bluuebunny/crossref_metadata_2025 huggingface dataset:
THE ROLE OF URINARY EXOSOMAL SODIUM CHLORIDE COTRANSPORTER IN SUBTYPING PRIMARY ALDOSTERONISM
Authors: Kong Linghui , Tang Xiaofeng , Kang Yuanyuan , Dong Lei , Tong Jianhua , Xu Jianzhong , Wang Ji-Guang , Shen Weili , Zhu Limin
Published: June 2022

Objective:

Adrenal venous sampling (AVS) is recognized as the gold standard for subtyping primary aldosteronism (PA), but its invasive nature and technical challenges limit its availability. A recent study reported that sodium chloride cotransporter (NCC) in urinary exosomes is a promising marker for assessing the biological activity of aldosterone and can be treated as a potential biomarker of PA. The current study was conducted to verify the hypothesis that the expression of NCC and its phosphorylated form (pNCC) in urinary exosomes are different in various subtypes and genotypes of PA and can be used to select AVS candidates.

Design and method:

A total of 27 patients with PA were enrolled in the study.Patients with LI > = 4 and < 4 were classified into high LI (hLI) and low LI (lLI) groups, respectively. Urinary exosomes were isolated from spot urine samples using ultracentrifugation. NCC and pNCC expressions were tested in patients diagnosed with PA who underwent AVS. Sanger sequencing of KCNJ5 was performed on DNA extracted from adrenal adenoma.

Results:

Compared with the lLI group, the hLI group had higher levels of 24 h urinary aldosterone (28.6 ± 11.8 vs 14.9 ± 4.6, P = 0.0002) and supine PAC (314 ± 115 vs 163 ± 53, P < 0.0001) on admission (Table 1). In addition, the pre-saline infusion test (pre-SIT) supine PAC (after correction of hypokalemia) in the hLI group was higher than that in the lLI group (342 ± 172 vs 224 ± 59, P = 0.0141). pNCC was more abundant in the urinary exosomes in the high lateralization index (hLI, > = 4) group (1.64 folds, P = 0.0080) than in the low LI (lLI, < 4) group (Figure 1). Carriers of the somatic KCNJ5 mutations, compared with non-carriers, had more abundant pNCC expression in urinary exosomes (1.99 folds, P = 0.0399) (Figure 2).

Conclusions:

The expression of pNCC in urinary exosomes in patients with PA with various subtypes and genotypes was different. They can be used as biomarkers of AVS for PA subtyping.
INTEREST OF MEASURING THE INTIMA MEDIA THICKNESS IN THE EVALUATION OF HYPERTENSIVE
Authors: Ouail Djamel Eddine , Tebbani Meriem , Bouali Fayçal
Published: June 2022

Objective:

The measurement of the Intima Media Thickness (IMT) allows the diagnosis of the early stages of atherothrombosis. There is a direct correlation between the intima media thickness and CVRF in particular hypertension.

The objective of our study is to describe the profile of IMT in hypertensive patients and to analyze the correlations with subclinical damage to target organs.

Design and method:

Descriptive and analytical prospective study of a cohort of asymptomatic hypertensive patients aged over 35 received in consultation. All the patients had benefited from a measurement of the intima media thickness. An intima-media thickness > 0.9 mm is considered pathological.

At the same time, patients benefit from a systematic assessment in search of other target organ damage, namely cardiac, neurological, renal and ophthalmological damage.

Results:

252 patients included in our work, it is 146 women or 58%. The average age of our series is 59.5 years.

The EIM is pathological in 34.9% of patients.

In multivariate analysis, the two independent factors associated with pathological ADR are age > 55 years and smoking.

Chi-square correlation analysis shows us a highly significant correlation between pathological IMT and LVH on ultrasound, carotid plaques and stenosing plaques, and urinary albumin excretion and kidney disease chronic.

Intima Media thickness values are positively correlated with indexed left ventricular mass values (pearson 0.190**, p = 0.004), pulse pressure values (pearson = 0.226**[0.123, 0.344] p = 0.000), to the values of the Sokolow index (0.145*[0.032, 0.261] p = 0.029) and to the values of proteinuria and particularly to microalbuminuria (0.187**[0.013, 0.369] p = 0.008) The values of the media intima thickness are negatively correlated with MDRD clearance values (-0.140* [-0.250, -0.019] p = 0.037)

Conclusions:

Carotid intima media thickness is an excellent screening test for target organ damage in hypertensive patients. It is a simple and non-invasive measure, it reflects early lesions of atherosclerosis. Our study clearly shows the strong correlation between the values of the intima media thickness and the values of all the screening tests for target organ damage.
WHAT ARE THE FACTORS ASSOCIATED WITH UNCONTROLLED BLOOD PRESSURE IN BRAZILIAN HYPERTENSIVE PATIENTS?
Authors: De Paula Araujo Thayza , Borges Lucas Gabriel S. , Barroso Weimar K. Sebba , Batista Sandro Rodrigues , Vitorino Priscila V.O.
Published: June 2022

Objective:

Uncontrolled arterial hypertension (AH) is defined by BP > or = 140/90 mmHg. It has a high prevalence, is associated with the causes of pseudoresistance and is related to several complications and negative health outcomes. Thus, the objective of this study was to investigate the factors associated with the lack of blood pressure control in hypertensive Brazilians treated in public and private services.

Design and method:

Cross-sectional, analytical, multicenter and national study, carried out with hypertensive adults and elderly individuals, followed by 45 outpatient clinics, included from September 2013 to October 2015 and submitted to interview, clinical and anthropometric evaluation. The outcome variable was uncontrolled pressure (BP > or = 140mmHg systolic and/or > or = 90 mmHg diastolic). Simple and multiple logistic regression analysis was performed.

Results:

A total of 2,643 participants with a mean age of 61.6 (11.9), 55.7% female and 46.4% with uncontrolled BP were evaluated. Uncontrolled BP was associated: age over 60 years (OR: 1.31 [1.11 - 1.55]); practice of irregular physical activity (OR: 1.28 [1.06 - 1.55]); attending the emergency room for hypertensive crises in the last six months (OR: 1.80 [1.46 - 2.22]); increase in body mass index (OR: 1.02 [1.01 - 1.04]); low adherence to drug treatment (OR: 1.22 [1.04 - 1.44]) and menopause (OR: 1.36 [1.07 - 1.72]). The following were negatively associated: fruit consumption (OR: 0.90 [0.85 - 0.94]); presence of dyslipidemia (OR: 0.75 [0.64 - 0.89]), acute myocardial infarction (OR: 0.59 [0.46 - 0.76]) and peripheral arterial disease (OR: 0.52 [0.34 - 0.78]).

Conclusions:

Factors associated with non-BP control were: advanced age, increased body mass index, practice of irregular physical activities, need for emergency care and low adherence to pharmacological treatment and protective factors: presence of acute myocardial infarction and peripheral arterial disease, and higher daily fruit intake.
ANTIHYPERTENSIVE TREATMENT PRESCRIBING BEHAVIOURS IN FRENCH GENERAL PRACTICE IN 2021
Authors: Mourad Jean Jacques , Jamet Philippine , Huguet Michael , Bourbia Sami , Hubert Sidonie , Azria Philippe , Ferreira Emmanuel , Antakly Yara
Published: June 2022

Objective:

Hypertension (HT) is the leading reason for visits to general practitioners (GPs). Due to insufficient adherence and marked therapeutic inertia, there is room for improving blood pressure control in France. The objective of this study is to describe the antihypertensive treatment prescribing behaviours in French general practice.

Design and method:

Data from the IQVIA Longitudinal Patient Database (LPD) France were used. LPD France is a permanent observatory to which a nationally representative panel of physicians – including GPs (n=1200) – contribute anonymised electronic medical records (EMR). The analysis included all antihypertensive treatment prescriptions from July 2020 to June 2021, which were then extrapolated to the entire population. The following definitions were used to categorise the prescribing behaviours: INITIATION - for hypertensive patients already registered with the GP and who had been prescribed an antihypertensive treatment for the first time in 24 months; RENEWAL - for hypertensive patients whose therapeutic class had not changed, apart from dosage modifications, changes of molecule within the same class and titrations; CHANGE - for hypertensive patients for whom a therapeutic class had been added, withdrawn, and/or changed.

Results:

In 2021, a total of 11 557 545 hypertensive patients had received an antihypertensive treatment prescription following consultation with a GP. These were distributed as follows:

Conclusions:

These findings provide informative data on the prescribing behaviours of GPs, primarily marked by a renewal rate that does not appear to reflect the reality of blood pressure control in France. Prescription modifications are in the minority, and essentially consist of class rotations. This observation requires urgent reflection when it comes to the training of prescribers and the value placed on blood pressure control under the French public health objectives pay-for-performance scheme.

*IQVIA EMR LPD Médecins Généralistes ‘. EMR = Electronic Medical Records, LPD = Longitudinal Patient Data
HYPERTENSION, THE MAIN RISK FACTOR FOR STROKE IN A UNIVERSITY HOSPITAL CENTER IN NORTHWEST ALGERIA
Authors: Abdrebbi Samira Benbekhti , Meguenni Kaouel
Published: June 2022

Objective:

High blood pressure is the most important risk factor associated with cerebrovascular accidents and one of the main risk factors associated with heart disease.

The objective of our study was to determine the place of arterial hypertension among the risk factors for stroke at the University Hospital Center of TLEMCEN.

Design and method:

Prospective descriptive study, on a sample of patients with stroke and admitted to the TLEMCEN University Hospital. A questionnaire was administered by interview to the patients. Data were entered and analyzed using Epi-info 6 software.

Results:

2/3 of patients with arterial hypertension were found out of a total of 205 stroke victims.

Arterial hypertension Hypertension is the main risk factor for stroke, ischemic or hemorrhagic. It occupies a prominent place in the personal medical history (63.40%), as well as the family history, found in 61.06% of patients. Other risk factors were: hypercholesterolemia, diabetes, heart disease and transient ischemic attack; with respectively 27.80%, 20.50%, 14.10% and 11.70%.

Arterial hypertension was frequent in the acute phase of the stroke and often proportional to the extent of the stroke.

Conclusions:

Screening and effective treatment of high blood pressure, the main risk factor for stroke, as well as the fight against other risk factors are essential elements of stroke prevention.
IDENTIFYING A METABOLOMICS PROFILE ASSOCIATED WITH MASKED HYPERTENSION IN TWO INDEPENDENT COHORTS: DATA FROM THE AFRICAN-PREDICT AND SABPA STUDIES
Authors: Strauss-Kruger Michél , Kruger Ruan , Vuren Esmé Jansen Van , Jacobs Adriaan , Louw Roan , Mels Carina
Published: June 2022

Objective:

Individuals with masked hypertension (MHT) have a greater risk of adverse cardiovascular outcomes compared to normotensives (NT). Exploring metabolomic differences between NT and MHT individuals may help provide a better understanding of the aetiology of MHT.

Design and method:

We analysed the data of N = 910 young apparently healthy participants (83% NT and 17% MHT) (mean age 24 ± 3 years) from the African-PREDICT and N = 210 older participants (63% NT and 37% MHT) from the SABPA (mean age 42 ± 9.6 years) studies. Clinic and ambulatory blood pressures (BPs) were used to define BP phenotypes. Urinary amino acids and acylcarnitines were measured using liquid chromatography time-of-flight mass spectrometry in the SABPA and liquid chromatography tandem mass spectrometry in the African-PREDICT studies.

Results:

Clinic and 24hr BPs were higher in MHT compared to NT adults (all p < 0.001). In the SABPA study, amino acids (leucine/isoleucine, valine, methionine and phenylalanine) and acylcarnitines (C0-, C3-, C4- and total acylcarnitines) were more abundant in MHT than NT adults. In the African-PREDICT study, only C0- and C5-carnitines were higher in MHT. When adjusting for waist circumference, all differences between NT and MHT individuals became non-significant for both studies (all q> 0.05). With unadjusted analyses in NT adults from the SABPA study, 24hr SBP correlated positively with only C3-carnitine. Conversely in MHT, positive correlations of 24hr SBP with leucine/isoleucine, valine, methionine, phenylalanine, C0- and C3-carnitine were evident (all p < 0.05). In the African-PREDICT study, 24hr SBP correlated positively with C0- (r = 0.101; p = 0.006) and C5-carnitine (r = 0.195; p < 0.001) in NT adults, and C5-carrnitine in MHT (r = 0.169; p = 0.034).

Conclusions:

Using two independent cohorts, we demonstrated significant differences between the metabolomic profiles of NT and MHT adults, which may reflect different stages in the alteration of branched-chain amino acid (BCAA) metabolism early on and later in life. These changes in BCAA metabolism are also likely modulated by central adiposity.
EFFECT OF A COMBINATION OF POLYMORPHIC VARIANTS OF THE PPARG2 (PRO12ALA), ADRB2 (GLN27GLU), ADRB2 (AGR16GLY), ADRB3 (TRP64AGR), AND FABP2 (THR54ALA) GENES AND THE RISK OF ARTERIAL
Authors: Komir Iryna , Isayeva Ganna
Published: June 2022

Objective:

To establish the relationship between different combinations of polymorphic variants of PPARG2 (Pro12Ala), ADRB2 (Gln27Glu), ADRB2 (Agr16Gly), ADRB3 (Trp64Agr), and FABP2 (Thr54Ala) genes and hypertension

Design and method:

191 adults (33.1% of men and 66.9% of women), mean age (52.7 ± 10.8) years with hypertension were examined. Blood pressure was measured according to the guidelines for the management of patients with hypertension of the European Society of Cardiology (2018). Conducted daily monitoring of blood pressure. Determination of polymorphisms in the genes PPARG2 (Pro12Ala), ADRB2 (Gln27Glu), ADRB2 (Agr16Gly), ADRB3 (Trp64Agr), and FABP2 (Thr54Ala) of the PPARG2 (Pro12Ala) receptor by the method of real-time polymerase chain reaction polymerase chain reaction. Statistical processing of the obtained data was performed using the statistical package SPSS 17 (IBM)

Results:

In the study population, target blood pressure reduction was observed in 63% of patients after 12 months of follow-up. Patients with controlled arterial hypertension (60.7%) predominated in the group of those who reached the target blood pressure values, while patients with overt hypertension (42.9%) predominated in the group with those who did not reach the target blood pressure values. Patients were divided into groups depending on the phenotype of hypertension. The odds ratio for hypertension was found to be 1.11 for PPARG2 (CC vs CG+GG); 1.32 for ADRB2 (CG vs CC+CG); 1.05 for ADRB2 (AG vs. AA+AG); 2.0 for ADRB3 (TT vs. CC) and 1.33 for FABP2 (GG vs. AG+AA) (95% confidence interval). The odds ratio of the combination of the polymorphic CC variant of the ADRB3 gene (Trp64Agr) and the AA variant of the ADRB2 gene (Agr16Gly) in groups with overt AH was 2.33. Other combinations of genes and their polymorphic variants did not provide a reliable diagnostic criterion for the relationship with arterial hypertension phenotypes

Conclusions:

The combination of the CC variant of the ADRB3 gene (Trp64Agr) and the AA variant of the ADRB2 gene (Agr16Gly) is a reliable marker of overt arterial hypertension
SPONTANEOUSLY HYPERTENSIVE RATS EXHIBIT ENHANCED CARDIAC CONNEXIN-43 AND REDUCED PRO-FIBROTIC MARKERS IN RESPONSE TO COLD ACCLIMATION
Authors: Andelova Katarina , Bacova Barbara Szeiffova , Sykora Matus , Pavelka Stanislav , Pravenec Michal , Tribulova Narcis
Published: June 2022

Objective:

We have previously shown that down-regulation of myocardial gap junction channel protein, connexin-43 (Cx43), and up-regulation of extracellular matrix (ECM) proteins in hearts of spontaneously hypertensive rats (SHR) promote occurrence of lethal arrhythmia. Cold acclimation has a potential for reducing cardiovascular risk, especially in setting of various pathological conditions, but there is a gap of knowledge concern the heart response to adaptive thermogenesis. The purpose of the study is to explore myocardial Cx43 and ECM proteins in genetically hairless strain of SHR (SHRM) that represents rewarding model of increased adaptive thermogenesis.

Design and method:

Adult hairless males and females SHRM strain that harbors mutated desmoglein-4 gene and their wild type SHR were housed at standard 22 C (that is below thermo-neutrality for these animals) and 12:12 hour light: dark cycle. WKY control rats were used as reference normotensive strain. Heart samples of the left ventricular tissue from euthanatized rats were used for the proteomics of Cx43, protein kinases, which phosphorylates Cx43, and for ECM markers TGF-, SMAD2/3, MMP-2, collagen-1. Immunofluorescence detection of Cx43 was performed to examine its myocardial topology.

Results:

Cx43 protein and its phosphorylated status was reduced in males and females SHR vs WKY rat hearts. In contrast, adaptive thermogenesis resulted in increased both parameters in SHRM regardless the sex. Moreover, pathological topology of Cx43 attributed to its enhanced localization at lateral sides of the cardiomyocytes in SHR was attenuated in SHRM. In addition, there were gentle differences in protein levels of PKA, PKG, PKC, MAPK, Akt between SHR and SHRM. Protein level of TGF- and SMAD 2/3 were increased in SHR compare to WKY rat hearts but decreased in SHRM unlike collagen-1 that was not altered in SHRM compare to SHR.

Conclusions:

Findings revealed beneficial up-regulation of myocardial Cx43 along with down-regulation of extracellular matrix proteins in response of hairless SHR to increased thermogenesis.
DIFFERENT APPROACHES FOR THE ASSESSMENT OF LEFT ATRIAL VOLUME IN A LARGE SAMPLE OF PATIENTS UNDERGOING AN ECHOCARDIOGRAM FOR CARDIOVASCULAR RISK STRATIFICATION
Authors: Paini Anna , Aggiusti Carlo , Bertacchini Fabio , Stassaldi Deborah , Capellini Sara , Arnoldi Chiara , Caletti Stefano , Cannata Marco , Gatta Roberto , Muiesan Maria Lorenza , Salvetti Massimo
Published: June 2022

Objective:

Left atrial (LA) enlargement (LAE) is associated to an increased risk of cardiovascular complications, and in particular of atrial fibrillation. When LA size is measured by echocardiography, LA volume measurement is preferred over linear measurements. In fact, the strength of the relationship between cardiovascular diseases is stronger for LA volume than for LA linear dimensions. Recently it has been proposed a new method (LAV_e) to estimate LA volume in order to provide a surrogate of biplane LA volume when direct measurement is not available.

The aim of our study was to evaluate the correlation between LA volume assessed by the biplane method(LAV_bip) and LA volume estimated by the linear measurements(LAV_e) and to assess the prevalence of LA enlargement in a large sample of patients undergoing an echocardiogram for cardiovascular risk stratification at an ESH excellence centre in Italy.

Design and method:

4941 subjects undergoing a diagnostic work-up for arterial hypertension (known or suspect) were analysed. LAV_bip was assessed as by the area-length method using the apical 4-chamber and 2-chamber views and LAV_e was calculated according to the formula: 2.323*(LA parasternal linear diameter2.071). LAV was indexed to height2.

Results:

Mean age was 56 ± 16 years, BMI 26 ± 5, 43% of subjects had normal weight, 39% overweight, 18% obese, 54% males, 84 % were hypertensives.Mean LAV_bip was 46.2 ± 18.4 and LAV_e was 35.4 ± 11.6 ml. Mean LAV_bip/h2 was 16.2 ± 6.3 and LAV_e/h2 was 12.4 ± 4.1 ml/h2. The correlation coefficients between the two variables were respectively 0.62 and 0.60 (p < 0.0001). Bland & Altman analysis showed a progressive increase in discrepancy between the two measures with increasing LAV_bip. The prevalence of LA enlargement was 32% with the biplane method and 10 % with the elliptical estimation.

Conclusions:

In a large sample of subjects undergoing a diagnostic work-up for arterial hypertension we observed a possible underestimation of LAV and a lower prevalence of left atrial enlargement when the elliptical approach is used. These results, if confirmed in other populations, suggest that direct measurement of left atrial volume should be preferred, if available.
ANALYSIS OF THE VENTRICULAR-ARTERIAL COUPLING DERIVED FROM PROXIMAL AORTIC STIFFNESS: IMPACT ON AEROBIC CAPACITY ACROSS THE HEART FAILURE SPECTRUM
Authors: Pugliese Nicola Riccardo , Balletti Alessio , Armenia Silvia , Biase Nicolo De , Faita Francesco , Mengozzi Alessandro , Paneni Francesco , Ruschitzka Frank , Virdis Agostino , Ghiadoni Lorenzo , Taddei Stefano , Williams Bryan , Antonini-Canterin Francesco , Masi Stefano
Published: June 2022

Objective:

Ventricular-arterial coupling (VAC) can be evaluated as the ratio between arterial stiffness (pulse wave velocity, PWV) and myocardial deformation (global longitudinal strain, GLS). We aimed at evaluating VAC across the spectrum of heart failure (HF).

Design and method:

We introduced a Doppler-derived, single-beat technique to estimate aortic arch PWV (aa-PWV) in addition to tonometry-derived carotid-femoral PWV (cf-PWV). We measured PWVs and GLS in 155 healthy controls, 75 subjects at risk of developing HF (American College of Cardiology/American Heart Association Stage A-B) and 236 patients in HF Stage C with preserved (HFpEF, n = 104) or reduced ejection fraction (HFrEF, n = 132). We evaluated peak oxygen consumption (VO2) and peripheral extraction (AVO2diff) using combined cardiopulmonary-echocardiography exercise stress.

Results:

aa-PWV was obtainable in all subjects and significantly lower than cf-PWV in all subgroups (p < 0.01). PWVs were directly related and increased with age (all p < 0.0001). cf-PWV/GLS was similarly compromised in HFrEF (1.08 ± 0.36) and HFpEF (1.05 ± 0.22), while aa-PWV/GLS was more impaired in HFpEF (0.69 ± 0.11) than HFrEF (0.60 ± 0.15; p < 0.01). Stage A-B had values of cf-PWV/GLS and aa-PWV/GLS (0.66 ± 0.25 and 0.47 ± 0.12) higher than controls (0.47 ± 0.10 and 0.40 ± 0.10) but lower than Stage C (all p < 0.01). Peak AVO2diff was inversely related with cf-PWV/GLS and aa-PWV/GLS (all p < 0.01). cf-PWV/GLS and aa-PWV/GLS independently predicted peak VO2 in the overall population (adjusted R2 = 0.32 and 0.35; all p < 0.0001) but only aa-PWV/GLS was independently associated with flow reserve during exercise (R2 = 0.51; p < 0.0001).

Conclusions:

Abnormal VAC is directly correlated with greater severity of HF and worse functional capacity. HFpEF shows a worse VAC than HFrEF when expressed by aa-PWV/GLS.
LEFT ATRIAL VOLUME INDEX (LAVI) AS A PREDICTOR OF PAROXYSMAL ATRIAL FIBRILLATION IN PATIENTS WITH RESISTANT ARTERIAL HYPERTENSION
Authors: Kocianova Eva , Kamasova Monika , Hanajikova Barbora , Jelinek Libor , Obrova Jana , Kvapil Tomas , Taborsky Milos
Published: June 2022

Objective:

Heart damage in hypertension occurs at three stages, a compensatory, reversible subclinical and irreversible clinical phase. Atrial fibrillation appears in the third phase, but we can find echocardiographic signs pointing to it in the subclinical phase. Although cardioembolic stroke is a feared cardiovascular complication with a possible life-long impact on a patient’s health, silent atrial fibrillation is not routinely screened in patients with advanced hypertension. The aim of the work was to assess the relationship of left atrial dilation and silent atrial fibrillation in patients with resistant arterial hypertension.

Design and method:

Data were collected in 211 patients with arterial hypertension treated with at least three combinations of antihypertensives with no prior history of atrial fibrillation. The first 109 patients with paroxysmal atrial fibrillation detected at 24-hour monitoring were assigned 102 age-appropriate controls with normal ECG Holter. Transthoracic echocardiography was performed on all patients, comparing baseline parameters of systolic and diastolic function - ejection fraction (EF), E/A velocity ratio, E/e motion velocity ratio, LAVI and peak tricuspid regurgitation gradient (PPG TR).

Results:

Patients with arterial hypertension and newly captured paroxysmal atrial fibrillation had a significantly higher E wave height (p = 0.005), a higher E/A ratio (p = 0.0004), a comparable E/e’ (p = 0.21), a higher PPG TR (p = 0.045) and a significantly greater left atrial indexed volume-LAVI (36.1 ± 10.3 vs 31.0 ± 9.6, p = 0.0002).

Conclusions:

Patients with resistant arterial hypertension and paroxysmal atrial fibrilation have significantly higher indexed left atrial volume. Patients with increased LAVI may benefit from performing extended cardiac rhythm monitoring in the prevention of cardioembolic events.
MICRO- AND MACROVASCULAR ALTERATIONS IN RHEUMATOID ARTHRITIS COMPARED TO TYPE 2 DIABETES MELLITUS: EVIDENCE OF SIMILAR DEGREE OF ORGAN DAMAGE
Authors: Anyfanti Panagiota , Nikolaidou Barbara , Gavriilaki Eleni , Triantafyllou Areti , Lazaridis Antonios , Dolgyras Panagiotis , Dimitriadou Antonia , Douma Stella , Gkaliagkousi Eugenia
Published: June 2022

Objective:

Rheumatoid arthritis (RA) is characterized by excess cardiovascular risk attributed to the chronic inflammatory load in combination with the accumulation of traditional cardiovascular risk factors. RA is being currently perceived as a cardiovascular risk factor equivalent to type 2 diabetes mellitus (DM2), although recent relevant studies have provided conflicting results. The aim of the present study was to compare markers of micro- and macrovascular dysfunction between patients with relatively well-controlled RA and patients with DM2.

Design and method:

Patients with RA who presented low levels of systemic inflammation and patients with DM2, who were free from cardiovascular comorbidities including hypertension, were studied. A control group that comprised of healthy volunteers was additionally included. All participants underwent applanation tonometry (Sphygmocor device) to assess a) carotid-femoral pulse wave velocity (PWV), b) augmentation index corrected for 75 bpm (AIx@75), c) central systolic/diastolic blood pressure (cSBP/cDBP) as markers of large artery stiffening. Subendocardial viability ratio (SEVR) or Buckberg index was measured with the same device as a functional marker of microvascular myocardial perfusion. In addition, carotid ultrasound was applied to evaluate a) carotid intima-media thickness (cIMT), as a marker of systemic atherosclerosis, and b) beta-stiffness index, as a marker of local stiffness in the carotid arteries.

Results:

We studied 31 patients with RA at remission or low disease activity, 32 patients with DM2 and 69 controls matched for age and office blood pressure. Significant differences were observed in several outcomes of the study between patients and controls; by contrast, none of the studied parameters (PWV, AIx@75, cSBP/cDBP, cIMT, beta-stiffness index, and SEVR) significantly differed between patients with RA and patients with DM2 (Table 1).

Conclusions:

Patients with RA present impaired markers of micro- and macrovascular dysfunction, even in the absence of cardiovascular comorbidities including hypertension and whilst at remission or low disease activity. Moreover, the degree of divergent micro- and macrovascular alterations in this well-characterized group of RA patients appears comparable to that associated with DM2. These findings are line with the widely held perception that RA should be regarded as a novel cardiovascular risk factor equivalent to DM2.
HERA3 STUDY: CAN PRESSURE-FLOW MEASUREMENTS AND COMPUTATIONAL FLOW SIMULATIONS GUIDE US WHEN TO TREAT RENAL ARTERY STENOSIS?
Authors: Van De Velde Lennart , Collard Didier , Verberne Hein , Lamers Armand , Zijlstra Ijsbrand , Vogt Liffert , van den Born Bert-Jan
Published: June 2022

Objective:

To stent or not to stent remains a difficult decision in patients with renal artery stenosis (RAS). Up to date, no diagnostic test that reliably identifies patients that will benefit from endovascular intervention has been established. Our goal is to develop and validate an image-based flow simulation method for predicting blood pressure improvement after renal arterial revascularization.

Design and method:

In total 30 patients scheduled for percutaneous renal transluminal angioplasty (PTRA) for atherosclerotic RAS or fibromuscular dysplasia RAS will be included in the HERA-3 study. Baseline imaging consists of computed tomography angiography (CTA). Before and after PTRA duplex ultrasound, renography and 24-h ambulatory blood pressure (ABPM) measurements are obtained. Based on the pre-operative CTA and duplex-imaging, personalized flow simulations are performed using computational fluid dynamics (CFD). During PTRA, pressure-flow measurements are obtained with a 0.014” Combowire (Philips-Volcano) before and after intrarenal dopamine administration. A non-invasive renal fractional flow reserve (rFFR) –the pressure gradient during vasodilation- is derived from the CFD simulation and compared to the invasively measured rFFR for validation. In addition, the renal flow reserve (RFR) -the relative increase in flow during vasodilation relative to resting condition- is obtained.

Results:

Twelve patients have been included in the study so far. Preliminary results show an encouraging agreement between the CFD-based and invasively measured rFFR. Second, in select cases with an anatomically moderate RAS (65% diameter reduction), a low RFR was found before PTRA, which markedly increased after PTRA. This suggests that a subset of RAS lesions cause a stronger flow impediment than can be expected on anatomic lesion grading.

Conclusions:

In patients with RAS, it is feasible to obtain the functional flow metrics rFFR and RFR during angiography. Second, preliminary data suggest that the rFFR can be non-invasively estimated using computational flow analysis based on CTA and ultrasound imaging. Future analysis can establish the predictive value of these metrics for predicting blood pressure improvement after PTRAS.
RENAL MICROPERFUSION RESPONSE TO A COLD PRESSURE TEST IS DECREASED IN HYPERTENSIVE PATIENTS
Authors: Hendriks-Balk Mariëlle , Damianaki Aikaterini , Polychronopoulou Erietta , Brito Wendy , Pruijm Menno , Wuerzner Grégoire
Published: June 2022

Objective:

Microcirculation is essential to supply oxygen and nutriments to tissue. Alteration in the microcirculation is often proposed as a mechanistic link between hypertension and target organ damage. The recent developments in contrast-enhanced ultrasonography (CEUS) have enable the quantification of renal microcirculation. The objective of this study was to compare the microcirculatory response during a cold pressure test (CPT) in hypertensive (HT) patients with those in healthy normotensive (NT) participants.

Design and method:

This was a prospective case-control study. Hypertensive (HT) and normotensive (NT) participants underwent two separate CPT of 2 minutes. Doppler ultrasound was used to measure renal resistive index (RRI) and CEUS to measure the perfusion index (PI) as a proxy of renal tissue microcirculation. Renal Doppler and CEUS were performed before and during the CPT. We compared baseline measures and responses to CPT of HT and NT groups using a Wilcoxon test.

Results:

Sixteen hypertensive and nineteen normotensive male participants were included. HT participants were older and had higher blood pressure and body mass index. Baseline RRI was similar in both group, but HT had lower PI (median with interquartile range): 1083 U(447–1476) vs 1772 U(1295–2557), p = 0.016. The CPT decreased the RRI in NT and increased the RRI in HT, resulting in a different CPT response -0.026 [CI -0.045; -0.008, p = 0.006]. The CPT increased the PI in both groups but the response was blunted in HT patients - 755U ± 518, (p = 0.01).

Conclusions:

Compared to healthy participants, hypertensive patients show a paradoxal RRI response and a lower increase in perfusion index during CPT suggesting that microcirculation and possibly renal autoregulation is altered. This is the first demonstration showing that CEUS enables the detection of microcirculatory differences between healthy participants and hypertensive patients.
CAROTID ELASTICITY IS IMPAIRED IN STAGE 1 HYPERTENSIVE PATIENTS EVEN IF BLOOD PRESSURE IS WELL CONTROLLED BY TREATMENT
Authors: Saladini Francesca , Rattazzi Marcello , Faggin Elisabetta , Palatini Paolo , Puato Massimo
Published: June 2022

Objective:

Whether impaired arterial elasticity in stage 1 hypertension can be brought back to normal by antihypertensive treatment is unknown. Aim of this study was to evaluate the impact of long-term well-controlled blood pressure (BP) on carotid artery elasticity and endothelial function in stage 1 hypertensive patients at low cardiovascular risk.

Design and method:

We studied 40 middle-age hypertensives whose BP had been kept at target by pharmacological treatment and/or lifestyle modifications for a mean of 7.5 years. Carotid compliance coefficient (CC) and distensibility coefficient (DC) were measured by B-mode ultrasound system. Measurement of carotid intima-media thickness (IMT) was performed in each carotid artery segment, bilaterally. Endothelial function was evaluated by post-occlusion flow mediated dilation (FMD). hs-CRP and osteoprotegerin were measured as markers of inflammation. Forty normotensive subjects matched for age and sex served as controls.

Results:

In the hypertensive subjects, BP levels were well controlled throughout the study period (mean office BP 133.7 ± 9.0/81.2 ± 7.0 mmHg; mean 24 hours BP was 124.2 ± 10.4/78.2 ± 7.5 mmHg). However, compared to controls, significantly higher office BP levels and waist circumference were present. Compared to normotensives, carotid elasticity (DC 24.5 ± 9.0 vs 37.0 ± 8.5 10–3/kPa, and CC 0.92 ± 0.34 vs 1.28 ± 0.36 mm2/kPa, p < 0.0005 for both) as well as endothelial function (FMD 5.7 ± 2.4% vs 9.2 ± 2.9%, p < 0.0005) were significantly impaired in hypertensives. Moreover, hs-CRP and osteoprotegerin were higher in HT than in NT (1.41 ± 1.07 vs 0.97 ± 0.65 mg/L, p = 0.030; 1246 ± 560 vs 936 ± 148 pg/ml p = 0.001). In a logistic regression, hypertensive status was a significant predictor of local carotid vascular stiffness (DC < 30 10–3/kPa) with an odds ratio of 14.98 (95%CI, 2.60–18.55) p < 0.0005 for crude data; when data were adjusted for age, FMD, OPG, and BMI, the odds ratio only slightly decreased (13.04 (2.27–74.96), p = 0.004). Hypertensive status remained a significant predictor also after the adjustment for systolic, diastolic, mean BP.

Conclusions:

Despite the “pseudo-normalization’’ of BP levels, hypertensive patients with long term well-controlled BP according to current standards exhibited increased local arterial stiffness, endothelial dysfunction and increased markers of inflammation. Whether an earlier and more aggressive intervention could be useful to reduce arterial stiffening and improve endothelial function in hypertension should be explored.
OUTCOME-BASED THRESHOLD FOR CAROTID-FEMORAL PULSE WAVE VELOCITY: THE IDCARS STUDY
Authors: An Dewei , Cheng Yi-Bang , Aparicio Lucas S. , Thijs Lutgarde , Huang Qi-Fang , Wei Fang-Fei , Barochiner Jessica , Sheng Chang-Sheng , Yang Wen-Yi , Niiranen Teemu J. , Boggia José , Stolarz-Skrzypek Katarzyna , Gilis-Malinowska Natasza , Tikhonoff Valérie , Wojciechowska Wiktoria , Casiglia Edoardo , Narkiewicz Krzysztof , Filipovský Jan , Kawecka-Jaszcz Kalina , Wang Ji-Guang , Li Yan , Staessen Jan A.
Published: June 2022

Objective:

Guidelines recommend a > 10m/s threshold of carotid-femoral pulse wave velocity (cf-PWV) to detect hypertension mediated organ damage. However, the > 10m/s threshold was derived from the cf-PWV distribution across cross-sectional studies with limited contribution of prospective cohort studies. Using data from the International Database of Central Arterial Properties for Risk Stratification (IDCARS), we aimed to determine an outcome-based threshold for cf-PWV.

Design and method:

Adults (> = 18 years) recruited by eight IDCARS centres and followed up for 6 months or longer qualified for inclusion in the current subject-level meta-analysis. Cf PWV was measured using the Sphygmocor device (Itasca, IL). Pulse transit distance was determined by subtracting the distance between the carotid sampling site and the suprasternal notch from the distance between the carotid and femoral sample sites. The primary endpoint consisted of fatal and nonfatal cardiovascular events. Total and cardiovascular mortality and fatal and nonfatal coronary events were secondary endpoints. The cf-PWV threshold was determined by multivariable Cox regression with average risk based on established risk factors in the whole cohort as reference.

Results:

After 5.0 years of follow-up (median), of 3494 participants (mean age: 52.2 years; women: 55.3%; mean cf-PWV: 7.8 m/s), 156 (4.5%) experienced the primary endpoint, and 104 (3.0%) died, 25 (0.7%) of cardiovascular disease and 77 (2.2%) had a coronary event. After whole adjusting for sex, age, systolic blood pressure, heart rate and other cardiovascular risk factors, the outcome-driven cf-PWV thresholds were 8.6, 9.1, 8.7 and 8.6 m/s for a composite cardiovascular endpoint, all-cause and cardiovascular mortality and a coronary event, respectively. A cf-PWV > = 9 m/s (n = 752, 21.5%), compared with slower velocities, had an increased risk of a composite cardiovascular endpoint (HR: 1.75; 95% CI: 1.20–2.54, P = 0.004).

Conclusions:

The outcome-based threshold of > = 9 m/s for cf-PWV, which was present in 20% of the IDCARS participants, is close to the cut-off limit proposed by guidelines based on other approaches.
ARTERIAL HAEMODYNAMIC PARAMETERS LINKED TO ARTERIAL PULSATILITY, EXCESS WAVE PROPAGATION AND COGNITIVE FUNCTION
Authors: Jordan Andrew N. , Aizawa Kunihiko , Gooding Kim M. , Llewellyn David , Casanova Francesco , Mawson David M. , Gates Phillip E. , Adingupu Damilora D. , Elyas Salim , Hope Suzy V. , Strain W. David , Clark Chris E. , Bellenger Nicholas G. , Sharp Andrew S.P. , Parker Kim H. , Hughes Alun D. , Shore Angela C.
Published: June 2022

Objective:

Hypertension is associated with the development of cognitive impairment and dementia in an ageing population. Aortic stiffness and alterations in central artery haemodynamics could intensify the penetration of excess wave energy into the cerebral circulation, damaging the microvasculature in addition to age-associated vascular changes. We aimed to determine whether haemodynamic parameters linked to arterial pulsatility and excess wave propagation was associated with cognitive function in a sample of normotensive and hypertensive individuals.

Design and method:

We studied 35 treatment-naïve patients with stage II/III hypertension (HT: 63.8 ± 7.4yrs, 19F, SBP 175.6 ± 16.8 mmHg) and 35 age-, sex- and body mass index-matched normotensive individuals (NT: SBP 127.2 ± 8.2 mmHg). Indices of excess pressure including excess pressure integral (INTXSP) and peak excess pressure (MAXXSP) were obtained by radial artery tonometry. Aortic forward compression wave intensity (FCWI) and aortic pulse wave velocity (aPWV) were estimated as proposed by Hughes et al (Front Physiol. 2020). A battery of cognitive examination tests was administered including Addenbrooke’s Cognitive Examination-III (ACE), Mini-Mental State Examination (MMSE), Trail making test part A (TMT-A) and B (TMT-B).

Results:

Both INTXSP (9.2 ± 2.7 vs 5.4 ± 1.2 mmHg s) and MAXXSP (54.1 ± 12.8 vs 33.4 ± 5.9 mmHg) were significantly higher in HT compared to NT (p < 0.001). Additionally, FCWI [14.9 (12.0–20.0) vs 8.0 (6.8–9.3) x105 W/m2] and aPWV (7.2 ± 1.7 vs 4.5 ± 0.8 m/s) were significantly greater in HT compared with NT (p < 0.001). Higher INTXSP was associated with poorer ACE (rs = -0.310, p = 0.009), longer TMT-A (r = 0.409, p < 0.001) and TMT-B (r = 0.380, p = 0.001). Similarly, higher MAXXSP was associated with poorer ACE (rs = -0.343, p = 0.004), longer TMT-A (r = 0.397, p = 0.001) and TMT-B (r = 0.330, p = 0.006), and greater aPWV was associated with poorer ACE (rs = -0.331, p = 0.005), longer TMT-A (r = 0.397, p = 0.001) and TMT-B (r = 0.324, p = 0.007). Higher FCWI was associated with longer TMT-A (rs = 0.378, p = 0.002) and TMT-B (rs = 0.260, p = 0.038), and showed a trend to be associated with poorer ACE (rs = -0.238, p = 0.054). None of the haemodynamic indices was associated with MMSE.

Conclusions:

Haemodynamic parameters linked to excess arterial wave propagation are associated with poorer cognitive function. These observations reveal a potential mechanism linking hypertension and cognitive impairment, and reinforce the importance of blood pressure control to reduce cognitive impairment risk.
SALT-SENSITIVITY IN HEALTHY NORMOTENSIVE MEN IS ASSOCIATED WITH IMPAIRED BAROREFLEX SENSITIVITY
Authors: Oppelaar Jetta J. , Bouwmeester Thomas A. , Silova Anastasia A. , Collard Didier , Wouda Rosa D. , Rorije Nienke M.G. , Engberink Rik H.G. Olde , Van Den Born Bert-Jan H. , Vogt Liffert
Published: June 2022

Objective:

Blood pressure (BP) responses to Na+ intake show great variability, discriminating sodium sensitive (SS) from salt resistant (SR) individuals. The pathophysiology behind salt-sensitivity is still not fully elucidated. A pivotal role for the sympathetic nervous system to BP increase after sodium loading is suggested. Therefore, we aimed to investigate the effect of the sympathovagal balance on Na+-induced BP effects and if Na+-induced effects on sympathetic activation contribute to salt-sensitivity.

Design and method:

We performed a randomized cross-over study in 31 young healthy men with normal BMI and eGFR. Subjects followed both an 8-day low Na+ diet (LSD, < 50mmol/d) and high Na+ diet (HSD, > 200mmol/d), in 18 subjects the diets were extended to 14-days. SS was defined as an increase of three or more mmHg standardized measured office MAP after HSD. Cardiac-output (CO) and cross correlation baroreflex sensitivity (xBRS) were measured with continuous non-invasive finger photoplethysmography. Systemic vascular resistance (SVR) was calculated as the ratio of MAP by CO.

Results:

After HSD, SS men (19%) showed a mean 6.2 (±2.1 SD) mmHg increase in MAP. No absolute differences in Na+-induced effects on CO and SVR could be observed between groups. After HSD, xBRS was 34% lower in SS men compared to SR men (Fig1A). Sodium loading resulted in a mean xBRS decrease of 3.4 (±6.5 SD) ms/mmHg in SS men, whilst xBRS increased with 2.3 (±6.3 SD) ms/mmHg in SR men (p = 0.06). HSD xBRS values were significantly correlated with Na+-induced BP changes in the complete group when corrected for age and BMI (Fig1B).

Conclusions:

Salt-sensitivity of BP in young normotensive men seems to be predominantly driven by changes in sympathovagal balance. The significant correlation between xBRS and delta BP further suggests a continuous relation between sympathetovagal balance and salt exposure. Further studies are needed to unravel pathophysiological mechanisms underlying Na+-effects on sympathetic regulation.
EXERCISE AND AMBULATORY BLOOD PRESSURE: A SYSTEMATIC REVIEW OF RANDOMIZED CONTROLLED TRIALS WITH META-ANALYSIS
Authors: Decorte Elise , Dewilde Camille , Michielsen Matthijs , Smart Neil , Cornelissen Veronique
Published: June 2022

Objective:

Hypertension remains the biggest single contributor to the global burden of disease and to the global mortality rate. Lifestyle changes, including exercise therapy, are recommended in the prevention and treatment of high blood pressure (BP). To date, most randomized controlled trials (RCT’s) have evaluated the effect of exercise therapy on resting office blood pressure (BP). Data on the efficacy of exercise on ambulatory BP (AMBP), nowadays considered the gold standard measurement, remain scant. The current systematic review and meta-analysis aimed to summarize the effect of different exercise modalities on AMBP in individuals with a normal, high normal BP or hypertension.

Design and method:

This systematic review was conducted and reported according to the PRISMA-guidelines. A systematic literature search was conducted in three databases including only RTC’s involving exercise of at least 4 weeks in adults with a normal, high-normal BP or hypertension without concomitant diseases and published as a full-text in a peer-reviewed journal up to October 2021. Random effects models were used for analyses, with data reported as weighted means and 95% CI. We included 30 trials, including 36 study groups (n = 31 aerobic endurance exercise interventions, n = 4 resistance exercise interventions; n = 1 combined exercise intervention) randomizing a total of 1919 participants.

Results:

Analyses were performed with Comprehensive Meta-Analysis software (CMA 2.0). Aerobic endurance exercise significantly decreased 24 h AMBP (-2.8/-1.7 mmHg; p < 0.05); daytime AMBP (-3.6/-2.8mmHg; p < 0.001), nighttime ABMP (-1.6/-1.1; p < 0.05). Following resistance training, only a decrease in daytime systolic BP (-5.3 mmHg; p> 0.05) was observed without a statistically significant effect on daytime diastolic BP or nighttime BP (p > 0.05 for both).

Conclusions:

This meta-analysis confirms the BP lowering potential of exercise therapy in the management of BP. Daytime, nighttime and 24 h AMBP were significantly lower following an aerobic exercise intervention. The limited data available on resistance exercise warrants more research to confirm the resistance exercise as a sole exercise therapy to lower AMBP.
POSITIVE PULMONARY ARTERY REMODELING AFTER A SERIES OF BALLOON PULMONARY ANGIOPLASTIES IN A PATIENT WITH CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION
Authors: Yarovoy Sergey , Chazova Irina , Danilov Nikolay , Matchin Yuri
Published: June 2022

Objective:

To demonstrate positive pulmonary artery remodeling after balloon pulmonary angioplasty (BPA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH).

Design and method:

A 68-year old female was admitted to pulmonary hypertension department with swelling of the feet and legs, low level of arterial blood saturation (92%). She passed two episodes of pulmonary embolism – 7 and 5 years before the hospitalization. The patient was treated with anticoagulants (warfarin), diuretics (furosemide, spironolactone). Invasive pulmonary angiography confirmed thromboembolic lesions of pulmonary artery. Another types of pulmonary hypertension, except CTEPH, were excluded. Multidisciplinary commission considered her as inoperable due to obesity and anemia of unknown origin. But it was technically possible to perform BPA.

The patient underwent 5 sessions of BPA. Before and just after the first BPA and 3 months after the last BPA intravascular ultrasound (IVUS) of pulmonary arteries was performed.

Results:

According to the results of treatment the functional class improved in the patient (from 4 to 3), the distance in 6-minute walking test slightly increased (from 290 to 303 m), and the mean preassure in pulmonary artery decreased from 40 to 35 mm Hg. When assessing the size of the pulmonary arteries, underwent angioplasty, there were determined signs of positive remodeling (Table 1). According to invasive angiography the diameter of branches of the subsegmental arteries increased up to 14.3%. According to the results of IVUS, comparable results were obtained: 10% increase of the lumen diameter.

Conclusions:

successful series of BPA in patients with CTEPH can lead to the significant positive remodeling of pulmonary arteries.