bluuebunny/crossref_metadata_2025 huggingface dataset:
RECOVERY OF PHYSICAL ABILITY OF PATIENTS AFTER ACUTE Q-MYOCARDIAL INFARCTION WITH ARTERIAL HYPERTENSION
Authors: Tereshchenko Nataliia , Malynovska Irina , Shumakov Valentin , Tereshkevych Lesya , Voloshyna Oxana
Published: April 2021

Objective:

To establish the physical recovery of patients who have suffered Q-MI with AH during 1 year follow-up.

Design and method:

91 patients (pts) were divided into 2 groups: 1 group (63 pts) in which Q-MI was preceded by AH and 2 group (28 pts) with Q-MI without AH. Physical exercise test (PET) on a bicycle ergometer before inclusion in the study and was performed in the dynamics while 1 year after MI.

Results:

Diabetes mellitus (DM) was diagnosed in 13 (20.6%) and in 2 (7.1%) pts respectively. On the results of the 1st PET on the BE in the1st group, the PET level was (75,0; 75–100) W, and the cost of work was (2.13; 1.68 - 2.53) units. In the 2nd group, these variables were (75.0; 75.0 - 100.0) W and (1.85; 1.47 - 2.03) units. One year after MI in the 1st group the PET level increased to (125.0; 100.0 – 125.0) W (p = 0,01) and the cost of work remained at the previous level (1.43; 1.39 – 1.52) units (p = 0.09), in the 2nd group the PET level remained at the previous survey (125.0; 125.0 - 140.0) W (p = 0.12) and the cost of the work became more economical (1.12; 0.89 - 1.36) (p = 0.04). It is advisable to emphasize that in the 1st group the level of blood pressure (BP) raised up to153 mm Hg at the top of the1st PET, to 161 mm Hg at the 2nd and to 176 mm Hg at the 3rd test; in the 2nd group these variables were respectively 146, 161 and 164 mm Hg. The target BP levels were reached at all stages of follow-up.

Conclusions:

Pts with Q-MI and AH are (a) older; b) have more frequent development of DM; c) less economical execution PET; d) have higher levels of BP at the top of the PET at all stages of follow-up and e) regular outpatient monitoring of BP made it possible to individualize the therapy and reach the target of levels in all pts.
ASSOCIATION BETWEEN THE PRESENCE OF CORONARY ARTERY DISEASE AND INTENSIVE LOWERING BLOOD PRESSURE AT THE TIME OF CORONARY COMPUTED TOMOGRAPHY ANGIOGRAPHY
Authors: Suematsu Yasunori , Tsukihashi Yohei , Shiga Yuhei , Miura Shin-Ichiro
Published: April 2021

Objective:

Blood pressure (BP) lowering treatment should be an intensive BP control according to JSH2019 guideline. Coronary computed tomography angiography (CCTA) has become more widely available in many general hospitals and enables the accurate non-invasive assessment of coronary artery stenosis for screening. The presence or severity of coronary artery disease (CAD) in patients with intensive BP control at the time of CCTA were compared with those in patients without hypertension (HTN).

Design and method:

One thousand one hundred consecutive subjects (65 yrs., males 53%) who were clinically suspected of having CAD or who had at least one cardiac risk factor underwent CCTA. The patients were divided into 4 groups: the patients without HTN (non-HTN group), hypertensive patients with intensive BP lowering (Intensive group, < 130/80 mmHg), standard BP lowering (Standard group, 130–139/80–89 mmHg) and uncontrolled BP (Uncontrolled group, 140/90 mmHg<) groups.

Results:

% CAD in patients with HTN was significantly higher than that in patients without HTN. Interestingly, % CAD in the intensive group was also significantly higher than that in patients without HTN. The intensive group showed older, higher body mass index and the number of significantly stenosed coronary vessels, lower levels of high-density lipoprotein cholesterol in blood, higher rates of dyslipidemia, diabetes, anti-dyslipidemia and anti-diabetic medications.

Conclusions:

The hypertensive patients with intensive BP lowering showed older, higher rate of CAD and more severe coronary stenosis. Thus, it was suggested that the patients also need more rigorous management of other coronary risk factors, as well as intensive BP lowering, and the patients need to perform CCTA much earlier than we think.
CLINICAL EFFECTS OF BETA-BLOCKERS IN HYPERTENSIVE PATIENTS WITH ACUTE MYOCARDIAL INFARCTION AFTER ONE YEAR
Authors: Joo Seungjae , Beom Jong -Wook , Lee Jae -Geun , Choi Joon -Hyouk , Kim Song -Yi , Kim Ki -Seok , Jeong Myung -Ho
Published: April 2021

Objective:

Although the oral beta-blocker therapy is recommended at least 3 years after acute myocardial infarction (AMI), especially in hypertensive patients to control blood pressure, the evidence to support its clinical benefit is very poor. This study aimed to investigate the long-term clinical effects of beta-blockers in hypertensive patients with AMI who had no major adverse cardiac events (MACE) until 1 year after the initial attack.

Design and method:

Among 13,624 patients who were enrolled in nationwide AMI database of South Korea, the KAMIR-NIH Registry, 4,610 hypertensive patients, who underwent echocardiographic study and had no MACE (a composite of cardiac death, MI, revascularization or readmission due to heart failure) until 1 year, were selected in this study.

Results:

Beta-blockers were prescribed in 4,237 hypertensive patients (92%) at 1 year after AMI. On multivariable Cox-proportional hazard analysis, beta-blockers further reduced 1-year cardiac death (1.4 vs. 7.5/100 person-year; HR 0.23; 95% CI 0.14–0.38; p < 0.001), MI (1.1 vs. 3.1/100 person-year; HR 0.33; 95% CI 0.16–0.68; p = 0.002), and MACE (5.8 vs. 11.1/100 person-year; HR 0.54; 95% CI 0.37–0.79; p = 0.001). However, clinical outcomes showed a significant interaction with left ventricular ejection fraction (LVEF). Beta-blockers decreased 1-year MACE of patients with LVEF =<40% (11.3 vs. 24.5/100 person-year; HR 0.40; 95% CI 0.19–0.84; p = 0.015) and 40% <LVEF <50% (6.3 vs. 18.9/100 person-year; HR 0.43; 95% CI 0.22–0.85; p = 0.015, but not those with LVEF >=50% (4.7 vs. 5.8/100 person-year; HR 0.77; 95% CI 0.42–1.43; p = 0.411). ∗HR; hazard ratio, CI; confidence interval.

Conclusions:

Beta-blockers improved the clinical outcomes in hypertensive patients with mid-range as well as reduced LVEF until 2 years after AMI. However, its benefit in hypertensive patients with preserved LVEF was questionable.
LEFT VENTRICULAR GLOBAL LONGITUDINAL STRAIN ACROSS THE SPECTRUM OF COMPLEXITY OF STABLE CORONARY ARTERY DISEASE
Authors: Caunite Laima , Kamzola Ginta , Knoka Evija , Mazule Mairita , Pelcberga Renate , Trusinskis Karlis
Published: April 2021

Objective:

In patients with stable coronary artery disease left ventricular ejection fraction may remain within normal range. Myocardial strain is a precise tool for evaluation of early subclinical systolic function changes in a number of cardiac pathologies. Our aim was to determine if there is correlation between left ventricular global longitudinal strain (GLS) and complexity of coronary artery disease.

Design and method:

Study included stable coronary artery disease (SCAD) patients undergoing elective percutaneous coronary intervention (PCI). Patients with PCI in previous 3 months or target vessel, history of previous MI or atrial fibrillation at the time of study were excluded. No patients with medium or pronounced left ventricular hypertrophy, significant valvular pathology, hypo- or akinetic segments visually, or decreased ejection fraction were included. Complexity of coronary artery disease was calculated by SYNTAX score. Transthoracic echocardiography was performed on Philips iE33 the day before revascularization. Myocardial strain was determined by 2D speckle tracking on TOMTEC ARENA using 16-segment model and results were analysed by SPSS 22.

Results:

Study included 90 patients, mean age 64,6 years. Mean SYNTAX score was 12.63 (± 5.88). 76 patients had low SYNTAX score (< 18 points), 10 had medium SYNTAX score (18–27 points), 4 had high SYNTAX score. GLS was decreased in 75 (83.33 %) patients (mean GLS was -15.84 ± 5.19). Overall correlation between the SYNTAX score and GLS was weak: Spearman's rank correlation r = 0.30 (p = 0.002). In patients with decreased GLS correlation r was 0.41; p < 0.001. In patients with preserved GLS correlation was r = 0.336, p = 0.11. There was no significant difference between mean SYNTAX score when comparing groups with normal/decreased GLS.

Conclusions:

In this study left ventricular systolic function assessed by global longitudinal strain had a statistically significant weak correlation with complexity of coronary artery disease.
EFFECTIVENESS OF THE COMBINATION OF TRIMETAZIDINE AND BISOPROLOL IN PATIENTS WITH ANGINA PECTORIS: A POST-HOC ANALYSIS OF CHOICE-2 STUDY
Authors: Glezer Maria , Logunova Natalya
Published: April 2021

Objective:

Objectives. To evaluate the effectiveness of the combination of trimetazidine (TMZ) and bisoprolol in angina patients in real-world clinical practice.

Design and method:

Methods. This is a post-hoc analysis of CHOICE II, a Russian, multicenter, 6-month, open-label, prospective observational study that assessed the effect of adding TMZ modified release 35 mg bid to antianginal treatment. 896 patients with persistent symptomatic stable angina were included in CHOICE-II, of whom 221 receiving TMZ -bisoprolol were included in the post-hoc analysis. Patients took TMZ 35 mg bid for the entire study duration. There was no optimization of other antianginal drugs.

Results:

Results. The mean age of patients was 64.8 ± 8.9 years. 52.0% were female. 91.9% had hypertension. Mean heart rate was 71.9 ± 9.6 beats per minute. At baseline patients had stable angina, mostly with CCS Class II (65.6%) or Class III (30.8%). Both angina frequency and short-acting nitrate (SAN) use decreased significantly on TMZ-bisoprolol from baseline to month 6 from 6.2 ± 5.3 to 1.5 ± 1.9 attacks/week and from 5.5 ± 4.4 to 1.0 ± 1.4 SAN/week, respectively (P < 0.001 for both). Exercise capacity also improved: angina-free walking distance significantly increased (from 308 ± 207 to 497 ± 253 meters, P < 0.001), as well as the number of flight of stairs until angina (from 2.9 ± 2.0 to 4.5 ± 2.3, P < 0.001). At 6 months, the number of patients presenting dyspnea decreased from 169 (76.5%) to 87 (39.4%). % of patients with CCS Class I angina increased more than 10-fold during the treatment period (from 2.3% to 27.6%) while % of patients with CCS Class III angina decreased 3-fold (from 30.8% to 10.0%). After 6 months of treatment, mean systolic and diastolic blood pressure decreased by 13.4 ± 13.1 and 6.7 ± 9.4 mm Hg staying within normal ranges, respectively. 3 patients (1.4%) prematurely discontinued the study treatment combination.

Conclusions:

Conclusion. This analysis supported the antianginal effectiveness of TMZ-bisoprolol in real-life clinical practice.
LIPID CONTROL AFTER AN ACUTE MYOCARDIAL INFARCTION REGARDING THE ANTIHYPERTENSIVE REGIME
Authors: Carrera Jon Ortiz , Fernández Pascual Císcar , Escrig Ana Isabel Renau , López Cristina Campo , Aldea Carmen Morata , García Fernando Martínez
Published: April 2021

Objective:

-Lipid control is essential after an acute myocardial infarction (AMI).

-The information regarding the grade of lipid control in hypertensive patients after an AMI is scarce.

-Our objective was to assess the grade of lipid control according to their antihypertensive treatment.

Design and method:

-The sample includes 130 patients admitted during the year 2017 in the Cardiology department with a diagnosis of AMI (ICD 9 410) and with, at least, one ambulatory lipid determination during the follow-up. The threshold to considerer an appropriate lipid control was 55 mg/dL but we also analyzed according to the previously threshold of 70 mg/dL.

-Differences regarding the percentage of lipid control were evaluated using the Chi-square test. This analysis was adjusted by the intensity of lipid treatment and by the type and number of antihypertensive drugs used.

-Mean differences in lipid levels were assessed using ANOVA. This analysis was adjusted by age, sex and the intensity of lipid treatment.

-The relationship between lipid levels and the time elapsed since the infarction was assessed by means of Pearson's correlation coefficient.

-Every statistical analysis was performed using Stata IC 14.

Results:

-Globally, the level of control was 31% considering 55 mg/dL and an additional 29% if 70 mg/dL was the desired LDLc threshold. Although the percentage of controlled patients increased according to the number of antihypertensive medications, these differences were not statistically significant.

-The same occurs for the LDLc levels, which were similar among groups: 0–1; 2–3 or more than 3 antihypertensive drugs (figure 1). The only significant differences were found in those having diuretics who have higher LDL levels (77,2 vs 64,4 mg/dL, respectively, p-value=0.04) in the unadjusted but not after adjustment and without any differences in the percentage of control.

-A positive correlation was found between the LDLc and the elapsed time since the AMI.

Conclusions:

-The percentage of lipid control after an AMI is low and it seems to get worse along time.

-We did not find an association between the complexity of antihypertensive treatment and the LDL levels. Diuretics could impact negatively the grade of lipid control.
SPONTANEOUS CORONARY ARTERY DISSECTION IN A PATIENT WITH CUSHING DISEASE
Authors: Vieira Joana Tender , Besteiro Bruno , Cunha Ana , Lemos Luís , Faceira Ana , Marques Pedro , Almeida Jorge
Published: April 2021

Objective:

Spontaneous coronary artery dissection (SCAD) is an uncommon cause of acute myocardial infarction, caused by a non-traumatic and non-iatrogenic separation of the coronary arterial wall, especially amongst young women with no conventional cardiovascular risk factors. The most common factors associated with SCAD are fibromuscular dysplasia (FMD), postpartum, multiparity, connective tissue disorders, systemic inflammatory conditions and hormonal therapy. After extensive diagnostic workup some cases are labeled as idiopathic. In the literature reported cases of aortic, cervical and carotid arterial dissections, but not SCAD, were associated with Cushing syndrome.

Design and method:

We describe a 46-year-old woman with a past medical history of Cushing disease (ACTH-producing pituitary tumor) treated surgically in 2009 that presented with SCAD.

Results:

A nulliparous, hypertensive, obese and non-smoker 46-year-old woman with a surgically treated Cushing disease in 2009, presented to the emergency department with a retrosternal chest pain with radiation to the left arm lasting for 30 minutes, nausea and diaphoresis. No ischemic changes were seen in the electrocardiogram but serum high sensitive troponin I test rose to a pic level of, 96.3 ng/L (normal range <16 ng/L). Cardiac catheterization revealed diffuse distal stenosis of the anterior descending coronary artery, compatible with spontaneous dissection type 2, with Thrombolysis in Myocardial Infarction (TIMI) II flow. The patient was treated conservatively, with anticoagulation during hospitalization and single anti-aggregation without reported complications. Further investigations were performed to explore possible etiologies or associations for SCAD. Serum inflammatory, auto-immune and immunologic workups were negative. Angio-CT scan of the abdomen and supra-aortic trunks showed no signs of FMD or inflammatory changes.

Conclusions:

Cushing Syndrome is not considered a traditional risk factor for SCAD. As there are reported cases of arterial dissections in the literature associated with this entity and common causes of SCAD were excluded we hypothesized that the patient past medical history may have contributed to SCAD. In fact, high cortisol levels may increase blood vessel fragility, making vessel walls more vulnerable. To the best of our knowledge there are no other reported cases in the literature of Cushing syndrome associated SCAD.
ASSOCIATION OF ARTERIAL STIFFNESS WITH ALL-CAUSE MORTALITY AMONG HOSPITALIZED COVID-19 PATIENTS
Authors: Rodilla Enrique , Belda Alberto , Canales Sergio , Quilis Maria , Saez Maria Carmen , Roldan Alicia , Cortes Xavi , Aguilar Marta , Albert Amparo , Garijo Marta , Malek Tamara , Palop Marta , Pinel Jorge , Salvador Inmaculada , Sanchez Vanesa , Vicente Julio , Saura Alberto , Jimenez Iratxe , Mendizabal Andrea , Lloris Amparo , Ridaura Bianca , Karroud Zinneb , Nicolas Angela , Morro Santiago , Fernandez Monica , Beltran Noemi , Reino Sandra , Carmena Amparo , Gag Angela , Pascual Jose Maria
Published: April 2021

Objective:

Older age and cardiovascular comorbidities are well-known risk factors for all-cause mortality in COVID-19 patients. Hypertension (HT) and age are the two principal determinants of arterial stiffness (AS). The objective of this study is to estimate AS in COVID-19 patients requiring hospital admission and analyze its association with all-cause mortality.

Design and method:

This cross-sectional, observational, retrospective multicenter study includes 122170 patients who required hospital admission in 150 Spanish centers, included in the nationwide SEMI-COVID-19 Network. We compared estimated AS as pulse pressure > 60 mmHg and compared clinical characteristics between survivors and nonsurvivors.

Results:

Mean age was 67.5 ± 16.1 years, 42.5% were women. Most patients were white (90.0%). Globally, 2606 (21.4%) subjects died. Blood pressure (BP) < 120 mmHg and BP > 140 at admission predicted higher all-cause mortality (23.5% and 22.8%, respectively, p < 0.001), compared to BP between 120–140 mmHg (18.6%). 4379 patients with AS (36.0%) were older and had higher systolic and lower diastolic BP. Multivariate analysis showed that even adjusting for gender (males, OR: 1.6, p = 0.0001), age tertiles (second and third tertiles, OR: 2.0 and 4.7, p = 0.0001), Charlson-Index (second and third tertiles, OR: 4.8 and 8.6, p = 0.0001), heart failure, previous and in-hospital antihypertensive treatment, AS and BP < 120 mmHg significantly and independently predicted all-cause mortality (OR: 1.27, p = 0.0001 and OR: 1.48, p = 0.0001, respectively).

Conclusions:

Our data show that arterial stiffness, defined as pulse pressure above 60 mmHg at hospital admission, and BP at admission < 120 mmHg were important determinants with independent prognostic value for all-cause mortality in COVID-19 patients requiring hospitalization.
CONDUCTING AN RCT IN THE COVID-19 PANDEMIC: TARGETING VULNERABILITY TO SEASONAL AND ACUTE WEATHER CHANGES TO KEEP AUSTRALIANS WITH CARDIOVASCULAR DISEASE OUT OF HOSPITAL - THE RES
Authors: Moini Nasreen , Patel Sheila K. , Ramchand Jay , Hook Jody , Mcdonald Christine F. , Stewart Simon , Burrell Louise
Published: April 2021

Objective:

Australia is experiencing ever more frequent/provocative weather and environmental challenges, including more extreme heatwaves and catastrophic bushfires. Concurrently, the annual challenge of wintry conditions to a population adapted to warmer conditions persists. Remarkably, however, there are no proven interventions to reduce seasonal challenges to the cardiovascular health of vulnerable individuals. In a world-first, the REsilience to Seasonal ILlness and Increased Emergency admissioNs CarE (RESILIENCE) Trial will test the hypothesis that an individually tailored, intervention program will reduce the risk of re-hospitalisation and mortality in vulnerable individuals.

Design and method:

300 adult patients admitted to the Austin Hospital in Melbourne, Australia with heart disease and multimorbidity will be recruited and randomised (1:1) to standard care (SC) or the RESILIENCE program (RP) over 12-months. Applying a COVID-19 adapted protocol, the RP group will have their bio-behavioural profile and home environment assessed post-discharge, to determine their vulnerability to seasonal events. An individualised case-management program, including a virtual clinic review with a dedicated RP cardiac nurse and physician, will be applied to promote seasonal resilience. The primary end-point is all-cause days alive out of hospital (DAOH) during 12-month follow-up.

Results:

With study recruitment delayed due to COVID-19 restrictions, virtual screening of medical in-patients has confirmed the need and potential for the RP. Of 630 potential participants identified over a 6 week period, 196 patients (31%) met eligibility criteria – 85 women and 79 men, mean (±SD) age 79 ± 11 years. Non-eligibility was largely due to non-chronic form of heart disease (34%), no comorbidity (23 %), and inability to give informed consent (15%).

Conclusions:

Preliminary data suggest that once commenced, we will rapidly recruit the requisite number of trial participants and depending on the results, we will be able to determine the cost-effectiveness of the RP to reduce seasonally-induced admissions and mortality.
YOUNG PATIENTS WITH TYPE 1 DIABETES MELLITUS WITHOUT CARDIOVASCULAR DISEASES ARE CHARACTERIZED BY HIGH FREQUENCY OF UNFAVOURABLE BLOOD PRESSURE PHENOTYPES
Authors: Medvedev D. , Safarova A. , Troitskaya E. , Stavtseva Y. , Efimova V. , Kobalava Z.
Published: April 2021

Objective:

Type 1 diabetes mellitus (T1DM) remains a disease with high risk of cardiovascular disease (CVD). Hypertension (HTN) may be underdiagnosed in this population. Data on ABPM profile in patients with T1DM are lacking. The aim of the study was to assess the prevalence of different BP phenotypes and dipping patterns in patients with T1DM without known CVD.

Design and method:

Study group included 125 patients with T1DM aged 18–44 years: 60% males, 29.2 ± 7.6 years, median DM duration 6.9 years). 24-hour ABPM of brachial BP was performed with BPLab Vasotens. BP levels and phenotypes were classified according to 2018 ESC/ESH HTN guidelines. p < 0.05 was considered significant.

Results:

Mean office BP was 120.9 ± 14.6/77.3 ± 9.3mmHg, daytime–120.7 ± 10.4mmHg, nighttime-112.8 ± 11.4/72.6 ± 9.9mmHg, 24-h BP–119.5 ± 9.3/75.2 ± 8.7mmHg. High normal BP was registered in 9.6% HTN in 4.8%. According to ABPM measurement sustained HTN was confirmed in 4.8%, true normotension–in 72% and masked HTN was found in 23.2%. Isolated nocturnal HTN was revealed in 14.4%. Patients with sustained HTN compared to masked HTN had longer median duration of DM (14.8 vs 5.3 years) and higher median urine albumin-creatinine ratio (UACR) (33.4 vs 18.1 mg/g), p < 0.05. For further analysis patients with sustained and masked HTN were united into one group. Patients with HTN compared to normotensives were older (31.5 ± 7.9vs29.1 ± 8.2 years), higher median UACR (23.8 vs 14.5 mg/g) and received higher insulin doses (41.3vs28.6 U), p < 0.01. Median SBP diurnal index (DI) in normotensives was 10.3%, in hypertensives –6.2% (p < 0.05). Dipping profiles of SBP in patients with HTN and normotensives were as follows: 57.1% non-dippers, 20% night-peakers and 22.9% dippers vs 37.8% non-dippers and 62.2% dippers respectively (p < 0.05). Non-dipping profile (DI < 10%) compared to dipping profile was characterized by a trend to higher median UACR (27.9 vs 16.7 mg/g), longer median DM duration (7.2 vs 6.1 years), p = 0.05.

Conclusions:

Young patients with T1DM have high frequency of masked HTN and non-dipping profile. Worse BP phenotypes were associated with higher albuminuria. Routine ABPM may be recommended in this population in order to reveal high-risk patients and optimize the treatment.

The publication was prepared with the support of the RUDN University Program 5-100
DECREASED POSTURAL CHANGES OF CARDIO-ANKLE VASCULAR INDEX IN HYPERTENSIVE PATIENTS WITH TYPE 2 DIABETES MELLITUS - THE COUPLING REGISTRY
Authors: Hashizume Toshikazu , Kabutoya Tomoyuki , Hoshide Satoshi , Kario Kazuomi
Published: April 2021

Objective:

Aim: The cardio-ankle vascular index (CAVI) has been proposed as noninvasive marker of arterial stiffness independent of blood pressure. Usually CAVI is measured in supine position to evaluate arterial stiffness in patients with hypertension (HT), but changes of CAVI have not been evaluated at standing position. We investigated the postural changes of CAVI (standing/supine ratio = CAVI ratio) in hypertensive patients with and without type 2 diabetes mellitus (T2DM), (the HTDM group and the HT group).

Methods:

A total of 1414 hypertensive patients (779 males; age, 67 ± 11 years) were enrolled from the Coupling registry that was designed to determine the impact of CAVI on cardiovascular events in a Japanese cohort. CAVI measurements were performed in supine and standing position after 3 minutes. We compared CAVI ratio between the HTDM group and the HT group.

Design and method:

Supine and standing CAVI in HTDM group (n = 546) was significantly higher than in the HT group (n = 868) (supine; 9.3 ± 1.3 vs. 8.7 ± 1.4, p < 0.001, standing; 11.6 ± 1.6 vs. 11.2 ± 1.8, p < 0.001), but CAVI ratio in the HTDM group was significantly smaller than that in the HT group (1.25 ± 0.14 vs. 1.30 ± 0.17, p < 0.001). Moreover, all patients were divided into quartiles of CAVI ratio. The proportion of T2DM in the 4th quartile group (the lowest CAVI ratio group) was superior to that between the 1st to 3rd quartile groups (49.7% vs. 34.9%) (p < 0.001). Multivariate logistic regression model for contributors of low CAVI ratio (?25th percentile; third quartile) identified T2DM [odds ratios (95% confidence interval): 1.55 (1.19–2.02), p = 0.001], older age [1.04 (1.02–1.05), p < 0.001], past cardiovascular disease [1.42 (1.04–1.92), p = 0.025], high heart rate [1.02 (1.01–1.03), p < 0.001], and body mass index over 25 [1.49 (1.15–1.93), p = 0.003] as independent factors.

Results:

These results suggest that postural changes of CAVI in hypertensive patients with T2DM might be decreased and lower CAVI ratio might be one of the important clinical markers of arterial stiffness
IN NEWLY DIAGNOSED PATIENTS WITH TYPE 2 DIABETES MELLITUS FLOW-MEDIATED DILATATION IS IMPAIRED AND ASSOCIATED INDEPENDENTLY WITH THE DIAGNOSIS OF DIABETES
Authors: Nikolaidou Barbara , Anyfanti Panagiota , Gavriilaki Eleni , Lazaridis Antonios , Triantafyllou Areti , Mastrogiannis Kontantinos , Zarifis Hippocrates , Douma Stella , Gkaliagkousi Eugenia
Published: April 2021

Objective:

Type 2 diabetes mellitus (T2DM) is associated with endothelial dysfunction that mediates long-term complications. However, it is still unclear whether endothelial dysfunction is evident from the early stages of the disease. We aimed to investigate endothelial dysfunction in newly diagnosed and untreated patients with T2DM.

Design and method:

We enrolled consecutive patients diagnosed with T2DM no longer than 6 months ago, as well as age and gender matched controls. We recorded a detailed medical history, laboratory exams, office and 24-hour blood pressure (BP) levels and ASCVD (Atherosclerotic Cardiovascular Disease) risk. Endothelial dysfunction was estimated with the gold standard non-invasive method, flow mediated dilatation (FMD).

Results:

We studied 70 individuals aged 56 ± 10 years (29 T2DM and 41 controls). Only 11 T2DM patients were on treatment with metformin and was administered for less than 3 months. T2DM patients had increased office BP (p < 0001) and systolic BP at night (p = 0.037) compared to controls. FMD was also impaired in T2DM (5.3 ± 2.5% versus 7.7 ± 4.5%, p = 0.014). FMD showed a negative association only with T2DM (p = 0.021), day systolic BP (p = 0.031), and positively with HDL (p = 0.038). In the multivariate analysis, T2DM diagnosis was the only independent predictor of FMD.

Conclusions:

Our results suggest that endothelial dysfunction is evident in newly diagnosed T2DM patients and independently associated with diabetes diagnosis. BP and cholesterol levels were also associated with FMD highlighting the need for early intervention in factors associated with endothelial dysfunction from the early stages of the disease.
UPDATED META-ANALYSIS OF TRIALS ASSESSING THE CARDIOVASCULAR EFFICACY OF SODIUM-GLUCOSE CO-TRANSPORTER-2 INHIBITORS AND GLUCAGON-LIKE PEPTIDE-1 RECEPTOR AGONISTS IN BLACK PATIENTS
Authors: Patoulias Dimitrios , Imprialos Konstantinos , Stavropoulos Konstantinos , Katsimardou Alexandra , Toumpourleka Maria , Mavridou Maria , Papadopoulos Christodoulos , Doumas Michael
Published: April 2021

Objective:

Recent, large observational studies have demonstrated that black patients feature increased odds for suffering from type 2 diabetes mellitus (T2DM), while they experience an increased risk for the development of T2DM related cardiovascular co-morbidities, cardiovascular and all-cause mortality, compared to Caucasian patients. Therefore, appropriate treatment strategies are urgently required, in order to ameliorate these health disparities.

Design and method:

We searched PubMed from its inception to 30 September 2020. We sought to determine the effect of sodium-glucose co-transporter 2 (SGLT-2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1RAs) on cardiovascular outcomes of interest in black patients utilizing data from the “hallmark” cardiovascular outcome trials, extracting data from sub-analyses reported across the selected studies. We set as primary cardiovascular efficacy outcome the composite of major adverse cardiovascular events (MACEs), including cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke, as defined across all the selected cardiovascular outcome trials.

Results:

SGLT-2 inhibitor treatment resulted in a non-significant decrease in the risk for MACEs, equal to 3% (RR = 0.97, 95% CI; 0.61 to 1.53, I2 = 30%). Similarly, GLP-1RA treatment produced a non-significant decrease in the risk for MACEs, equal to 7% (RR = 0.93, 95% CI; 0.69 to 1.25, I2 = 49%).

Conclusions:

Neither SGLT-2 inhibitors nor GLP-1RAs provide significant cardiovascular benefit in black patients, in terms of MACEs incidence. Future trials enrolling a larger proportion of black patients will clarify whether these observations are due to inadequate power of present CVOTs, or due to true racial disparities with the use of novel antidiabetics.
DIGITAL PATH OF THE HYPERTENSIVE PATIENT BEFORE A FIRST VISIT IN A TERTIARY CARE HYPERTENSION UNIT: A REAL-LIFE PILOT STUDY
Authors: Postel-Vinay Nicolas , Gardini Margherita , Nogueira Lima , Lorthoir Aurelien , Amar Laurence
Published: April 2021

Objective:

There is growing evidence that the information and communication technologies (ICT) can improve health care access, patient education, compliance or outcomes, particularly in chronic diseases such as hypertension. In this e-Health context, our group validated, several years ago, a standardized patient self-questionnaire (Hy-Quest) and a software system to help patients manage Home Blood Pressure Measurement (Hy-Result software). But to what degree can patients use ICT before any face to face contact with a health care professional?

Design and method:

Between October 2017 and October 2018, 304 patients booked an appointment through the website of an ESH Excellence Centre, (www.centre-hypertension.org). Among them, 81% were first-visiting patients and 75% declared owning a sphygmomanometer. A simple, short E-mail was sent to a sample of 63 of them asking them to complete two tasks before attending their first appointment: ie. complete the Hy-Quest questionnaire (Hy-Q)and self-measure their blood pressure (BP), communicating their readings using the Hy-Result software (Hy-R).

Results:

Patients who responded were 56 (19-86) years old, had a mean office BP of 143/90 mmHg, a mean home BP of 137/84 mmHg under 1.8 antihypertensive drug/person. The mean duration of hypertension was 9 years (0–46). Attending their first visit, 54% of patients were able to successfully get through the digital path (27% completing Hy-Q+Hy-R; 25.4% Hy-Q only; 1.6% Hy-R only). Different problems (unattended or delayed visit, neither Hy-Q nor Hy-R completed, refusal to participate, computer problems) led the remaining 46% of patients to an unsuccessful digital path [Fig.].

Conclusions:

This pilot study shows that approximately half of the patients can contribute to preparing their first visit by going through a digital path starting from the online reservation, to filling in

Hy-Quest and communicating their self-measured BP readings using the Hy-Result software. This study confirms the interest for continuing with a larger study to confirm these percentages, to gain a better understanding of the reasons that prevent the patient from preparing online for his first visit and subsequently, optimize the steps of the hypertensive patient's digital path.
A CASE OF ACROMEGALY COMPLICATED BY PRIMARY ALDOSTERONISM DIAGNOSED DURING THE COURSE OF HEART FAILURE
Authors: Kimura Miwa , Yamashita Kaoru , Ishikawa Toru , Saitou Fumiko , Kimura Shihori , Takano Noriyoshi , Seki Yasufumi , Masui Kenta , Bokuda Kanako , Sasaki Nobukazu , Yatabe Midori , Yatabe Junichi , Watanabe Daisuke , Amano Kosaku , Sawada Tatsuo , Kawamata Takakazu , Morimoto Satoshi , Ichihara Atsuhiro
Published: April 2021

Objective:

[Case] A 32-year-old male was admitted to the Department of Cardiology of our hospital complaining of weight gain, exertional chest pain, dyspnea, and palpitation. He was pointed out hypertension at the age of 18 and started taking oral antihypertensive drugs at the age of 27. Although his high blood pressure was well-controlled with calcium channel blocker, angiotensin receptor blocker, and alpha-and beta-blocker, he had stopped taking medicines since the age of 30. He was diagnosed as congestive heart failure due to hypertensive heart disease and was transferred to our department for the further examination of suspected secondary hypertension after his heart failure was improved.

Design and method:

Aldosterone / renin activity ratio (ARR) was >= 200, and primary aldosteronism (PA) was suspected. In consideration of his impaired cardiac function, a captopril challenge test and a rapid ACTH stimulation test were conducted. Since both were positive, the diagnosis of PA was made. Although computed tomography (CT) scans revealed a left adrenal adenoma, adrenal venous sampling showed overproductions of aldosterone from both adrenal glands, and thus he was treated with eplerenone, a mineral corticoid receptor blocker.

Results:

He was also suspected to have acromegaly because he had protruded chin, thickened lips, enlarged nose, and enlarged hands and feet. Brain magnetic resonance (MR) imaging detected a macroadenoma in the pituitary gland. Endocrinological examinations showed high concentrations of serum GH of 7.78 ng/ml and insulin-like growth factor 1 (IGF-1) of 824 ng/ml (+8.8SD), and 75 g oral glucose tolerance test (OGTT) showed a nadir of GH as 5.22 ng/ml, indicating a failure of suppression of GH. Acromegaly was diagnosed and transsphenoidal sinus pituitary surgery was done after monthly intramuscular injections of octreotide 20 mg four times.

Conclusions:

[Discussion] We experienced a case of acromegaly complicated by PA diagnosed during the course of heart failure. Both acromegaly and PA may be involved in the development of heart failure, however, the combination of acromegaly and PA is rare. We will discuss Its pathophysiology with a literature review.
ACTUAL PREVALENCE OF ENDOCRINE DISORDERS ASSOCIATED WITH HYPERTENSION IN ADULT HYPERTENSIVES REFERRED TO AN ENDOCRINE HYPERTENSION CLINIC
Authors: Chiodini I. , Aresta C. , Ripepi F. , Bilo G. , Pengo M.F. , Persani L. , Parati G.
Published: April 2021

Objective:

Background: Although some guidelines suggest the screening for endocrine hypertension (eHy) in subjects at risk, the eHy actual prevalence and its causes in adult hypertensives at risk of endocrine disorders are still unknown. The aim of the present study is to evaluate the eHy prevalence in a group of adults at risk for endocrine disorders.

Patients and Methods:

We consecutively screened patients with hypertension (n = 120), referred to our outpatient clinic for suspected endocrine hypertension due to the presence of: malignant Hy, grade 3 or resistant Hy, sudden new onset of Hy or its unexpected worsening, Hy onset before 30 years without family history or cardiovascular risk factors and Hy with disproportionate organ damage. We excluded all subjects with known secondary hypertension and/or taking drugs interfering with cortisol secretion. Eventually, 47 patients (35 F, mean age 53.5 ± 14.7) fulfilling the inclusion and exclusion criteria have been enrolled. In all patients we performed: cortisol and aldosterone secretion levels, thyroid function, insulin-like growth factor 1, calcium-phosphate metabolism, urinary fractionated metanephrines and 24 h ambulatory blood pressure (BP) monitoring.

Design and method:

We found 24 patients with eHy (9, 8, 3, 1, 1, 1, 1 with primary hyperaldosteronism, subclinical hypercortisolism, pheochromocytoma, acromegaly, hyperthyroidism, hyperparathyroidism and still uncertain cause, respectively). eHy patients had higher BP levels (mean BP 110.7 ± 15.3 vs 100.8 ± 7.3 mmHg, p < 0.005) and a more frequently altered dipping pattern (non dipping or rising patterns) (60% vs 9.1%), as compared to those with essential Hy, while age, body mass index (BMI), familiar history of hypertension, gender, prevalence of diabetes and of obesity were comparable between the two groups. The altered dipping pattern was found to be independently and directly associated with eHy (odd ratio, OR, 28.9, 95% confidence interval, 95%CI, 1.26–667.2, p = 0.035), and age (OR 1.15, 95%CI1.01–1.3, p = 0.031, but not with BMI, family history of Hy and mean BP levels.

Results:

Among patients at risk for eHy, about 50% of individuals are in fact affected by an endocrine disease potentially causing Hy. In Hy patients, the presence of an altered dipping pattern may be considered highly suggestive for the presence of an otherwise asymptomatic endocrine disorder.
PHYSIOLOGICAL AND BIOCHEMICAL STUDIES OF AGEING RAT HEART WITH EXPERIMENTAL ARTERIAL HYPERTENSION
Authors: Revnic Cristian Romeo , Sonea Cosmin , Revnic Flory
Published: April 2021

Objective:

It has been shown that DOCA-NaCl dependent arterial hypertension appears before any kidney lesions and there are proofs which suggest the role of NaCl retention or sensitivity to this in etiology of essential arterial hypertension The aim of our study was concerned with evaluation of physiological and biochemical parameters of rat heart with arterial hypertension experimentally induced with (DOCA) as well as to investigate the antioxidant potential and lipid metabolism parameters.

Design and method:

16 white male Wistar rats (180 + 20 g), aged 20 months old, fed on standard chew, have been divided into two groups of 8 rats each: group A Controls and group B treated with DOCA for 4 weeks with 2 (i.m.) injections /week) with 10 mg/kg b.w. and two weeks afterwards drinking water has been replaced by saline solution (0.9%NaCl + 0.2%KCl). Evaluation of physiological parameters: heart rate (H.R.), coronary flow (C.F.) and left ventricle systolic pressure (L.V.S.P.) of heart from controls and hypertensive rats has been achieved on isolated heart in Langendorff perfusion system with Krebs Hanseleit bicarbonate buffer at a constant pressure. Oxidative stress has been imposed by applying a 45 minutes ischemia which has been followed by 120 minutes reperfusion. Biochemical studies of antioxidant system have been performed on plasma and left ventricle tissue by evaluating: SOD, GGT, Lipid peroxides, CK, LDH, Cholesterol, LDL, HDL with standard biochemical methods.

Results:

Our data have pointed out that for about one hour (C.F.) presented higher values as well as (LVSP) and (H.R). in DOCA treated rats, above the values from Controls. These data account for an intense cardiac activity imposed by the onset of arterial hypertension following DOCA treatment. A reduction in GGT in myocardium due to hypoxia generated by cardiac insufficiency following DOCA treatment is accompanied by a reduction of antioxidant potential and both HDL and CK markers of myocardial lesion exhibited higher values.

Conclusions:

Following 4 weeks DOCA treatment a pathological state is achieved similar with Essential arterial hypertension found in humans, accounted for by the following changes: an intensification of contractile activity, cardiac hypertrophy and the increase in lipid peroxides level, LDH and CK activity.
EFFECTS OF ESAXERENONE ON BLOOD PRESSURE, BAPWV AND CAROTID ARTERIAL ELASTICITY IN ESSENTIAL HYPERTENSIVE PATIENTS
Authors: Yamagishi Toshio
Published: April 2021

Objective:

Esaxerenone is a novel nonsteroidal mineralocorticoid receptor blocker being developed for hypertension treatment. We investigated the effects of esaxerenone on blood pressure (BP), baPWV, and carotid arterial intima-media thickness (IMT) and elasticity in essential hypertension.

Design and method:

Forty hypertensive patients (twenty-five males, aged 67 years) were assigned to receive esaxerenone (2.5 mg once daily) for 12 weeks. The 20 patients were added on previous drugs with esaxerenone and for 20 patients currently medicated with eplerenone, esaxerenone was substituted for that. Changes in home BP, estimated glomerular filtration rate (eGFR), baPWV, central blood pressure (cSBP) were evaluated. The carotid arterial IMT and elastic modulus in the circumferential direction (Eq) were simultaneously measured by the high-resolution Doppler technique, “Phased Tracking Method”.

Results:

Esaxerenone reduced home BP (systolic/diastolic, 141.1 ± 13.2/79.6 ± 11.4 to 130.8 ± 11.0/74.6 ± 11.1mmHg), heart rate (72.7 ± 11.9 to 67.8 ± 8.1 bpm), cSBP (146.1 ± 27.7 to 136.5 ± 26.4 mmHg), baPWV (17245 ± 323 to 1595 ± 287 cm/sec) significantly (p < 0.05) after 12weeks in both groups. The significant reduction of home BP (systolic/diastolic,) in group A and B were seen (-14.0 ± 4.7/-5.4 ± 2.6 mmHg and -6.2 ± 2.5/-4.5 ± 2.2 mmHg, respectively). There were no significant changes in eGFR (67.8 ± 23.0 to 67.4 ± 19.3 mL/min/1.73m2) nor serum potassium (3.9 ± 0.7 to 4.1 ± 0.6mEq/L). Eq (720 ± 34 to 400 ± 44) was reduced significantly without changes in IMT. The histogram analysis of the Eq data revealed the drug decreased harder components of the elasticity distribution, suggesting improvement of endothelial dysfunction.

Conclusions:

These data demonstrate that once-daily esaxerenone provides potent antihypertensive and antiatherosclerotic effects.
THE EFFECT OF SONIC HEDGEHOG IN PROTECTIVE FROM OX-LDL-INDUCED ENDOTHELIAL APOPTOSIS
Authors: Xue Yan , Huang Huashan , Yu Huizhen , Lin Liang , Chen Junming , Zhu Pengli
Published: April 2021

Objective:

Sonic hedgehog (Shh) is of pivotal importance to embryonic and adult blood vessels development and homeostasis. The aim of our study is to further investigate the role of Shh in oxidized low-density lipoprotein (ox-LDL) medicated endothelium damage and apoptosis.

Design and method:

Western immunoblots were assessed to the protein expression of hedgehog component, Bcl-2 and caspase 3 in human umbilical vein endothelial cells (HUVECs) induced by ox-LDL. The flow cytometry of FITC Annexin V/PI and caspase 3 activity kit were used to determine cell apoptosis.

Results:

Our study found that ox-LDL can induce the apoptosis of HUVECs in vitro and the protein expression of Shh was down regulated. Furthermore, retreatment with rShh or transfection with phShh can increase the anti-apoptosis protein Bcl-2 expression and decrease cell apoptosis. These protection effects of rShh or phShh could be abolished by cyclopamine, which is a hedgehog signaling inhibitor. Moreover, we performed co-immunoprecipitation assay to demonstrate that Shh interacted with nuclear factor-kB (NF-kB)p65 in HUVECs. Additionally, ox-LDL upregulated the phosphorylation of NF-kBp65 and inhibitor-kB -a (IkBa), and these effects lessened notably after rShh and phShh treatment.

Conclusions:

Our findings suggest that Shh plays an important protective role in alleviating ox-LDL-mediated endothelial apoptosis by inhibiting NF-kB signaling pathway and controlling mitochondrial signaling.
EFFECT OF CHOLECALCIFEROL ON PULSE WAVE VELOCITY IN WOMEN WITH ARTERIAL HYPERTENSION IN PREMENOPAUSAL AND EARLY POSTMENOPAUSAL PERIODS
Authors: Kezhun Liudmila
Published: April 2021

Objective:

Aim: To assess effect of cholecalciferol on pulse wave velocity (PWV) in women with arterial hypertension (AH) in premenopausal and early postmenopausal periods who received 25 (OH)D supplementation.

Design and method:

Materials and methods: We investigated 102 women with AH stage II risk 3 aged 50 (48; 53) years: 50 females in premenopausal period – group I and 52 females in early postmenopausal period – group II. Serum level of 25 (OH)D was determined by the immunoenzymatic assay. In groups I and II we identified subgroups with the level of 25 (OH)D < 30ng/ml: subgroup IB (n = 25) and subgroup IIB (n = 21) respectively, in which antihypertensive therapy was supplemented with cholecalciferol 2,000 IU/day for 3 months. In subgroups IA (n = 25) and IIA (n = 31) cholecalciferol was not administered. The PWV was determined by assessing the elastic properties of blood vessels using computer rheovasography. Statistical analysis was performed by means of «STATISTICA 10.0».

Results:

Results: At baseline the level of 25 (OH)D was lower (p < 0,05) in subgroups IB (19,3 ± 8,5ng/ml) and IIB (18,2 ± 9,5ng/ml) than in the comparable subgroups IA (26,7 ± 11,5ng/ml) and IIA (27,4 ± 10,5ng/ml). After supplementation the level of 25 (OH)D increased (p < 0,001) in subgroup IB (37,28 ± 11,97ng/ml) and in subgroup IIB (36,4 ± 10,0ng/ml), and became higher (p < 0,001) than in the comparable subgroups I and IIA. At baseline subgroups IA and IB, IIA and IIB did not differ (p > 0,05) by PWV. Following the therapy PWV decreased (p < 0,01) in all groups.

However, the PWV was significantly lower (p < 0,05) in subgroups IB (3,7 (3,1;4,3) m/s) and IIB (4,1 (3,6; 4,5) m/s) than in the comparable subgroups IA (4,2 (3,6; 5,2)m/s) and IIA (4,8 (4,0;5,6) m/s), correspondingly.

Conclusions:

Conclusion: Correction of 25 (OH)D level by intake of cholecalciferol 2000 IU/day for 3 months leads to reduction of PWV in women with AH.
ASSOCIATION OF BLOOD PRESSURE WITH ALBUMINURIA AND LEFT VENTRICULAR HYPERTROPHY IN YOUNG, MIDDLE AND OLDER AGE GROUPS OF PATIENTS
Authors: Zhang Wei , Liu Chang-Yuan , Ji Li-Nong , Wang Ji-Guang
Published: April 2021

Objective:

We investigated the association of blood pressure with albuminuria and left ventricular hypertrophy (LVH) in young, middle and older age groups of patients.

Design and method:

Our study participants were treated patients with hypertension or diabetes, enrolled in a China nationwide registry. The 2510 patients were classified into young (<45 years, n = 345), middle (45–65 years, n = 1383) and older (>65 years, n = 782) age groups. Clinic blood pressure was measured three times consecutively on each of the two planned clinic visits. These six readings were averaged for statistical analysis. Albuminuria was defined as a urinary albumin-to-creatinine ratio of > 30 mg/g. LVH was assessed by the electrocardiogram (ECG) Cornell product method.

Results:

The prevalence of albuminuria and ECG-LVH was 17.8% and 3.7%, respectively, in all patients and 18.1% and 4.2%, respectively, in 2026 (80.7%) patients on antihypertensive medication. The mean (±SD) systolic/diastolic blood pressure was 132.0 ± 16.5/85.2 ± 11.9 mmHg, 136.8 ± 17.9/81.7 ± 11.2 mmHg, and 139.8 ± 16.7/75.8 ± 10.4 mmHg in young, middle and older age groups. In the young age group, the prevalence of albuminuria increased from 8.8% in blood pressure < 120/80 mmHg to 14.6%, 16.0% and 16.5% in blood pressure at 120–130/80–85, 130–140/85–90 and > 140/90 mmHg. The corresponding values were 8.9%, 7.0%, 18.1% and 22.2%, respectively, in the middle age group, and 21.2%, 15.5%, 16.4% and 24.4%, respectively, in the older age group. The prevalence of ECG-LVH was slightly but non-significantly (P for trend > 0.09) higher with increasing blood pressure similarly in all age groups.

Conclusions:

The relationship between blood pressure and organ damage seems to be age-dependent for albuminuria but not ECG-LVH.