bluuebunny/crossref_metadata_2025 huggingface dataset:
INTERCONNECTION BETWEEN TUBULAR RENAL DYSFUNCTION AND GENES POLYMORPHISM IN PATIENTS WITH ARTERIAL HYPERTENSION
Authors: Koziolova Natalya , Chernyavina Anna
Published: April 2021

Objective:

Objective: to assess the relationship between NGAL concentration as an indicator of tubular disorders, and genetic markers of cardiovascular risk in hypertensive patients.

Design and method:

Materials and methods: 89 patients of working age with hypertension (mean age 48.32 ± 8.71) were examined, who were divided into 2 groups depending on serum NGAL. Group 1 - 20 patients with NGAL levels above reference values, Group 2 - 69 patients with NGAL levels in the range of normal values. For all patients, to evaluate tubular renal function, the concentration of NGAL in serum was determined by ELISA. All patients were examined for genotypes of AGT Thr174Met, GNB3 C825T, MTHFR C677T, MTRR Ile22Met, ApoE Cys130Arg, PRARA rs4253778.

Results:

Results: patients in the groups did not significantly differ in age, gender, risk factors, concomitant diseases and therapy, blood pressure and lipid profile. In group 1, the occurrence of AGT, MTHFR, and PRARA gene polymorphism was significantly higher in heterozygous form than in group 2 (p = 0.002, p < 0.001, and p = 0.037, respectively). Patients in the groups did not significantly differ in occurrence of GNB3, MTRR, and ApoE gene polymorphism. Correlation analysis showed a direct relationship between the concentration of NGAL in the blood and the presence of AGT gene polymorphism (r = 0.38; p < 0.05), GNB3 (r = 0.33; p < 0.05), MTHFR (r = 0.35; p < 0.05). The association of NGAL with the polymorphism of the GNB3, MTRR, and ApoE genes was not statistically significant.

Conclusions:

Conclusions: in patients of working age with hypertension, tubular dysfunction, assessed by the concentration of NGAL in the blood, is associated with the presence of AGT, MTHFR, PRARA gene polymorphism in a heterozygous form.
RARE LOSS-OF-FUNCTION MUTATIONS OF PTGIR IDENTIFIED IN FIBROMUSCULAR DYSPLASIA AND SPONTANEOUS CORONARY ARTERY DISSECTION
Authors: Georges Adrien , Albuisson Juliette , Berrandou Takiy , Dupré Délia , Lorthioir Aurélien , Amar Laurence , Januszewicz Andrzej , Motreff Pascal , Adlam David , Azizi Michel , Gornik Heather , Ganesh Santhi , Kovacic Jason , Jeunemaitre Xavier , Bouatia-Naji Nabila
Published: April 2021

Objective:

Fibromuscular Dysplasia (FMD) and Spontaneous Coronary Artery Dissection (SCAD) are related, non-atherosclerotic arterial diseases mainly affecting middle-aged women. Little is known about their physiopathological mechanisms. We aimed to identify rare genetic causes to elucidate molecular mechanisms implicated in FMD and SCAD.

Design and method:

We analyzed 29 exomes that included familial and sporadic FMD. Follow-up was conducted by targeted or Sanger sequencing (1,071 FMD and 365 SCAD patients) or lookups in exome (264 FMD) or genome sequences (488 SCAD), all independent and unrelated. We used TRAPD burden test to test for enrichment in patients compared to gnomAD controls. The biological effects of variants on receptor signaling and protein expression were characterized using transient overexpression in human cells.

Results:

We identified one rare loss-of-function variant (LoF) (MAFgnomAD = 0.000075) shared by two FMD sisters in the prostaglandin I2 receptor (hIP) gene (PTGIR), a key player in vascular remodeling. Follow-up in >1,300 FMD patients revealed four additional LoF allele carriers and a putative enrichment in FMD (PTRAPD = 8 × 10-4), in addition to several rare missense variants. We confirmed the LoFs (Q163X and P17RfsX6) and one missense (L67P) to severely impair hIP function in vitro. Genetic analyses of PTGIR in SCAD revealed one patient who carries Q163X, one with L67P and one carrying a rare splicing mutation (c.768+1C>G), but not a significant enrichment (PTRAPD = 0.12) in SCAD.

Conclusions:

Our study shows that rare genetic mutations in PTGIR are enriched among FMD patients and found in SCAD patients, suggesting a role for prostacyclin signaling in non-atherosclerotic stenosis and dissection.
DIFFERENTIALLY EXPRESSED MICRORNAS AND THEIR TARGETS WERE IDENTIFIED IN PERIPHERAL BLOOD MONONUCLEAR CELLS OF PATIENTS WITH HYPERTENSION ASSOCIATED OR NOT WITH TARGET ORGAN DAMAGE
Authors: Berillo Olga , Huo Ku-Geng , Fraulob-Aquino Julio C. , Richer Chantal , Briet Marie , Boutouyrie Pierre , Lipman Mark L. , Sinnett Daniel , Paradis Pierre , Schiffrin Ernesto L.
Published: April 2021

Objective:

Hypertension is associated with subclinical target organ damage including cardiac, vascular and kidney injury. The immune system plays a role in HTN and target organ damage in animal models. Activation of T cells has been reported among peripheral blood mononuclear cells (PBMCs) of patients with HTN. MicroRNAs are crucial post-transcriptional regulators of immune cells. Whether microRNAs play a role in the activation of immune cells in HTN complicated by target organ damage in humans remains unknown. We aimed to address this question by identifying differentially expressed (DE) microRNAs and their mRNA and non-coding RNA (ncRNA) targets in PBMCs of patients with HTN complicated or not with target organ damage. mRNA targets of DE microRNAs were predicted with TargetScan using the inversely related DE mRNAs as a filter to improve prediction efficiency.

Design and method:

Normotensive (NTN), hypertensive patients (HTN) and patients with HTN associated with at least 2 other features of the metabolic syndrome (MetS) or with chronic kidney disease (CKD) grades 3-4 were studied (n = 15-16 in each group). PBMCs were isolated from blood, RNA extracted for RNA sequencing (RNA-seq) using Illumina HiSeq-2500 and data were analyzed using a systems biology approach. DE genes microRNAs and mRNAs were identified with fold change (FC) >1.5 and P < 0.005. DE miRNAs with FC >2 and RNA-seq count number (CM) >500, and with predicted targets with CM >300 were validated by reverse transcription-quantitative PCR (RT-qPCR).

Results:

DE microRNAs, mRNAs and other ncRNAs were identified by RNA-seq in HTN (22, 19 and 0), MetS (57, 401 and 11) and CKD (6, 26 and 2) compared to NTN. TargetScan predicted that 7 microRNAs target 3 mRNAs in NTN, 57 microRNAs target 55 mRNAs in MetS and 3 microRNA target 2 mRNAs in CKD. Three of 14 selected miRNAs were validated by RT-qPCR: miR-409-5p (46% down, P < 0.05) and miR-411-5p (60% down, P < 0.001) and novel miR-pl-86 (2-fold up, P < 0.05) in MetS vs NTN.

Conclusions:

RNA-seq and RT-qPCR validation showed that DE miR-409-5p, miR-411-5p and the novel miR-pl-86 may play a role in HTN associated with MetS.
EFFECT OF A COMMON UMOD VARIANT ON RENAL FUNCTION, BLOOD PRESSURE, AND FITNESS IN A COMMUNITY-BASED COHORT OF ELDERLY SUBJECTS
Authors: Algharably Engi Abdel Hady , Fuentes Linda Elizabeth Villagomez , Toepfer Sarah , König Maximilian , Demuth Ilja , Bertram Lars , Kreutz Reinhold , Bolbrinker Juliane
Published: April 2021

Objective:

Uromodulin is encoded by UMOD and common genetic variants in UMOD have been associated with renal function, blood pressure (BP), and hypertension. Observational studies indicated that elevated BP during middle age might be associated with dementia and impaired cognitive function in later life. The aim of this study was to investigate the association of UMOD rs4293393-A>G with renal function, BP, and fitness outcomes in older participants of the Berlin Aging Study II (BASE-II).

Design and method:

Data for 1556 participants (median age 68 years, range 60–84, 51.2% females) in BASE-II were analyzed. BP measurements were determined by standardized automated measurements, estimated glomerular filtration rate (eGFR) by the CKD Epidemiology Collaboration equation, and genotypes by Affymetrix SNP Array 6.0. Genotype-phenotype association analysis was performed by analysis of covariance and logistic regression models

Results:

The number of subjects with rs4293393-genotype AA, AG, and GG were 1038 (66.7 %), 416 (29.6 %) and 57 (3.7%), respectively. Carriers of the G-allele exhibited significantly lower serum creatinine levels compared to non-carriers (AA, 0.91 mg/dl, CI: 0.90 – 0.92 vs. AG, 0.88 mg/dl, CI: 0.87–0.90 vs. GG, 0.88 mg / dl, CI: 0.84–0.93; P = 0.010). G-allele carriers had significantly higher eGFR values (AA, 76.4 ml/min pro 1.73 m2, CI: 75.7–77.2 vs. AG, 78.4 ml/min pro 1.73 m2, CI: 77.3–79.5 vs. GG, 78.5 ml/min pro 1.73 m2, CI: 75.4–81.7; p = 0.010) and a lower risk of chronic kidney disease (OR: 0.651 [95% CI: 0.43–0.98], P = 0.038). UMOD genotypes were not associated with BP, diagnosis of hypertension or with parameters of cognitive function and physical performance

Conclusions:

These findings corroborate previous findings on the role of UMOD for renal function in the elderly. However, our data reveal no association between UMOD variants and BP or parameters of fitness in a cohort of elderly subjects in a community-based cohort in Germany.
PARTIAL EPITHELIAL-TO-MESENCHYMAL TRANSITION AND T CELL-MEDIATED INFLAMMATION IN BENIGN NEPHROSCLEROSIS AND DIABETIC NEPHROPATHY
Authors: Nordbø Ole Petter , Landolt Lea , Eikrem Øystein , Scherer Andreas , Leh Sabine , Palmer Jessica Furriol , Apeland Terje , Marti Hans-Peter
Published: April 2021

Objective:

We wanted to investigate to which degree patients with benign nephrosclerosis (BN) or type 2 diabetic nephropathy (T2DN) present inflammation and/or partial epithelial-to-mesenchymal transition (EMT) in renal formalin-fixed and paraffin-embedded (FFPE) biopsies.

Design and method:

The following FFPE kidney biopsies from adult patients (n = 6 biopsies per group) were analysed: BN, T2DN and normal-appearing renal biopsy tissue (Ctrl). Messenger RNA was purified from whole tissue sections (10 mm) and subjected to RNA sequencing. Immunohistochemistry (IHC) was performed on 3-mm FFPE sections.

Results:

Dimention reduction with principal component analysis showed a distinct separation between diseased and Ctrl tissues. Further, the BN expression profile overlapped significantly with T2DN.

More detailed analysis of gene expression profiles revealed the activation of T-helper type 1 (TH1) and CD8 cytotoxic T-cell (CTL) signatures and the upregulation of the complement system in both diseases. IHC validated CD8 and CD4 cells as well as complement component 3 and the terminal complement complex C5b-9. We show upregulation of EMT- related genes and validated increased abundance of AXL and Vimentin by IHC.

Conclusions:

BN and T2DN tissues show a phenotype related to TH1, CD8 CTL inflammation and the complement system. Further, processes related to EMT were upregulated in both diseases.
LOWERING CUTOFF FOR HYPERTENSION IS RAISING THREE TIMES HEALTH EXPENDITURE IN INDIA
Authors: Maheshwari Anuj , Verma Narsingh , Gupta Arvind , Gupta Vitull Kumar , Patni Bijay , Gupta Balkishan , Saboo Banshi , Kaur Amrit , Srivastava Saurabh , Kumar B. Rajendra , Agarwal Vivek , Gupta Amit , Jain Payal , Singh Smriti , Chaowdhary Sandeep , Chandra Kp , Rangwala Joozer , Kumar Santosh , Kumar Ch Vasanth , Muthusamy Vv
Published: April 2021

Objective:

Recently American College of Cardiology (ACC)/AHA high blood pressure guideline drops both the systolic and diastolic blood pressure levels by 10 mm Hg leading the rise of overall crude prevalence of hypertension among U.S. adults from 31.9% to 45.6%. Surely these recommendations suggesting target 130/80 based on almost 50% reduction in CV events and mortality but at the same time clubbed with a rise of hypotension and acute renal failure apart from possible increase in adverse events of hypertension medications.

Design and method:

Keeping aim to study the impact of reducing cut off for hypertension in developing country like India we screened apparently healthy 129710 individuals, who never checked their blood pressure before, picked at various public places after their due consent to reveal data without disclosing their identity for blood pressure measurement in seated position after five minutes rest with three readings and taken the average of last two readings. Their demographic and details of habit also recorded.

Results:

There has been a tremendous rise in prevalence from 16.49% to 44.71% while dropping the cut off from 140/90 to 130/80. Interestingly in younger population less than 30 years of age prevalence of hypertension has been 7.7% with classical cut off 140/90 but rising more than four times 33.11% when cut off drops to 130/80. In elderly population above 60 years, a considerable rise of more than double from 28.8% to 59.6% noted.

Conclusions:

For developing world it is not only a huge rise in health expenditure but also in a country like India where 72% population is less than 40 years of age, it imparts an impression of being sick in a larger part. With this new cut off every third youngster can be labelled hypertensive. As sympathetic overdrive plays a major role in young population with hypertension, it is necessary to find an appropriate cut off for them which can not be similar to elderly. Early use of anti-hypertensive drugs not only opens door to various side effects but also paves way for lightheaded, fatigue, weakness while endeavoring lower targets.
HYPERTENSION AWARENESS, TREATMENT AND CONTROL AMONG MINORITY ETHNIC POPULATIONS IN EUROPE: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Linden Eva Van Der , Couwenhoven Brandon , Daams Joost , Born Bert-Jan Van Den , Agyemang Charles
Published: April 2021

Objective:

Ethnic minority populations in Europe are disproportionally affected by hypertension-related complications. Early detection, adequate treatment and control of hypertension can help to prevent these complications. We conducted a systematic review and meta-analysis to quantify levels of hypertension awareness, treatment and control among minority ethnic populations residing in Europe compared to the host European population.

Design and method:

MEDLINE, EMBASE and Web of Science were systematically searched for population-based studies reporting levels of hypertension awareness, treatment or control in minority ethnic populations in Europe. Using Review Manager, pooled odds ratios (OR) with corresponding 95% confidence intervals (CI) were calculated, stratified by ethnic group.

Results:

3532 records were screened of which sixteen were included in the analysis, comparing data of 26,800 subjects from five minority ethnic groups with 57,000 subjects from the European host population. African origin populations were more likely to be aware (OR 1.26, 95% CI 1.02–1.56) and treated (OR 1.49, 1.18–1.88) for hypertension, but less likely to have their blood pressure (BP) controlled (OR 0.56, 0.40–0.78), compared to the European host population. Compared to the host population, South Asian (SA) origin populations were more likely to be aware (OR 1.15, 1.02–1.30) of their hypertension status, but there were no differences in treatment and control rates. In Turkish and Moroccan origin populations, hypertension awareness rates were lower (Turkish OR 0.81, 0.65–1.00; Moroccan OR 0.46, 0.62–1.00), as were treatment levels in Moroccan population (OR 0.77, 0.60–0.97), and a trend towards lower BP control rates compared to the European populations. Hypertension awareness and control rates did not differ between Chinese origin populations and the European host population (no data on treatment available).

Conclusions:

Levels of hypertension awareness, treatment and control differ between ethnic groups in Europe. Effort should be made to improve hypertension control in African origin populations and awareness, treatment and control in Turkish and Moroccan populations, aiming to reduce ethnic inequalities in hypertension-related complications.
A PREDICTIVE TOOL FOR FORECASTING ANTI-HYPERTENSION MEDICATION REQUIREMENTS IN LOW- AND MIDDLE-INCOME COUNTRIES
Authors: Sahoo Swagata Kumar , Pathni Anupam K. , Kaur Prabhdeep , Kunwar Abhishek , Sharma Bhawna , Farrell Margaret L. , Moran Andrew E. , Komrska Jan , Frieden Thomas R.
Published: April 2021

Objective:

To develop a mathematical tool for estimating medication requirement that would improve the uninterrupted supply of medications for large-scale hypertension control programs in low- and middle-income countries.

Design and method:

In a steady state, annual drug procurement forecasts can simply replicate the previous year's consumption. For a new or rapidly growing hypertension control program, however, forecasting drug requirement requires consideration of not only patients currently on medication, but also rates of new patient registration and drop-out.

To forecast antihypertensive drug requirements, a simple mathematical tool was developed based on the morbidity method, requiring minimal inputs and assumptions. The tool hinges on use of a standard step-wise treatment protocol which uses specific medications and doses and considers hypertension prevalence, number of existing patients, expected new monthly enrollments, proportion of patients with controlled blood pressure at each protocol step, and expected loss-to-follow up over time. Outputs include forecasted quantities of specific medications for any specific time period and associated budgets. The tool provides flexibility for correction of projected requirements based on programmatic data, thus making the estimation more accurate.

Results:

The tool was implemented in an Indian hypertension control program starting with a priori assumptions and refined iteratively as program data became available. It was customised for use in specific Indian states based on their treatment protocol, population size and primary health care coverage. The monthly drug requirement projected by the tool helped to quantify drug volumes for periodic procurement, and to overcome shortages observed in some areas in first year of the program. More than 10 states in India have adopted this tool for procurement and budget planning.

Conclusions:

This simple, pragmatic antihypertension drug forecasting tool can help ensure prudent resource allocation in hypertension control programs and facilitate reliable delivery of medications for patients in low- and middle-income countries. This tool can also quantify the financial implications of alternative treatment protocols, inform protocol design, and be adapted to other chronic disease control programs.
WHAT DOES THE FINDING OF MINIMAL MITRAL REGURGITATION MEAN?
Authors: Paterno Carlos Alberto
Published: April 2021

Objective:

bjective: Leonardo da Vinci intuited that the cardiac valves were key to the functioning of the heart. Minimal mitral regurgitation in young's is often interpreted as haemodynamically insignificant. Morphological changes in the arterial wall can lead to mitral regurgitation, left atrial enlargement, and atrial fibrillation (AF). The aim is to know the measures of the central haemodynamic parameters (CHPs), brachial blood pressure (BP) values, and the prevalence of headache and AF, in both genders with minimal mitral regurgitation.

Design and method:

Design and Methods: For this cross-sectional retrospective study, data were collected from 323 patients: Female/Male 189/134, from 20 to 89 years old, divided and analyzed in each one of the 7 decades. Some patients were unaware of having hypertension, others with and without antihypertensive therapy. The finding of AF was confirmed with the presence of brief phases in the 24hs-Holter monitoring. The CHPs were measured with a SphygmoCor System PVX (AtCor-Medical Australia), a validated device employing the high-fidelity technique of applanation tonometry according to established protocols. Also, the difference of Augmentation Index (Diff-AIx) between the normal levels and the observed values was assessed according to normal range by age.

Results:

Results: Average BP was higher than normal: Female- Male 141/83–137/82 mmHg. CHPs and BP values increased in each one of the 7 decades, both genders. Frequently, the patients were symptomatic, among the female/male the headache was found in 61%/25%, with a high prevalence of up to 69 years old in 85%/88% of them. Also, they presented symptoms such as sweating, asthenia, thoracalgia, palpitations. Hypertension would not be silent chronic disease. AF was found in 49 patients (15%), female/male 22/ 27 (12%/20%), increasing the prevalence with age, after 50/60 years old was observed in 68/78%.

Conclusions:

Conclusions: Minimal mitral regurgitation would not be a bystander, it can be the consequence of the higher values of the brachial BP, the central haemodynamic parameters and the Diff-AIx. The appearance of minimal mitral regurgitation principally among younger can indicate that the brachial BP found is higher than normal and the optimal levels should be reassessed.
ASSESSMENT OF PLAQUE VULNERABILITY USING A NOVEL TECHNIQUE: MULTI-SPECTRAL PHOTOACOUSTIC IMAGING (CVENT-PAI)
Authors: Obeid Hasan , Imaizumi Yuki , Bruno Rosa-Maria , Julia Pierre , Calvet David , Boutouyrie Pierre
Published: April 2021

Objective:

Identification of intraplaque haemorrhage using magnetic resonance imaging (MRI) is expensive, technically demanding and sometimes uncomfortable. Photoacoustic imaging (PAI) is a new non-invasive technique combining multi-wavelength infrared laser light and ultrasound (US) imaging, able to discriminate blood and other components in the tissues. The measurement by the multi-spectral PAI is likely to be more applicable and therefore could be complementary to MRI.

Validate a portable multimodal and multi-wavelength PAI system, for the identification of intraplaque haemorrhage and compare with MRI.

Design and method:

Patients underwent carotid MRI, and US. Photoacoustic (PAI) acquisitions are performed and analysed posteriori blindly of the status of the subjects and results of MRI/US. All patients gave written informed consent. Histology of plaque will be performed as gold standard.

Results:

We included 22 patients (71 ± 5 years old) with carotid stenosis grade of >70% (NASCET). PAI imaging was feasible in all patients. On raw images, only clutter signal can be observed. After adequate post processing, carotid wall with the intima media and plaques were clearly visible with PAI. PAI signal from the lumen can be observed, also strong PAI signals are visible inside the plaque in a reproducible manner. Correspondence between MRI and PAI will be analysed later.

Conclusions:

The use of the PAI technique for carotid plaque assessment is feasible, and PAI signal are observed inside the plaque. Further analyses are needed to assess the reflected PA signal inside the plaque, for haemorrhage detection in the future.
COMPARISON OF PRIMARY PREVENTION OF CARDIOVASCULAR DISEASE GUIDELINES BETWEEN AUSTRALIA, ENGLAND AND THE UNITED STATES
Authors: Chapman Niamh , Breslin Monique , Lay-Flurrie Sarah , Zhou Zhen , Sharman James , Nelson Mark , Mcmanus Richard
Published: April 2021

Objective:

Background: Cardiovascular disease (CVD) primary prevention guidelines recommend absolute CVD risk estimation to guide lipid and blood pressure lowering therapy recommendations but these are inconsistent despite relying on similar evidence. This study aimed to understand the effect of such inconsistencies on the populations recommended for treatment according to CVD primary prevention guidelines in Australia, England and the United States.

Design and method:

Methods: Data were drawn from Australian(n = 3,942), English(n = 1,899) and United States(n = 2,949) national health surveys in adults aged 40 years or older. Participants were classified as recommended for therapy based on absolute CVD risk stratification and clinical characteristics denoting high risk according to each country's guidelines. Agreement was assessed by Kappa statistic.

Results:

Results: Agreement in therapy recommendation according to CVD primary prevention guidelines was minimal to weak (Kappa = 0.30–0.51). This reflected different populations being targeted due to different risk thresholds (risk calculation agreement Kappa = 0.07–0.45) and different clinical risk criteria (high risk characteristic agreement Kappa = 0.22–0.73).

Conclusions:

Conclusion: Despite a similar evidence base apparently underpinning guidance, there is very little agreement between populations targeted for CVD primary prevention in Australia, England and the United States. This disparity is driven by differences in both absolute CVD risk stratification thresholds and the clinical characteristics considered to denote high risk. Whilst different countries may adopt different policies on the appropriate level of risk to target, given a largely common evidence base, international consensus on how to define population CVD risk would allow optimum targeting of primary prevention.
PRIVATE HEALTH SECTOR PREFERENCES IN TREATMENT OF HYPERTENSION IN INDIA: EVIDENCE FROM HYPERTENSION DRUGS MARKET DATA
Authors: Pathni Anupam Khungar , Sahoo Swagata Kumar , Mahajan Tanushree , Swaroop Kishan , Moran Andrew , Shivashankar Roopa , Sharma Bhawna , Negi Sagri
Published: April 2021

Objective:

In India, there are an estimated 200 million adults with high blood pressure. National and international guidelines recommend calcium channel blockers (CCB), diuretics, angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) for first line treatment of uncomplicated hypertension, while beta-blockers (BB) have been relegated to second-line treatment. As the private sector provides 70% of out-patient care in the country, we assessed private health sector preferences of antihypertensive medications using market data.

Design and method:

Sales of all antihypertensive formulations in India from 2016–2018 were analysed, using a large nationally representative dataset for the private sector pharmaceuticals market. In addition to analysis at the National level, data for five states was analysed to determine any inter-state variations.

Results:

The Indian hypertension drug market grew at a compounded annual growth rate of 6.9% from 2016 to 2018 with a total of 21,066 million tablet or capsule sales in 2018. Two-drug single pill combinations (SPCs) had the highest market share in 2018, with 36% of market volumes, followed by CCBs (18%), BBs (16%), ARBs (14%), diuretics (5%), ACEI (3.6%), and three-or-more-drug SPCs (2.8%). Among two-drug SPCs, amlodipine/atenolol (9.8%) was the most preferred, followed by telmisartan/hydrochlorothiazide (4.1%) and amlodipine/telmisartan (3.8%).

There were inter-state variations in the market share of antihypertensive drugs. In four states, two-drug SPCs accounted for approximately 40% of all antihypertensives sold (range 38%-42%). This was followed by BBs as the second most preferred drug class in two states (range 18%-19%), while CCBs were preferred in the other two states (range 16%-18%). In the fifth state, CCBs (25%) were most preferred, followed closely by BBs (21%). Amlodipine/atenolol was the most preferred molecule in two states, amlodipine in another two states and telmisartan in the fifth state.

Conclusions:

Despite changes in standard hypertension treatment guidelines, evidence from pharmacy sales data indicate variable treatment practices in the private health sector in India, with a preference for beta blockers. This study highlights the need to improve hypertension care quality through private sector engagement strategies including sensitisation, regular training programmes and possibly provider incentives for evidence-based practice.
IS THE CONTROL OF CARDIOVASCULAR RISK FACTORS IS DIFFERENT IN PRIMARY AND SECONDARY PREVENTION? COMPARISON OF 2 COHORTS OF HYPERTENSIVE PATIENTS WITHIN 10 YEARS
Authors: Lopez-Sublet Marilucy , Lequeux Benoit , Gallo Antoine , Dourmap Caroline , Delsart Pascal , Coz Sylvie Regnier Le , Steichen Olivier , Lamirault Guillaume , Boulestreau Romain , Ott Julien , Dimitrov Yves , Sautenet Benedicte , Feit Bertrand , Artifoni Mathieu , Baguet Severine , Irigoin Marc , Mourad Jean Jacques , Le Jeune Sylvain , Sosner Philippe
Published: April 2021

Objective:

Euroaspire surveys highlighted the insufficiency of control of cardiovascular risk factor (CVRF) in coronary patient in secondary prevention. Patient profiles have changed, making it difficult to analyse these data over time. Our aim was to establish the state of CVRF control in two cohorts of French hypertensive patients in different clinical situations of primary and secondary prevention by following the variables assessed in Euroaspire.

Design and method:

Of each of the 22 participating hypertension specialist consultations, the first 20 patients (followed for at least one year) were included. Theoretical objectives were notified for each patient according to clinical profile. Two cohorts were formed, Cohort 1 (C1) in 2009 (n = 185) and Cohort 2 (C2) in 2019 (n = 260). Patients were classified according to their prevention (P) profile: primary (P1) and secondary (P2).

Results:

Baseline data are summarized in Table 1. The main statistically significant results between C2 vs C1 respectively are: younger people (58.8 vs 63.9 y) and more women in P1 (50% vs 32%); higher systolic blood pressure (BP) in P2 (143.7 vs 134.7 mm Hg), whereas higher diastolic BP in P1 (81.7 vs 76.6 mm Hg); fewer diabetic patients in P1 (19% vs 41%); poorly BP targets met in P1 (43% vs 63%); lower number of antihypertensive drugs in both groups (P1: 2.17 vs 2.66; P2: 2.62 vs 3.16); prescription of statins felt by half in P1 (30% vs 43%) within 10y.

Conclusions:

The high prevalence of unhealthy lifestyles, modifiable CVRF and inadequate use of drug therapies to achieve BP and lipid goals, are documented findings of the Euroaspire surveys in coronary patient, which we confirm in our hypertensive patients. Indeed, the P1 patient is less well managed than 10 years. In P2, there is no difference between the two cohorts, no improvement in BP control, possibly related with a reduction in the number of antihypertensive drugs. Ambition targets allocated for global prevention by combating the clinical inertia in titrating treatments must be a medical priority in clinical practice.

Thanks to patients and Club des Jeunes Hypertensiologues.
EXAGGERATED BLOOD PRESSURE RESPONSE IN EXERCISE IS ASSOCIATED WITH LACK OF LEFT VENTRICULAR HYPERTROPHY REGRESSION IN HYPERTENSIVE PATIENTS AFTER 6 YEARS FOLLOW-UP
Authors: Andrikou I. , Tsioufis K. , Dimitriadis K. , Konstantinidis D. , Leontsinis I. , Karaminas N. , Kalos T. , Tolis P. , Anastasiou A. , Andrikou E. , Tousoulis D.
Published: April 2021

Objective:

Regression of left ventricular hypertrophy (LVH) is independently associated with improved cardiovascular outcome. In this study we aimed to investigate the role of exaggerated blood pressure response (EBPR) during exercise in LVH regression in hypertensive subjects over time.

Design and method:

1413 hypertensive subjects, (mean age 57 ± 11 years), 51% males, with baseline office blood pressure (BP) 144/89mmHg were followed for a mean period of 6.4 ± 3.0 years. At baseline and last follow-up visit all patients underwent office BP, laboratory tests and echocardiographical determination of left ventricular mass index (LVMI). At baseline, all subjects underwent treadmill exercise testing (Bruce protocol) in order to identify the presence of EBPR based on the systolic BP elevation at peak exercise (> or = 210 mmHg for men and > or = 190 mmHg for women). Main outcome variable was LVH Regression/prevention (LVH Regr/prev), defined as: LVH at baseline visit with normal LVMI values at last visit or absence of LVH at baseline and last visit. BP control was considered optimal when the mean of office BP measurements during follow-up was < 140/90 mmHg.

Results:

46% of study population presented LVH Regr/prev during follow-up period. Cox-regression analysis, after adjustment for clinical and biochemical variables, revealed that low levels of baseline LVMI (HR = 0.98, 95% CI 0.97–0.99, p < 0.0001), absence of EBPR (HR = 0.81, 95% CI 0.67–0.98, p = 0.02) and optimal BP control during follow-up (HR = 1.19, 95% CI 1.01–1.56, p = 0.03) were independent predictors of LVH Regr/prev during follow-up.

Conclusions:

In conclusion, beyond optimal BP control, EBPR is a significant predictor of structural cardiac alterations overtime. These finding strengthens the clinical importance of EBPR during the baseline evaluation of hypertensive subjects.
COMPARISON OF TWO HAEMODYNAMIC MONITORING SYSTEMS IN THE CARDIAC CATHETERIZATION LABORATORY: THE MANIFOLD (MANUAL) VS. AUTOMATED ACIST CVI®
Authors: Mahmud Azra , Balghith Mohammad , Ayoub Kamal , Alanezi Abdulrehman Fahad , Alanezi Abdulrehman , Alhadadi Bandar , Alshammary Hanan , Alshehri Jaber , Alshammary Majed , Alghamdi Ali , Khan Fayaz Mohammad
Published: April 2021

Objective:

Hemodynamic monitoring is an integral part of any cardiac catheterization procedure and can be potentially prone to many distortions, including damping and resonance. The optimum damping ratio recommended for accurate haemodynamic monitoring ranges between 0.4 to 0.8. The most common systems used include Manifold, the manual system and the automated, ACICT CVi® device, which is claimed to be as accurate as the manual system and easier to use.

The aim of this prospective study was to compare damping ratio, ascending aortic pressure waveform and invasive blood pressures (BP) between manifold and ACIST CVi®, in patients undergoing cardiac catheterization.

Design and method:

This study was conducted at the cardiac catheterization Laboratory at King Abdul-Aziz Cardiac Center, National Guard Health Affairs, Riyadh in adult patients undergoing elective cardiac catheterization procedures. The fast-flush test was performed at the beginning of the procedure using manifold and ACIST in a cross-over fashion. The square wave was analysed to calculate the damping coefficient for each device. Data was analyzed by JMP Pro (SAS for Windows, Version 13) p < 0.05 considered significant. The patients gave informed consent and the study was approved by the Institutional Ethics Committee.

Results:

We compared the two systems in a randomised cross-over fashion in 54 subjects (mean age 58.1 ± 12, 24% females). The mean damping ratio was 0.61 ± 0.11 (range 0.34–0.95) with manifold vs. 0.95 ± 0.27 (range 0.53–2.1) with ACIST, mean difference 0.33, p < 0.0001. The over-damped ACIST yielded lower BP measurements compared with manifold; mean difference 6 mm Hg systolic and 5 mm Hg diastolic with almost 30% of the subjects showing a discrepancy of > 10 mm Hg between the two systems.

Conclusions:

To the best of our knowledge, this is the first study comparing a manual haemdynamic monitoring system to an automated one used widely in cardiac catheterization laboratories. In our study, while the mannifold met the international recommendations for accurate haemodynamic monitoring, ACIST device was overdamped, resulting in significant underestimation of invasive pressures. We recommend using the manifold system for studies involving haemodynamically compromised patients and in patients depending upon accurate haemodynamics for diagnostic purposes.
EVALUATION OF THE CARDIOPROTECTIVE EFFECT OF MANGIFERIN IN AN EXPERIMENTAL MODEL OF ISCHEMIA REPERFUSION INJURY
Authors: Bhatia Jagriti , Suchal Kapil , Bhargava Poorva , Malik Salma , Arya Ds
Published: April 2021

Objective:

The injurious effects of restoration of coronary blood flow following myocardial infarction is a major concern as reperfusion predisposes to myocardial injury. Mangiferin is a polyphenolic antioxidant present in the bark, fruits, roots and leaves of Mangifera indica Linn (Anacardiaceae). It is known to modulate biological targets in inflammation & oxidative stress. It also possesses anti-oxidant, anti-apoptotic; anti-atherogenic and anti-diabetic actions. Hence, we hypothesized that the anti-oxidative, anti-inflammatory, and anti-apoptotic effects of mangiferin may also be involved in the prevention of IR injury.

Design and method:

Male albino Wistar rats were divided into four groups i.e. sham, IR-control, Mangiferin-40 + IR and Mangiferin 40 per se. Mangiferin was administered at a dose of 40 mg/kg, intraperitoneally for 15 days. On the 15th day, myocardial IR injury was induced by occluding the left anterior descending coronary artery for 45 minutes followed by reperfusion for 60 minutes. At the end of the surgical procedure, the rats were sacrificed, the hearts excised and processed.

Results:

IR-control rats showed significant cardiac dysfunction along with a raised serum cardiac injury markers, and a significant decrease in tissue antioxidants as compared to sham group. Histopathological examination of IR rats showed myocardial necrosis, edema and inflammatory cell infiltration. Pre-treatment with mangiferin significantly suppressed myocardial oxidative damage, maintained membrane integrity, and attenuated the levels of pro-inflammatory cytokines, pro-apoptotic proteins and TGF-beta. Additionally, mangiferin significantly reduced the phosphorylation of p38, and JNK and enhanced phosphorylation of ERK1/2.

Conclusions:

Mangiferin ameliorates myocardial IR injury by alleviating oxidative stress mediated apoptosis and modulating MAPK mediated inflammation.
INVESTIGATION OF BIOACTIVE FLAVONOID SOURCED FROM CITRUS FRUITS ON ITS EFFECT UPON CARDIAC HYPERTROPHY: AN EXPERIMENTAL STUDY
Authors: Bhargava Poorva , Bhatia Jagriti , Arya Ds
Published: April 2021

Objective:

Cardiac hypertrophy is an adaptive process of the heart. It is a leading cause for heart failure, which in turn has a high mortality rate. Hesperidin (HES) is a bioactive flavanone glycoside with agonistic activity on Peroxisome Proliferator-Activated Receptor gamma (PPAR-gamma), reported to be an inhibitor of cardiac hypertrophy signalling pathways. Therefore, we investigated the cardio-protective effect of this bioactive flavonoid in isoproterenol induced cardiac hypertrophy.

Design and method:

Male albino Wistar rats were divided into 6 groups (n = 6) and administered isoproterenol (3 mg/kg/day s.c.) or hesperidin (200 mg/kg/day, p.o.) and isoproterenol or enalapril (30 mg/kg/day p.o.) and isoproterenol or a combination of hesperidin and enalapril for 28 days. On the 29th day, rats were anaesthetized followed by cannulation of coronary artery to record hemodynamic parameters. Blood sample was collected and heart was excised to evaluate for parameters like biochemical, histopathological, ultrastructural and immunohistochemical studies.

Results:

Hesperidin significantly normalized heart weight/body weight ratio and cardiomyocyte area in the treated rats. Moreover, hesperidin improved cardiac function and attenuated pathological changes as seen in the heart tissue sections. A decline in the levels of cardiac injury markers (CK-MB, LDH) and inflammatory markers TNF-alpha, IL-6) was observed. Additionally, hesperidin suppressed oxidative stress and apoptosis along with an increased PPAR-gamma expression.

Conclusions:

Hesperidin has a good potential for attenuation of cardiac hypertrophy and acts by virtue of its PPAR-gamma agonistic, anti-inflammatory, anti-apoptotic and anti-oxidant properties.
FORWARD WAVE AND ITS IMPACT ON AUGMENTATION INDEX: DO GENDER DIFFERENCES EXIST?
Authors: Kokhan Elizaveta , Kiyakbaev Gayrat , Kobalava Zhanna
Published: April 2021

Objective:

Some studies have found that women have markedly higher aortic augmentation index (Aix) than men. Traditionally, this difference has been attributed to the early return of the reflected wave because of shorter stature and increased aortic stiffness in women. However, augmentation pressure is also affected by the shape of the forward wave. We aimed to assess the impact of gender on the association between forward aortic wave time, pressure and Aix in hypertensive patients.

Design and method:

30 men and 37 women with hypertension were enrolled. Central hemodynamic was assessed using applanation tonometry method (SphygmoCor-Australia). We estimated central systolic and diastolic pressure, Aix, Aix adjusted by heart rate (Aix@75), pulse wave velocity (PWV), forward wave pressure (FWP), ejection duration (ED), time to peak forward wave (T1), time to peak systolic wave (T2) and reflected wave foot time (Tr).

Results:

Men and women had similar median of age (64 vs 66, p = 0.34), heart rate (77 vs 78, p = 0.40), peripheral systolic (133 vs 130mmHg, p = 0.32) and diastolic (80 vs 77mmHg, p = 0.16) pressure. Despite similar central systolic (119 vs 117mmHg, p = 0.47), diastolic (81 vs 78mmHg, p = 0.19) pressure and PWV (9.9 vs 9.4m/s, p = 0.79), women had higher Aix (33 vs 23%, p < 0.001), and Aix@75 (34 vs 26%; p < 0.001). Men and women had similar T2 and FWP, but Tr was higher in men (134 vs 130ms; p = 0.04), whereas ED (301 vs 314ms) and T1 (105 vs 109ms) – in women (p < 0.05). Tr minus T1 was higher in men (30 vs 22ms; p = 0.014). In a multivariate regression analysis in men Aix@75 was significantly associated with PWV (beta = 0.75, p = 0.005), whereas in women – with T1 (beta = 0.32, p = 0.04) and Tr (beta = 0.42, p = 0.009).

Conclusions:

As according to previous reports, women had higher Aix and Aix@75 and shorter time to backward wave return. However, we also found that men and women had different ejection patterns and women had higher forward wave peak time, that was significantly related to Aix@75 only in them. It may indicate that shape and time of the forward wave may also contribute to higher Aix in women compared to men.
BLOOD PRESSURE CONTROL OF HYPERTENSIVE PATIENTS WITH HIGH HEART RATE (RESULTS FROM NATURE HTN)
Authors: Hammami Rania , Bahloul Amine , Charfeddine Salma , Triki Faten , Ellouze Tarek , Abdessalem Salem Ben , Zakhama Lilia , Added Faouzi , Abid Leila
Published: April 2021

Objective:

High heart rate (HHR) is related to sympathic hyperactivity and. Betablockers are downgraded in the management of hypertension, however many studies showed that HHR is associated with elevated blood pressure and increased risk for cardiovascular disease. We aimed in this work to analyze the clinical profile of patients with HHR and to assess the implication of this finding on blood pressure control, based on data from the largest Tunisian national registry Nature HTN

Design and method:

Nature HTN is a national multicentric study conducted by the Tunisian society of cardiology and including hypertensive patients who consulted their doctors during one month in 2019. We defined HHR by a HR higher or equal to 80bpm. We compared two groups, group1 = HR lower than 80 bpm and group 2: HR higher than 80 bpm.

Results:

We enrolled 25890 hypertensive patients, with female predominance (SR = 1.2) and mean age 64.4 ± 12.2 yo. The hypertension was newly diagnosed in 2286 patients (8.8%) and known more than six months in 23601 persons. The mean HR was 73.8 ± 11 (extremes: 40–150). HHR was found in 4878 patients (19.2%). Patients of group 2 were more frequently female (56.5% versus 43.5%, p = 0.009). The prevalence of HHR were higher in diabetic (21 versus 18%, p < 0.001), smokers (21.4% versus 18.8%, p < 0.001) and obese (21.3% versus 18.2%, p < 0.001), patients with apnea syndrome (26.5% versus 19%, p < 0.001), patients with atrial fibrillation (29.9% versus 18.3%, p < 0.001). Patients of group 1 practiced physical activity more frequently than group 2 (15.8% versus 11.6%, p < 0.001), and are more compliant to drug and salt intake. BP control was lower in patients with HHR (40.5% versus 52.4%, p < 0.001). HHR was found as a predictor of uncontrolled BP on multivariate analysis (OR = 1.59, 95% CI (1.48–1.71), p < 0.001).

Conclusions:

Our study showed that HR is an integral part of the assessment of the hypertensive patient. Older beta-blockers do not low the central pressure and that s why no effective on cardiovascular events. Newer beta blockers are efficient on central blood pressure and could be largely used in the management of Hypertension.
HEART FAILURE WITH PRESERVED EJECTION FRACTION AMONG SYMPTOMATIC PATIENTS WITH HIGH-RISK HYPERTENSION: DIFFERENCES IN NEW DIAGNOSTIC ALGORITHMS
Authors: Gudieva Khyadi , Safarova Ayten , Kobalava Zhanna
Published: April 2021

Objective:

We aimed to assess diagnostic scales (H2FPEF, HFA-PEFF) on a frequency of revealing HFpEF in patients with arterial hypertension (AH) and symptoms of heart failure (HF).

Design and method:

Study included 180 high risk hypertensive patients with at least one symptom or sign of HF and left ventricular ejection fraction (LV EF) more or equal 50%, 54,4 % female, 72.3 ± 9.4 years (M ± SD), obesity 54.4 %, diabetes mellitus 38.9 %, atrial fibrillation 61 %, chronic kidney disease 60 %, estimated glomerular filtration rate (eGFR) 57.5 ± 16.33 ml/min/1.73 m2, NT-proBNP level 121 (51.7; 287.7) pg/ml. Patients with significant valvular heart disease, acute coronary syndrome, acute infections, pulmonary embolism, neoplasm, eGFR < 30 ml/min/1.73 m2, body mass index > 40 kg/m2 were not included.

HFpEF was assessed by ESC HFA-PEFF and H2FPEF algorithms. Stress-echo with passive leg raising (PLR) was used to detect impaired LV diastolic function reserve and the increase in LV filling pressure.

Results:

Using ESC HFA-PEFF score patients were divided into 3 groups: low probability/absence of HF in 8.6 % of cases (<2 points), 37.9% of patients have confirmed HF (5 points), patients with intermediate risk of HF and required for stress echocardiography – 53.6 % (2–4 points). After the stress-ECHO HFpEF was additionally detected in 13.3% of patients. Low (<2 points), intermediate (2–5 points) and high probability (>5 points) of HFpEF was identified in 7.4, 60 and 32.6 % of patients according to H2FPEF score.

Conclusions:

Thus, the frequency of HFpEF using HFA-PEFF was 60%. Stress - ECHO with PLR increases the verifying of HFpEF in 13.3%. High probability of HFpEF according to H2FPEF score was 32.6%. Considering the differences in HFpEF detection using different algorithms, further research are recommended.