bluuebunny/crossref_metadata_2025 huggingface dataset:
THE CLINICAL CHARACTERISTICS OF PATIENTS WITH NORMOTENSION IN PHEOCHROMOCYTOMAS AND PARAGANGLIOMAS
Authors: Zhao Lin , Zhang Ting , Fan Hua , Liu Yecheng , Zhou Xianliang , Zhu Huadong
Published: June 2023

Objective:

The predominant symptom of pheochromocytomas and paragangliomas (PPGLs) is variable hypertension (HTN); however, not all patients with PPGLs develop HTN. Studies of the clinical characteristics of normotensive patients and which patients are more likely to develop HTN in PPGLs are rare. This study was performed to identify the clinical features to better understand this clinical entity.

Design and method:

All consecutive adult patients with PPGLs were retrospectively enrolled from January 2018 to June 2020. The clinical characteristics of the patients were investigated. Multivariate logistic regression analysis was used to identify risk factors and receiver operating characteristic curves were used to evaluate the diagnostic performance of the variables.

Results:

There were 203 patients in the analysis, including 115 patients with normotension. Fewer patients with normotensive PPGLs had diabetes (p<0.001) and clinical symptoms (p<0.001). The 24-h urinary epinephrine (p = 0.002) and 24-h urinary norepinephrine (24hU-NE) concentrations (p<0.001) were lower, and tumor diameter (p<0.001) was smaller in patients with normotensive PPGLs. Multivariate logistic regression analysis showed that diabetes and 24hU-NE concentration were independent and negative risk factors for normotensive PPGLs. The area under the curve of 24hU-NE concentration and diabetes for predicting normotensive PPGLs was 0.788 and 0.634, respectively. Combining diabetes and 24hU-NE concentration into one model, the area under the curve of the model for predicting normotensive PPGLs was 0.817.

Conclusions:

Normal blood pressure couldn’t exclude PPGLs. Identifying the clinical characteristics of normotensive and hypertensive patients in PPGLs is helpful for risk stratification and individualized assessment and treatment.
ENDOTHELIAL FUNCTIONAL STATUS IN PATIENTS WITH HYPERTENSION AND TYPE 2 DIABETES MELLITUS AFTER COVID-19
Authors: Uzokov Jamol , Alyavi Bakhromkhon , Orziev Daler , Ubaydullaev Shakhboz
Published: June 2023

Objective:

Aim of the study was to estimate endothelial functional status in patients with hypertension and type 2 diabetes mellitus (T2DM) who underwent Covid-19.

Design and method:

56 patients with hypertension and T2DM after coronavirus infection (Group I) and 56 patients with hypertension and T2DM without any history of Covid-19 (Group II) were enrolled in this study. Group I patients aged 43-75 years, mean age 62.4±12.5 years; male = 46% and Group II patients aged 42-77 years, mean age 63.6±13.7 years; male = 43%. Endothelial functional status was assessed by flow-mediated vasodilation of brachial artery (FMD). All statistical analysis were performed by SPSS 26.0 software.

Results:

FMD of brachial artery was significantly decreased in patients with hypertension and T2DM after Covid-19 than those patients without Covid-19 (P<0.01). There were a correlation between Covid-19 and reduced FMD in Group I (r = 0.7, CI 95%, P = 0.032). When we assessed systolic function of the left ventricle, there were a positive correlation between reduced FMD and low ejection fraction (r = 0.6, CI 95%, P = 0.028), however this correlation were more pronounced in Group I (P = 0.001). Multivariate analysis revealed that reduced flow-mediated vasodilation of brachial artery was independent predictor of poor systolic function of patients with hypertension and T2DM especially in those after Covid-19 (odds ratio [OR] 1.52, P = 0.026). When we separately analyzed between men and women there were not any statistical significant changes between male and female (P>0.05).

Conclusions:

Patients with hypertension and type 2 diabetes mellitus after Covid-19 had impaired FMD of brachial artery. Even though, there were positive correlation between flow-mediated vasodilation of brachial artery and reduced ejection fraction, patients with hypertension and T2DM after Covid-19 had strong correlation of it. In hypertensive patients with type 2 diabetes mellitus who have undergone Covid-19, FMD independently associated with poor left ventricular systolic function.
REAL VS PERCEIVED BLOOD PRESSURE AND LDL-CHOLESTEROL CONTROL IN HYPERTENSIVE PATIENTS WITH DYSLIPIDEMIA: A CROSS-SECTIONAL EPIDEMIOLOGICAL STUDY IN ROMANIA (SNAPSHOT-1)
Authors: Vinereanu Dragos , Tanasescu Rodica , Vittos Oana , Ciobanu Andreea , Dolofan Bogdan , Trambitas Nicoleta , Johnson Neil , Guja Cristian
Published: June 2023

Objective:

To assess cardiovascular (CV) risk measurement, blood pressure (BP) and LDL-cholesterol (LDL) control rates, in hypertensive patients with dyslipidemia, based on current recommendations of guidelines, and compare them with assessment provided by physicians.

Design and method:

Cross-sectional, observational, multicenter epidemiological study (SNAPSHOT-1), conducted in Romania, involved 130 investigators (general practitioners, cardiologists, and diabetologists), and included 2469 hypertensive patients with dyslipidemia.

Results:

Study population (65±10 years; 40.9% men) had the following characteristics: 12.1% smokers; 40.9% overweight and 45.2% obese (BMI 30.1±5.2 kg/m2); 80.0% had comorbidities, most frequently diabetes mellitus (45.0%), angina (28.8%), and chronic kidney disease (18.8%). Mean systolic / diastolic BP were 137.6±17.1 / 81.0±10.4 mmHg, total cholesterol was 199.1±54.3 mg/dL, HDL-C 51.2±15.9 mg/dL, LDL-C 118.4±46.4 mg/dL, and triglycerides 162.1±92.4 mg/dL.

CV risk was estimated by the investigators as “high” or “very high” for 34.3% and 35.4% of patients, respectively, whereas calculated CV risk according to the SCORE chart 1 was “high” or “very high” for 12.6% and 81.8% of patients. Thus, only 41.5% of the investigators estimated CV risk accurately, while 54.2% underestimated it.

Hypertension was treated in 98.1% of patients. BP was considered controlled by investigators in 71.2% of patients, whereas BP control based on European recommendations was achieved by only 25.0% of patients. Dyslipidemia was treated in 90.9% of patients. LDL-C was considered controlled by investigators in 46.1% of patients, whereas LDL-C control based on European recommendations was achieved by only 8.8% of patients. Both BP and LDL-C were considered controlled by investigators in 39.6% of patients, whereas both targets were controlled based on European recommendations in only 3.3% of patients (Figure).

44.7% of patients were treated with a single-pill combination for hypertension, and only 9.0% received treatment for both hypertension and dyslipidemia in a single pill.

Conclusions:

This study showed that CV risk is underestimated by physicians in more than half of patients. BP and LDL-C control is markedly overestimated by physicians, while real control rates remain very low. Use of single-pill combinations is still low.
INHOSPITAL DETECTION OF ELEVATED BLOOD PRESSURE (INDEBP): PRELIMINARY RESULTS OF A RETROSPECTIVE ANALYSIS
Authors: Vischer Annina , Nafaa Fiona , Schaffhauser David , Socrates Thenral , Mayr Michael , Breidthardt Tobias , Burkard Thilo
Published: June 2023

Objective:

Elevated blood pressure (BP) values are commonly reported in hospitalized patients. Previous retrospective studies have shown that adaptions of BP medication are associated with a worse outcome. Objective of this study was to analyze the prevalence of elevated BP values in medical non-cardiac inpatients and to assess the proportion of patients with treatment modifications in response to elevated BP values during the hospital stay.

Design and method:

Retrospective analysis of randomly selected non-cardiac medical inpatients in a tertiary hospital in 2019 and 2021. Exclusion criteria were cardio-vascular hospitalization, missing general consent or age <18 years. Routine BP measurements from clinical checks were recorded, elevated BP defined as > = 140 and/or > = 90 mmHg. Antihypertensive treatment at admission was compared to that at discharge. Complications during hospitalization were a compound of myocardial injury, intracerebral bleedings, ischemic stroke/TIA, acute kidney injury, falls/syncope and death. Data were extracted from electronic health records. Categorical data was analyzed with a Fisher's exact test, continuous data with a Mann-Whitney-U-test.

Results:

301 patients were included, 101 (33.6%) in 2019, and 200 (66.4%) in 2021, 130 (43.2%) were female, median age was 66 years (IQR 55.5 – 76). 152 (50.5%) had a history of hypertension. 47 patients (15.6%) had exclusively normal BP values during a median of 10 days (IQR 5 – 21) of hospitalization. Of those 254 patients (84.4%) with elevated BP during the hospitalization, 105 (41.3%) had their antihypertensive treatment adapted: 54/254 patients (21.3%) had > = 1 new antihypertensive, 18/254 patients (7.1%) had the antihypertensive dose increased, 11/254 (4.3%) had the antihypertensive agent exchanged, 47/254 (18.5%) had an antihypertensive stopped, and 22 (8.7%) had the dose decreased (multiple answers possible). Patients with treatment modifications had significantly more complications (22.9 vs 10.3%), p-value 0.012. Differences between patients with and without treatment adaptions are shown in the Table.

Conclusions:

Elevated BP is a frequent and significant clinical problem during hospitalization. Nearly half of the patients with elevated BP had their medications adapted during hospitalization. Modification of antihypertensive therapy was associated with more complications, whereby no statement can be made about causality.
PRE-DONATION OBESITY AND POST-DONATION HYPERTENSION IN LIVING KIDNEY DONORS
Authors: Tantisattamo Ekamol , Naunsilp Piengpitch , Puchongmart Chanokporn , Wattanachayakul Phuuwadith
Published: June 2023

Objective:

The association of obesity status during the pre-kidney donation period with the risk of developing post-donation hypertension (HTN) is unclear. We aim to evaluate the effect of pre-donation obesity status on the rate of post-donation systolic and diastolic hypertension (SHTN and DHTN).

Design and method:

A retrospective cohort study using the SRTR database included living kidney donors (LKD) undergoing donation between March 2008 and July 2020. Risks for developing SHTN and DHTN defined as SBP and DBP >/ = 130 and >/ = 80 mmHg, respectively among 3 groups categorized by pre-donation obesity status (normal weight, overweight, and obesity) was examined by multiple Cox regression analysis.

Results:

Of 174,359 LKD, mean±SD age was 41±12 years and 60% were female. Pre-donation normal weight, overweight, and obesity account for 36%, 41, and 23%, respectively with median (IQR) BMI of 22.81 (21.30, 23.96), 27.35 (26.16, 28.57), and 32.19 (30.96, 33.98). SBP and DBP at 6 months, 1 year, and 2 years post-donation were 120.06/74.51, 120.08/74.63, 120.35/75.07 mmHg, respectively (PSBP and PDBP <0.001) (Figure 1). After adjusting for demographics, pre-donation SBP and DBP, pre- and post-operative creatinine, post-donation urine protein, and the interaction term between the pre-donation BMI and gender, overweight and obese groups had a significantly greater risk for developing SHTN compared to normal weight group (HRoverweight 1.32, 95%CI 1.23, 1.41; HRobese 1.70, 95%CI 1.57, 1.84; Figure 2) only in those with normotensive during pre-donation. The pattern of the association was the same for DHTN (HRoverweight 1.28, 95%CI 1.21, 1.35; HRobese 1.52, 95%CI 1.43, 1.62; Figure 3). Stratifying patients into those with and without pre-donation hypertension, gender was an effect modifier with a higher risk for developing STHN and DHTN observed in obese female patients with pre-donation normotension (Pinteraction for SHTN 0.002 and DHTN 0.019).

Conclusions:

Pre-donation overweight and obesity increase the risk of developing post-donation SHTN and DHTN. Obese female donors are at greater risk than obese male donors among those with pre-donation normotension.
IMPACT OF EXTRACELLULAR WATER ON BLOOD PRESSURE DEPENDING ON AGE AND GENDER IN THE CROSS SECTION STUDY KARDIOVIZE 2030
Authors: Prosecky Robert , Novak Jan , Kovacovicova Petra , Hrabcakova Maria , Kunzova Sarka , Kruzliak Peter
Published: June 2023

Objective:

A random sample of 2146 volunteers from the Brno population aged 25-64 (1173 women and 973 men) was selected as part of the Kardiovision 2030 cross-section study. Study participants were approached based on the databases of health insurance companies and examined using the Czech Post-MONICA Study methodology.

Design and method:

Data from the Kardiovize 2030 study were used for the purposes of the work. Basic anthropometric data, blood pressure values, history of hypertension and measurements by direct segmental multifrequency bioelectrical impedance method were obtained. Study participants were approached based on the databases of health insurance companies. We characterized the majority of hypertensives in our group with simple parameters such as fat tissue and body water in different compartments by multichannel bioimpedance analysis.

Results:

The chance of hypertension occurs when the extracellular water (ECW) increases by 1 L

The Impact of extracellular water demonstrated by spatial thin-plate models increase with age.

Conclusions:

The impact of extracellular water on the level of pressure is statistically significant against the normotonic population. Extracellular pressure has a major influence on systolic pressure and its influence increases with age. The impact of ECW is greater in women.
BURDEN OF CARDIOVASCULAR DISEASES, KIDNEY DISEASES AND DEMENTIA ATTRIBUTABLE TO HYPERTENSION IN FRANCE
Authors: Grave Clémence , Bonaldi Christophe , Carcaillon-Bentata Laure , Gabet Amélie , Blacher Jacques , Olié Valérie
Published: June 2023

Objective:

Cardiovascular and renal diseases and dementia constitute major hypertension-related conditions and have a high burden for public health. The aim of our study was to estimate the burden of these diseases attributable to hypertension in France by providing the number of hospital stays and deaths attributable to hypertension in 2017.

Design and method:

Age- and sex-specific attributable fractions were calculated by combining relative risks extracted from the literature with the prevalence of hypertension (defined as a systolic blood pressure higher than 140mmHg) estimated in the Esteban Study, a national representative survey. These fractions were applied to the nationwide statistics of death and hospitalization stays with a primary diagnosis for cardiovascular or renal diseases, or dementia whose risk is known to increase with hypertension. Data were extracted from the French National Health Insurance Information System (SNDS) which contains nationwide and exhaustive hospital stays and deaths occurring in France.

Results:

In France in 2017, 1 043 207 hospital stays and 185 459 deaths related to cardiovascular, renal or dementia condition occurred. Of these, 164 093 hospital stays (119 640 in men and 44 453 in women) and 35 017 deaths (17 436 in men and 16 142 in women) were estimated to be attributable to hypertension, representing 16% of all cardiovascular, renal and dementia-related hospital stays and 19% of all cardiovascular renal and dementia deaths. Regarding the attributable fraction, the largest impact was observed on hemorrhagic stroke (26.8% of cases attributable to hypertension in men and 15.8% in women) and on ischemic heart disease (25.0% in men and 15.4% in women). For all cardiovascular diseases the highest attributable fraction were reach in adults aged 55-74 years old.

Conclusions:

In France, the burden attributable to hypertension is high and is expected to increase in the coming years given the aging of the population. The reduction of the burden attributable to hypertension requires ambitious public health policies aimed at promoting healthy lifestyles but also an improvement in the awareness and management of hypertension, which has not improved over the last 20 years, unlike in several other European countries.
CHANGES IN HEALTH BEHAVIORS FOLLOWING A HYPERTENSION DIAGNOSIS: THE KOREAN GENOME AND EPIDEMIOLOGY STUDY (2003-2018)
Authors: Ahn Song Vogue , Ro Hyojin , Lee Sihoon
Published: June 2023

Objective:

The management of hypertension requires a healthy lifestyle. However, it is unclear if individuals change their health behaviors after being diagnosed with hypertension. Thus, we aimed to evaluate the changes in smoking, alcohol consumption, exercise, and obesity following hypertension diagnosis using data from a community-based cohort.

Design and method:

We analyzed 5091 participants without hypertension at baseline from the Korean Genome and Epidemiology Study between 2003 and 2018. Participants were classified into the hypertension diagnosis group if they were diagnosed with hypertension by a physician during follow-up. Biennial health check-ups were used to measure health behaviors including smoking, drinking, exercise, and obesity. Generalized estimating equations were used to assess the differences by group and time and group-by-time interactions.

Results:

The group diagnosed with hypertension was more obese than the group not diagnosed with hypertension (p < 0.001). However, smoking (p < 0.001) and alcohol consumption (p < 0.001) decreased over time in all participants, and exercise (p < 0.001) increased. A group-by-time interaction was observed for smoking, with the group diagnosed with hypertension exhibiting greater reductions in smoking over time (p = 0.005). There were no significant interactions found for other behaviors.

Conclusions:

Our study provides limited evidence that a hypertension diagnosis alone may not be enough to encourage behavior change, except for smoking reduction. Thus, strategies to motivate behavior change need to be identified, given the importance of a healthy lifestyle in hypertension management.
APELIN AS A POTENTIAL DOWNSTREAM MEDIATOR OF THE IGF-1 CARDIOPROTECTIVE PATHWAY IN THE HYPERTROPHIED MYOCARDIUM OF SPONTANEOUSLY HYPERTENSIVE RATS
Authors: Yeves Alejandra , Coto Joshua Godoy , Cavalli Fiorella , Pereyra Erica , Enni Irene
Published: June 2023

Objective:

Hypertension is a complex cardiovascular disease and contributes to worldwide morbidity and mortality associated to the development of hypertensive cardiac hypertrophy and the progression of heart failure. Hypertensive myocardium is characterized by mitochondrial dysfunction and redox disbalance. On the other hand, aerobic exercise upregulates several humoral factors such as insulin like growth factor-1 (IGF-1) and apelin, involved in cardioprotective effects. Particularly, whether apelin mediates IGF-1 cardioprotective effects by an autocrine paracrine mechanism is not clear yet.

Objective. To determine the acute effects of IGF-1/apelin on oxidative stress and mitochondrial status, as well as the possible crosstalk between the signaling pathways triggered by them in spontaneously hypertensive rats (SHR) myocardium.

Design and method:

Adult SHR isolated hearts or cardiomyocytes were perfused during 10 min in the presence or absence of IGF-1 or apelin, and the specific antagonist of their receptors (AG1024 and ML221 for IGF1R and APJ, respectively). We explored reactive oxygen species (ROS) production, SOD activity, APJ cellular distribution, mitochondrial membrane potential (↖ ⇘) and permeability transition pore opening through the calcium retention capacity (CRC).

Results:

IGF-1 exerted an antioxidant effect evidenced by an increase in SOD activity (U/mg, IGF-1: 59.8±5.2, vs Control: 41.6±3) and decrease in ROS production (%, IGF-1: 66±12, vs Control: 100±8). In mitochondria, IGF-1 prevented loss induced by H2O2 (IGF-1: 0.934±0.016, vs Control: 0.827±0.027) and increased CRC (IGF-1: 251±34, vs Control: 135±23).

Interestingly, IGF-1 upregulated APJ expression (IGF-1: 175.8±27.7 vs Control: 100±16 % mRNA) while favoring its translocation to the sarcolemma (Pearson coefficient: IGF-1: 0.880±0.011 vs Control: 0.758±0.031) in isolated cardiomyocytes. Moreover, exogenous apelin was able to emulate IGF-1 antioxidant and mitochondrial actions (SOD: 64±5.3 U/mg; ROS: 64± 7 %; ↖ ⇘ loss induced by H2O2: 0.981±0.025 and CRC 264±31). These effects were prevented by inhibition of APJ (Apelin+ML221: SOD: 33±4.4, CRC: 84±17, 0.808±0.042) but not by AG1024 (Apelin+AG: 0.985±0.068, CRC: 245±47).

Conclusions:

In conclusion, our data suggest that IGF-1 by sequentially activating its own receptor and the apelin/APJ pathway is responsible for cardioprotection. Therefore, apelin emerges as a downstream effector of the cardiac IGF-1 signaling pathway.
POLYMORPHIC VARIANTS OF AGT (RS4762) AND GNB3 (RS5443) GENES AS RISK FACTORS FOR SEVERE ARTERIAL HYPERTENSION
Authors: Voroniuk Kseniia , Sydorchuk Larysa , Hinhuliak Oleksandr , Repchuk Yuliia , Semianiv Marianna , Sokolenko Alina , Biletsky Semen , Ivashchuk Sergiy , Petrynych Oksana , Kazantseva Tetiana , Dzhuriak Valentyna
Published: June 2023

Objective:

The aim of our study was to evaluate the role of AGT (rs4762) and GNB3 (rs5443) gene polymorphisms as risk factors for severe hypertension.

Design and method:

The case-control study involved 100 patients with EAH stage II, 1-3 degrees of blood pressure (BP), high and very high cardiovascular risk. Among the patients there were 21% (21) men, 79% (79) women. The mean age of patients was 59.86±6.22 y.o. The control group consisted of 60 almost healthy individuals with relevant age (49.13±6.28y.o.) and gender distribution (63% - women, 37% - men). The AGT (rs4762) gene polymorphism was studied by a qualitative polymerase chain reaction (PCR) in real time.

Results:

Severity of EAH does not depend on polymorphic variants of AGT (rs4762) and GNB3 (rs5443) genes. The distribution showed no statistically significant differences in the aforementioned distribution. Individuals with the first degree of hypertension met more often with the CC genotype of the GNB3 gene (rs5443) by 22.23% than among patients with the T allele (x2 = 3,66; p = 0,055) in patients with EAH.

Conclusions:

Epidemiological analysis did not confirm the polymorphic variants of the AGT (rs4762) and GNB3 (rs5443) genes as predictors of the severe course of EAH according to the degrees of BP elevation.
RISK CONFERRED BY POLYMORPHIC VARIANTS OF VITAMIN D RECEPTOR (VDR) AND ANGIOTENSIN II TYPE 1 RECEPTOR (AGTR1) GENES FOR ESSENTIAL HYPERTENSION
Authors: Semianiv Marianna , Sydorchuk Larysa , Biletsky Semen , Petrynych Oksana , Kazantseva Tetyana , Repchuk Yuliaya , Semianiv Ihor , Sokolenko Alina , Yarynych Yuliaya , Voroniuk Ksenia , Dzhuriak Valentina
Published: June 2023

Objective:

The aim of this study was to establish the role of 1166A>C polymorphism of the AGTR1 gene (rs5186) and A/G polymorphism of the VDR gene (rs2228570) in risk prediction of essential hypertension (EH).

Design and method:

The study included patients with EH and hypertensive-mediated organs damage (2nd stage), moderate, high/very high cardiovascular risk. 100 subjects were involved in the case-control study. There were 70.84% females, 29.16% males among them, the mean age was 57.86±7.81 yo. Age- and gender-matched controls (n = 60) whose blood pressure measurements were in normal range and without any apparent diseases were randomly selected to compare with the patient data. In order to detect AGTR1 (rs5186) and VDR (rs2228570) gene polymorphism the qualitative real-time polymerase chain reaction was done. AGTR1 gene genotyping was performed for 72 patients and 48 healthy individuals and VDR gene – for 100 patients and 60 healthy subjects.

Results:

The distribution of genotypes and alleles AGTR1 (rs5186) and VDR (rs2228570) in the study and control groups did not differ significantly (p>0.05). C-allele of AGTR1 gene (rs5186) increases the risk of EAH more than 2 times [OR–2.31; 95% CI OR:1.19–4.47; p = 0.011], as well as AC- and the combination of AC- + CC-genotypes [OR–2.09; 95% CI OR:1.03–4.25; p = 0.038 and OR–2.30; 95% CI OR:1.14–4.64; p = 0.017]. The epidemiological analysis showed that polymorphic variants VDR (rs2228570) genes are not the risk factors of EH in the observed. Although, the combination of wild alleles of both genes in the homozygous state (AAAGTR1/AAVDR) makes a protective effect [OR = 0,42; OR 95%CI:0,18-1,0; ⇙2 = 3,74; p = 0,05], the combination of minor alleles (C-allele AGTR1 /AAVDR+C-allele AGTR1/AGVDR) increases the risk of EH more than threefold [OR = 3,36; OR 95%CI:1,24-9,09; ⇙2 = 5,88; p = 0,015].

Conclusions:

Genotypes and alleles of VDR (rs2228570) gene are not associated with the risk of developing EH in the examined. C-allele of AGTR1 gene (rs5186) increases the risk of hypertension more than 2 times [OR–2.31; p = 0.011]. Combination of minor C-allele of AGTR1 gene and A-allele of VDR gene (C-allele AGTR1 /AAVDR+C-allele AGTR1/AGVDR) escalates the risk of EH more than 3 times [OR = 3,36; p = 0,015].
A FRAMESHIFT MUTATION IN THE SCNN1B GENE CAUSING LIDDLE SYNDROME AND A GENOTYPE-PHENOTYPE CORRELATION OF 18 CASES WITH THE P603 RESIDUE VARIANT
Authors: Lu Yiting , Liu Xinchang , Zhang Di , Sun Lin , Yang Kunqi , Zhang Lin , Liu Yaxin , Zhou Xianliang
Published: June 2023

Objective:

Liddle syndrome is an autosomal dominant form of monogenic hypertension caused by mutation of the SCNN1A, SCNN1B, and SCNN1G genes, which respectively encode various subunits of the epithelial sodium channel. In this report, we describe a frameshift mutation in SCNN1B in a Chinese family with early-onset hypertension and hypokalemia.

Design and method:

DNA was extracted from leucocytes in peripheral blood obtained from all family members. Whole-exome sequencing and Sanger sequencing were performed to verify the candidate variant and conduct co-segregation analysis. We also reviewed the clinical and biochemical characteristics of patients with the same mutation described in the literature and performed a genotype–phenotype correlation analysis.

Results:

Whole-exome sequencing identified a c.1806dupG frameshift variant in SCNN1B leading to substitution of alanine for proline at position 603 and premature emergence of a stop codon at position 607. Phenotypic heterogeneity is evident in patients with the mutation reported in the literature and is reflected in the proportions with hypertension (94.4%), hypokalemia (58.9%), hypoaldosteronemia (52.9%), and hyporeninemia (41.1%). Patients with the mutation have a good response to targeted ENaC inhibitor therapy.

Conclusions:

We have identified a frameshift mutation (c.1806dupG) in SCNN1B in a Chinese family characterized by early-onset hypertension and hypokalemia. Confirmatory genetic testing is necessary and targeted therapy should be used to prevent premature onset of clinical endpoints events in patients suspected to have mutation. Genotype-phenotype correlation analysis involving the P603 residue variant provides further evidence of phenotypic heterogeneity and guidance for clinical management of Liddle syndrome.
ASSESSING CAUSALITY BETWEEN CAROTID-FEMORAL PULSE WAVE VELOCITY AND COGNITIVE FUNCTION: A MENDELIAN RANDOMIZATION STUDY
Authors: Chuang Shao-Yuan , Chung Ren-Hua , Lin Chen-Hua , Cheng Hao-Min , Pan Wen-Harn , Chen Chen-Huan
Published: June 2023

Objective:

Arterial stiffness is usually significantly associated with cognitive function. We conducted a Mendelian randomization study to investigate the causal relationship between measures of arterial stiffness and cognitive function in a cross-sectional survey.

Design and method:

A total of 1516 adults aged more 30 years old in the CardioVascular Disease risk FACTors in two townships Study (CVDFACTS) with wave 6 and wave 7 during 2013-2020 were evaluated for artery stiffness with carotid-femoral pulse wave velocity (CFPWV) and cognitive function with Mine-Mental Short Evaluation (MMSE). A genome-wide association study was used to identify the genetic variants associated with CFPWV. Mendelian Randomization analysis was conducted using the R software.

Results:

A total of 87 SNP were identified (p-value<10-6) in the KDM4B gene (Chromosome-19) and 3 SNPs [rs10085112, rs2613776 and rs147498368] of them were independently associated with CFPWV. We constructed a polygenetic risk score (PRS, 1-6) with the 3 significant SNPs. PRS was the genetic variant and instrumental variable in the Mendelian Randomization. PRS was significantly associated with CFPWV (beta = -0.37, p = 0.0003), the “exposure”, and MMSE (beta = 0.14, p = 0.031), the “outcome”. In contrast, PRS was not associated with age, sex, systolic/diastolic blood pressure, body mass index, fasting glucose, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, C-reactive protein, creatinine and uric acid, the “confounders”. Mendelian Randomization estimate (95% confidence intervals) of the causal effect of the exposure (CFPWV) on the outcome (MMSE) was -0.433 (-0.810, -0.056, p-value = 0.0244).

Conclusions:

Our study provides evidence that KDM4B gene may be instrumental in the causal relationship between artery stiffness measured by CFPWV and cognitive function measured by MMSE in a Han Chinese population.
DRUG-MEDIATED IMPROVEMENT IN GLOBAL DNA METHYLATION AMONG HYPERTENSIVE INDIVIDUALS: OBSERVATIONS FROM NORTH-INDIAN POPULATION-BASED STUDY
Authors: Kallur Nava Saraswaty
Published: June 2023

Objective:

Hypertension has been reported to affect global DNA methylation levels negatively. However, the effect of anti-hypertensive drugs on methylation levels remains understudied. The present study aims to explore the relationship between the use of anti-hypertensive drugs and peripheral blood leucocyte global DNA methylation levels in two North-Indian populations.

Design and method:

The present study combines the observations of two population-based cross-sectional studies conducted among adult individuals (aged 30 years and above) of either sex belonging to the Jat community of Palwal, Haryana (n = 543) (completed), and the Jat Sikh community of Mansa district, Punjab (n = 148) (ongoing). Data pertaining to socio-demographic variables and the use of anti-hypertensive drugs were collected using pre-tested and modified interview schedules. Anthropometric measurements and blood pressure were captured from each participant using standard protocols. Peripheral blood leucocyte global DNA methylation levels were estimated using ELISA-based colorimetric technique. SPSS version 22 was used to perform statistical analysis.

Results:

Hypertensive cases were found to be significantly hypomethylated than the control groups in both communities. When stratified for medication, the median global DNA methylation level of hypertensive cases on any type of anti-hypertensive drug was found to be significantly higher than that of those hypertensive individuals who were not on medication. In fact, median DNA methylation levels of hypertensive cases on medication were comparable to that of controls. These trends were consistent in both the studied populations.

Conclusions:

The use of anti-hypertensive drugs appears to improve the global DNA methylation level among hypertensive cases. More studies are required to understand the pathway through which antihypertensive drugs act on DNA methylation levels and if improving DNA methylation levels through dietary interventions would have a similar antihypertensive effect.
HYPERTENSIVES USERS OF HEALTH WEB PORTALS: WHO ARE THEY? PROTOCOL AND PRELIMINARY RESULTS
Authors: Bédard Joany Rousseau , Cloutier Lyne , Michaud André
Published: June 2023

Objective:

In Canada, 1 in 4 adults has hypertension. Many of them, concerned about their health, often turn to Internet to seek information. In order to meet this information need, the Quebec Society of Vascular Sciences has created a web portal. The information presented has been developed by profesionals but formulated as to be understand easily by lay people. However, literature still offer little to no data on the characteristics of users of these health portals. The purpose of the study is to characterize hypertensives who use health web portals.

Design and method:

This descriptive cross-sectional study is part of an ongoing multicenter project. This current study includes 250 participants with vascular disorders and aims to characterize all users of a health web portal. In the course of this sub-study, only individuals with a diagnosis of hypertension (n > 125) are included for analysis.

Results:

A validated and tested self-administered electronic questionnaire was developed with the Technology Acceptance Model 3 and will be presented in the communication. This questionnaire also explores personal characteristics, motivation and digital competence. The protocol and the preliminary results describing the characteristics of individuals with hypertension who use a health web portal, including motivations for use and digital competence will also be included.

Conclusions:

The results will help guide arterial hypertension societies in the development of health information Web portals.
LONG-TERM EFFECTIVENESS OF A VILLAGE DOCTOR-LED MULTIFACETED STRATEGY ON BLOOD PRESSURE CONTROL: A CLUSTER RANDOMIZED TRIAL
Authors: He Jiang , Ouyang Ouyang , Sun Guozhe , Guo Xiaofan , Zhang Xingang , Mu Jianjun , Wang Dao Wen , Chen Jing , Sun Yingxian
Published: June 2023

Objective:

We tested the effectiveness of a village doctor-led multifaceted strategy on blood pressure (BP) control over 36 months among patients with hypertension in rural China. Village doctors are community health workers who provide basic primary health care in rural China.

Design and method:

326 villages were randomly assigned to the village doctor-led intervention or usual care. Individuals aged 40 years or older with an untreated mean BP 140/90 mm Hg or greater (130/80 mm Hg or greater in individuals with clinical cardiovascular disease) or treated BP 130/80 mm Hg or greater were recruited. The trained village doctors initiated and titrated antihypertensive medications according to a simple stepped-care protocol with supervision from primary care physicians. They also delivered discounted and free medications to patients and conducted health coaching on lifestyle change, medication adherence, and home BP monitoring. Intention to treat analysis was conducted.

Results:

At baseline, mean age (62.8 vs. 63.2 years), percentage of women (60.9% vs. 61.6%), mean systolic BP (157.0 vs. 155.5 mm Hg), and diastolic BP (88.1 vs. 87.3 mm Hg) were comparable between intervention and control groups. At 36 months, 72.5% of participants in the intervention and 11.7% in the control group had a BP less than 130/80 mmHg, with a net group difference of 60.8% (P<0.0001). Mean systolic BP decreased by -30.8 mmHg from baseline to 36 months in the intervention group and by -7.6 mm Hg in the control group, with a net group difference of -23.1 mm Hg (P<0.0001). Intervention effects on other outcomes are shown in the Table. No treatment-related serious adverse events were reported in either group.

Conclusions:

Conclusions: In rural China, the village doctor-led multifaceted strategy significantly reduced BP over 36 months in patients with hypertension. This proven-effective and sustainable implementation strategy could be scaled up throughout rural China and in other low- and middle-income countries for hypertension control.
RELATIONSHIP BETWEEN DIASTOLIC FUNCTION AND CARDIOVASCULAR OUTCOMES IN PATIENTS DURING 5 YEARS FOLLOW-UP AFTER DIAGNOSIS OF HYPERTENSION IN THE ARGENTINE POPULATION
Authors: Renna Nicolas Federico , Diez Emiliano Raul , Sanchez Francisco , Bernasconi Pablo , Miatello Roberto Miguel , Ramirez Jesica Magali
Published: June 2023

Objective:

The aim of the study is to determine the impact of the presence of diastolic dysfunction in patients recently diagnosed with arterial hypertension on cardiovascular events after a follow-up period of 5 years.

Design and method:

A prospective observational study was conducted in 902 patients with a new hypertension diagnosis who underwent 24-hour blood pressure monitoring and echocardiography between 2015 and 2019. The incidence of serious adverse cardiovascular events (MACE) was analyzed using a Cox proportional hazards model adjusted for potential confounders.

Results:

The mean age was 59.7 years; 52% were female, 29.2% had dyslipidemia, 25.8% were smokers, and 7.9% had diabetes mellitus. During a median follow-up period of 33 months, 139 MACE occurred. For each year, HR increased by 1.03 (95% confidence interval [CI]:1.02-1.04, p < 0.001, Figure 1). In men, the adjusted hazard ratio (HR) was 1.49 (95% confidence interval [CI]:1.05-2.13, p = 0.027). Body mass index (BMI) presented a HR of 1.03 (95% CI: 1.00-1.06, p < 0.001). The Diastolic Function (DF) HR increased for Grade II to 3.28 (95% CI: 1.98-5.41, p < 0.001) and for Grade III to 2.95 (95% CI: 1.26-6.91, p < 0.001).

Conclusions:

The DF grade II and III was the most important prognostic factor for MACE in patients with hypertension.
DISTRIBUTION OF THE DEGREE OF RIGHT VENTRICULAR HYPERTROPHY WITH DIFFERENT SEVERITY OF LEFT VENTRICULAR HYPERTROPHY IN ARTERIAL HYPERTENSION
Authors: Kerimkulova Aiman , Veber Viktor , Proshina Lidiya , Markabayeva Akbayan , Nurpeissova Riza , Adiyeva Madina , Idrissov Alisher
Published: June 2023

Objective:

To study the interrelation of the influence of left ventricular hypertrophy (LVH) on the frequency of the distribution of the degree of right ventricular hypertrophy (RVH) in patients who died suddenly during their lifetimes who suffered from arterial hypertension according to an autopsy

Design and method:

A retrospective study was conducted, which explored the autopsy protocols of patients suffered from hypertension (1999-2014) in Semey, Kazakhstan, suffered from hypertension during life and died suddenly. The normal wall thickness of the left ventricle was taken as 0.7-1.2 cm, the right ventricle 0.2-0.3 cm. The hypertrophy of the walls of the left and right ventricles was conventionally divided into 2 degrees. The hypertrophy of the walls of the left ventricle and the right ventricle was conditionally divided into 2 degrees, LVH: I degree - 1.3-2.0 cm, II degree - 2.1 or more; RVH: I degree - 0.4-0.6 cm, II degree - 0.7 cm or more.

Results:

When conducting a study of these protocols of persons, the thickness of the right ventricle was presented in 614 autopsy protocols. The distribution of LVH was the following: 1 degree 51.1%; 2 degree 48.9%. While the data on the distribution of RVH are as follows: the norm is 13%; 1st degree 33.9%; 2 degree 53.1%. At the same time, with 1 degree of left ventricular hypertrophy, the following distribution of RVH is noted: the norm is 22.6%; 1st degree - 46.8%; 2 degree - 30.6%. Then with 2 degrees of LVH, respectively: 3%, 20.3%, 76.7%, p <0.0001. At 1 and 2 degrees of LVH, the frequency of detection of 2-degree RVH was, respectively, 30.6% and 76.8%. A direct correlation was found between the wall thickness of the left and right ventricles (r = 0.478).

Conclusions:

RVH is a common symptom in hypertension, up to 87% according to autopsy examination. LVH 1 and 2 degrees in the study group were equally distributed. The more pronounced the values of the degree of LVH, the more pronounced the degree of RVH. With LVH of the 2 degree, 2 times more often detected 2nd degree RVH.
BP PHENOTYPES IN PATIENTS UNDERGOING LONG-TERM PERITONEAL DIALYSIS DEFINED WITH HOME VERSUS AMBULATORY BP MONITORING
Authors: Vareta Georgia , Georgianos Panagiotis , Vaios Vasilios , Sgouropoulou Vasiliki , Chrapis Panagiotis , Anastasiou Stefanos , Divanis Dimitrios , Zebekakis Pantelis , Liakopoulos Vassilios
Published: June 2023

Objective:

The concomitant assessment of office with out-of-office blood pressure (BP) measurements enables the identification of white-coat and masked hypertension. The aim of the present study was to explore the prevalence of these BP phenotypes in end-stage kidney disease patients undergoing peritoneal dialysis (PD) with the use of home versus ambulatory BP monitoring.

Design and method:

In 140 patients receiving long-term PD in 4 centers of Northern Greece, we assessed the BP with the following methods: (i) triplicate office BP measurements after a 5-minute seated rest with the automatic device HEM 705-CP (Omron, HealthCare); (ii) home BP measurements twice daily for 7 consecutive days with validated BP monitors; (iii) 24-hour ambulatory BP monitoring with the oscillometric device Mobil-O-Graph (IEM, Stolberg, Germany). The BP phenotypes were diagnosed using the threshold of 140/90 mmHg for office measurements and the threshold of 135/85 mmHg for home and daytime ambulatory BP recordings, respectively.

Results:

When office BP recordings were assessed together with home BP measurements, 57 patients (40.7%) were classified as normotensives, 8 patients (5.7%) had white-coat hypertension, 21 patients (15.0%) had masked hypertension and the remaining 54 patients (38.6%) had sustained hypertension. With the evaluation of office and daytime ambulatory BP, 59 patients (42.1%) had normotension, 13 patients (9.1%) had white-coat hypertension, 19 patients (13.6%) had masked hypertension and 49 patients (35.0%) had sustained hypertension. In 119 out of 140 patients (85.0%), there was absolute agreement between home and daytime ambulatory BP in the diagnosis of BP phenotype (k-coefficient: 0.775, P<0.001).

Conclusions:

The present study shows that among patients undergoing PD, there is satisfactory agreement between home and daytime ambulatory BP in the identification of phenotypes of white-coat and masked hypertension.
IS HOME BLOOD PRESSURE MONITORING USEFUL IN THE DIAGNOSIS AND MANAGEMENT OF REFRACTORY HYPERTENSION?
Authors: Santos Taissa Lorena Dos , Margallo Victor da Silva , Pimenta Carlos Filipe dos Santos , Cavalcanti Aline de Holanda , Nemer Camila Bello , Fortes Carolina de Carvalho , Sousa Vitória Miriam da Silva de , Chedier Bernardo , Muxfeldt Elizabeth Silaid
Published: June 2023

Objective:

Refractory hypertension (RefHT) is defined as uncontrolled blood pressure (BP) despite the use of 5 or more antihypertensives including a long-acting thiazide diuretic and a mineralocorticoid receptor antagonist. It is a subgroup of resistant hypertension (RHT) with recent definition and behavior of extreme severity and refractoriness to treatment. Among resistant hypertensives, the use of ABPM is mandatory, and it has already been shown that HBPM is a good alternative in the follow-up of these patients.

Design and method:

Cross-sectional study of a historical cohort of patients with RHT. A total of 354 patients (23.9% male; mean age 60.4 ± 11.1 years old) were submitted to 24-hour ABPM and 5-day HBPM (triplicate morning and evening measurements). All underwent a standardized protocol for assessment of cardiovascular risk, sociodemographic and anthropometric data, laboratory evaluation (metabolic profile and renal function), transthoracic Doppler echocardiography and measurement of pulse wave velocity (PWV).

The prevalence of refractory hypertension diagnosed by office BP, HBPM and ABPM were calculated. Sensitivity, specificity, predictive values, and likelihood ratios for HBPM were also calculated. Agreement between the procedures was evaluated using kappa coefficients and the Bland–Altman method.

Results:

The prevalence of refractory hypertension was 20.3% by ABPM and 18.9% by HBPM. Compared to resistant ones, refractory hypertensives diagnosed by HBPM are younger, with a higher prevalence of heart failure and higher levels of albuminuria. In turn, patients with RefHT diagnosed by ABPM are also younger, but they have a higher prevalence of stroke and previous cardiovascular disease, in addition to higher albuminuria.

HBPM overestimated systolic BP by 11.2 ± 18.4 mmHg (correlation coefficient = 0.63; Bland-Altman coefficient = 37) and diastolic BP by 2.4 ± 9.2 mm Hg (correlation coefficient = 0.80; Bland-Altman coefficient = 18). The specificity, sensitivity, and positive and negative predictive values of HBPM in detecting RefHT diagnosed by ABPM were 88%, 98%, 97%, and 94%. The kappa coefficient showing excellent agreement (kappa = 0.884).

Conclusions:

HBPM presented good agreement with ABPM and can be used as a diagnostic method of refractory hypertension.
ASSESSMENT OF LEFT VENTRICULAR FUNCTION USING SPECKLE TRACKING ECHOCARDIOGRAPHY IN PATIENTS WITH ESSENTIAL HYPERTENSION
Authors: Mabrouk Mohammad Shafiq , Abdelhady Yasser Ahmed , Hassan Mostafa Mohammad
Published: June 2023

Objective:

Hypertension leads to left ventricular hypertrophy which directly predisposes to and aggravates irreversible deterioration of LV function. Novel quantitative techniques in echocardiographic deformation imaging such as speckle-tracking echocardiography (STE) can measure LV strain. In this study, we will test speckle-tracking echocardiography as a diagnostic tool for the early detection of cardiac malfunction due to arterial hypertension

Design and method:

This cross-sectional, case-control study was held at Beni Suef University Hospitals between March/2018 and February/2020. The study included 90 patients that were divided into 3 groups. Group I (control group) included 30 people without apparent cardiovascular risk factors and matched in age and sex with the study groups. Group II included 40 hypertensive patients without echocardiographic evidence of left ventricular hypertrophy (LVH). Group III included 20 hypertensive patients with echocardiographic evidence of left ventricular hypertrophy (LVH). All patients underwent full clinical examination, conventional echocardiography, and 2D speckle tracking echocardiography

Results:

The studied groups were comparable regarding age and sex. Septal and posterior wall thickness and left ventricular mass index were significantly higher among group III. Otherwise, other conventional echo parameters were comparable. There was statistically significant difference between the 3 groups regarding 2D speckle tracking echocardiography

Conclusions:

In hypertensive patients with or without LVH, subclinical reduction or impairment of the LV systolic function can occur & may not be detected with conventional echocardiography but can be detected by 2D STE presented by mainly decreased myocardial segments deformation detected by decreased longtitudinal systolic strain mainly affecting basal segment