bluuebunny/crossref_metadata_2025 huggingface dataset:
EARLY DIAGNOSIS OF HYPERTENSIVE DISEASE IN YOUTH WITH NORMAL SYSTOLIC AND DIASTOLIC BLOOD PRESSURE LEVELS
Authors: Paterno. Carlos Alberto
Published: June 2023

Objective:

Hypertensive cardiovascular disease can develop functional and/or structural organ damage by the increase of the volume/pressure and arterial stiffness, even before the current cut-off level of the systolic/diastolic blood pressure. The aim of this study was to evaluate in a young population with normal blood pressure levels if they presented any cardiovascular risk factors, arterial stiffness, signs, and symptoms of hypertensive disease.

Design and method:

This is a retrospective cross-sectional study developed between the years 2007/2022 from 9,600 non-invasive applanation tonometry, females-males 200-103 were entered, with an age range of 18 and 30 years old, and an average age of 24 years. Patients made their first cardiology visit without a previous diagnosis of arterial hypertension or decompensated associated diseases with a blood pressure not higher than 130/80 mmHg. Anthropological data, systolic/diastolic blood pressure, and heart rate were registered. Central Haemodynamics Parameters were measured with a SphygmoCor-PVX device (AtCor, Australia), a validated system employing the high-fidelity technique of applanation tonometry according to established protocols.

Results:

The average systolic/diastolic blood pressure among female-male was 112.9/72.4 mmHg-119.8/73.9 mmHg, respectively. Also, the Central Aortic Pressure in the female-male groups was 100.0 mmHg/103.7 mmHg, while the maximum values are 101.5 mmHg/106.0 mmHg, but the differences between the observed values and the normal levels of the Augmentation Index (a surrogate measure of arterial stiffness) were higher than normal in female-male 3.6%-4.6% indicating an incipient arterial stiffness. Into the female-male groups, were observed hyperlipidemia 10%-10%, smoking 26%-20%, minimal-mitral regurgitation 5%-8%, headache 46%-26%, palpitations 33%-25%, asthenia 22%-14%, sweating 9%-14%, and chest-pain 16%-27%, respectively. The percentage of women who had a history the polycystic ovarian syndrome was 19%, and the women in current or former estrogen-progesterone therapy were 17%-12%, respectively. Among the female-male groups that do not register any risk factor, symptoms, signs, or arterial stiffness were 8.5%-10%.

Conclusions:

In young people with normal blood pressure values, it is important to know the risk factors, symptoms, signs, and arterial stiffness of hypertensive disease for early diagnosis and to be able to optimize the time to start therapy.
REVISITING THE “ISCHEMIC CASCADE” WITH CONTEMPORARY METHODS
Authors: Yaneva-Sirakova Teodora , Georgiev Ranko , Mileva Niya , Hristova Irina , Psalla Dimitra , Vassilev Dobrin
Published: June 2023

Objective:

The current understanding for acute ischemia is based on the concept for the “ischemic cascade”. According to it, coronary occlusion induces a predefined consequence of phenomena, in which every consecutive process occurs after induction from the previous one. We sought to investigate the temporary correlation between electrical and mechanical changes at the time of acute ischemia in a pig model.

Design and method:

We made closed and open chest experiments with 4 pigs. We registered simultaneously intracoronary ECG (icECG) from a balloon-occluded artery, fluoroscopic movement of a regular PCI wire, echocardiography, contrast echocardiography – to confirm perfusion region and hemodynamic monitoring. We compared the time events, that occurred on icECG, epicardial electrode ECG (eECG), echocardiography, movement of the intracoronary regular PCI wire. The study was funded by the Bulgarian National Science Fund Research Grant for Fundamental Scientific Research 2021 KP-06-X53/15 and approved by the Bulgarian Food Agency.

Results:

Our preliminary results showed that icECG and the movement of the PCI wire during acute myocardial ischemia at the time of balloon occlusion, go simultaneously. The wall motion on echocardiography was with a time lag. When we compared the icECG form different sites of the coronary arteries, there was a time lag and lower magnitude of the ST segment elevation at distance from the site of the total occlusion.

Conclusions:

Based on these preliminary results with simultaneous registration of the icECG and PCI wire movement, we conclude that the electrical and mechanical phenomena at the time of acute ischemia occur simultaneously as assessed with contemporary methods. The regular PCI wire can be used for both purposes. This can be applied in humans for the detection of ischemia at the time of intracoronary interventions, which improve patient care and reduce procedural risk.
ABNORMAL INTER-ARM SYATOLIC BLOOD PRESSURE DIFFERENCE IN ADULTS WITH CONGENITAL HEART DISEASE
Authors: Murakami Tomoaki , Shiraishi Masahiro , Horibata Yoko , Tateno Shigeru , Kawasoe Yasutaka , Niwa Koichiro
Published: June 2023

Objective:

Many papers have been reported that hypertension and cardiovascular disease are high frequency in adults with congenital heart disease. It is well known that significant inter-arm blood pressure difference can predict cardiovascular risk. We investigate the inter-arm blood pressure difference in adults with congenital heart disease.

Design and method:

We enrolled 100 consecutive subjects aged 20 years or more, who visited the Department of Adult Congenital Heart Disease, Chiba Cardiovascular Center. The exclusion criteria were history of arrhythmia, which makes accurate pulse wave analysis impossible and history of cardiac operation within 6 months. The patients were classified into 3 groups. The patients in group A had undergone surgery, which sacrifice subclavian arteries (subclavian flap method and original Blalock-Taussig shunt). The patients in group B had undergone surgery to their subclavian arteries, which conserve their subclavian arteries (modified Blalock- Taussig shunt). The patients in group C had not undergone surgery to their subclavian arteries. The bilateral brachial blood pressures were simultaneously measured using form PWV/ABI (Colin, Komaki, Japan). The inter-arm systolic blood pressure difference greater than 10mmHg was defined as significant inter-arm systolic blood pressure difference.

Results:

Patients’ age was 36.6±14.9 years. Mean difference between bilateral brachial systolic blood pressures was 8.2±13.6 mmHg. Twenty-one patients demonstrated the inter-arm systolic blood pressure difference (29%). Nine patients were classified as group A and all patients in group A demonstrated inter-arm systolic blood pressure difference (29.1±35.6mmHg). Sixteen patients were classified as group B and 9 patients had undergone modified Blalock-Taussig shunt bilaterally. Four patients (44%) in group B demonstrated inter-arm systolic blood pressure difference (bilateral; 3, unilateral: 1). In 75 group C patients, 8 patients (11%) demonstrated inter-arm systolic blood pressure difference. There was no difference between group C patients in with and without the inter-arm systolic blood pressure difference in body mass index, hemoglobin A1 level, lipid profile.

Conclusions:

The significant inter-arm systolic blood pressure difference in adults with congenital heart disease is not uncommon. The intervention can strongly influence on their inter-arm systolic blood pressure difference.
THE ROLE OF CARDIOVASCULAR MAGNETIC RESONANCE IMAGING IN NONINVASIVE ASSESSMENT OF PULMONARY HYPERTENSION SEVERITY
Authors: Kazimli Aygun , Ryzkov Anton , Berezina Aelita , Naymushin Alexandr , Moiseeva Olga
Published: June 2023

Objective:

Pulmonary hypertension characterized by structural and mechanical changes in pulmonary vascular bed. Invasively calculated pulmonary artery (PA) stiffness indeces are associated with mortality in pulmonary hypertension (PH). CMRI-derived pulmonary artery distensibility (PAD) index reflects vascular remodeling in patients with pulmonary PH. The aim of the study was to evaluate the relationship between noninvasive PAD index and invasive PA stiffness indeces and basic determinants of PH severity.

Design and method:

We included 48 pts with PH (mean age 42.8± 14.7 yrs, m:f = 13:35): 27 idiopathic pulmonary arterial hypertension pts, 5 pts scleroderma PAH, 6 corrected congenital heart disease and 10 with inoperable CTPEH. All pts underwent 6-min walk test (6MWT), right heart catheterization (RHC), ECHO, CMRI, cardiopulmonary exercise testing (CPX). PA stiffness index and elastic modulus were calculated using data from RHC and CMRI. Pulmonary artery distensibility index (%) were derived from cross-sectional images of the main PA on cardiac magnetic resonance imgaging.

Results:

We revealed increased PA stiffness index 6.1 (4.6–10.2) and elastic modulus 424 mm Hg (254-678), decreased PAD index in PH pts 10% (9 –16.5). There was a significant negative correlation between PAD index and PA stiffness index (r = –0.90; p < 0.0001), so we derived the formula to calculate the invasive PA stiffness using noninvasive PAD index: PA stiffness index = 102.4/ PAD index. There was also a negative correlation between PAD and elastic modulus (r = –0.91; p < 0,0001). Patients with decreased PAD index < 20 % had higher NT-proBNP level (1558 (738-4341) versus 306 (178-370); p<0.05), also ECHO signs of RV systolic dysfunction:lower TAPSE (1.7 ±0.4 cm versus 2.0±0.4 cm; p = 0,04), tricuspid annular systolic velocity (10±2 versus 12±1 cm/sec; p = 0,007), global RV myocardial deformation (13±4% versus 21±5%; p = 0,001) and RV fractional area change ( 24±7%; p = 0,02) and reduced cardiac output which were determined by RHC (4.0 ± 1.1 versus 4.9 ±1.2 l/min; p < 0,05).

Conclusions:

Noninvasive CMRI-derived PA distensibility index strongly correlated with PA stiffness indeces, and may be used for noninvasive assessment of PH severity.
ROLE OF UBIQUITINYLATION MODIFICATION OF SIRTUIN 3 IN HYPERTENSION-ASSOCIATED CARDIOMYOCYTE INJURY
Authors: Sun Runmin , Wang Qiongying , Yu Jingle
Published: June 2023

Objective:

The present study was designed to investigate whether mitochondrial dysfunction and oxidative stress in HTN-injured cardiomyocytes are associated with SIRT3 ubiquitination and whether SIRT3 deubiquitination can ameliorate the related cardiomyocyte injury.

Design and method:

The human cardiomyocyte AC16 cell line was selected as the study target. The SIRT3-K288R cell line construction was verified by immunoprecipitation and the effect of Ang-II on SIRT3 class ubiquitination was explored; the expression of SOD2, Acetyl-SOD2 (MnSOD), protein acetylation level, inflammatory vesicles NLRP3, etc. in different subgroups were determined by Western Blot to explore the ubiquitination-like modifications and SIRT3 deacetylation in HTN-related cell injury

Results:

(1) Immunoprecipitation results showed that the level of SIRT3 class ubiquitination was reduced after SIRT3-K288R transfection; compared to the control group, the level of SIRT3 class ubiquitination was increased in the presence of AngII; (2) Western Blot results showed that compared to the HTN cell injury model, the cardiomyocytes in the SIRT3-K288R intervention group had increased Acetyl- SOD2/SOD2 levels were increased (p < 0.05) and protein acetylation levels were decreased in the SIRT3-K288R intervention group compared with the HTN cell injury model, indicating that SIRT3 deubiquitination increased the deacetylation effect on mitochondria and increased cellular antioxidant stress enzyme activity; (3) Western Blot results showed that compared with the HTN cell injury model, cardiomyocytes in the SIRT3-K288R intervention group NLRP3 and NOX4 levels were significantly reduced, indicating that SIRT3 deubiquitination could improve the inflammatory response to Ang-II-related cell injury.

Conclusions:

In the HTN-associated cell injury model, the level of SIRT3 class ubiquitination was significantly increased, and the removal of ubiquitination modification by viral transfection could improve oxidative stress, protein acetylation levels and associated inflammatory responses in HTN-injured cardiomyocytes, indicating that SIRT3 class ubiquitination may play an important mechanism in HTN-associated cell injury, and reducing SIRT3 class ubiquitination modification may be a possible direction for future research.
EPIDEMIOLOGY OF CARDIOVASCULAR MORTALITY IN PATIENTS AGED UNDER 60 IN THE CARDIOLOGY DEPARTMENT FROM SEPTEMBER 2019 TO AUGUST 2022
Authors: Alassane Ngaide Aliou , Diaba Gaye Ngone , Salvador Mingou Joseph , Tening Diouf Marguerite , Diarra Sene Mame , Rassoul Diop Khadim , Youssou Diouf , Abdoul Kane
Published: June 2023

Objective:

The objectives of our study were to study the cardiovascular mortality of the active population, to analyze the epidemiological, clinical, paraclinical aspects, the complications and to determine the etiological aspects related to this mortality.

Design and method:

This was a descriptive and analytical retrospective study over 3 years from September 2019 to August 2022 in patients aged at least 15 and at most 60 years old hospitalized and deceased in the cardiology department of the General Idrissa POUYE hospital in Dakar. The data was recorded on a survey sheet and entered into the EPI Info 7.2.5.0 software, and the analysis carried out by the R. Studio software version 2022.12.0 + 353 and Excel 2019. The significance threshold retained was a p value < 0.05.

Results:

Our study enrolled 73 dead patients, either a specific mortality of 8.8% and a proportional mortality of 39%. The predominance was male with a male/female sex ratio of 1.2. The average age was 44 years old. The cardiovascular risk factors found were dominated by physical inactivity (76.7%), hypertension (28.8%) and smoking (21.9%). Physical examination found signs of heart failure in 63% of cases. Biology noted above all anemia (59%), impaired renal function (25%) and high troponin in 87% of cases. The electrocardiogram essentially found arrhythmias (46.6%). The chest X-ray mainly showed cardiomegaly (49.3%), pleuro-pneumonopathy (33%). Echocardiography showed altered LVEF (81%), PAH (78%) and kinetic disorders (40%). Coronary angiography, performed in 4 patients, showed 2 bi-truncal lesions, 1 mono-truncular and 1 tri-truncular. The most used treatments were diuretics (63%), amines (47.9%), AVKs (42%), BBs (36%), ACE inhibitors or ARA2 (31%). Thrombolysis was performed in 5 SCA and 4 PE and angioplasty in 4 patients. The analytical study shows that the data most related to mortality were age, socio-economic level, ischemic heart disease (p = 0.034), rheumatic valvular disease, pulmonary embolism (p = 0.034), hypertension (p = 0.009), smoking (p = 0.011), diabetes (p = 0.011), dyslipidemia, bed rest (p = 0.001), morbid obesity (p = 0.001) and infection with COVID-19 (p = 0.017).

Conclusions:

The predominance of ischemic heart disease, pulmonary embolism and valvular heart disease in premature mortality statistics should encourage strengthening cardiovascular prevention.
24-HOUR AMBULATORY BLOOD PRESSURE MEASUREMENT USING A PULSE ARRIVAL TIME BASED BLOOD PRESSURE MODEL BY A PROTOTYPE WEARABLE SENSOR
Authors: Heimark Sondre , Hove Christine , Stepanov Alexey , Boysen Elin Sundby , Gløersen Øyvind , Bøtke-Rasmussen Kasper Gade , Gravdal Hans Jacob , Narayanapillai Kesi , Larstorp Anne Cecilie K. , Seeberg Trine M. , Waldum-Grevbo Bård
Published: June 2023

Objective:

Methods to enable cuffless blood pressure (BP) have gained widespread interest. If proven to be comparable to standard cuff measurements and more accepted by patients, these methods can improve hypertension care. We investigated accuracy and patient acceptability of a pulse arrival time (PAT) based model using a prototype cuffless device on the chest compared to standard 24-hour ambulatory blood pressure monitoring (24hABPM).

Design and method:

PAT was calculated using the electrocardiogram (ECG) and photoplethysmography (PPG) sensors incorporated in the chest belt. The model to predict BP from PAT was developed from a general population cohort during isometric exercise induced BP changes. Ninety-four normotensive and hypertensive adults underwent simultaneous 24hABPM with the prototype chest belt sensor and a validated cuff-based oscillometric device on the non-dominant arm. PAT-based BP predictions were compared to reference BPs using 2-minute time windows corresponding to reference measurements. Statistical analyses were performed using Stata® v. 17.0 (Statacorp., Texas, USA) with continuous data presented as means (SD) and compared using paired t-test. Correlation analysis and agreement were evaluated by Bland-Altman plots.

Results:

Mean age (SD) was 48.1 (14.3) years and 48 % had a prior hypertension diagnosis. Comparisons between reference and PAT-based mean 24-hour, daytime and nighttime BP showed that the PAT-based model generally overestimated BP (Table). The largest difference was seen during nighttime; the mean difference (SD) was 19.6 (22.2) mmHg and 17.0 (12.2) mmHg for systolic BP (SBP) and diastolic BP (DBP). Ninety-five % limits of agreements were [-29.8, 36.0 mmHg] and [-23.9, 63.0 mmHg] for daytime and nighttime SBP. The prototype sensor was reported to be more comfortable and less disturbing during daily activities and sleep compared to the reference device during 24hABPM (Figure).

Conclusions:

The present study demonstrated that a general PAT-based BP model significantly overestimated 24hABPM in normotensive and hypertensive subjects. The largest discrepancy was observed during nighttime. Although the PAT-based model did not provide accurate measurements of BP, the potential of cuffless BP technology is promising due to patient acceptability.
RARE CASE OF BUERGER'S DISEASE WITH ACUTE FULMINANT PROGRESSION TO DIGITAL ISCHAEMIA DESPITE AGGRESSIVE MEDICAL TREATMENT
Authors: Cangco Noe , Fang Jun-Tao , Lo Francis Albert , Borja Annamarie , Sule Ashish
Published: June 2023

Objective:

This case presents an unusual presentation of Buerger's disease.

Design and method:

We report a rare clinical presentation of TAO that may be of diagnostic clinical challenge at the onset.

Results:

Buerger's disease, also known as thromboangiitis obliterans (TAO), is a non-atherosclerotic, segmental inflammatory disease affecting small to medium-sized arteries and veins in the limbs. It is a rare disease seen mostly in young male smokers below 45 years of age. Disease course is typically gradual, progressing from claudication symptoms to rest pain eventually ischemic ulcers and gangrene. It is rare for patients to present with ischemic pain with rapid worsening in days.

This is an interesting case of a 52-year-old male with no known past medical history who presented with digital ischemic rest pain. Initial investigations revealed mildly elevated inflammatory markers, while imaging studies showed thrombosis of bilateral radial and ulnar arteries, with dampened photoplethysmography. He was assessed to be unsuitable for endovascular intervention, consequently was treated medically with anticoagulants, statin, and prostaglandin analogue. He subsequently showed clinical improvement, with no compromise of his hand circulation, and was able to return to work. We report a rare clinical presentation of TAO that may be of diagnostic clinical challenge at the onset. Asians may be affected above the age of 50 years with acute fulminant progression to ischaemia and digital gangrene despite of aggressive medical treatment.

Conclusions:

Buerger's disease, or thromboangiitis obliterans (TAO), is a rare condition that presents a diagnostic challenge to many clinicians. Asians may be affected above the age of 50 years with acute fulminant progression to ischaemia and digital gangrene in spite of aggressive medical treatment.
THE EFFECTS OF MOTIVATIONAL INTERVIEWING ON HYPERTENSION MANAGEMENT: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Huang Xinghe , Xu Nuo , Wang Yuyu , Sun Yixin , Guo Aimin
Published: June 2023

Objective:

Motivational interviewing is a patient-centered, directive counselling method designed to enhance behavior changes and has been widely applied in chronic disease management. However, the effectiveness of motivational interviewing on hypertension management has been not yet conclusive. This systematic review aimed to examine the effects of motivational interviewing-based interventions on hypertension management.

Design and method:

We conducted a systematic literature search in the following databases: PubMed, Embase, CINHAL, Cochrane Central Register of Controlled Trials, PsycINFO, and Web of Science from inception to 25 July, 2022. Randomized controlled trials involving adults diagnosed with hypertension and including motivational interviewing in the treatment interventions were included. Study selection process, data abstraction, and risk of bias assessment were completed independently by two researchers. When feasible, meta-analyses were conducted to estimate the pooled effects using Review Manager (Version 5.4).

Results:

In total, 14 studies with 5122 participants were included. Compared with no or minimal additional intervention, motivational interviewing-based intervention showed greater reduction in systolic blood pressure (MD: -5.28, 95% CI: -8.70, -1.86, P = 0.002) and diastolic blood pressure (MD: -2.34, 95% CI: -4.05, -0.63, P = 0.007) (Figure). Compared with the lower intensity intervention, motivational interviewing-based intervention produced statistically significant effect on reducing systolic blood pressure (MD: -2.72, 95% CI: -5.34, -0.10, P = 0.040); while there was no significant effect on reducing diastolic blood pressure (MD: -0.47, 95% CI: -2.21, 1.28, P = 0.600) (Figure). Qualitative synthesis suggests that motivational interviewing may improve medication adherence, self-efficacy, and quality of life, but the evidence was uncertain.

Conclusions:

Patients with hypertension could benefit from motivational interviewing-based interventions in blood pressure control. Motivational interviewing could be applied as a promising intervention strategy among patients with hypertension. Future research is warranted to evaluate the effects of motivational interviewing on improving medication adherence and psychological well-being.
IMPACT OF CARDIAC REHABILITATION PROGRAM IN ANXIETY AND DEPRESSION. A CASE-CONTROL STUDY
Authors: Costa Carlos Manuel Ol , Carvalho Simao Pedro , Jesus Ana Gomes Tania , Albuquerque Nelson Ferreira , Bastos Jose Mesquita , Neves Ana Briosa
Published: June 2023

Objective:

The association of depression with increased mortality is widely demonstrated in patients with cardiovascular disease (CVD). Depression and anxiety are common in this group and may adversely affect cardiovascular outcomes. The Hospital Anxiety and Depression Scale (HADS) englobes two scales (HASD-D for depression and HADS-A for anxiety) and is a 14-item tool to measure anxiety and depression symptoms in medical patients, which was shown to be an excellent tool when assessing the psychological well-being of patients undergoing cardiac rehabilitation. This study aims to evaluate whether entry into a rehabilitation programme is associated with a lower HADS score.

Design and method:

Single center, cross-sectional case-control study comparing a screening anxiety and depression score – Hospital Anxiety and Depression Score (HADS) - in patients submitted to a Cardiac Rehabilitation (CR) program with a matched control group. Each patient in the study group was matched by sex, age and primary pathology to an individual in the control group. The selection bias was reduced by the selection of control patients in our institution previously to the implementation of the CR program.

Descriptive analysis was performed using means and standard deviation (SD), medians and Interquartile range (IQR) for continuous data, and frequencies and percentages for qualitative variables. HADS Score was compared between groups using Independent-Samples T Test in SPSS® software.

Results:

We studied a total 36 patients (18 CR patients and 18 matched controls), 72.2% were men, and the mean age of patients was 55.2 years. Upon comparison, the patients in the CR group had a statistically significantly lower HADS Score compared with matched non-CR patients (2.7 vs 3.5, p<.05) (Table 1).

Conclusions:

This study suggests that inclusion into a cardiac rehabilitation programme helps to reduce the HADS scores of post-MI patients.
EFFECT OF KIDNEY TRANSPLANTATION ON INDICES OF CARDIORESPIRATORY FITNESS ASSESSED WITH CARDIOPULMONARY EXERCISE TESTING: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Pella Eva , Alexandrou Maria-Eleni , Boutou Afroditi , Theodorakopoulou Marieta , Sampani Erasmia , Dipla Konstantina , Zafeiridis Andreas , Sarafidis Pantelis
Published: June 2023

Objective:

Patients with kidney failure often present with reduced functional cardiovascular reserve and exercise intolerance. Kidney transplantation is the optimal treatment for patients with end-stage kidney disease as it is associated with longer survival and improved quality of life compared to hemodialysis or peritoneal dialysis.

Design and method:

This is a systematic review and meta-analysis of studies using cardiopulmonary-exercise-testing (CPET) to examine the cardiorespiratory fitness of patients with kidney failure before and after kidney transplantation. The primary outcome was differences in pre- and post-transplantation values of peak oxygen uptake (VO2peak). Literature search involved PubMed, Web of Science and Scopus databases, manual search of article references and grey literature. Quality assessment was undertaken with Newcastle-Ottawa-Scale.

Results:

From 379 literature records initially retrieved, 6 studies (207 participants) were included in final meta-analysis. A marginal, but not significant, improvement was observed in oxygen consumption during peak exercise compared to pre-transplantation values (standardized mean difference [SMD]: 0.32, 95%CI -0.02; 0.67). Oxygen consumption at anaerobic threshold (VO2AT) was significantly improved after kidney transplantation (weighted MD [WMD]: 2.30 ml/kg/min, 95%CI 0.50; 4.09), whereas no significant changes were observed in maximum heart rate (WMD: 10.45 bpm, 95%CI -3.97; 24.86). In subgroup analysis, consistent results were shown between patients having undergone transplantation preemptively and those after dialysis initiation (p-value for subgroup differences = 0.95). Of note, a trend for improvement in VO2peak was observed when pooling data reported from follow-up assessments undertaken at least 3 months post-transplantation surgery (SMD: 0.17, 95%CI -0.03; 0.38), but not earlier (WMD: -0.03 ml/kg/min, 95%CI -4.28; 4.23).

Conclusions:

Several major indices of cardiorespiratory fitness tend to improve after kidney transplantation compared to pre-transplantation values. This finding may represent another modifiable factor contributing to better survival rates of kidney transplant recipients compared to patients undergoing dialysis.
COMPARISON OF INFLUENCE OF OFFICE PULSE WAVE VELOCITY AND 24-HOUR AMBULATORY RECORDING OF AORTIC PULSE WAVE VELOCITY ON TARGET DAMAGE IN HYPERTENSION
Authors: Chao Huijuam , Wang Qian , Avolio Alberto , Zuo Junli
Published: June 2023

Objective:

Arterial stiffness, as measured by pulse wave velocity (PWV), is a significant determinant of target organ damage (TOD). The aim of this study was to assess the potential use of office PWV and 24-hour PWV for prediction of subclinical TOD in a hypertensive cohort.

Design and method:

We evaluated associations of TOD with office carotid-femoral pulse wave velocity (O-cf-PWV) by radial tonometry (SphygmoCor) and 24-hour ambulatory PWV measurements (24h-PWV, including day-PWV and night-PWV) by brachial oscillometry (Mobil-O-Graph 24h PWA Monitor) in 636 hospital inpatients (age 54 ± 13 years, 465 males) with primary hypertension. Subclinical TOD was defined as left ventricular hypertrophy (LVH) obtained by echocardiography, carotid intima-media thickness (IMT) >0.9mm and chronic kidney disease (CKD) including urine albumin/creatinine ratio (ACR) >3.5 mg/mmol in females and >2.5 mg/mmol in males or estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2.

Results:

After adjusting for confounding factors, both O-cf-PWV and 24h-PWV or night-PWV showed significant association with LV mass index (p<0.05). Only day-PWV was associated with eGFR (p = 0.039). When O-cf-PWV and 24h-PWV, including other confounding factors, were forced into the same logistic regression model, only O-cf-PWV (OR = 1.117, 95% CI:1.009-1.236, p = 0.033) remained significant determinants of increased LVH. Each 1 m/s increase in 24-h-PWV and day-PWV was associated with decreased risk of eGFR (odds ratio [OR] = 0.340 and 0.43, respectively). Only each increase in night-PWV was associated with risk of carotid IMT > 0.9 mm (OR = 1.360, 95% CI: 1.004 -1.843, p = 0.047). For ACR, neither 24-h-PWV nor O-cf-PWV was significant.

Conclusions:

O-cf-PWV improved prediction of LVH compared to ambulatory 24h-PWV under ambulatory conditions. Day-PWV may improve prediction of eGFR decline.
ARTERIAL STIFFNESS ASSESSED BY SYSTEMIC VERSUS REGIONAL INDICES: DETERMINANTS AND DIAGNOSTIC AGREEMENT
Authors: Kyriakoulis Konstantinos , Kollias Anastasios , Ntousopoulos Vasileios , Theodosiadi Aikaterini , Menti Ariadni , Stathopoulou Panagiota , Ntineri Angeliki , Stergiou George S.
Published: June 2023

Objective:

Arterial stiffness is closely associated with aging and hypertension and may improve the stratification of cardiovascular risk in patients with hypertension. This study investigated the determinants and the diagnostic agreement of systemic (brachial-ankle pulse wave velocity [baPWV]) and regional (carotid distensibility coefficient [DC]) arterial stiffness indices.

Design and method:

Adults referred to a hypertension outpatient clinic were subjected to: (i) triplicate office blood pressure (BP) measurement using a validated professional oscillometric upper-arm cuff device Microlife WatchBP Office, (ii) baPWV measurements using an automated oscillometric device Microlife WatchBP Office Vascular, and (iii) DC and carotid intima-media thickness (cIMT) measurements with carotid ultrasound.

Results:

Data from 136 participants were analyzed (mean age 60±12 [SD] years, 71% males, body mass index 28±4 kg/m2, 83% hypertensives, 12% diabetics, 16% smokers, baPWV 14±2 m/sec, DC 24±9 10-3/kPa). There was a moderate negative association between baPWV and DC (r = -0.37, p<0.01). baPWV was positively correlated with age (r = 0.64, p<0.01), systolic office BP (r = 0.27, p<0.01) and cIMT (r = 0.29, p<0.01), while DC was inversely associated with age (r = -0.37, p<0.01), systolic office BP (r = -0.48, p<0.01), and cIMT (r = -0.29, p<0.01). In multivariable linear regression models (independent variables: age, sex, systolic office BP, cIMT, diabetes), age and systolic office BP appeared to be significant determinants of baPWV (beta = 0.12/0.05, respectively) and DC (beta = -0.32/-0.27, respectively). The agreement between the two methods in identifying individuals with increased arterial stiffness (1st quartile of DC distribution and 4th quartile of baPWV distribution) was fair (agreement 71%, kappa = 0.22, p<0.05).

Conclusions:

These results suggest that although these two methods for assessing arterial stiffness are correlated and determined by similar variables, their agreement in identifying individuals with increased arterial stiffness is fair, implying that they may provide complementary information.
EFFECTS OF LIFESTYLE ADVICE ASSOCIATED WITH BEETROOT-BASED NUTRACEUTICAL ON 24-HOUR BLOOD PRESSURE IN A POPULATION WITH HIGH-NORMAL BLOOD PRESSURE OR GRADE 1 HYPERTENSION
Authors: Spannella Francesco , Giulietti Federico , Massacesi Adriano , Poliseno Chiara , Festa Roberto , Cavazzin Enrico , Sacco Giulio , Mazza Alberto , Sarzani Riccardo
Published: June 2023

Objective:

2018 ESH hypertension guideline supports life-style changes as initial approach to be taken in both subjects with high-normal blood pressure (BP) and patients with grade 1 hypertension and low cardiovascular (CV) risk. Among many nutraceuticals, most with unproven or unlikely benefits, bioactive substances enriched with nitrates, sources of nitric oxide (i.e. red beets) exert proven vasodilator effects and may decrease BP levels. Aim: to evaluate the effect of lifestyle advice and beetroot-based nutraceutical on 24-h BP in a population with high-normal BP or grade 1 hypertension and low CV risk.

Design and method:

Longitudinal study on 43 consecutive subjects referred to two hypertension centers. A 24-h ambulatory BP monitoring (ABPM) was performed at baseline and after 3 month the introduction of lifestyle advice and beetroot-based nutraceutical [Cosmony, Servier, a nutraceutical based on Beta vulgaris L. (500 mg of dry beetroot extract)].

Results:

Mean age: 49.9±10.7 years. Male prevalence: 53.5%. Median follow-up: 98 (92-121) days. Overweight/obese prevalence: 58.1%. The 62.8% of subjects had a grade 1 hypertension. At baseline, 24-h BP, daytime BP and night-time BP were 127.2±6.8/79.6±5.6 mmHg, 131.3±7.5/83.4±5.5 mmHg and 117.8±7.7/70.2±5.0 mmHg, respectively. At follow-up, all BPs showed a statistically significant decrease (all p<0.005), except for diastolic night-time BP (p = 0.074) (-3.4±5.9/-2.2±3.7 mmHg for 24h BP; -3.9±6.0/-3.0±4.0 for daytime BP and -3.3±7.4/-1.3±4.7 for night-time BP). The percentage of subject with daytime BP <130/85 mmHg had increased from 25.6% at baseline to 48.8% at follow-up. The decrease in BP was independent of gender and overweight/obesity, whereas it was more evident in the group of grade 1 hypertensives compared with the group with high-normal BP.

Conclusions:

Lifestyle advice in association with a nutraceutical, source of nitric oxide, may be a valid initial non-pharmacological therapy in subjects with high-normal BP or grade 1 hypertension and low CV risk.
COFFEE CONSUMPTION RELATES TO A REDUCTION OF VASCULAR AND HEART DAMAGE IN WELL-CONTROLLED HYPERTENSIVES
Authors: Marozzi Marialuisa Sveva , Trani Miriam Di , Zotti Francesca , Rignani Federica , Gramegna Davide , Amodio Gianfranco , Santoro Giuseppe , Benedittis Lorenzo De , Schirosi Gabriella , Ranieri Giuseppe , Nazzaro Piero , Cicco Sebastiano
Published: June 2023

Objective:

Nutritional interventions might prevent hypertension-related organ damage but are far to be fully defined. Coffee is one of the most used beverages all over the world. Many studies tried to define the optimal amount of coffee to understand whether coffee has a role in cardiovascular prevention. Thus, we evaluated heart and vascular damage in well-controlled hypertensives according to coffee consumption.

Design and method:

We evaluated 316 primary hypertensives (150F, 166M, aged 62.22±10.76) evaluated for target organ damage. The number of coffee cups per day was asked during the visit.

Results:

The median coffee consumption was 2 cups per day and patients were subdivided into tertiles: Group 1, 0-1 cups 112 patients (57F, 55M; 64.21±10.91 y.), Group 2, 2 cups, 101 patients (53F; 48 M; 61.95±10.10 y.), Group 3, >2 cups, 103 patients (40F; 63M; 60.32±10.95 y.). No differences were seen in BMI, systolic and diastolic BP. Group 1 had a higher left ventricular mass than the other two groups (p = 0.0008 and p = 0.019 respectively) while no difference there was between group 2 and 3. Similarly, Group 1 had a significant reduction in E/e’ ratio (p = 0.042 and p = 0.019, respectively). No significance was found between Group 2 and 3 for left ventricular mass and diastolic function. Group 3 had an increased intima-media thickness (p = 0.004 and p = 0.005 vs Group 1 and 2, respectively). Prevalence of carotid stenosis was lower in Group 3 (p = 0.011 and p = 0.039, respectively) and was comparable in Group 1 and 2.

Conclusions:

Coffee consumption at least of 2 cups/day may have a role in prevention of heart remodelling and diastolic dysfunction.
THE EFFECT OF PLANT-BASED AND MYCOPROTEIN-BASED MEAT SUBSTITUTES ON CARDIOMETABOLIC RISK FACTORS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF CONTROLLED INTERVENTION TRIALS
Authors: Gibbs Joshua
Published: June 2023

Objective:

Plant-based and mycoprotein-based meat substitutes are predicted to play a key role in the re-duction of meat intake, however, their impact on human health is unclear. The main objective of this meta-analysis was to assess the short-term effects of meat substitutes on important cardiometabolic biomarkers (total cholesterol, TC; LDL-cholesterol, LDL-C; HDL-cholesterol, HDL-C; Triglycerides, TG; Systolic blood pressure, SBP; Diastolic blood pressure, DBP; Fasting blood glucose, FBG; weight) in controlled clinical trials.

Design and method:

Embase and MEDLINE were searched to identify controlled clinical trials with meat substitute interventions and cardiometabolic biomarker outcomes. Standardised mean differences in TC, LDL-C, HDL-C, TG, FBG, SBP, DBP, and weight and 95% confidence intervals were pooled using a random effects model. Risk of bias, heterogeneity, sensitivity, and publication bias were assessed.

Results:

Of the 934 records identified, 12 studies met the inclusion criteria. In the pooled analyses the consumption of meat substitutes was associated with significantly lower TC (-0.50 mmol/L [95% CIs -0.70, -0.29]), LDL-C (-0.39 mmol/L [-0.57, -0.21]), and TG (-0.15 mmol/L [-0.29, -0.01]), non-significantly lower FBG (-0.08 [-0.23, 0.08]), SBP (-0.32 [-1.79, 1.41]), and weight (-0.12 [-1.52, 1.27]), and non-significantly higher HDL-C (0.01 [-0.02, 0.05]) and DBP (0.49 [-0.30, 1.28]). There was evidence of publication bias, and some heterogeneity was detected. The certainty of evidence was moderate for the TC and HDL-C results, low for the LDL-C, TG, SBP, DBP, and weight results, and very low for the FBG results.

Conclusions:

Replacement of some or all meat with plant-based or mycoprotein-based substitutes may lower TC, LDL-C, and TG.
LIPID DISORDERS BEFORE AND AFTER SUCCESFUL LIVER TRANSPLANTATION
Authors: Adamczak Marcin , Gojowy Damian , Urbaniec-Stompor Joanna , Adamusik Joanna , Wojcik Gabriela , Karkoszka Henryk , Krol Robert , Wiecek Andrzej
Published: June 2023

Objective:

Liver transplantation (LTx) is the only successful treatment for end-stage liver disease. Long term results of liver transplantation not only depend upon graft survival but it may be also affected by superimposed cardiovascular morbidities. This single center, retrospective, clinical study was aimed to assess the prevalence of lipid disorders in patients before and after successful LTx.

Design and method:

One hundred eleven patients (mean age 49.7±12.2 years) who underwent Ltx because of liver cirrhosis and survived at least 2 years with functioning graft were included in this retrospective analysis. The prevalence of dyslipidemia was assessed before and two years after LTx. This was analyzed in relation to etiology of liver disease, including alcohol toxicity, viral or autoimmune diseases.

Results:

Before and after LTx the prevalence of hypertriglyceridemia, hypercholesterolemia and hypertriglyceridemia accompanied by hypercholesterolemia were 13.5% and 40.5%, (P<0.001), 17.1% and 51.4% r (P<0.001), as well as 7.2% and 27.9% (P<0.001) respectively.

There was no significant differences in prevalence of hypertriglyceridemia (7.4% vs 10.0% vs 16.2%), hypercholesterolemia (14.8% vs 16.7% vs 14.2%) as well as hypertriglyceridemia accompanied by hypercholesterolemia (3.7% vs 3.3% vs 10.8%) in patients before LTx with the autoimmune, alcoholic and viral cause of liver cirrhosis, respectively. Two years after LTx the prevalence of hypertriglyceridemia (18.5% vs 66.7%, P<0.001) and hypercholesterolemia (29.6% vs 70.0%, P = 0.002), as well as hypertriglyceridemia accompanied by hypercholesterolemia (14.8% vs 46.7%, P = 0.009) was significantly lower in patients with the autoimmune cause of liver cirrhosis in comparison to patients with the alcoholic liver disease.

Conclusions:

1. The prevalence of dyslipidemia is increased after LTx. 2. The prevalence of dyslipidemia after LTx may be related to the cause of liver injury before LTx.
THE MEDITERRANEAN DIET AND GLYCEMIC REGULATION IN PATIENTS WITH DYSLIPIDEMIA AND DIABETES MELLITUS TYPE 2
Authors: Mavrokefalou Evgenia , Kakou Anta - Monica , Konidari Diimitra , Theodosis Spyridon , Iasonos Maria , Marakomichelakis George
Published: June 2023

Objective:

The Mediterranean diet is considered a cornerstone in the regulation of the person with dyslipidemia and diabetes mellitus.

The aim of the study is to record the eating habits of patients with dyslipidemia and type 2 diabetes mellitus and to correlate these habits with their regulation.

Design and method:

This study involved 948 patients (490 men and 458 women with an average age of 61.6±7 years). A registration questionnaire was used for their demographic, somatometric data, their eating habits, their medication and patients’ compliance with them was reassessed with a review after six months.

Results:

The duration of dyslipidemia was 12.7±14.2 years and DM2 was 12.8±14.4 years. The mean value of glycosylated hemoglobin was (HbA1c) 6.73±2.55%, with 57.1% of patients having HbA1c less than 7%. The body mass index (BMI) was 32.6±6.85 in both sexes (p = 0.440). 66.8% of patients were overweight, and obese with women having higher rates. 87.1% of patients consume breakfast, fruits more than 7 times a week consume 33.1%, vegetables at least 2 times 53.6%, meat 2 times 42%, fish 1 time 46.8%, legumes 65%, chicken 2 times 29.1% and sweets consume 16.6% of patients. A positive association with the regulation of dyslipidemia and DM2 is shown by the consumption of balanced breakfast (p = 0.001) and the presence of 2 main meals in the daily schedule (p = 0.008). The high consumption of junk food (p = 0.009), the consumption of soft drinks (p = 0.056) and the consumption of sweets (p< 0.001) had a negative impact. 27% of patients were in higher education, 43.5% in secondary education, and 31.5% in basic education. Insufficient control of dyslipidemia was in 60,5% of patients. The prevalence of metabolic syndrome was found to be less in those who followed the Mediterranean diet.

Conclusions:

The eating habits of people with dyslipidemia and DM2 affect their regulation having a positive effect especially on glycemic regulation. The adoption of the Mediterranean diet is accompanied by a reduction in the risk of developing metabolic syndrome.
MICROCIRCULATION AND BLOOD PRESSURE/HEART RATE RESPONSE DURING EXERCISE STRESS TESTING IN HYPERTENSIVE PATIENTS
Authors: Liatakis Ioannis , Konstantinidis Dimitrios , Tzorovili Evaggelia , Siafi Eirini , Tatakis Fotis , Leontsinis Ioannis , Drogkaris Sotirios , Zammanis Ioannis , Fragoulis Christos , Andrikou Ioannis , Filippou Christina , Kalos Theodoros , Grigoriou Kalliopi , Sakalidis Athanasios , Tsoumpou Ioanna , Manta Eleni , Kakouri Niki , Thomopoulos Costas , Dimitriadis Kyriakos , Tsioufis Konstantinos
Published: June 2023

Objective:

A hypertensive response during exercise has been associated with adverse cardiovascular outcomes in general population and hypertensive patients. On the other hand, microcirculation is the major site of control of vascular resistance and thus has a key role in the etiopathogenesis of hypertension. The aim of our study was to investigate the presence of a possible correlation between blood pressure and heart rate response during exercise with a microcirculation index (capillary rarefaction) in a cohort of hypertensive patients.

Design and method:

We studied 105 untreated patients with stage I-II essential hypertension (70% men, mean age: 59.5 years, mean office blood pressure: 150/92mmHg). Patients with diabetes mellitus, secondary hypertension, atherosclerotic cardiovascular disease, heart failure, significant chronic renal or pulmonary disease and any other systemic illness or orthopedic problems that would not allow maximal effort on a treadmill were excluded. All participants underwent maximal exercise testing, using the Bruce protocol, as well as nail-fold videocapillaroscopy assessment by using VideoCap 3.0 videomicroscope.

Results:

A significant negative correlation between diastolic BP at minute-1 of the recovery phase and capillary density expressed in capillaries/mm was revealed (Pearson's r = -0.365, p = 0.043). A significant negative correlation was also observed between capillary density and peak heart rate (Pearson's r = -0.364, p = 0.024) as well as between heart rate increase from stage 1 to 2 and capillary density Pearson's r = -0.746, p = 0.013). Our study shows that in a small cohort of hypertensive patients, capillary rarefaction was associated with a steeper increase in heart rate during exercise, as well as with a higher peak heart rate and higher diastolic blood pressure values during the recovery phase.

Conclusions:

These findings suggest that new indices such as capillary rarefaction may provide insights into possible autonomic dysfunction and could also be taken into account in the assessment of hypertensive patients.
ARTERIAL STIFFNESS IN PREHYPERTENSIVE PATIENTS WITH PREDIABETES - A PILOT STUDY
Authors: Jug Juraj , Prkacin Ingrid
Published: June 2023

Objective:

Prediabetes is associated with higher cardiovascular risk and increased all-cause mortality in the general population. The aim of this study was to determine whether there are differences in primary laboratory findings and pulse wave velocity (PWV) between prehypertensive patients with and without prediabetes.

Design and method:

This study included 58 patients (39 women, 19 men) with prehypertension according to the JNC7 criteria from 2003 (systolic blood pressure [SBP] 120-139mmHg or diastolic blood pressure [DBP] 80-89mmHg based on 2 or more seated measurements on each of 2 or more office visits) from one family practice in Health center Zagreb-west. Patients were divided into two groups depending on having prediabetes (fasting plasma glucose [FPG] 5.6-6.9 mmol/L – according to American Diabetic Association (ADA) criteria from 2014). Basic laboratory tests (cholesterol, creatinine, fasting glucose, and potassium), anthropometric, 24h ambulatory blood pressure, and pulse wave velocity (PWV) measurements (with Agedio B900) were done in all patients. Renal function was calculated with the CKD-EPI formula (KDIGO 2020). Mann-Whitney U test, multiple linear regression model, and descriptive statistics were used in data processing in Statistica v.12.0.

Results:

Normal FPG was found in 41 patients (70.7%), while 17 patients had prediabetes (29.3%). Prehypertensive patients with prediabetes were older (median 58 vs. 54 years; p<0.01), had significantly higher uric acid concentration (median 324 vs 282 mmol/L; p<0.05), and higher PWV (median 8.20 vs. 7.45m/s; p<0.01). No differences were found in the concentration of potassium, LDL cholesterol, triglycerides, and body mass index (median 24kg/m2). FBG levels were independently and significantly associated with PWV (beta = 0.33; p<0.05).

Conclusions:

This pilot study indicates the possible existence of accelerated atherosclerosis in prehypertensive individuals with prediabetes compared to those with normal FPG. Research on a larger sample is needed to confirm these findings.