bluuebunny/crossref_metadata_2025 huggingface dataset:
THE EFFECTS OF DIFFERENT INTERDIALYTIC INTERVALS ON CARDIORESPIRATORY FITNESS ASSESSED WITH CARDIOPULMONARY EXERCISE TESTING IN HEMODIALYSIS PATIENTS
Authors: Pella Eva , Boulmpou Aristi , Boutou Afroditi , Theodorakopoulou Marieta P. , Haddad Nasra , Karpetas Antonios , Giamalis Panagiotis , Papagianni Aikaterini , Papadopoulos Christodoulos E , Vassilikos Vassilios , Sarafidis Pantelis
Published: May 2024

Objective:

Long interdialytic interval in thrice-weekly hemodialysis is associated with excess cardiovascular and all-cause mortality risk. Impaired cardiorespiratory fitness is a strong predictor of mortality in hemodialysis. This study investigated differences in cardiorespiratory fitness assessed with cardiopulmonary exercise testing (CPET) between the end of the 2-day and the 3-day interdialytic interval.

Design and method:

A total of 28 hemodialysis patients, randomized in two different sequences of evaluation underwent CPET and spirometry examination at the end of the 2-day and the 3-day intervals. The primary outcome was the difference in oxygen uptake at peak exercise [VO2peak(ml/kg/min)] assessed with CPET. Volume status was assessed with interdialytic-weight-gain (IDWG), lung ultrasound, bioimpedance spectroscopy (BIS), and inferior vena cava measurements. A total of 14 age- and sex-matched controls were also evaluated.

Results:

Hemodialysis patients at the end of both 2-day and 3-day intervals presented lower values in all major CPET parameters than controls. VO2peak(ml/kg/min) was significantly higher at the end of the 2-day than the 3-day interval (15.24±4.18 vs 13.64±2.76;p<0.001); similar were the results for VO2peak(ml/min) (1188±257 vs 1074±224;p<0.001) and VO2peak(%predicted) (58.9±9.2 vs 52.3±8.6;p<0.001). Numerical but no statistically significant differences were detected in VO2-anaerobic-threshold(ml/kg/min) and VO2-anaerobic-threshold(ml/min) between the two time-points. Maximal work load (90.1±23.2 vs 79.3±25.1;p<0.001), exercise duration, HR at peak exercise and oxygen pulse also showed lower values at the end of the 3-day interval. FEV1 levels were similar between the two evaluations. Generalized-linear-mixed-model analysis including IDWG as random covariate attenuated the observed differences in VO2peak(ml/kg/min). Changes in BIS-derived overhydration indexes were moderately correlated with changes of VO2peak(ml/kg/min).

Conclusions:

The 3-day interval was associated with further impairment of VO2 at peak exercise. This effect was predominantly driven by excess fluid accumulation during the extra interdialytic day.
PREVALENCE AND CONTROL OF ARTERIAL HYPERTENSION AMONG PATIENTS WITH GLOMERULAR DISEASES
Authors: Mustedanagic Matea , Paponja Kristina , Jelakovic Bojan , Stambuk Sandra Karanovic
Published: May 2024

Objective:

Glomerular diseases (GD) are strongly associated with arterial hypertension (AH). Increased blood pressure(BP) contributes to the pathogenesis and progression of kidney damage and impacts patients’ outcomes and overall morbidity and mortality. Our aim was to analyse the prevalence and control of AH among patients with GD hospitalized for native kidney biopsy.

Design and method:

This retrospective analyses included 189 consecutive subjects who underwent kidney biopsy during a 5-year period(2015-2019). The patients were grouped according to the presenting clinical syndrome: rapidly progressive glomerulonephritis (RPGN), nephritic syndrome(NiS), nephrotic syndrome(NS), chronic azotaemia+/-erythrocyturia/proteinuria (CA), syndrome of asymptomatic erythrocyturia+/- proteinuria (AEP). Data on office BP values measured according to the ESH guidelines upon admission as well as other clinical and laboratory values were collected from medical records.

Results:

Median BP value for the whole group was 140/85 (100-220/56-114) mmHg. AH was present in 98.9% of all patients. 77.0% were treated and BP control was achieved in 43.1% treated patients, while resistant hypertension was present in 23.6%. Median number of medications was 2 (0-6) with predominance of RAAS blockers (49,7%), CCBs (44,4%) and loop diuretics (33,8%). The subgroup data are shown in Table 1.

Important statistically significant correlation of both systolic and diastolic BP with proteinuria (rho = 0.327, p < 0.001, rho = 0.237, p = 0.002) and eGFR (rho = - 0.298, p < 0.001, rho = - 0.224, p= 0.002) was found in the whole group.

Conclusions:

High prevalence of AH, low rates of its’ control partially due to therapeutic inertia and 23,6% of resistant hypertension was found among our patients with glomerular diseases. BP was associated with severity of kidney damage and proteinuria. We observed a difference with regards to the clinical presentation which necessitates further investigation with inclusion of ABPM findings.
DIALYSATE SODIUM AND SHORT-TERM BLOOD PRESSURE VARIABILITY IN PATIENTS WITH INTRADIALYTIC HYPERTENSION: A RANDOMIZED CROSSOVER STUDY
Authors: Iatridi Fotini , Ekart Robert , Xagas Efstathios , Karpetas Antonios , Theodorakopoulou Marieta , Karkamani Eleni , Chalkioti Ioanna , Revela Ioanna , Giamalis Panagiotis , Sarafidis Pantelis
Published: May 2024

Objective:

Increased blood pressure (BP) variability (BPV) is associated with high cardiovascular risk in hemodialysis. Patients with intradialytic-hypertension (IDH) also exhibited an increased cardiovascular risk than hemodialysis patients without this condition. The impact of non-pharmacological BP-lowering interventions on BPV in this population remains unknown. This analysis evaluated the effect of low (137 mEq/L) compared to standard (140 mEq/L) dialysate sodium concentration on short-term BPV in patients with IDH.

Design and method:

In a randomized cross-over manner, 29 patients with IDH underwent 4 hemodialysis sessions with low (137 mEq/L) followed by 4 sessions with standard (140 mEq/L) dialysate sodium or vice versa according to randomization arm. 48-h ABPM was performed from the start of the 4th session on each dialysate sodium. BPV indices during the 48-h, 24-h, day-time and night-time periods were calculated with validated formulas.

Results:

Mean 48-h BP was lower by 5.3/2.6 mmHg with low compared to standard dialysate sodium concentration, (p=0.005/p=0.007) respectively). All 48-h systolic BPV indices examined showed non-significant differences between low and standard dialysate sodium (SBP-SD: 16.99±5.39 vs. 16.98±4.33 mmHg; p=0.982; SBP-wSD: 15.93±5.02 vs. 16.12±4.16 mmHg, p=0.769; SBP-ARV: 11.99±3.67 vs. 11.45±3.35 mmHg, p=0.392 and SBP-CV: 12.36±3.65 vs. 11.92±3.18%, p=0.302, with low vs. standard dialysate sodium, respectively). Diastolic BPV indices were numerically, but not statistically, lower with low dialysate sodium. Overall, significant differences were observed in some further comparisons relevant to a trend for lower BPV during daytime 2 and higher BVP during nighttime 2 during treatment with low dialysate sodium.

Conclusions:

Low dialysate sodium concentration does not affect BPV levels in patients with IDH. Future research should further explore alternative interventions to reduce BP and BPV in this high-risk population.
EFFECT OF LOW VERSUS STANDARD DIALYSATE SODIUM ON 48-H AMBULATORY BLOOD PRESSURE IN PATIENTS WITH INTRADIALYTIC HYPERTENSION: A RANDOMIZED CROSSOVER STUDY
Authors: Iatridi Fotini , Ekart Robert , Xagas Efstathios , Revela Ioanna , Karpetas Antonios , Theodorakopoulou Marieta , Karagiannidis Artemios , Georgiou Areti , Malandris Konstantinos , Tsouchnikas Ioannis , Sarafidis Pantelis
Published: May 2024

Objective:

Intradialytic hypertension (IDH) is associated with increased risk for cardiovascular events and mortality. Patients with IDH exhibit higher 48-h blood pressure (BP) levels than patients without this condition. Volume and sodium excess are considered a major factor contributing in the development of this phenomenon. This study evaluated the effect of low (137mEq/L) compared to standard (140mEq/L) dialysate sodium concentration on 48-h BP in patients with IDH.

Design and method:

In this randomized, single-blind, crossover study, 29 patients with IDH underwent 4 hemodialysis sessions with low (137mEq/L) followed by 4 sessions with standard (140mEq/L) dialysate sodium or vice-versa. Mean 48-h BP, pre-/post-dialysis and intradialytic BP, pre-dialysis weight, interdialytic weight gain (IDWG) and lung ultrasound B-lines were assessed.

Results:

Mean 48-h SBP/DBP were significantly lower with low compared to standard dialysate sodium concentration (137.6±17.0/81.4±13.7mmHg with low vs 142.9±14.5/84.0±13.9mmHg with standard dialysate sodium, p=0.005/p=0.007 respectively); SBP/DBP levels were also significantly lower during the 44-h and different 24-h periods. Low dialysate sodium significantly reduced post-dialysis (SBP/DBP: 150.3±22.3/91.2±15.1mmHg with low vs 166.6±17.3/94.5±14.9mmHg with standard dialysate sodium, p<0.001/p=0.134 respectively) and intradialytic (141.4±18.0/85.0±13.4mmHg with low vs 147.5±13.6/88.1±12.5mmHg with standard dialysate sodium, p=0.034/p=0.013, respectively) BP compared with standard dialysate sodium. Pre-dialysis weight, IDWG and pre-dialysis B-lines were also significantly decreased with low dialysate sodium.

Conclusions:

Low dialysate sodium concentration significantly reduced 48-h ambulatory BP compared with standard dialysate sodium in patients with IDH. These findings support low dialysate sodium as a major non-pharmacologic approach for BP management in patients with IDH.

Registered at ClinicalTrials.gov with study number NCT05430438.
PREDICTORS OF KIDNEY EVENTS IN TYPE 2 DIABETES MELLITUS PATIENTS WITH CHRONIC HEART FAILURE PATIENTS
Authors: Berezin Alexander , Fushtey Ivan , Berezina Tetiana , Berezin Oleksandr
Published: May 2024

Objective:

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have a favorable impact on the kidney function in patients with heart failure (HF), while there is no clear evidence of what factors predict this effect. The aim of the study was to identify plausible predictors for kidney function outcome among patients with HF and investigate their association with SGLT2i.

Design and method:

We prospectively enrolled 480 patients with type 2 diabetes mellitus (T2DM) treated with diet and metformin and concomitant chronic HF and followed them for 52 weeks. We determined kidney outcome as a composite event that includes >40% reduced estimated glomerular filtration rate from baseline, newly diagnosed end-stage CKD or kidney replacement therapy. The relevant medical information and measurement of the biomarkers were collected at baseline and at the end of the study.

Results:

The composite kidney outcome was detected in 88 (18.3%) patients of the entire population. All patients received guideline-recommended optimal therapy, which was adjusted to phenotype/severity of HF, cardiovascular risk and comorbidity profiles, and fasting glycaemia. Levels of irisin, adropin and apelin significantly increased in patients without clinical endpoint, whereas in those with composite endpoint the biomarker levels exhibited a decrease with borderline statistical significance (Figure 1). Multivariate logistic regression revealed that use of SGLT2i (OR=0.92 p=0.048), baseline serum levels of irisin <4.50 ng/ml (OR=1.51, p=0.001) and adropin <2.10 ng/ml (OR=1.15, p=0.001) along with and a <15% increase in the levels of these biomarkers (OR=1.60, p=0.001)and <6% (OR=1.21, p=0.001), respectively, remained an independent predictor for composite kidney endpoint. We established that irisin <4.5 ng/ml and <15% increase in irisin serum levels added more valuable predictive information than the reference variable. However, the combination of irisin <4.5 ng/ml at baseline and <15% increase in irisin serum levels (area under curve = 0.91, 95% confident interval = 0.87-0.95) improved the discriminative value of each biomarker alone.

Conclusions:

We suggest that low levels of irisin and its inadequate increase during administration of SGLT2i are promising predictors for unfavorable kidney outcome among patients with T2DM and concomitant HF
IMPACT OF LONG-TERM CONSUMPTION OF POTASSIUM -ENRICHED SALT ON BLOOD PRESSURE AND MORTALITY IN THE NURSING HOME POPULATION
Authors: Zhang Hongye , Wang Xingyu , Dou Xianfeng , Meng Xianmin , Wei Hua , Li Weiwei , Zhao Jingguo , Guo Yu , Li Dongfeng , Zhao Sufang , Dong Yuehong , Liu Yongjuan , Zhang Buqiang , Huang Xiuxian , Liu Xin , Liu Lisheng
Published: May 2024

Objective:

To examine the effects of long-term consumption of potassium-enriched salt (KCl: NaCl=1:1 by weight) on various health outcomes, including blood pressure, urinary sodium-potassium ratio, stroke, cardiovascular disease (CVD), and all-cause mortality, among individuals living in nursing homes.

Design and method:

In northern China, a total of 29 nursing homes were selected using cluster random sampling, with each county representing a cluster. These nursing homes were then divided into two groups: the intervention group, which consumed potassium-enriched, low-sodium salt, and the control group, which consumed regular salt. Baseline and seven follow-up surveys were conducted using standard cardiovascular disease epidemiological survey methods from 2011 to 2018. For the purpose of survival analysis, the population considered consisted of individuals aged 40 years or older who had stayed in the nursing home for at least six months.

Results:

In the baseline assessment, there were no significant differences in the average blood pressure between the two groups. However, during the follow-up surveys, it was observed that the intervention group had significantly lower systolic blood pressure (SBP) and a lower sodium-potassium ratio. The survival analysis was conducted on a total of 3543 participants, with 1065 death events recorded. After adjusting for age and sex using Cox proportional hazards models, the intervention group had an HR of 0.883 (95% CI 0.782-0.997) compared to the control group for all-cause mortality. Subgroup analysis was also performed for individuals aged 40-70 years, which revealed that the intervention group had lower HRs for all-cause mortality, CVD (including stroke), and stroke death, with HRs of 0.780 (95% CI 0.633-0.964), 0.664 (95% CI 0.489-0.903), and 0.681 (95% CI 0.473-0.981), respectively. For individuals aged over 70 years, the results were not statistically significant.

Conclusions:

Long-term consumption of potassium-enriched salt in northern China is safe and feasible. It significantly reduces blood pressure, and urinary sodium-potassium ratio, and lowers the risk of mortality in individuals aged 40-70. These results support the potential benefits of using potassium-enriched, low-sodium salt as a public health intervention to improve cardiovascular health outcomes in this population.
THE EFFECT OF HIGH VERSUS LOW ADHERENCE TO THE DASH DIET ON BLOOD PRESSURE: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Theodoridis Xenophon , Chourdakis Michail , Papaemmanouil Androniki , Chrysoula Lydia , Mermigkas Fotis , Chroni Violeta , Dipla Konstantina , Triantafyllou Areti
Published: May 2024

Objective:

The objective of our study was to systematically review the current literature and perform a meta-analysis to evaluate the effect of the level of adherence to the DASH diet on blood pressure.

Design and method:

The identification of relevant studies, data extraction and critical appraisal of the included studies were performed independently by two reviewers. A random-effects model was employed to synthesize the available evidence using the standardized mean difference (SMD) as the appropriate effect size.

Results:

A total of 37 and 29 articles were included in the qualitative and quantitative analysis, respectively. The pooled effect for systolic blood pressure was SMD = -0.18 (95%CI: -0.32 to -0.04; I2 = 94%; PI: -0.93 to 0.57) and for diastolic blood pressure it was SMD = -0.13 (95%CI: -0.19 to -0.06; I2 = 94%; PI: -0.42 to 0.17).

Conclusions:

Our findings showed that greater adherence to the DASH diet has a beneficial effect on blood pressure compared to the lowest adherence. Increased compliance with DASH diet recommendations might also have a positive effect on cardiometabolic factors and overall health status. Future studies should aim to standardize the tools of adherence to the DASH diet and utilize rigorous study designs to establish a clearer understanding of the potential benefits of the level of adherence to the DASH diet in blood pressure management.
BLOOD PRESSURE CHANGES DURING SMOKING CESSATION ON DULAGLUTIDE AND PLACEBO TREATMENT – A SECONDARY ANALYSIS OF THE RANDOMIZED, DOUBLE-BLIND, PLACEBO- CONTROLLED SKIP TRIAL
Authors: Beck Julia , Hasenböhler Flavia , Lengsfeld Sophia , Burkard Thilo , Meienberg Andrea , Jeanloz Nica , Vukajlovic Tanja , Bologna Katja , Bathelt Cemile , Vogt Deborah , Werlen Laura , Christ-crain Mirjam , Winzeler Bettina
Published: May 2024

Objective:

Smoking is an established major risk for atherosclerosis and cardiovascular mortality. However, the impact of smoking cessation on blood pressure remains controversial. Despite strong evidence linking smoking cessation to reduced cardiovascular risk, conflicting studies suggest potential increases in blood pressure after smoking cessation. Post cessational weight gain may contribute to these confliciting findings. We have recently shown that the glucagon-like peptide-1 (GLP-1) analog dulalgutide counteracts post-cessational weight gain. Therefore, the aim of this secondary analysis was to investigate blood pressure changes during smoking cessation in dulaglutide versus placebo treated individuals.

Design and method:

This is a predefined secondary analysis of the SKIP trial, a randomized, double-blind, placebo-controlled trial, conducted at the University Hospital Basel in Switzerland. Participants (n=218) underwent a 12-week smoking cessation program including standard of care and weekly injections of dulaglutide 1.5 mg or placebo. A mediation path analysis was performed to quantify the effect of predefined variables and relationships.

Results:

In the short term (12 weeks), smoking cessation led to a weight gain of +0.96 kg [CI 0.23, 1.70, p-value = 0.01], with each kilogram increase associated with a systolic blood pressure rise of +0.55 mmHg [- 0.0, 1.11, p-value = 0.055]. Dulaglutide treatment resulted in a weight reduction of -3.02 kg [CI - 3.69, - 2.63, p-value = 0.001], and each kilogram decrease lowered systolic blood pressure by -1.66 mmHg [-3.40, 0.08, p-value = 0.06]. No direct effect on systolic blood pressure was observed for smoking cessation or dulaglutide without weight influence. In the long term (52 weeks), smoking cessation led to a significant weight increase of +4.20 kg [2.67, 5.74, p-value < 0.001]. No direct effect of smoking cessation on systolic blood pressure was observed, either independently or through weight change.

Conclusions:

Our findings indicate that blood pressure changes during smoking cessation are primarily mediated by weight change. This underlines the importance of weight control and a potential beneficial role of GLP-1 analogues in the context of smoking cessation.
POOR LIFESTYLE HABITS IN NORMOTENSIVE SUBJECTS WITH POSITIVE FAMILY HISTORY OF ARTERIAL HYPERTENSION
Authors: Abramovic Inga , Alagic Marieta , Andelic Ana Marija , Horvat Petra , Ivankovic Iva , Zdilar Ana Marija , Domislovic Marija , Glavic Mihaela Marinovic , Jelakovic Bojan
Published: May 2024

Objective:

Lifestyle habits and genetic predisposition are the main factors in the development of various diseases, including arterial hypertension. The study aimed to analyze differences in lifestyle habits among the normotensive patients, based on having a positive or negative family history of hypertension.

Design and method:

The study included 350 normotensive participants, of which 191 reported a positive family history of arterial hypertension (AH) (69.6% of women) and 159 reported no family history (64.1% of women). The participants were randomly selected as part of the „Epidemiology of Hypertension in Croatia- 2“project (a random sample of general adult population in Croatia). Data were systematically collected through a structured questionnaire.

Results:

The consumption of fast food, ranging from several times a month to every day, showed statistical difference between participants with a positive family history of AH compared to those with a negative history of AH (72% vs. 66.1%; p=0.037). No statistical significance was found between groups and the consumption of red meat, daily consumption of fruits and vegetables, and alcohol consumption (hard liquor) (p=0.162; p= 0.506; p=0.091, respectively). There were no differences in physical inactivity (occasional or no physical activity weekly) between participants with a positive family history of AH compared with a negative history of AH (47.8% vs. 54.7%; p=0.863). Significantly fewer smokers were observed in those with a positive family history of AH compared with those with history of AH (34.5% vs. 40%, p=0.052). There were no differences in consumption of more than three cups of black coffee (p=0.450).

Conclusions:

Positive family history of AH is associated with fewer smokers and more physical activity which may indicate greater awareness of the impact of lifestyle habits on health. However, subjects with positive family history consumed fast food more frequently. Education of the whole population about the healthy lifestyle is crucial for reducing the increasing trend for the prevalence of AH, and this should be even more emphasized in subjects with positive family history of AH.
EXERCISE AS MEDICINE; CHRONOTHERAPY IN HYPERTENSION MANAGEMENT
Authors: Rayamajhi Supratik , Currie Katharine , Mcmohan Jill , Duwadi Ayushma , Tonson Anne , Joshi Amey
Published: May 2024

Objective:

Adequate blood pressure regulation is a critical target in the management of hypertension and CVD. Circadian rhythms are increasingly recognized for their impacts on health outcomes including vascular function and metabolism. We posited that optimized exercise combined with chronotherapy will lead to meaningful improvements in BP, vascular health, and cardiovascular outcomes by coordinating the timing of interventions with diurnal rhythms.

Design and method:

Our studies, funded by National Institute of Health (NIH), are focused on ambulatory BP monitoring (ABPM) to capture circadian variations in BP, including nocturnal BP and morning surge. In particular, the project focuses on the efficacy of physical activity to improve nocturnal BP. We are using a 48-hr period of ABPM to reliably access nocturnal BP, which has not been implemented in other exercise studies focusing on ambulatory BP, in addition to measuring sleep with actigraphy. Given nocturnal BP is recognized as a strong indicator of cardiovascular health and outcomes, examining how interventions modify this ambulatory BP outcome is needed to understand the effect of the intervention on health and future risk.

Results:

Our preliminary data on all non-Hispanic 22 female subjects included 7 African Americans with average age of 68 and average BMI of 30.6. Mean seated BP (all BP values reported in mm of Hg) was 135/73 while awake BP from ABPM was 135/76 and awake central BP (calculated with device using a proprietary algorithm) was 126/78. Mean asleep BP determined from analysis of wrist actigraphy data was 117/61 and mean asleep central BP was 112/64. Mean nocturnal BP (calculated by average of the 4 lowest systolic blood pressure measures during the asleep period, waiting at least 1 hour after going to bed) was 116.7/61.6. Average nocturnal systolic dip was 30.4 and nocturnal diastolic dip was 14.4 with percentage nocturnal dips at 20.3% and 14.2% respectively.

Conclusions:

In our preliminary results, we found that evening exercise as chronotherapy in hypertensive post-menopausal patients showed significant nocturnal dipping of blood pressure.
OVERWEIGHT AND OBESITY AND ITS ASSOCIATION WITH HYPERTENSION IN COLOMBIA: PURE COHORT
Authors: Montoya Isabela Gomez , Uribe Maria Gabriela Ruiz , Quiñones Daniela Hernandez , Bello Daniel Martinez , Mayorga Maritza Perez , Lopez-lopez Jose Patricio , Lopez-jaramillo Patricio
Published: May 2024

Objective:

To assess the association between overweight and obesity with blood pressure levels and incident hypertension in a prospective cohort with 12 years of follow-up.

Design and method:

Individuals aged 35 to 70 years from the Prospective Urban Rural Epidemiology Colombia cohort study were included. Participants with a history of hypertension and diabetes at baseline were excluded. Overweight and obesity was defined as a body mass index (BMI) greater or equal to 25 kg/m2. Blood pressure (BP) was measured at baseline and every 3-year follow-up. Hypertension was defined as a self-reported history of hypertension, baseline systolic BP greater or equal to 140 mmHg, diastolic BP greater or equal to 90 mmHg, or use of BP-lowering medications. Overweight and obese participants were propensity score matched using a 1:1 ratio with non-overweight participants. We used conditional logistic regression to evaluate the association between overweight, obesity, and hypertension, calculating the odds ratio and a 95% CI. Systolic BP and diastolic BP were analyzed in a linear mixed model as response variables, with matching pairs as random effects. The regression models were adjusted by sex, age, physical activity, tobacco use, alcohol use, education, waist-hip ratio, the alternative healthy eating index score, grip strength adjusted by weight, triglyceride-glucose index, and systolic BP at baseline. We established a p-value of <0.05 as significant.

Results:

Of 7500 participants, 1146 were matched, obtaining 573 pairs. The mean BMI was 25.2 kg/m2 (SD 4.02). The frequency of women was higher in the overweight group (68.1% vs. 60.9). The baseline SBP in overweight participants was 116.92 (SD 12.62) and 118.30 (SD 11.74) in non-overweight. 37.2% of overweight participants developed hypertension, but only 29.7% in non-overweight at follow-up. There was a 32% higher risk of hypertension in overweight participants (OR 1.32 95% CI:1.08-1.61). Being overweight and obese was associated with a higher increase in SBP of 2.53 mmHg (CI: 0.74-4.31) and DBP levels of 2.80 mmHg (CI: 1.68-3.93) at follow-up.

Conclusions:

Overweight and obesity, independently of other risk factors were associated with increased hypertension incidence and with higher SBP and DBP levels at 12 years of follow-up.
EFFICACY OF A PSYCHOTHERAPEUTIC GROUP ON PATIENTS WITH OBESITY AND HYPERTENSION
Authors: Gabos Priscila , Watanabe Danielle , Bortolotto Luiz
Published: May 2024

Objective:

To evaluate the effectiveness of (brief obesity group therapy) BOG as a psychological treatment compared to a control group (CG) in reducing weight, BMI and blood pressure and metabolic profile in patients with obesity and heart disease. To evaluate the effectiveness of the BOG on improving repertoires for coping with stressful situations related to obesity. Verify changes in behaviors that cause emotional suffering and relief from suffering based on the perception of participating patients.

Design and method:

Controlled clinical trial with patients with obesity and cardiovascular (CV) disease (hypertension, coronary artery disease and/or heart failure). Method: Clinical data (weight, BMI, blood pressure (BP), blood glucose, cholesterol levels, triglycerides) were collected from the electronic medical records before and after the intervention in BOG e CG. Quantitative variables (clinical data and coping strategies) expressed by means and standard deviations were compared by the T-Student test. Qualitative variables (behaviors causing emotional suffering, emotional reactions) were analyzed by thematic content analysis and Wilcoxon test

Results:

Thirty-eight patients with obesity and CV disease were studied, 19 for each group. After the BOG group therapy, there was a significant (p<0.05) reduction in BMI, weight, and systolic BP of the patients (Before: 39±6 kg/m2, 102±22 kg, 149±24 mmHg vs. after 34±7 kg/m2, 91±24 kg, 132±13 mmHg). In CG, there was a significant (p<0.05) increase in BMI, weight and systolic BP (Before: 35±5 kg/m2, 91±27 kg, 161±28 mmHg vs. after 36±5 kg/m2, 93±21 kg, 171±31 mmHg). We did not observe significant differences in laboratory variables in both groups. It was observed an improvement in the use of active coping, positive reinterpretation and self-distraction and a reduction in the use of maladaptive copings of self-blame, denial and behavioral disinvestment. A reduction in negative feelings, an increase in positive feelings and an attenuation of the desire to eat were identified.

Conclusions:

BOG was effective and brought clinical benefits in patients with obesity and CV disease, with significant reductions in weight, BMI and systolic BP, in addition to improvements in psychological aspects. It should be considered as a psychological treatment.
OBESITY AND VITAMIN D INSUFFICIENCY IN HYPERTENSIVE PATIENTS
Authors: Cherif Abdelghani Bachir , Bennouar Salam
Published: May 2024

Objective:

Our objective was to study the association between obesity and vitamin D status and to compare vitamin D levels before and after supplementation according to weight status in hypertensive patients.

Design and method:

A retrospective cohort study, involving 1455 patients. Student's paired-samples t-test was used to compare vitamin D levels before and after supplementation. The Pearson Correlation “r” test was used to analyze the correlation between vitamin D, anthropometric indices (body mass index (BMI) and waist circumference (WC)) and systole blood pressure (SBP).

Results:

A negative correlation was noted between the anthropometric indices (BMI and WC) and the vit D level. A highly significant variation was reported between the level of 25(OH) D before and after supplementation (p<0.001), however, the response to vitamin D supplementation in obese patients was significantly lower than in normal weight subjects. The univariate analysis showed a significant association between obesity and male gender (p = 0.02), SBP (p = 0.08), the cumulative number of cardiovascular risk factors > 5 (p = 0.07). The multivariate analysis showed a significant association between obesity and male gender (p = 0.02), SBP (p = 0.08), the cumulative number of cardiovascular risk factors > 5 (p = 0.07). presence of obesity (p=0.01) and SBP more 150 mmhg (p=0.03) were predictor factors of poor response to vit D supplementation.

Conclusions:

Vitamin D deficiency is very common in obese subjects, specific recommendations for supplementation should be adopted according to body weight, diabetes and hypertension.
U-SHAPED ASSOCIATION OF WEIGHT-ADJUSTED-WAIST INDEX AND ARTERIAL STIFFNESS AMONG US HYPERTENSIVE PATIENTS: A POPULATION-BASED STUDY
Authors: Wei Taotao , Lin Xin , Yu Jing
Published: May 2024

Objective:

The weight-adjusted-waist index (WWI) is an innovative measure of obesity that appears to surpass body mass index (BMI) in assessing lean body mass and fat mass. This study aimed to evaluate the relationship between WWI and arterial stiffness in hypertensive adults in the United States.

Design and method:

This study included 9,753 adults diagnosed with hypertension from the National Health and Nutrition Examination Survey (NHANES) spanning from 2007 to 2016. The WWI was computed by dividing waist circumference (WC) by the square root of body weight, with arterial stiffness (represented by estimated pulse wave velocity, ePWV) as the outcome. Weighted multiple linear regression and smooth curve fitting were used to test for linear and nonlinear associations. Threshold effects were determined using a two-part linear regression model. Additionally, subgroup analyses and interaction tests were conducted.

Results:

Among the participants included, the mean WWI was 11.32 ± 0.76. After multivariable adjustment, WWI showed a significant nonlinear association with ePWV. A U-shaped association between WWI and ePWV was observed. Specifically, WWI below the threshold (WWI < 10.41) was negatively associated with arterial stiffness [β=-0.50, 95%CI:(-0.57, -0.43)], while WWI above the threshold (WWI > 10.41) was positively associated with arterial stiffness [β=0.09, 95%CI:(0.07-0.11)].

Conclusions:

Our study indicates a U-shaped association between WWI and arterial stiffness among hypertensive adults in the United States. However, this needs to be confirmed in large clinical trials.
WEIGHT LOSS IN HYPERTENSIVE PATIENTS WITH OBESITY UNDER THE INFLUENCE OF LIRAGULTIDE IS ASSOCIATED WITH A REDUCTION IN INSULIN RESISTANCE AND INCREASED EFFECTIVENESS OF THERAPY
Authors: Koval Sergiy , Rieznik Larisa , Starchenko Tetyana , Penkova Marina , Lytvynov Vadim
Published: May 2024

Objective:

One of the most important areas of treatment for patients with arterial hypertension (AH) with abdominal obesity (AO) is reduction of body weight (BW), which can be achieved using the glucagon-like peptide-1 (GLP-1) receptor agonist liraglutide. Objective: to study the relationship between the degree of weight loss under the influence of liraglutide and the effectiveness of antihypertensive and lipid-lowering therapy in hypertensive patients with AO.

Design and method:

42 patients with AH of 2-3 degrees and AO of I-II degrees (24 men) aged from 46 to 60 years were examined using standard methods. Insulin resistance (IR) was determined by HOMA-IR. All patients received three-component antihypertensive therapy (a fixed combination of perindopril, indapamide and amlodipine) and, due to elevated low-density lipoprotein-cholesterol (LDL-C), atorvastatin in optimal doses. Liraglutide was administered as daily subcutaneous injections at a daily dose of 0.6 mg, with a gradual weekly dose increase of 0.6 mg to reach 3.0 mg/day. The duration of observation was 16 weeks.

Results:

After 16 weeks of treatment with liraglutide, 30 patients (71%) (the first subgroup) experienced a decrease in BW of 5% or more compared to baseline. At the same time, in 13 patients (29%) (second subgroup) BW decreased by less than 5% compared to the initial level or did not decrease. In the first subgroup of patients, a significant decrease in IR was detected from (5.06 ± 1.14) to (2.40 ± 1.22), p<0.05), whereas in the second subgroup the IR indicator did not change significantly. Among patients of the first subgroup, a significantly higher frequency of achieving target levels of “office” blood pressure (in 100% of patients) and target levels of LDL-C (in 73% of patients) was found in comparison with patients of the second subgroup (in 69% of patients, p<0.05) and in 39% of patients, p<0.05), respectively).

Conclusions:

A pronounced decrease in BW in hypertensive patients with AO under the influence of liraglutide is associated with a significant decrease in IR and also with a significant increase in the effectiveness of both antihypertensive and lipid-lowering therapy.
DEPRESSIVE SYMPTOMS AND MULTIPLE CHRONIC CONDITIONS:FINDINGS FROM THE CHINA HEALTH AND RETIREMENT LONGITUDINAL STUDY ON AGING AMONG MIDDLE-AGED AND OLDER ADULTS
Authors: Ma Weiping , Zhu Huarui , Zhang Ling
Published: May 2024

Objective:

This study aimed to explore the risk associations of depressive symptoms with hypertension, diabetes mellitus, hyperlipidemia, heart disease, and stroke among Chinese middle-aged and older adults and to provide a scientific basis for screening high-risk groups for chronic diseases.

Design and method:

A total of 8,255 middle-aged and older adults from the China Health and Retirement Longitudinal Study (CHARLS) in the 2020 waves were included. Depressive symptoms were measured using the 10-item version of the Center for Epidemiological Studies Depression Scale (CESD-10). The association between depressive symptoms and multiple chronic diseases was assessed using multivariable logistic regression analysis.

Results:

The mean age of the 8255 included subjects was (59.12±8.93) years and the detection rate of depressive symptoms was 25.34%. The differences in the detection rate of depressive symptoms among middle-aged and elderly people of different gender, age, living conditions, marital status, smoking status, alcohol consumption, and types of diseases such as hypertension were statistically significant (P<0.05). After adjusting for several variables, Logistic regression analysis showed that the associations between depressive symptoms and heart disease (OR=2.108, 95% CI: 1.601-2.775), diabetes mellitus (OR=1.396, 95%CI: 1.009-1.932), and stroke (OR=1.929, 95%CI: 1.028-3.622) were statistically significant (P < 0.05), whereas no significant association was found between depressive symptoms and hypertension and hyperlipidemia (P>0.05).

Conclusions:

The data showed that depressive symptoms were significantly associated with chronic diseases, including diabetes, heart disease, and stroke, suggesting that necessary measures should be taken to reduce the occurrence of depressive symptoms and the prevalence of multiple Chronic diseases, improve the mental condition of middle-aged and elderly people, and improve their quality of life.
OCCUPATIONAL THERAPY COMBINED WITH ADAPTED PHYSICAL ACTIVITY IN FRAIL ELDERLY SUBJECTS PRESENTING COMORBIDITY WITH HYPERTENSION
Authors: D’Amico Ferdinando , Grasso Rosetta , D’Amico Rossella
Published: May 2024

Objective:

The study investigates the effectiveness of a home care project combining occupational therapy and adapted physical activity in frail elderly patients presenting comorbidity with hypertension.

Design and method:

33 elderly patients treated for hypertension in either mono/combined therapy have been examined (15 Males - 18 Females - mean age 79 + 4 years). The design of the study included before and after a 12-month-monitoring: 1) Clinical blood pressure measurement (PA); 2) Ambulatory blood pressure monitoring (ABPM); 3)Echocardiography; 4)Cumulative Illness Rating Scale (CIRS); 5) Short Physical Perfomance Battery (SPPB). CIRS stood for all diseases scoring 3 or more. SPPB combined results of balance tests-gait speed-chair stand showing frailty for scores between 5 and 9. Frail subjects alternated the adapted physical activity with a 3-day-per-week occupational therapy programme aimed at strengthening balance&walking and monitored by an occupational therapist via telephone.

Results:

21 subjects (M 10, F 11) scored 7.5 in SPPB (Group A); 12 subjects (M 5, F 7) scored 10.2 (Group B). Clinical BP measurement showed prevalence of uncontrolled hypertension (PAS 160±3-PAD 96±34 mmHg, p<0.005) in group A (frail subjects after SPPB evaluation). In monitoring before and after the functional examination we evaluated: 1) BP: SBP 158+21 vs 138+14 mmHG (p<0.01), DBP 96+12 vs 88+10 mmHg (p<0.01)-2) PP 74.12+2 vs 57+4 mmHg (p<0.05)-3) LVM 133/110 gr/m2 vs LVM 130/110 gr/m2, LVM/h > 58/45 gr/h 2.7 vs LVM/h > 55/45 gr/h 2.7 (0.01)-4) SPPB 7.5 vs > 8.6 scores in the frail subjects group.

Conclusions:

The adapted physical excercise programme applied to elderly subjects suffering from hypertension resulted in a combined PP-LVM control. The combined medication and adapted excercise-occupational therapy determined both PP-LVM control and strengthening of physical ability in frail elderly subjects presenting comorbidity with hypertension.
BLOOD PRESSURE VARIABILITY AND FRAILTY IN THE OLDER PEOPLE: THE HYPER-FRAIL-BPV STUDY
Authors: Croce Alessandro , Bilo Grzegorz , Pengo Martino F , Zambon Antonella , Soranna Davide , Riccò Alice , Ornago Alice Margherita , Bellelli Giuseppe , Parati Gianfranco
Published: May 2024

Objective:

Blood pressure (BP) exhibits considerable variability that tends to increase with age. Frailty is a geriatric syndrome characterized by a reduction in physiological functional reserve and ability to maintain homeostasis, resulting in an increased vulnerability to adverse events. Frailty prevalence increases with age therefore BP variability (BPV) can be significantly increased in older frail patients. Nevertheless, the management of hypertension in older and frail patients has received little attention in the literature and represents an unresolved clinical question. We aimed to evaluate short term BPV in a cohort of elderly hypertensive patients and evaluate its association with frailty.

Design and method:

In this monocentric cross-sectional study we recruited hypertensive patients aged 75 years or older, evaluated at the Hypertension Center of Istituto Auxologico italiano IRCCS from May 2022 to August 2023. All patients underwent 24-hour blood pressure monitoring and a comprehensive geriatric assessment. Frailty was assessed through the Frailty Index (FI) according to the Rockwood's accumulation model. Based on the FI patients were classified as Fit (FI < 0.15), Pre-Frailty (0.15 < FI < 0.25) or Frailty (FI > 0.25).

Results:

131 patients were recruited and a total of 106 patients were analysed because of missing data. The median age was 80 years [76-83], included patients were predominantly females (73%). Overall, 23 were fit, 50 in the pre-frailty category and 33 were frail. For each of the 7 systolic BPV indices considered, we fitted a multivariable linear model to estimate their relationship with continuous FI adjusting for age, sex, BMI, short physical performance battery, mini mental state examination, presence of falls in the last year, median 24h systolic blood pressure, mean diastolic 24h blood pressure and mean 24h heart rate. A significant positive association was observed only for SD night as depicted in Table 1.

Conclusions:

Nighttime BPV was associated with frailty in a cohort of elderly hypertensive subjects. The mechanisms behind this association and its impact on cardiovascular risk stratification in elderly patients should be further investigated.
UNVEILING THE GAPS: HYPERTENSION CONTROL BEYOND THE CASCADE OF CARE FRAMEWORK
Authors: Silberzan Lena
Published: May 2024

Objective:

While the cascade of care framework established a typical “aware-treated-controlled” path to hypertension control, less is known about alternative paths to hypertension control.

This study aimed to: (i) Identify untypical paths to hypertension control; (ii) Assess social factors associated with untypical hypertension control scenarios.

Design and method:

This analysis included 170,263 French adults aged 25-69 in CONSTANCES population-based epidemiological cohort between 2012 and 2020. Blood pressure (BP) measurements following a standardized protocol during clinical examinations and hypertension history were obtained at inclusion. Pharmacological treatment data were collected from the Système National des Données de Santé (SNDS) database. Hypertension was defined by systolic BP>140/90 mmHg and/or antihypertensive treatment. Awareness, treatment, and control were assessed through participant declarations, reimbursement for antihypertensive drugs, and BP measurements, respectively. Social factors and cardiovascular morbidities associated with untypical control paths were examined using logistic regressions.

Results:

In our study, 30.8% (n=52,434) of respondents had hypertension. While the care cascade identified 13% of hypertensive respondents achieving control, this percentage rose to 19% when considering the alternative “unaware-treated-controlled” path (n=9,980). Consequently, one-third of hypertension control was not captured by the typical cascade framework.

The untypical path to control was associated with female gender (adjusted odds ratio [aOR], 1.68 [95% confidence interval (CI), 1.52-1.86]), younger age (aOR1-unit decrease, 1.08 [95% IC, 1.08-1.09]), higher education level (aORmost educated 1/4 vs less educated 1/4, 1.43 [95% IC, 1.25-1.64]), and comorbidity with another cardiovascular disease (aOR, 6.47 [95% IC, 5.79-7.23]). Northern African origin (aORvs Majority population, 1.32 [95% IC, 1.05-1.66]) was also positively associated with untypical control path, while Sub-Sahara African origin was negatively associated with untypical control path (aORvs Majority population, 0.46 [95% IC, 0.29-0.71]).

Conclusions:

This study underscores that adhering strictly to a sequential cascade of care approach may exclude socially characterized groups not fitting into defined categories. Revision of the cascade of care framework, incorporating diverse treatment modalities and recognizing potential patient reentries, is suggested to accurately assess hypertension control.
CHARACTERISING A UK COHORT WITH RETINAL ISCHAEMIC EVENTS
Authors: Tanner Alexander , Santos-paulo Stephanie , Mensah Ekow , Sunnasy Nilesh , Vundavall Sriram , Kane Ingrid , Rajkumar Chakravarthi
Published: May 2024

Objective:

Retinal ischaemic events (RIE), consisting of central retinal artery occlusions (CRAO), branch retinal artery occlusion (BRAO), and amaurosis fugax (Amfug), are commonly observed in older adults, often manifesting as sudden painless monocular visual loss. CRAO and BRAO are regarded as minor strokes, while Amfug is likened to a cerebral TIA. We present an RIE patient cohort, their clinical characteristics, and outcomes as a first step in evaluating our patient outcomes, service provision, and potentially highlighting areas for improvement.

Design and method:

This study is a retrospective consecutive case series from a major stroke centre in the UK: Royal Sussex County Hospital, Brighton. The electronic patient records of the stroke department were reviewed to identify all patients between August 2018 and December 2021 who had been managed following a diagnosis of RIE. Descriptive and inferential statistics were conducted on detailed clinical and demographic data of study participants, exploring their frequency distributions and testing associations between the three groups of RIE.

Results:

One hundred and eleven (111) study participants with RIE were identified from the stroke register, with 56.8% (n=63) diagnosed with amaurosis fugax, 25.2% (n=28) with BRAO, and 18.0% (n=20) with CRAO. Mean age was 70.6 ± 1.2 years (SEM) and 35.1% (n=39) were female. Characteristics such as blood pressure, total cholesterol, glucose and inflammatory markers (ESR and CRP) were noted to be higher in CRAO and BRAO compared to Amfug, though not statistically significant (p>0.05). Similarly, 97%(n=195) carotid doppler scans showed greater or equal stenosis ipsilateral to the RIE, with calculated Fazeka scores showing 1.2 ± 0.1 (SEM) (n=49). Outcomes post RIE demonstrated 6.8% mortality within one year of RIE diagnosis and 14.3% of this attributable to ischaemic stroke.

Conclusions:

Our cohort demonstrates that RIE is largely a large vessel disease as depicted in the risk factors identified and scores from carotid doppler and Fazeka. With RIE showing similar risk factors as that for strokes, it is essential that patients presenting with RIE should have their risk factors strictly addressed to reduce complications, morbidity and mortality associated with RIE as in all large vessel diseases.