bluuebunny/crossref_metadata_2025 huggingface dataset:
RISK FACTORS FOR HOSPITALIZATION FOR A MAJOR ACUTE CARDIOVASCULAR EVENT AFTER ACUTE KIDNEY INJURY WITH FULL RECOVERY: A SINGLE CENTER EXPERIENCE
Authors: Mahmoud Nouha Ben , Hamouda Mouna , Maatoug Jihene , Salem Meriem Ben , Salah Manel Ben , Letaief Ahmed , Aloui Sabra , Skhiri Habib
Published: June 2022

Objective:

Acute kidney injury (AKI) was found to be associated with an increased risk of major adverse cardiovascular events (MACE) in the general population. We aim to evaluate the risk factors of patients having had an episode of AKI with full recovery exposing them to the risk of MACE

Design and method:

We conducted a retrospective single center study including all patients hospitalized in the nephrology ward since 2002 to 2015, which experienced an AKI episode with full recovery. AKI was defined according to KDIGO criteria. Our primary outcome was to identify risk factors in our population exposing them to MACE after AKI.

Results:

Our study included 107 men and 107 women with median age was 61 years. KDIGO stage 3 was the major stage (115 patients), 31 of whom required hemodialysis. Hypertension was found to be the major co morbidities in our population with 37.4% of patients followed by diabetes (32.2%). Median creatinine was 3.79 mg/l (1.26 – 34.57 mg/l). Most patients had anemia (65.4%).

Among 176 patients for whom we have followed up, in the short, medium and long term: 19, 20 and 2 patients had respectively developed a MACE. The characteristics of patients according to the occurrence of MACE or not are illustrated by the table 1

The risk factors found in our population were presence of co morbidities, vascular disease and anemia in univariate analysis and only anemia in multivariate analysis (table 2).

Patients with anemia and vascular disease had 2.4 times more the risk ti develop MACE after AKI with full recovery than patients without anemia and no past history of vascular disease

Conclusions:

Patients with anemia, past history of vascular disease are at risk of MACE after AKI with full recovery and those patients should be better monitored in the short, medium and long term. Our aim is to detect the MACE earlier so we decrease the cardiovascular mortality
ASSOCIATION OF SERUM URIC ACID WITH LEFT VENTRICLE, LEFT VENTRICULAR FILLING PRESSURE AND LEFT ATRIAL SIZE IN HYPERTENSIVE PATIENTS WITHOUT ATRIAL FIBRILLATION
Authors: Papavasileiou M.V. , Mytas D. , Karamanou A. , Moustakas G. , Aravantinos D. , Patsianis S. , Pittaras A.
Published: June 2022

Objective:

The atherogenic and inflammatory effect of the serum uric acid, is evident, as well as its role and its significance in the endothelial dysfunction and cardiovascular process.

The aim of this study was to investigate a possible association between the serum uric acid levels with echo parameters that express the structure and function of left ventricle in hypertensive patients.

Design and method:

We studied 2841 hypertensive patients (54% female), treated (53%) or newly diagnosed untreated, of mean age: 57,9 ± 13.5 years, without any known cardiovascular disease and with mean office systolic/diastolic arterial blood pressure (S/DBPo): 147,9 ± 20.4/91.6 ± 13,1 mmHg, mean office heart rate (HRo): 75,3 ± 11,1 bpm, average body mass index (BMI): 28.3 ± 4,9 kg/m2and average waist circumference (WC) 96.1 ± 12.9 cm.

The levels of serum uric acid (SUA), urea and creatinine were recorded. eGFR was calculated according Cockcroft-Gault Equation.All studied patients underwent transthoracic Echo –Doppler ultrasound and left ventricular mass and mass index (mass/m2), left atrial diameter and volume index (N = 336) were measured. In a substudy population (N = 513) by transmitral tissue Doppler, mitral velocity was measured and filling pressure of left ventricle (e/e’) was calculated.

Using Pearson correlation method we correlated SUA with echo Doppler –tissue Doppler parameters

Results:

Table: Pearson correlation between serum uric acid levels and left ventricular mass index, left atrial diameter, left atrial volume index, filling pressure of left ventricle. 

Conclusions:

In hypertensive patients treated or not, a significant positive correlation exists between SUA and parameters indicating structure and function of left ventricle, underlying the important meaning of uric acid in the configuration of left ventricle.
FLOW MEDIATED-DILATATION IS ALREADY ABNORMAL IN PRE-IMPAIRED GLUCOSE TOLERANCE (PRE-IGT) AND WITH NO CORRELATION WITH SYSTOLIC BLOOD PRESSURE AND DIASTOLIC BLOOD PRESSURE
Authors: Salmon Jeannine Ann , Magbuhat Ann Lorraine , Guerrero-Sali Ruby Jane , Purino Francis , Macindo John Rey , Mercado-Asis Leilani
Published: June 2022

Objective:

Pre-impaired glucose tolerance (Pre-IGT) is a stage of compensatory hyperinsulinemia to maintain normoglycemia. It is the earliest stage of glucose dysmetabolism, where beta cells can still compensate for the insulin resistance thru hyperinsulinemia. Endothelial dysfunction is a critical part in the pathogenesis of macrovascular and microvascular chronic complications in type 2 diabetes, ordinarily due to uncontrolled hyperglycemia. In pre-IGT the main problem is hyperinsulinemia on a background of normal blood sugar. C-peptide, a segment cleaved off from pro-insulin is equimolar to insulin, and has shown to cause intima media thickening. This study was undertaken to determine endothelial function of patients with pre-IGT thru flow-mediated dilatation of the brachial artery and to correlate the FMD with the insulin level, systolic blood pressure and diastolic blood pressure.

Design and method:

This is a cross-sectional analytical study of adult patients with risk factors for developing diabetes such as, having first-degree relative with diabetes, obesity, history of gestational diabetes, and polycystic ovary syndrome (PCOS). Systolic and diastolic BP, BMI, 2-hour serum insulin, blood sugar, and lipids were determined. Patients with pre-IGT underwent brachial artery FMD.

Results:

Of the 27 subjects, 21 (77.8%) had pre-IGT. The mean oral glucose tolerance test at 2-hours post-prandial was normal at 109.53 mg/dL (SD = 30.26). Results of the laboratory tests were as follows: mean Hba1c and insulin at 2 hours were 5.34% (SD = 0.44) and 112.21 uIU/mL (SD = 111.24, normal range 2.60–24.90), respectively. Comparative analyses of the demographic and clinical profiles showed similar characteristics between the normoinsulinemic and the pre-IGT subjects (p > 0.05), although there were more with positive history of type 2 DM and obesity on the latter group. Systolic and diastolic BP levels were normal. Of the 27 subjects, four (4) had abnormal FMD which had a small positive correlation with thee insulin level, systolic BP, and diastolic BP, although not statistically significant (p > 0.05).

Conclusions:

Endothelial dysfunction has shown to exist already in the pre-IGT subjects depicted in the abnormality in the arterial flow-mediated dilatation study. Systolic BP and diastolic BP levels have not shown any significant correlation with the FMD finding, and the insulin level.
ACUTE ST-ELEVATION MYOCARDIAL INFARCTION IN OBESE HYPERTENSIVE PATIENTS – CAN WE CONSIDER A DIFFERENT APPROACH?
Authors: Duarte Fabiana , Santos Inês , Barrada Maria Inês , Oliveira Luís , Serena Cátia , Fontes António , Monteiro André , Machado Carina , Dourado Raquel , Santos Emília , Pelicano Nuno , Pacheco Miguel , Tavares Anabela , Martins Dinis
Published: June 2022

Objective:

Several risk factors, including smoking habits, hypertension, obesity and diabetes, are negatively associated with adverse cardiovascular events. Acute ST-elevation myocardial infarction (STEMI) is a serious problem associated with a high burden of cardiac disease.

To determine if obese hypertensive patients had a different clinical presentation and/or a poorer outcome, mainly related to hemorrhagic complications and major adverse cardiovascular events (MACE).

Design and method:

Retrospective single center cohort study enrolled 121 patients with STEMI diagnosis, admitted to our intensive unit care. In-hospital hemorrhagic complications (IHHC) included intracerebral hemorrhage, resulting in hemodynamic compromise or requiring a blood transfusion were accessed. MACE was a composite endpoint of in-hospital cardiovascular death and sustained ventricular arrhythmic events.

Results:

The mean age was 58.3 ± 12.7 years and 102 were male (84.3%). Thirty-six patients (29.8%) were overweight and twenty-four (19.8%) were obese. Hypertension was more prevalent in women (84.2% vs. 47.1%, respectively; p 0.003) and also diabetes (42.1% vs. 13.8%, respectively; p 0.021). Obese hypertensive patients were mainly women (52.6% vs. 27.5%; p 0.030). There were no statistically differences in other comorbidities between genders.

All obese hypertensive patients were medicated for hypertension, 15 (39.5%) with one drug and 7 (18.4%) with two drugs. The mean systolic blood pressure (SBP) at presentation was 126 ± 2.3 mmHg and diastolic blood pressure was 78.5 ± 1.5 mmHg. Obese hypertensive patients had higher blood pressure values (SBP mean 136 ± 33 mmHg), but no differences in symptoms (p 0.20) or Killip-Kimball classification (p 0.93) were evident.

Regarding to in-hospital hemorrhagic complications, females had a statistically significant higher risk (22.2% vs. 7.1%, p 0.045), but it was independent of other comorbidities, including hypertension, obesity or diabetes (r = 0.249; ANOVA p-value < 0.005).

In the subset of obese hypertensive patients, no differences in IHHC (p 0.56) or MACE (p 0.18) were detected.

Conclusions:

Obese hypertensive patients were mainly women medicated with one drug. Despite higher blood pressure values, this group had similar outcomes, including hemorrhagic events. The authors advocate that a good control of risk factors is crucial to minimize their impact on clinical outcomes.
ASSOCIATION OF FREE ANDROGEN INDEX AND SEX HORMONE BINDING GLOBULIN AND LEFT VENTRICULAR HYPERTROPHY IN POSTMENOPAUSAL HYPERTENSIVE WOMEN
Authors: Chen Jianshu , Yu Jing
Published: June 2022

Objective:

The aim of the present study was to explore the relationship between androgen and LVH in postmenopausal hypertensive women.

Design and method:

Enrolled in this study were 378 postmenopausal hypertensive women who were admitted to the department of cardiology between December 2018 and December 2020.

Results:

According to left ventricular mass index (LVMI) evaluated by echocardiography, the patients were divided into LVH group (n = 172) and non-LVH group (n = 206). Their clinical characteristics were collected. Based on the result of propensity score matching analysis, 160 cases in each group were matched successfully. After correcting for confounding factors by various models, the results showed that free androgen index (FAI)and sex hormone-binding globulin (SHBG)were the influencing factors of LVH in postmenopausal women with hypertension. Patients with elevated SHBG were 5% less likely to develop LVH than those without elevated SHBG (OR:0.950, 95%CI 0.922–1.578). Postmenopausal hypertensive patients with elevated FAI were 16% more likely to have LVH than those without elevated FAI (OR:1.608, 95%CI 0.807–3.202). Multiple linear regression showed that LVMI increased by 61.82 g/m2 for every 1 unit increase in FAI. In addition, SHBG decreased by 1 nmol/l, and LVMI increased by 0.177 g/m2. Subgroup analysis showed that patients in the controlled BP group had a lower risk of LVH for every additional unit of SHBG compared with the uncontrolled BP group. The risk of LVH for each additional unit of FAI in the uncontrolled BP group was higher than that in the controlled BP group.

Conclusions:

The results of this present study showed that the occurrence of LVH was positively correlated with FAI and negatively correlated with SHBG in postmenopausal women with hypertension. The increase of FAI level and the decrease of SHBG level may be related to the occurrence and development of LVH in postmenopausal hypertension.
SYNERGISTIC EFFECT OF HIGH HOMOCYSTEINE AND LOW VITAMIN B12 LEVELS ON THE PREVALENCE OF ATRIAL FIBRILLATION IN HYPERTENSIVE PATIENTS
Authors: Liakos C. , Karpanou E. , Markou M. , Grassos C. , Tousoulis D. , Vyssoulis G. , Tsioufis C.
Published: June 2022

Objective:

Atrial fibrillation (AF) is common arrhythmia in hypertensive patients. Besides hypertension, several other conditions are deemed to be associated with AF. High blood homocysteine levels (hyperhomocysteinemia) is a known risk factor for cardiovascular disease and are associated with vitamin B12 deficiency that possibly increase cardiovascular risk, as well. The present study assessed the possible effect of high homocysteine and low B12 levels on AF prevalence in hypertensive patients.

Design and method:

This retrospective study comprised all hypertensives referred to our institutions and had a blood sample measurement of homocysteine and B12 (n = 32800). The presence of sustained AF (SAF; Long-standing/Persistent or Permanent AF) was recorded with a resting electrocardiogram (ECG). Paroxysms of AF (PAF) were confirmed with previous relevant ECGs provided by the patient. The population was divided in quartiles according to homocysteine levels (groups 1, 2, 3 and 4 for increasing levels) and B12 levels (groups 1, 2, 3 and 4 for decreasing levels). The prevalence of AF (SAF and PAF) was calculated for each homocysteine and B12 quartile group as well as for each of the 16 homocysteine/B12 combination quartile subgroups.

Results:

The mean values for homocysteine were 13.3 ± 7.2 ?mol/l and for B12 525 ± 196 pg/ml. The prevalence of SAF, PAF and all-type AF (SAF and PAF) was 5.0%, 6.1% and 11.1%, respectively. For homocysteine quartiles 1, 2, 3, 4, SAF prevalence was 2.9%, 5.3%, 11.7%, 24.3% (pfor trend 0.049), PAF prevalence was 0.6%, 0.9%, 4.6%, 14.0% (pfor trend 0.090) and all-type AF prevalence was 3.2%, 5.4%, 11.5%, 22.2% (pfor trend 0.051), respectively. For B12 quartiles 1, 2, 3, 4, SAF prevalence was 2.9%, 6.4%, 11.0%, 20.2% (pfor trend 0.030), PAF prevalence was 2.5%, 5.1%, 7.7%, 9.0% (pfor trend 0.009) and all type-AF prevalence was 2.4%, 7.1%, 16.8% 21.0% (pfor trend 0.019), respectively. The synergistic effect of increasing homocysteine and decreasing B12 values on SAF, PAF and all-type AF prevalence is presented in Figure.

Conclusions:

High homocysteine levels and low vitamin B12 levels are individually and synergistically associated with the prevalence of AF in hypertensive individuals. Underlying mechanisms merit further examination.
STAGE-DEPENDENT RESPONSES OF VASCULAR AND PARENCHYMAL CELLS IN THE HYPERTENSIVE RAT BRAIN
Authors: Ulbrich Philipp , Morton Lorena , Briese Michael , Lämmlin Naomi , Mattern Hendrik , Hasanuzzaman Mohammed , Westhues Melina , Garz Cornelia , Becker Axel , Dityatev Alexander , Jandke Solveig , Yilmazer-Hanke Deniz , Sendtner Michael , Dunay Ildiko , Schreiber Stefanie
Published: June 2022

Objective:

Long-term hypertension doubles all-cause dementia risk in aging by structural and functional alterations of the cerebral microvasculature and its surrounding tissue. However, therapeutical blood pressure lowering by itself is limited in its effectiveness depending on the progression of structural vessel remodeling, microvascular dysfunction and parenchymal tissue damage.

Design and method:

Therefore, the aim of this study was to investigate pathophysiological processes in different stages of hypertension. We explored acute, early- and late-chronic hypertension effects in the frontal brain of hypertensive rats, applying behavioral tests, histology, immunofluorescence, FACS and vascular/neural tissue RNA sequencing.

Results:

In response to initial increasing blood pressure and in absence of vascular pathology, microglia cells were found in close proximity to blood vessels and with morphological features of activation. Early chronic hypertensive animals showed frontal brain specific behavioral deficits, blood-brain-barrier leakage, leukocyte immigration, loss of glial reactivity and altered pathways related to cellular energy supply, protein synthesis and catabolism. In late chronic hypertension behavioral deficits and glial reactivity loss persisted. We also observed active angiogenesis, vascular fibroblast-related collagen aggregation and pathways related to decreased responsiveness to nutrients and increased metabolic demand. Additionally, we identified late-chronic vascular accumulation of insulin-like growth factor 1 (IGF1) binding proteins in brains of rats and humans with hypertensive cerebral small vessel disease, possibly attenuating protective IGF1 signaling in the cerebral microvasculature.

Conclusions:

Our results point towards stage-dependent reactions of vascular, glial, immune and neuronal cells in response to hypertension. Future studies have to verify, whether these mechanisms are valid in humans as well and whether they might be targeted to attenuate small vessel disease progression.
INCIDENCE AND TIME-TRENDS OF PREGNANCY-RELATED STROKE, THE NATIONWIDE CONCEPTION STUDY
Authors: Olié Valérie , Martin Alice , Lailler Gregory , Béjot Yannick , Gabet Amélie , Grave Clémence , Regnault Nolwenn , Deneux-Tharaux Catherine , Claire Mounier-Vehier , Tstatsaris Vassilis , Kretz Sandrine , Plu-Bureau Geneviève , Blacher Jacques
Published: June 2022

Objective:

Despite the potentially devastating effects of pregnancy-related stroke, few studies have been done on the incidence by type of stroke. We aimed to study the nationwide incidence rates and recent temporal trends for all types of pregnancy-related stroke and to compare this incidence with that of stroke in nonpregnant women.

Design and method:

We conducted a study of 6 297 698 women aged 15 to 49 years who gave birth in France between 2010 and 2018 with no history of stroke before pregnancy by collecting data from the French National Health Insurance Information System database. Poisson regression were used to estimate incidence by types of stroke for the different pregnancy periods and the incidence rate ratio of stroke in pregnant versus nonpregnant French women.

Results:

Among the 6 297 698 women, 1261 (24.0 per 100,000 person-years) experienced a first ever stroke during pregnancy, peripartum, or the first 6 weeks of postpartum. Of the pregnancy-related strokes, 42.9% were ischemic (IS), 41.9% were hemorrhagic (with similar proportion of intracerebral and subarachnoid hemorrhage) and 17.4% were cerebral venous thrombosis (CVT). Compared with nonpregnant women, incidence rates of stroke were similar during pregnancy for IS (aIRR = 0.9(0.8–1.1), slightly higher for all hemorrhagic strokes (IRR = 1.4(1.2–1.8), and considerably increased for CVT (IRR = 8.1(6.5–10.1). Pregnancy-related stroke incidence rose between 2010 and 2018 for ischemic and hemorrhagic stroke but was stable for CVT. In a multivariate model, hypertensive disorders of pregnancy and chronic hypertension before pregnancy were associated with pregnancy-related stroke (OR = 4.65 (4.08–5.30); OR = 2.41 (1.89–3.06)). The risk associated with hypertensive disorders was double for hemorrhagic stroke (OR = 8.60 (7.18–10.30)).

Conclusions:

The risk of pregnancy related CVT was more than eight-fold higher than that observed in nonpregnant women.The incidence of pregnancy-related ischemic and hemorrhagic stroke is increasing over time, and efforts should be made in terms of prevention considering treatable cardiovascular risk factors and hypertensive disorders in pregnant women.
NEUROLOGICALLY ASYMPTOMATIC PATIENTS FREQUENTLY PRESENT CEREBRAL INJURIES DURING MALIGNANT HYPERTENSION: A MRI STUDY
Authors: Boulestreau Romain , Lucas Ludovic , Cremer Antoine , Doublet Julien , Rubin Sebastien , Sibon Igor , Gosse Philippe
Published: June 2022

Objective:

Acute and diffuse microvascular damage characterizes malignant hypertension (MHT), the deadliest form of hypertension. Although its ophthalmological, renal and cardiological repercussions are well known, brain involvement is considered rare with few descriptions, although it is one of the main causes of death. We aim to describe brain MRI abnormalities in patients admitted for MHT crisis but without objective neurological signs.

Design and method:

This single-center, cross-sectionnal observational study recruited patients with malignant Hypertension (MHT). MHT was defined by severe hypertension and severe hypertensive retinopathy OR subacute damage of three among the target organs: heart, kidney, brain, vessels (thrombotic microangiopathy). Patients under 18 years old, under chronic dialysis and not willing to participate were excluded. Brain MRI was performed within 21 days following diagnosis and was reviewed by a stroke neurologist who recorded the following markers: acute ischemic stroke(DWI and FLAIR positive), acute intracerebral hemorrhage (T2* and FLAIR positive), acute brain edema with extensive posterior white matter hyperintensity suggesting a PRES, and small vessel disease including old lacunar infarct, white matter hyperintensities (WMH), presence of dilated perivascular spaces.

Results:

We included 58 patients without neurological signs, 66% were men, and mean age was 45.6+/-11.3 years. Brain MRI were normal in 26% of patients but we found at least one acute abnormality on brain MRI in 29% and an Small Vessel Disease score (SVD score) of two or higher in 52%.In patients with neurological signs, these findings were 9, 53 and 70%, respectively. A PRES was found in 16% of asymptomatic patients and 31% had an ischemic stroke and/or a cerebral hematoma.

Conclusions:

PRES, recent hematoma, ischemic stroke and severe cerebral microangiopathy are common findings in MHT patients without neurological signs on admission. The impact of these findings on patient management, and their cerebrovascular and cognitive prognostic value, should be established. Brain MRI might need to become systematic in patients suffering from MHT episodes.
HYPERTENSION PHENOTYPES IN YOUNG INDIVIDUALS BASED ON COMBINED OR ISOLATED ELEVATION OF OFFICE, HOME AND AMBULATORY BLOOD PRESSURE MEASUREMENTS AND ASSOCIATION WITH ORGAN DAMAGE
Authors: Kollias Anastasios , Ntineri Angeliki , Zeniodi Maria Elena , Stambolliu Emelina , Servos George , Moyssakis Ioannis , Destounis Antonios , Vazeou Andriani , Stergiou George S.
Published: June 2022

Objective:

To assess the prevalence of white-coat (WCH) and masked (MH) hypertension detected by only ambulatory or only home blood pressure (BP) monitoring (isolated), or both (dual), and their association with preclinical target organ damage (TOD).

Design and method:

Young individuals referred for elevated BP and healthy volunteers aged 6–25 years were evaluated with office (2–3 visits; triplicate measurements), home (7 days, duplicate morning and evening measurements) and 24-hour ambulatory BP monitoring. TOD assessment included echocardiographic left ventricular mass index (LVMI), carotid intima-media thickness (IMT) and pulse wave velocity (PWV; Complior). Normotension (NT) was defined as normal office, home and ambulatory BP and sustained hypertension (SH) as all measurements being elevated. WCH and MH phenotypes were identified based on isolated or combined (dual) home and ambulatory BP values.

Results:

Analysis included 320 individuals (mean age 13.8 ± 3.8 years, 66.6% males, 32.2% children, 55.9% adolescents, 11.9% young adults, BMI 24.1 ± 4.8 kg/m2), of whom 276 had LVMI, 212 IMT and 168 PWV assessment. 182 (56.9%) participants had NT and 39 (12.2%) SH. Among 54 (16.9%) participants with WCH, 35 had dual WCH (64.8%) and 19 (35.2%) isolated ambulatory or home WCH. Among 45 (14.1%) with MH, 17 had dual MH (37.8%) and 28 isolated ambulatory or home MH (62.2%). Participants with dual and isolated intermediate phenotypes didn’t differ according to age, sex and BMI. Individuals with SH had higher LVMI, IMT and PWV than NT (all P < 0.05; Figure). Intermediate phenotypes based on selective or combined elevation of out-of-office BP presented intermediate values of indices of TOD between NT and SH. Isolated ambulatory or home WCH was associated with higher LVMI values than NT (P < 0.05), whereas dual MH was associated with higher IMT than NT (all P < 0.05).

Conclusions:

These findings suggest that in young individuals intermediate hypertension phenotypes with selective (isolated WCH) or combined elevation of BP (dual MH) in out-of-office measurement methods appear to carry an increased risk of preclinical TOD compared with NT.
MEAN PLATELET VOLUME IS A PREDICTOR OF BLOOD PRESSURE NORMALIZATION IN PEDIATRIC HYPERTENSION
Authors: Skrzypczyk Piotr , Bujanowicz Adam , Pawlik Katarzyna , Wroniewicz Tobiasz , Szyszka Michal , Ofiara Anna , Wabik Anna , Panczyk-Tomaszewska Malgorzata
Published: June 2022

Objective:

Arterial hypertension in adolescents is a risk factor for elevated blood pressure and cardiovascular sequelae in adult life. The study aimed to analyze factors influencing blood pressure tracking in pediatric patients with primary hypertension (PH).

Design and method:

We analyzed retrospectively 77 children with primary hypertension (53 boys, 24 girls, 13.9 ± 2.7 years) and observation period at least 12 months, in whom we assessed clinical data, anthropometric parameters, office blood pressure, ABPM, and biochemical data, including markers of subclinical inflammation: mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR).

Results:

At the onset of the observation, all patients had arterial hypertension – newly diagnosed (n = 51) or already treated with antihypertensive drugs (n = 26). The observation period was from 1 to 5.25, mean: 2.1 ± 1.0 years. Blood pressure (BP) normalized in 13 (16.9%) patients; seven were previously treated with antihypertensive medications. Patients in whom BP normalized compared to those with sustained hypertension were not-significantly younger (12.9 ± 3.1 vs. 14.1 ± 2.6 [years], p = 0.171), had higher birth weight (3866 ± 425 vs. 3163 ± 614 [g], p = 0.024) and lower initial MPV (9.2 ± 1.4 vs. 10.1 ± 1.3 [fL], p = 0.041) and lower BMI Z-score (0.5 ± 1.0 vs. 1.2 ± 1.2, p = 0.047) and total cholesterol (143.4 ± 26.0 vs. 167.6 ± 33.6 [mg/dL], p = 0.047) after the observation period. Z-score of systolic blood pressure (SBP) at the end of observation correlated with initial values of: BMI Z-score (R = 0.248, p = 0.032), MPV (R = 0.237, p = 0.046), PLR (R = 0.240, p = 0.044), and with nighttime diastolic BP dipping in ABPM (R = -0.309, p = 0.009). SBP Z-score at the end of the observation period also correlated with Z-scores of body weight and BMI (R = 0.327, p = 0.004; R = 0.384, p<0.001) and LDL-cholesterol (R = 0.297, p = 0.031) at the end of observation and with the increase in body weight during the observation period (R = 0.384, p < 0.001). At the end of the observation period, the Z-score of diastolic blood pressure correlated with MPV (R = 0.371, p = 0.003).

Conclusions:

1. The chance of normalization of blood pressure in pediatric patients with primary hypertension is influenced by birth weight, body mass loss, and degree of subclinical inflammation.

2. Mean platelet volume might serve as a predictor of blood pressure change in pediatric patients with primary hypertension.
THE SALT STUDY - SALT INTAKE IN ADOLESCENTS TODAY
Authors: Shah Kriya , Shah Hardik , Vijan Shradha , Kamat Shambhavi , Kirpalani Dilip , Kirpalani Ashok
Published: June 2022

Objective:

High daily salt consumption amongst adolescents is one of the most relevant etiological factors for future risk of hypertension and other lifestyle diseases. The aim of this study is to evaluate and compare the amount and pattern of sodium (Na) consumption in urban and rural school-going adolescents and identify high risk groups for conducting awareness and intervention programs.

Design and method:

Subjects aged 12 - 15 years from 3 schools in and around Mumbai were given a questionnaire detailing their demographic, anthropometric data and eating habits. A self-administered semi-quantitative Food Frequency Questionnaire was used to record consumption pattern of 22 high salt containing food items, divided into 5 categories (bakery, fried, packed, preserved and fast foods). Each participant`s sodium consumption from these food items was calculated. Additional sodium consumption from regular meals was excluded.Data analysed with MS Excel.

Results:

1141 (urban- 565; rural- 576; Males-612,Females -524) participated. 13 % subjects added table salt while 62 % ate frozen foods < twice a month. Median Sodium consumption of the study population was 473 mg/day (~ 1 g salt) (Q1-Q3: 254 - 851 mg/day). Daily Median Na consumption was significantly higher (p < 0.05) in urban students (724 mg/day) as compared to rural (292 mg/day). Bakery and fried foods comprised 51% of sodium consumption amongst rural, whereas all five food categories had equal representation in the urban population. An alarming 54 % subjects’ BMI (34 % urban, 20 % rural) was above the normal range. Higher BMI values correlated significantly with higher daily Na consumption (p = 0.001, Mann-whitney test).

Conclusions:

The salt intake over and above the usual dietary salt consumption was high (~ 2 g per day for urban and ~1 g/day for rural adolescents). More than half the study population was found to be either overweight or obese. This double whammy has a singular potential for producing future hypertensives. Thus targeted awareness, counselling and intervention programs for salt reduction in adolescents is the urgent need of the hour.
HYPERTENSIVE HEART DISEASE IN ADOLESCENCE. PRELIMINARY RESULTS OF THE PESESCAD-HTA STUDY
Authors: Fernandez Guillermo Albert Perez
Published: June 2022

Objective:

Identify the presence of hypertensive heart disease and its relationship with prehypertension and hypertension

Design and method:

A descriptive, cross-sectional study was carried out in 385 prehypertensive adolescents and 128 adolescents with essential hypertension, aged 12–15 years, from among a total of 1,545 adolescents screened in the School Screening for High Blood Pressure in Adolescents Project (PESESCAD-HTA). An echocardiogram was performed in 513 adolescents (prehypertensive plus hypertensive). For the multivariate analysis of risk factors related to LVH, a decision tree was obtained using the chi square automatic interaction detector (CHAID) technique.

Results:

Among prehypertensive and hypertensive adolescents, the prevalence of left ventricular hypertrophy was 6.49% (CI = 4.43–9.41) and 21.09% (CI = 14.92–58.95), respectively. In the sample of 513 individuals with prehypertension and hypertension, a decision tree was designed, using the chi square automatic interaction detector (CHAID) technique, with the presence of left ventricular hypertrophy as the dependent variable.

Conclusions:

The best predictors of left ventricular hypertrophy were a family history of obesity, and its interaction with the age and the sex of the adolescent.
ESTIMATION OF DAILY SALT INTAKE IN CHILDREN WITH ESSENTIAL HYPERTENSION
Authors: Kos Martina , Mihalj Martina , Hamidovic Nikolina , Dumancic Dijana , Kolobaric Nikolina , Stupin Ana , Drenjancevic Ines , Puseljic Silvija , Jukic Ivana
Published: June 2022

Objective:

The development of arterial hypertension is influenced by genetic and environmental factors, with high salt intake being a known environmental contributor. This study aimed to estimate daily salt intake in children with essential arterial hypertension and in normotensive children, and to assess the relationship between their blood pressure values and 24-h urinary sodium excretion.

Design and method:

Total of 26 children participated in this study; 12 children with essential arterial hypertension (HT) and 14 normotensive children (NT) (both sexes, age ranged 12–17). Systolic, diastolic and mean blood pressure and heart rate were measured. 24-h urine samples were analysed for excreted sodium concentration whereas daily salt intake based on 24-h urinary sodium excretion was calculated using appropriate formula. Statistical analysis was conducted by t-test (between groups), and Pearson’s or Spearman’s correlation test was used to determine the correlations between blood pressure (SBP, DBP and MAP) and 24-h urinary sodium excretion (p < 0.05 was considered statistically significant).

Results:

Body mass index (BMI) was similar between groups. Calculated salt intake was significantly higher in children with essential hypertension compared with normotensive children. Systolic (SBP), diastolic (DBP) and mean (MAP) arterial blood pressure were significantly higher in children with essential arterial hypertension compared with normotensive children, while there were no difference in heart rate between HT and NT groups. 24-h urinary sodium excretion was significantly higher in the HT compared with the NT group. 24-h urinary sodium excretion was positively associated with SBP (r = 0.673), DBP (r = 0.513) and MAP (r = 0.651).

Conclusions:

Even though BMI was similar, 24-h urinary sodium excretion was significantly higher in hypertensive children indicating their higher daily salt intake, which is associated with higher blood pressure in these children.
PREVALENCE OF MASKED HYPERTENSION IN CHILDREN AND YOUNG ADULTS WITH CHRONIC KIDNEY DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Goulas Ioannis , Evripidou Kleo , Doundoulakis Ioannis , Nika Thomai , Chainoglou Athanasia , Stabouli Stella
Published: June 2022

Objective:

Hypertension is a common complication and an important risk factor for adverse cardiovascular outcomes in patients with chronic kidney disease (CKD). Studies characterizing blood pressure status on young renal transplant recipients and young dialysis patients using ambulatory blood pressure monitoring are limited and report different prevalence rates. The aim of this meta-analysis was to estimate the prevalence of white-coat and masked hypertension in children and young adults with chronic kidney disease.

Design and method:

We performed a systematic review and meta-analysis of observational studies assessing the prevalence of blood pressure status using ambulatory blood pressure monitoring in children and young adults with chronic kidney disease. Records were identified by search in Medline, Scopus, and CENTRAL databases and sources of grey literature until December 2021. We conducted a random-effects meta-analysis of proportions (double arcsine transformation).

Results:

Overall, we included 10 studies with a total of 1140 children and young adults with CKD and a mean age of 13.79 ± 4.35 years. 301 and 76 patients presented masked hypertension and white-coat hypertension, respectively. We estimated an overall pooled masked HTN prevalence of 27% (95% CI: 18% to 36%, I2 = 87%) and an overall pooled prevalence of white-coat HTN of 6% (95% CI: 3% to 9%, I2 = 78%) (figure 2). Among renal transplant recipients masked HTN had a prevalence of 29% (95% CI: 14% to 47%, I2 = 86%). Further assessment of heterogeneity was qualitatively conducted.

Conclusions:

Masked hypertension is significantly prevalent in children and young adults with CKD, thereby warranting clinical attention when assessing cardiovascular risk in this population. Ambulatory blood pressure monitoring is of high importance when assessing blood pressure status in children with CKD.
CENTRAL SYSTOLIC BLOOD PRESSURE DETERMINES LEFT VENTRICULAR MASS INDEX IN CHILDREN ON DIALYSIS
Authors: Stabouli Stella , Askiti Varvara , Chainoglou Athanasia , Malakasioti Georgia , Chrysaidoy Katerina , Mila Maria , Karava Vasiliki , Marinaki Smaragdi , Kotsis Vasilios , Mitsioni Andromachi
Published: June 2022

Objective:

Cardiovascular disease is highly prevalent in the chronic kidney disease population. The aim of the present study was to assess data from 24 h ambulatory blood pressure (BP) monitoring and 24 h pulse wave analysis (PWA) in dialyzed children and investigate their association with left ventricular mass as a marker of increased cardiovascular risk.

Design and method:

Children and adolescents aged 6 to 18 years, on dialysis for more than 12 months, [16 on peritoneal dialysis (PD) and 12 on hemodialysis (HD)], underwent 24 h ambulatory BP monitoring, 24 h PWA, and echocardiography. The population represents the whole pediatric dialysis cohort in Greece for the years 2019-2020.

Results:

Left ventricular mass index (LVMI) levels and prevalence of left ventricular hypertrophy (LVH) were similar between PD and HD patients. Peripheral and central BPs, and pulse wave velocity (PWV) values were also similar between PD and HD patients. However, HD patients presented significantly higher augmentation index (AIx75) (30.54 ± 6.14 vs 22.10 ± 9.96 %, p < 0.05), cardiac index (CI) (4.35 ± 0.90 vs 3.35 ± 0.54 l/m2, p < 0.005) and heart rate (94.20 ± 9.39 vs 84.92 ± 12.61 beats/min, p < 0.05) compared to the PD patients. Mean arterial pressure (MAP) z score (R2 = 0.34, P < 0.005), SBP/DBP dip (R2 = 0.21 and R20.22, respectively, P < 0.05), central systolic BP (cSBP) z score (R2 = 0.39, P < 0.001), PWV (R2 = 0.26, P = 0.005), CI, (R2 = 0.14, P < 0.05), AIx (R2 = 0.26, P = 0.005) associated with LVMI. Among laboratory parameters only Hb levels associated with LVMI. In stepwise linear regression with dependent variable LVMI and covariates Hb, MAP, SBP/DBP dip, cSBP, PWV, CI, AIx, the parameter that independently associated with LVMI levels was cSBP (B = 2.68, 95%CI 1.45–3.91, p < 0.001). All children with LVH in the PD group and 50% with left ventricular hypertrophy in the HD group had high cSBP (>95th pc).

Conclusions:

cSBP is the major determinant of LVMI levels in children on dialysis. Performing PWA seems to have an important role on the assessment of CV risk in children on dialysis.
SCHOOL HEALTH EDUCATION PROGRAM IN PAKISTAN (SHEPP)-FINDINGS FROM A FEASIBILITY TRIAL IN SCHOOL CHILDREN FROM A LOWER MIDDLE-INCOME COUNTRY
Authors: Almas Aysha , Iqbal Romaina , Ghani Abdul , Samad Zainab , Sabir Sania , Kazmi Khawar
Published: June 2022

Objective:

The school environment plays an essential role in promoting health education and physical activity for children and adolescence, which they adapt into their adulthood. We aim to test feasibility of threefold health education program in children and its potential efficacy on physical activity and diet and cardio metabolic risk factors by including BP, BMI, and waist circumference.

Design and method:

The SHEPP was a parallel group feasibility intervention trial conducted in 2 schools over a 23 month period. All children aged 9–11 years enrolled from the above-mentioned schools were included. The SHEPP Intervention comprised of health education on healthy lifestyle and physical activity sessions for children, training of teachers and awareness sessions for parents conducted over 10 months. Primary outcome was feasibility of SHEPP in terms of recruitment, retention, and treatment fidelity. Secondary outcomes were physical activity levels, dietary intake (of fruits, vegetable), and cardio metabolic risk factors (blood pressure, BMI, and waist circumference (WC)

Results:

Results:

A total of 1280 preadolescent children were assessed for eligibility and 1191 were found eligible. The overall recruitment n (%) was 982/1191(82.5 %) with 505(51.4) from SHEPP intervention school and 477(48.6) in Routine Activity school. The overall retention rate n (%) at 10 month follow up was 912/982(92.8), with 465/505(92) in SHEPP intervention school and 447/477(93.7) in routine activity school. In treatment fidelity 132/144(92) %) Physical activity sessions and all (100%) health education sessions were conducted for each of the 12 classes. There was increase by134(196) minutes in the SHEPP intervention school v 29.8(177) in the routine activity school (P value < 0.001).The increase in out of school physical activity component of physical activity was more compared to in In school Physical activity from baseline to follow-up (101.0(187) v 33(27)). Overall, there was increase in vegetable intake n (%) (>3 serving /day) in SHEPP intervention school (28(5.5) to 108(21.4)) from baseline to follow-up compared to routine activity school (36(7.5) to 71(14.9)).

Conclusions:

We found that intervention using SHEPP is feasible in schools and may help children to carry healthy lifestyle in adulthood by increasing physical activity.
ANDROGEN DEFICIENCY ASSOCIATES WITH INCREASED ADVANCED GLYCATED END PRODUCTS, GALECTIN-3 IN HYPERTENSIVE MEN WITH BENIGN PROSTATIC HYPERPLASIA
Authors: Sirenko Oksana , Kuryata Olexandr
Published: June 2022

Objective:

The aim of the study was to estimate the interaction between testosterone level with advanced glycation end products, galectin-3 in hypertensive men.

Design and method:

The study included 38 men with hypertension and benign prostatic hyperplasia. Advanced glycation end products, matrix metalloproteinases-9 activ¬ity, galectin-3, C-reactive protein, testosterone level were determined in all of patients. The 1st group was made up of men with hypertension and benign prostatic hyperplasia with testosterone deficiency; 2nd group – of men without testosterone deficiency.

Results:

Men with hypertension and benign prostatic hyperplasia with testosterone deficiency had a significantly higher level of advanced glycation end products, galectin-3 (p < 0.001). The presence of androgen deficiency in hypertensive men with benign prostatic hyperplasia was associated with increased levels of advanced glycation end products (OR = 2.8, p < 0.001), galectin-3 (OR = 2.2, p < 0.001).

Conclusions:

testosterone deficiency in hypertensive men with benign prostatic hyperplasia is associated with increased serum advanced glycation end products, galectin-3.
CLINICAL CHARACTERISTICS OF PATIENTS WITH ACUTE MYOCARDIAL INFARCTION IN A SPECIALIZED HOSPITAL
Authors: Kedelbaeva Kamilya , Berkinbaev Salim , Dzhunusbekova Gulnar , Tundybaeva Mira , Kabdulkaeva Aliya , Samitova Sabina , Ormanbek Aida , Duisenova Zhanylsyn , Akbarova Assem
Published: June 2022

Objective:

To study the features of the clinical course of AMI.

Design and method:

A retrospective study of medical records of patients with AMI included 754 patients. Statistical processing was carried out using the SPSS 13 software (IBM, USA). Variables with parametric distribution are presented as x ± SD. To compare qualitative variables, the Pearson Chi-square test was used. Differences in the data were considered statistically significant at p < 0.05.

Results:

84.1% patients with a favorable outcome of AMI and 15.9% were fatal cases. In the analysis elderly people prevailed. For men 65 (± 11.3), for women 72 (± 10.1) years, p = 0.001. Obesity was observed more often in men than in women (35% vs. 26%; p < 0.001). Dyslipidemia occurred more often in men than in women (57.5% vs. 42.5%; p = 0.525). CKD, AF, DM were predominantly diagnosed in women compared with men (58.8% vs. 41.2%; p = 0.001; 15.8% vs. 10.8%; p = 0.049; 54.9% vs. 45.1%; p = 0.001). The frequency of CHF, AH, repeated AMI was higher in men (65.5% versus 34,%; p = 0.35, AH 58.2% versus 41.8%; p < 0.001, repeated AMI 62, 4% versus 37.6%; p = 0.520). The proportion of men who underwent CABG was higher than that of women (13.3% versus 9.2%: p = 0.176). In addition, men were more likely to undergo PCI and further stenting (85.7% versus 78.1%; p = 0.007; stenting. 58.9% versus 48%; p = 0.006). In the duration of hospitalization men lay longer than women (11 (+ - 4.05) versus 9.5 (+ - 4.2) p = 0.003). Fatalities were higher in women - 52.5%, among men it was 47.5% (p = 0.005).

Conclusions:

Unfavorable risk factors for the development of AMI were more often identified among men. Comorbid diseases such as diabetes, AF, CKD were more common in women than in men. AH, CHF, repeated AMI were more detected in men. Therapeutic procedures such as CABG, PCI and stenting were performed more in men. In terms of hospitalization terms, the men stayed in the hospital longer.
ASSESSMENT OF THE SEVERITY OF THE DEGREE OF CONCOMITANT NOSOLOGIES ACCORDING TO THE CHARLSON INDEX IN PATIENTS WITH MYOCARDIAL INFARCTION
Authors: Kedelbaev Kamilya , Berkinbaev Salim , Dzhunusbekova Gulnar , Tundybaeva Mira , Duisenova Zhanylsyn , Ormanbek Aida , Akbarova Assel , Samitova Sabina
Published: June 2022

Objective:

Determination of the severity of comorbid pathology in patients with acute myocardial infarction.

Design and method:

The retrospective study included 634 medical records of a patient with myocardial infarction. Statistical processing was carried out using the SPSS 13 software. To compare qualitative variables, the Pearson 2 test was used for paired values. Differences in the data were considered statistically significant at p < 0.05. To compare the groups, we used the ANOVA test. One-way Pearson correlation analysis was carried out.

Results:

The comorbidity of AMI patients was assessed using the Charlson comorbidity index. The patients were divided into 3 groups: Group I (low comorbidity, CI < 3 points) accounted for 4.4% of the patient; Group II (average comorbidity, CI 3–5 points) - 48.3% of the patient; Group III (high comorbidity, CI more 5 points) - 47.3% of the patient. Charlson’s comorbidity index was 5.5 ± 1.9 points. The total number of nosologies in AMI patients also increased with age (r = 0.741, p = 0.001). Low comorbidity was found in 92.9% of men and 7.1% of women. Average comorbidity: 75.2% and 24.8%, respectively. Patients with a high Charlson comorbidity index were defined in the same way in 49.7 % men and 50.3% women, p = 0.0001. Patients with high comorbidity were more likely to have anemia than patients with low comorbidity. 28.3% and 10.7% cases, pIII – I = 0.0001. It was also revealed that the higher the comorbidity index was, the higher the troponin level was (p = 0.024).

Conclusions:

In the studied patients with AMI, a high degree of severity of comorbidity was determined. The total number of nosologies in AMI patients increased with age. High comorbidity, which increased with age, was defined in the same way in both men and women. Patients with a high severity of comorbidity was level of troponin in the blood was higher, possibly related to age, which is associated with a worse hospital prognosis. When calculating the comorbidity index, Charlson showed a low 10-year survival rate of our patients (21%).
ASSOCIATION BETWEEN THE PRESENCE OF COMORBIDITIES AND CARDIOVASCULAR OUTCOMES IN A HYPERTENSIVE LATIN AMERICAN POPULATION
Authors: de Sousa Andrea , Magalhães Fabrício Galdino , da Silva Suelen Benta , Inuzuka Sayuri , Teixeira Maria Emília , Batista Sandro Rodrigues , Barroso Souza Weimar Kunz Sebba , Sousa Ana Luiza Lima
Published: June 2022

Objective:

To analyze the association between the presence of comorbidities and cardiovascular outcomes in hypertensive Latin American patients.

Design and method:

A cross-sectional study with a sample of patients from the First Brazilian Hypertension Registry (I RBH), that recruited patients aged 18 and over, diagnosed with hypertension for at least 4 weeks. Participants were followed for one year in public and private services. Comorbidities were categorized as hypertension associated with diabetes mellitus or dyslipidemia (2 morbidities) and hypertension with diabetes mellitus and dyslipidemia (3 morbidities). The association of morbidity combinations with the following cardiovascular outcomes was performed: acute myocardial infarction, angina, heart failure and myocardial revascularization. Data were analyzed using the chi-square test and a significance level of p < 0.05.

Results:

The sample consisted of 2.642 patients aged 61 ± 11.8 years. Within the evaluated sample of hypertensive patients, dyslipidemia (46.9%) was the most prevalent, followed by diabetes mellitus (29.7%). The triad hypertension, diabetes and dyslipidemia was present in 19% of participants and responded for the highest prevalence of cardiovascular outcomes: acute myocardial infarction (21.7%, p < 0.001), angina (7.8%, p = 0.02), heart failure (7.6%, p < 0.001) and myocardial revascularization (14.7%, p < 0.001).

Conclusions:

Acute myocardial infarction was the most present outcome among hypertensive and diabetic patients. Cardiovascular outcomes were associated with of other morbidities in addition to hypertension.