bluuebunny/crossref_metadata_2025 huggingface dataset:
RIGHT VENTRICULAR FUNCTION IN ARTERIAL HYPERTENSION (M-MODE ECHOCG STUDY)
Authors: Tsverava Mikheil , Ugiadze Sophio
Published: June 2023

Objective:

Until recently Researchers underestimated right ventricular (RV) physiological and described it as passive conduit with a little pumping capability which just connects right atrium (RA) with pulmonary artery. Over the last decades, numerous studies have demonstrated the physiological and clinical importance of RV function. Contrary to the LV, the RV has much complex geometry. It consists of an inlet, outlet, and apical trabecular portion which are different structurally and functionally.

There is no information about Right ventricular outflow structure and function in patients with Arterial Hypertension (AH).

The aim of the research was to study the changes of RV Outflow and Inflow functional parameters in patients with Arterial Hypertension.

Design and method:

We studied 214 patients AH (male-115, fem-99, mean age 55.6±12.2, mean arterial pressure – systolic 174.1±15.2, diastolic 96.8±11.2). Control group consist from 180 normal persons (male-88, fem-92, mean age 49.7±12.2, mean arterial pressure – systolic 122.1±12.2, diastolic 71.8±10.2). All participants undergone standard EchoCG examination. Two-dimensional echocardiograms of the parasternal short axis view at the level of the aortic root were obtained for the RVOT sizes and fractional shortening (RVOT-FS) values. M-mode recordings of the RVOT were obtained and dimensions were measured at end -diastole and end systole. RV outflow Fractional Shortening (RVoutFS%, calculated with formula (RVoutDiastD-RVoutSystD)/RVoutDiastD%).

Results:

12 patients had stage-1 AH, 138- stage 2 and 64 stage 3 AH. In AH group RV wall thickness (4.2±0.9 mm versus 3.5±0.7mm), RV outflow tract systolic and diastolic diameters (32.8±4.8mm and 14.7±3.2mm versus 30.8±4.7 and 13.2±2.8mm) where greater and RVoutFS% (55.1±4.8% versus 58.8±4.3%) Pulmonary flow acceleration time (121.6±17.1versus 132.6±12.2 msec) lesser then in control. On the other hand, there was no difference in TAPSE between the groups.

Conclusions:

Despite any differences in RV inflow function There are prominent changes in RV outflow tract function and structure in patients with AH. RVoutFS% is a marker of early functional changes of RV in patients with AH
DISTINCT CARDIAC CONNEXIN-43 EXPRESSION IN HEMODYNAMICALLY UPLOADED AND UNLOADED HEART MAY IMPACT VULNERABILITY TO MALIGNANT ARRHYTHMIAS
Authors: Bacova Barbara Szeiffova , Andelova Katarina , Sykora Matus , Benova Tamara Egan , Kurahara Lin Hai , Slezak Jan , Tribulova Narcis
Published: June 2023

Objective:

Experimental and clinical studies suggest that myocardial hypertrophy in response to hypertension and hyperthyroidism increases propensity to cardiac arrhythmias. While these are rare in conditions resulting in myocardial atrophy, such as hypothyroidism or type-1 diabetes mellitus (T1DM). One of the crucial factors impacting the susceptibility of the heart to life-threatening arrhythmias is gap junction channel protein connexin-43 (Cx43), which ensure cardiac cell-to-cell coupling for electrical signal propagation that induce contraction.

We aimed to explore abundance of Cx43 protein and its cardiomyocyte topology in hemodynamically uploaded hypertrophied versus unloaded hypotrophic cardiac phenotype.

Design and method:

Analysis were performed in left ventricular tissue of adult male rats of following groups: 1. spontaneously hypertensive rat (SHR); 2. normotensive Wistar Kyoto rats (WKY) treated for 8-weeks with L-thyroxine (0.15 μg/kg, i.v.) to induce hyperthyroid status; 3. WKY rats treated with methimazol (0.05% solution, p.o.) to induce hypothyroid status; 4. WKY rats treated with strepotozotocin (50mg/kg, i.p.) to induce T1DM. Animals were compared with non-treated normotensive control rats.

Results:

Comparing to healthy non-treated rats there was a decrease of total myocardial Cx43 protein and its variant phosphorylated at serine368 in SHR and hyperthyroid rats. Besides, enhanced abnormal localisation of Cx43 was demonstrated on lateral sides of hypertrophied cardiomyocytes. In contrast, total Cx43 protein and its serine368 variant were increased in atrophied left ventricle of hypothyroid and T1DM rats. It was associated with less pronounced alterations in Cx43 topology. In parallel, the abundance of PKC epsilon, which phosphorylates Cx43 at serine368 that stabilize Cx43 function and distribution was reduced in hypertrophied heart while enhanced in atrophied once.

Conclusions:

Findings suggest that differences in the abundance of cardiac Cx43, its variant phosphorylated at serine368 and Cx43 topology may explain, in part, distinct propensity of uploaded and unloaded heart to malignant arrhythmias. It suggests that hemodynamically overloaded heart might benefit from interventions promoting unloading.

This research was supported by VEGA grants 2/0002/20, 2/0006/23, Slovak Research and Development Agency under the Contract no. 21-0410
HEMODYNAMICS STRESS TEST USING FINGER-TO-TOE PULSE WAVE VELOCITY IN SUPINE AND SITTING POSITION IN END-STAGE KIDNEY DISEASE
Authors: Khataei Sanam , Rico Élizabeth De , Addhour Saliha , Fortier Catherine , Côté Nadège , Tairi Amira , Agharazii Mohsen
Published: June 2023

Objective:

Aortic pulse wave velocity (PWV), a measure of arterial stiffness can either be measured by the ratio of distance to pulse transit time or, estimated based on the pulse wave profile (ePWV). Aortic PWV measurements are performed in the supine position as there is no added hydrostatic pressure along the arterial path, and the recording of the arterial pressure waveform of the femoral arterial is easier to perform. However, finger-to-toe PWV (ftPWV), a surrogate for aortic PWV, can easily be performed in other positions, such as the sitting position, giving the opportunity to examine arterial wall properties in a dynamic manner. The aim of the study was to observe the impact of the position (supine vs sitting) on the ePWV and on the measured ftPWV in patients with end-stage kidney disease.

Design and method:

In a cross-sectional study involving adult hemodialysis patients, we performed vascular assessments in the supine and the sitting position within the first 2 hours of their hemodialysis session. The ePWV was obtained using the Mobil-O-Graph and ftPWV was obtained using the pOpmètre®. Three measures were taken with each device. Generalized estimated equations were then used to calculate the average of ePWV and ftPWV with respect to each position.

Results:

In 46 patients (17 females), the average age was 71±12 years and the blood pressure was 136±24 /77±15 mmHg. The ePWV was 10.8 m/s (IC95% :10.1-11.4 m/s) in the supine position and 10.7 m/s (IC95%: 10.0-11.3 m/s) in the sitting position. However, the ftPWV was 12.1 m/s (IC95%: 9.6-14.7 m/s) in the supine position but it increased to 22.0 m/s (IC95%: 15.0-29.0 m/s) in the sitting position. This increase of 9.8 m/s was highly significant (P = 0.006) even though the brachial blood pressure and the heart rate had barely changed.

Conclusions:

This study shows that finger-to-toe PWV increases in the sitting position, offering us the opportunity to explore this postural changes in PWV as a possible vascular stress test.
IMPACT OF BODY POSITION ON ARTERIAL STIFFNESS OF ELASTIC AND MUSCULAR ARTERIES
Authors: Rico Elizabeth de , Côté Nadège , Addour Saliha , Khataei Sanam , Legault Laurent , Tairi Amira , Philibert Emy , Fortier Catherine , Agharazii Mohsen
Published: June 2023

Objective:

Arterial stiffness is assessed through determination of pulse wave velocity (PWV) over an arterial segment of interest. Measurements are traditionally done in a supine position, which is both practical for high quality arterial pressure wave recordings, and the stability of pressure exerted on the arterial wall along the arterial path. The aim of this project was to study the effect of body position on the stiffness of elastic and muscular arteries.

Design and method:

This study was conducted with healthy adults. Aortic (cf-PWV) and brachial stiffness (CR-PWV) were repeatedly measured in three different positions (supine, 30̊ and 60̊) using the Complior Analyse. Brachial blood pressure (Mobil-O-graph) was also measured in each position. Generalized Estimating Equations in SPSS were performed to establish changes of PWV between positions.

Results:

In 23 healthy individuals (65% female, mean age of 36±15 years, and mean systolic (SBP) and diastolic blood pressures (DBP) of 120±2 mmHg and 76±2 mmHg, respectively), CF-PWV increased progressively with body tilting (8.7 (CI95% = 8.0–9.4) m/s supine, 9.4 (CI95% = 8.8–10.0) m/s at 30̊ and 9.5 (CI95% = 8.8–10.1) m/s at 60̊) (p<0.001)). On the other hand, CR-PWV didn’t significantly change with body tilting (8.7 (CI95% = 8.0–9.3) m/s supine, 8.8 (CI95% = 8.0–9.6) m/s at 30̊ and 8.9 (CI95% = 8.1–9.6) m/s at 60̊). SBP didn’t significantly change with body tilting (120 (CI95% = 116-125) mmHg supine, 121 (CI95% = 116–125) mmHg at 30̊ and 122 (CI95% = 117-126) mmHg at 60̊), while DBP increased (76 (CI95% = 71-80) mmHg supine, 78 (CI95% = 73–83) mmHg at 30̊ (p<0.022) and 81 (CI95% = 77-85) mmHg at 60̊ (p<0.001)). Heart rate also increased with body tilting (68 (CI95% = 64–72) BPM supine, 69 (CI95% = 65–73) BPM at 30̊ and 77 (CI95% = 72–82) BPM at 60̊ (p<0.001)).

Conclusions:

These preliminary results show that elastic and muscular arteries tend to react differently to body positions, without significant changes in arterial stiffness of medium muscular arteries in the arm.
DETERMINANTS OF ELASTIC AND STIFFENING PULSE PRESSURE COMPONENTS: RESULTS OF THE NEW HUNGARIAN ABPM REGISTRY
Authors: Nemcsik János , Páll Dénes , Takács Johanna , Koller Ákos , Járai Zoltán
Published: June 2023

Objective:

Pulse pressure (PP) received relative less attention in the guidelines regarding its potential role in the hypertension-mediated target organ damage. Recently it has been proposed that PP can be divided into two components: elastic PP (elPP) and stiffening PP (stPP). Thus the aim of our study was to explore the determinants of 24-hour, daytime and nighttime elPP and stPP in a new national ambulatory blood pressure monitoring (ABPM) database.

Design and method:

ABPM data were collected from the Hungarian ABPM Registry between February 2021 and August 2022. The Hungarian ABPM Registry is a an ongoing multicenter, open-label, observational non-interventional study. Meditech ABPM-06 monitors were used for ABPM measurements. Basic patients’ data were documented in electronic case report forms and were later analyzed together with ABPM data. elPP and stPP were calculated according to Gavish et al (DOI:10.1097/HJH.0000000000003258).

Results:

14817 ABPM data were analyzed. The average age of the subjects was 55.29 ± 15.1 years, 7845 (48.9%) of them were men. 24h, daytime and nighttime elPP were 47.42 ± 8.89, 46.45 ± 9.34 and 45.93 ± 10.94 mmHg, respectively. 24h, daytime and nighttime stPP were 8.51 ± 5.86, 9.15 ±6.56 and 8.62 ± 7.81 mmHg, respectively. Under the age of 50 years all elPPs were significantly lower in women compared to men, while all stPPs were lower in both sexes in age under 50 (p<0.05). Independently from age and sex, obesity increased all elPPs, while under the age of 50 years nighttime stPP was elevated only in obese women (p<0.05). The independent determinants of daytime and nighttime elPPs were age, systolic blood pressure (sBP), obesity and diabetes with adding ischemic heart disease in case of 24h elPP. The independent determinants of 24h and daytime stPPs were age, sBP and diabetes, while in case of nighttime stPP age, sBP and sex.

Conclusions:

The new Hungarian ABPM Registry underline the importance of PP and its elastic and stiffening components. The evaluation of their determinants can help to better understand the pathomechanisms responsible for the development of hypertension-mediated target organ damage.
DIFFERENCES IN AMBULATORY BP LEVELS AND INTENSITY OF ANTIHYPERTENSIVE TREATMENT BETWEEN MEN AND WOMEN UNDERGOING PERITONEAL DIALYSIS
Authors: Georgianos Panagiotis , Vaios Vasilios , Vareta Georgia , Georgianou Eleni , Sgouropoulou Vasiliki , Varouktsi Garyfallia , Tsinari Ariti , Zebekakis Pantelis , Liakopoulos Vassilios
Published: June 2023

Objective:

The aim of the present study was to compare the ambulatory blood pressure (BP) levels and intensity of antihypertensive treatment between men and women with end-stage kidney disease receiving long-term peritoneal dialysis (PD).

Design and method:

Following a case-control design, 48 male PD patients from Northern Greece were matched for age and history of heart failure with 48 female patients in a 1:1 ratio. All patients underwent 24-hour ambulatory BP monitoring with the oscillometric device Mobil-O-Graph (IEM, Stolberg, Germany). The BP-lowering medications actually taken by the patients were prospectively recorded.

Results:

Age, dialysis vintage and the burden of cardiovascular comorbidities did not differ between men and women. There were no significant sex differences in ambulatory systolic BP (24-hour period: 129.0±17.8 vs. 128.5±17.5 mmHg, P = 0.138; daytime: 129.6±17.5 vs. 129.7±17.4 mmHg, P = 0.991; nighttime: 127.0±19.8 vs. 125.9±18.8 mmHg, P = 0.776). However, the levels of ambulatory diastolic BP were consistently higher in men than in women over the entire 24-hour period (81.5±12.1 vs. 76.8±10.3 mmHg, P<0.05) as well as during daytime (82.5±11.8 vs. 78.1±10.4 mmHg, P<0.05) and during nighttime (78.8±13.9 vs. 73.8±11.1 mmHg, P<0.05). The proportion of patients with 24-hour ambulatory BP <130/80 mmHg was numerically lower in men than in women (35.4% vs. 43.8%), despite the greater intensity of antihypertensive treatment in men. As compared with women, men were receiving a higher average number of BP-lowering medications daily (2.4±1.1 vs. 1.8±1.1, P<0.05) and were being treated more commonly with beta-blockers (85.1% vs. 66.7%, P<0.05) and dihydropyridine calcium-channel-blockers (70.2% vs. 43.8%, P = 0.01).

Conclusions:

The present study shows that among patients undergoing PD, the ambulatory BP levels and intensity of antihypertensive treatment are higher in men than in women. Prospective observational studies are needed to explore whether these sex differences in the severity of hypertension contribute to a higher risk for adverse health outcomes in men receiving long-term PD.
PROGNOSTIC SIGNIFICANCE OF BLOOD PRESSURE FLUCTUATIONS IN THE MORNING AND EVENING FOR CARDIOVASCULAR OUTCOMES
Authors: Cheng Chi-Chen , Chang Wei-Lun , Chuang Shao-Yuan , Lee Yu-Hsuan , Huang Chi-Jung , Cheng Hao-Min , Chiang Chern-En , Chen Chen-Huan , Asayama Kei , Ohkubo Takayashi , Niiranen Teemu J. , Boggia José , Staessen Jan A.
Published: June 2023

Objective:

Independent of office blood pressure (BP) levels, home BP is associated with the occurrence of cardiovascular events. Abnormal diurnal variations in BP have been linked to cardiovascular disease (CVD). However, data on diurnal patterns of home BP, the morning and evening BP difference (MEdiff), are scarce. This study looked into the relationship between all MEdiff indices and cardiovascular outcomes.

Design and method:

The association was assessed using data from the International Database of Home Blood Pressure in Relation to Cardiovascular Outcome (IDHOCO), which comprised 6753 patients from five cohorts. We found 1254 patients who had taken home BP readings every morning and every evening for more than 14 days. The MEdiff over a 13-day period, omitting the first day, for each patient were used to calculate the average (MEdiff_sbp_avg), minimum (MEdiff sbp_min), and maximum (MEdiff_sbp_max) values. MEdiff is defined as morning (6AM-8AM) minus evening BP (8PM-10PM) measures. The prognostic values of these parameters were assessed using Cox proportional hazards models. Factors adjusted in the base model included age, sex, body mass index, total cholesterol, high-density lipoprotein cholesterol, smoking status, prevalence of diabetes, history of cardiovascular disease, and antihypertensive drug treatment.

Results:

Only MEdiff_min_sbp strongly predicted CVD (183 events; mean follow-up time of 13.4 years), but MEdiff_avg_sbp (hazard ratio: 0.906, 95% CI: 0.087-1.018 per SD), MEdiff_max_sbp (0.949, 0.846-1.064 per SD) did not. Spline regression analysis with thresholds of -17 mmHg and -4 mmHg revealed a U-curve association between MEdiff_min_sbp and the risk of CVD outcomes. Three groups were identified by MEdiff_min_sbp: lower than -17 mmHg (Low, n = 574), between -17 and -4 mmHg (medium, n = 568) and higher than -4 mmHg (high, n = 112). Compared to the low group, the high group had a significantly higher risk of CVD (1.353, 1.052-1.739), in the models with adjustment for the mean of the morning and evening SBP values, and MEdiff_avg_sbp or various BP variability indices.

Conclusions:

MEdiff_min_sbp was strongly associated with an increased risk of cardiovascular outcomes, suggesting that it could be a useful BP index for describing abnormal BP diurnal variations for CVD risk prediction.
A KETOGENIC DIET REDUCES TISSUE SODIUM CONTENT: AN EXPLORATORY STUDY
Authors: Shoumariyeh Tarik , Trattnig Siegfried , Zaric Olgica , Mcintyre Christopher , Oberbauer Rainer , Kovarik Johannes Josef
Published: June 2023

Objective:

Hypertension and diabetes are a substantial global public health problem. The prevalence of these diseases will further increase in the near future, leading to increased health and socioeconomic costs. Hence efficient therapeutic approaches are urgently needed. It has been previously shown that nutritional approaches including a very-low carbohydrate, or a ketogenic diet potentially decrease body weight, blood pressure and glucose levels in patients with type 2 diabetes along with an overall significant reduction in their pill burden. However, the detailed physiological mechanisms underlying the observed induction and maintenance of diabetes remission remain largely unknown.

Previous studies have shown that the skin could be a buffer system for sodium and that skin sodium content could be both a pathogenic cause and a marker of hypertension and salt sensitivity.

Since a nutritionally created metabolic milieu such as nutritional ketosis can lower blood pressure, we hypothesize that this dietary approach also reduces tissue sodium content.

Design and method:

By using 7-T 23Na MRI technique, we performed an exploratory study and analyzed skin and muscle sodium concentration before, and after a 6-week ketogenic diet in three healthy probands. Nutritional ketosis was verified by frequent check of blood ketone (beta-hydroxybutyrate; BOHB) levels greater than 0.3 mmol/L.

Results:

Preliminary data of our planned exploratory study (in patients with chronic kidney disease and type 2 diabetes mellitus and healthy probands) demonstrated that compared to baseline 6 weeks of ketogenic diet decreased tissue sodium content in the skin (16.6 ± 2.1 vs. 12.6 ± 2.1 mmol/L), in the medial gastrocnemius muscle (20.5 ± 0.9 vs. 16.7 ± 0.7 mmol/L), in the lateral gastrocnemius muscle (19.7 ± 1.0 vs. 16.0 ± 1.0 mmol/L) and in the soleus muscle (13.1 ± 0.8 vs. 11.5 ± 0.5 mmol/L).

Conclusions:

Our results indicate a massive reduction of tissue sodium concentration in healthy volunteers in response to a ketogenic diet which might be associated with the observed clinical benefits and be implicated in the anti-hypertensive effects of this powerful dietary intervention. Findings of this study could have an impact on future treatment strategies of various chronic diseases.
SKIN SODIUM CONTENT AS A PREDICTOR OF BLOOD PRESSURE RESPONSE TO RENAL DENERVATION
Authors: Günes-Altan Merve , Schmid Axel , Kannenkeril Dennis , Linz Peter , Ott Christian , Bosch Agnes , Schiffer Mario , Uder Michael , Schmieder Roland
Published: June 2023

Objective:

In patients with treatment resistant hypertension (TRH), renal denervation (RDN) emerged as an adjacent therapeutic option. It has been detected that patients with TRH have elevated Sodium (Na) content in muscle and skin. This analysis aimed at evaluating whether tissue Na content predicts blood pressure (BP) response after RDN.

Design and method:

Radiofrequency device based endovascular RDN was performed in 53 patients with uncontrolled TRH (office BP> = 140/90 mmHg and diagnosis confirmed by 24-h ambulatory BP monitoring) in our certified RDN center. Office and 24-h ambuatory BP were measured at baseline and after 6 months. To assess tissue Na content 23Na-MRI was performed at baseline prior to RDN. We splitted the study cohort based on the median systolic 24-h ambulatory BP reduction after 6 months into responders and non-responders and compared tissue Na content and baseline characteristics between these groups. The study was registered at http://www.clinicaltrials.gov (NCT01687725).

Results:

53 patients were followed up for at least 6 months. Office systolic and diastolic BP were reduced by -12.9±21.1 mmHg and -7.7±12.5 mmHg and 24-h ambulatory systolic and diastolic BP were reduced by -8.6±14.0 mmHg and -4.7±9.5 mmHg after 6 months. Responder could be characterized as patients with low tissue sodium content in skin, more female patients, patients with aldosteron-antagonists, high baseline 24-h night-time heart rate and high LDL-cholesterol (see table, only p<0.10 are shown). This results remained significant after adjustment for baseline 24-h SBP. Similar results were obtained if the two groups were created based on the median of 24-h day-time and night-time BP reduction after 6 months.

Conclusions:

We identified Na in skin, sex, 24-h night-time heart rate, aldosterone antagonists and LDL-cholesterol as predictors of the systolic BP response. We conclude that 23Na-MRI may assist to select patients with uncontrolled TRH who will have a clinically meaningful BP reduction following RDN treatment.
COMPRESSION OF RENAL ARTERIES BY THE DIAPHRAGMATIC CRUS: PROPOSAL FOR A NEW CLASSIFICATION
Authors: Basset Thomas , Ghelfi Julien , Thony Frederic , Mathieu Rodiere , Mathieu Finas , Gilbert Ferretti , Olivier Ormezzano
Published: June 2023

Objective:

Renal artery entrapment (RAE) is a rare cause of hypertension, and its management remains debated between surgical and endovascular approaches. The aim of this study was to propose an updated classification of RAEs.

Design and method:

This retrospective study included all patients referred to our center between 1995 and 2021 with a diagnosis of RAE confirmed by CT scan. The primary objective was to describe the type of renal artery (RA) compression (ostial or truncular location and focal or long extension). The association between the type of compression and age, side of compression and high origin of the RA was also evaluated.

Results:

Forty patients with 45 RAE were included. The compression was focal and ostial in 22 arteries (49%), long and truncular in 13 RA (29%) and focal and truncular in 10 RA (22%), of which 2 RA (4%) originated from the thoracic aorta with a transdiaphragmatic passage. From this distribution, an updated classification with 4 types of RAE was proposed including: type 1: ostial compression, type 2: long truncular compression, type 3: focal truncular entrapment and type 4: truncular entrapment with intrathoracic RA origin. There was no association between the type of RAE and the patient's age (p = 0.09) or the side of compression (p = 0.42). Type 2 and type 4 RAEs were associated with a higher origin of the compressed artery (p = 0.04).

Conclusions:

This study proposed an updated classification of RAE with four type of compressions. Knowledge of these conditions may be helpful for a future treatment algorithm.
CARDIAC MANIFESTATION IN PATIENTS WITH TAKAYASU'S ARTERITIS IN THE CONTEXT OF ALTERATION OF VENTRICULAR-ARTERIAL COUPLING
Authors: Galita Andreea Madalina , Andrei Oana
Published: June 2023

Objective:

Takayasu's arteritis is a chronic, progressive inflammatory disease of the large vessels, diffusely disseminated. Thus, it can affect any organ system and can have a wide range of clinical manifestations. In the absence of control of triggering factors and in the absence of treatment, the long-lasting evolution of the inflammation and the detection in advanced stages has led to the appearance of vascular stiffness and left ventricular hypertrophy. Therefore, the decrease in both arterial and ventricular elastance has led to a decrease in mechanical work and myocardial efficiency, which is the expression of altered ventricular-arterial coupling.

Design and method:

We present the case of a 25-year-old patient, with no significant personal history, admitted to our clinic for the management of high blood pressure values. Biologically, the patient has stage IV chronic kidney disease and significant inflammatory syndrome. The echocardiography shows significant concentric ventricular hypertrophy, with mild systolic dysfunction, due to diffuse hypokinesia and low ventricular mechanical work. Given the multiple arguments of renovascular pathology, we took a native CT angiography which showed circumscribed lesions in the vertebral arteries, carotid, upper mesenteric and left subclavian artery. Therefore, we suspect the Takayasu's arteritis as a possible diagnosis and the treatment with systemic corticosteroid was started, which led to the decrease of the inflammatory syndrome and to the reduction of the inflammation at carotid arteries level, evidenced by a vascular Doppler ultrasound.

Results:

Ventricular-arterial coupling is important for understanding the pathophysiological mechanisms underlying both arterial and left ventricular remodeling. The development of advanced imaging techniques has led to the possibility of non-invasive analysis of the ventricular-atrial relationship which is important for determining the mechanical work, and thus for a better understanding of the mechanisms that led to the development of ventricular hypertrophy.

Conclusions:

Although left ventricular hypertrophy is common in patients with high blood pressure, in a young patient thorough investigation of other possible etiologies has an important role in therapeutic management. Contrary to the literature data, in the present case there is an association between the episodes of severe hypertension and the ones of arteritis activity.
ASSOCIATION BETWEEN SYSTOLIC BLOOD PRESSURE AND CHANGE IN EGFR OVER TIME IN A MULTI-ETHNIC COHORT: THE HELIUS STUDY
Authors: Tonkin-Hill Gina , Bouwmeester Thomas , Vriend Esther , Galenkamp Henrike , Valkengoed Irene Van , Collard Didier , Vogt Liffert , Born Bert-Jan van den
Published: June 2023

Objective:

The assess the extent to which blood pressure relates to progression of CKD, among different ethnicities with disparate cardiorenal risk. We assessed the relationship between baseline systolic blood pressure (SBP) and change in renal function over time in a multi-ethnic population.

Design and method:

This analysis used baseline and follow-up data from 9 828 participants in the prospective Healthy Life in an Urban Setting (HELIUS) cohort study, a population-based study, including individuals of Dutch, South-Asian Surinamese, African Surinamese, Ghanaian, Turkish and Moroccan descent. Linear regression and interaction analysis were used to assess the association between baseline SBP and change in eGFR over time.

Results:

Overall eGFR decreased by -0.30 ml/min/1.73m2 (95%CI[-0.42, -0.19], p<0.001) per 10 mmHg increase in baseline SBP after 6.3 (SD 1.1) years of follow-up. This curve steepened from a SBP of 120 mmHg onwards to -0.44 ml/min/1.73m2 (95%CI[-0.61, -0.27], p<0.001) for every 10 mmHg increase in SBP. The association was significantly influenced by ethnicity (p<0.001), diabetes (p = 0.003) and albuminuria (p = 0.002), but not by age or sex. Individuals with albuminuria or diabetes had a more than 3 times larger SBP related eGFR decline compared to those without diabetes or albuminuria. Dutch, African Surinamese and Moroccan participants had a slightly steeper eGFR decline, but the direction of effect was consistent across all subgroups.

Conclusions:

Our findings confirm the relation between SBP and eGFR over time in different ethnic groups, steepening from a SBP of 120 mmHg onwards and may help to further guide strategies for preventing hypertension related CKD.
EFFECTS OF SODIUM-GLUCOSE CO-TRANSPORTER 2 INHIBITORS ON HEART FAILURE IN CHRONIC KIDNEY DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Alexandrou Maria Eleni , Tsitouridis Alexandros , Theodorakopoulou Marieta , Kamperidis Vasileios , Pella Eva , Sampani Erasmia , Xanthopoulos Andrew , Papagianni Aikaterini , Sarafidis Pantelis
Published: June 2023

Objective:

Sodium-glucose co-transporter 2 (SGLT-2) inhibitors significantly reduce the risk for hospitalizations for heart failure (HF) in patients with diabetes, and HF; findings in patients with chronic kidney disease (CKD) are not uniform. Objectives: We aimed to perform a meta-analysis exploring the effect of SGLT-2 inhibitors on HF events in patients with CKD and across subgroups defined by baseline kidney function.

Design and method:

A systematic search in major electronic databases was performed. Randomized controlled trials providing data on the effect of SGLT-2 inhibitors on the primary outcome, time to hospitalization or urgent visit for worsening HF in patients with prevalent CKD at baseline or across subgroups stratified by baseline estimated glomerular-filtration-rate (eGFR) were included.

Results:

Twelve studies (n = 89,191 participants) were included in the meta-analysis. In patients with CKD, treatment with SGLT-2 inhibitors reduced the risk for HF events by 32% compared to placebo (hazard ratio [HR] 0.68; 95%CI 0.63-0.73). Reduction in HF events with SGLT-2 inhibitors was more prominent in patients with eGFR<60 ml/min/1.73m2 (HR 0.68; 95%CI 0.62-0.74) than in those with eGFR> = 60 ml/min/1.73m2 (HR 0.76; 95%CI 0.69-0.83). Subgroup analysis according to type of SGLT-2 inhibitor showed a consistent treatment effect across all studied agents (p subgroup-analysis = 0.44). Sensitivity analysis including data from studies including only diabetic patients showed an even more pronounced effect in eGFR subgroup<60 ml/min/1.73m2 (HR 0.62; 95%CI 0.54-0.70).

Conclusions:

Treatment with SGLT-2 inhibitors led to a significant reduction in HF events in patients with CKD. These findings may change the landscape of HF treatment in patients with advanced CKD.
ANEMIA IN HYPERTENSIVE PATIENTS WITH CHRONIC RENAL FAILURE, WHAT ARE THE CHARACTERISTICS?
Authors: Nigassa Nawel Brikci , Bendiab Nabila Taleb
Published: June 2023

Objective:

During chronic renal failure, the progressive impairment of kidney functions results in a set of manifestations, initially biological, then clinical. Anemia and high blood pressure are common complications during chronic kidney disease.

The aim of this study is to determinate the main characteristics of anemia in hypertensive patients with chronic kidney disease

Design and method:

This descriptive work is a retrospective cross-sectional study aimed at evaluating the iron status of 70 hypertensive chronic renal failure patients. The average age in this study was 65 years with a male predominance (51%).

In our study, 70 patients with chronic renal failure of all stages participated, hypertensive and anemic.

The count of the blood elements and the hemoglobin assay were done by optical measurement using the ADVIA® 2120i automaton. The assay of vit B12, folate and ferritin in the blood by enzymatic chemiluminescence.

Results:

In our study, the mean hemoglobin was 10.18 g/dl, In our series of hemodialysis patients, mean serum ferritin was 276±207.14 ng/ml. In our population, blood pressure averages are of the order of: 130.29 ± 22.33 mm Hg for PAS, and 69.86 ±10.16 mm Hg for DBP.

Regarding patients with chronic renal failure not on dialysis 43.5% of patients had serum ferritin low.

50% had normal ferritinemia, and 6.45% of patients had elevated serum ferritin.

Ford's study found 2.92% of patients with low serum ferritin, 25.05% had a normal level, and 72.02% had hyperferritinemia. At 26% of patients in our population, the blood pressure figures were > 140/90 mmHg, while 74% of patients reached the target .

Conclusions:

Chronic renal failure exposes to numerous hematological and cardiovascular type complications, which can themselves induce health problems, in addition Correction of anemia is not always beneficial for patients suffering from CKD in due to increased blood pressure.

Perform periodic biological and hormonal analyzes. Recommend lifestyle and dietary measures in all hypertensive patients, chronic renal failure. Carry out awareness campaigns with the general public for a better understanding of chronic kidney disease
EFFECT OF ORAL FLAVONOIDS ON ARTERIAL STIFFNESS IN CKD – A PILOT PROSPECTIVE STUDY
Authors: Haddad Nasra , Bagopoulou Natasa , Kontogiorgos Ioannis , Papatolios Thomas , Papadopoulou Evaggelia , Makridis Dimitrios , Tzimikas Stergios , Fountoglou Anastasios , Kalaitzidis Rigas , Karasavvidou Despoina
Published: June 2023

Objective:

Flavonoids, the main category of polyphenols possess antioxidative and antihypertensive properties mediated through endothelial protection, renin-angiotensin-aldosterone and sympathetic system suppression. The aim of the study was to evaluate the effect of oral flavonoids administration in arterial stiffness indices and of oxidative stress markers in patients with Chronic Kidney Disease (CKD).

Design and method:

The enrolled patients received chocolate bars rich in polyphenols (200 mg) daily for a period of 3 months The patients underwent clinical examination and laboratory test arterial stiffness measurements with Sphygmocor. Markers of oxidative stress (total phenolic contents, total plasma antioxidant capacity, protein carbonyls) were also measured.

Results:

Sixteen patients were enrolled in the study, [median age 62.5 years (± 8,2), 14 patients (87,5%) were male]. Clinical characteristics, blood pressure measurements, arterial stiffness indices and markers of oxidative stress are summarized in table 1,2 and 3.

Peripheral systolic Blood Pressure (PSBP) was decreased by 13,56 mmHg (± 2,57), (p<0,001). Pulse wave velocity (PWV) and central pulse pressure (CPP) were significantly decreased (8,2 m/sec (5,1-9,22), vs 8,85 m/sec (6,7-11,75), (p<0,001) and 47,63 (36,5-60) versus [59,13 mmHg (43,5-69 respectively) at the end of the study], (p = 0,003). Markers of oxidative stress were also improved. A decreased in plasma proteinic carbonyls 52,54 nmol/ml ± 25,04 versus (73,50 nmol/ml ± 18,65, (p<0,001) was

observed while antioxidative capacity was increased 3,55% (1,15-6,38) versus 12,51% (6,26-17,66) (p = 0,013). Importantly no side effects were observed during the study period.

Conclusions:

In this pilot study, oral flavonoid supplementation in the dose of 200 mg may improve arterial stiffness indices and systolic blood pressure measurements and contribute to the improvement of antioxidative capacity in CKD patients.
FEATURES OF DAILY BLOOD PRESSURE IN PATIENTS WITH ARTERIAL HYPERTENSION WITH CHRONIC KIDNEY DISEASE
Authors: Duysewnbaeva Aziza , Srojidinova Nigora , Saidakbarova Feruza
Published: June 2023

Objective:

To study the daily profile of blood pressure in patients with arterial hypertension (AH) with chronic kidney disease (CKD).

Design and method:

The study included 120 patients with AH I-III degree, who received inpatient treatment. CKD stages were determined according to glomerular filtration rate (eGFR), according to the modern KDIGO 2013 classification. Daily blood pressure profile (DAP) was assessed using the Medicom-combi device (Russia).

Results:

Among the examined patients, preserved renal function of CKD C1 was observed in 20.8% (n = 25); CKD C2 – in 50.8% (n = 61); CKD C3A – in 19.2% (n = 23); CKD C3B – in 9.2% (n = 11) p<0.001. CKD C4 and terminal stages were not detected. It was revealed that according to increasing of degree of CKD, values of the average daily SBP (p = 0.013) average daytime SBP (p = 0.04), mean night SBP (p = 0.001) significantly rises. The load index of elevated daytime and nighttime SBP was high in AH patients with lower eGFR values, p = 0.001. A normal daily profile of SBP/DBP had 28%/32% of patients of the 1st group vs 24.61%/37.70% of patients of the 2nd group vs 37.78%/21.73% of patients of the 3rd group vs 0% /0% of patients of the 4th group, SBP ⇙2 = 40.62 p<0.01; DBP ⇙2 = 47.21, p<0.001. The number of non-dippers in SBP was somewhat higher in the group of patients with CKD C3b: night reduction speed (NRS) SBP 40% in group 1 vs 49.1% in group 2 vs 52.17% in group 3 vs 54.54% in group 4 group ⇙2 = 9.35, p = 0.02. In the group of patients with CKD C3b, individuals with a daily profile of SBP/DBP night-pickers significantly prevailed: 32%/20% vs 14.75%/13.11% vs 13.04%/13.04% vs 45.45%/ 54.54% (in groups 1, 2, 3 and 4, respectively) in SBP ⇙2 = 32.47 p<0.001, in DBP ⇙2 = 64.25 p<0.001. There was a significant increase in patients with a daily profile of over-dipper according to DBP in patients with CKD C3b:0% vs 4.91% vs 13.04% vs 27.27% ⇙2 = 41.47, p<0.001.

Conclusions:

AH patients with CKD have more pronounced disturbances in the daily blood pressure profile, which contribute to an increased risk of developing complications of arterial hypertension.
DIFFERENCES IN ASSOCIATION OF EJECTION DURATION AND CAROTID-FEMORAL PULSE WAVE VELOCITY WITH TARGET ORGAN DAMAGE
Authors: Bai Yaya , Jia Huiying , Avolio Alberto , Qian Yi , Zuo Junli
Published: June 2023

Objective:

Target organ damage (TOD is affected differently by cardiac and vascular function parameters such as ejection duration (ED) and carotid-femoral pulse wave velocity (cfPWV). This study aimed to quantify the relative differences in relationship of TOD with ED and cfPWV.

Design and method:

The study was conducted in 1254 patients (64.27% males) from Ruijin Hospital (December 2018 to August 2022). All participants provided urine and blood samples and information from medical records. cfPWV was measured using applanation tonometry and leg cuff waveforms (SphygmoCor, AtCor Medical, Sydney, Australia), and ED was obtained from waveform features. TOD was assessed in terms of left ventricular hypertrophy (LVH), microalbuminuria, chronic kidney disease (CKD), and abnormality of carotid intima-media thickness (CIMT).

Results:

Stepwise linear regression models of cfPWV and ED (individually or together) showed that cfPWV was positively correlated with left ventricular mass index (LVMI) (beta = 0.131, p 0.002) and Log (albumin-creatinine ratio, ACR) (beta = 0.123, p = 0.004), while ED was negatively correlated with LVMI (beta = –0.244, p < 0.001) and positively correlated with the estimated glomerular filtration rate (eGFR) (beta = 0.115, p = 0.003). When cfPWV and ED were added separately or together in multiple stepwise logistic regression models, cfPWV was associated with CKD [odds ratio (OR) = 1.240, 95% confidence interval (CI) 1.055–1.458, p = .009], while ED was associated with LVH (OR = 0.983, 95% CI 0.975–0.992, p < 0.001). In the control group with normal cfPWV (< 10 m/s) and normal ED (range 281-321 ms), LVH was significantly lower in patients with high ED (OR = 0.574, 95% CI 0.374–0.882, p = 0.011), but significantly elevated in those with high cfPWV and low ED (OR = 6.799, 95% CI 1.305–35.427, p 0.023).

Conclusions:

cfPWV was more strongly associated with renal damage, while ED was more strongly associated with cardiac dysfunction. As an index of arterial stiffness, cfPWV has an influence on wave reflection which can affect and ED, with a combined effect on LVH.
ASSOCIATION OF ARTERIAL STIFFNESS WITH LEFT VENTRICULAR FUNCTION AND THE IMPACT OF CARDIAC REHABILITATION IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION
Authors: Joo Seungjae , Yoon Homin , Kang Bomin , An Soyeon , Boo Kiyoung , Lee Jaegeun , Choi Joonhyouk , Kim Songyi
Published: June 2023

Objective:

Arterial stiffness has an important role in the pathophysiology of coronary artery disease and heart failure. The association of arterial stiffness with left ventricular (LV) function and the impact of cardiac rehabilitation in patients with acute myocardial infarction (AMI) were investigated in this study.

Design and method:

Echocardiographic indexes of LV volumes, systolic function, and diastolic function were measured in the usual way. Effective arterial elastance (EA) and index (EAI) was calculated from stroke volume measured using LV outflow waveform. The exercise-based, outpatient cardiac rehabilitation (CR) program, which was composed of 8 to 12 visits during 4 weeks to 6 months, was provided, and the follow-up (F/U) echocardiographic study was done after 6 months.

Results:

Twenty-nine patients (age 58.7+/-10.2 years) with AMI were enrolled, but 8 patients denied CR program. At baseline, EAI was significantly associated with E’ (beta -0.379, P = 0.035) and LV global longitudinal strain (GLS) (beta 0.458, P = 0.014). F/U echocardiographic data showed decreased EAI (from 0.95+/-0.24 to 0.85+/-0.28 mmHg/ml/m2, P = 0.039), increased E’ (from 6.34+/-2.34 to 7.40+/-2.86 cm/sec, P = 0.032), and improved LV GLS (from -13.7+/-2.8 to -16.6+/-3.0%, P <0.001) in patients with CR program, but not in patients without CR program. Changes of EAI was significantly associated with changes of E’ (beta -0.396, P = 0.048).

Conclusions:

Arterial stiffness was associated with LV dysfunction in AMI patients. The CR improved the arterial stiffness and LV dysfunction.
CLINICAL INERTIA REGARDING LIFESTYLE CHANGES AND THE ADHERENCE TO THE ADVICE IN HYPERTENSIVE PATIENTS LIVING IN THE CROATIAN RURAL AREA DAMAGED BY AN EARTHQUAKE
Authors: Skelin Juraj , Prgomet Luka , Vuksan-Cusa Zrinka , Bosnic Klara , Jelakovic Bojan
Published: June 2023

Objective:

Hypertension is a worldwide health issue that can heavily impact the patient's health and life expectancy if not treated. There are many habits in our day-to-day life that can help or hinder the treatment of hypertension.

Our objective was to describe the frequency of doctors’ advice regarding salt intake, weight loss and physical activity and the adherence of patients with hypertension to those suggestions in the rural population from the earthquake damaged area.

Design and method:

Our sample consists of 120 patients diagnosed with hypertension who participated in “The Silent Killer Hunt” project in this rural area. The patients were given a questionnaire which included questions about their doctors’ advice regarding salt intake, weight loss and physical activity and whether or not they took that advice.

Results:

Out of 120 patients, 66% were advised to reduce their salt intake and 91.4% of them implemented the advice; 46.6% of the patients who were overweight were given guidance to reduce their body weight and 72.9% were compliant, while out of the 53.4% who were not given advice, 78.2,% had a BMI>25 g/m2. Lastly, out of 58.4% of our participants who were given instructions to increase their physical activity, 94.9% had a BMI>25 kg/m2 and 71.2% were adherent. Out of the 41.6% who were not given advice, 78.6% had a BMI>25 kg/m2.

Conclusions:

Given how lifestyle changes can be a powerful tool in battling hypertension, our results show that the frequency of doctors giving advice regarding lifestyle changes is much lower than it should be, while the adherence of patients to the instructions given by their doctors is above average, especially regarding salt intake. This indicates that to reach better results, physicians need to give more focus to their communication with patients.
THE EFFECT OF LOW-CARBOHYDRATE DIET ON HYPERTENSIVE PATIENTS WITH OBESITY
Authors: Kim Hyun-Jin , Choi Jong Han , Cho Yoon Jeong , Ko Seung-Hyun , Chon Suk , Kang Jee-Hyun , Kim Kyoung-Kon , Kim Eun Mi , Kim Hyun Jung , Song Kee-Ho , Kim Kwang Il
Published: June 2023

Objective:

Non-pharmacological treatment such as a healthy diet, is important for hypertensive patients as it has a effect of lowering blood pressure (BP). We aimed to evaluate the effect of low-carbohydrate diet (LCD) on hypertensive patients with obesity.

Design and method:

Four electronic databases (KoreaMed, Embase, Medline, and the Cochrane Library) were searched from their inception to June 2021. Randomized clinical trials evaluating LCD (<130 g/day or <26% of the 2000 kcal/day diet) and very low-carbohydrate diet (VLCD) (<20-50 g/day or <10% of the 2000 kcal/day) for at least 8 weeks in adults with hypertension were eligible. Studies in which more than 50% of patients taking antihypertensive drugs, or systolic blood pressure (SBP) of 140 mmHg or more or diastolic blood pressure (DBP) of 90 mmHg or more were included. Primary outcomes were change of SBP and DBP. The comparative diets were diets with calorie restriction equivalent to those of the intervention diets, and most were included in a calorie-restricted diet and a low fat diet.

Results:

From 18, 151 studies identified in the initial search results, 6 randomized studies were included in the final analysis. Compared to the control diet, decreased SBP (mean difference: -3.25; 95% CI -7.28, 0.77) is observed in LCD for a period of six months or less, with no statistically significant difference in more than six months to one year or less and more than one year (36-52weeks: mean difference -1.30; 95% CI -76.04, 3.44, and > 1year: mean difference -4.51, 95% CI -15.38, 6.37) (Figure). LCD did not effect on DBP compared to control diet. VLCD marginally decreased SBP compared with the control diet, but not lead to a significant difference in DBP.

Conclusions:

For obese adults with hypertension, LCD had no additional benefit in reducing BP and weight compared to calorie-restricted or low fat diets when maintained for one year or longer. There is insufficient evidence to support the beneficial effect of a LCD in adults with hypertension, and further studies are needed to evaluate the effect of LCD in hypertensive patients.
METABOLIC (TCPO2) AND HEMODYNAMIC DISCORDANCE IN PERIPHERAL VASCULAR EVALUATION OF POSTOPERATIVE STUMP NECROSIS. ABOUT TWO CASES AND LITERATURE REVIEW
Authors: Ouail Djamel Eddine , Tebbani Meriem
Published: June 2023

Objective:

Amputation levels are discussed based on hemodynamic approach.

Transcutaneous oximetry (TcPO2) is a metabolic test of the local perfusion of peripheral tissues.

we report two cases of discordance between hemodynamic and metabolic tests in the evaluation of the level of amputation on stump necrosis.

Design and method:

study of two cases of amputation level decision using ABI, arterial doppler ultrasound and TcPO2

Results:

1st case: patient A D 52 years old, type 2 diabetic for 11 years, admitted 12 days after amputation of the left forefoot following a complication of the infectious and neuropathic diabetic foot. The clinical examination found an infected necrosis of the amputation stump, the ABI is at 1.22. The arterial Doppler ultrasound objective an atheromatous overload and a good arterial flow. The TcPO2 is 69 mmHg next to the stump, contrasting with a TcPO2 of 27 mmHg on the right. The decision was a necrectomy associated with an antibiotic therapy adapted to the antibiogram. The evolution was favorable.

2nd case: patient S B 71 years old, hypertensive for 20 years, paraplegic for 20 years following a spinal trauma. Hospitalized for management of acute ischemia of the lower limbs on paroxysmal AF. Doppler ultrasound performed in the context of the emergency was in favor of the total occlusion of the regular poplar and leg arteries. Rejected from revascularization, evolution under anticoagulant was marked by the appearance of dry gangrene of both feet. The preoperative evaluation was in favor of a TcPO2 of 41 mmHg on the left and 75 mmHg on the right. An amputation of the two forefeet was performed. The postoperative evolution was characterized by a necrosis of the left stump requiring a complementary gesture with good consequences.

Conclusions:

The two cases clearly demonstrate the discrepancy between the classic evaluation (anatomical and hemodynamic) and the metabolic evaluation (TcPO2)

The TcPO2 provides valuable assistance in deciding the level of amputation regardless of the diabetic, hypertensive, elderly patient profile….and regardless of the vascular profile; normal, PAD, post acute ischemia

The TcPO2 is essential before each amputation procedure independently of the hemodynamic evaluation.