bluuebunny/crossref_metadata_2025 huggingface dataset:
PROGNOSTIC VALUE OF MASKED UNCONTROLLED HYPERTENSION DEFINED BY DIFFERENT AMBULATORY BLOOD PRESSURE CRITERIA
Authors: Coccina Francesca , Pierdomenico Anna Maria , Cuccurullo Chiara , Vitulli Piergiusto , Pizzicannella Jacopo , Madonna Rosalinda , Trubiani Oriana , Cipollone Francesco , Pierdomenico Sante Donato
Published: April 2021

Objective:

Masked uncontrolled hypertension (MUCH), that is, normal clinic but high out-of-office blood pressure (BP) in treated hypertensive patients is at increased cardiovascular risk than controlled hypertension (CH), that is, normal clinic and out-of-office BP. Based on ambulatory BP, MUCH can be defined as daytime and/or nighttime and/or 24-hour BP above threshold values. It is unclear whether different definitions of MUCH show similar prognostic information. This study assessed the prognostic value of MUCH defined by different ambulatory BP criteria.

Design and method:

The occurrence of a composite end-point was evaluated in 738 treated hypertensive patients with normal clinic BP (<140/90 mmHg) who were selected from 2264 treated subjects. Participants were classified as having daytime MUCH (BP >135/85 mmHg) regardless of nighttime BP (Group 1), nighttime MUCH (BP >120/70 mmHg) regardless of daytime BP (Group 2), 24-hour MUCH (BP >130/80 mmHg) regardless of daytime or nighttime BP (Group 3), daytime MUCH only (Group 4), nighttime MUCH only (Group 5) and daytime + nighttime MUCH (Group 6).

Results:

There were 215, 357, 275, 42,184 and 173 patients with MUCH from Group 1 to 6, respectively. During the follow-up (10 ± 5 years), 148 events occurred in patients with CH and MUCH. Results of univariate and multivariate Cox regression analyses are reported in the Table.

Conclusions:

The prognostic impact of MUCH defined according to various ambulatory BP definitions may be different.
IN SEARCH OF THE OPTIMAL CUFF FOR BLOOD PRESSURE MEASUREMENT IN THE VERY OBESE
Authors: Palatini Paolo , Benetti Elisabetta , Fania Claudio , Ermolao Andrea , Spinella Paolo , Battista Francesca , Gasperetti Andrea , Saladini Francesca
Published: April 2021

Objective:

Rectangular (cylindrical) cuffs and bladders are currently used for blood pressure (BP) measurement at the upper arm. However, large arms have a conical shape which make cylindrical cuffs potentially unsuitable. Aim of this study was to study the shape of the arm in people with severe obesity and to investigate the effect of the shape of the cuff on BP measurement in these subjects.

Design and method:

In 79 obese subjects with upper arm mid-circumference >40 cm and 79 subjects of control, cylindrical and tronco-conical cuffs of appropriate size were compared. We considered the upper arm either as a single truncated cone (model 1) or as the sum of two tronco-conical shapes, with bases at the proximal and middle arm circumference, respectively (model 2). The frustum slant angle of the proximal (upper angle) and distal (middle angle) truncated cones were measured. If the difference between upper and middle angles is equal to zero, the upper arm can be assimilated to a single truncated cone as in model 1. If the difference is positive (model 2), it means that the distal half of the arm is more conical than the proximal half.

Results:

In the Obese, upper angle was greater than middle angle, whereas in the Nonobese the two angles were similar (p < 0.0001 versus Obese for both angles). In the Obese, the cylindrical cuff overestimated BP measured with the tronco-conical cuff by 4.3 ± 5.4/3.1 ± 4.7 mmHg, whereas in the Nonobese slight discrepancies were found between the two cuffs (p < 0.0001/<0.0001versus Obese). In the whole study sample, the difference between the upper and middle angles was correlated with systolic BP (p = 0.0008) and diastolic (p < 0.0001) BP discrepancies. In a multivariable linear regression, the difference between the two angles was an independent predictor of the between-cuff BP differences in obese men (p = 0.004/0.0007) but not in obese women.

Conclusions:

In very obese people, the tronco-conical shape of the upper-arm is more pronounced on the distal than the proximal half, a feature that amplifies the BP measurement error when cylindrical cuffs are used.
ARM BASED ON LEG BLOOD PRESSURES (ABLE-BP): CAN LEG BLOOD PRESSURE MEASUREMENTS PREDICT BRACHIAL BLOOD PRESSURE? INDIVIDUAL PARTICIPANT DATA META-ANALYSIS FROM THE INTERPRESS-IPD
Authors: Mcdonagh Sinead , Sheppard James , Warren Fiona , Boddy Kate , Fordham Jayne , Farmer Leon , Lewis Philip , Baumber Rachel , Martin Una , Clark Christopher
Published: April 2021

Objective:

Hypertension, a key modifiable risk factor for prevention of stroke, is diagnosed and managed using upper arm blood pressure (BP) measurement. Amputations, altered muscle tone or limb deformities can prevent accurate brachial BP measurement and cardiovascular risk estimation, thus placing a cohort with known vascular risks at a disadvantage. Leg BP measurement is often used as a practical alternative, but limited data exist to guide clinicians’ interpretation of leg BP values for the diagnosis and treatment of hypertension.

Using data from the INTERPRESS-IPD Collaboration, which holds 34,543 individual records from 15 international studies, we will examine the relationship between arm and leg BP, develop and validate a multivariable model predicting arm BP from leg BP and investigate the prognostic role of leg BP in cardiovascular event and mortality risk prediction.

Design and method:

In an observational cohort design, individual participant data meta-analyses will be undertaken to explore cross-sectional relationships between arm and leg BP in multivariable models. Using hierarchical linear regression models, we will investigate the association between arm and leg BP and participant characteristics. Planned predictor variables will include age, sex, cardiovascular disease risk and past medical history. Prognostic models will be derived for all-cause and cardiovascular mortality and cardiovascular events. Heterogeneity will be assessed using I2 2 and tau2. Study quality will be assessed using a modified Quality In Prognostic Studies tool.

Results:

Arm and leg BP records exist for 34,543 individuals. The median follow-up period is 8.5 years, with 3,870 participants experiencing cardiovascular events and 3,096 dying within 10 years. Further analyses are underway and arm-leg BP models will be presented at the conference.

Conclusions:

We will provide the first evidence-based method for estimating individual brachial systolic BP, and cardiovascular risk, from leg BP measurements. Our findings will support clinicians and patients in detecting and managing hypertension more effectively where leg measurements are required.
ARTERIAL STIFFNESS AND MALNUTRITION BUT NOT ABPM ARE ASSOCIATED WITH ALL-CAUSE MORTALITY IN PATIENTS UNDERGOING CHRONIC HEMODIALYSIS
Authors: Matasin Marija , Premuzic Vedran , Katalinic Lea , Barisic Ivan , Gallineo Lana , Jelakovic Bojan
Published: April 2021

Objective:

Our aim was to analyze association of diurnal variations of blood pressure with all-cause and cardiovascular (CV) mortality in patients undergoing chronic hemodialysis during a follow-up of 48 months.

Design and method:

A total of 126 HD patients (74m 52w; average age 61.5 ± 15.8) were enrolled. All patients were dialysed by European and KDIGO guidelines. ABPM (24-hours) was performed with SpaceLab 90207 after mid-week dialysis; pulse wave velocity (PWV) and aortic augmentation index (AIx) were measured using Arteriograph after mid-week dialysis. Malnutrition-inflammation score (MIS) and protein energy wasting (PEW) score were calculated in all enrolled patients. There were 67.6% of patients without prior CV disease, and prior coronary heart disease, valvular disease, atrial fibrillation, stroke, and peripheral arterial disease were diagnosed in 7.1%, 5,6%, 4.7%, 8.7%, 3.9% patients, respectively. Prior diabetes and prior hypertension were diagnosed in 26.2% and 92.4%, respectively.

Results:

There were 74.6% of non-dippers, while white coat hypertension and masked hypertension were diagnosed in 25.4% and 7.9%, respectively. During the follow up period of 48 months 69 patients died from all-cause and 53 from CV mortality. Diurnal variations of blood pressure were not associated with all-cause mortality. Neither white-coat nor masked hypertension were associated with all-cause mortality. Patients with arterio-venous fistula showed significantly better survival when compared to patients with permanent dialysis catheters and in the linear regression model MIS/PEW and PWV were the only predictors of longer survival (b = −0.371, p = 0.001; b = −0.249, p = 0.009).

Conclusions:

Blood pressure characteristics (ABPM) were not predictors of all-cause mortality in patients undergoing chronic hemodialysis. On contrary, arterial stiffness and malnutrition were associated with shorter survival. Observed better survival of patients with A-V fistula compared to patients with permanent catheter is very probably reverse epidemiology. Due to small number of CV deaths we were not able to perform analyzes of CV deaths.
POTENTIAL OF AROMATHERAPY AS A LIFESTYLE MEASURE IN BLOOD PRESSURE REDUCTION: AN ANCIENT PRACTICE INCORPORATED IN MODERN MEDICINE: PILOT PROJECT
Authors: Cuti Edina Catic , Kovacevic Idriz , Cuti Tomislav
Published: April 2021

Objective:

Aromatherapy is ancient practice of using natural oils to enhance psychological and physical well-being. Despite its long history there is paucity of scientific evidence regarding autonomic response to aromatherapy.

Purpose of this prospective study is to evaluate potential beneficial effects of aromatherapy using essential oils Ylang Ylang and Citrus on blood pressure and heart rate in real life practice.

Design and method:

In this prospective study 52 subjects were involved (mean age 59,2; 71% men) with verified and treated hypertension.

The subjects were divided into two groups. Treatment group (N = 21) received aromatherapy and a control group (N = 31) did not receive aromatherapy prior to seeing a nephrologist.

Blood pressure measurements were taken before and after aromatherapy.

Blood pressure was measured using Omron M6 device as defined by ESH/ESC guidelines and central blood pressure and Pulse Wave Velocity were measured using MobiloGraph.

Due to statistical requirements blood pressure was analyzed separately by systolic and diastolic component through paired samples t-test. Statistical differences were tested on significance level of 5%.

Results:

Statistically significant reduction in systolic (t(20) = 6.338, p = 0.000)) and diastolic blood pressure (t(20) = 4.557, p = 0.000) was found in the treatment group.

There was statistically significant improvement in heart rate within treatment group (t(20) = 5.206, p = 0.000)). Heart rate was lowered from 79 ± 12 bpm to 72 ± 11 bpm.

Control group had significantly higher systolic (135 ± 18 mmHg) and diastolic (92 ± 13 mmHg) central blood pressure compared to the treatment group (119 ± 10 mmHg and 77 ± 10 mmHg respectively). T-test (students’ t-test) was used for statistical analysis.

Conclusions:

This pilot study suggests there may be a beneficial effect of short term aromatherapy on blood pressure and heart rate reduction. This practice could be utilized in variety of clinical scenarios such as lessening the white coat effect. Additional studies with larger patient population and longer follow up are needed to gain better insights into the effect of aromatherapy on autonomic system.
EFFECTS OF SKIN TONE AND AMBIENT LIGHTING ON ACCURACY OF CONTACTLESS MEASUREMENT OF HEART RATE AND PULSE TRANSIT TIME: AN INVESTIGATION TOWARD IMAGE-BASED BLOOD PRESSURE ESTIMATION
Authors: Shirbani Fatemeh , Hui Tsz Him , Tan Isabella , Butlin Mark , Avolio Alberto
Published: April 2021

Objective:

Image-based photoplethysmography (iPPG) using video of the skin offers potential for contactless blood pressure (BP) estimation from the pulse transit time (PTT). Optical properties of human skin and ambient lighting are likely to affect accuracy of image-based PTT (iPPT) and are investigated here.

Design and method:

Twelve healthy volunteers (6 female, 27 ± 6 years) with a range of skin tones (Fitzpatrick skin scores of 5 to 27) were recruited. For each subject, the experiment was performed in standard fluorescent room lighting (100 lux) and repeated at five other levels of light intensity (40–310 lux). Two-minute videos were acquired from each subject's face and palm of the left hand; simultaneous electrocardiogram (ECG) and non-invasive finger BP were also measured. In each frame, two regions of interest (ROIs) were selected from the subject's face and hand, and the average of green colour intensity for each ROI were calculated as iPPG. The iPPG signal was band-pass filtered between 0.66–3 Hz, (corresponding to a 40–180 bpm heart rate (HR) range). HR was calculated as the dominant peak in the Fourier spectrum of filtered iPPG. Beat-to-beat values of iPTT were calculated between the corresponding feet of the iPPG pulsations.

Results:

The absolute error between average HR (errHR) determined from ECG and that calculated from iPPG in both ROIs was significantly correlated with room lumen (RL) and skin score (SC) (errHR = – 0.08 × RL + 0.67 × SC + 12, p < 0.05). The minimum HR error was in standard room lighting (errHR = 3.9 ± 8.9 bpm). Using average iPTT in room lighting as the reference, the percentage error (iPTT%err) between reference iPTT and iPTT in other lighting conditions significantly decreased with lower lighting conditions but was not significantly changed with skin tone score (iPTT%err = -0.09 × RL + 55, p < 0.05).

Conclusions:

Skin tone and ambient lighting intensity affects accuracy of contactless HR measurement. Only light intensity affects accuracy of iPTT measurement. It is likely that errors in contactless BP estimation are minimised in standard room lighting conditions but increase in dimmer conditions.
IS AUSCULTATION ADEQUATE TO ESTIMATE BLOOD PRESSURE RESPONSES RELATED TO BODY POSITION CHANGES?
Authors: Wuerzner Gregoire , Vybornova Anna , Wurzner Arlène , Polychronopoulou Erietta , Fallet Sibylle , Sola Josep , Alpert Bruce
Published: April 2021

Objective:

The auscultatory blood pressure (BP) measurement technique, relying on the K1 and K5 Korotkoff sounds, is the current reference to validate new devices in the standard sitting position. There are few data to tell whether it should also be used for device validation in other body positions, since the K1 and K5 sounds can be affected by changes in vascular tone. In this study, we recorded the BP responses to body position changes by the auscultatory method, and we compared them to data from simultaneous recordings by a volume-clamp method.

Design and method:

Systolic (SBP) and diastolic (DBP) were estimated on the left upper arm by two independent blinded observers, and on the ipsilateral middle finger by a volume-clamp device (Nexfin, BMEYE, The Netherlands) in the supine followed by the standing position, and in the standing followed by the supine position. The auscultatory readings were repeated if readings differed more than 4mmHg between the two observers. A first auscultation was performed before the position change, and a second one 150 s after the position change. Because volume-clamp measurements were not available during upper-arm cuff inflation, the mean of volume-clamp values in a 30 s window prior to auscultation onset were used for the analyses.

Results:

Sixty-seven participants, between 21 and 65 years old, participated in this study. As illustrated in the figure, volume-clamp reported a consistent mean DBP increase of 9.3 mmHg when moving from supine to sitting, and a consistent mean DBP decrease of 10.4 mmHg when moving from sitting to supine. These results agree with those previously reported using simultaneous invasive and volume-clamp measurements. On the contrary, auscultation detected no consistent body position-related change in the DBP readings. Neither auscultation nor volume-clamp detected consistent body position-related changes in SBP readings.

Conclusions:

Compared to volume-clamp, auscultation was not able to detect any consistent changes in BP during orthostatic challenge. Our study suggests that the use of Korotkoff sounds to estimate BP in body positions other than sitting and relaxed may not be appropriate.
OUTCOME-DRIVEN THRESHOLDS OF CENTRAL SYSTOLIC BLOOD PRESSURE AND CROSS-CLASSIFICATION OF SYSTOLIC HYPERTENSION AT CENTRAL AND BRACHIAL ARTERIES
Authors: Cheng Yi-Bang , Aparicio Lucas S. , Thijs Lutgarde , Melgarejo Jesus D. , Huang Qi-Fang , Sheng Chang -Sheng , Gilis-Malinowska Natasza , Wei Fang -Fei , Niiranen Teemu J. , Yang Wen -Yi , Boggia José , Stolarz-Skrzypek Katarzyna , Barochiner Jessica , Wojciechowska Wiktoria , Tikhonoff Valérie , Casiglia Edoardo , Narkiewicz Krzysztof , Filipovský Jan , Czarnecka Danuta , Kawecka-Jaszcz Kalina , Jula Antti M. , Struijker-Boudier Harry A.J. , Wang Ji-Guang , Zhang Zhen-Yu , Li Yan , Staessen Jan A.
Published: April 2021

Objective:

We aimed to determine the outcome-driven thresholds for central systolic blood pressure (cSBP) based on the new ACC/AHA hypertension classification and to explore the characteristics and prognosis associated with central systolic hypertension (cSHT).

Design and method:

In 5580 participants enrolled from 9 populations (mean age 54.2 years; 54.1% women), cSBP was estimated tonometrically from the radial waveform (SphygmoCor, Atcor, Australia). We determined the thresholds for cSBP, resulting in 5-year cardiovascular risks similar to those associated with the 2017 ACC/AHA classification of brachial systolic blood pressure (bSBP). Statistical methods included analysis of covariance, the log-rank test and proportional hazards regression.

Results:

Over 4.1 years (median), 203 persons died (6.4 per 1000 person years) and 252 experienced a composite cardiovascular endpoint (8.2 per 1000 person-years). After rounding to the nearest 5 mm Hg, approximate thresholds for elevated cSBP and stages 1 and 2 and severe cSHT were 110, 120, 130 and 150 mm Hg, respectively. In 3659 untreated subjects, those with isolated cSHT (cSBP > = 120 mmHg, n = 137, 3.7%), compared to the participants with central (cSBP < 120 mmHg) and brachial (bSBP <130 mmHg) normotension (n = 1953, 53.4%), were older, more likely being female, had smaller height, slower heart rate and higher augmentation index. The opposite was true for isolated brachial hypertension (bSHT; bSBP > = 130 mmHg, n = 192, 5.3%). Among 1921 treated patients, the use of b-blockers was more frequent (50% vs. 36.2%, P = 0.027), whereas in isolated cSHT (n = 72, 3.8%) compared with controlled cSBP, RAAS inhibitors less often used (50% vs. 65.3%, P = 0.013). Among all participants, with brachial and central normotension as reference, the multivariable-adjusted hazard ratios (95% confidence interval) of the composite cardiovascular events were 1.29 (0.57–2.90; P = 0.54) for isolated bSHT, 2.30 (1.22–4.33; P = 0.01) for isolated cSHT, and 2.00 (1.39–2.88; P = 0.002) for concordant cSHT and bSHT.

Conclusions:

Outcome-driven thresholds of central systolic BP were approximately 10 mm Hg lower than their brachial counterparts. cSHT, either isolated (4%) or combined bSHT (90%), was characterised by greater systolic augmentation and was associated with higher cardiovascular risk.
USE OF DOUBLE FIXED-DOSE COMBINATION OF OLMESARTAN AND AMLODOPINE VERSUS FIXED-DOSE COMBINATION OF LISINIPRIL AND AMLODOPINE IN UNCONTROLLED HYPERTENSIVE PATIENTS
Authors: Koval Sergey , Penkova Marina , Starcenko Tatiyana , Rieznik Larisa
Published: April 2021

Objective:

To check the efficacy of double fixed-dose combination of Olmesartan (O) and Amlodopine (A) versus the fixed-dose combination of Lisinopril (L) and amlodipine (A) in obese patients with uncontrolled moderate-to-severe arterial hypertension (AH).

Design and method:

Design and method: 60 hypertensive patients with abdominal obesity. The first subgroup of patients (n = 30) received fixed-dose combination: O and A (20 mg/5 mg; 40 mg/10 mg), the second subgroup (n = 30) - L and A (10 mg/5 mg; 20 mg/5 mg; 20 mg/10 mg). The examinations were carried out at baseline and in 6 months.

Results:

Results: The frequencies of BP target levels after treatment were higher in the first subgroup than in the second (75% versus 53%, p < 0.05). According to 24-hour BP monitoring, the fixed - doses combination of O/A lowered such parameters as 24-hour systolic BP and diastolic BP, systolic BP (night) and diastolic BP (night) more significantly than fixed-doses combination L/A. The adherence to double fixed-dose combination O/A was also higher in comparison with fixed combination L/A (85% versus 61%, p < 0.05). It has been established that lower fixed-doses combination of O/A (20 mg / 5 mg) were more often used compared to L/A (20% versus 10%, P < 0.05) in this patients. At the same time, the maximum doses of these drugs were necessary to achieve target BP levels in a significantly lower number of patients receiving a fixed dose combination of O/A compared to patients on L/A (60% against 81%, p < 0.05).

Conclusions:

The study demonstrated superior efficacy of O/A in reducing office BP, as well as 24-h ambulatory BP versus L/A in obese patients with uncontrolled moderate-to-severe AH. Achievement of target BP levels in patients with AH and abdominal obesity was possible at lower fixed-dose combination of O/A than L/A.
EFFECT OF ACCESSORY RENAL ARTERY ON ESSENTIAL HYPERTENSION
Authors: Song Wei , Wu Fengyuan , Guo Ran , Lu Yan , Zhang Ying , Jian Yinong
Published: April 2021

Objective:

Whether the accessory renal arteries (ARAs) are involved in hypertension has been disputed for decades. Our study was designed to determine whether there were differences between primary hypertensive patients with or without ARAs.

Design and method:

Patients who has been diagnosed with essential hypertension in our hospital between June 2017 and October 2019 were collected. They were divided into two groups according to the presence or absence of ARAs confirmed by computed tomography angiography of renal arteries. Control group comprised 126 patients whose kidneys were supplied by single arteries while ARAs group comprised 118 patients with accessory renal arteries. The background and clinical data of these patients were collected.

Results:

There were no significant differences in age, hypertension duration, diabetes, smoking, BMI and drug history of antihypertensive treatment between the two groups (all P > 0.05). In our study, 45.8% of accessory renal arteries were on the left, 29.7% on the right and 24.5% on both sides. Male patients had a higher incidences of ARAs (72.9%).Mean blood pressure in 24 hours was 143/93 ± 15/11 mmHg in ARAs group while 151/99 ± 14/10 mmHg in control group. The blood pressure was significantly high in patients with ARAs than patients without ARAs (P < 0.01). Renin concentration was higher in ARAs group than control (P = 0.037). Target organ damage was compared. The thickness of left ventricular posterior wall and interventricular septum was dramatically increased in ARAs group compared with that of control (all P < 0.01).Left atrial dimension of ARAs group was greatly larger than control (P < 0.01). Creatinine and cystatin C was increased in ARAs group compared with that of control (P = 0.032 and 0.01 respectively). Flow-mediated dilation (FMD) was remarkably low in ARAs group compared with control (P = 0.017). Left carotid intima-media thickness (IMT), right femoral IMT and bilateral popliteal IMT of ARAs were significant thicker than control group (all P < 0.05).

Conclusions:

We concluded that patients with accessory renal arteries may have higher blood pressure. The mechanism involved maybe the increased renin concentration. Hypertensive patients with accessory renal artery may lead to more serious damage in target organs.
RELATIONSHIPS BETWEEN SHORT-TERM BLOOD PRESSURE VARIABILITY AND LEFT VENTRICULAR DIASTOLIC DYSFUNCTION IN HYPERTENSIVE PATIENTS
Authors: Mulé Giuseppe , Guarino Laura , Nardi Emilio , Calandra Leonardo , Di Maggio Antonio , Sorce Alessandra , Mancia Ettore , Giambrone Marta , Imbrogio Vincenzo , Cottone Santina
Published: April 2021

Objective:

Although an accurate assessment of fast blood pressure (BP) fluctuations occurring within the 24 hours, ideally requires continuous beat-to-beat recording, its assessment is also possible through non-invasive, intermittent 24 h ambulatory BP monitoring (ABPM) Short-term BP variability (SBPV) seems to be relevant to the pathophysiology of target organ damage and to the incidence of clinical events.

Our study was aimed to assess in hypertensive patients the relationships between some echocardiographic indices of DD and SBPV.

Design and method:

We enrolled 289 hypertensive subjects (age: 54 ± 16 years) recruited from those consecutively attending our Hypertension Centre. All the patients underwent: a 24-h ambulatory BP monitoring (ABPM) and an echocardiogram. We calculated the following indices of SBPV: standard deviation and average real variability (ARV) of diurnal and nocturnal systolic (SBP) and diastolic BP (DBP), 24 h weighted SD and ARV of SBP and DBP. Diastolic function was assessed by measuring from the mitral inflow profile, the E-wave (E) and A-wave (A) peak velocities, E/A ratio and E-deceleration time. Isovolumic relaxation time was calculated between aortic valve closure and the start of E-wave. Tissue Doppler imaging of the mitral annulus was obtained placing the sample volume in the lateral mitral valve annulus to evaluate: systolic peak velocity (Sm), early (Em) and late (Am) diastolic myocardial velocities. The E/em ratio was also calculated.

Results:

All the indices of systolic SBPV examined showed significant correlations with A-wave and with Em (p < 0.01). The correlations with the greatest strenght were those between Em and ARV of 24 h SBP (r = -0.273; p < 0.001) and between Em and weighted SD of 24 h SBP (r = -0.307; p < 0.001). These associations held even after adjustment in multiple regression models for confounders such as age, sex, average 24 h systolic BP and heart rate (p < 0.01).

Conclusions:

Our findings, showing an independent association between SBPV and some indices of diastolic dysfunction able to predict the development of heart failure, corroborate the concept that an increased short-term systolic BP variability may not be an innocuous phenomenon.
ASSOCIATION BETWEEN SHORT TERM BLOOD PRESSURE VARIABILITY AND ARTERIAL STIFFNESS IN SUSPECTED HYPERTENSIVES
Authors: Vieira Mateus Marchiori , Resende Luiz Antônio Pertili R. De , Resende Elizabeth Mantovani R. De , Filho Dalmo Correia , Neto Otavio Barbosa , Dias Valdo José , Resende José Augusto Mantovani De , Vieira Livia Marchiori , Moreira Guilherme Marchiori , Resende Ana Luísa Mantovani De , Silva Marco Antônio Vieira Da
Published: April 2021

Objective:

To evaluate the association between arterial stiffness and short term blood pressure variability (BPV).

Design and method:

Four hundred fifty-five suspected hypertensive patients were referred to record a 24-hours ambulatory blood pressure monitoring (ABPM), and also were randomly enrolled from a population. They performed an oscillometric pulse wave analysis, using Mobil-O-Graph (I.E.M., Stolberg, Germany), following recommendations of Expert Consensus Document on the Measurement of Aortic Stiffness-2012. They also had a 24- hour of ABPM recorded. ABPM was made following protocols of European Guidelines. Short term BPV was evaluated by systolic or diastolic BP with: the standard deviation (SD) of 24 hs BP (24hBP-SD), Daytime BP-SD, Nighttime BP-SD, the 24 hs BP coefficient of variation (24hs CV), the weighted 24-h BP-SD and average real variability of 24-hour BP (ARV 24-h BP). Statistical Analysis: the Pearson correlation coefficient (r) was calculated by an univariate way comparing all systolic and diastolic BPV measures with brachial pulse wave analysis (bPWV). Partial correlation was adjusted to age and gender, and then for age, gender, 24 hs BP, and office BP do to avoid statistic influence of such confounders.

Results:

Data from 455 patients were analyzed. Clinical characteristics of the sample: age 48.8 ± 13.93 – women (41.9%), white people (69.5%), treated hypertensives (36%), diabetes (12.7%), statin use 22%, body mass index 28. 6 ± 5.8, smokers (8.6%), obese (36.3%). The findings are showed in table 1. All BPV variables had a significant correlation with bPWV. Daytime BP-SD and weighted 24-h BP-SD showed the best association. The worst results of the correlation were found, in systolic, in nighttime BP-SD, and in diastolic, in 24 hs CV. However, the comparison of diastolic 24hBP-SD and bPWV showed a negative correlation.

Conclusions:

Our data indicated an association between short blood pressure variability and oscillometric pulse wave velocity. A moderate correlation was demonstrated by systolic BPV and weak by diastolic. The best results of the association between the studied variables were shown in Daytime BP-SD and in weighted 24-h BP-SD.
BLOOD PRESSURE VARIABILITY IN TWO CONSECUTIVE BLOOD PRESSURE MEASUREMENTS IN HYPERTENSIVE AND NON-HYPERTENSIVE PATIENTS
Authors: Albuquerque Nila , Borges Samantha , Silva Liana Queren Lima , Silva Lais Vitoria , Rabelo Talita Maria , Lino Kecia , Rocha Fabian Elery , Araujo Thelma
Published: April 2021

Objective:

The aim of this study was to compare blood pressure variability (BPV) in two consecutive blood pressure measurements in hypertensive and non-hypertensive patients.

Design and method:

A total of 92 patients from an outpatient clinic underwent two consecutive blood pressure measurements. The first one was using a calibrated aneroid sphygmomanometer and the second the HBP-1100 automatic blood pressure monitor. Auscultatory measurement was simultaneously performed by two trained observers using a dual-head teaching stethoscope and one supervisor who checked if differences between observers were less than or equal to 4 mmHg. Interval between measurements was at least 30 and at most 60 seconds. Blood pressure variability was defined as the standard deviation around the mean of the two systolic blood pressure (SBP) and diastolic blood pressure (DBP) readings. The paired sample t-test was used to determine whether there is a difference between the mean SBP and DBP variability in two observation sets, defined as hypertensive and non-hypertensive patients.

Results:

A total population of 92 from an outpatient clinic [66.3% female; mean age: 39.18 years; 32.61% hypertensives] underwent two consecutive blood pressure measurements in different methods. 184 valid blood pressure measurements were performed. Mean auscultatory SBP and DBP was 114.13 ± 17.95/ 69.48 ± 14.08 mmHg, respectively. Using the oscillometric method, mean SBP and DBP was 119.26 ± 16.94/71.89 ± 14.047 mmHg. Mean SBP difference between the two measurements was 5.13 ± 8.57 and 2.402 ± 6.85. SBP variability in hypertensive patients is statistically significantly higher (p = 0.01), whereas for DBP there is no significant difference (p = .0.78). Blood pressure variability in hypertensive patients with altered body mass index (BMI) was not statistically different (p = 0.30 and p = 0.56 for SBP and DBP, respectively).

Conclusions:

Increased SBP variability between two measurements was identified in hypertensive patients, regardless of BMI. As blood pressure variability is a recognized risk factor for cardiovascular events, its investigation should be included in the management of hypertensive care even in the interval between two blood pressure measurements.
IMPACT OF MODEL CHOICE WHEN STUDYING THE RELATIONSHIP BETWEEN BLOOD PRESSURE VARIABILITY AND RISK OF STROKE
Authors: De Courson Hugues , Ferrer Loic , Barbieri Antoine , Tully Phillip , Woodward Mark , Chalmers John , Leffondre Karen , Tzourio Christophe
Published: April 2021

Objective:

Long-term blood pressure variability (BPV), an increasingly recognized vascular risk factor, is challenging to define and to analyze. In order to take into account two major methodological issues - conditioning on the future and uncertainty around BPV value - we compared different models on the risk of stroke in a large dataset

Design and method:

We used data from the PROGRESS trial, a secondary stroke prevention trial which included 6105 subjects followed-up during 4 years. The median number of BP measurements was 12 and 727 strokes occurred. We compared a naive Cox model including BPV as a fixed covariate calculated on the entire follow-up, to other models aimed at avoiding conditioning on the future and taking into account uncertainty around BPV value.

Results:

We found that BPV was associated with an increased risk of stroke when using a naive Cox Model (HR = 1.19, 95% CI: 1.10 – 1.30) but not when using other models dealing more appropriately with the issue of conditioning on the future.

Conclusions:

These results illustrate that the methods used to estimate the association between BPV and stroke may affect the estimates and that more appropriate models tend to reduce this association.
THE INFLUENCE OF RENAL DENERVATION ON BLOOD PRESSURE VARIABILITY IN PATIENTS WITH RESISTANT HYPERTENSION
Authors: Anna Moiseeva , Alexandru Caraus , Nicolae Ciobanu , Vitalie Moscalu , Oleg Calenici , Angela Bitca , Nadejda Sapojnic , Mihaela Caraus
Published: April 2021

Objective:

Comparative evaluation of the impact of renal denervation versus pharmacological treatment with sympathetic nervous system (SNS) blockers on blood pressure variability in patients with resistant hypertension.

Design and method:

75 patients with resistant hypertension without comorbidities after a 3-week standardized treatment with Losartan, Amlodipine and Indapamide and confirmation of their resistance were randomized into three groups, depending on medication supplimented to the previously administred: group I M - selective I1-imidazoline agonist Moxonidine, group II B – cardioselective beta-blocker Bisoprolol, group III D – renal artery denervation (RDN). Blood pressure variability assessed by ambulatory blood pressure monitoring (ABPM) were determined at baseline, 3 and 6 months follow-up.

Results:

The media/day and media/night systolic blood pressure (SBP) variability increased at the baseline in all three groups was reduced statistically significant from 3 months of monitoring, reaching the maximum effect towards the end of the study, when its normal values were recorded in all observational groups.

Although treatment group supplimented with Moxonidine demonstrated an effect superior to that with Bisoprolol, and RDN - superiority to both, all three schemes had an authentic dynamics in improving SBP at 6 months of evaluation (p < 0,001) (Fig.1).

The evolution of diastolic blood pressure (DBP) media/day and media/night variability noted a beneficial effect, starting with 3 months, the improvement of this parameter being maintained until the end of the study. Although the reduction of DBP variability was statistically authentic in all three groups at all stages of evaluation, the Bisoprolol treatment group noted a smaller effect in improving this parameter, the higher net effect being manifested by the RDN patients group (p < 0,001) (Fig.2).

Conclusions:

RDN in patients with resistant hypertension reduced statistically significant SBP and DBP variability starting with 3 months of follow-up and reaching maximum effect at the end of the study, simultaneously demonstrating superiority over treatment with SNS blockers.
ANTIHYPERTENSIVE TREATMENTS AND RISKS OF LUNG CANCER: A LONG-TERM RETROSPECTIVE COHORT STUDY IN HONG KONG
Authors: Li Jinhui , Lam Amy Sm , Yau Sarah Ty , Yiu Karen Kl , Tsoi Kelvin Kf
Published: April 2021

Objective:

There remains a lack of strong evidence to identify the association between antihypertensive treatments (AHTs) and the risk of lung cancer. We studied the relationship between AHTs and the risk of lung cancer for further investigation.

Design and method:

The Aspirin Cohort was conducted from 2000 to 2013. The adjusted hazard ratio (HR) with 95% confidence intervals (95% CIs) was assessed for lung cancer risk through Cox proportional hazards models with inverse probability weighting. The cumulative duration of usage was also considered.

Results:

Among all the participants, 8,618 used aspirin only, 238,663 used AHT only, and 182,747 used both aspirin and antihypertensive, with lung cancer incidence rates of 2.5%, 2.8%, 2.4%, and 3.7% respectively. The mean age was 67.5 (SD = 12.0) years old. Among the classes of AHT, the lung cancer incidence rates for ACEi/ARB, CCB, alpha-blocker, and beta-blocker were 1.6%, 2.5%, 3.9%, and 2.2% respectively. Compared to the patients from the control group, the overall lung cancer risk decreased significantly (HR: 0.63, 95% CI: 0.60–0.66) for the patients who accepted AHT. For specific classes of AHTs, there were significant association between ACEi/ARB (HR: 0.45, 95% CI: 0.32–0.62), alpha-blocker (HR: 0.64, 95% CI: 0.54–0.76), and beta-blocker (HR: 0.79, 95% CI: 0.65–0.96) usage and decreased lung cancer risk. When aspirin and alpha-blocker were used simultaneously, it reduced the risk of lung cancer significantly (HR: 0.53, 95% CI: 0.34–0.84). Moreover, as the follow-up period went on, the use of AHTs was still associated with a decreased risk of lung cancer after 5-year (HR: 0.60, 95% CI: 0.57–0.63) and 7-year (HR: 0.63, 95% CI: 0.60–0.66) of usage. Similar effects were also identified for the combination usage of aspirin and ATHs. Specifically, analyses by the different duration of follow-ups for ACEi/ARB and alpha-blocker treatment also revealed significantly decreased lung cancer risk consistently.

Conclusions:

Long-term AHTs among the Chinese population might lower the risk of lung cancer. This study should offer further reassurance to patients using AHTs, but more evidence is warranted to address the effects of these drugs on the risk of lung cancer.
EVALUATION OF CARDIOVASCULAR COMPLICATIONS AT CHRONIC HEMODIALYSIS
Authors: Zemmouchi Souheila , Amiar Billel , Tebbani Rachida
Published: April 2021

Objective:

Despite the effectiveness of dialysis in the treatment of uremic death, chronic hemodialysis patients have a reduced life expectancy, largely related to the development of a very frequent, often early and sometimes severe and concealed cardiovascular damage in these patients. Throughout this study, we set out to determine the frequency of cardiovascular complications at the dialysis center of Constantine's EHS and to define the main cardiovascular risk factors

Design and method:

A cross-sectional, mono-centric descriptive study type, over a two-year period, from January 1, 2016 to December 31, 2017, including 117 hemodialysis patients at EHS Daksi Constantine

Results:

Subclinical cardiovascular complications were the most frequent, namely left ventricular hypertrophy (78%) and valvular calcification (13%), and a combination of several cardiovascular complications was observed. Two-thirds of our population was hypertensive. MAPA demonstrated the non-Dipper character in 74% of hypertensive patients, which is strongly correlated with an increase in left ventricular mass. The cardiovascular mortality rate related to coronary insufficiency (IDM and sudden death) is very high in our series (60%).

Conclusions:

Hemodialysis is a purification technique that exposes patients to multiple cardiovascular complications.
MAGNESIUM AND TAURINE, FIRST PROVEN TO BE PREVENTIVE NUTRIENTS IN STROKE-PRONE RAT MODELS WERE 24-H URINARY BIO-MARKERS ASSOCIATED WITH LOWER CV RISKS WORLD-WIDELY, ALSOINJAPANESE AND MEDITERRANEAN POPULATIONS
Authors: Yamori Yukio , Sagara Miki , Mori Hideki , Mori Mari
Published: April 2021

Objective:

Since stroke was prevented by taurine(T)- and magnesium(Mg)-rich diets even in salt-loaded stroke-prone SHR models, we examined the association of 24-hour urinary(24U) T and Mg/creatinine (C) ratios with cardiovascular risks (CVR) world-wide and studied these biomarkers in Japanese and Mediterranean populations (J, M) in comparison with Euro-Western populations(EW).

Design:

The association of 24U T and Mg/C with CVR was cross-sectionally analyzed among 4211 participants, 49.7% females(F), aged 48–56 years in 50 populations from 22 countries according to the WHO-CARDIAC study protocol and further analyzed comparatively in 6 J (864, 53.8%F), 6 M(574, 50.2%,F from Greece, Sicily, Italy, Spain, Portugal) and 6 EW(549,45.9% F from Sweden,Ireland, Scotland, Canada, Australia,New Zealand).

Design and method:

In a world-wide linier regression analysis, T/C and Mg/C were inversely associated with BMI, systolic and diastolic blood pressure (SBP, DBP) and serum total cholesterol (TC) significantly (P for linear trend <0.001, respectively). The prevalence of obesity, hypertension and hypercholesterolemia among the subjects of the lowest quintile of T/C (Mg/C) was 2.84 (2.49), 1.22 (1.49) and 2.20 (2.39) times higher (P < 0.05 or <0.001) than those in the subjects of the highest quintile.

In a comparison of J and M (both males and females) with EW, 24U T and Mg/C in both populations were significantly higher than in EW, and SBP, DBP, TC and non-HDL cholesterol were significantly lower in J and M, despite their significantly higher 24U salt, than in EW, indicating that these biomarkers could contribute to lower coronary heart disease mortality, benefiting longevity in J and M.

Conclusion:

T and Mg are regarded as beneficial dietary factors for reducing CVR world-wide and are related with the merits of J and M diets compared with EW diets despite the higher salt intake, indicating that low salted T- and Mg-rich dietary intakes are recommendable for promoting CVR reduction.
ASSOCIATION BETWEEN THE VISCERAL ADIPOSITY INDEX AND HYPERTENSION-MEDIATED ORGAN DAMAGE IN THE COMMUNITY-DWELLING ELDERLY CHINESE: THE NORTHERN SHANGHAI STUDY
Authors: Xu Chong , Zhao Song , Yu Shikai , Chi Chen , Fan Ximin , Ji Hongwei , Teliewubai Jiadela , Zhang Yi , Xu Yawei
Published: April 2021

Objective:

The visceral adiposity index (VAI) was a novel indicator of visceral fat function and insulin resistance. Numerous studies had investigated that the VAI was associated with cardiovascular damage. However, few data are found on the correlation of VAI and hypertension-mediated organ damage (HMOD). We aimed to evaluate the association of HMOD with the VAI in the community-dwelling elderly Chinese population.

Design and method:

A cohort of 3363 elderly participants was recruited from June 2014 to August 2019. The relationship between the VAI and cardiometabolic risk factors was analyzed by Pearson's correlation. We used multivariable linear and logistic regression analysis to verify the relationship between the VAI and HMOD.

Results:

The VAI was significantly correlated with cardiometabolic risk factors (P < 0.001). In multivariable linear regression analysis, the VAI was associated with carotid-femoral pulse wave velocity (cf-PWV; b = 0.047, P = 0.024), ankle-brachial index (ABI; b = -0.003, P = 0.022), urine albumin to creatinine ratio (UACR; b = 3.893, P = 0.008), estimated glomerular filtration rate (eGFR; b = -0.526, P = 0.003). After the VAI was put into the multivariable logistic regression model, higher VAI was significantly related to cf-PWV > 10m/s (OR = 1.50, [95% CI, 1.12–2.00]; P = 0.006), micro-albuminuria (OR = 1.32, [95%CI, 1.03–1.70]; P = 0.019) and chronic kidney disease (OR = 1.56, [95% CI, 1.03–2.37]; P = 0.031).

Conclusions:

Higher VAI might be related to an increased risk of arterial stiffness and kidney damage. The VAI may be used as a tool to evaluate early HMOD in the elderly Chinese population.
POLYMORPHISM ROLE OF GNB3 GENE IN THE DEVELOPMENT OF LEFT VENTRICULAR HYPERTROPHY OF PATIENTS WITH PRIMARY ARTERIAL HYPERTENSION
Authors: Voroniuk Kseniia , Sydorchuk Larysa , Petrynych Oksana , Biletsky Semen , Kazantseva Tetiana , Repchuk Yuliia , Semianiv Marianna , Sokolenko Alina
Published: April 2021

Objective:

To analyze the distribution of polymorphic variants of the guanine gene of the binding G protein of the beta-3 subunit (GNB3) of patients with primary arterial hypertension;

Design and method:

In a single-step study, 72 patients with EH II-nd stage, 1–3 degrees of raising blood pressure, high and very high cardiovascular risk occurred. Patients’ gender consists of 29.16% (21) of men, 70.84% (51) of women. The average age of the patients is 59.87 ± 7.98 yr. The control group consisted of 48 healthy individuals, comparable in age (43.36 ± 7.1 yr.) and sexual division (62.5% for women, 37.5% for men). A study of the 825C > T polymorphism of the GNB3 gene has been performed by real-time BDP.

Results:

The genetic marker 825C > T of the GNB3 gene polymorphism (rs5443) is determined by replacing thymine (T) with cytosine (C) in the gene position with 825 DNA (12p13). Substitution of C with T in the GNB3 protein at position 825 of the amino acid sequence is accompanied by impaired replication of the 9th exon, which leads to the loss of a portion of the polypeptide chain, consisting of 41 amino acids. Genotypes division inpatient group with EH and in the observation group are as follows: the TT genotype is found in 8.33% (6) patients and 4.16% (2) of the control group, the Tt genotype in 41.66% (30) and 50% (24), respectively, the tt genotype is found in 50% (36) of patients and in 45.83% (22) of practically healthy patients (p < 0.05). The partition of polymorphic variants corresponded to the population balance of Hardy-Weinberg (x2 = 3.28, p > 0.05). The relative frequency of the wild C-allele and the mutational T-allele (PT = 0.24; PC = 0.71) does not differ between the research and control groups (x2 < 1.0; p > 0.05). The studied polymorphism of the GNB3 gene (5443) is not associated with an increased risk of EH [OR = 1.18; 95% CI: 0.56–2.46; p > 0.05].

Conclusions:

The alleles and genotypes of 825C > T polymorphism of the GNB3 gene (rs5443) are not risk factors for the development of EH in the examined.
THE IMPORTANCE OF CHRONICK KIDNEY DISEASE IN A PORTUGUESE DIABETIC RESISTANT HYPERTENSION POPULATION
Authors: Pereira Flávio , Lopes Susana , Briosa Ana , Cavadas Susana , Mesquita José
Published: April 2021

Objective:

Introduction: Resistant hypertension (RH) isn’t well studied with Ambulatory blood pressure monitoring (ABPM).

Objective:

Study in a RH population obtained in hypertension department to characterize Diabetes Mellitus (DM) patients and identify cardiovascular (CV) outcome predictors.

Design and method:

ABPM - collected 1999–2018. Identified RH patients according to the ESC Guidelines 2018 and selected DM patients. Sample was characterized and analysed for predictors of CV events (CVe). CVe - ischaemic stroke (IS), acute coronary syndrome (ACS), acute heart failure (if hospitalized - AHF), peripheral arterial disease (PAD). Follow-up finished with event, the last evaluation of the patient or death. Statistical significance was assumed if p < 0.05.

Results:

Sample - 268 RH patients - 119 DM patients (80 males, 39 females). Age - 62.5 + /- 9.9 years (mean + /- SD), Follow-up - 5.1  + /- 4.6 years. Dyslipidaemia - 79.8%, obesity - 58.0%, Chronic Kidney Disease (CKD) - 36.1%, history of previous CVe – 47.9% (PCVe). CVe observed - 32 (8 IS, 10 ACS, 9 AHF, 5 PAD). 4 death from non-CVe. When the sample was analysed events vs no-event, those with event had higher creatinine, history of PCVe and CKD. In Univariate Cox analysis for the prognosis of future CVe, it was significant: age, PCVe, creatinine and 24 h Diastolic Blood Pressure (24DBP) (Table 1). In a multivariate Cox Analysis with the variables: age, gender, PCVe, glycaemia, creatinine, CKD and its staging, statistical significance was age, creatinine, CKD and its staging. Glycaemia was almost significant (Table 1). In Kaplan-Meier survival curve free of events, PCVe, CKD and CKD staging revealed worst survival prognosis (respectively log rank 7.85, p < 0.05; 7.72, p = 0.000; 49.5, p = 0.000). We analysed the CKD subgroup and verified that those with CKD were older, lower body mass index, less 24DBP and night-time blood pressure.

Conclusions:

In our diabetic RH population, CKD, elevated creatinine, increasing age and PCVe were independently associated with increasing incidence of CVe. It seems that our action in these patients should aim to stricter control in order to retard the progression of CKD, despite attention in glycaemic control.