bluuebunny/crossref_metadata_2025 huggingface dataset:
LINKING ARTERIAL STIFFNESS TO THE BIOLOGICAL PROFILE OF INFLAMMATION AND COAGULATION AT HYPERTENSIVE PATIENTS WITH OR WITHOUT METABOLIC SYNDROME
Authors: Gavrila Adrian
Published: April 2021

Objective:

The objective of the study was to estimate how the arterial stiffness (AS) correlates with pro-inflammatory and pro-thrombotic imbalances, at hypertensive patients (pts) with or without metabolic syndrome (MS).

Design and method:

50 hypertensive pts (mean age = 57.5 ± 9.6 years, 52% males) -group 1 and 50 hypertensive pts with MS, matched for age and sex (mean age = 59.4 ± 10.8 years, 54% males) -group 2. AS was evaluated by measuring carotid-femural pulse wave velocity (PWV) using SphygmoCor system. PWV greater than 10 m/s was considered abnormal. Inflammation profile was estimated by serum measurement of C reactive protein (CRP) and fibrinogen (F). Pro-thrombotic profile was determinate by serum measurement of von Willebrand factor (vWf), antithrombin III (AT III) and plasminogen activator inhibitor (PAI-1).

Results:

In group 1, 21 pts (42%) had increased PWV: 11.6 ± 0.2 m/s. In group 2, 23 pts (46%) had increased PWV: 12.4 ± 0.5 m/s. The difference is not significantly statistic between the two groups (p = 0.07). In group 1, increased PWV was significantly associated with higher level of CRP (2.17 ± 0.66 mg/L vs 7.23 ± 1.17 mg/L, p = 0.02). In group 2, increased PWV was found in a significantly higher proportion at pts with higher level of CRP (2.04 ± 0.75 mg/L vs 8.63 ± 1.16 mg/L, p = 0.004) and also with greater proportion of vWf (70.42 ± 23.78% vs 164.22 ± 29.83%, p = 0.001) and with higher level of PAI-1 (0.34 ± 0.18 u/mL vs 0.68 ± 0.21 u/mL, p = 0.04).

Conclusions:

Hypertensive pts with MS have increased PWV in a greater but not significant proportion than hypertensive pts without MS. Increased PWV at hypertensive pts seems to reflect a proinflammatory status. Moreover, increased PWV at hypertensive pts with MS appears to express both pro-inflammatory status and pro-thrombotic imbalance.
OXIDATIVE STRESS AND INFLAMMATION LEVELS ARE INCREASED IN OBESE SUBJECTS
Authors: Gaman Mihnea-Alexandr , Epingeac Mirela Elena , Diaconu Camelia Cristina , Gaman Amelia Maria
Published: April 2021

Objective:

The adipose tissue is involved in the generation of oxidative stress in obese subjects via production of adipokines which are a source of reactive oxygen species (ROS). Low-grade chronic inflammation and the depletion in antioxidants encountered in obese subjects are also involved in the crosstalk between oxidative stress and obesity. We aimed to evaluate oxidative stress levels and inflammation markers in 85 obese patients vs. 30 healthy, non-obese controls.

Design and method:

Oxidative stress was evaluated using a CR3000 analyzer via the FORT (Free Oxygen Radicals Testing for ROS quantification) and FORD (Free Oxygen Radical Defence for the measurement of antioxidant levels) assays from a single drop of capillary blood.

Results:

FORT values were increased and FORD values were decreased in obese patients vs. controls (Table 1). Fibrinogen levels were increased in obese patients vs. controls: 405.78 ± 36.11 mg/dL vs. 267.97 ± 36.64 mg/dL in controls, p-value < 0.0001. CRP levels were increased in obese patients vs. controls: 6.75 ± 0.79 mg/dL vs. 3.24 ± 0.58 mg/dL in controls, p-value < 0.0001. Serum ferritin levels were increased in obese patients vs. controls 321.30 ± 18.85 ng/mL vs. 158.60 ± 59.09 ng/mL in controls, p-value < 0.0001. We recorded positive weak correlations between FORT – CRP (r = 0.03) and FORT – ferritin (r = 0.03), very weak correlations between FORT – fibrinogen (r = 0.06). The correlation between FORD – fibrinogen was very weak and negative (r = -0.06).

Conclusions:

Oxidative stress and inflammation markers (fibrinogen, CRP, serum ferritin) were increased and antioxidant levels were decreased in obese subjects versus controls. Further studies are needed to investigate the crosstalk between obesity, oxidative stress and inflammation and to clarify to which extent these findings can be translated into the prevention and management of obesity.
EARLY AND MENOPAUSAL WEIGHT GAIN AND ITS RELATIONSHIP WITH THE DEVELOPMENT OF DIABETES AND HYPERTENSION
Authors: Csaba Móczár , Imre Rurik
Published: April 2021

Objective:

To compare data of lifelong weight gain of persons, analyzing its correlation with developed metabolic diseases, with special attention to women's weight gain around pregnancy, delivery and menopause.

Design and method:

A retrospective international study was planned and organized to compare selfrecorded data of lifelong weight gain among 60–70 year old patients analyse their correlation with metabolic diseases they developed with special attention to women's weight gain around pregnancy, delivery and menopause in primary care settings in Germany, Hungary, Italy, Slovakia and the Ukraine.

People between 60y-70y were asked to fill in a questionnaire on body weights in previous life decades and heights. Recent parameters were measured.

Results:

Of the recruited 815 participants, 319 men and 496 women presented all the required data. Diabetics of both genders had the highest baseline weight at 20 years of age. The weight and BMI of the whole study population increased steadily until their seventies, but to a lesser extent after their fifties. Compared to the control group, changes over decades were the greatest among diabetics and also greater among patients with hypertension. Weight increase in the first decades (20–30-year-old men and 30–40-yearold women) was a significant risk factor for the development of diabetes (OR = 1.044; p = 0.002; 95 % CI: 1.01–1.07). Among patients with diabetes and hypertension, both diagnoses were set up earlier than among those with a single morbidity. Among females, weight increase around pregnancy and menopause correlated significantly with higher odds for the diagnoses of diabetes and/or hypertension, irrespective of the number of children.

Conclusions:

During their decade-long relationship with their patients, family physicians are expected to identify the higher weight gain of their patients, especially among younger generation and intervene, if necessary.
ASSOCIATION BETWEEN EPICARDIAL ADIPOSE TISSUE THICKNESS AND PARAMETERS OF THE LEFT VENTRICULAR DIASTOLIC FUNCTION AND LEFT VENTRICULAR REMODELING IN PATIENTS WITH ABDOMINAL OBESITY
Authors: Azimova Marina , Blinova Nataliya , Zhernakova Yulia , Azimova Makka , Dobrovolskaya Svetlana , Saidova Marina , Ternovoy Sergey , Chazova Irina
Published: April 2021

Objective:

The aim of study to assess the correlation between epicardial adipose tissue (EAT) with the parameters of the left ventricular remodeling and diastolic function in patients with abdominal obesity.

Design and method:

The study included 104 patients (37,5% men, 62.5% women), mean age 38.59 ± 6.09 years with abdominal obesity (waist circumference (WT) > 80 cm in women, > 94 cm in men), without cardiovascular diseases and diabetes mellitus. All patients underwent transthoracic echocardiographic examination (Vivid 7, Vivid 9 (GE Healthcare, USA)): left ventricular (LV) mass, LV mass index, LV mass/height index, LV diastolic function (assessed by the E/e’ ratio, Emlat, Emsept, Em/Am ratio) were estimated; EAT thickness measured on the free wall of the right ventricle from both parasternal long- and short-axis views at end-systole and end-diastole during three cardiac cycles.

Results:

The average of EAT thickness was at end-systole 6,7 ± 2,0 mm, end-diastole- 4,2 ± 1,7 mm. EAT correlated with WT (EAT at end-systole r = 0,43; p < 0,05; EAT at end-diastole r = 0,43; p < 0,05). EAT thickness was significantly correlated with LV diastolic function: positive correlation with E/Em ratio (EAT at end-systole r = 0,62; p < 0,05; EAT at end-diastole r = 0,56; p < 0,05); negative correlation was found with Em/Am ratio (EAT at end-systole r = -0,66; p < 0,05; EAT at end-diastole r = -0,59; p < 0,05); Emlat (EAT at end-systole r = -0,62; p < 0,05; EAT at end-diastole r = -0,51; p < 0,05); Emsept (EAT at end-systole r = -0,65; p < 0,05; EAT at end-diastole r = -0,60; p < 0,05). EAT thickness correlated with with LV mass (EAT at end-systole r = 0,52; p < 0,05; EAT at end-diastole r = 0,51; p < 0,05); LV mass index (EAT at end-systole r = 0,31; p < 0,05; EAT at end-diastole r = 0,32; p < 0,05); (EAT at end-systole r = 0,52; p < 0,05; EAT at end-diastole r = 0,51; p < 0,05); LV mass/height index (EAT at end-systole r = 0,44; p < 0,05; EAT at end-diastole r = 0,43; p < 0,05).

Conclusions:

The data suggest that EAT as ectopic visceral fat depot may affect on diastolic function and LV remodeling. Increased EAT thickness is strongly associated with LV diastolic disfunction.
BRACHIAL-ANKLE PULSE WAVE VELOCITY IS INVERSELY ASSOCIATED WITH OBESITY IN A HEALTHY CHINESE POPULATION
Authors: Zuo Junli , Tang Biwen , O’rourke Michael , Avolio Alberto , Adji Audrey
Published: April 2021

Objective:

Obesity is generally considered undesirable on account of its association with metabolic syndrome and other risk factors for cardiovascular disease. However, obese subjects paradoxically appear to have better outcome following certain interventions (eg vascular interventions in heart failure) compared to non-obese subjects, suggesting a vascular protective effect of obesity (obesity paradox). This study aimed to quantify the association between indices of obesity and arterial stiffness as measured by brachial-ankle pulse wave velocity (baPWV) in a healthy Chinese population.

Design and method:

Normal individuals (n = 858) attending a health assessment clinic for cardiovascular disease screening at Ruijin Hospital North, Shanghai, China, between April 2017 and June 2018, had measurements of baPWV (Omron, BP-203RPEIII VP-1000) and brachial systolic (SP), diastolic (DP), mean (MP) and pulse pressure (PP). Subjects were divided into 3 groups according to their Body Mass Index (BMI, kg/m2): BMI less than 24, normal; 24–28, overweight; greater than 28, obese (using Chinese guidelines).

Results:

All brachial pressures were significantly higher as BMI increased. baPWV increased significantly when the normal group was compared with overweight or obese groups (p < 0.001). However, no differences were apparent between the overweight and obese group, with baPWV being lower in the obese group with higher BMI. Using baPWV as the independent continuous variable in multiple linear regression, age, MP and heart rate were all positively associated with baPWV, whereas BMI was negatively associated with baPWV after adjusting for confounding factors (β=-0.104, p < 0.001). A negative linear relationship between BMI class and baPWV was only apparent for males less than50 years (p = 0.01) and females of age above 50 years (p < 0.01).

Conclusions:

baPWV, as a measure of arterial stiffness, is higher for similar SP values in the normal individuals when compared to those in overweight and obese groups, consistent with the “obesity pardox”. The disparate effects of BMI on baPWV are likely due to sex differences that affect arterial stiffness in older overweight and obese individuals.
ASSOCIATION OF TRIGLYCERIDE-GLUCOSE INDEX AND SUBCLINICAL LEFT VENTRICULAR SYSTOLIC DYSFUNCTION IN YOUNG HYPERTENSIVE SUBJECTS
Authors: Ezhova Nadezhda , Shavarova Elena , Khomova Irina , Bazdyreva Elena , Shkol’nikova Ekaterina , Kobalava Zhanna
Published: April 2021

Objective:

Triglyceride-glucose (TyG) index is a marker of insulin resistance (IR) which has previously appeared to be a promising predictor of hypertension (HTN), coronary artery calcification and non-alcoholic fatty liver disease. However, the interrelation between TyG index and subclinical left ventricular systolic dysfunction has never been studied.

Design and method:

We evaluated anthropometric and metabolic characteristics, clinical blood pressure and performed 24-hours ambulatory blood pressure monitoring (ABPM) and echocardiography including two-dimensional speckle tracking in 94 young treatment-naive hypertensives (age 23 [21;25] years, 85,1% males, body mass index (BMI) 25,88 ± 4,78 kg/m2) free of diabetes mellitus. Most patients (67%) had masked HTN and diagnosis was stated with ABPM. IR was estimated with HOMA-IR and TyG index which was calculated as ln[fasting triglycerides (mg/dL) × fasting plasma glucose (mg/dL)/2]. All patients were divided in two subgroups according to LV GLS median, e.g. with GLS of -20,05 or less and > -20,05. Then we compared main clinical variables including obesity and metabolic characteristics and blood pressure levels in derived subgroups. We used Student's t-test and Mann-Whitney U-test to compare variables with normal and non-normal distribution, respectively. To investigate the relationship between IR indices and GLS we performed simple and multiple linear regression analysis.

Results:

The subgroups were comparable in age, sex and race composition; there was also no significant difference in BMI, waist circumference (WC), waist-to-hip ratio (WHR), WC to height ratio. Insulin and HOMA-IR values were identical. The groups were significantly different in triglycerides levels (0,86 ± 0,31 vs 1,32 ± 0,79 mmol/L for GLS < -20,05 and > -20,05, respectively, p < 0,001) and TyG index (8,05 ± 0,39 vs 8,44 ± 0,55, respectively, p < 0,05). 24-hours SBP and DBP were higher in group with worse GLS: 131,2 ± 11,4 vs 139,3 ± 16,7 mm Hg and 77 [73;85,5] mm Hg, respectively, with p < 0,05 for both. In simple linear regression TyG index was a significant predictor of GLS value with beta = 0,407 (p < 0,001). After addition of age, sex, WHR and office DBP into the model TyG index remained independently associated with GLS with beta = 0,253 (p < 0,05).

Conclusions:

In young hypertensives TyG index is an independent predictor of GLS impairment.
EFFECTS OF 12-WEEK YOGA-BASED LIFESTYLE INTERVENTION ON METABOLIC SYNDROME Z-SCORE, BODY COMPOSITION AND QUALITY OF LIFE IN INDIAN ADULTS WITH METABOLIC SYNDROME
Authors: Yadav Rashmi , Yadav Raj Kumar
Published: April 2021

Objective:

The study evaluated the effect 12-week yoga-based lifestyle intervention (YBLI) on continuous metabolic syndrome (Met S) z-score, body fat percentage and health related quality of life (HRQoL) in adults having Met S.

Design and method:

In this prospective, single-arm, lifestyle intervention study 54 adults with metabolic syndrome (as per Joint Interim Statement, 2009) were assigned to pretested 12-week YBLI intervention. It consisted of asanas, pranayama, relaxation techniques, lectures, group support, dietary advice under supervision for ∼2 hrs/day for 2 week followed by continuation of the practices at home for subsequent 10 weeks. Outcome measures were assessed before and after the intervention and included: Met S z-score calculated by summing the standardized values for cardio-metabolic risk factors, body fat percentage assessed by dual energy X-ray absorptiometry, and HRQOL assessed using WHOQOL-BREF questionnaire.

Results:

Subjects showed (mean age 38.1 ± 5.6 years) significant reduction in Met S z-score {0.3 ± 2.4 vs. -1.3 ± 2.4, p < 0.01) and body fat percentage (32.3 ± 54.3 vs. 31.5 ± 5.5, p < 0.01) from baseline to week 12. Significant improvement was found in the domains of the HRQOL i.e. physical (64.4 ± 14.7 vs. 77.3 ± 12.7, p < 0.01); psychological (61.0 ± 16.8 vs. 74.6 ± 12.6 p < 0.01); social (75.9 ± 14.5 vs. 79.6 ± 12.3, p < 0.01) and environmental (66.4 ± 14.3 vs. 75.8 ± 11.6, p < 0.01).

Conclusions:

Participation in YBLI led to the improvement in cardio-metabolic risk, body fat percentage and HRQOL in Indian adults having Met S.
EFFECT OF A 12-WEEK YOGA-BASED LIFESTYLE INTERVENTION ON VASCULAR INFLAMMATORY MARKERS IN PRE-DIABETIC OVERWEIGHT/OBESE INDIAN ADULTS
Authors: Yadav Rashmi , Yadav Raj Kumar
Published: April 2021

Objective:

To study the effect of a 12-week yoga-based lifestyle intervention (YBLI) on circulating levels of inflammatory markers in prediabetic overweight/obese Indian adults.

Design and method:

Prospective, single-arm, lifestyle intervention study was conducted in 59 prediabetic (n = 59) (fasting plasma glucose, FPG 100 to 125 mg/dL), overweight/ obese (body mass index; BMI 23–40 Kg/m2) subjects. The subjects were assigned with pretested YBLI consisting of asanas, pranayama, meditation, and relaxation techniques with group support, dietary advice under supervision for approx. 2 hrs each day for 2 weeks followed by continuation of the practices at home for next 10 weeks. Outcome measures were weight, waist to hip ratio (WHR), FPG, serum insulin, blood pressure (BP), homeostatic model insulin resistance (HOMA-IR), and plasma levels of tumor necrosis factor (TNF)-alpha, interleukin-6 (IL-6) and leptin, adiponectin measured before and after the intervention.

Results:

Results: After intervention, subjects (mean age = 38.5 ± 5.5 years, BMI = 30.4 ± 4.1 Kg/m2) had significant reduction in weight, WHR, diastolic BP, and HOMA-IR. There was statistically significant reduction in IL-6 {median (range) 1.1 (0.5, 2.4) vs. 0.8 (0.4,1.5) pg/mL, p = 0.02} and leptin {22.9 (13.9, 45.0) vs. 21.6 (12.0, 42.6) ng/mL, p < 0.01)}; and significant increase in adiponectin {6.0 (4.4, 7.6) vs. 6.5 (4.7, 9.2) ng/mL, p < 0.02); while no significant difference was noticed in TNF-alpha levels.

Conclusions:

Conclusion: A 12-week YBLI might effectively modify levels of IL-6, leptin, and adiponectin as observed in this study and overall reduction in inflammation in obesity.
IMPACT OF OVERWEIGHT AND OBESITY ON BLOOD PRESSURE CONTROL AMONG HYPERTENSIVE PATIENTS (RESULTS FROM NATURE HTN)
Authors: Hammami Rania , Bahloul Amine , Triki Syrine , Charfeddine Selma , Triki Faten , Zakhama Lilia , Addad Fawzi , Abdessalem Salem , Abid Leila
Published: April 2021

Objective:

Given the increase of sedentarily and bad diet in our life, the prevalence of obesity and overweight has remarkably increased among the most of population, last years. We aimed in this work to assess the impact of weight on blood pressure control in hypertensive patients based on data from the Tunisian national registry Nature HTN

Design and method:

Nature HTN is a national multicentric study conducted by the Tunisian society of cardiology and including hypertensive patients who consulted their doctors during one month in 2019. We collected clinical data, blood pressure measurements and lab test. We defined Overweight.

Results:

We enrolled 25890 hypertensive patients, with female predominance (SR = 1.2) and mean age 64.4 ± 12.2 year-old. The hypertension was newly diagnosed in 2286 patients (8.8%) and known more than six months in 23601 persons. The mean BMI was 28.1 ± 4.57. Obesity and overweight were observed respectively in 25.8% and 44.6%. Female were significantly more obese than male (34.7% vs 17.6%, p < 10-3). Patients with uncontrolled BP were more frequently obese (30.5% vs 27.4%, p < 10-3) and have a higher BMI. Among patients with overweight or obesity there was a correlation the prevalence of uncontrolled BP and the severity of obesity (71.5% in overweight people, 74.8 in patient with moderate obesity, 79.4% in patients with severe obesity, p = 0.001). Moreover obesity was found as independent predictor of non-controlled BP in our cohort (OR = 1.14, 95% CI[1.07–1.21].

Conclusions:

Obesity is a health problem growing and should keep in mind when treating patients with hypertension because it is a strong predictor of non-controlled BP.
DISSOCIATION BETWEEN LONG-TERM WEIGHT LOSS INTERVENTION AND BLOOD PRESSURE. AN 18-MONTH RANDOMIZED CONTROLLED TRIAL
Authors: Gepner Yftach , Goldstein Nir , Shelef Ilan , Schwarzfuchs Dan , Zelicha Hila , Meir Anat Yaskolka , Tsaban Gal , Grossman Ehud
Published: April 2021

Objective:

Obesity is associated with elevated blood pressure (BP). In patients with obesity and hypertension, weight loss lowers BP, but the long-term effect of weight loss on BP is less clear. We aimed to assess the effect of long-term weight loss intervention on BP in normotensive and hypertensive subjects.

Design and method:

In an 18-month trial, 278 subjects (mean age 47.9 ± 9.3 years, 89% male, 56% hypertensive) with abdominal obesity or elevated serum triglycerides and low high-density-lipoprotein cholesterol were recruited for weight loss intervention. Body weight and BP were measured at baseline, after 6 and 18 months.

Results:

After 6 months of intervention, in the weight loss phase, body mass index (BMI) decreased by an average of -2.2 ± 1.5 kg/m2 (p < 0.001) and both diastolic BP (DBP) and systolic BP (SBP) decreased by -2.1 ± 8.8 mmHg, and -2.3 ± 12.9 mmHg, respectively (P < 0.01 for both). The change in BMI was similar in normotensive and hypertensive subjects (-2.0 ± 1.6 and -2.3 ± 1.5, p = 0.246). However, DBP and SBP decreased significantly (-5.2 ± 7.1 mmHg, and -6.2 ± 12.5 mmHg, respectively, p < 0.001 for both) in hypertensive subjects, and increased in normotensive subjects (1.8 ± 9.3 mmHg, p = 0.041 and 2.7 ± 11.7 mmHg, p = 0.017, respectively). After 18 months, in the weight maintenance phase, BMI slightly increased (0.9 ± 1.3 kg/m2, p < 0.001) but remained significantly lower than at baseline (p < 0.0001). Unlike BMI, DBP and SBP increased significantly in hypertensive subjects (p < 0.001) and returned almost to baseline levels.

Conclusions:

Weight-loss intervention reduced BP in hypertensive patients, but this was not maintained in the long run.
THE MATCHED CASE CONTROL STUDY OF PREGNANCY HYPERTENSION PATIENTS AND THE NEONATAL BABY
Authors: Zhao Xu , Kou Chengkun , Yu Jing
Published: April 2021

Objective:

To investigate the detection rate and effects of risk factors on gestational hypertension and the effect of maternal gestational hypertension on neonatal outcome.

Design and method:

This investigation study was proceeded on December 2013 -2014 November in Gansu Province maternal and child health hospital. The questionnaire covers the general situation of pregnant women and newborns, and describes the general characteristics of pregnancy-induced hypertension in Maternal and Child Health Hospital of Gansu Province. The first case-control study included pregnant women with pregnancy-induced hypertension as the case group.The second case-control study included mothers with a history of pregnancy-induced hypertension in the case of newborns.The second case-control study designed to explore the relationship between pregnancy-induced hypertension and newborns outcomes.

Results:

Of all 2143 pregnant women screened, 60 patients with pregnancy-induced hypertension were screened and the detection rate of pregnancy-induced hypertension was 2.7%. Univariate analysis showed that the weight gain during pregnancy was higher than normal, the age of less than 30 years old, and the two factors of pre-pregnancy BMI were related to the occurrence of hypertensive pregnancy. Multivariate logistic regression analysis showed that the weight gain during pregnancy was high in normal women. Pre-pregnancy BMI is a risk factor for gestational hypertension, age less than 30 years of age is the protective factor of gestational hypertension. Mothers with gestational hypertension may affect the growth and development of the newborns, newborns birth weight is low, pregnancy-induced hypertension newborns Apgar score lower than the control group. The study compared the data of newborns heart Doppler ultrasound, the study found that pregnant women with high blood pressure left ventricular ejection fraction lower than newborns who mother without pregnancy-induced hypertension.

Conclusions:

Pregnancy weight gain higher than normal, pre-pregnancy BMI is a risk factor for the occurrence of pregnancy hypertensive. Age less than 30 years is a protective factor of pregnancy-induced hypertension. Risk factors and protective factors of hypertension in pregnancy affect the occurrence and development of the disease.
BONE MORPHOGENETIC PROTEIN 2 PROMOTES HUMAN TROPHOBLAST CELL INVASION AND ENDOTHELIAL-LIKE TUBE FORMATION THROUGH ID1-MEDIATED UP-REGULATION OF IGF BINDING PROTEIN-3
Authors: Zhao Hongjin , Klausen Christian , Zhu Hua , Chang Hsun-Ming , Li Yan , Leung Peter C.K.
Published: April 2021

Objective:

Extravillous cytotrophoblasts (EVTs) invade into the uterine wall and remodel spiral arteries for proper placentation. Insufficient EVTs invasion and poor spiral arterial remodeling are associated with preeclampsia occurrence. Studies from us and others have demonstrated that the transforming growth factor-beta superfamily member bone morphogenetic protein 2 (BMP2) plays important roles in endometrial decidualization and trophoblast cell invasion. However, BMP2 has also been shown to regulate endothelial cell migration and capillary-like tube formation, as has its downstream signaling molecule inhibitor of DNA binding 1 (ID1). Interestingly, insulin-like growth factor binding protein 3 (IGFBP3) also promotes endothelial precursor cell migration and angiogenesis. Moreover, Id1 shows regulatory effect on Igfbp3 expression in rat prostate epithelial cells. However, whether ID1 and IGFBP3 are integrated in BMP2 signaling and involved in the regulation of trophoblast invasive and endovascular differentiation remains unknown. The objective of our study was to examine the effects of BMP2 on ID1 and IGFBP3 expression and their roles in BMP2-regulated human trophoblast invasion and endothelial-like tube formation.

Design and method:

Primary and immortalized (HTR8/SVneo) cultures of human trophoblast cells were employed as study models. RT-PCR and Western blot assay were used to study mRNA and protein levels. Small interfering RNA (siRNA) was used to check the roles of key molecules. Matrigel-coated transwell assay and endothelial-like tube formation assay were used to examine cell invasiveness and angiogenesis respectively.

Results:

BMP2 treatment increased ID1 and IGFBP3 mRNA and protein levels in HTR8/SVneo and primary human EVT cells. Intriguingly, ID1 was essential for BMP2-induced IGFBP3 up-regulation in both study models, and BMP2-induced trophoblast invasion was attenuated by knockdown of either ID1 or IGFBP3. In addition, BMP2 significantly increased endothelial-like tube formation and knockdown of ID1 and IGFBP3 reduced basal and BMP2-induced tube formation in HTR8/SVneo cells. Similarly, BMP2 increased placenta growth factor (PlGF) production in HTR8/SVneo cells and these effects were attenuated by knockdown of ID1 or IGFBP3.

Conclusions:

Our results reveal that BMP2 promotes trophoblast cell invasion and endothelial-like tube formation by ID1-mediated IGFBP3 up-regulation.
IMPACT OF PREVIOUS HYPERTENSIVE DISORDER DURING PREGNANCY ON ANTHROPOMETRIC MEASUREMENTS, 24-HOUR BLOOD PRESSURE AND ARTERIAL STIFFNESS
Authors: Verardino Renata , Rodrigues Sara , Berger Ana , Costa-Hong Valeria , Macedo Thiago , Baptista Fernanda , Bortolotto Maria , Francisco Rossana , Zugaib Marcelo , Bortolotto Luiz
Published: April 2021

Objective:

Preeclampsia (PE) increased the risk of cardiovascular diseases even in women without previous arterial hypertension (AH). The possible causes include changes in metabolic profile and vascular abnormalities, such as increased arterial stiffness. We aim to compare anthropometric measurements, 24-hour blood pressure profile, and arterial stiffness in women who developed PE during pregnancy with (superimposed PE) or without (isolated PE) a previous history of AH.

Design and method:

We selected from registries of a tertiary hospital women with a previous pregnancy complicated by isolated PE or superimposed PE that occurred 2 to 5 years earlier. Anthropometric measurements: weight, height, body mass index – BMI and waist circumference (WC); Blood pressure (BP) measurements: office Systolic BP (SBP) and diastolic BP (DBP); 24-ambulatory BP monitoring; Arterial stiffness: pulse wave velocity (PWV) measured by Arteriograph® method.

Results:

Twenty-five patients were evaluated.

Conclusions:

Women previous superimposed PE had higher values of WC, awake SBP and PWV when compared to women with isolated PE. These results indicate incremental impairment of vascular and metabolic profile of PE on women with previous chronic AH.
THE PROTEOME OF HIGH DENSITY LIPOPROTEIN CHANGES THROUGHOUT GESTATION IN HEALTHY PREGNANCY AND DIFFERS BETWEEN HEALTHY PREGNANCY AND PREECLAMPSIA IN THE THIRD TRIMESTER
Authors: Patanapirunhakit Patamat , Sulaiman Wan , Karlsson Helen , Ljunggren Stefan , Graham Delyth , Freeman Dilys
Published: April 2021

Objective:

High-density lipoprotein (HDL) has well-established anti-atherosclerotic properties in the non-pregnant population. HDL may have a potential role in protecting maternal vascular function during pregnancy that fails to occur in preeclampsia. HDL function is determined by its protein and lipid composition. This study aimed to examine protein composition of HDL at different gestations throughout healthy pregnancy and to compare HDL proteome in the third trimester of healthy pregnancy and preeclampsia.

Design and method:

HDL was isolated from two cohorts of n = 10 healthy pregnant women at 8 different timepoints throughout pregnancy; pre-pregnancy, week 4.6, week 6.1, week 8.4, (cohort 1) and week 15, week 25, week 35 and 3 months post-natal (cohort 2), and from healthy pregnant (n = 10) and preeclampsia (n = 6) women at the third trimester. The proteome of HDL was measured by nano liquid chromatography coupled to tandem mass spectrometry (nLC-MS/MS).

Results:

There were 16 proteins in HDL that showed significant differences throughout healthy pregnancy which were apolipoprotein A-IV, apolipoprotein C-II, apolipoprotein C-III, apolipoprotein C-IV, apolipoprotein F, apolipoprotein L-I, angiotensinogen, alpha-1-acid glycoprotein 2, alpha-1-antitrypsin, cathelicidin antimicrobial peptide, fibrinogen alpha chain, fibrinogen beta chain, prenylcysteine oxidase 1, serum amyloid a-I, serum paraoxonase/lactonase 3 and vitronectin. In preeclampsia, HDL apolipoprotein A-I was lower than healthy pregnancy, while HDL alpha-1-antitrypsin, pigment epithelium-derived factor and vitamin D-binding protein were higher.

Conclusions:

There were significant differences in the protein composition of HDL during pregnancy and between healthy pregnancy and preeclampsia in the third trimester. These compositional differences may be involved in HDL function and may indicate HDL's role in vascular protection in pregnancy.
NIGHT DIASTOLIC VALUES OF AMBULATORY BLOOD PRESSURE ARE THE MORE PREDICTIVE OF THE OUTCOMES IN PREGNANCY COMPLICATED WITH HYPERTENSION
Authors: Bastos Jose Mesquita , Carvalho Diana , Aveiro Marcelo , Correia Ana , Damiao Pedro
Published: April 2021

Objective:

The prognostic value of 24-hour ambulatory monitoring(ABPM) in pregnancy complicated with hypertension remains uncertain

Design and method:

Observational, 234 pregnant observed in appointment between 2007- July 2019 submitted to ABPM. Mean age 32.1 ± 5.5 years, follow-up 263.9 ± 16.5 days, was defined from gestation to delivery. Event defined: maternal death(MD), fetal or neo natal death(FD), pre-eclampsia (PE) or eclampsia(E), gestational diabetes(DG), prematurity or delayed fetal growth (PF), dystocic delivery(DD).It was observed 118 events((62 PE),32(DG),14 (PF),8(DD),2(FD))

Results:

Comparing pregnancies with events versus without, those with event were significantly older, more prevalence of risk factors for BP in PG, shorter follow up / days, higher 24 h Systolic BP(SBP), 24 h Diastolic BP (DBP),day SBP and DBP, night SBP and DBP, lower Systolic and Diastolic Dipping (table 1). In Cox's multivariate analysis for events and adjusted for: age, BMI, number of risk factors for HP in PG - [pre-existing HP, previous gestational HP, previous pre-eclampsia,restriction of previous intrauterine growth, previous membrane detachment, previous fetal death, previous gestational diabetes, smoking history, obesity, family history of preeclampsia, family history of cardiovascular disease, artificial insemination]classified has:(0,1,2,3,> = 4), office SBP, office DBP, gestation n°, give birth n°, were statistically significant for: 24 h SBP, 24 h DBP respectively HR 1.02 (IC1.00-1.03); 1.03 (IC1.01-1.05); Day DBP 1.02 (IC 1.00-1.05); Night SBP, Night DBP, Systolic BP dipping, Diastolic BP dipping respectively HR 1.02(IC1,01-1.03);1.03(IC1.01-1.05);0.96 (IC 0.94-0.98); 0.96 (IC 0.94-0.99) When DBP dipping was adjusted to night DBP, night DBP remains significant and DBP dipping loses respectively HR 1.03(IC 1.00-1.05) and 0.99(IC 0,95- 1.02). When analyzed DBP dipping by the pattern dipping (D)/non dipping (ND, (ND-35 D-198), in a crosstabs analysis, those with event ND pattern was found in 71% and 28,6 % with no event(X2 6.9 p < 0,05). In a survival curve free of events, the presence of the diastolic dipping ND_D pattern, ND was associated to a worst prognosis (log rank 11.2 p < 0.001)

Conclusions:

Night diastolic values are the best prognosis for prediction of events related to outcomes in pregnant woman's with hypertension, special DBP. Casual BP and even home ambulatory blood pressure are scanty for this period.
HYPERTENSIVE DISORDER OF PREGNANCY AND THE RISK OF AUTISM SPECTRUM DISORDER IN OFFSPRING: META-ANALYSIS
Authors: Greca Elona , Avdullari Oresta , Khan Abdul Haseeb , Marku Ndok , Dibra Graciela
Published: April 2021

Objective:

Aim of this meta-analysis is to examine the association between Hypertensive Disorder of Pregnancy and ASD. ASD is the broad current designation for a group of conditions with deficits in social interaction and communication and RRBs(restricted repetitive behaviors), common severe pervasive neurodevelopmental disorder of undetermined etiology. Environmental exposures, especially pregnancy complications, have been increasingly recognized as a potential risk factor for ASD.

Design and method:

We conducted a systematic literature search onPubMed, Embase and PsycINFO databases were searched. Pooled relative risks (RR) with 95% confidence intervals were calculated. Subgroup and sensitivity analyses were performed. Heterogeneity was assessed using Cochran's Q- and the I test. The presence of publication bias was evaluated by Egger's test and visual inspection of the symmetry in funnel plots.

Results:

A total of t welve studies meet the inclusion criteria with more than 307146 participant,including 6209 ASD. Subgroup analysis of clinical classification include: gestational hypertension, pre-eclampsia, chronic hypertension complicating pregnancy. The risk of ASD in pre-eclampsia is with OR 1.47 and CHP with OR 1.37 slightly higher than those of mothers with gestational hypertension OR 1.2. In consistence with most previous researches, higher ASD prevalence was observed in male than female,indicating a potential role for gender in the pathophysiology of ASD.

The figure shows a Forest plot of the correlation between HDP and ASD

Conclusions:

This meta-analysis implies a possible link between Hypertensive Disorders of Pregnancy and the risk of Autism Spectrum Disorder in offspring. However, further investigation should be conducted to confirm this conclusion, and intensive prenatal surveillance and early prediction for ASD is needed.
ONE YEAR AFTER THE INTRODUCTION OF ESH/ESC GUIDELINES-IS THERE A CHANGE IN THE THERAPEUTIC INERTIA IN BULGARIA?
Authors: Grue Ivan , Tsanova Veska
Published: April 2021

Objective:

Fixed dose combinations are the back bone of the 2018 ESH/ESC guidelines for management of AH, in order to achieve early and constant BP control and good adherence to the therapy. Therapeutic inertia remains a big obstacle, especially in primary care.

The aim of our study was to evaluate the changes in the therapy of ambulatory patients, sent for consultation with cardiologist, one year after the introduction of 2018 Guidelines.

Design and method:

We studied the medical records of 300 patients with grade II and III AH- 190 male and 110 female, aged between 34 and 83 years. The patients were sent for consultation with cardiologist after 3 months of unsuccessful therapy led by the GPs.

Results:

We found that despite of the poor BP control, at the first presentation in the cardiologists’ office, 48 % of the patients were still on monotherapy! Among them 40 % received ARB, 30 %- ACEI, 10%- Ca channel blocker 10 %, 10% beta –blocker and 10 % central-acting agents. In 20% of the patients the second step was to double the dose of the monotherapy. In the group of patients, that were prescribed a second drug as a next step of therapy, 60% received thiazide or thiazide-like diuretic, 20%- Ca channel blocker and 20% -moxonidine or other central-acting agent. Only 20% of patients received a single pill combination /SPCs/ but in 10% a combination of beta –blocker and diuretic was preferred. In 55% of the study group the cardio-vascular risk was calculated. Only 25 patients underwent ABPM. The good news is that after a consultation with cardiologist, 70% of the patients achieved good BP control in 4 weeks time.

Conclusions:

Therapeutic inertia is still a major problem in Bulgaria. 45% of the patients were left without cardio-vascular risk assessment. Monotherapy was the starting option in almost half of grade II and II hypertension patients. The intensification of the therapy was delayed and free combinations were preferred over SPCs. The use of central-acting agents and beta –blocker /diuretic combinations was greater than expected.
HYPERTENSION TREATMENT AND CONTROL IN NEPAL: A SYSTEMATIC REVIEW OF BARRIERS AND FACILITATORS
Authors: Dhungana Raja Ram , Pandey Achyut Raj , Shrestha Nipun , Pedisic Zeljko , De Courten Maximilian
Published: April 2021

Objective:

Understanding country-specific factors influencing cascade of care for hypertension is critical to address the high unmet need for hypertension treatment and control. This study aimed to systematically synthesise the evidence on barriers and facilitators of hypertension treatment and control in Nepal.

Design and method:

We systematically searched for available literature in Embase, PubMed, Web of Science Cinahl, ProQuest and WorldCat. A total of 2131 identified documents were assessed against a predefined set of inclusion criteria. Studies that were carried out among healthcare providers and hypertensive persons and that investigated factors associated with hypertension treatment and control in Nepal were included in the review. We used the Mixed Methods Appraisal Tool (MMAT) to assess the methodological quality of the selected studies. For qualitative findings, we used the framework synthesis approach to generate themes on barriers and facilitators, and we framed them under the domains of “health system”, “provider”, and “patient”.

Results:

Six eligible studies, three qualitative, two quantitative and one mixed methods, were identified. Unaffordability of care and lack of resources were two pertinent barriers related to the health system. Lack of interest in counselling the patients on medication use, lifestyle modifications, and long-term monitoring were common barriers linked to healthcare providers. Poor help-seeking behaviour, poor adherence to medication, fear of long-term medication use, and adverse effects of drugs were the most cited impediments among patients. Availability of free essential healthcare services and family support were enablers of hypertension treatment and control.

Conclusions:

Several barriers and two facilitators of hypertension treatment and control in Nepal were identified. To improve management and control of hypertension in Nepal, comprehensive interventions are needed, because barriers exist at the health system, provider, and patient level.
THERAPEUTIC APPROACH FOR HYPERTENSION MANAGEMENT AND CONTROL IN PATIENTS RECEIVING OLMESARTAN-BASED TREATMENT: THE “FAMILY” NON-INTERVENTIONAL STUDY IN PRIMARY CARE IN GREECE
Authors: Kollias Anastasios , Katsimagklis Georgios , Mastrokostopoulos Antonios , Stergiou George S.
Published: April 2021

Objective:

To evaluate the characteristics, office blood pressure (OBP) levels and usual treatment strategies of hypertensive patients receiving olmesartan-based therapy in general practice.

Design and method:

A nationwide non-interventional survey was performed by primary-care doctors who assessed consecutive hypertensives on stable (> = 4 weeks) olmesartan-based therapy. Patients’ characteristics, OBP levels and treatment changes were reported.

Results:

A total of 4,883 hypertensives on olmesartan-based therapy (age 66.5 ± 11.2 years, men 54%, diabetics 26%, smokers 23%) were assessed by 491 doctors (48% cardiologists, 39% internists, 12% general practitioners, 1% others). Average OBP was 137.6 ± 16.0/82.4 ± 9.8 mmHg (systolic/diastolic) and 56% had controlled OBP (<140/90 mmHg). Participants were receiving 2.2 ± 0.8 antihypertensive drugs (olmesartan monotherapy 21%; 2 drugs 44%; 3 drugs 30%; > = 4 drugs 5%). Of subjects on olmesartan combinations (79%), 89% used fixed-dose pills (37% olmesartan-amlodipine; 28% olmesartan-hydrochlorothiazide; 35% olmesartan-amlodipine-hydrochlorothiazide). Cardiologists prescribed fixed-dose combinations more frequently than general practitioners or internists (77/75/72% respectively, p < 0.01). 13% of patients reported missing at least one dose per week, with most common reported cause the complexity of treatment regimen (75%). OBP control was (i) higher in nondiabetics than diabetics (58% vs. 52%, p < 0.01), despite using fewer drugs (2.2 ± 0.8 vs. 2.4 ± 0.8 drugs, p < 0.01), (ii) lower in patients on monotherapy compared to 2, 3 or > = 4 drugs (53/56/59/57% respectively, p < 0.05) and (iii) higher in patients on fixed-dose than free combinations (58% vs. 53%, p < 0.01). In cases with uncontrolled OBP the following actions were decided: dose increase 18%; drug addition 17%; drug substitution 3%; treatment simplification using fixed-dose combination 7%; no change 55%.

Conclusions:

Combination therapy and particularly fixed-dose combinations are widely prescribed in primary care. However, uncontrolled OBP is common, even in patients on monotherapy, and is worse in diabetics. Physicians’ inertia and complexity of regimen are major barriers in achieving optimal control. More intense and simpler therapy, with wider use of triple fixed-dose combinations and second-line drugs, are necessary to improve the control of hypertension in primary care.
PRIMARY HEALTH CARE PHYSICIANS’ KNOWLEDGE AND ADHERENCE TO HYPERTENSION MANAGEMENT GUIDELINES IN SOUTHWEST OF SAUDI ARABIA
Authors: Shnaimer Jubran , Gosadi Ibrahim
Published: April 2021

Objective:

Aim of the study: to measure adherence of primary health care (PHC) physicians in Jazan to Saudi guidelines for the management of hypertension (SHMGs).

Specific Objectives:

-To assess the source of guidelines PHC physicians in Jazan is using for management of hypertension cases.

-To measure knowledge of PHC physicians in Jazan about Saudi hypertension guidelines.

Design and method:

This cross-sectional study was conducted in 170 PHC centers in Jazan region, southwest of Saudi Arabia. A self-administered questionnaire was distributed and collected from 316 PHC physicians working in Jazan from June until September 2019. Data were analyzed using descriptive statistics and chi-square test, with a significance level of P < 0.05.

Results:

316 PHC physicians in Jazan participated in the present study; their mean of age (SD) was 38.17 ± 9. More than half of the participants were males (53%). The majority of PHC physicians were non-Saudi (72.47%). Most of the participants were General practice (61.7%). The results revealed that the total Knowledge score of PHC physicians was 7.96 ± 2.55, and the total practice score 7.29 ± 1.69 concerning HTN Saudi hypertension management guidelines. An average number of patients seen daily at the clinic (P = 0.015) and Attendance of training sessions for HTN management (P = 0.020) were the significant factors associated with the level of knowledge and adherence concerning the SHMGs in our study.

Conclusions:

The present study concluded that PHC physicians in Jazan did not fully adhere to all Saudi Hypertension Management Guidelines. The total mean score of the physician's knowledge and practice showed undesirable results. The reason could be explained through low levels of work experience and not having attended any training courses; the study suggested an urgent need for performing continuous education courses on high Blood Pressure levels.
THE HYPERTENSION CANADA PROFESSIONAL CERTIFICATION PROGRAM: A NOVEL IMPLEMENTATION STRATEGY FOR HYPERTENSION GUIDELINES
Authors: Watson Kaitlyn , Tsuyuki Ross , Beahm Nathan , Sedore Rebecca , Bell Alan
Published: April 2021

Objective:

The uptake of clinical practice guidelines into practice is poor for many chronic conditions, including hypertension. What is missing is an implementation strategy for incorporating guidelines into primary care practice. Herein, we describe the development of the Hypertension Canada Professional Certification Program (HC-PCP), a novel approach to guidelines implementation.

Design and method:

First, we identified 15 competencies believed to be important for primary care professionals to master when providing hypertension care. These competencies were surveyed for consensus by front-line clinicians through the Hypertension Canada e-newsletter. Clinicians were asked to rank the importance (on a Likert scale from 1 = not important to 5 = very important) of each competency for a primary care provider when undertaking a certification in hypertension management.

Results:

A total of 121 clinicians responded to the survey. Of these, 38% were pharmacists, 31.4% were registered nurses, 10.7% were physicians, and 7% were nurse practitioners. There was at least one respondent from each Canadian province and territory, except for the Northwest Territories. All 15 competencies received a mean rank of at least 4. The competencies with the lowest rank was “Demonstrates a sound knowledge of the epidemiology of hypertension” (mean 4.07 (SD 0.85)) and the highest was “Ability to screen and identify hypertension” (mean 4.83 (SD 0.04)). We then used these competencies to develop an online certification program, the HC-PCP. Some features include regular quizzes, submission of a video outlining the learner's blood pressure measurement technique, and submission of 3 patient cases for expert review. The program was launched recently: www.hypertension.ca/professional-certification-program/.

Conclusions:

We have developed a novel online hypertension certification program based upon the Hypertension Canada guidelines. The HC-PCP has been launched to pharmacists first, and is also being tested in a stepped wedge randomized trial called RxPATH (www.epicore.ualberta.ca/home/rxpath/).