bluuebunny/crossref_metadata_2025 huggingface dataset:
ACCURACY OF THE AUTOMATED OSCILLOMETRIC HOME BLOOD PRESSURE MONITOR BRAUN BUA4000 WITH WIDE RANGE CUFF: VALIDATION ACCORDING TO THE AAMI/ESH/ISO UNIVERSAL STANDARD
Authors: Menti Ariadni , Ntineri Angeliki , Ntousopoulos Vasileios , Theodosiadi Aikaterini , Stathopoulou Panagiota , Kyriakoulis Konstantinos , Kollias Anastasios , Stergiou George S.
Published: June 2023

Objective:

To evaluate the blood pressure (BP) measurement accuracy of the Braun BUA4000 automated oscillometric upper-arm cuff device for self-home use in a general population according to the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization (AAMI/ESH/ISO) Universal Standard (ISO 81060-2:2018) and its Amendment 1.2020-01.

Design and method:

Participants were recruited to fulfil the age, sex, BP, and limb distribution criteria of the AAMI/ESH/ISO Universal Standard in general population using the same arm sequential BP measurement method. A single wide-range cuff of the test device was used for arm circumference range 22-42 cm.

Results:

A total of 98 individuals were recruited and 85 were analyzed (mean age 60.3±16.1 [SD] years, 44 men, arm circumference 31.5±5.1 cm, range 22-41.5 cm). For validation Criterion 1, the mean difference ±SD between the test device and reference BP readings (N = 255) was 0.9±6.4/-0.3±6.4 mmHg (systolic/diastolic; threshold < = 5±8 mmHg). For Criterion 2, the SD of the averaged BP differences between the test device and reference BP per individual (N = 85) was 5.15/5.81 mmHg (systolic/diastolic; threshold < = 6.88/6.95 mmHg).

Conclusions:

The Braun BUA4000 automated oscillometric home BP monitor fulfilled all the requirements of the AAMI/ESH/ISO Universal Standard (ISO 81060-2:2018) in a general population and can be recommended for clinical use.
ASSOCIATION OF PRESSURE CONTROL RATE AND USE OF ANTI-HYPERTENSIVE DRUGS AMONG BRAZILIAN HYPERTENSIVE PATIENTS
Authors: Magalhaes Fabricio Galdino , Sousa Andrea Cristina , Inuzuka Sayuri , Amorim Kécia Cristina Faria Oliveira , Batista Sandro Rodrigues , Barroso Weimar Kunz Sebba , Sousa Ana Luiza Lima
Published: June 2023

Objective:

To analyze the association between the rate of blood pressure (BP) control and the use of antihypertensive drugs among hypertensive patients.

Design and method:

Analytical cross-sectional study, using data from the TeleMRPA platform, which records data from Residential Blood Pressure Measurements (MRPA). Variables used: age, sex, systolic BP (SBP) and diastolic BP (DBP) at office and residential, amount of medication in use, categorized into monotherapy, dual therapy, triple combination and four or more; BP variability. Comparison between categories was performed using the chi-square test and ANOVA test for comparison of means, considering a 95% confidence interval and significance level p<0.05.

Results:

Participants were 25,543 hypertensive patients, with a mean age of 60.6 (±14.4) years, minimum age 18 and maximum age 114 years. 63.1% were women and were older (mean 61.9 (±14.3) than men (58.5 (±14.2). The BP control rate was 42.3% in total sample, being proportionally higher among women (67.6%). The BP control rate was higher among young adults (<60 years) than among the elderly; 60 to 70 years. The amount of antihypertensive drugs was distributed in 42.6% in monotherapy, 37.4% double, 15.7% triple, and 4.4% four or more. Women used proportionally more triple combination (16.2%) than men (14.7%; p = 0.014) and in the other combinations there was no difference in the distribution of therapies and gender. than among the elderly (38.2%); drug combinations had higher proportions among the elderly. BP control rates were higher among those on monotherapy (42.7%) and dual combination (43.4%) than among the elderly what a triple combination (41.4%) and four or more (32.5%).

Conclusions:

The BP control rate was higher among women and among young adults. Monotherapy was more present among young adults and as the amount of drug combination increased, the rate of BP control decreased.
HOME BP MONITORING IMPROVES THE DIAGNOSIS OF HYPERTENSION IN HEMODIALYSIS PATIENTS
Authors: Leonidou Kalia , Kontogiorgos Ioannis , Georgianos Panagiotis , Vaios Vasilios , Karligiotis Apostolos , Georgianou Eleni , Zebekakis Pantelis , Stergiou George S. , Liakopoulos Vassilios , Kollias Anastasios
Published: June 2023

Objective:

Although routine blood pressure (BP) measurements taken shortly before or after dialysis provide imprecise reflection of interdialytic ambulatory BP, this method continues to form the basis for the diagnosis of hypertension among patients on hemodialysis. Home BP monitoring (HBPM) is a guideline-recommended technique that may improve the diagnosis of hypertension in this population. Using 44-hour ambulatory BP monitoring (ABPM) as the reference-standard method, this study aimed to compare the diagnostic performance of home versus routine pre- and postdialysis BP recordings in hemodialysis patients.

Design and method:

In 70 stable patients with end-stage kidney disease receiving thrice-weekly hemodialysis, BP was assessed with the following methods: (i) routine predialysis and postdialysis BP measurements averaged over 2 weeks; (ii) HBPM for 7 days (dublicate morning and evening measurements, Microlife WatchBP Home N); (iii) ABPM (20 min intervals over an entire interdialytic interval - 44 hours, Microlife WatchBPO3).

Results:

The mean age of the patients was 65.3±13.3 years; 45 patients (64%) were males, and 62 (88.7%) had a known history of hypertension. The mean [95% confidence interval (CI)] of the difference between ambulatory systolic BP (SBP) and (i) predialysis SBP was 11.43 (8.24, 14.62) mmHg, (ii) postdialysis SBP was 3.9 (0.37, 7.56) mmHg, and (iii) home SBP was 8.61 (6.05, 11.17). The area under the receiver operating characteristic curve for the detection of an ambulatory daytime SBP equal or higher than 135 mmHg was significantly higher for home SBP measurements 0.934 (95% CI: 0.871-0.996) as compared to predialysis 0.778 (95% CI: 0.643-0.913) and postdialysis 0.766 (95% CI: 0.623-0.909) BP recordings (P = 0.02 for both comparisons). 1-week averaged home SBP at the cut-off point of 141.0 mmHg provided the best combination of high sensitivity (85.7%) and high specificity (92.9%) in diagnosing systolic ambulatory hypertension.

Conclusions:

The present study shows that among patients on hemodialysis, HBPM for 1 week provides greater accuracy than 2-week averaged routine pre- and postdialysis BP recordings in the diagnosis of hypertension confirmed by the reference-standard method of interdialytic ABPM.
HEALTHY VASCULAR AGEING PROTECTS COMMUNITY DWELLING ELDERLY FROM ALL-CAUSE MORTALITY: 5-YEAR EVIDENCE FROM THE NORTH SHANGHAI STUDY
Authors: Zhongyuan Ren , Jia Ruonan , Xu Yawei , Zhang Yi , Zhao Yifan
Published: June 2023

Objective:

Healthy vascular ageing (HVA) defined by normal pulse wave velocity (PWV) has been recognized as a valuable indicator of vascular status. And HVA strongly correlates with preclinical targeted organ damage (TOD). While the long-term benefit of HVA remains to be investigated. The study aims to investigate the long-term outcome of population with HVA based on large registered North Shanghai Study.

Design and method:

Since Jun. 2014, 3363 community-dwelling elderly Chinese (age larger than 65 years) were enrolled in the Northern Shanghai Study. HVA was defined as normal carotid femoral PWV that stratified by age and blood pressure. TOD was measured and categorized as vascular TOD indicated by carotid-femoral PWV and ankle-brachial index, cardiac TOD indicated by left ventricular hypertrophy and diastolic dysfunction, and renal TOD indicated by estimated glomerular filtration rate and urinary albumin/creatinine ratio. Follow-up outcome including all-cause mortality, cardiovascular and non-cardiovascular mortalities were evaluated.

Results:

1016 participants (30.2%) with HVA were identified. Compared with non-HVA group, although no gender difference, HVA group had younger age, lower blood pressure, lower body mass index (BMI), and milder TODs. Through a follow-up period of 5.7±1.8 years, 233 (6.9%) all-cause deaths, including 94 (2.8%) cardiovascular deaths were observed. Participants with HVA showed significantly higher survival from all-cause deaths (Log-rank P = 0.002) and cardiovascular deaths (Log-rank P = 0.003), but statistically non-significant survival from non-cardiovascular deaths (Log-rank P = 0.098). Subgroup analysis showed that HVA was a significant protective factor in female (HR 0.412 (0.245, 0.692), P = 0.002), participants aged 65-70 (HR 0.417 (0.194, 0.897), P = 0.025), participants with BMI<25 (0.570 (0.386, 0.842) P = 0.005), and participants with at least 1 TOD (HR 0.634 (0.444, 0.907), P = 0.013). Moreover, the protective value of HVA was only significant in participants without cardiac TOD (0.681, (0.464, 0.998), P = 0.049), participants with renal TOD (0.547, (0.354, 0.844), P = 0.006), and participants with vascular TOD (0.461 (0.251, 0.848), P = 0.013).

Conclusions:

In community-dwelling elderly, HVA could be a significant protective factor for all-cause deaths, especially in subpopulation of female, age 65-70, BMI<25 and with renal and/or vascular TOD.
PREDICTABILITY OF LOW OFFICE SYSTOLIC BLOOD PRESSURE FOR LOW HOME SYSTOLIC BLOOD PRESSURE IN THE PATIENT CONSIDERED FOR DOWN TITRATION OF ANTIHYPERTENSIVE MEDICATION
Authors: Shin Jinho , Lee Yonggu , Heo Ran , Kim Hyun Jin , Kim Byung Sik , Shin Jeong-Hun , Pyun Wook Bum
Published: June 2023

Objective:

With the recent trend of intensive blood pressure (BP) control strategy, some patients are considered for down-titration when office systolic BP (SBP) go below 120 mmHg. Considering many factors related to visit to visit BP variability and the discrepancy between office and out of office BPs, the predictability of low office SBP for low home SBP needs to be studied.

Design and method:

In a retrospectively study design, during 2020.09.01∼2022.05.31, patient recommended for home blood pressure monitoring (HBPM) for the decision for down-titration by physician's discretion. Physician's discretion was regarded to be present when OSBP < 120 mmHg. Additionally, patient data in the next visit in whom incidental home SBP were < 120mmHg were added for the analysis for the predictability and concordance of low office SBP for the low home SBP in the next visit, and the sustainability of the low office SBPs were calculated.

Results:

Among 82 enrolled patients, 69 patients with complete pre-HBPM office SBP, office SBP and HBPM data at the next visit were available were analyzed. Home SBP (112.1±8.9 mmHg, p<0.001 for both) were significantly lower than pre-HBPM (123.0±17.8 mmHg) office SBP and office SBP at the next visit (122.5±12.9 mmHg). Among 33 patients with low pre-HBPM office SBP, 28 patients (85.5%) showed low home SBP. Low pre-HBPM office SBP were sustained in 17 patients (51.5%). Among 59 patients with low home SBP, 31 patients (52.5%) were pre-HBPM office SBP were 120 mmHg or higher. At the time of HBPM, overall concordance rate between low office SBP and low home SBP were 33.3% (23 patients).

Conclusions:

The predictability of office SBP for low home SBP is good enough to decide down-titration at the next visit and the low office SBP were sustained in more than a half. But a half of low home SBP patients is detected incidentally by HBPM. Whether routine HBPM for down-titration will be needed for patients’ safety needs further study.
CONSENSUS TOWARDS THE UTILISATION OF BISOPROLOL IN COMBINATION WITH TELMISARTAN IN INDIAN PATIENTS WITH HYPERTENSION
Authors: Sawhney Jps , Garg Rajeev , Makkar Jitendra , Dani Sameer , Guha Santanu , Dalal Jamshed , Ray Saumitra , Agarwal Rajeev , Kaul Upendra , Solanki Dharmesh
Published: June 2023

Objective:

To formulate a consensus statement for the utilization of bisoprolol in combination with telmisartan based on the contemporary evidence and the real-world experiences of the Indian cardiologists

Design and method:

A virtual collaborative educational initiative was convened from November 2022, to December 2022, through a series of 8 nationwide virtual interactive meetings by leading cardiologists (n = 90) at the forefront of cardiovascular care (CERTAIN Study Group). The cumulative clinical experience was approximately 2,500-man-years, who rated their level of agreement for 14 questions with each item on a 5-point Likert scale. This was preceded by a contemporary evidence-based discussion on the contemporary updates for hypertension and for the combination of bisoprolol (beta blocker) and telmisartan (ARB). Weighted mean for the Likert scale was calculated and consensus was pre-defined as a score > 100. GraphPad 9.4.0 and ANOVA were used for statistical analysis.

Results:

The highest agreement score was for the concurrence for the diabetes have consistently higher risks over the whole BP range (127), bisoprolol is a suitable choice for management of Left Ventricular Dysfunction post MI (124), bisoprolol has impactful clinical implications for modulation of resting heart rate in patients with CAD (123), telmisartan has a distinctive pharmacological properties that translate into a clinically relevant approach for management of hypertension (122), bisoprolol is beneficial in patients with hemodialysis (120), bisoprolol in combination with telmisartan is useful in patients with co-morbidities (115), bisoprolol has modulatory properties for the impact of remodelling in patients with heart failure (111), bisoprolol in combination with telmisartan is a useful tool to manage hypertension. (Figure). The highest mean response scores (±SD, 95% CI) for consensus were for agree (25±10, 95% CI 19 to 31) followed by strongly agree (14±11, 95% CI 7.6 to 20)

Conclusions:

We observed a high preference for the combination of bisoprolol with telmisartan for use in patients with hypertension with comorbidities. We attribute this to a high level of perceived effectiveness, based on the recent clinical trials.
BLOOD PRESSURE MEASUREMENTS IN HYPERTENSIVE PATIENTS OVER 60 YEARS OLD IN A PRIMARY CARE HEALTH CENTER NEAR BY A BIG CITY: WHAT ABOUT THE THERAPEUTIC GOALS?
Authors: Filippelli Leila Ayelen Miserque , Lemo Tatiana , Miserque Wadit
Published: June 2023

Objective:

Until today we have no universal worldwide definition about the value to be used to determine if the patient have arterial hypertension or not, even worse in the elderly, such an special population with all the risk arround to not have blood pressure (BP) under control.

It is that according to differents guidelines that we relies on for diagnosis and treatment.

For example, for the European Society of Cardiology/European Society of Hypertension (ESC/ESH) is defined as a systolic BP (SBP) greater than or equal to 140 mmHg or a diastolic BP (DBP) greater than or equal to 90 mmHg, Against to the American College of Cardiology and the American Association of Cardiology (ACC/AHA) that define as a normal BP less than 120/80 mmHg. Meanwhile for the Argentine Society of Cardiology (SAC) BP would be less than 130 and/or 85 mmHg.

To determine if the hypertensive population that participated in this study meets the therapeutic goals proposed in the guidelines or not.

Design and method:

We included patients older than 60 years old previusly diagnosed with arterial hypertension who where attended between march and june in 2022, retrospectively. They were classified according to age and sex and blood pressure value at the time of the evaluation, taken according to recommendations.

Results:

855 hypertensive subjects were recruited (female 28%, 71,9±7,8 years); with an average SBP of 138.9±17,4 mmHg, an average DBP of 85.9±12,9 mmHg and an average mean pressure (MAP) of 103.5±13,8 mmHg.

Table 1 shows the results obtained for SBP, DBP, and MAP according to age.

Conclusions:

No matter which guideline is taken as reference, the vast majority of the hypertensive population studied continues without controlling their BP values, finding themselves above the goals of any of the mentioned guides, knowing the great risk that this can cause in this such a special population. More universal studies are needed to achieve a global reference value.
SMARTPHONE-BASED OPHTHALMOSCOPY TO DIAGNOSE HYPERTENSIVE CRISIS IN THE EMERGENCY DEPARTMENT: A PILOT STUDY
Authors: Kalic Haris , Broddin Bregt E.K. , Kramer Suzanne C. , Mostard Guy J.M. , Buijs Jacqueline , Twist Daan J.L. van
Published: June 2023

Objective:

Suspected hypertensive crisis requires comprehensive evaluation in the emergency department(ED). Fundoscopy is of pivotal importance to diagnose grade III&IV hypertensive retinopathy which requires prompt intravenous blood pressure control. However, routine fundoscopy by ophthalmologists is time-consuming and delays treatment. In this pilot study, we introduced smartphone-based ophthalmoscopy to evaluate its feasibility as a faster alternative.

Design and method:

We retrospectively evaluated ED length of stay in all patients who underwent smartphone-based ophthalmoscopy for suspected hypertensive crisis. Smartphone-based ophthalmoscopy included 30-second retinal video recordings performed by residents, which were remotely evaluated by an ophthalmologist. Patients were matched in a 1:3-ratio to a historical cohort who underwent conventional fundoscopy by an ophthalmologist. We evaluated ‘total time in ED(TTED)’ which is time in waiting room(TIW) until ED-discharge for all patients and ‘true treatment time(TTT)’ defined as TTED minus TIW for a subset of patients.

Results:

38 patients with hypertensive crisis underwent smartphone-based ophthalmoscopy. 5 were excluded because of technical difficulties requiring conventional fundoscopy and 2 due to inadequate time-registration. Consequently we included 31 patients and matched them with 93 controls. Mean TTED was 196±65min for the smartphone-group and 225±75min for the control-group(p = 0.059). Mean TTT (available for 19 and 81 patients, respectively) was significantly lower in the smartphone-group: 171±64min vs. 217±75min(p = 0.015). Additional survival analysis revealed shorter ED-stay in the smartphone-group (p = 0.030 & p = 0.011 for TTED & TTT, respectively).

Conclusions:

The use of smartphone-based ophthalmoscopy in suspected hypertensive crises was feasible and associated with reduction of treatment time in the ED as compared to conventional fundoscopy by an ophthalmologist.
ELUCIDATING LOCAL PHOSPHODIESTERASE 3A SIGNALING AS A BASIS FOR GAINING INSIGHT INTO HYPERTENSION-DRIVING MECHANISMS
Authors: Liu Tiannan , Zuhlke Kerstin , Sholokh Anastasiia , Klussmann Enno
Published: June 2023

Objective:

Mutant PDE3A causes hypertension by driving mechanisms that increase peripheral vascular resistance. However, the media to lumen ratio of vessels in mutant PDE3A rat models varied between second-order mesenteric arteries and thoracic aorta. This observation may be related to alterations of the mutant PDE3A in its intracellular location, its hyperactivity and aberrant phosphorylation, which could lead to altered compartmentalized cAMP signaling. PDE3A hydrolyzes cAMP. Therefore, we hypothesized that alterations in compartmentalized cAMP signaling in vascular smooth muscle cells (VSMC) contributes to the hypertension.

Design and method:

Three different VSMC models were established: VSMCs from rat thoracic aorta, VSMCs from rat secondary mesenteric arteries and VSMCs expressing mutant PDE3A that were differentiated from human induced pluripotent stem cells. The expression levels of PDE3A and candidate genes were detected by immunofluorescence microscopy, Western blotting and qPCR based on results of RNA sequencing. cAMP and Ca2+ signaling pathways are being evaluated by FRET technology and Ca2+ imaging.

Results:

VSMCs differentiated from human induced pluripotent stem cells could detect abundant expression of vascular smooth muscle cell markers. Differential expression levels of PDE3A and the two screened candidate genes were found in different types of VSMCs.

Conclusions:

Elucidating differences in cAMP and Ca2+ cycling between different types of VSMCs yielded new insight into the mechanisms of hypertension. The mutant PDE3A signaling may be a starting point for an innovative, PDE3A compartment-specific pharmacological concept for the treatment of hypertension.
PEAK HOME BLOOD PRESSURE AS AN EARLIER AND STRONG NOVEL RISK FACTOR FOR STROKE: THE PRACTITIONER-BASED NATIONWIDE J-HOP STUDY EXTENDED
Authors: Kario Kazuomi , Tomitani Naoko , Fujiwara Takeshi , Okawara Yukie , Kanegae Hiroshi , Hoshide Satoshi
Published: June 2023

Objective:

While home blood pressure (BP) measurement is recommended for hypertension management, the clinical implications of peak home BP values have not been well studied. This study investigated the association between pathological threshold or frequency of peak home BP and cardiovascular events in patients with > = 1 cardiovascular risk factor.

Design and method:

The Japan Morning Surge-Home Blood Pressure(J-HOP) study enrolled participants from 2005–2012 with extended follow-up from December 2017 to May 2018, which generated the dataset for this analysis. Average peak home systolic BP (SBP) was defined as average of the highest three BP values on 14-day measurement period. Patients were divided into quintiles of peak home BP, and the risk of stroke, coronary artery disease (CAD) and atherosclerotic cardiovascular disease (ASCVD; stroke+CAD) was determined.

Results:

In 4231 patients (mean 65 years) followed for 6.2years there were 94strokes and 124CAD events. The adjusted hazard ratio (HR) (95% CI) for the risk of stroke and ASCVD in patients with average peak home SBP in the highest versus lowest quintile was 4.39(1.85–10.43) and 2.04(1.24–3.36), respectively. Risk was greatest for stroke in the first 5 years: HR 22.66(2.98–172.1). The pathological threshold of average peak home SBP for 5-year stroke risk was 176 mmHg. There was a linear association between the number of times peak home SBP >175 mmHg and stroke risk.

Conclusions:

Peak home BP was a strong risk factor for stroke, especially within the first 5 years. We propose exaggerated peak home SBP >175 mmHg as an early and strong novel risk factor for stroke.
SEASONAL EFFECT ON BLOOD PRESSURE VARIABILITY IN HYPERTENSIVE PATIENTS ASSESSED BY DIFFERENT MEASUREMENT METHODS
Authors: Kollias Anastasios , Kyriakoulis Konstantinos , Menti Ariadni , Ntousopoulos Vasileios , Destounis Antonios , Kalogeropoulos Petros , Myrsilidi Aikaterini , Stergiou George S.
Published: June 2023

Objective:

The seasonal variation in temperature is well known to affect the level of blood pressure (BP). However, its impact on BP variability is uncertain. This study investigated the seasonal variation in BP variability in hypertensive patients assessed using office and out-of-office BP measurements.

Design and method:

Adult hypertensives on stable antihypertensive drug treatment were assessed with office (OBP), home (HBP), and ambulatory BP (ABP) measurements in winter, next summer, and in the next winter. BP variability was quantified using the standard deviation (SD) and coefficient of variation (CV).

Results:

Fifty-eight participants had complete data for winter and summer (mean age 65.2±7.9 [SD], 64% males, 21% obese, 48% smokers, 11% diabetes, 18% cardiovascular disease, 28% on a single antihypertensive drug, 38% on 2 drugs, 34% on > 2 drugs). OBP, HBP and daytime ABP were lower in summer than in winter (P<0.01), whereas nighttime ABP was unchanged (P = NS) (Figure). SD and CV for systolic OBP were higher in winter than summer (P<0.01/<0.05, respectively). BP variability assessed by HBP and ABP measurement did not differ in winter and summer (Figure). Forty participants had complete data for winter-summer-next winter. OBP, HBP and daytime ABP were higher in the second winter compared with summer excluding any order effect. Respective CV values showed no difference (p = NS).

Conclusions:

These preliminary data suggest that despite the considerable impact of seasonal changes in temperature on the levels of BP, its variability is not affected. Thus, variability appears to be an intrinsic feature of the individual's BP behaviour, which is largely unaffected by extrinsic seasonal factors.
ASSOCIATION OF AMBULATORY AND HOME BLOOD PRESSURE VARIABILITY FOR CARDIOVASCULAR OUTCOMES
Authors: Narita Keisuke , Hoshide Satoshi , Kario Kazuomi
Published: June 2023

Objective:

Although blood pressure (BP) variability (BPV) is reportedly associated with cardiovascular prognosis, there is no evidence that either ambulatory BPV (ABPV) or home BPV (HBPV) is a superior clinical marker.

Design and method:

We analyzed the association of ABPV and HBPV with cardiovascular prognosis in 1,319 hypertensive outpatients who underwent both home and ambulatory BP measurements in the Japan Morning Surge-Home Blood Pressure (J-HOP) study. BPV is evaluated by standard deviation (SD), coefficient of variation (CV), and average real variability (ARV) of 24-h ambulatory and average morning and evening home systolic BP.

Results:

During the median 6.9 years of follow-up, 109 cardiovascular events occurred. All SD, CV, and ARV of HBPV were significantly associated with cardiovascular risk even after adjusted by ABPV (1-SD of HR [95%CI] in SD, CV, and ARV of HBPV: 1.47 [1.23–1.75]; 1.48 [1.24–1.75]; and 1.33 [1.14–1.54]). In the model improvement using goodness-of-fit, HBPV values significantly improved the model predictability when adding to the model including confounding factors and mean 24-h ambulatory SBP and ABPV values. However, these relationships were not shown in ABPV parameters.

Conclusions:

Based on the findings from this study using both ambulatory and home BP monitoring in the same individuals, HBPV, i.e., day-to-day BPV, was suggested to have superiority in predicting for cardiovascular incidence compared to ABPV, i.e., short-term BPV through 24-hours.
ASSOCIATION BETWEEN MASKED NOCTURNAL HYPERTENSION AND DEPRESSION DISORDER IN COVID-19 POSITIVE PATIENTS
Authors: Koh Jong Hoon , Kim Miyoung , Kang Minjong
Published: June 2023

Objective:

An effect of depression for masked hypertension are scarce. We evaluated the prevalence and clinical characteristics of masked nocturnal hypertension (MNH) under hypertension in COVID 19 positive patients

Design and method:

The study evaluated 158 hypertensive patients with COVID 19 positive and depression disorder, evaluated by self BP monitoring. Among the participants, classified as masked nocturnal hypertension(MNHT) ( Daytime BP below 135/85 mmHg and night-time BP over 120/70 mmHg.

Results:

COVID 19 positive patients with depressive symptoms had a significantly higher incidence of hypertension in women compared to men with depressive symptoms. In the logistic regression analysis, the presence of depressive symptom was significantly associated with masked hypertension with COVID 19 positive independently of age, body mass index, education level, and current smoking and drinking status.

Conclusions:

COVID 19 positive patients with Depressive symptoms were highly associated with the incidence of hypertension among middle aged women and The highly significant predictive risk factor of depression disorder might be high nighttime BP. Comparison of clinic BP with either daytime high BP or awake high BP
ASSOCIATION BETWEEN BMI AND AMBULATORY BLOOD PRESSURE CHARACTERISTICS: EVIDENCE FROM POPULATION-BASED AMBULATORY BLOOD PRESSURE MONITORING COHORT
Authors: Zhang Xinmin , Cai Qiujing , Zhao Xiaolei , Zeng Mingfa , Liu Lisheng , Hu Aihua
Published: June 2023

Objective:

The aim of our study was to investigate the association between BMI and Chinese hypertensive patients’ ambulatory blood pressure characteristics.

Design and method:

According to the inclusion criteria and exclusion criteria, recruiting participants for analysis. Overweight was defined as BMI = > 18.5 kg/m2, and obesity as BMI = > 25 kg/m2. ABPM characteristics were defined according to European guidelines. Hypertension was defined as elevated mean ambulatory BP (>135/85 mmHg in day-time, >120/70 mmHg in the night-time, >130/80 mmHg over 24-h). There are four kinds of blood pressure circadian rhythm, dippers, non-dippers, reverse dippers, and extreme dippers. The effects of BMI on ambulatory blood pressure characteristics were analyzed using between-group analysis of variance and logistic regression analysis.

Results:

In our cohort, 35367 hypertensive patients who were eligible for this study were analyzed finally, including 19380 men (54.8%) and 15987 women (45.2%) aged from 19 to 99 (mean age 58.86 years). The mean 24hBP of the study subjects was 126.41±16.00/78.79±11.62 mmHg. The different BMI groups showed that ambulatory BP increased with BMI, and the obese group had the highest increase in BP, HR, and systolic BP (P < 0.05). Blood pressure variability and systolic load tended to increase with BMI, while the nocturnal blood pressure drop rate tended to decrease. When analyzing the type of hypertension among the participants, the prevalence of MBPS and morning hypertension increased significantly with the elevated BMI (P < 0.05), and the highest prevalence of MBPS was found in the obese group. Logistic regression analysis revealed that the increased risks of MBPS and morning hypertension were the highest in the obese group, corresponding to a 2.1-fold (P < 0.05) and 1.6-fold (P < 0.05) increase in risk, respectively, with no change in trend after adjustment.

Conclusions:

BMI may affect the characteristics of hypertensive patients’ ambulatory blood pressure. The blood pressure variability and 24h SBP tended to increase with BMI, and the incidence of MBPS was highest in the obese group.
EFFECT OF COVID-19 ON BLOOD PRESSURE VARIABILITY IN HYPERTENSIVE PATIENTS
Authors: Dumitrescu Silviu Ionel , Munteanu Alice , Stanciu Silviu , Hantulie Ileana , Popescu Raluca , Gurzun Magdalena , Ionescu Ruxandra , Ciobanu Diana , Cecoltan Serghei , Boingiu Rares , Prisascariu Irina
Published: June 2023

Objective:

To investigate the influence of COVID-19 on blood pressure variability in hypertensive patients with known subclinical organ damage (SCOD) previously assessed by evaluation of brachial artery Flow Mediated Dilatation (FMD), carotid artery Intima Media Thickness (IMT), left ventricular mass indexed to BSA (LVMI), E/e` ratio, left atrial volume indexed to BSA (LAVI).

Design and method:

We assessed 108 hypertensive patients who had SARS-CoV-2 infection in the previously 3 months before evaluation. All subjects included where evaluated for the presence of SCOD in the last 12 months before COVID-19 and underwent a 24-hour noninvasive ABPM on a working day, performing usual daily activities and avoiding heavy physical exercise. BP and heart rate readings were obtained every 15 minutes during daytime and every 30 minutes during nighttime. Subjects recorded a journal of the activities performed and the time of retiring to bed, ABPM recordings being divided into ‘awake’ or ‘asleep’ periods based on diary entries and not on predefined time intervals. BP variability was calculated as the standard deviation (SD) of mean blood pressure.

Results:

The hypertensive patients with previously known subclinical disease (SCOD+) compared with those without it (SCOD–) had significantly higher systolic and diastolic BP after SARS-CoV-2 infection, and significantly increased variability of both systolic and diastolic BP. Also, they had a significantly reduced decrease of nocturnal systolic BP (table 1). The analysis for each marker of subclinical organ damage indicated that increased systolic BP variability in hypertensive COVID-19 patients was significantly correlated with carotid IMT (r = 0.517, p = 0.001), brachial artery FMD (r = 0.426, p = 0.008), LVMI (r = 0.397, p = 0.009), E/e` ratio (r = 0.543, p = 0.001), left atrial volume indexed to BSA (LAVI) (r = 0.478, p = 0.003) and that diastolic BP variability is significantly correlated with carotid IMT (r = 0.362, p = 0.09), brachial artery FMD (r = 0.491, p = 0.006), LVMI (r = 0.369, p = 0.008), E/e` ratio (r = 0.422, p = 0.005), left atrial volume indexed to BSA (LAVI) (r = 0.407, p = 0.002).

Conclusions:

Our study indicates that SARS-CoV-2 infection in hypertensive patients induces an increased blood pressure variability which is significantly correlated with the presence of previously diagnosed subclinical disease.
IMPLICATION OF PULMONARY ARTERY SYSTOLIC PRESSURE FOR PROLONGED CARDIOPULMONARY BYPASS DURATION IN PATIENTS UNDERGOING RE-REPAIR FOR DEGENERATIVE MITRAL REGURGITATION
Authors: Xu Hang , Liu Sheng
Published: June 2023

Objective:

Emerging evidence revealed that the longer duration of cardiopulmonary bypass (CPB) during cardiac surgery renders patients at higher risk of adverse outcomes. However, little is known regarding the risk factor of prolonged CPB in patients undergoing re-repair of degenerative mitral regurgitation (DMR). We aimed to explore the prognostic significance of pulmonary artery systolic pressure (PASP) on CPB duration in patients undergoing re-repair of DMR.

Design and method:

Patients with DMR undergoing re-repair in our center were consecutively enrolled from Jan 2009 to Dec 2021. Patients were stratified into the prolonged CPB group (CPB time < 132 min, n = 61) and the shorter CPB (CPB time < 132, n = 59). Preoperative Univariable and multivariable logistic regression analyses were used to evaluate the impact of PASP on the risk of prolonged CPB duration.

Results:

Of the 120 patients enrolled, 61 had prolonged CPB time (50.8%). The mean preoperative PASP was higher in the prolonged CPB group compared with the shorter CPB group (45.2±21.9 vs. 37.7±15.1, P < 0.05). CPB time increased with higher preoperative PASP (P < 0.05). For per 10 units of pre-PASP value increase in patients undergoing re-repair for DMR, there were 1.25 times more likely to be associated with a prolonged CPB time (adjusted odds ratio [OR] 1.25, 95% confidence interval [CI] 1.01-1.56, P < 0.05). Patients with preoperative PASP > 50mmHg had an adjusted OR of 3.66 (95% CI 1.36-9.84, P < 0.05) for a prolonged CPB period compared with those with preoperative PASP < 50mmHg.

Conclusions:

Preoperative PASP in patients requiring re-repair for DMR was associated with a higher likelihood of an extended time of CPB. Regular screening of pulmonary hypertension may aid in perioperative risk-stratification in patients prior to re-repair for DMR.
VACUOLAR H+-ATPASE AS A NOVEL TARGET TO LOWER LOW DENSITY LIPOPROTEIN CHOLESTEROL
Authors: Wang Na , Liu Xinyu , Lin Hui , Danser A.H Jan , Lu Xifeng
Published: June 2023

Objective:

Low density lipoprotein cholesterol (LDL-c) is cleared from the circulation through binding to the hepatic LDL receptor (LDLR). The (pro)renin receptor [(P)RR, also known as vacuolar H+-ATPase (V-ATPase) accessory protein 2 or ATP6AP2)] is a regulator of this process. Indeed, (P)RR silencing markedly reduced LDLR protein abundance and thereby LDL uptake. Since V-ATPase is a multi-subunit complex (consisting of 13 subunits), in this study we evaluated the role of subunits other than the (P)RR.

Design and method:

siRNAs were designed against all V-ATPase subunits, transfected into HepG2 cells, and evaluated for their capacity to affect cell surface LDLR. Given that silencing subunit ATP6V1B2 upregulated LDLR most, we next designed an adeno-associated virus expressing shAtp6v1b2 and injected this into C57BL/6 mice and then investigated the effects of Atp6v1b2 knocking-down on LDL metabolism in vivo.

Results:

Silencing subunit ATP6V1B2 in HepG2 cells increased surface LDLR and total LDLR protein abundance by 1.5- and 2.3-fold, respectively. This was accompanied by both LDLR mRNA upregulation, suggestive for de novo protein synthesis, and enhanced LDL uptake following exposure to excess LDL. Silencing ATP6V1B2 significantly increased the mRNA levels of sterol regulatory element-binding protein 2 (SREBP2)-targeted genes (SQLE, HMGCR, and NPC1) as well as the nuclear SREBP2 protein level. In vivo, knocking-down Atp6v1b2 decreased plasma total cholesterol by 23%, without affecting total triglycerides. This was accompanied by LDLR upregulation in the liver, both at the mRNA and protein levels.

Conclusions:

The V-ATPase subunit ATP6V1B2 is an important regulator of LDLR expression. This involves the transcription factor SREBP2, and allows substantial LDL-c lowering. V-ATPase might be a novel pharmacological target to lower cholesterol.
TRANSGENERATIONAL IMPACT OF EARLY CHILDHOOD FAMINE EXPOSURE IN THE COHORT OF LENINGRAD SIEGE SURVIVORS’ OFFSPRINGS
Authors: Tolkunova Kristina , Moguchaya Ekaterina , Boiarinova Maria , Usoltsev Dmitrii , Vasilyeva Elena , Rotar Oxana , Konradi Aleksandra , Shlyakhto Evgeny , Artomov Mykyta
Published: June 2023

Objective:

Famine exposure in early life may promote the epigenetic transgenerational inheritance of phenotypic variability. It may increase susceptibility or contribute to disease resistance in offspring. The research aims to assess the prevalence of cardiometabolic risk factors in the descendants of besieged Leningrad residents and in controls from population-based sample comparable in sex, age, and body mass index (BMI).

Design and method:

The besieged Leningrad residents were exposed to famine in early childhood during the Second World War (1941-1944). There were examined 87 descendants of Leningrad Siege survivors aged 18 to 63 (56 children and 29 grandchildren) without cardiovascular complications. Anthropometry, blood pressure (BP) measurement, biochemical blood tests were performed, glomerular filtration rate (GFR) was estimated using the CKD-EPI equation. Controls from the population-based national epidemiological ESSE-RF study (n = 175) were matched by sex, age, and BMI. Phenotypes of controls and descendants were compared, correcting for multiple hypothesis testing.

Results:

After multiple comparison correction only higher creatinine level and low GFR were recorded as statistically significant differences between Siege survivors’ descendants and the control group (Table 1).

Table 1. Comparative analysis of Leningrad Siege survivors’ descendants and control group.

Conclusions:

Ancestral famine exposure in early childhood contributed to a decrease of kidney filtration capacity in offspring. One of the potential mechanisms could be associated with alterations in epigenome through programming of nephron deficiency in germ cells but further molecular studies would be required for confirmation.
OXALATE-DEGRADING ACTIVITY IN FECAL MICROBIOTA IS ASSOCIATED WITH OBESITY AND CARDIOVASCULAR EVENTS IN END-STAGE KIDNEY DISEASE PATIENTS
Authors: Stepanova Natalia , Tolstanova Ganna , Akulenko Iryna , Savchenko Svitlana , Dobbynchuk Taisa
Published: June 2023

Objective:

In contrast to the general population, the obesity paradox observed in end-stage kidney disease (ESKD) patients is associated with a better CVD prognosis. Considering the similar signature of the gut microbiota in oxalate metabolism, obesity, and CVD, we hypothesized that altered oxalate-degrading activity (ODA) in the fecal microbiota, rather than obesity per se, might influence the development of CVD in ESKD patients.

Design and method:

A total of 32 ESKD patients aged 52.5 (40-62) years were enrolled in this retrospective observational cohort pilot study. CVD events were defined as any new-onset disease of the heart and associated blood vessels during the 3-year follow-up period after completion of evaluation.

The fecal total ODA, defined as the total ability of the different strains of oxalate-degrading bacteria to metabolize oxalate, was determined by redoximetric titration with KMnO4; results were expressed as % oxalate degradation per 0.01 g of feces. Data analysis and all graphs were generated using MedCalc software.

Results:

Total fecal ODA ranged from -16 to 24%/0.01 g feces and was inversely correlated with BMI (Fig. 1). During the 3-year follow-up period, 5/7 (71.4%) obese patients, 2/11 (18.2%) overweight patients, and 2/14 (14.3%) normal-weight patients experienced CVD (⇙2 = 8.4, p = 0.01). The ROC analysis showed that a negative total fecal ODA (<-1%/0.01 g feces) was the most appropriate cut-off point for predicting CVD events in ESKD patients, with a sensitivity of 77.8% and a specificity of 74% (Fig. 2). In univariate Cox regression analysis, both obesity (HR 8.2, 95% CI 1.2; 18.1) and negative fecal total ODA (HR 9.4, 95% CI 2.3; 19.4) were associated with CVD events. In the multivariate model of Cox regression analysis adjusted for age, dialysis vintage, diabetes, and dyslipidemia, negative total fecal ODA, but not obesity, was associated with CVD events in our cohort (Fig. 3).

Conclusions:

Our findings provide preliminary evidence that a decrease in fecal total ODA is associated with obesity and the development of CVD in ESKD patients. Further studies are needed to determine altered fecal total ODA as a risk factor for the development of CVD in ESKD patients.
PROGNOSTIC VALUE OF LV GLOBAL STRAIN FOR PREDICTING POSTOPERATIVE MYOCARDIAL INJURY AND MORTALITY IN PATIENTS WITH MAJOR NONCARDIAC SURGERY: MULTICENTER, PROSPECTIVE, OBSERVATIONAL
Authors: Seo Hye Sun , Park Soo Young , Moon Inki , Jung In Hyun , Kim Minkwan
Published: June 2023

Objective:

The role of preoperative echocardiography at rest is less well studied. We analyzed the prognostic value of left ventricular global longitudinal strain (LVGLS) for predicting postoperative 30-day cardiovascular events and myocardial injury after noncardiac surgery (MINS).

Design and method:

We performed a prospective cohort study in two referral hospitals enrolling participants over 45-year-old with more than one cardiovascular risk factor or 65-year-old aged who planned elective noncardiac major surgery and underwent resting echocardiography before surgery. Preoperative demographic, clinical, and echocardiographic data, including LVGLS, were collected. Subjects with minor surgery, reduced ejection fraction below 40%, more than moderate valvular heart disease, and presence of regional wall motion abnormality were excluded. The primary endpoint was a composite of all-cause death, non-fatal myocardial infarction, and acute coronary syndrome (ACS) needing urgent revascularization at early postoperative period. MINS was defined as absolute increase troponin of at least 14 pg/mL between two measurements.

Results:

From 2020 June to 2022 March, 871 participants were enrolled; the mean age was 72.9 (SD 9.3) and 60.8% were female. There were 12 cases of the primary endpoint (1.4%): 10 cases of death, and 3 cases of revascularization due to ACS. Participants with impaired LVGLS <16.6% had a higher incidence of the primary endpoint (log-rank P = 0.015) than those without. This result was concordant after adjustment with clinical variable and preoperative troponin-T level (hazard ratio 1.30, 95% confidence interval [CI] 1.03–1.65; P = 0.027). In sequential Cox analysis and net reclassification index, LVGLS had incremental value for predicting the primary endpoint after noncardiac surgery. Among 538 (61.8%) participants available pre and post-troponin assay, LVGLS can predict MINS independently (odds ratio 3.54, 95% CI 1.70–7.36; P = 0.001).

Conclusions:

Preoperative LVGLS has independent and incremental value to predict early postoperative cardiovascular events and MINS.
INDEPENDENT ASSOCIATION BETWEEN URIC ACID LEVELS AND MYOCARDIAL MECHANO-ENERGETIC EFFICIENCY AS ASSESSED BY ECHOCARDIOGRAPHY
Authors: Paini Anna , Bertacchini Fabio , Aggiusti Carlo , Stassaldi Deborah , Capellini Sara , Muiesan Maria Lorenza , Salvetti Massimo
Published: June 2023

Objective:

In the last decades several studies have investigated the relationship between serum uric acid (SUA) levels and cardiovascular disease and heart failure. Low myocardial mechano-energetic efficiency (MEE), estimated as stroke volume/heart rate ratio per g of left ventricular (LV) mass (LVM) is an independent predictor of cardiovascular (CV) events and heart failure.

Design and method:

Aim of the study was to evaluate the relationship between SUA and myocardial mechano-energetic efficiency index (MEEi) in 694 consecutive uncomplicated patients attending the outpatient at an ESH Excellence Centre in Italy.

Methods BP values were measured by the physician with an automated oscillometric device, after 5 minutes of rest. All patients underwent transthoracic echocardiography, and standard indices of systolic function were calculated. In all patients myocardial mechanoenergetic efficiency (MEE) was calculated as stroke volume/heart rate and indexed to LV mass (MEEi = MEE/LVM) (de Simone et al, 2016).

Results:

Results Mean age was 57±13 yrs, 52% female, 21 % obese, 10 % diabetics, 69 % with a previous diagnosis of hypertension (77 % treated). MEEi was lower in males (0.42±0.14 vs 0.49±0.16, p<0.001), and in patients with diabetes (0.38±0.11 vs 0.47±0.16, p<0.001). At multivariate analysis the variables independently correlated with MEEI were male sex, systolic blood pressure, presence of obesity, plasma glucose levels, and serum uric acid, but not age and eGFR (CKD EPI).

At receiver operating curves (ROC) analysis the optimal cutoff of uric acid for the prediction on reduced MEEI was 5.4 mg/dl (AUC 0.611. 95 CI 0.574-0.648).

Conclusions:

Conclusions In a large sample of uncomplicated patients attending the outpatient clinic at an ESH Excellence Centre in Italy uric acid is an independent predictor of myocardial mechanoenergetic efficiency. In this population the optimal cutoff of uric acid for reduced MEEI is 5.4 mg/dl. These findings may contribute to the explanation of the greater risk of heart failure in patients with increased uric acid levels.
CARDIOVASCULAR EVENTS IN TYPE 2 DIABETIC PATIENTS
Authors: Rihab Zouaoui , Meriem Khadhar , Sarra Haddad , Mouna Jerbi , Hanen Gaied , Raja Trabelsi , Rim Goucha
Published: June 2023

Objective:

Cardiovascular diseases represent the first cause of death of patients with type 2 diabetes.

The aim of our work is to identify the prevalence of cardiovascular disease in type 2 diabetes.

Design and method:

This is a retrospective descriptive study conducted over a period of three years (January 2013- January 2016) including type 2 diabetic patients followed up at the nephrology consultation of Mongi slim hospital. Clearance was calculated according to the MDRD formula. The stage of chronic kidney disease (CKD) was defined according to the KDIGO 2012 classification.

Results:

Our study included 42 patients with diabetic kidney disease followed at our nephrology consultation.

The mean age was 63.3 [31-80] with a sex ratio M/F = 1.47.

Eighty-eight percent of our patients had hypertension.

At the first consultation our patients already had macrovascular disease: 4 patients were suffering from peripheral artery disease, 4 patients had heart failure, a history of ischemic stroke was found in 4 patients and acute coronary syndrome in 11 patients.

Regarding cardiovascular risk factors, obesity was found in 13 patients, 6 patients were smokers and 25 patients (59.5%) had dyslipidemia with a mean cholesterol level of 4.48 +/- 1.09 mmol/l.

The mean fasting blood glucose level was 10.5 +/-5.23 mmol/l and a mean glycated hemoglobin was 8.24 +/-2.22%.

The renal impact was as follows: chronic kidney disease stage 3A in 12 patients (28.6%), stage 3B in 14 patients (33.3%), stage 4 in 6 patients (14.3%) and stage 5 in 2 patients.

During the course of the study, 7 patients had an acute coronary syndrome and 1 patient had an ischemic stroke.

Conclusions:

Diabetes is a cardiovascular risk factor in itself. Although nothing can be done about the non-modifiable risk factors (heredity, age, gender), it is possible to act early and effectively on the other modifiable factors.