bluuebunny/crossref_metadata_2025 huggingface dataset:
RESULTS OF SIDI BEL ABBES PROSPECTIVE STROKE STUDY (SPSS)
Authors: Chami Mohammed Amine , Beghdadli Benal
Published: April 2021

Objective:

Stroke represents a major public health concern worldwide. In Algeria, it is the first cause of cardiovascular mortality preceding myocardial infarction. Thus stroke is the third leading cause of death in developed countries.

Objectives:

to describe stroke's features among inpatients at the internal medicine department of the university hospital of Sidi Bel-Abbes (Algeria).

Design and method:

This is a cross-sectional descriptive study whose data were collected prospectively during the period from 01/10/2014 to 31/12/2017.

Both sexes with first or recurrent stroke were included.

Quantitative Data were presented in percentage and gender comparison with Student t test ± SD.

Results:

499 patients have been included in the study: 222 women (44.5%) and 277 men (55.5%). The mean age was 68.40 ± 13.72 years with no difference in gender (p > 0,05).

Admission time was respectively over 3 hours and over 4 h 30 mn 91,2% and 87,1%.

Mean length of stay was 10,23 ± 8,27 days.

Ischemic stroke represented 83,5%.

The most frequents risk factors were hypertension (65.1%), diabetes mellitus (34.1%) smoking 15,8% stroke history (14.4%).

The NIHSS score was more than 25, 5–25 and less than 5 in 4.8%, 79,4% and 14,6 % respectively.

At admission, no significant difference was shown in relation to glycemia, total cholesterol, LDL cholesterol and HDL cholesterol by gender.

Ischemic Stroke was caused by atrial fibrillation in 15% of cases.

According to Rankin Score, patients had moderately severe disability and severe disability respectively in 22,8% and 20,6%.

Conclusions:

The results of our study corroborate most studies of age, sex, stroke type and confirm that hypertension is the most important risk factor for stroke.

Diabetes is more commonly found in our study than in international data.

The delay in admission time is the main obstacle to the prescription of thrombolysis.

The stroke poses a management problem which requires an urgent opening of neuro-vascular units throughout the national territory beside carrying out an awareness campaign of the signs of stroke and the urgency of its medical care.
NOCTURNAL HOME VERSUS AMBULATORY BLOOD PRESSURE MONITORING IN CHILDREN AND ADOLESCENTS: ASSOCIATION WITH PRECLINICAL TARGET-ORGAN DAMAGE
Authors: Stambolliu Emelina , Kollias Anastasios , Bountzona Ioanna , Ntineri Angeliki , Servos George , Vazeou Andriani , Stergiou George
Published: April 2021

Objective:

To evaluate the relationship between nighttime blood pressure (BP) assessed by home (HBP) or ambulatory (ABP) monitoring with preclinical damage in children and adolescents.

Design and method:

Apparently healthy children and adolescents (age 6–18 yeas) referred for elevated BP were subjected to (i) 24 h ABP monitoring (Microlife WatchBP O3), (ii) 7-day HBP monitoring during daytime (duplicate morning and evening measurements) and nighttime (3 nights, 3 readings/night) (Microlife WatchBP Home-N), and measurement of (iii) carotid intima-media thickness (cIMT) and carotid distensibility coefficient (cDC), (iv) carotid-femoral pulse wave velocity (PWV; Complior device), and (v) echocardiographic left ventricular mass index (LVMI).

Results:

94 individuals were analyzed (mean age 13.2 ± 2.8 years, 54 males, BMI 24.8 ± 5.2 kg/m2, 18 with 24 h ABP > 95th centile). Daytime HBP was slightly lower than daytime ABP (difference -2.0 ± 6.4/-0.8 ± 5.0 mmHg, systolic/diastolic, p < 0.01/NS), whereas nighttime HBP was slightly higher than nighttime ABP (2.5 ± 7.1/2.1 ± 6.2 mmHg, p < 0.01/ < 0.01). There was a strong association between ABP and HBP (daytime r = 0.83/0.79 and nighttime 0.79/0.60, systolic/diastolic) (all p < 0.05). Nighttime systolic ABP and HBP were associated with all indices of target-organ damage (LVMI r = 0.36/0.30 for ABP/HBP; cIMT 0.47/0.49; cCD -0.31/-0.25; PWV 0.50/0.56 (p = NS for HBP-ABP comparisons). The agreement between nighttime HBP and ABP in identifying: (i) subjects with asleep ABP > 90th percentile was 73% (kappa 0.38, p < 0.01) and (ii) non-dippers 55% (kappa 0.16).

Conclusions:

These results suggest that in children and adolescents nocturnal HBP monitoring is feasible, is strongly correlated with nighttime ABP and gives similar correlations with preclinical target-organ damage. The agreement between these methods in identifying individuals with nocturnal hypertension is satisfactory, whereas for non-dippers it is moderate.
REPRODUCIBILITY OF OFFICE, HOME AND AMBULATORY BLOOD PRESSURE MEASUREMENTS IN CHILDREN AND ADOLESCENTS
Authors: Bountzona Ioanna , Ntineri Angeliki , Kollias Anastasios , Stambolliu Emelina , Alamara Christina , Vazeou Andriani , Stergiou George
Published: April 2021

Objective:

To compare the reproducibility of blood pressure measurements taken in the office (OBP), at home (HBP) and with ambulatory monitoring (ABP) in children and adolescents.

Design and method:

Apparently healthy children and adolescents (age 6–18 years) referred for elevated BP were included. OBP was measured in 2 visits (triplicate auscultatory measurements), HBP on 7 days (duplicate morning and evening measurements) and 24 h ABP at 20-minute intervals. All measurements were repeated after 1–6 months. The reproducibility of OBP (visit 1 and 2), HBP (7 days) and ABP (24 h, daytime, nighttime) was quantified using test-retest correlations coefficients (r) and standard deviation of differences (SDD) between repeated measurements.

Results:

58 subjects were included (mean age 13.0 ± 2.9 years, 60.3% boys, average interval between assessments 4.1 ± 2.1 months). All BP differences between sessions were non-significant apart from diastolic OBP at visit 1 (p < 0.05; Table). The reproducibility of HBP was comparable to that of 24 h ABP and both were superior to that of OBP. The reproducibility of 24 h ABP tended to be superior to that of daytime and nighttime values (Table). Similar conclusions were provided by SDD and r values.

Conclusions:

These data suggest that in children and adolescents out-of-office BP measurements are more reproducible than OBP measurements. 7-day HBP and 24 h ABP appear to have similar reproducibility.
PREDICTION OF EARLY ONSET OF ARTERIAL HYPERTENSION BY DISCRIMINANT ANALYSIS IN CHILDREN
Authors: Samarina Olga , Chuykov Alexsander , Kovtun Olga
Published: April 2021

Objective:

The prevalence of essential hypertension among children has risen over the last several decades in accordance with the rise in childhood obesity. Early identification and management of elevated blood pressure in the pediatric population are important to decrease the risks of end-organ damage and mortality in the pediatric and adult population. Using a discriminant analysis study of children, we sought to construct a predictive model of individuals who are at a higher risk factor of the occurrence of arterial hypertension in childhood.

Design and method:

The complex of genetic, environmental and biological risk factors were analyzed on a test sample of 75 subjects (49 patients with essential hypertension and 26 normotensive children). Linear discriminant analysis was used to generate a predictive model. The accuracy of our prognostic model was defined in another group of patients (n = 10).

Results:

Seventeen variables were found to be predictive of early onset of arterial hypertension in children. Stepwise discriminant analysis revealed that the overweight and obesity (Wilks Lambda = 0.552; F = 53.895; P < 0.001), the familial tendency to high blood pressure (Wilks Lambda = 0.352; F = 14.445; P < 0.001), the individual accumulation of risk factors (Wilks Lambda = 0.333; F = 10.654; P = 0.001), low weight at birth (Wilks Lambda = 0.351; F = 14.319; P < 0.001) and living in poor socioeconomic conditions (Wilks Lambda = 0.350; F = 14.045; P < 0.001) were the strongest discriminators in the model. The ‘low-risk’ persons could be distinguished from the ‘high-risk’ individuals with an almost 97% correctness. The model of prognosis was tested on the control group. The accuracy of prognosis was 90%, with a sensitivity of 100% and specificity of 80%.

Conclusions:

A personalized prognostic model makes it possible to predict the early onset of arterial hypertension in children. This reliable method for identification of the subset of the pediatric population predisposed to arterial hypertension would aid a targeted implementation of intervention strategies.
IMPACT OF 2017 AAP AND 2016 ESH GUIDELINES ON PAEDIATRIC HYPERTENSION PREVALENCE
Authors: Fanelli Elvira , Di Monaco Silvia , Pappaccogli Marco , Eula Elisabetta , Fasano Chiara , Masera Guglielmo , Rabbone Ivana , Rabbia Franco , Veglio Franco
Published: April 2021

Objective:

2016 European Society Hypertension (ESH) and 2017 American Academy of Paediatrics (AAP) guidelines on hypertension in children and adolescents substantially diverge, for the first time, in the definition of hypertension. The aim of this study was to retrospectively assess the impact of the two different guidelines on prevalence of high blood pressure in a population of obese and normal-weight children and adolescents.

Design and method:

This study included an historical cohort of 624 subjects in age range 2–18 years, among referred to Paediatric Endocrinology Division and Hypertension Centre. They had previously undergone a blood pressure and anthropometric parameters measurement. Subjects were classified in normotensive, pre-hypertensive or hypertensive on the base of the latest ESH and AAP guidelines. Weight, height and body mass index (BMI) percentiles were considered according to age and gender. Subgroups by gender, BMI, age range were examined.

Results:

Mean age was 12 ± 3 years, with male accounting for 59% of population. According to 2017 AAP guidelines cut-offs, 204 subjects (32,7%) were hypertensive, while only 110 subjects (17,6%) were hypertensive according the 2016 ESH definition, with a statistical significance of difference observed (p < 0,01). A higher proportion of hypertensive subjects when applied AAP nomograms was observed in all different subgroups for age, sex and BMI. However, the greater disagreement in the two classification was observed in aged less than 16 years of age and normal-weight subjects.

Conclusions:

AAP and ESH BP guidelines implies significant differences in BP classification in children and adolescent: with AAP nomograms application, excluding overweight subjects, a higher proportion of subjects were, and in the future will be, classified as hypertensive in all categories group.
ANGIOTENSIN RECEPTOR - NEPRILYSIN INHIBITION IS SUPERIOR TO ANGIOTENSIN RECEPTOR INHIBITION ALONE FOR THE TREATMENT OF SEXUAL DYSFUNCTION IN FEMALE SPONTANEOUSLY HYPERTENSIVE RATS
Authors: Zhuang Chenchen , Wang Qiongying , Mou Yuping , Yu Jing
Published: April 2021

Objective:

We investigate the effect of angiotensin receptor - neprilysin inhibition on sexual dysfunction (SD) for female SHR rats.

Design and method:

A total of 50 female SHR rats were randomly divided into 5 groups (n = 10/group): Wistar rats (no medication); SHR rats (no medication); Valsartan (30 mg/kg/day p.o.); Sacubitril / valsartan (SAC/VAL) (60 mg/kg/day p.o.); SAC/VAL + A799 (100ng/kg/day i.v.). The blood pressure was measured before intervention and after 1-month intervention. Vaginal smears were performed and examined daily via light microscopy for determination of the stage of each rat's estrous cycle. Paced mating behavior is observed in nighttime, including number of mounts, intromissions, smelling female vagina, and rejection by kicking male rats.

Results:

Blood pressure in SHR rats received SAC/VAL was obviously lower than SHR rats without intervention, but similar to valsartan. The different cell populations across the cycle were improved in SAC/VAL, and worse in SHR rats without intervention. The numbers of mounts, intromissions, smelling and kicking male rats for rejection were significantly superior to Valsartan and SHR without intervention, and the difference was significant statistic.

Conclusions:

SAC/VAL is a novel drug of angiotensin receptor - neprilysin inhibition to improve blood pressure and SD.
ANGIOTENSIN RECEPTOR-NEPRILYSIN INHIBITOR SUPPRESSED CARDIAC DYSFUNCTION BY ANGIOGENESIS IN MICE MODEL OF ATHEROSCLEROSIS
Authors: Suematsu Yasunori , Ideishi Akihito , Tashiro Kohei , Miura Shin-Ichiro
Published: April 2021

Objective:

We previously reported that Angiotensin receptor-neprilysin inhibitor (ARNI) has the effects of suppression of myocardial hypertrophy and fibrosis in addition to reduction of afterload by natriuretic effect. We investigated the effects of ARNI against mice model of atherosclerosis.

Design and method:

Atherosclerotic model was induced by high cholesterol diet for 4 weeks to apolipoprotein E knockout mice. We divided into four groups: no treatment (CTL), valsartan 30 mg/kg (VAL), sacubitril (neprilysin inhibitor) 30 mg/kg (SAC), and ARNI 60 mg/kg for additional 13 weeks.

Results:

Body weight and systolic blood pressure in the VAL, SAC and ARNI groups did not show significant differences compared to those in the CTL group. Serum brain natriuretic peptide (BNP) in ARNI group (605 ± 221 pg/ml) was significantly increased than that in VAL (391 ± 57 pg/ml) and SAC (357 ± 91 pg/ml) groups, but not CTL group (393 ± 192 pg/ml). Although the rate of atherosclerotic area in aorta was 16.3 ± 5.8 % after treatment, there were no significant differences between the groups. In the CTL group, left ventricular ejection fraction (LVEF, 81.6 ± 4.8 %) and fractional shortening (FS, 44.8 ± 5.8 %) at baseline were significantly reduced after treatment (67.8 ± 8.2 % and 33.3 ± 6.1 %). Interestingly, LVEF (76.6 ± 6.7 %) and FS (40.1 ± 6.1 %) after treatment in the ARNI group were significantly preserved compared to those in the CTL group. In real time polymerase chain reaction analysis of LV after treatment, relative mRNA expression of BNP and angiogenetic factors including ATPase sarcoplasmic/endoplasmic reticulum Ca transporting 2, vascular endothelial growth factor A, cluster of differentiation 34 in ARNI group were significantly increased than those in the CTL group.

Conclusions:

Although ARNI did not suppress atherosclerosis in mice, it preserved LVEF via improving angiogenetic ability.
THYROID DYSFUNCTION IN NEWLY DIAGNOSED HYPERTENSIVE PATIENTS
Authors: Almustafa Bader , Alshubini Aqeela , Alrumaih Zainab , Aljaffer Yasser , Alhai Saleh , Aldubaisi Bashayer , Alzayer Ahmed , Alfaraj Nada , Albabli Afrah
Published: April 2021

Objective:

To determine the prevalence of thyroid dysfunction in patients with hypertension attending primary health care clinics in QATIF province.

Design and method:

Thyroid dysfunction, defined as TSH levels below 0.5 or above 3.5 mU/L, was tested in a total of 1,092 patients with new diagnosis of HTN or DM2, from 15 Nov 2012 till 20 Sep 2017, in 3 Primary Health Care centers. Data of 20% of this population were traced by systematic random sampling to review their detailed demographic and clinical information. This included manual and electronic review of medical records.

Data collected include demographics, Hx of Comorbidity, ToD and other CVR, vital measures, lipids, FBS and A1c.

Data verified and cleaned for outliers, recoded and grouped. Analysis done by SPSS including Univariate, Bivariate, Crosstab, chi square and binary logistic regression for Thyroid Dysfunction.

Results:

TFT and basic demographic and clinical data were traceable in 163/185 (88.1% of the sample). Females constitute 61.3% while obesity 60.4%, Mean Age 50.6 (13) yrs, Hypertension 60.1%, DM2 58.3% and Dyslipidemia 73%.

Prevalence rate of thyroid dysfunction was 20.3%. No statistically significant difference was noted between groups of gender, BMI, Age, being DM or HTN or having an abnormal ECG finding.

Binary logistic regression showed no significant effect of any of the included independent variables, including Age, BMI Level, pulse, SBP, DBP, DM, FBS, Dyslipidemia, T. Cholesterol, LDL, HDL, Triglyceride, sex, Age Group, DBP by SBP and T. Cholesterol by LDL by Triglyceride. However, 97% of the them were at age of 35 or above.

Conclusions:

In newly diagnosed CMR patients, 20.9% are having Thyroid dysfunction. It was unpredictable by Hx, demographics, ToD and other CVR. TFT may be a must to-do test in these patients, regardless of their demographic and clinical presentations.
10-YEAR DYNAMIC OF FREQUENCY, USED DOSES AND ORIGINAL AND GENERIC FORMS OF MAIN DRUG GROUPS IN CORONARY HEART DISEASE REGISTRY
Authors: Tolpygina Svetlana , Martsevich Sergey
Published: April 2021

Objective:

To assess dynamics of reception frequency, used doses and use of original and generic forms of antiplatelet drugs, statins, beta-blockers, ACE-inhibitors/ARBs in stable coronary heart disease (CHD) patients in 2004–2014 within the CHD registry.

Design and method:

Patients with angiographically confirmed in 2004–2007 CHD, who came for a follow-up visit in 2010 (n = 303) and in 2014 (n = 125) were included.

Results:

Statins were taken by 7.6% of patients prior to hospitalization and by 86.5% of patients at discharge, antiplatelet drugs by 68% and 96%, beta-blockers by 24,8% and 94%, and ACE-inhibitors by 19% and 83% of patients, respectively (p < 0.001). Statins were taken by 67% and 70% of patients 4 and 7 years after discharge, respectively, antiplatelet drugs by 80% and 90%, beta-blockers by 80% and 75%, ACE-inhibitors by 66% and 65% of patients, respectively. The main 4 groups of drugs for secondary prevention of CHD were taken by 15% of patients prior to hospitalization, by 69% of patients at discharge (p < 0.001), by 41% 4 years, and by 35% 7 years after discharge (p < 0.01). From 2004 to 2014 all groups of drugs with an exception of antiplatelets were used in low and medium doses with an increase in the use of generic forms, especially for statins (76%).

Conclusions:

Frequency of assignment of beta-blockers, ACE-inhibitors/ARBs and statins in patients with stable CHD was low prior to hospitalization, increased during their hospital stay and decreased 4 and 7 years after discharge. Throughout these 10 years all drugs were used in medium and low doses, with an increase in the use of generic forms.
ELEVATED ONE-HOUR POSTLOAD PLASMA GLUCOSE LEVELS IDENTIFY CORONARY HEART DISEASE PATIENTS WITH GREATER SEVERITY OF CORONARY ARTERY LESIONS AND HIGHER RISK OF ONE-YEAR RE-ADMISSION
Authors: Cao Lifei , Wang Ping , Luan Hui , Chen Hui , Luo Chaodi , Tian Gang
Published: April 2021

Objective:

To investigate the relationship of one-hour postload plasma glucose (1-h PG) during the oral glucose tolerance test (OGTT) with the severity of coronary artery lesions and risk of one-year re-admission with adverse cardiovascular events in coronary heart disease (CHD) patients with normal glucose tolerance (NGT).

Design and method:

266 consecutive CHD patients who underwent coronary angiography and had NGT confirmed by OGTT during hospitalization were prospectively enrolled and followed in two groups according to the 1-h PG cut-off point of 155 mg/dL (1-h PG<155 mg/dL, n = 149 and elevated 1-h PG levels, n = 117). Angiographic severity was assessed by number of diseased vessels, lesion morphology and Gensini score. The risk of one-year re-admission with adverse cardiovascular events after discharge was analysed using Kaplan-Meier analysis.

Results:

Subjects with elevated 1-h PG levels had higher incidence of multi-vessel disease and complex lesions (76.9% vs 47.7%,P < 0.001 and 48.7% vs 32.2%,P = 0.002), Gensini score [60(33–88) vs 28(16–44), P < 0.001], and risk of one-year re-admission (19.8 vs 8.9%,Breslow test P = 0.016) than subjects with a 1-h PG<155 mg/dL. In the stepwise multivariate regression analysis, the variable that remained significantly associated with the Gensini score was 1-h PG accounting for 13.1% of its variation. Subgroup analyses by sex showed that men with elevated 1-h PG levels had higher incidence of complex lesions (46.8% vs 32.1%, P = 0.033) and risk of one-year re-admission (19.9 vs 8.9%, Breslow test P = 0.031) than men with a 1-h PG<155 mg/dL, but this trend was not seen in women.

Figure 1. Kaplan–Meier curves showing the cumulative risk of one-year re-admission with adverse cardiovascular events after discharge in all subjects and stratified by sex.

Conclusions:

CHD patients with NGT and elevated 1-h PG levels had a greater severity of coronary artery lesions and an increased risk of re-admission with adverse cardiovascular events, particularly in men.
HYPERTENSIVE PATIENTS ON TREATMENT AND COVID-19 IN FRANCE: FLAHS 2020 SURVEY
Authors: Hanon Olivier , Pathak Atul , Silhol François , Wimart Marie Catherine , Girerd Xavier
Published: April 2021

Objective:

Evaluate the occurrence of COVID-19 in the first half of 2020 in treated hypertensive patients and describe their medical follow-up during lockdown.

Design and method:

The FLAHS 2020 survey was performed in July/August 2020 by a self-administered questionnaire sent to 6,000 individuals aged 35 years and over from Kantar Health's Métascope permanent sampling base (a representative panel of the population living in metropolitan France). A subject was declared ill with COVID if he answered Yes to the question: Have you been ill with COVID-19 with a diagnosis confirmed or not by a doctor? The representativeness of the results for the metropolitan French population was performed by adjusting the data on geographical area, living conditions, socioeconomic category, gender and age.

Results:

Among the 4069 adults aged 35 years and older, symptomatic COVID-19 was reported by 2.2% [CI95:1.9–2.5] of respondents. The prevalence was 2.7% [CI95:1.4–4.0] among those treated with antihypertensive medication, 2.0% [1.7–2.3] among those not treated, 1.9% [1.3–2.5] among men and 2.5% [1.9–3.1] among women. Among subjects reporting COVID-19. During lockdown, 61.9% of treated hypertensive patients [60.6–63.2] were able to have medical contact, of which 9.8% [8.5–11.1] was by telephone and 5.9% [4.6–7.2] by videoconsultation, which was more frequent in the 35–54 age group with 13.1% [12.5–16.7] than in the 75+ age group with 3.5% [1.2–5.5]. 81.4% [2.8–5.4] of treated hypertensive patients visited the pharmacy at least once, and 4.1% [2.8–5.4] had their treatment delivered at home. Discontinuation of usual treatment was reported by 0.9% [0–2.2] of hypertensive patients, with a higher frequency in those aged 75 years and over (1.7% [0–4.0]).

Conclusions:

In the first half of 2020 in metropolitan France, COVID-19 in its symptomatic and self-reported form concerned treated hypertensive patients and the general population in a similar way. During lockdown there was no obvious disruption of care in the treated hypertensive patients and teleconsultation had a significant development, particularly for the visio-consultation in the 35–54 age group.
GENDER DIFFERENCES IN COVID-19 PATIENTS WITH ARTERIAL HYPERTENSION
Authors: Ciarambino Tiziana , Ciaburri Filippina , Paoli Vera Delli , D’avino Marinella , Campania Direttivo Fadoi
Published: April 2021

Objective:

To evaluate the gender differences in covid-19 patients with arterial hypertension.

Design and method:

This is a retrospective observational study comparing the association by gender of hypertensive status and with mortality among hospitalized patients with COVID-19. All patients admitted to our Hospitals, from 12 March to 12 April 2020 with confirmed COVID-19 were included in this study. Patients with COVID-19 included in this study were diagnosed according to World Health Organization interim guidance. Patients’ demographic characteristics and clinical data (symptoms, comorbidities, laboratory findings, and outcomes) during hospitalization were collected from electronic medical records. The primary endpoint was all-cause mortality by gender during hospitalization.

Other endpoints included the time elapsed between onset of symptoms and discharge, the rates of use of invasive mechanical ventilation, and the differences by gender in the treatment.

The diagnosis of hypertension was given by the patient's physician prior to the infection with SARS-CoV-2.

Results:

In total, 877 consecutive hospitalized patients with confirmed COVID-19 were enrolled in the study.

The median time from symptom onset to hospitalization was 4.6 for men and 2.6 days for women (p < 0.05).

Among these patients, 58% had a medical history of hypertension (57% men and 46% for women), p < 0.05.

The spectrum of symptoms of COVID-19 at admission between the two cohorts did not differ significantly.

A total of (15.0%) patients died in the hypertension cohort (14% for men and 16% for women; p ns)

In particular, patients with hypertension had the propensity to develop more severe/critical COVID-19 disease (P for trend < 0.001) and were more likely to receive invasive mechanical ventilation (P < 0.001).

Conclusions:

Patients with COVID-19 and hypertension have been reported to have an increased risk of adverse outcomes. In particular female patients with hypertension require intensive care (16% vs 11% for men, p < 0.05) but no differences by gender for mortality rate we report. As described above, these data showed that hypertensive patients are at the highest risk for outcomes adverse. To further verify our results, as well as this hypothesis, we have also designed a randomized controlled trial.
RELATIONSHIP BETWEEN SERUM TOTAL BILIRUBIN CONCENTRATION AND MACROVASCULAR COMPLICATIONS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS
Authors: Tanaka Masami , Nishimura Takeshi , Meguro Shu , Irie Junichiro , Saisho Yoshifumi , Mitsuishi Masanori , Itoh Arata , Inaishi Jun , Nakajima Yuya , Itoh Hiroshi
Published: April 2021

Objective:

The presence of more than one atherosclerotic macrovascular disease (cerebrovascular, cardiovascular, and peripheral arterial diseases) in the same patient is called polyvascular disease, which carries a very high cerebro- and cardiovascular morbidity and mortality. Recently, hypobilirubinemia is recognized as a possible risk factor for the development of atherosclerosis besides classical risk factors such as hypertension, hyperglycemia, and hyperlipidemia. We investigated this study to clarify the pathophysiological significance of total bilirubin in type 2 diabetic patients complicated by polyvascular diseases.

Design and method:

This is a retrospective cross-sectional study including 696 type 2 diabetic patients. First, we compared serum total bilirubin concentration (TBC) between patients with and without cerebrovascular disease (CBVD), coronary artery disease (CAD), and peripheral arterial disease (PAD). Secondly, we performed logistic regression analyses in order to find independent risk factors for atherosclerotic cerebro- and cardiovascular diseases (CBVD, CAD, and PAD). Lastly, we compared TBC among the patients with none, one, and two or three macrovascular diseases.

Results:

Among 696 type 2 diabetic patients, 106, 131, and 45 patients were complicated by CBVD, CAD, and PAD, respectively. Patients with CBVD and PAD showed significantly lower serum TBC than those withoutCBVD and PAD (CBVD: 0.67 ± 0.25 vs. 0.76 ± 0.38 mg/dL, p = 0.011, PAD: 0.65 ± 0.26 vs. 0.76 ± 0.34 mg/dL, p = 0.030). In addition, there was a tendency that TBC was lower in patients with CAD than in those without CAD (0.69 ± 0.27 vs. 0.76 ± 0.33 mg/dL, p = 0.06). It was shown that TBC was an independent risk factor for CBVD (p = 0.022), but not for CAD (p = 0.35) or PAD (p = 0.19). TBC of the patients with none (n = 469), one (n = 172), two (n = 51) or three (n = 4) macrovascular diseases were 0.77 ± 0.39, 0.65 ± 0.27, and 0.60 ± 0.37 mg/dL, respectively.

Conclusions:

Diabetic patients without macrovascular diseases exhibited the highest TBC among three categories of the patients. On the other hand, patients with two or three macrovascular complications showed the lowest TBC. Therefore, TBC can be used as a possible biomarker which identifies type 2 diabetic patients with polyvascular disease.
APIGENIN ATTENUATES DIABETIC NEPHROPATHY IN TYPE 1 DIABETIC RATS
Authors: Malik Salma , Arya Dharamvir Singh
Published: April 2021

Objective:

The present study was designed to evaluate the effect of apigenin on progression and development of diabetic nephropathy in diabetic rats.

Design and method:

Adult male albino Wistar rats were divided into 7 groups: control, diabetic control, apigenin treatment groups (5–20 mg/kg; p.o.), ramipril (2 mg/kg; p.o.) and apigenin per se (20 mg/kg) group. Except control and per se groups, type 1 diabetes in other groups were induced by a single injection of streptozotocin (55 mg/kg; i.p). After confirmation of diabetes (FBG>250 mg/dl), rats were randomly divided into different treatment groups and observed for period of 8 months.

Results:

After 8 months, STZ resulted in attenuation of renal function (increased BUN and serum creatinine), increased oxidative stress and inflammation (increased cytokines and NF-kappa B) in the diabetic rats. In addition, there was fibrosis (increased transforming growth factor, fibronectin and type IV collagen), apoptosis (increased bax, caspase-3 and decreased bcl-2) and activation of MAPK pathway in diabetic-control group. These results were further supported by histopathological examination, which revealed presence of inflammation, collagen deposition and glomerulosclerosis in renal tissue of diabetic rats. In contrast, pre-treatment with apigenin significantly ameliorated STZ-induced functional and pathological changes in diabetic rats. In addition, it attenuated fibrosis, inflammation and apoptosis and also prevented activation of MAPK pathway in diabetic rats. All these protective effects were comparable to the ramipril treated group.

Conclusions:

Apigenin ameliorated oxidative stress, inflammation, apoptosis and fibrosis in diabetic rats by attenuation of MAPK pathway and prevented diabetic complication in diabetic rats.
INTRARENAL RESISTANCE INDEXES ARE INDEPENDENTLY ASSOCIATED WITH GLYCATED HEMOGLOBIN LEVELS IN NON-DIABETIC ESSENTIAL HYPERTENSIVE PATIENTS WITH NORMAL RENAL FUNCTION
Authors: Catena Cristiana , da Porto Andrea , Colussi Gianluca , Vivarelli Cinzia , Bulfone Luca , Sechi Leonardo A.
Published: April 2021

Objective:

Intrarenal resistance indexes (IRI) are markers of an early renal microvascular damage. The identification of factors that can influence the IRI could be useful in the prevention of renal damage in essential hypertensive (EH) patients. The aim of the study was to evaluate whether mild changes of glucose metabolism are associated with increased IRI in non-diabetic EH patients.

Design and method:

In 271 EH patients (age 50 ± 13 years, 141 males, 102 never treated) with normal renal function we measured the glomerular filtration rate, plasma lipids levels, fasting plasma glucose (PG), insulin (I), and glycated hemoglobin (GH), the HOMA-index, the area under the curve of PG (GAUC) and I (IAUC) after an oral glucose tolerance test (OGTT), the PG level at 120 minutes of OGTT (G120), and we measured IRI by Doppler ultrasound of intrarenal vessels.

Results:

Patients were divided according to quartiles of IRI. PG, GAUC, G120 and GH increased progressively with increasing levels of IRI. No differences were found in I levels and HOMA across IRI quartiles. IRI was significantly and directly correlated with age, diastolic blood pressure, PG, I, HOMA, GAUC, G120, and GH. At logistic regression analysis, the highest IRI quartile (average value: 0.68 ± 0.04) was independently associated with HG>5.9% (OR = 4.09, P = 0.027) and G129 (OR = 1.01, P = 0.009).

Conclusions:

In non-diabetic EH patients with normal renal function, subtle changes in glucose homeostasis are associated with increased intrarenal vascular resistance and might contribute to development of overt renal damage.
SHORT-TERM TEMPERATURE VARIATION ON THE LEVEL OF HIGH SENSITIVITY C-REACTIVE PROTEIN IN CHINA
Authors: Kang Yuting , Wang Zengwu , Chen Zuo , Zhang Liinfeng , Wang Xin , Zhen Congyi , Jiang Linlin , Shao Lan , Tian Ye
Published: April 2021

Objective:

Epidemiological studies have shown associations between air temperature and inflammatory markers, but few studies have estimated the relationship of temperature variation (TV) with serum biomarkers for cardiovascular diseases (CVD). The current study first to explore the association between ambient temperature variation and high sensitivity C-reactive protein (hsCrp).

Design and method:

A cross-sectional survey of CVD risk factors was conducted among Chinese participants aged 35 to 64 years in 2009 to 2010, during which hsCrp was also collected. Ambient maximum and minimum temperature were from National climate center. TV was defined as the standard deviation of daily minimum and maximum temperatures during exposure days. Using linear mixed effects models, we examined the relationships between TV and hsCrp for Chinese population.

Results:

Our study population consisted of 11,623 participants with mean age of 49.80 years (± 8.0 years) enrolled in our study. Per 1 °C increase in temperature variation were significantly related with 2.32% (95%CI: 1.38–3.28), 3.63% (95%CI: 2.45–4.83), 6.08% (95%CI: 4.65–7.53) and 6.81% (95%CI: 5.28–8.36) increase in hsCrp, with greater effect during warm season.

Conclusions:

Exposure to TV is associated with increased hsCrp. Our findings add to the growing evidence regarding the potential impact of climatic factors on important health outcomes.
ACTIVE IMMUNOTHERAPY AGAINST RECEPTOR FOR ADVANCED GLYCATION END PRODUCTS ATTENUATES THE PROGRESSION OF DIABETIC KIDNEY DISEASE
Authors: Azegami Tatsuhiko , Hayashi Kaori , Hishikawa Akihito , Yoshimoto Norifumi , Nakayama Takashin , Itoh Hiroshi
Published: April 2021

Objective:

To combat global increases in the prevalence of diabetic kidney disease (DKD), we aimed to develop a new therapeutic vaccine targeting receptor for advanced glycation end products (RAGE).

Design and method:

RAGE vaccine was a water-in-oil emulsion composed of Freund's adjuvant and RAGE partial peptide that was conjugated to the carrier protein KLH. Male DBA2/J mice were subcutaneously immunized with three doses of KLH (vehicle) or RAGE vaccine and subsequently induced diabetes by multiple low-dose streptozotocin. To investigate the renal protective effect of RAGE vaccine, we measured urine albumin to creatinine ratio (UACR) and analyzed renal histology using light and electron microscopy.

Results:

There was no difference in blood glucose between vehicle-treated mice and vaccinated mice. On the other hand, immunization with the RAGE vaccine significantly attenuated the increase in UACR (vehicle group 850.6 ± 208.6 vs vaccine group 333.6 ± 104.7 ug/mg, n = 10/group, p < 0.05). In the histological analyses, total glomerular volume of vaccinated mice was siginificantly less than that of vehicle-treated mice (vehicle group 5.28 ± 0.52 vs vaccine group 3.18 ± 0.17 um3, p < 0.01) and glomerular mesangial matrix expansion was attenuated in vaccine-treated mice (vehicle group 23.6 ± 1.6 vs vaccine group 18.8 ± 0.8%, p < 0.01). Ultrastructural morphometric study (n = 3/group) also indicated that glomerular basement membrane thickness was significantly suppressed in vaccinated mice compared with vehicle-treated mice (vehicle group 215.3 ± 1.9 vs vaccine group 181.3 ± 1.8 nm, p < 0.01).

Conclusions:

These results suggest that active immunotherapy targeting RAGE is effective for the attenuation of DKD in streptozotocin-induced diabetic mice.
WHITE-COAT HYPERTENSION AND MASKED HYPERTENSION IN HYPERTENSIVE KIDNEY TRANSPLANT RECIPIENTS
Authors: Loutradis Charalampos , Korogiannou Maria , Xagas Efstathios , Marinaki Smaragdi , Argyris Antonios , Protogerou Athanasios , Sarafidis Pantelis , Boletis John
Published: April 2021

Objective:

Patients suffering from chronic kidney disease (CKD) have inadequate control of blood pressure (BP) ranging between 30 to 40%. In addition 35% of them have white-coat hypertension or masked hypertension. Recent epidemiologic data in the general population associate both of the aforementioned BP patterns with poor outcomes. The objective of this study is to examine the prevalence of these hypertension phenotypes in hypertensive kidney transplant recipients.

Design and method:

150 kidney transplant recipients were included in this study. They underwent 24-hour ABPM with the Mobil-O-Graph NG device. Hypertension was defined as: (1) office BP (oBP) > or = 140/90 mmHg or use of antihypertensive agents, (2) ambulatory BP > or = 130/80 mmHg or use of antihypertensive agents. Patterns of BP control were defined as follows: (1) truly controlled BP (oBP < 140/90 and 24-hr BP < 130/80mmHg), (2) uncontrolled hypertension (oBP > or = 140/90 and 24-hr BP > or = 130/80mmHg), (3) white-coat hypertension (oBP > or = 140/90 and 24-hr BP < 130/80mmHg), (4) masked hypertension (oBP < 140/90 and 24-hr BP > or = 130/80mmHg).

Results:

The prevalence of hypertension was 88.0% according to office BP readings and 93.3% according to ABPM (p = 0,112). 125 individuals (89,3% of the total) were hypertensives receiving antihypertensive agents. Among them, according to office BP readings and 24-hr ABPM, 44 (31,0%) hypertensive patients had BP control and 30 (21,1%) had uncontrolled hypertension. Moreover, among the hypertensive patients, 10 (7,0 %) had the white-coat hypertension phenotype and 58 (40,8%) had masked hypertension (Fig 1).

Conclusions:

The use of ABPM in kidney transplant recipients reveals low control of BP, low prevalence of white-coat hypertension and markedly high prevalence of masked hypertension. The last finding is particularly important, considering the established association between masked hypertension and increased cardiovascular risk.
MEDICATION, COMORBIDITY AND POLYPHARMACY BURDEN IN ROMANIAN PATIENTS WITH CHRONIC KIDNEY DISEASE
Authors: Gaman Mihnea-Alexandr , Cozma Matei Alexandru , Dobrica Elena Codruta , Diaconu Camelia Cristina
Published: April 2021

Objective:

Polypharmacy (prescription of minimum 5 drugs/day) is often encountered in chronic kidney disease (CKD) patients due to their high number of comorbidities. Thus, a vicious cycle is born: the prescription of more drugs can lead to drug-drug (DDI) or food-drug interactions (FDI) and adverse effects mistakenly considered new comorbidities and treated with new medications. We evaluated polypharmacy use and the potential risk of DDI/FDI in Romanian CKD patients.

Design and method:

Retrospective, observational study in an internal medicine clinic. Data were extracted from medical records of patients attending the clinic in a two-month period in 2018. Patients were divided into CKD patients and controls (patients diagnosed with a different disease other than CKD). DDI/FDI were checked via the Drug Interactions Checker. The hospital's ethics council approved the study (approval 4263/13.05.2019). Written informed consent was collected from all patients. Regulations imposed by the national law/Declaration of Helsinki [1975&2008(5) revised] were respected. We presented categorical variables as frequencies/percentages and continuous variables as mean±standard deviation. Continuous variables were compared via independent samples t-tests. Categorical variables were compared using Fisher's exact test. The level of significance was set at 5% and presented as p-values. The analysis was performed using GraphPadQuickCalcs.

Results:

Study group: 22 CKD patients, 72.72 ± 10.37 years, range 54–93 years, 54.55% males. Controls: 144 patients, 67.90 ± 13.31 years, range 22–92 years, 52.77% females. CKD patients had more comorbidities (P = 0.0001) and drug prescriptions at discharge (P = 0.005) versus controls. Polypharmacy was noted in 95.45% (N = 21) of CKD patients versus 74.30% (N = 107) of controls (P = 0.02). CKD patients were at a higher risk of DDI (P = 0.01) and especially major and moderate DDI (P = 0.005 and P = 0.02, respectively) versus controls. CKD patients had a similar risk of potential FDI and DDI to controls (Table 1). The most frequent potential DDI and FDI interactions in CKD patients are depicted in Table 2.

Conclusions:

Polypharmacy is a serious reason for concern in CKD patients. Their management should be targeted at reducing medication burden and revised to include only drugs with low DDI/FDI risks. Patients should be carefully monitored and informed regarding the risks posed by polypharmacy.
ARTERIAL STIFFNESS CIRCADIAN PATTERN AND CARDIOVASCULAR MORTALITY IN HEMODIALYZED PATIENTS
Authors: Premuzic Vedran , Katalinic Lea , Barisic Ivan , Mesar Ines , Jelakovic Bojan
Published: April 2021

Objective:

Our aim was to analyze association of circadian pattern of 48-hours pulse wave velocity (PWV) and augmentation index (AIx) with cardiovascular (CV) mortality in patients undergoing chronic hemodialysis (HD).

Design and method:

85 patients (mean age, 48m; 37w) were followed-up until for 36-months or till the time of death. Blood pressure (BP) (Omron M6), 48-h PWV and AIx (Arteriograph) and 24-h ABPM (SpaceLab 90207)-both after mid-week dialysis session were measured in all patients. PWV dippers = night-time PWV drop > 0.5 m/s; PWV risers = night-time PWV rise > 0.5 m/s compared to the day-time period. Aix dippers= night-time Aix drop > 10%; Aix risers= night-time Aix rise > 10% compared to day-time period.

Results:

After 36 months of follow-up, CV mortality was 49.4% (men 57.1%, women 42.9%). Deceased patients were older when enrolled and when had started with dialysis (both p < 0.001). There were no differences in prevalence of hypertension (100% vs. 95.3%), diabetes (23.8% vs. 11.6%) and number of hypertensive drugs (3.51 vs. 3.23) between two groups (all p > 0.05). Deceased patients had significantly longer duration of hypertension (p < 0.01) as well as significantly higher proportion of AIx and PWV risers and higher nocturnal AIx levels than survived patients. On the non-dialysis day both nocturnal AIx and PWV levels were higher in deceased group with significantly more AIx and PWV dippers when compared to survivors. PWV risers were significantly older when enrolled and when started with dialysis and had significantly higher ultrafiltration rates than PWV non-risers and survived significantly shorter. In the linear regression model survival was negatively associated with age, duration of hypertension, ultrafiltration but the strongest association was with AIx and PWV risers on the non-dialysis day. On logistic regression only PWV rising pattern on non-dialysis day had increased HR of 1.78 [CI 1.60, 1.96] for CV mortality.

Conclusions:

Non-rising patterns of PWV and AIx on non-dialysis days were significantly associated with CV mortality in patients undergoing chronic HD. Our data confirmed importance of 48-hour measurements of PWV and Aix in prediction of CV mortality.
RELATIONSHIP AMONG ARTERIAL STIFFNESS PARAMETERS AND TARGET ORGAN DAMAGE
Authors: García Fernando Martínez , De Gracia Ana , Calaforra Oscar , Solaz Elena , Vicente Antonio , Pichler Gernot , Redon Josep
Published: April 2021

Objective:

Carotid-femoral (cf) PWV is considered the gold standard for arterial stiffness (AS) but other different parameters can add information about systemic or local AS. Whether that information is clinically redundant or complementary is currently unknown. We analyzed the relationship among different AS parameters to each other and with a target organ damage (TOD) score.

Design and method:

AS data were retrospectively evaluated in a sample of 1031 hypertensive patients. Cf-PWV and Augmentation index (Aix) by peripheral applanation tonometry (PAT) were determined with an SphygmoCor® device. Local PWV, local Aix, Ep module, Beta parameter and arterial compliance were determined by echo-tracking at the carotid level with an Aloka ultrasound (US) device. Left ventricular mass (LVM) was assessed by echocardiography, intima-media thickness (IMT) and plaques by carotid US and albumin-creatinine ratio (ACR) by immunonephelometry. A 24 points subclinical target organ damage (TOD) score was created using not only qualitative (presence or absence) but also quantitative information (magnitude of damage). The relationship among parameters of AS to each other and with the score of TOD were established by Pearson or Spearman correlation coefficients.

Results:

There was a significant relationship between cfPWV and the score of subclinical TOD, the higher the score, the higher the PWV (r = 0.19, p-value < 0.05).

All echo-tracking parameters, particularly the Ep module were also significantly related to the score but not the Aix by PAT. There were significant correlations among the different measures of AS to each other. The highest correlation was found between the Aix determined by tonometry and local Aix determined by carotid echo-tracking (r = 0.71, p-value < 0.05). By contrast the correlation between the cfPWV and local carotid PWV was very low (r = 0.28, p-value < 0.05).

Conclusions:

There was a significant correlation among different AS parameters and probably these parameters may add extra information to the gold standard (cfPWV). The presence of an increase in AS parameters is linearly related with the presence of subclinical TOD at other levels. Further studies are needed to determine the clinical prognostic values of combined AS parameters.
RELATIONS OF THE AORTIC STIFFNESS AND CENTRAL BLOOD PRESSURE WITH FEATURES OF THE LEFT VENTRICLE IN ASCENDING AORTIC ANEURYSM
Authors: Gurevich Alexandra , Zherdev Nicolay , Emelyanov Igor , Chernyavskiy Mikhail , Uspenskiy Vladimir , Konradi Alexandra
Published: April 2021

Objective:

To reveal relations of the arterial stiffness, central blood pressure (BP) with left ventricular (LV) structure and function in patients with ascending aortic aneurysms (AAA).

Design and method:

We examined 44 patients with AAA (30 (68%) males; 55 ± 13 years old) before AAA surgical repair. Office brachial BP (BBP) was measured by OMRON (Japan). Arterial stiffness was evaluated by carotid-femoral pulse wave velocity (PWV). Central BP (CBP) and PWV were measured with the SphygmoCor (Australia). Ambulatory BP monitoring was performed with the BPLab (Russia) with 24-hour measuring of BBP and CBP. A transthoracic echocardiographic examination was performed with a Vivid 7 GE (USA).

Results:

Hypertension was observed in 40 (91%) patients. LV hypertrophy (LVH) was found in 41 (94%) patients (mean LV mass index (LVMI) 163 ± 48 g/m2). Diastolic dysfunction presented in 39 (89%) patients. PWV was inversely related to the AAA diameter (r = - 0.389, P = 0.03): PWV decreased with an increase of the aortic diameter at the level of the aortic root. A decrease of PWV correlated with a decline of relative wall thickness (RWT) (r = 0.365, P = 0.040), but eccentric LVH occurred only in 17 (38%) patients with AAA. PWV correlated directly with LV ejection fraction (r = 0.464, P = 0.048), but PWV was inversely related to LV end-diastolic size (LVED) (r = -0.533, P = 0.003). Rigid type diastolic disturbances (E/A ratio>2) were negatively correlated with PWV (r = -0.652, P = 0.041). Office pulse BBP and CBP correlated with the LVMI (r = 0.428, P = 0.019 and r = 0.508, P = 0.002, respectively). 24-hour pulse BBP and CBP were correlated with LVMI (r = 0.660, P = 0.018 and r = 0.721, P = 0.008, respectively). The increase of LVED had a closer association with office pulse CBP (r = 0.459, P = 0.007) than with office pulse BBP (r = 0.410, P = 0.017).

Conclusions:

Eccentric LV hypertrophy was accompanied by a significant reduction of PWV in patients with AAA. The severity of the diastolic dysfunction increased with a decline of PWV. PWV is probably not suitable for accurate assessment of the arterial stiffness in AAA due to the apparent confounding effect of aortic diameter. In AAA central pulse BP had a closer association with LVMI and LVED than brachial pulse BP.