyperfiltration associates with increased fluid flow shear stress (FFSS) on podocytes. This can lead to irreversible podocyte damage, which in turn negatively affects the permeability and integrity of the glomerular filtration barrier. AngiotensinII (AngII) is an important mediator in chronic kidney disease. The negative effects of AngII are at least partially opposed by the alternative signaling pathways within the renin-angiotensin system (RAS) consisting of angiotensin-converting enzyme 2 (ACE2), angiotensin-(1-7) (Ang-[1-7]) and the MAS1 receptor. This counteracting pathway may exert renoprotective effects and support anti-inflammatory processes. As the pathomechanisms and signaling pathways underlying podocyte damage induced by FFSS are not fully understood, our aim is to elucidate the potential renoprotective impact of the alternative RAS axis in human podocytes in the context of glomerular hyperfiltration.

Design and method:

Conditionally immortalized human podocytes (hPCs) were used for mechanistic studies. Cells seeded on collagen IV coated Culture Slips® were inserted in a Streamer® Shear Stress Device and exposed to FFSS of 1dyne/cm2 for 2h. Control cells were not exposed to FFSS. Afterwards, the formation rate of AngII to Ang-[1-7] was measured in whole cell lysates (1 experiment, n = 6 samples per condition) using spiked AngII as a substrate with and without addition of Z-Pro-Prolinal and MLN-4760. Additionally, gene expression analyses of the enzymes involved in Ang-[1-7] formation were performed.

Results:

Preliminary data show an increased AngII to Ang-[1-7] formation rate in hPCs following FFSS exposure compared to control. Ang-[1-7] formation under both conditions is reduced by addition of Z-Pro-Prolinal, whereas MLN-4760 has no effect. RNA-expression levels of prolylcarboxypeptidase and prolylendopeptidase are not significantly affected upon FFSS compared to control. In contrast, ACE2 is significantly upregulated by FFSS although expression levels are substantially lower under both conditions compared to prolylcarboxypeptidase and prolylendopeptidase.

Conclusions:

Our results suggest an elevated AngII to Ang-[1-7] formation rate upon FFSS in hPCs compared to no-flow control. Under both settings, Ang-[1-7] formation in hPCs seems to be mediated by prolylcarboxypeptidase and/or prolylendopeptidase but not ACE2. These results support further studies to confirm the potential role and mechanisms of Ang-[1-7] upregulation in response to glomerular hyperfiltration.
THE RENIN ANGIOTENSIN SYSTEM BLOCKADE DOES NOT SIGNIFICANTLY REDUCE THE RISK OF CARDIOVASCULAR EVENTS IN DIALYSIS PATIENTS: A META-ANALYSIS OF 5 RCTS
Authors: Georgianos Panagiotis , Tziatzios Georgios , Roumeliotis Stefanos , Georgianou Eleni , Vaios Vasilios , Liakopoulos Vassilios , Agarwal Rajiv
Published: June 2023

Objective:

Angiotensin-converting-enzyme-inhibitors (ACEIs) and/or angiotensin-receptor-blockers (ARBs) are recommended by guidelines as first-line therapies for the management of hypertension in the general population. However, the cardioprotective benefit of these agents among patients on chronic dialysis remains uncertain. This meta-analysis aimed to explore the effect of ACEIs/ARBs on cardiovascular events in this high-risk patient population.

Design and method:

We searched Medline/PubMed and Cochrane database of clinical trials from inception through February 2022 to identify randomized controlled trials (RCTs) comparing the effect of ACEIs/ARBs relative to placebo or no add-on treatment in patients receiving dialysis. RCTs were eligible in quantitative data synthesis, if they were assessing fatal or non-fatal cardiovascular events as a primary efficacy endpoint.

Results:

We identified 5 RCTs including a total of 1,582 dialysis patients. As compared with placebo or no add-on treatment, the use of ACEIs/ARBs was not associated with a significantly lower risk of cardiovascular events [risk ratio (RR): 0.79; 95% confidence interval (CI): 0.57-1.11; I2 = 73%, P = 0.005]. Furthermore, there was no benefit of ACEIs/ARBs on cardiovascular mortality (RR: 0.82; 95% CI: 0.59-1.14; I2 = 6%, P = 0.37) and all-cause mortality (RR: 0.86; 95% CI: 0.64-1.15; I2 = 44%, P = 0.13). These results were consistent, when the included RCTs were stratified into subgroups according to the hypertension status and ethnicity of patients, sample size, duration of follow-up and method quality.

Conclusions:

The present meta-analysis showed that among patients on dialysis, the use of ACEIs/ARBs is not associated with a significantly lower risk of cardiovascular events and all-cause mortality as compared with placebo or no add-on treatment.
ALDOSTERONE IN POLYCYSTIC OVARY SYNDROME
Authors: Chaabouni Khansa , Issaoui Nader , Khanfir Fatma , Frikha Moez , Boudaouara Imene , Bouzid Imene , Eloud Zoubeir , Aloulou Dorra , Elleuch Aida , Ayadi Fatma
Published: June 2023

Objective:

Aldosterone was involved in several metabolic disorders. Elevated levels were also reported in polycystic ovary syndrome (PCOS).

Objective:

to investigate aldosterone and metabolic abnormalities in PCOS at first discovery

Design and method:

we conducted a case-control study. First diagnosed PCOS patients were included with age and body mass index matched controls. Fasting blood samples were taken at the 3rd day of mezes. Aldosterone was assayed by ELISA DRG kit. The other parameters were dertemined by cobas 6000-Roche.

Results:

A total of 77 participants were enrolled: 41 PCOS and 35 controls. Aldosterone levels were significantly higher in PCOS. Median value in controls was 160ng/mL. We observed that 70% of aldosterone levels in PCOS were above this median value. Increased aldosterone levels were associated with elevated fasting glucose. Although, There was no significant difference in the prevalence of insulin-resistance, dyslipidemia, obesity, and metabolic syndrome between patients with different aldosterone levels distribution.

Conclusions:

Elevated aldosterone levels could be the primum movens activating carbohydrate metabolic alterations. Once elevated, aldosterone levels could give evidence of preclinic alterations at an early stage of PCOS.
MAGNESIUM: A BLOOD PRESSURE MODULATOR
Authors: Vernaglione Luigi , Balestra Cosima , Renzo Brigida Di , Flores Antonio , Schiavone Palmira , Capaccio Flavia , Covella Patrizia , Spinelli Alessandra , Mangiulli Marco , Leonardi Giuseppe , Recupero Michi , Giorgi Annarita De , Mariotti Amalia
Published: June 2023

Objective:

Magnesium plays an important role at cardiac level as it affects myocardial metabolism, calcium homeostasis, tone and vascular peripherals resistances. Low serum magnesium levels are associated with an increased risk of coronary artery disease and arteriosclerosis.

Design and method:

We propose a case of a 57 y.o. male, non smoker hypertensive patient treated with sartans and potassium kanreonate. In the past medical history: biopsy-proven chronic gastropathy and revascularized ischemic heart disease. He arrived in ER for dizziness, nausea and severe hypertension. The patient presented psychomotor agitation, muscle pain and paraesthesia. Blood tests revealed hypocalcaemia, hypokalaemia, hypomagnesaemia. Electrolyte supplementation was performed with a significant improvement of clinical picture. Two months later, the patient is back to the ER for hypertensive crisis. So he is hospitalized in the Nephrology Unit to be studied.

Results:

Blood tests revealed: haemoglobin: 12.2 g/dl, serum creatinine: 0.6 mg/dL, serum potassium levels: 4 mEq/L, serum calcium levels: 9.1 mg/dL, and serum magnesium levels: 1.2 mg/dL. Abdominal echo resulted negative for acute lesions and the renal artery Doppler did not show stenosis. Plasma and urinary catecholamines were normal. During the hospitalization, due to severe symptoms, iv supplementation with Magnesium sulphate (1 fl IV/week) was performed with an increased of serum magnesium levels and progressive hemodynamic compensation. On the contrary, serum sodium and potassium levels and magnesuria were normal, rather than increased. The patient was discharged after performing genetic investigations for possible tubulopathy (in progress) and with a programmed outpatient follow-up in which we observed the normalization of blood pressure values with the same antihypertensive therapy, but with magnesium values rather normal.

Conclusions:

Blood pressure control is affected by serum magnesium levels .
HIGH SALT INTAKE DID NOT DIMINISH BENEFICIAL EFFECT OF RENAL DENERVATION ON BLOOD PRESSURE, KIDNEY FUNCTION AND METABOLIC PROFILE - CROATIAN REAL-LIFE STUDY
Authors: Begic Zvonimir , Jelakovic Ana , Basic Matija , Perkov Drazen , Lovric Mila , Prkacin Ingrid , Fodor Ljiljana , Kolaric Melanija , Sarac Antonela , Vrkic Tajana Zeljkovic , Dika Zivka , Stambuk Sandra Karanovic , Zivko Marijana , Josipovic Josipa , Kacinari Patricija , Abramovic Ivana , Jelakovic Bojan
Published: June 2023

Objective:

Last trials clearly documented and confirmed the efficacy of renal denervation (RDN) on decrease of blood pressure (BP). Our aim was to analyze the effects of RDN beyond BP lowering in truly resistant hypertensive patients in real-life conditions.

Design and method:

Out of 31 truly resistant patients whose secondary forms of hypertension were ruled out and were enrolled into the Croatian Spyral RDN registry, 18(10 m, 8 w, average age 49.3) were eligible for analysis. Office BP, ABPM, central BP and PWV were measured with Omron M6, Mobilograph and Sphygmocor devices, respectively. Albuminuria and salt intake were determined from 24-h urine samples, eGFR using the CKD Epi equation. Sympathetic/parasympathetic activity was measured with an ANX-3.0 ANSAR device. All RDN procedures(Spyral Medtronic) were done by one physician (average number of ablation spots was 41/procedure). Patients were examined day before and that day, 1,3,6, and 12 months after the RDN. Reponse was drop of office systolic BP by 10 mmHg or more 6 months after RDN. There were no differences in the RDN procedure between responders and non-responders.

Results:

Office and ABPM values dropped the day after RDN and remained significantly lower at the end of the follow-up (6.5/-5.5 and -16.2/9 mmHg, respectively). The effect of RDN on BP was not abolished with high salt intake(15.5 g/day at the end of follow up). eGFR remained stable, and even slight improvement was observed at the end of follow-up(+8.4 ml/min/1.72m2); albuminuria significantly decreased (-115 mg/day). All metabolic parameters (lipids, uric acid) improved at the end of follow-up. LFa/RFa decreased the day after RDN and remained lower during the follow-up period. After RND central systolic BP and Aix decreased more in responders than in non-responders (-12.8 vs. -7.3; -7 vs. -2.6) while PP amplification was improved in responders (1.22 to 1.33) but decreased in non-responders (1.33 to 1.25).

Conclusions:

In real-life circumstances, BP significantly decreased after RDN despite large salt ingestion. eGFR and albuminuria improved as well as metabolic parameters at the end of follow-up and all of the beneficial changes run in parallel with observed decrease in sympathetic activity.
EVALUATION ON CLINICAL APPLICATION OF LOW-DOSE TRADITIONAL QUADRUPLE ANTIHYPERTENSIVE COMPOUND PREPARATION IN CHINA
Authors: Sun/Ningling Ningling Sun , Chen/Yuanyuan Yuanyuan Chen , Wang/Hongyi Hongyi Wang , Xi/Yang Yang Xi
Published: June 2023

Objective:

To evaluate whether a relatively old multi-drug SPC prescription can be adapted to current treatments of hypertension.

Design and method:

1. In a retrospective, real-world study, 22148 patients with hypertension who visited 4 hospitals in China from 2011 to May 2016 were selected as the subjects. A comparison was conducted between treatment with compound reserpine and triamterene tablets (Reserpine/Triamterene CAS) and with four other single-pill combinations (SPCs) (losartan/hydrochlorothiazide, valsartan/hydrochlorothiazide, irbesartan/hydrochlorothiazide, and amlodipine/valsartan) for 20 days. The compliance rate was analyzed after patients’ propensity score matching analysis. 2. A meta-analysis of 7 randomized controlled trials on the safety and efficacy of compound reserpine and triamterene tablets published from 2000 to 2020 was conducted.

Results:

1. Treatment with 1 compound reserpine and triamterene tablet daily (R/L) resulted in a blood pressure compliance rate (BP < 140/90 mmHg) of 63 to 68%. Compared with valsartan/amlodipine, R/L achieved a compliance rate of 63% vs 50%; with valsartan/hydrochlorothiazide, of 64% vs 59%; with losartan/hydrochlorothiazide, of 67% vs 57%, and with irbesartan/hydrochlorothiazide, of 68% vs 59%. All P values were < 0.05 (Figure 1).

2. Seven studies were included in the meta-analysis. In five studies, the overall response rate of hypotensive treatment with compound reserpine and triamterene tablets was higher in efficacy study compared with other hypotensive drugs (OR = 2.23, 95% CI: 1.32 ∼ 3.75) (Figure 2), and there was no significant difference in the incidence of adverse reaction with compound reserpine and triamterene tablets in the 6 trials included in the safety study (OR = 0.91, 95% CI: 0.68 ∼ 1.22) (Figure 3).

Conclusions:

China is faced with high prevalence of hypertension, low control rate, and scarce medical resources and economic resources in primary medical care, but ultra-low-dose SPC (R/L) can improve the antihypertensive effect and reduce the incidence of adverse reactions (Figure 4) through the synergistic effect among different components of the drug and has good patients’ compliance and low price. We confirmed that through systematic review and meta-analysis, ultra-low-dose SPC (R/L) is suitable for the treatment of hypertension, especially those with refractory hypertension.
YOGIC EXERCISE- ITS EFFECT ON BLOOD PRESSURE AND DEPRESSION SCORE IN MYOCARDIAL INFARCTION
Authors: Prasad Avneesh
Published: June 2023

Objective:

To study the effect of yoga on blood pressure and Beck's depression inventory score in myocardial infarction cases

Design and method:

Our study was conducted on 200 patients randomized into test group (n = 100) who were subjected to conventional treatment and yoga and control group (n = 100) who were subjected to conventional treatment.

The study was conducted on patients diagnosed as myocardial infarction having age >18 years and patient's consent. Patients with hemodynamic instability, heart failure, past yoga, arrhythmia, pacemaker, autonomic neuropathy and musculoskeletal disease were excluded.

Initially, assessment of clinical & biochemical parameters were performed. Blood pressure was noted and Beck's depression score was calculated by filling a questionnaire. Yoga was taught to the test group on 4th day after MI and were encouraged to perform 10 minutes of pranayam, shavasan and transcendental meditation each . Follow up after 18 weeks for assessment of blood pressure & depression score was done. The study was conducted for 2 years.

Results:

After 18 weeks of intervention, among the yoga group a significant improvement (p = 0.001)was seen for systolic BP(2.09%) & diastolic BP (2.09%) . A significant improvement was seen among the control (p = 0.001) for systolic (2.06%) and diastolic BP (1.48%). A significant improvement was noted for Beck's depression inventory score (p = 0.001) among the yoga(19.76%) as well as control group (11.52%).

A statistically significant decrease in control group was seen for systolic blood pressure when compared to the yoga group (p = 0.01) after 18 weeks. A decrease was seen for diastolic blood pressure (p = 0.44) and Beck's depression inventory score (p = 0.304) among yoga group in comparison to control group that was statistically insignificant.

Conclusions:

It was concluded from study that a significant decrease in systolic & diastolic BP and Beck's depression score was found when intragroup comparison was done. A significant decrease was seen among controls for systolic BP and statistically insignificant decrease was seen for diastolic BP and Beck's Depression score among yoga group after 6 weeks.

Therefore, large multicenter trials with more sample size is needed to ascertain the effect of yoga on blood pressure and depression score.
QUANTITATIVE ANALYSES OF THE ESC GUIDELINES ON SPORTS CARDIOLOGY AND EXERCISE
Authors: Koller Akos , Takacs Johanna
Published: June 2023

Objective:

Exercise and sports are important components of preventing/delaying the development of cardiovascular disease (CVD) as evidenced by reduced all-cause morbidity and mortality. Because of that, the European Society of Cardiology (ESC) published “2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease” (GL-SCE) summarizing recommendations and supporting evidence to ‘prescribe’ various types of exercise and sports regimens that can be used to prevent, delay, or alleviate CVD. Thus we aimed to assess quantitatively the efficacy of the GL-SCE providing help in the sport- /exercise-related treatment decision-making in specific cardiovascular condition

Design and method:

An analytic study was conducted on the GL-SCE regarding the Classes of Recommendations (CLASS) and the Levels of Evidence (LEVEL) (n = 159). Then LEVEL areas under CLASS were calculated to form a Certainty Index (CI: -1 to +1).

Results:

The frequency of CLASS I and CLASS III was relatively high in GL-SCE (52.2%) and GL-CS) (in Clinical Settings: 50.7%). Yet, the most frequent LEVEL was C (41.2%–83.8%), indicating only a relatively low quality of scientific evidence in GL-SCE. The GL-SCE showed a relatively high CI (+0.57), 78.4% Certainty, and 21.6% Uncertainty.

Conclusions:

The GL-SCE provides substantial help in decision-making through the recommendations

(CLASS), but the supporting evidence (LEVEL) in most cases is only lower quality, which is well reflected in the newly developed Certainty Index identifying issues that should be clarified and investigated in future studies.
ASSESSMENT OF THE PHYSICAL CAPABILITIES OF HEART FAILURES AFTER CARDIOVASCULAR REHABILITATION: ABOUT 125 CASES FROM FEBRUARY 2021 TO DECEMBER 2022
Authors: Alassane Ngaide Aliou , Gaye Ngone Diaba , Mingou Joseph Salvador , Diouf Marguerite , Houenassi M L Colomb , Diop Khadim Rasso , Diouf Youssou , Kane Abdoul
Published: June 2023

Objective:

The objective of this work was to evaluate the effects of cardiac rehabilitation on the physical abilities of patients with heart failure, to compare the parameters of the stress test, the 6-min walk test and cardiac ultrasound before and after cardiac rehabilitation.

Design and method:

This is a descriptive and analytical cross-sectional study with retrospective and prospective data collection which took place from February 1, 2021 to December 31, 2022. Patients with heart failure of all etiologies combined who received an outpatient cardiovascular rehabilitation program. Data were collected on a pre-established survey form and included anamnestic, clinical, paraclinical and 6-min walk test data. Informed consent was obtained. Data analysis was performed with SPSS version 18 software. Any difference less than 0.05 was considered statistically significant.

Results:

During this study, the frequency of rehabilitated heart failure patients out of the total number of rehabilitated patients for all etiologies was 45.59%. The average age was 57.97 with extremes at 41 and 74 years. The most represented age group was that of 61 to 70 years (35.5%). The predominance was male with a sex ratio of 2.1. The cardiovascular risk factors found were dominated by dyslipidemia (80.6%), physical inactivity (71%), high blood pressure (41.90%) and diabetes (38.70%). The level of cardiovascular risk was high in 48.39% and very high in 35.48% of cases. Coronary disease was the main etiology of heart failure with 80.65% of cases. Systolic blood pressure increased from 126.87 to 126.42 mmhg (p = 0.91), diastolic blood pressure from 78.74 to 74.48 mmhg (p = 0.090) and resting heart rate from 79.23 bpm to 67.06 bpm (p = 0.000). The average LVEF increased from 38.75 to 45.26% (p = 0.001), the number of METS from 4.42 to 7.48 (p = 0.000), as well as the 06-minute walk test from 328 m to 470 m (p = 0.000). No deaths or rehospitalizations were observed during the study.

Conclusions:

The study shows that cardiovascular rehabilitation is beneficial in heart failure patients with a marked improvement in symptoms, physical capacity and quality of life.
NET CLINICAL BENEFIT OF A REDUCED DOSE OF DIRECT ORAL ANTICOAGULANTS IN NON-VALVULAR ATRIAL FIBRILLATION: A META-ANALYSIS OF RANDOMIZED TRIALS
Authors: Drogkaris Sotirios , Konstantinidis Dimitrios , Thomopoulos Costas , Ntalakouras John , Siafi Eirini , Tatakis Fotis , Kolokathis Konstantinos , Mantzouranis Emmanouil , Chalmoukou Konstantina , Kariori Maria , Kouremeti Maria , Paliodimou L. , Tsivgoulis Georgios , Dimitriadis K. , Tsioufis Konstantinos
Published: June 2023

Objective:

To evaluate the net clinical benefit of a reduced dose of direct oral anticoagulants (DOACs) compared to warfarin in nonvalvular atrial fibrillation.

Design and method:

We searched three electronic databases covering the period until end-February 2021. All-cause death, non-fatal stroke/systemic embolism, and major bleeding events, with or without the inclusion of myocardial infarction, were used to define two different net clinical benefit outcomes. In addition, we evaluated different component outcomes of net clinical benefit as secondary outcomes. Finally, each outcome's risk ratios and 95% Confidence Intervals (CI) were calculated (random-effects model).

Results:

In the four randomized trials included (n = 29,779 patients), the net clinical benefit - with or without the inclusion of myocardial infarction - of low-dose DOACs, compared to warfarin, was a 12% (95% CI, 7%-16%) or a 10% (95% CI, 5%-13%) reduction of events, respectively. Compared to warfarin, the reduced dose of DOACs decreased death outcomes, major bleeding events, and hemorrhagic stroke, whereas all thrombotic outcomes were not different among the groups.

Conclusions:

DOACs at low doses present a more favorable net clinical benefit profile than warfarin.
SIESTA DIPPING AND CIRCADIAN BLOOD PRESSURE PATTERNS IN ACUTE ISCHEMIC STROKE
Authors: Kakaletsis Nikolaos , Ntaios George , Milionis Haralampos , Karagiannaki Anastasia , Chouvarda Ioanna , Dourliou Vasiliki , Ladakis Ioannis , Kaiafa Georgia , Vemmos Konstantinos , Savopoulos Christos
Published: June 2023

Objective:

The purpose of this study was to investigate the alterations of blood pressure (BP) during the midday (siesta time) and the changes of circadian BP patterns in acute phase of ischemic stroke (AIS) with the severity of stroke and their predictive role for the 3 months outcome.

Design and method:

A total of 228 AIS patients (prospective multicenter follow-up study, NCT01915862) underwent 24-hour ambulatory blood pressure monitoring (ABPM) every 20 minutes within 48 hours from stroke onset using an automated oscillometric device. Clinical and laboratory findings were recorded. Mean BP parameters during day (7:00-22:59), midday (13:00-16:59) and night (23:00-6:59) and siesta and nocturnal dipping were calculated. Endpoints were death and disability/death at 3 months.

Results:

Siesta SBP dippers had less severe stroke, lower incidence of hypertension and SBP/DBP on admission, lower levels of serum glucose and WBC and delayed initiation of ABPM compared to risers. There was a reverse relation of siesta SBP dipping with both nocturnal dipping (r = -0.27, p<0.001) and the severity of stroke (r = -0.13, p = 0.049). The “double dippers” (siesta and nocturnal dipping) had the least severe stroke, the lowest SBP/DBP on admission and heart rate from ABPM and lower risk of an unfavorable outcome, while the “double risers” had the opposite results, by an approximately 5-fold risk of death/disability at 3 months.

Conclusions:

These findings indicate different circadian BP patterns according to stroke severity during the acute phase of AIS, potentially driven by patient's physical stress and maybe alterations of the sympathetic nervous system activity, which should be considered as markers of patient's state and prognosis.
ISCHEMIC STROKE THE CAUSE OF MORTALITY IN LOW INCOME COUNTRIES EXPERIENCE OF MAKWALLA HEALTH CARE SERVICES
Authors: Dennis Anthony
Published: June 2023

Objective:

Ischemic stroke is the third leading cause of mortality in low income countries. The main aim of this study was to determine the rate and predictors of in-hospital mortality due to ischemic stroke in the Makwalla health care center and the University of Abuja Nigeria.

Design and method:

The study was Conducted from April 2019-May 2021 at the Makwalla health care center and the University of Abuja Teaching hospital. A census using restrospective cohort study design was conducted on medical records of adult patients with the diagnosis of ischemic attending the medical inpatient ward of the health facilities between November 2017 and September 2020.

Cox hazard regression was used to determine the predictors of hospital Mortality. A two sided statistical test at 5% level of significance was used.

Results:

The main (+SD) duration of hospital stay was 11.5(10.04) days of total 208 patients 26(12.5%) Patients died in the hospital. Cox regression revealed that only a decrease in renal function particularly elevated serum creatinine (AHR = 8.848,95% CI:1:616-67.437) was associated with a statistically significant increase of in-hospital mortality. The symptom onset to admission time varied greatly among patients and ranged from 1 hour to 168 hours.

Conclusions:

The in hospital Mortality associated Ischemic stroke found to be high . Mainly elevation serum creatinine was highly associated with poorer out come in terms of in-hospital morality. Much work should be done on improving the knowledge and awareness of the community regarding ischemic stroke and stroke in general to encourage early medical seeking behavior and reduce mortality and long term disability.
THE EFFECT OF ALLOPURINOL AND FEBUXOSTAT ON BLOOD PRESSURE IN ADULTS WITH CHRONIC HYPERURICEMIA
Authors: Pigazzani Filippo , Jennings Claudine , Rogers Amy , Mackenzie Isla , MacDonald Thomas
Published: June 2023

Objective:

To observe the effect of the xanthine oxidase inhibitors Allopurinol and Febuxostat on blood pressure in adults with chronic hyperuricemia.

Design and method:

This was a sub-study of the Febuxostat versus Allopurinol Streamlined Trial (FAST). FAST was a randomised controlled trial comparing the cardiovascular safety of febuxostat and allopurinol in individuals with symptomatic hyperuricemia previously receiving allopurinol. At the screening visit, patients were invited to participate in the Blood Pressure (BP) sub-study. A validated BP monitor and an instruction booklet were provided. Each set of home BP measurements was taken over four consecutive days, three times each in the morning and evening. BP was recorded at baseline (on allopurinol therapy), after 7-days allopurinol washout, and 8 weeks after randomisation to febuxostat or allopurinol. Differences in BP in the allopurinol and febuxostat group were evaluated. The relationship between serum uric acid level reductions and BP changes was also assessed.

Results:

Between December 2012 and January 2014, 298 FAST participants consented to the BP sub-study. 223 participants who submitted a complete set of BP data were included in the analysis; 104 were randomised to Allopurinol and 119 to Febuxostat. Baseline characteristics were balanced between groups. Overall mean change in BP from washout to 8 weeks of randomised treatment was not significant in either group [Mean BP change in Allopurinol arm: SBP -0.10 mmHg (95% CI -1.76,1.56), p = 0.9; DBP 0.50 mmHg (95% CI -1.82,2.81), p = 0.6. Mean BP change in Febuxostat arm: SBP -0.77 mmHg (95% CI -4.20,2.67), p = 0.7; DBP -0.41 mmHg (95% CI -2.56,1.73), p = 0.7]. No significant BP differences were observed between groups at each time point. Reduction in serum uric acid by > 60 μmol/L at 8 weeks on either therapy was not associated with statistically significant changes in BP.

Conclusions:

There was no significant difference in the effect of allopurinol or febuxostat on blood pressure after 8 weeks of randomised therapy in the FAST study. Larger reductions in serum uric acid at 8 weeks had no effect on BP change.
EFFECTS OF PCSK-9 INHBITORS ON ARTERIAL STRUCTURE AND FUNCTION: PRELIMINARY RESULTS
Authors: Maloberti Alessandro , Vatta Alessandro , Grasso Alice , Garofani Ilaria , Morelli Martina , Giani Valentina , Fortuna Matteo , Gualini Elena , Giannattasio Cristina
Published: June 2023

Objective:

One of the latest chapters in the research for new and stronger lipid lowering therapies has led to the development of PCSK9 inhibitors. In addition to the benefit on lipid profile, a limited number of studies have been published showing a possible improvement in vascular function and structure following their administration. To evaluate the effects of PCSK9 inhibitors on structural (via carotid Intima Media Thickness – IMT) and functional (carotid-femoral Pulse Wave Velocity – cf-PWV - and brachial artery Flow Mediated Dilatation - FMD) arterial properties.

Design and method:

Twenty-two dyslipidemic patients with a clinical indication to PSCK9 inhibitors were prospectively recruited at the Cardiology Rehabilitation of ASST Grande Ospedale Metropolitano Niguarda Hospital (Milan, Italy). Anthropometric, clinical and therapeutic data were recorded. Each patient underwent instrumental examinations to assess cf-PWV, IMT and FMD at T0 (before the start of therapy), T1 (after 6 months) and T2 (after 12 months).

Results:

In the 22 patients who reached 6 months of follow up there was a significant reduction in LDL cholesterol (from 127.8±31.7 to 47.4±29.1 mg/dl, p<0. 0001) while there was no significant difference in arterial parameters (cf-PWV: from 10.5±3.5 to 9.4±2.3 m/s, p = 0.092; FMD: from 11.4±8.1 to 9.8±8.3%, p = 0.407; IMT: from 775.6±192.8 to 768.7±144.7, microm, p = 0.854). Similar results were also obtained in the 12 patients who reached one year of follow-up: LDL from 129.4±29.1 to 48.8±21.9 mg/dl, p<0.0001; cf-PWV from 10.4±3.3 to 10.5±2.9, p = 0.874; FMD from 12.0±9.1 to 11.0±5.6%, p = 0.930; IMT from 745.1±203.9 to 770.0±127.3 microm, p = 0.710.

Conclusions:

Our study confirm the strong LDL reduction with PCSK9 inhibitors that are needed in order to reach the targets set by the ESC 2019 guidelines. In contrast, they do not show a significant effect on arterial function and structure in terms of cf-PWV, FMD and carotid IMT.