bluuebunny/crossref_metadata_2025 huggingface dataset:
LEFT VENTRICULAR HYPERTROPHY AFTER RENAL TRANSPLANTATION: SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Tian Zhejia , Bergmann Kai , Kaufeld Jessica , Schmidt-ott Kai , Melk Anette , Schmidt Bernhard
Published: May 2024

Objective:

Left ventricular hypertrophy in end-stage renal disease patients undergoing renal replacement is linked to an increased risk for cardiovascular diseases. Dialysis does not completely prevent or correct this abnormality, and the evidence for kidney transplantation varies. This analysis aims to explore the relationship between kidney transplantation and left ventricular hypertrophy.

Design and method:

MEDLINE and Scopus were systematically searched in October 2023. All cross-sectional and longitudinal studies that fulfilled our inclusion criteria were included. Outcome was left ventricular mass index. We conducted a meta-analysis using a frequentist random effects model. Meta-regression was applied to examine the left ventricular mass index changes dependent on various covariates. Sensitivity analysis was employed to handle outlying or influential studies and address publication bias. All analyses were conducted using R version 4.3.2.

Results:

From 7416 records, 46 studies met the inclusion criteria with 4122 included participants in total. Longitudinal studies comparing LVMI in renal transplant recipients before transplantation and thereafter demonstrated an improvement of left ventricular mass index after kidney transplantation - 0.44 g/m2 [-0.60; -0.28] (SMD [95% confidence interval]). By meta-regression analysis blood pressure was identified as predictor of LVMI change. A younger age at the time of kidney transplantation and well-controlled anemia were also associated with regression of left ventricular hypertrophy. In studies longitudinally comparing kidney transplant recipients with patients staying on dialysis no difference was detected -0.09 g/m2 [-0.33; 0.16] (SMD [95% confidence interval]). Meta-regression using changes of systolic blood pressure as covariate showed an association between higher blood pressure and an increase in left ventricular mass, regardless of the modality of renal replacement treatment.

Conclusions:

In conclusion, our results indicated a potential cardiovascular benefit, defined as the regression of left ventricular hypertrophy, after kidney transplantation. This benefit was primarily attributed to improved blood pressure control rather than the transplantation itself.
DOES ANGIOTENSIN RECEPTOR NEPRILYSIN INHIBITOR EXACERBATE RENAL FUNCTION IN PATIENTS WITH CHRONIC KIDNEY DISEASE?
Authors: Suehiro Yohei , Sugano Naoki , Kidoguchi Satoshi , Yokoo Takashi
Published: May 2024

Objective:

Angiotensin receptor neprilysin inhibitor (ARNI) is a new drug with potent antihypertensive effect and has been reported to exert cardiovascular protection in the patients with heart failure. On the other hand, recent meta-analyses revealed that the use of ARNI may increase urinary protein excretion in those with chronic kidney disease (CKD). Thus, whether ARNI has renal protective effect in CKD patients remains unclear. Therefore, we examine the change of renal function and proteinuria before and after the treatment with ARNI.

Design and method:

A total of 88 patients who were started to receive sacubitril/valsartan at our hospitals between September 2021 and March 2023 were included. We evaluated the change of estimated glomerular filtration rate (eGFR), urinary protein excretion, and blood pressure before and six months after the administration of sacubitril/valsartan among the following three groups; 1) those without CKD (non-CKD), 2) those with mild kidney impairment (CKDG3), and 3) those with advanced kidney impairment (CKDG4/5).

Results:

Regarding eGFR and urinary protein, no significant changes were observed during six months in all the groups. The rates of changes in eGFR during the study period were equivalent among three groups (non-CKD, CKDG3, CKDG4/5; -7.3% ±15.4, -2.5% ±15.3, 0.3% ±3.1, P=0.48), which were not different from the rates of changes in the preceding six months. The changes in urinary protein were also similar among three groups (non-CKD, CKDG3, CKDG4/5; 0.01 g/gCr Interquartile Range {IQR} -0.01 to 0.04, -0.015 g/gCr IQR -0.17 to 0.04, 0.01 g/gCr IQR -0.77 to 0.70, P=0.53). In contrast, the treatment with sacubitril/valsartan equally exerts antihypertensive effect for all the groups (non-CKD, CKDG3, CKDG4/5; -9.7 mmHg ±15.4 P<0.05, -11.0 mmHg ±14.7 P<0.05, -8.0 mmHg ±14.7 P<0.05).

Conclusions:

The present study could not reveal renal protective effects of sacubitril/valsartan, whereas could show a potent antihypertensive effect without worsening renal function in the patients with CKD.
INCREASE IN ARTERIAL STIFFNESS IN LIVING KIDNEY DONORS AFTER RENAL DONATION
Authors: Kannenkeril Dennis , Günes-altan Merve , Bosch Agnes , Striepe Kristina , Heller Katharina , Schiffer Mario , Janka Rolf , Amann Kerstin , Schmieder Roland E.
Published: May 2024

Objective:

Low glomerular filtration rate (GFR) is associated with high cardiovascular mortality and morbidity. Living kidney donor’s vascular characteristics have been poorly investigated till now. In this analysis, living kidney donors were followed up with respect to vascular parameters for one year after renal donation.

Design and method:

Blood pressure (BP) and different arterial stiffness parameters were assessed before, 6 months and 1 year after renal donation using a 24-hour blood pressure device (Mobil-o-graph®). Cortical, medullary and total renal perfusion of the donors were assessed using Arterial Spin Labeling MRI before and 6 months after donation. Preimplantation biopsy of the donor kidney was obtained. Biopsies were scored for glomerulosclerosis, interstitial fibrosis, tubular atrophy, and arteriosclerosis, which was combined to a total renal chronicity score. Living donors with and without chronic renal histological changes were compared.

Results:

Twenty five living kidney donors with mean age of 54±9.4 were followed up for one year. The estimated GFR and urinary albumin creatinine ratio (UACR) were 87.7±15.9ml/min/1.73m2 and 19.5±18.4mg/g creatinine respectively at baseline. 12months after renal donation the eGFR was 55.6±10.9 ml/min/1.73 m2 and the UACR was 19.5±12.2mg/g creatinine. Pulse wave velocity (7.5±1.4 vs. 7.8±1.4;p=0.001), peripheral resistance (1.1±0.19 vs. 1.23±0.19;p=0.003), and augmentation index (heart rate corrected) (24.4±5.5 vs. 26.7±6.1;p=0.025) over 24 hours increased significantly 12months after donation, while no change has been noticed in systolic and diastolic BP. A relationship has been found between eGFR at baseline and mean 24-hour pulse wave velocity at 12months (r=-594, p=0.002). An increase in cortex perfusion was found 6 months after donation (351±53.4 vs. 88±40.7;p=0.013). The 24-hour systolic BP (116.6±6.8 vs. 129.1±10.7;p=0.011), -diastolic BP (73.2±4.4 vs. 81.3±5.6;p=0.006) and -central BP (118.6± 8.9 vs. 128.9±7.7;p=0.013) at 12 months post donation was significantly higher in donors with renal histological changes compared to donors without renal histological changes, while no difference in BP was noticed at baseline between thesegroups.

Conclusions:

Our data indicates that arterial stiffness increases after living kidney donation. This can be interpreted as an early change before increase in BP. Living donors with chronic renal histological changes tend to develop high BP after donation.
ASSOCIATION BETWEEN ORTHOSTATIC HYPERTENSION AND FRAILTY AMONG OLDER PATIENTS WITH HYPERTENSION
Authors: Kim Kwang Il , Choi Jung -Yeon , Ryu Dong Ryeol , Lee Hae -Young , Cho Myeong -Chan , Kim Cheol -Ho
Published: May 2024

Objective:

Frailty frequently co-exists with hypertension in older patients. We aimed to evaluate the association between frailty and positional change in blood pressure, especially orthostatic hypertension.

Design and method:

Participants were recruited from 12 University hospitals in South Korea. Using a digital device, trained research nurses measured blood pressure in the supine and standing positions. Physical frailty was evaluated using the Korean version of the FRAIL questionnaire, gait speed, and hand-grip strength. Orthostatic hypertension was defined as a >= 20-mmHg increase in systolic blood pressure within 3 min of standing and upright systolic blood pressure of >= 140 mmHg.

Results:

We analyzed the data of 2,065 participants who had been enrolled until December 31, 2022. The mean age was 73.2 ± 5.6 years and 52.0% were female. The mean blood pressure was 137.1 ± 14.9 / 75.1 ± 9.7 mmHg. Among the participants, 1,886 (91.3%) showed normal response after standing, but 94 (4.6%) had orthostatic hypertension, and 85 (4.1%) had orthostatic hypotension. Orthostatic hypertension was associated with female sex, obesity, cognitive function, physical frailty, and lower quality of life (QOL). In the multivariable analysis, body mass index and frailty status were independently associated with orthostatic hypertension.

Conclusions:

Orthostatic hypertension is associated with physical frailty, cognitive impairment, and low QOL in older patients with hypertension. Therefore, evaluation of orthostatic blood pressure changes to confirm orthostatic hypertension or hypotension in frail older adults will serve as an important diagnostic procedure in vulnerable patients. Further studies are required to identify the underlying mechanisms of this association.
ASSOCIATION OF BLOOD PRESSURE WITH MORTALITY IN OLDEST OLD PEOPLE WITH FRAILTY IN CHINA: RESULTS FROM CHINESE LONGITUDINAL HEALTHY LONGEVITY SURVEY (CLHLS)
Authors: Liu Lu , Ruan Haiyan , He Sen , Chen Xiaoping
Published: May 2024

Objective:

To determine the target blood pressure in old people (80+ years) with frailty.

Design and method:

In this community based, longitudinal prospective study, we enrolled 3,134 oldest old people with frailty. The exposure-response associations between blood pressure and all-cause mortality, cardiovascular disease (CVD) mortality, and non-CVD mortality were assessed by the penalized cubic splines fitted in Cox models.

Results:

During 5 years follow-up, 2,532 deaths were documented. An approximate L-shaped association between systolic blood pressure (SBP) and 5-year all-cause mortality was identified. Compared with 140 mmHg (inflection point), the risk of all-cause mortality significantly increased for SBP below 127 mmHg, which varied from HR of 1.050 (95% CI: 1.003-1.100) to 1.576 (95% CI: 1.128-2.203). After 140 mmHg, mortality risk gradually fell with increasing SBP, although not reaching statistical significance. Diastolic blood pressure (DBP) suggested a significant U-shaped association with 5-year all-cause mortality with 90 mmHg conferred the lowest risk. Before that, the risk of all-cause mortality rose with decreasing DBP, which varied from HR of 1.041 (95% CI: 1.001-1.082) to 1.304 (95% CI: 1.005-1.692). After 90 mmHg, although the observed differences were not statistically significant, mortality risk tended to rise with increasing DBP. Among the 2,037 participants with a confirmed cause of death, 346 died from CVDs and 1,691 died from non-CVDs. In comparison with 120 mmHg, SBP above 134 mm Hg exhibited a significantly elevated CVD mortality risk; when SBP below 121 mmHg, significantly increased non-CVD mortality risk could be found in comparison with SBP at 140 mmHg. As for DBP, it could not predict CVD mortality risk; there was an approximate U-shaped association between DBP and non-CVD mortality that DBP below 69 mmHg was associated with a higher risk with 85 mmHg as the reference. Stratified and sensitivity analyses showed robustness of main findings.

Conclusions:

In the oldest old people with frailty, in addition to all-cause mortality, blood pressure management should balance CVDs risk and non-CVD risk. Maintaining blood pressure at 120-140/80-100 mmHg can reduce all-cause mortality risk and meanwhile may prevent the adverse events due to excessively higher or lower blood pressure.
BLOOD PRESSURE EFFECTS OF TRAZODONE IN HYPERTENSIVE OLDER ADULTS
Authors: Capacci Marco , Rivasi Giulia , Ceolin Ludovica , Turrin Giada , Rossi Lorenza , Menale Silvia , Bisignano Maria Francesca , Liccardo Alessandra , Mossello Enrico , Ungar Andrea
Published: May 2024

Objective:

Trazodone is commonly prescribed in older adults and may have hypotensive effects due to the inhibition of alpha-adrenergic receptors.

The present study aimed to investigate the effects of trazodone on blood pressure (BP) and its related risk of syncope and falls in hypertensive older adults.

Design and method:

A longitudinal observational study involving patients aged 75 or older was conducted at the Hypertension Clinic and Memory Clinic of the Division of Geriatric and Intensive Care Medicine, Careggi Hospital, Florence. Participants underwent multidimensional geriatric assessment including office BP measurement, 3-minute active stand test (BP measurement immediately after standing [T0] and at 1 [T1] and 3 minutes [T3]), home and ambulatory BP monitoring. The composite outcome of syncope and falls was assessed at 12 months and its association with trazodone was analysed using multivariate Cox regression analysis.

Results:

Among 123 participants (mean age 81 years, 59% female), 12 (10%) reported regular trazodone use. Participants receiving trazodone showed lower office diastolic BP (71.8 mmHg vs. 80.1 mmHg, p=0.042) and a greater systolic and diastolic BP reduction immediately after standing (δsystolicT0 16.2 mmHg vs. 9.7 mmHg, p=0.038; δdiastolicT0 11 mmHg vs. 1.7 mmHg, p=0.003). No differences were reported as regards home and ambulatory BP. Incidence of syncope and falls at 12 months was 25%, with a significantly higher rate in patients receiving trazodone (58.3% vs. 21.2%, p=0.005). Trazodone was associated with an increased risk of syncope or falls independently of physical performance (HR 2.654, 95% CI 1.104 - 6.378). This association was not confirmed when multivariate Cox analysis was adjusted for dementia diagnosis (HR for trazodone 1.874, 95% CI 0.736 – 4.773; HR for dementia 2.556, 95% CI 1.018 – 6.419).

Conclusions:

In older adults with hypertension, trazodone is associated with a greater orthostatic BP drop and might increase the risk of syncope and falls.
PROGNOSIS OF RESISTANT HYPERTENSION IN KOREAN HYPERTENSIVE PATIENTS: A NATIONWIDE OBSERVATIONAL COHORT STUDY
Authors: Lee Chan Joo , Lee Ho Kyu , Seo Jiwon , Kang Dayoung , Hwang Jinseub , Park Sungha , Pyun Wook Bum
Published: May 2024

Objective:

The prognosis of resistant hypertension is known to be worse than that of non-resistant hypertension, but studies on the prevalence and outcomes of resistant hypertension in Korean hypertensive patients are scarce.

Design and method:

A total of 2,086,208 patients, a 25% sample of hypertensive patients, were extracted from the Korean National Health Insurance Service Database from 2013 to 2018. Among them, excluding patients with missing values and those with a history of cardiovascular disease, a total of 935,169 patients were divided into resistant hypertension and non-resistant hypertension with a target blood pressure of 140/90 mm Hg. The primary outcome was a composite of all-cause death, myocardial infarction, stroke, and heart failure events during follow-up. Secondary outcomes were individual events of the primary outcome, end-stage renal disease (ESRD), and atrial fibrillation.

Results:

The average age of all subjects was 62.3 ± 11.4 years, and 50.1% were men. The prevalence of resistant hypertension was 7.4%. Compared with non-resistant hypertensive patients, resistant hypertensive patients were older, more likely to be male, smokers, non-exercisers, and obese, and had a higher prevalence of diabetes, dyslipidemia, and chronic kidney disease. The median follow-up duration was 6.0 years. The incidence of the primary outcome was 32.7 and 21.5/1000 person-years in the resistant and non-resistant hypertension, respectively. In a multivariable Cox proportional hazards analysis adjusting for age, sex, BMI, alcohol consumption, exercise, income, and comorbidities, the hazard ratio for the primary outcome was 1.32 (95% CI, 1.29-1.35, p<0.001) for resistant hypertension compared with non-resistant hypertension. The risk of all-cause death, myocardial infarction, stroke, heart failure, and atrial fibrillation were each significantly higher in patients with resistant hypertension, and the risk of ESRD was three times higher.

Conclusions:

This large-scale nationwide observational study showed that Korean patients with resistant hypertension have a significantly higher risk of clinical events compared with non-resistant hypertensive patients, with results like those of the previous studies from other countries. This study emphasizes the need to pay more attention to managing resistant hypertension.
TREAT TRIAL: MULTI-CENTER CROSS-SECTIONAL TREATMENT EVALUATION OF APPARENT RESISTANT HYPERTENSION IN BELGIUM
Authors: Brouwers Sofie , Huart Justine , Chabot Mathilde , Van Nieuwenhuyse Bregt , Munhoz Daniel
Published: May 2024

Objective:

The goal of the TREAT study is to evaluate the prevalence of apparent treatment-resistant hypertension (aRHT) in a Belgian setting and to evaluate which determining factor of pseudo-resistant hypertension contributes the most to this prevalence: white coat hypertension (WCH), underdosing of adequate drugs or poor adherence to prescribed medicines.

Design and method:

TREAT is a single-visit, multicentric, non-interventional, cross-sectional survey. Inclusion criteria were the following: patients over 18 years old receiving 3 or more antihypertensive molecules and referred to specialized hospital centres for aRHT. The data were collected according to the patient’s medical records. Self-reported adherence to antihypertensive treatment was collected and a Hill-bone medication adherence scale was also proposed.

Results:

A total of 232 patients were included. Mean anti-hypertensive treatment duration was 10.6(±9.1) years. Patients were treated with a mean of 3.8(±1.1) antihypertensive molecules and 2.8(±1.1) antihypertensive pills. Only 48.5% of the aRHT patients were treated with the triple therapy recommended by the 2023 ESH hypertension guidelines (i.e. renin-angiotensin-aldosterone system inhibitor (RAASi), calcium channel blocker (CCB) and diuretic), and only 29.1% of patients were treated with the maximal recommended dose. Inadequate dosing was mostly present with diuretics, only 60% of patients was treated with at least half the maximum dose of a diuretic. WCH was present in 11% of patients in whose ambulatory BP measurements were available in records (n=136). Therapeutic adherence was self-reported as poor or moderate in 17.6% of patients (n=41). The Hill-bone medication adherence scale (n=140, 60.4%) showed a mean score of 12(±4.2) (good adherence). In this cohort, 31.8% of patients seemed to have true resistant hypertension.

Conclusions:

Among patients referred to specialized centres for aRHT, about 2/3 of patients have in reality pseudo-resistant hypertension. Whereas WCH and poor adherence seems to be limited in our dataset, many patients were polymedicated with non-recommended combinations of antihypertensive molecules in 1 out of 2 patients, with inadequate dosing in 2 out of 3 patients. Pseudo-resistant hypertension seems in our cohort to be mainly related to under-use of triple combination therapy and most likely also due to underdosing.
EFFECT OF SEQUENTIAL NEPHRON BLOCKADE X DUAL RENIN-ANGIOTENSIN SYSTEM BLOCKADE + BISOPROLOL IN THE TREATMENT OF RESISTANT HYPERTENSION, A RANDOMIZED CONTROLLED TRIAL (RESHYPOT)
Authors: Cestario Elizabeth Do Esp , Vilela-martin José Fernando , Cosenso-martin Luciana Neves , Rubio Tatiane Azevedo , Uyemura Jessica Rodrigue Roma , Da Silva Lopes Valquiria , Fernandes Letícia Aparecid Barufi , Tacito Lucia Helena Bonalume , Junior Heitor Moreno , Yugar-toledo Juan Carlos
Published: May 2024

Objective:

The primary aim was to compare sequential nephron blockade (SNB) versus dual renin-angiotensin system blockade (DRASB) plus bisoprolol in patients with resistant hypertension to observe reductions in systolic and diastolic blood pressure (SBP and DBP) levels after 20 weeks of treatment.

Design and method:

This trial was an open-label, prospective, randomized, parallel-group, clinical study with optional drug uptitration. Participants were evaluated during five visits at 28-day intervals.

Results:

The mean age was 55.5 years in the SNB and 58.4 years in the DRASB + bisoprolol group (p=NS). Significant office BP reductions were observed in both groups. SNB group, SBP decreased from 174.5±21.0 to 127.0±14.74 mmHg (p<0.0001), and DBP decreased from 105.3±15.5 to 78.11±9.28 mmHg (p<0.0001). DRASB group, SBP decreased from 178.4±21.08 to 134.4 ± 23.25 mmHg (p<0.0001) and DBP decreased from 102.7±11.07 to 77.33±13.75 mmHg (p<0.0001). Ambulatory blood pressure monitoring

(ABPM) showed also significant SBP and DBP reductions in both groups (p<0.0001). Central systolic blood pressure had a greater reduction in the SNB group pre x post-intervention (128.8± 22.1 x 117.4± 17.9) (p = 0.03).

Conclusions:

In patients with RHTN adherent to treatment, SNB and DRASB plus bisoprolol showed excellent therapeutic efficacy, although SNB was associated with earlier SBP reduction and a greater reduction in Central systolic blood pressure.
LONG-TERM FOLLOW-UP OF PATIENTS WITH HIGH ALDOSTERONE-TO-RENIN RATIO BUT NEGATIVE CONFIRMATORY TEST FOR PRIMARY ALDOSTERONISM
Authors: Buffolo Fabrizio , Pecori Alessio , Reincke Martin , Outland Merve , Veglio Franco , Schwarzlmüller Paul , Bidlingmaier Martin , Kunz Sonja , Stremmel Christopher , Mengozzi Giulio , Priolo Gabriella , Mulatero Paolo , Adolf Christian , Monticone Silvia
Published: May 2024

Objective:

About 10% of patients with hypertension has elevated aldosterone-to-renin ratio and 50-70% of them have a negative confirmatory test for primary aldosteronism (PA). However, the appropriate follow-up of these patients is currently unknown. We investigated the incidence of PA in patients with previous negative confirmatory testing for PA, with a follow-up comprised between 2 and 8 years.

Design and method:

A total of 184 patients with a previously positive screening test for PA followed by a negative confirmatory test were enrolled in two hypertension centres: Torino and München. We repeated the screening test for PA and, if positive, the confirmatory test: either seated saline infusion test or captopril challenge test.

Results:

About 20% of patients had confirmed PA diagnosis after a mean follow-up of 5 years: 16% in Torino and 24% in München. When subtype diagnosis was offered systematically, 31% of patients displayed a unilateral form of PA. Patients with new onset of PA showed higher systolic blood pressure (142±17 versus 133±12 mmHg, P=0.005), diastolic blood pressure (89±8 versus 85±9 mmHg, P=0.007) and a higher rate of cardiac organ damage (60.9% versus 35.8%, P=0.031) than patients without PA, despite similar implementation of anti-hypertensive therapy. A mild progression of autonomous aldosterone secretion was present even in patients without confirmed PA, with increase of aldosterone post-saline infusion test (3.3 [2.3-4.3] versus 4.5 [3.5-5.4] ng/dL; P<0.001), but with relatively stable blood pressure levels. Among patients without PA, aldosterone post-saline infusion test at follow-up was positively associated with the follow-up time (β 0.262 [0.005; 0.520]; P=0.046).

Conclusions:

One fifth of patients with a negative confirmatory test for PA develop overt PA over time. A clinical follow-up of patients with a negative confirmatory test is advisable, along with the repetition of PA investigation, especially in patients with worsening of blood pressure control.
MYOCARDIAL MECHANO-ENERGETIC EFFICIENCY CHANGES IN PRIMARY ALDOSTERONISM PATIENTS
Authors: Muiesan Maria Lorenza , Stassaldi Deborah , Capellini Sara , Rosei Claudia Agabiti , Bertacchini Fabio , Aggiusti Carlo , Salvetti Massimo , Paini Anna , De Ciuceis Carolina , Dusi Margherita , Camossi Roberto , Ghignatti Simone , Buso Giacomo
Published: May 2024

Objective:

Cardiac organ damage has been found to be highly prevalent in primary aldosteronism (PA), possibly contributing to the increased risk of cardiovascular events. We reported a lower myocardial mechanoenergetic efficiency index (MEEi) in patients with PA as compared with essential hypertensive patients, possibly reflecting an impairment of production and utilization of energy in the myocardium. We analyze changes of echocardiographic parameters of cardiac anatomy and function, including MEEi, in a group of PA patients with a long-term follow-up (FU).

Design and method:

One-hundred-sixty-six patients (age 49 ± 10 years, 42% women) with PA underwent echocardiography and clinical evaluation at time of diagnosis and during FU (mean 85 ± 54 months) of treatment (23% adrenalectomy, 77% medical treatment). MEEi was obtained as the ratio between stroke volume and heart rate (HR) and normalized per grams of LV mass and δMEEi was calculated as difference between follow-up and baseline MEEi.

Results:

In the whole group a significant decrease in Blood Pressure (from 147/91mmHg to 132/81 mmHg p=0.0001) was observed, while body mass index (BMI) was increased (p=0.05) during FU. A decrease in LV mass index was observed (from 46.0 ± 16.7 to 36.9 ± 8.6 g/m2.7, p < 0.001), without significant changes in relative wall thickness (RWT). A decrease in left atrial volume was also observed, while E/e’ did not change. Midwall fractional shortening was reduced, while MEEi did not change (from 0.453 ± 0.15 to 0.445 ± 0.16 mL/s/g, ns from baseline to FU). A significant correlation was observed between changes in MEEi and changes in LVMi; patients with higher improvement in MEEi (>0.07 mL/s/g) had a higher LVMi at baseline and a greater decrease of LVMi and of RWT, in addition to greater reduction in HR and lower values of total cholesterol and LDL cholesterol at FU. No differences were observed between medically or surgically treated patients.

Conclusions:

In both medical and surgical treatment groups a reduction in LVH was observed. The improvement in MEEi seems to be related to a decrease in LVH, independently of medical or surgical treatment.
MANAGEMENT OF HYPERTENSION IN THE EARLY POSTPARTUM: A RANDOMIZED CONTROLLED TRIAL
Authors: Bortolotto Luiz , Marques Rossana , Maia Sabina , Araujo Andre
Published: May 2024

Objective:

Although managing arterial hypertension during pregnancy has been widely discussed, few studies have dealt with the postpartum period. Consequently, the treatment of hypertension in the postpartum generally relies on specialist opinion and guidelines supported by a low level of evidence. We aim to evaluate blood pressure control during the immediate postpartum in hypertensive women who had used methyldopa during pregnancy, comparing continuation of that drug with switching it for captopril.

Design and method:

A single-blind, randomized clinical trial involving 172 postpartum women with arterial hypertension who had previously used methyldopa during pregnancy at a minimum dose of 750 mg/day for at least one week prior to delivery. Following delivery, the patients were randomized either to continue with methyldopa (minimum dose 250 mg, three times a day) (methyldopa group, n=88) or to switch to captopril at an initial dose of 25 mg, three times a day) (captopril group, n=84). Logistic regression was used to compare the groups regarding the potential to maintain blood pressure below 140/90 mmHg at over 50% of measurements postpartum.

Results:

In the 48 hours following delivery, no significant differences were found in blood pressure control between the groups (methyldopa 92.0% versus captopril 95.2%), in the incidence of side effects, or postpartum depression (captopril median score 4.0; IQR: 1.0-9.0 versus methyldopa 4.0; 0.0-9.8) (P>0.05). There was no statistically significant difference between the groups with respect to any other clinical endpoint (mean number of hypertensive crises, time until control of blood pressure, need to add other drugs, or maternal and neonatal complications).

Conclusions:

Continuation of antihypertensive treatment with methyldopa in the postpartum yielded similar results to switching it for captopril, both with regard to the efficacy in controlling blood pressure and the safety of the treatment
IMPACT ON GLOBAL CARDIOVASCULAR RISK OF EARLY USE OF ANTI-HYPERTENSIVE AND LIPID-LOWERING THERAPY IN FIXED-COMBINATION: PRACTICAL IMPLICATIONS OF THE GUIDELINES RECOMMENDATIONS
Authors: Torin Gioia , Schiavon Laura , Napoli Ettore , Molinari Leonardo , Roversi Rossella , Pontesilli Giulia Maria , Zuin Marco , Cuppini Stefano , Mazza Alberto
Published: May 2024

Objective:

The 2018 ESH/ESC guidelines for the management of arterial hypertension strongly recommended the use of single-pill combination therapy as first-line treatment, approach confirmed also in the recent 2023 ESH guidelines. On the contrary, the 2019 ESC guidelines for the management of dyslipidemia recommended a stepwise treatment approach. This strategy is also applied in Italy through AIFA note 13, a regulatory tool which defines prescription and reimbursement of lipid-lowering drugs by the National Health Service. The aim of the study was to evaluate prospectively the effects of anti-hypertensive (HTT) and lipid-lowering therapy (LLT) in fixed-combination on global cardiovascular (CV) risk, in a group of hypertensive and dyslipidemic patients in primary prevention.

Design and method:

143 patients (mean age 60.2±10.9 years, 49% male) were consecutively enrolled in our center from 2018 to 2022. The subjects were defined hypertensives for systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) values >140/90 mmHg or in HTT, and dyslipidemic for non-HDL cholesterol values >130 mg/dL or in LLT. CV risk was calculated at baseline and at 1-year of follow-up with SCORE-2 and SCORE-2 OP algorithm, after starting anti-hypertensive (at the morning) and lipid-lowering therapy (after lunch) in single-pill combination. Categorical variables were compared with the X2 test while differences between continuous variables were evaluated by the analysis of variance for repeated measures. The prevalence of independent predictors of improvement vs. worsened/stable in SCORE-2 risk was assessed by the Poisson regression analysis.

Results:

SCORE-2 improved in 69.9% of cases. Adherence to treatment was 94%. Modification of antihypertensive and lipid-lowering therapy, reduction in SBP of 5 mmHg and adherence to treatment independently predicted the improvement in SCORE-2 (Figure). On the contrary, obesity and mild chronic renal failure (CKD) were associated with a worsening in SCORE-2.

Conclusions:

The early use of both HTT and LLT in fixed combination seems to improve in the medium-term the global CV risk. Therapeutic adherence has the same impact on CV risk as the modification of anti-hypertensive and lipid-lowering therapy.
PREVALENCE OF NONADHERENCE ONE YEAR PRIOR TO STROKE
Authors: Tavares Sofia , Lobo Mariana , Monteiro Isabel , Costa Teresa , Medeiros Teresa
Published: May 2024

Objective:

Estimate the prevalence of nonadherence to anti-hypertensive treatment in the year prior to patients’ admission to a Stroke Unit between October 2022 and October 2023.

Design and method:

We conducted a retrospective non-blinded analysis. Data of hypertensive patients admitted in a level B Stroke Unit from October 1st 2022 to October 31st 2023 due to ischemic stroke, hemorrhagic stroke or transient ischemic attack (TIA) was collected. Patients deceased before November 2023 were excluded due to data unavailability. At the admission moment (by local protocol) all patients were questioned if they took their medication daily, those records were also collected. We analysed data from the national prescription software platform and obtained the purchases from the prior 18 months to ensure enough pill acquisition for the year previous to the event. Descriptive analysis was performed using SPSS Statistics 23®

Results:

One-hundred-and-forty-five patients were included, 111 for ischemic stroke, 24 for hemorrhagic stroke and 10 for TIA. Forty-seven patients were excluded due to death (n=20), absence of medication/new diagnosis (n=27) or missing data (n=2). Seventy-eight were male (52.4%), the mean age was 76.1 years (±27.2) and 53.1% (n=77) had 3 or more modifiable cardiovascular risk factors. Sixty-nine were treated with only one anti-hypertensive drug and 13 with 3 or more drugs. Only 8 were treated with poly-pill combinations, the majority of the drugs were prescribed to be taken daily (n=135) and the number of pills per package ranged from 28 to 60 pills. Only 27 bought enough anti-hypertensive medication for 365 days. Ninety-four (64.8%) bought for less than 300 days and 75 (51.7%) for less than 250 days. Only 11.7% (n=17) assumed nonadherence at hospital admission.

Conclusions:

Adherence is hard to evaluate in real-world experience. The purchase of anti-hypertensive drugs does not confirm adherence, however, we consider it is highly unlikely that the patients who purchase drugs for less than 250 days for a year were adherent to therapy.
A FATAL CASE OF THERAPEUTIC NON-ADHERENCE IN HYPERTENSION
Authors: Silva Ana João , Martins Benedita , Cadavez Hugo
Published: May 2024

Objective:

This case report aims to reinforce the importance of therapeutic adherence and multidisciplinary approach in the effectiveness of treatment for hypertension.

Design and method:

To write this case report, an exhaustive review of the patient's clinical process was carried out, considering his follow-up in primary health care, hospitalizations and hospital consultations of various specialties.

Results:

This case report describes the clinical case of a 57-year-old male patient, with a personal history of hypertension diagnosed 10 years ago, complicated with mild concentric left ventricular hypertrophy. He also had anxiety disorder, without other relevant personal history. The systolic blood pressure profile was 150-220 mmHg and the diastolic profile was 90-120 mmHg. Since diagnosis, he was medicated with multiple associations of angiotensin converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, diuretics and beta blockers and followed up in an Internal Medicine consultation from 2015 to 2017, always persisting poor therapeutic adherence and suspension of medication on his own initiative due to alleged adverse effects. In 2021, he was referred to Psychiatry consultation due to therapeutic refusal, having been diagnosed with probable paranoid personality disorder. Due to the lack of insight into the psychogenic component and resistance to therapeutic interventions, it was decided to maintain an expectant attitude towards psychiatric pathology and consequently to hypertension. In 2023, the patient died suddenly at home, at the age of 57, of undetermined causes. He underwent a forensic autopsy, identifying a stroke as the cause of death.

Conclusions:

In Portugal, cerebrovascular diseases represent the main cause of mortality, with high blood pressure contributing to 51% of deaths due to stroke. Controlling modifiable risk factors, with a particular focus on hypertension, is essential to reduce premature mortality from cerebrovascular disease. Family doctors are in a privileged position to monitor hypertensive patients. This case report serves as a warning so that they can identify early therapeutic adherence problems, promoting a multidisciplinary approach with the aim of resolving them.
APPLICATION POSSIBILITIES OF DIETARY COUNSELING SUPPORT SOFTWARE IN THE TREATMENT AND PREVENTION OF HYPERTENSION
Authors: Simonová Erika , Varga László , Horváth Balázs
Published: May 2024

Objective:

Interpersonal counseling led by dietitians, based on empirical knowledge about behavioral change processes, is particularly effective in the treatment of hypertension. However, there are limitations that raise doubts about the accessibility of dietary counseling for everyone, tailored to their specific needs.

Our goal was to demonstrate that a well-chosen telemedicine method can effectively support dietary education.

Design and method:

Participants with hypertension received dietary advice based on the principles of the DASH diet and underwent regular blood pressure measurements for a period of 3 months. Their measured values and dietary logs were recorded in an application synchronized with a dietetic software. Using the software, the parameters logged by the patients (calories, fiber, sodium, potassium) were analyzed in detail based on the blood pressure values.

Results:

Our results will demonstrate that the introduction of a properly selected telemedicine method can assist patients in adopting a lifestyle change, providing timely and effective care. Significant improvements were observed in energy and nutrient intake, indicating the effectiveness of education, as patients, due to their increased knowledge, consciously chose healthier diets. As a result, the systolic values decreased on average by 13.35 mmHg, and the diastolic values decreased by an average of 11.7 mmHg during the course of the study.

Conclusions:

A dietary approach targeting blood pressure modification should be an important strategy in the prevention of cardiovascular diseases. Extensive literature confirms that various dietary components and numerous diets can influence blood pressure. The strongest evidence for lowering blood pressure or preventing high blood pressure through dietary intervention is in favor of DASH and the Mediterranean diet, and there are clear benefits to higher potassium intake, limiting sodium, and increasing fiber consumption.
BODY COMPOSITION PREDICTS HYPERTENSION USING MACHINE LEARNING METHODS: A COHORT STUDY
Authors: Drissi Hamed Bazrafshan , Bazrafshan Mehdi , Nematollahi Mohammad Ali , Jahangiri Soodeh , Asadollahi Arefeh , Salimi Maryam , Dehghan Azizallah , Mashayekh Mina , Roshanzamir Mohamad , Gholamabbas Ghazal , Alizadehsani Roohallah , Bazrafshan Hanieh , Islam Sheikh Mohammed Shariful
Published: May 2024

Objective:

Hypertension is one of the most important and preventable causes of cardiovascular disease (CVD), stroke, chronic kidney disease, and dementia which caused approximately 8.5 million deaths in 2015, in low & middle income countries. Hypertension depends on well known risk factors such as age, gender, family history, smoking, alcohol consumption, central obesity, overweight and physical inactivity. Evidence shows that body fat distribution is a more vital determinant of cardiovascular morbidity and mortality than increased fat mass. In the past few years, growing number of researchers have used machine learning and data mining algorithms to diagnose and treat health conditions such as heart11 and brain12 diseases. Their non-invasive nature and accuracy have enabled health professionals to quickly identify at-risk individuals and use more efficient preventive and managing strategies.

In this study, we used machine learning approaches to investigate whether BIA-derived body composition indices predict hypertension in a cohort of patients.

Design and method:

Data from a cohort study was used. Body composition analysis was done using bioelectrical impedance analysis (BIA); weight, basal metabolic rate, total and regional fat percentage (FATP), and total and regional fat-free mass (FFM) were measured. We used machine learning methods such as Support Vector Classifer, Decision Tree, Stochastic Gradient Descend Classifer, Logistic Regression, Gaussian Naïve Bayes, K-Nearest Neighbor, Multi-Layer Perceptron, Random Forest, Gradient Boosting, Histogram-based Gradient Boosting, Bagging, Extra Tree, Ada Boost, Voting, and Stacking to classify the investigated cases and fnd the most relevant features to hypertension.

Results:

4663 records were included (2156 were male, 1099 with hypertension, with the age range of 35–70 years old). Arm FFM, basal metabolic rate, total FFM, Trunk FFM, leg FFM, and male gender were inversely associated with hypertension, but total FATP, arm FATP, leg FATP, older age, trunk FATP, and female gender were directly associated with hypertension. AutoMLP, stacking and voting methods had the best performance for hypertension prediction achieving an accuracy rate of 90%, 84% and 83%, respectively.

Conclusions:

By using machine learning methods, we found that BIA-derived body composition indices predict hypertension with acceptable accuracy.
RELATIONSHIP OF BLOOD PRESSURE VARIABILITY WITH HEART RATE VARIABILITY IN PATIENTS WITH PERMANENT ATRIAL FIBRILLATION
Authors: Ntousopoulos Vasileios , Menti Ariadni , Tsiachris Dimitrios , Stergiou George , Kollias Anastasios
Published: May 2024

Objective:

To investigate the relationship between blood pressure (BP) variability and heart rate variability (HRV) in patients with atrial fibrillation (AF).

Design and method:

Patients with permanent AF were subjected to manual auscultatory BP measurements in the office (5 consecutive measurements, mercury sphygmomanometer; 2 observers simultaneously), and a 1-minute single-lead electrocardiogram (ECG) simultaneously with BP measurements. Intra-observer BP variability was assessed with standard deviation (SD) and coefficient of variation (CV), while HRV was assessed using SD (SDRR) and CV (CVRR) of ECG R-R intervals and the root-mean square differences of successive R-R intervals (RMSSD).

Results:

52 participants with permanent AF were analyzed (mean age [SD] 76±9.8 years, 64% males, mean systolic/diastolic BP 118.4±20.2/69.3±10.1 mmHg, heart rate [HR] 76.4±16.3, 92% treated hypertensives). None of the BP variability indices was correlated to the HRV indices. HR was inversely correlated with HRV indices (SDRR r=-0.63 and RMSSD r=-0.65, both p<0.01). In a sub-analysis of participants in the highest quartile of HR (>87 bpm) the SD of diastolic BP was correlated with SDRR (r=0.62, p<0.05) and showed a trend of correlation with CVRR and RMSSD (r=0.54/0.55, p=0.06/0.05 respectively). Likewise, the CV of diastolic BP showed a trend towards a positive association with SDRR, CVRR and RMSSD (r=0.54/0.44/0.49, p=0.06/0.13/0.09 respectively). No significant correlations were observed for systolic BP variability indices. In multivariable linear regression analysis in this subgroup (HRV indices as independent variables), SDRR was the only independent determinant for the SD of diastolic BP (β= 0.03, p<0.05).

Conclusions:

These preliminary findings suggest that in patients with permanent AF, HRV appears to be associated with the variability of diastolic BP when HR is above 87 bpm.
EUROPEAN SOCIETY OF HYPERTENSION PROTOCOL FOR VALIDATING NOVEL CUFFLESS BLOOD PRESSURE MONITORS DURING HANDGRIP ISOMETRIC EXERCISE
Authors: Kollias Anastasios , Stathopoulou Panagiota , Kyriakoulis Konstantinos , Avolio Alberto , Mukkamala Ramakrishna , Stergiou George
Published: May 2024

Objective:

According to the recent European Society of Hypertension (ESH) validation protocol for cuffless blood pressure (BP) devices, a novel isometric handgrip exercise test can be used as an alternative procedure to the bicycle test for assessing BP increase accuracy. This study evaluated the BP and heart rate (HR) response during the ESH handgrip exercise test.

Design and method:

Four baseline BP/HR measurements (R1-R2-R3-R4; mercury sphygmomanometer; 1-min intervals) were performed in resting sitting posture. The maximum grip strength of the dominant hand was determined using a grip strength dynamometer. Handgrip exercise was then performed using resistance set to 30% of the maximum grip strength (using a device with adjustable grip strength). Participants performed an ‘initial exercise session’ to induce BP increase via 12 sets of 8 repetitive handgrips alternating between hands (6 sets per hand, starting with the dominant one). Then, the first post-exercise reference BP measurement (R5) was obtained. Afterwards, a maintenance phase followed with 6 sessions of 4 sets of 8 repetitive handgrips with BP/HR measurements after each session (R6-R7-R8-R9-R10-R11). Resting BP was determined as the average of R3 and R4, whereas the average of R5-R7-R9-R11 was used for determining post exercise reference BP/HR levels.

Results:

45 individuals were analyzed [age 47±12 years, body mass index (BMI) 27±4 kg/m2, 69% males, 33% on antihypertensive therapy, resting systolic/diastolic BP 124±16/81±11 mmHg, HR 75±13 beats/min]. In 22% of the participants resting systolic BP was >= 140 mmHg. The average exercise-induced systolic BP increase was 7±5 mmHg. A systolic BP increase >= 8 mmHg, >= 10 mmHg, <5 mmHg was observed in 38%, 27%, and 33% of the participants respectively. No significant changes were observed in diastolic BP (1±3 mmHg) and HR (1±4 beats/min). There was a trend towards an inverse association between BMI and systolic BP increase (r= -0.27, P=0.07).

Conclusions:

The ESH handgrip exercise validation test for cuffless BP devices produces sustained increases in systolic BP in a considerable proportion of participants, similar to the bicycle test. Thus, this test is useful for validating the ability of cuffless devices to track BP increases.
RELATIONSHIP OF DAILY BLOOD PRESSURE PROFILE AND ARTERIAL STIFFNESS
Authors: Srojidinova Nigora , Duysenbaeva Aziza , Khafizova Lola , Urishbaev Ravshan
Published: May 2024

Objective:

To study the blood pressure daily profile in patients with hypertension (HNT) depending on the pulse wave velocity (PWV).

Design and method:

We studied 88 treated patients with HNT. The ambulatory BP monitoring (ABPM) was recorded with a Medicom-combi device (Russia) using the oscillometric method. PWV was determined using the SphygmoCor (AtCor Medical Pty Ltd, Australia). Statistical analysis was performed using the SPSS 24.0 software package.

Results:

Patients were divided into 2 groups depending on PWV level: the first group had a PWV < 10 m/s, and the second group had a PWV > 10 m/s. The mean PWV in the groups was 7.79±1.38 vs. 14.13±1.85 m/s, respectively (p<0.007). Office SBP and DBP didn’t differ between groups. Patients of the second group had significantly higher mean daily SBP (113.64±16.64 vs 128.23±16.91 mm Hg, p=0.0001), mean daytime SBP (116.77±8.99 vs 129.36±7.8 mm Hg, p=0.0001), and mean nighttime DBP (66.26±9.7 vs 71.64±7.1 mm Hg, p=0.04). The load index (LI) of daytime and nighttime SBP was higher in patients with PWV > 10 m/s. LI of SBP daytime: 9.72±15.82% vs. 27.74±35.24%, respectively, p = 0.001. LI of SBP nighttime: 18.34±26.44% vs. 44.2±38.81%, respectively, p = 0.001. Variability and nocturnal falls of SBP and DBP also didn’t differ between the groups. The number of dippers by SBP and DBP was higher in patients with normal PWV, but not significantly: 18% and 12% vs. 13% and 9%, SBP: χ2 = 0.04, p = 0.83; DBP: χ2 = 0.19, p = 0.45. The number of non-dippers by SBP and DBP was significantly higher in the first group: 65% and 66% vs. 50% and 50%; SBP: χ2 = 4.6, p = 0.032; and DBP: χ2 = 5.25, p > 0.05. However, the number of night-pickers by SBP and DBP significantly prevailed in the second group: 17% and 19% vs. 36.4% and 32%, respectively; SBP: χ2 = 9.2, p = 0.003, DBP: χ2 = 5.58, p = 0.019. There were no over-dippers in both groups.

Conclusions:

Hypertensive patients with high PWV values had more pronounced disorders in their daily blood pressure profile.