bluuebunny/crossref_metadata_2025 huggingface dataset:
SINGLE-PILL, TRIPLE ANTIHYPERTENSIVE THERAPY IN RURAL SUB-SAHARAN AFRICA: PRELIMINARY EXPERIENCE
Authors: Muggli Franco , Parati Gianfranco , Hunjan Isabella , Stroppa Clara , Bianchetti Mario , Muvunyi Bienvenu , Ntaganda Evariste , Umulisa Alice , Sinabubaraga Vincent , Radovanovic Dragana
Published: May 2024

Objective:

Arterial hypertension is worldwide the leading modifiable cardiovascular risk factor. Beside life-style changes, strong evidence supports the efficacy of pharmacological treatment in reducing the complications of hypertension. International guidelines have recommended single-pill, low-dose combinations as initial treatment strategy. We investigated whether management of hypertension through this approach is feasible and effective in a rural sub-Saharan Africa setting.

Design and method:

Diagnosis of hypertension was established over three sets of blood pressure measurements: during a community-based, house-to-house screening in 2020 and in 2022, and at the hypertension outpatient clinic. Blood pressure measurements were performed according to the ESH recommendations by trained personnel, using a validated, oscillometric device OMRON M7 IT-HEM-7322-E. In 98 individuals diagnosed to have arterial hypertension, once-daily, single-pill combination of olmesartan, amlodipine, and hydrochlorothiazide was prescribed at a dose suitable to their blood pressure values and clinical characteristics. They were instructed on its administration and potential side effects and encouraged towards lifestyle modifications. Treatment regimen was adjusted, if needed, at each outpatient clinic visit scheduled after 4, 8, 12, and 16 weeks

Results:

79 patients (aged 61 [53-70] years; median and interquartile range) strictly adhered to the treatment schedule, while overall 19 individuals dropped-out (aged 70 [65-80] years) because of different reasons. About 20% were tobacco smokers and nearly all consumed alcohol. Blood pressure was <140/90 mm Hg after 4 weeks in 44 (56%), after 8 weeks in 62 (78%), after 12 weeks in 69 (87%), and after 16 weeks in 74 (94%) participants. Excellent tolerance was widely reported.

Conclusions:

Management of hypertension with once-daily, single-pill combination of olmesartan, amlodipine, and hydrochlorothiazide as initial treatment was feasible and effective also in a rural sub-Saharan setting, with very high rate of hypertension control in patients adherent to treatment. Our results provide real life evidence in favor of extensive implementation of single-pill combination therapy also in low- and middle-income countries where local Health Care Systems should include recommendation on their usage in national guidelines and should make them available also in rural and remote areas at low or no cost as reliable first-line treatment strategy
EVENING DOSING VERSUS MORNING DOSING OF ANTI-HYPERTENSIVE MEDICATIONS FOR NOCTURNAL HYPERTENSION: A SYSTEMATIC REVIEW AND META-ANALYSIS OF 107 RANDOMIZED CONTROLLED TRIALS
Authors: Lee Eric Kam-pui , Poon Paul Km , Tse Emily Tsui-yee , Wang Shuqi , Ramdzan Siti Nurkamilla , Sit Regina , Ng Wei Leik , Chan Linda , Yu Chun -Pong
Published: May 2024

Objective:

Although nocturnal blood pressure (BP) is consistently a stronger predictor to cardiovascular events and death than daytime BP, specific treatment for nocturnal hypertension (HT) is lacking. As effects of one-daily anti-hypertensive (HT) medications are more pronounced within first few hours of ingestion, evening administration of anti-HT medications can be a feasible treatment for nocturnal HT. However, a relevant meta-analysis in patients with nocturnal HT has yet been conducted.

Design and method:

This is a systematic review and meta-analysis. Randomized-controlled trials that included patients with elevated mean nocturnal BP, compared evening anti-HT administration versus morning administration and reported nocturnal BP were included. Multiple databases were searched using search terms developed with a medical librarian. Grey literature search included reference lists of previous related reviews and clinicaltrial.gov. Studies selection and data extraction were conducted by 2 independent authors. Risk of bias assessment and overall quality of evidence were conducted using Cochrane risk-of-bias tool and GRADE by 2 independent authors. Meta-analyses were conducted using a random effect model.

Results:

A total of 107 studies were included and 76 Chinese studies were identified, which had never been included in previous reviews. Only a few studies investigated effects of beta-blockers (n=3) and diuretics (n=1). Evening administration of anti-HT medications were effective in reducing nocturnal systolic BP (4.12-9.1mmHg; I2 = 80.5-95.2%) and diastolic BP (3.38-5.87mmHg; I2=87.4-95.6%). Subgroup analyses found that effectiveness of evening administration was contributed by data from Hermida group and from China. Effectiveness of nocturnal BP reduction was similar with different types, doses, and half-lives of medications. Evening administration of anti-HT medications may reduce proteinuria, left ventricular hypertrophy (LVH), non-dipper and morning surge. The overall quality of evidence was ranked low to moderate. There is a lack of long-term RCT which reported clinically relevant cardiovascular outcomes (i.e. >1 year).

Conclusions:

Evening administration of anti-HT can further reduce nocturnal BP, non-dipping and excessive morning surge when compared to morning administration and can be a useful strategy for treatment of nocturnal HT. Evening administration may also be more effective to reverse surrogate cardiovascular outcomes such as proteinuria and LVH.
THE CHANGE IN QUALITY OF LIFE IN DRUG-TREATED HYPERTENSIVE PATIENTS AFTER 10 YEARS OF ANTIHYPERTENSIVE TREATMENT
Authors: Kantola Ilkka , Kantola Taru -Tuuli
Published: May 2024

Objective:

To clarify the change in quality of life in Finnish drug-treated hypertensive patients after ten years of antihypertensive treatment.

Design and method:

Earlier non-treated patients participated during the years 1999-2002 in a six-month study where their antihypertensive treatment was titrated either by using home or 24 hour ambulatory measurement. Thereafter they have been in the ordinary out-patient care,

The patients filled the SF-36 questionnaire before the start of antihypertensive therapy and after 10-13 years of use of antihypertensive therapy.

Results:

SF-36 questionnaire was filled out by 44 patients (23 females and 21 males, aged 66.1 (6.1), 55-77 years) after 10.6 (2.9) (6-13) years of antihypertensive treatment. All of them used at least one antihypertensive agent.

The mean (SD) SF-36 questionnaire scores after about 10 years of antihypertensive treatment were (maximum 100): Physical functioning 78.5 (19.9), role-physical 72.6 (34.0), bodily pain 68.1 (22.2), general health 64.5 (16.2), vitality 68.6 (15.8), social functioning 90.1 (19.0), role-emotional 76.0 (35.9), mental health 84.5 (14.4) and general health 3.2 (0.7). The mean of all the scores was 75.4 (17.8).

During the titration period (in the years 1999-2002) physical functioning decreased nearly significantly from 87.1 (12.4) to 83.3 (15.7), p=0.053. Other parameters did not change significantly.

During 10 years of antihypertensive treatment physical functioning decreased significantly from 84.5 to 79.8 (p=0.039). Instead, vitality (63.4 (22.2) to 69.6 (14.5), p=0.032), social functioning (85.8 (21.1) to 91.7 (14.9), p=0.028) and mental health (81.7 (14.4) to 85.7 (12.4), p=0.030) increased significantly. Other parameters did not change significantly.

Conclusions:

According to our results physical functioning decreased and vitality, social functioning and mental health increased during about 10 years of antihypertensive treatment. The decrease in physical functioning is probably explained by aging, because physical function decreases in normal population about 0.5/lifeyear. Perhaps, good antihypertensive treatment explains the increase in those three mental parameters. All three parameters and also physical functioning were better than in the normal population. Thus, it seems that according to the SF 36 questionnaire quality of life in Finnish treated hypertensive patients is quite good and do not decrease significantly during aging.
DECLINING RATES OF FIXED-DOSE COMBINATION PILLS FOR HYPERTENSION IN GERMANY FROM 2016 TO 2023
Authors: Götzinger Felix , Kieble Marita , Laufs Ulrich , Mahfoud Felix , Schulz Martin
Published: May 2024

Objective:

Current guidelines recommend the usage of fixed-dose combination (FDC) pills in primary and secondary prevention of cardiovascular diseases. Current data on the implementation of these recommendations in German clinical practice are scarce. The objective was to assess the use of antihypertensive FDCs in Germany from 2016-2023.

Design and method:

We analysed claims data from the German Institute for Drug Use Evaluation from January of 2016 to September of 2023, containing information on dispensed drugs in an outpatient care setting of approx. 87% of the German population (excluding private insurance) and evaluated the use of antihypertensive FDC pills according to time, age of the insured persons, and active substances contained in the FDC.

Results:

The use of FDC pills decreased from 2016 to 2022 from 22.2 million packages to 15.6 million packages, while the absolute number of antihypertensives prescribed increased from 143.8 million packages to 155.9 million packages. Consequently, the proportion of FDC pills in all antihypertensives decreased from 15.4% in 2016 to 10.0% in 2022. The amount of hydrochlorothiazide (HCT) containing FDC pills decreased from 2016 to 2022 (from 18.9 million packages to 11.0 million packages), while the amount of FDC pills that do not contain HCT increased from 2016 to 2022 (from 3.3 million packages to 4.7 million packages). Use of FDC pills has been declining in all age groups. FDC pills are used infrequently in patients over 80 years of age.

Conclusions:

Despite guideline recommendations, use of antihypertensive FDC pills in Germany is declining, showing continuing guideline inertia. The decrease is mainly driven by decreased prescriptions of HCT-containing FDC pills. Assumed higher medication cost for FDC compared to single pills and fear of non-melanoma skin cancer for HCT are potential reasons. Use of FDC pills should be advised and implemented in outpatient care in Germany.
RATIONALE AND DESIGN OF PHASE 3 TRIAL FOR BAXDROSTAT, A NOVEL HIGHLY SELECTIVE ALDOSTERONE SYNTHETASE INHIBITOR
Authors: Perl Shira , Azizi Michel , Bakris George , Brown Jenifer M. , Flack John M. , Jones Erika , Shibata Hirotaka , Wittes Janet , Wilderäng Ulrica , Olsson Daniel S. , Williams Bryan
Published: May 2024

Objective:

Aldosterone is a key driver of cardiorenal disease as well as hard-to-treat hypertension. Highly selective aldosterone synthase inhibitors (ASI) are a new class of anti-hypertensive therapy that hold great promise for management of blood pressure (BP), having demonstrated BP lowering in a proof-of-concept study. The rationale for and design of a phase 3 trial with the novel ASI baxdrostat are described here.

Design and method:

The international, multicenter, randomized, double-blind, placebo-controlled phase 3 BaxHTN trial (NCT06034743) will enroll approximately 720 adults with uncontrolled or resistant hypertension defined as seated office systolic BP greater than/equal to 135 mmHg despite 2+ antihypertensives including a diuretic, serum potassium 3.5-5.0 mmol/L, and eGFR greater than/equal to 45mL/min/1.73m2. Given the need to address long-term efficacy but limit placebo use due to the risks of uncontrolled hypertension, the study will have 4 sequential parts following placebo run-in: 1) 12-week double-blind period, 1:1:1 randomization to baxdrostat 2 mg, baxdrostat 1 mg, or placebo; 2) 12-week open label period, re-randomization of the placebo and 1 mg arms to 2 mg or standard-of-care; 3) 8-week randomized withdrawal period to 2 mg or placebo; and 4) 20-week open label period. The primary endpoint will be the change in office systolic BP from baseline to 12 weeks. Adverse events will be evaluated under independent data monitoring committee supervision.

Results:

Results are expected in late 2025.

Conclusions:

The phase 3 BaxHTN trial design will allow assessing the safety of baxdrostat and its effect on BP in patients with uncontrolled or resistant hypertension. Results are expected in late 2025.
EFFECT OF CHRONIC FUROSEMIDE THERAPY ON SERUM FREE LIGHT CHAIN IN CHRONIC KIDNEY DISEASE PATIENTS
Authors: Bisht Khushboo , Sinha Nishant
Published: May 2024

Objective:

Chronic kidney disease (CKD) is an important cause of morbidity and mortality worldwide.

There is a lack of information on the epidemiology and progression of CKD in low-middle-income countries. Chronic use of diuretics is considered to further decrease renal clearance, a pathophysiology not very clearly understood. Free light chains renal deposition is precipitated by loop diuretics. This study attempted to determine whether chronic diuretic usage was associated with increase serum free light chain and a reduction in renal clearance among CKD patients.

Design and method:

A single-center, record-based study of 84 CKD patients with an established diagnosis of CKD, loop diuretic therapy, between June 2019 and December 2019 was conducted after ethical approval by institutional ethics committee ((RIMS/2018/32). The study included participants with age above 18 years of age, never dialysed, non-neoplastic (specifically plasma cell disorder), non-pregnant, and those on loop diuretic were divided into 3 groups: group 1 with Furosemide exposure more than 6 months; Group 2 with furosemide exposure between 3 months to 6 months but less than 6 months; and Group 3 with furosemide exposure less than 3 months.

Results:

46 out of 84 patients were of group 1, 20 belonged to group 2 and 18 were in group 3. In group 1, mean eGFR of 103.6, mean free kappa of 100.98 and mean lambda of 126.65.2 was observed. Group 2 patients had mean eGFR of 125.6 with mean free kappa of 80.98 and mean lambda of 1002.2, whereas group 3 had mean eGFR of 15 5.5, mean free kappa of 79.8 and mean lambda of 96.65.2. It was also observed that 98% patients with stage 5 CKD had high serum free lambda level.

Conclusions:

This study revealed a strong association of serum free light chain level with stage of CKD in patients on diuretic therapy. Therefore, monitoring of Serum Free Light Chain among CKD patients on diuretic therapy can be an indirect evidence of furosemide induced renal function worsening.
ORTHOSTATIC HYPOTENSION IN PATIENT WITH HYPERTENSION AND THE ASSOCIATION OF ANTIHYPERTENSIVE PHARMACOLOGY TREATMENT
Authors: Doan Long , Nguyen Thi Lan Nhi
Published: May 2024

Objective:

This study aims to assess the prevalence of orthostatic hypotension (OH) and investigate potential associations between OH and specific antihypertensive medication treatments.

Design and method:

A prospective study with a 1-month follow-up in all hypertension patients being treated with antihypertensive medication, who were manifesting symptoms of suspect OH (lightheadedness, visual disturbances, and presyncope…) at the outpatient clinic of Hue University Hospital. Patients with too high or too low SBP (>180mmHg or <90mmHg); patients with a history or be diagnosed in this visit with ischemic or hemorrhagic stroke; patients with a history of any vestibular disorder; patients with cognitive dysfunction or pregnancy were excluded from the study. Patients with a history of diagnosed OH or postural orthostatic tachycardia syndrome were also excluded. All participants were taken medical history, clinical examination, laboratory tests, and orthostatic BP measure by upper arm automated oscillometric device (OMRON HEM-7600T) seated to standing with a 3-minute delay. OH is diagnosed when a decrease in SBP equal or more than 20 mmHg or DBP equal or more than 10 mmHg. Patients had routine consults and treatment at baseline. After 1 month, all OH patients were re-examined and taken orthostatic BP measurements.

Results:

Among 642 participants (mean age 61.4 ± 11.4), 122 (19.0%) patients were diagnosed for OH. There were no significant differences between age, sex, history of comorbidities. There are no association between OH and the uncontrolled hypertension ratio as well as the strict of BP control. In antihypertensive agents, the use of CCB (Amlodipine, Lercanidipine in the study) appears to reduce the risk of OH (p <0.001) and vice versa, the use of diuretics (Hydrochlorothiazide; Indapamide in the study) appears to increase the prevalence of OH (p<0.001). These associations were also demonstrated again through multivariate analysis (p=0.041, p=0.003, respectively). The use of 3 antihypertensive agents were also increase the prevalence of OH (p<0.001), although this was not significant in multivariate analysis (p=0.083).

Conclusions:

Orthostatic hypotension is a common condition in people treated for hypertension with medication. The choice and change of antihypertensive classes should be considered in patients with suspected orthostatic hypotension.
VISCERAL FAT TISSUE AS A SIGNIFICANT CARDIOVASCULAR RISK FACTOR IN CORRELATION WITH SUBCLINICAL ORGAN DAMAGE IN POSTMENOPAUSAL WOMEN
Authors: Woznicka-leskiewicz Lucyna , Posadzy-malaczynska Anna
Published: May 2024

Objective:

Postmenopausal women are a special group of the cardiological patients. Every effort should be made to search for subclinical organ damage in this group, the presence of which correlates with the amount of visceral fat tissue.

Design and method:

We examined 156 postmenopausal women. The average age of them was 65,3 years old. 41% of them had type 2 diabetes; 46% of them were taking statins. Pulse wave velocity (PWV), systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI) and lipid profile were evaluated. Visceral fat tissue, body weight and fat mass were performed by Tanita MC980 MA Plus analyzer. We assessed cardiovascular risk according to: SCORE2 and SCORE2- OP scales. Statistical calculations were performed in the StatSoft Statistica 10: ?Spearmana was taken to analyze the correlation of statistically significant values.

Results:

We revealed following results [∗for p<= 0,05; ∗∗for p<0,001].

People with higher body weight characterized by higher SBP and DBP. Lower fat mass and BMI resulted with lower DBP. The lower fat mass, BMI and the amount of visceral fat tissue, the higher HDL cholesterol level. People with higher fat mass, BMI and the amount of visceral fat tissue were more likely to have type 2 diabetes.Patients with higher amount of visceral fat tissue characterized by greater aortic stiffness and more often required lipid-lowering therapy. The amount of visceral fat tissue correlated with age of the patients and their cardiovascular risk assessed by SCORE2/SCORE2OP scales.

Conclusions:

The amount of visceral fat tissue should be taken into account in assessing the patient‘s cardiovascular risk and occurrence of cardiological subclinical organ damage. Weight loss must be considered as an important factor in the reducing of blood pressure. The likelihood of developing type 2 diabetes is correlated with higher BMI and fat mass. Reduction of BMI, fat mass and the amount of visceral fat tissue results with better lipid profile. Greater amount of visceral fat tissue results in more frequent need of starting lipid-lowering therapy.
ARTERIAL HYPERTENSION IN THE METABOLIC SYNDROME ADULT POPULATION OF ROMANIA AND CURRENT TREATMENT ADHERENCE - SUBANALYSIS OF DATA FROM THE SEPHAR IV STUDY
Authors: Stanciulescu Diana Irena , Dorobantu Maria
Published: May 2024

Objective:

Cardiovascular disease (CVD) remains to be the leading cause of mortality worldwide with significant increase in cardiovascular mortality trends in Eastern Europe. Romania's burden primarily stems from arterial hypertension and its complications, which account for 62% of all deaths. Metabolic syndrome (MS) arises from a combination of genetic and acquired factors that contribute to insulin resistance and chronic inflammation. When left unaddressed, it poses a substantial risk for the development of diabetes and cardiovascular disease, therefore our study aims to analyze the cardiovascular status of the adult population of Romania.

Design and method:

We evaluated a subgroup of 835 subjects from the total 1477 of SEPHAR IV population (Study for Evaluation of Prevalence of Hypertension and Cardiovascular Risk in an Adult Population in Romania) enrolled during May 15t–July 20th 2021, diagnosed with metabolic syndrome using the The National Cholesterol Education Program Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) (NCEP-ATP III) criteria (MS was present if at least three criteria were met): waist circumference of 102 cm in men and 88 cm in women, hypertryglyceridemia (150 mg/dL) or under specific treatment, low HDL-cholesterol (less than 40 mg/dL in men and less than 50 mg/dL in women), blood pressure readings higher than 130/85 mmHg, fasting blood glucose levels greater than 110 mg/dL or under specific treatment. We collected data regarding the presence of antihypertensive treatment at least 2 weeks prior to inclusion with two or more drugs.

Results:

There was a significanly higher prevalence of NCEP-ATP III arterial hypertension criteria in men (70.5%) compared to women (55.1%). MS was significantly more prevalent in women than men in the general study population, and was significantly more prevalent in the population first diagnosed with arterial hypertension or under current antihypertensive treatment. Previous treatment rate among the hypertensive MS patients was 66.8% and the control rate was 40.1%.

Conclusions:

The burden of cardiovascular risk disease is still very high in Romanian population, similar to other Eastern European countries, because of the insufficient prevention and control and firmly requires active changes.
ASSOCIATIONS OF 25-HYDROXYVITAMIN D WITH FOLATE, COBALANIN AND HOMOCYSTEINE LEVELS AND METHYLENE TETRAHYDROFOLATE REDUCTASE (MTHFR) GENE POLYMORPHISMS, IN HEALTHY GREEK ADULTS
Authors: Papadakis Ioannis , Papadomanolaki Maria , Charizani Aikaterini , Keramaraki Eleni , Malikides Vironas , Mazokopakis Elias
Published: May 2024

Objective:

The aim of this study was to investigate the associations of serum 25-hydroxyvitamin D [25(OH)D] with various demographic, anthropometric, genetic characteristics, and biochemical parameters, in healthy Greek adults.

Design and method:

Demographic (age, sex), anthropometric [body mass index (BMI)], genetic (MTHFR gene polymorphisms) characteristics, and biochemical parameters [serum folate, cobalamin (Cbl) and total homocysteine (tHcy) concentrations], which had been recorded and measured, among others, in the framework of periodic medical examination (military personnel) or check-up (non-military personnel) of 383 Greek healthy adults (199 men) were analyzed. Serum 25(OH)D, tHcy, folate and Cbl levels were determined using immunoassays methods. The MTHFR C677T and A1298C gene polymorphisms were genotyped using polymerase chain reaction and reverse hybridization.

Results:

Serum 25(OH)D concentrations were correlated with Cbl levels and MTHFR C677T gene polymorphism; while, they had a reverse correlation with serum tHcy levels, age, and BMI. There was no significant correlation between the serum 25(OH)D concentrations and sex, serum folate levels or smoking status. The individuals with 677TT genotype had statistically significant lower serum 25(OH)D levels than those with 677CC or 677CT genotype, while the individuals with 1298CC genotype had statistically significant higher serum 25(OH)D levels than those with 1298AA or 1298AC genotype. Moreover, the reverse correlation between the serum 25(OH)D and tHcy levels was statistically significant in all six MTHFR genotypes.

Conclusions:

Serum 25(OH)D levels are associated with age, BMI, serum tHcy and Cbl levels, and MTHFR C677T gene polymorphism. The most significant finding of our study is the observed reverse correlation of serum 25(OH)D levels with serum tHcy levels. Considering that vitamin D deficiency and hyperhomocysteinemia are associated with an increased risk for cardiovascular disease, we suggest that individuals with high serum tHcy levels should be further investigated, among others, for their serum 25(OH)D levels.
THE ARTERIAL STIFFNESS AS RISK FACTOR FOR THE OCCURRENCE OF ARTERIAL HYPERTENSION IN POSTOPERATIVE CRITICALLY ILL PATIENTS
Authors: Gatsori Panagiota , Intas George , Skopelitis Hlias , Katsoulas Theodoros , Stergiannis Pantelis
Published: May 2024

Objective:

The aim of the present study is to investigate the predictive value of arterial stiffness in the occurrence of arterial hypertension in critically ill patients. Also, the study investigates the risk factors of arterial hypertension in ICU patients.

Design and method:

This is a prospective observational study. The study included postoperative patients who were admitted to the ICU. We collected demographic characteristics of the patients, their clinical characteristics (i.e. hemodynamic status), clinical severity (APACHE II, SOFA score), lifestyle data (i.e. smoking, alcohol, drugs), and medical history (diabetes mellitus, cardiovascular diseases). Arterial stiffness assessment is performed by recording and analyzing the pulse wave in postoperative patients during the first 24 hours of admission to the ICU. The Sphygmocor software was used for pulse wave analysis and IBM SPSS v.27.0 software was used for statistical analysis.

Results:

The sample of the study consisted of 74 patients. Most of them were males (70.3%) aged 59.3±18.6 yrs and the rest were females (29.7%) aged 63.3±16.9 yrs. Totally, 54.1% of patients had emergency surgery, 60.8% survived and discharged from ICU, 52.7% had arterial hypertension, 70.3% had diabetes mellitus, 58.1% were smoking, and 63.5% had hypercholesterolemia. The APACHE II score of patients was found 21.2±7.2 and the SOFA score 7.5±2.8 The value of peripheral systolic blood pressure (PSBP) was 138.7±19.4 mmHg, peripheral diastolic blood pressure (PDBP) was 67.1±13.2 mmHg, mean peripheral blood pressure (MPBP) was 90.7±14.6 mmHg, pulse pressure (PP) was 53.1±15.3 mmHg and AIX@75 was 22.3±13.1%. Older patients (69.1±14.9 vs. 52.7±17.3, p=0.001), patients with diabetes mellitus (92.3% vs. 7.7%, p=0.001), patients with hypercholesterolemia (92.3% vs. 7.7%, p=0.001), patients with higher value of Albumin (2.9±0.5 vs. 2.5±0.6, p=0.025), and patients with a higher value of AIX@75 (26.8±10.5 vs. 18.3±14.1, p=0.004) had statistically significant higher percentages of arterial hypertension. Higher AIX values are associated with a greater likelihood of arterial hypertension (OR: 1.027; 95%CI: 1.004-1.049, p=0.018).

Conclusions:

The arterial stiffness is an independent risk factor for arterial hypertension in postoperative critically ill patients.
COMPARATIVE ANALYSIS OF ERGOSPYROMETRIC VARIABLES BETWEEN SEDENTARY AND NON-SEDENTARY PATIENTS WITH METABOLIC SYNDROME AND ESTABLISHED CARDIOVASCULAR DISEASE
Authors: Ingaramo Roberto , Lencinas Maria Florencia , Herrera Miriam Priscila , Chavarrea Tony Pilco , Bello Andrea
Published: May 2024

Objective:

To analyze the ergospirometric prognostic variables of VO2MAX, OUES, SLOPE VE/VCO2, and ventilatory class, between sedentary and non-sedentary patients with metabolic syndrome all suffering from any kind of established cardiovascular disease.

Design and method:

From November 2022 to September 2023, 99 patients, with an average age of 70 years, 51.5% women and 48.5% men, underwent an ergospirometry study. They were divided into two groups: sedentary (SP) and non-sedentary (NSP) according to the responses obtained from the IPAQ survey. Subsequently, the ergospirometric variables that measure cardiorespiratory and cardiovascular capacity related to maximum exercise capacity O2 metabolism (VO2MAX), the increase in oxygen consumption according to minute ventilation (OUES) and the response to ventilation according to CO2 production (slope VE/VCO2) were analyzed in both groups. For statistical analysis, the Student's t test and the Fisher exact test were used. The R v4.0.3 software was used.

Results:

The level of exercise was low in 56 (56.6%) and moderate or high in 43 patients. (43.4%). The NSP group presented higher levels of maximum oxygen consumption (18.3 vs 12.7, p=0.001), higher mean percentage of OUES (92 vs 63.9, p=0.001) and lower mean VE/VCO2 SLOPE ratio (26 vs 31, p=0.001). Among the NSP, 14% were found in ventilatory class 2 and 86% in class 3 and in the SP, 25% were found in class 1, 21.4% in class 2, and 48.2% in class 3. Although that a high percentage of NSP were in functional class 3 (86%) the same presented better values than those SP with better ventilatory class. We did not obtain statistical differences between both groups with respect to their underlying cardiovascular pathologies.

Conclusions:

A sedentary lifestyle is associated with higher erogospirometric variables risk in patients with metabolic syndrome and established cardiovascular disease. The level of physical activity is a factor that modifies this cardiovascular risk. Ergospirometry is an effective tool to measure cardiovascular prognosis.
ASSOCIATION OF C-REACTIVE PROTEIN LEVEL WITH THE RISK OF TYPE 2 DIABETES: SYSTEMATIC REVIEW AND A DOSE-RESPONSE META-ANALYSIS
Authors: Chien Kuo -LIONG , Hsu Jui -YUN , Tsai Szu -YING
Published: May 2024

Objective:

The relationship between C-reactive protein (CRP) levels and the risk of type 2 diabetes were positive; however, the non-linearity pattern was still unknown. We conducted a systematic review and a dose-response meta-analysis to examine the association between CRP levels and the risk of diabetes and the dose-response curve pattern.

Design and method:

A comprehensive search was conducted in PubMed and Embase databases from the inception to March 7, 2023. We treated CRP as both a continuous and a categorical variable to analyze the risk ratio of incident diabetes. In addition, we performed a dose-response meta-analysis to explore the pattern of the dose-response curve, and a meta-regression analysis for potential effect modifiers.

Results:

A total of 17 studies with high study quality were collected. The CRP level as a continuous variable was associated with a 12% increase in the risk of diabetes [95% confidence interval (CI), 1.06-1.17] per 1 mg/L increase. The high-low comparison showed a significantly higher risk of 71% (95% CI, 1.42-2.06). The dose-response analysis showed a saturation curve pattern, suggesting a high risk among CRP levels within 5 mg/L. In addition, we found that smoking played a modest effect modifier for the association between CRP and diabetes risk (p, 0.11).

Conclusions:

We validated that a high CRP level was associated with the risk of diabetes, and the pattern was likely to be a saturation shape.
ARTERIAL HYPERTENSION AND DYSLIPIDEMIA: ROLE OF LIPOPROTEIN(A)
Authors: Caprnda Martin , Jantosik Matej , Kromka Peter , Tomasik Juraj , Puska Marek
Published: May 2024

Objective:

Dyslipidemia is a common risk factor in patients with arterial hypertension (AH). Besides LDL cholesterol, also increased levels of Lipoprotein(a) (LpA) are associated with higher risk of cardiovascular events. Despite this, there are no established ways to treat LpA, because traditional hypolipidemic drugs have none or only modest effect on LpA levels; however, several promising drugs are in testing. Contrary to the current guidelines, due to absence of effective therapy, LpA levels aren’t routinely evaluated at clinical practice. Aim of our study was to measure LpA in outpatients with AH to see how many of them would be eligible for future treatment.

Design and method:

We included 55 outpatients who were examined at our department between October and December of 2023. Standard laboratory tests including LpA, basic history, anthropometric and clinical evaluation were carried out. LpA was measured using Randox kit and reported in mg/dl. LpA levels were expressed as median and interquartile range (IQR). Patients with normal LpA levels were defined as < 30 mg/dl and patients with elevated levels were defined as > 50 mg/dl.

Results:

We examined 55 patients with AH (29 men, 26 women) aged 71,36±10,19 years. Median level of Lp(a) was 18 mg/dl [IQR 8-46]. Normal LpA levels were in 65,5% patients and elevated LpA levels in 23,6% patients. There were no significant differences of LpA between genders, nor we found any significant correlation between LpA and total, LDL and HDL cholesterol, glycemia, creatinine, ALT, TSH, BMI or NTproBNP. However, there was a significant correlation between LpA and triacylglycerols (r = 0,307; p=0,024). We did not find higher levels of LpA in patients with previous myocardial infarction, stroke, or peripheral artery disease.

Conclusions:

In our study we found 23,6% patients with AH had LpA > 50 mg/dl. Some of these patients might be eligible for targeted LpA treatment in future.
HUNGARY'S COMPREHENSIVE HEALTH SCREENING PROGRAM 2010-2021 - ANALYSIS OF BLOOD PRESSURE VALUES
Authors: Barna István , Daiki Tenno , Kékes Ede , Dankovics Gergely
Published: May 2024

Objective:

The Comprehensive Health Screening Program of Hungary 2010-2020-2030 (MÁESZ) (http://www.egeszsegprogram.eu) is the only complex screening program in Hungary, in whose aim was to map the health status of our country.

Design and method:

Between 2010 and 2021, the truck screening program was present at 2,212 locations nationwide and performed more than eight million screening tests for more than 643,172 citizens. Based on the data obtained in the period between 2010-2021, we analyzed the parameters reflecting the state of health and the effect of the factors affecting them in different age groups.

Results:

Results In the period between 2010-2021, we processed the data of a total of 204,748 individuals (119,433 women and 85,315 men). The average age of women (n=119,433) who participated in the screening tests was 42.85 years, and for men (n=85,315) it was 40.43 years. We measured abnormal values in 32% of men and 21% of women. During the evaluation of each stage, we measured values above 160/100 mmHg in more than 21,000 individuals, nearly 13%, of which more than 5,000 visitors (2,439 women, 2,679 men) had a blood pressure above 180/110 mmHg. During the questionnaire evaluation, 38% of the respondents by comparing the measured values and the questionnaires, 13.7% of all women and 30.5% of all men did not know about their elevated blood pressure. During the questionnaire evaluation, 38% of the respondents indicated that there is a hypertensive patient in the family. In all age groups and in groups with elevated blood pressure in both sexes, higher body mass index and abdominal circumference values occur in greater numbers. The correlation of BMI and diabetes with the amount of body fat and blood pressure was significant. (by chi2 test p < 001). Based on the risk assessment questionnaire, 26% of those who appeared in the family had a heart attack, and 18% had a stroke.

Conclusions:

Based on the blood pressure data of the screening program, in the light of its statistical data, it can be stated that a large proportion of those participating in the tests belong to the high-risk group.
LEAD-ASSOCIATED MORTALITY IN THE US 1999-2020: A TIME-STRATIFIED ANALYSIS OF A NATIONAL COHORT
Authors: An Dewei , Yu Yuling , Hara Azusa , Martens Dries , Yang Wen -Yi , Cheng Yi -Bang , Huang Qi -Fang , Asayama Kei , Stolarz-skrzypek Katarzyna , Rajzer Marek , Verhamme Peter , Nawrot Tim , Li Yan , Staessen Jan
Published: May 2024

Objective:

We undertook time-stratified analyses of the National Health and Nutrition Examination Survey in the US to assess time trends (1999-2020) in the associations of blood lead (BL) with blood pressure (BP), mortality, the BL-associated population attributable fraction (PAF).

Design and method:

Vital status of participants, 20-79 years old at enrolment, was ascertained via the National Death Index. Regressions, mediation analyses and PAF were multivariable adjusted and standardized to 2020 US Census data.

Results:

In time-stratified analyses, BL decreased from 1.76 ug/dL in 1999-2004 to 0.93 ug/dL in 2017-2020, while the proportion of individuals with BL <1 ug/dL increased from 19.2% to 63.0%. Total mortality was unrelated to BL (HR for a 4-fold BL increment: 1.05 [95% CI: 0.93-1.17]). The HR for cardiovascular death was 1.44 (1.01-2.07) in the 1999-2000 cycle, but lost significance thereafter. BL was directly related to cardiovascular mortality, whereas the indirect BL pathway via BP was not significant. Low socioeconomic status (SES) was directly related to BL and cardiovascular mortality, but the indirect SES pathway via BL lost significance in 2007-2010. From 1999-2004 to 2017-2020, cardiovascular PAF decreased (P < 0.001) from 7.80% (0.17-14.4%) to 2.50% (0.05-4.68%) and number of lead-attributable cardiovascular deaths from 53,878 (1,167-99,253) to 7,539 (160-14,108).

Conclusions:

Due to implementation of strict environmental policies, lead exposure is no longer associated with total mortality, and the mildly increased cardiovascular mortality is not associated with blood lead via blood pressure in the US.
ASSOCIATION OF PLASMA ALDOSTERONE CONCENTRATION AFTER CAPTOPRIL SUPPRESSION TEST WITH LEFT VENTRICULAR REMODELING AND DIASTOLIC DYSFUNCTION IN PRIMARY ALDOSTERONISM
Authors: Tsai Cheng -HSUAN , Chen Uei -LIN , Wu Vin -CENT , Lin Yen -HUNG
Published: May 2024

Objective:

Cardiac remodeling is a critical pathological manifestation in primary aldosteronism (PA) attributed to excessive aldosterone secretion. The plasma aldosterone concentration (PAC) following the captopril suppression test (CCT) may serve as an indicator of unregulated aldosterone and could potentially offer improved predictive value for cardiovascular outcomes. This study aimed to explore the association between nadir aldosterone levels post-CCT and left ventricular remodeling as well as diastolic dysfunction.

Design and method:

We conducted a retrospective analysis of PA patients within the TAIPAI (Taiwan Primary Aldosteronism Investigation) cohort with complete baseline and post-CCT plasma renin activity (PRA), PAC, aldosterone-to-renin ratio (ARR), and echocardiography data for further investigation.

Results:

A total of 540 patients were included in the study. Among baseline and post-CCT PRA, PAC, and ARR, post-CCT PAC exhibited the strongest correlation with left ventricular mass index (LVMI) and diastolic dysfunction (E/e’). In multivariable regression analysis, post-CCT PAC emerged as an independent predictor of LVMI (beta: 24.6, 95% CI: 9.6 to 39.5, P=0.001) and diastolic dysfunction (beta: 1.9, 95% CI: 0.5 to 3.3, P=0.006). Restricted cubic spline analysis revealed significant correlations between both baseline and post-CCT PAC with LVMI, whereas only post-CCT PAC exhibited a significant correlation with diastolic function.

Conclusions:

Plasma aldosterone concentration following CCT, reflective of unregulated aldosterone excess, is significantly associated with left ventricular hypertrophy and diastolic dysfunction. PA patients with elevated post-CCT PAC may face increased cardiovascular risks, underscoring the importance of timely and appropriate management.
FIBROMUSCULAR DYSPLASIA IN CHILDREN – A SINGLE-CENTER EXPERIENCE
Authors: Skrzypczyk Piotr , Bujanowicz Adam , Ofiara Anna , Szyszka Michal , Tutka Agnieszka , Wabik Anna Maria , Zagozdzon Ilona , Krysiak Remigiusz , Zylkowski Jaroslaw , Panczyk-tomaszewska Malgorzata
Published: May 2024

Objective:

Fibromuscular dysplasia (FMD) is a stenotic disease of the arteries - most often renal, carotid, and cerebral. The disease can occur at any age and is the most common cause of renovascular hypertension in children. The study aimed to present the clinical course of FMD in patients of our Department.

Design and method:

In 2016-2023, the Department took care of 8 patients with FMD (4 boys, 4 girls). In all patients, we analyzed: age, sex, clinical symptoms, biochemical parameters, renin and aldosterone concentrations, imaging studies (ultrasonography, computed tomography), pharmacological and invasive treatment, and outcome.

Results:

Age at diagnosis ranged from 10/12 to 15 9/12 years. All patients were referred due to arterial hypertension (7/8 of 2nd degree). Patients presented various symptoms: hypertensive crisis with heart failure (patient 10/12 months), headache (2 patients), vomiting (1 patient), hyperactivity (1 patient), polydipsia and polyuria (1 patient). All patients had normal renal function, 5/8 hypokalemia, 1/8 hyponatremia, and 5/8 metabolic alkalosis; all had hyperreninemia with hyperaldosteronism. Imaging examinations showed critical stenosis of the renal artery trunk in 3 patients, slight stenosis in 1 patient, and stenosis of accessory arteries or branches of main arteries in the remaining patients. Stenosis in other vessels was found in 2 patients (left middle cerebral artery in one patient and abdominal aorta, celiac trunk, superior mesenteric artery, and inferior mesenteric artery in another one). Invasive treatment was performed in 6/8 patients - in 2 patients nephrectomy was necessary; in 2 – embolization of the vessel; in 2 – angioplasty, one patient is waiting for the procedure. Before the procedure, the patients required 3 (max. 5) antihypertensive drugs. After the procedure, antihypertensive treatment was discontinued in 3 patients, and the number and dose of drugs were reduced in the remaining patients.

Conclusions:

1. Renal artery stenosis should be excluded in all pediatric hypertensive patients, regardless of age and symptoms.

2.Patients with FMD require an individually selected therapeutic plan.

3.Vessel embolization is an effective method of treating stenoses of the peripheral branches of the renal arteries in the course of FMD in children.
PREDICTORS OF BLOOD PRESSURE RESPONSE TO CPAP TREATMENT IN PATIENTS WITH SLEEP APNEA
Authors: Seidel Maximilian , Kiziler Muhammed F. , Mathiakis Marios , Bertram Sebastian , Wang Simon , Seibert Felix S. , Babel Nina , Westhoff Timm H.
Published: May 2024

Objective:

Sleep apnea is associated with hypertension. Metaanalyses indicate that treatment of sleep apnea by continuous positive airway pressure (CPAP) reduces blood pressure (BP) by a mean of 3 mmHg. To date, predictors of BP response to CPAP remain incompletely understood. We hypothesized that the magnitude of CPAP-induced BP reduction depends on baseline apnea hypopnea index (AHI) and the extent of daytime sleepiness.

Design and method:

We performed a retrospective study on the association of BP response to CPAP with polysomnographic readings, intensity of sleepiness (measured by Epworth Sleepiness Scale, ESS), and epidemiologic parameters in 2461 patients with obstructive sleep apnea. BP response was defined as the difference between office BP at polysomonography examinations before and after initiation of CPAP.

Results:

555 patients fulfilled all in- and exclusion criteria and were included in the analysis. Median monthly CPAP usage was 143.7h (85.4-204.1h). BP was significantly higher at baseline than at follow-up (129.9±15.5 vs. 128.3±15.2, p=0.021) resulting in mean reduction of BP of -1.5±19.2 mmHg. Subjects with a higher than median baseline AHI (median 21) showed a more pronounced reduction of BP than those with lower AHI (AHI >21: 130.5±15.3 vs. 128.6±14.6, p=0.06; AHI <21: 129.5±15.8 vs. 127.9±15.8, p=0.18). CPAP therapy led to a significant reduction in sleepiness (8.3±4.8 vs. 6.6±4.5, p<0.0001). Those subjects with higher than median sleepiness score (ESS >8), however, did not show a significant difference in BP response compared to those with a lower sleepiness score. Receiver-operating characteristic (ROC) curve analyses investigating the accuracy of AHI and ESS to predict a BP reduction >5 mmHg revealed an AUC of 0.51 and 0.52, respectively.

Conclusions:

The study confirms that CPAP therapy for sleep apnea has a mild BP lowering effect. Although this effect is slightly higher in patients with above-average AHI, neither AHI nor ESS can be used to define threshold values predicting a BP decrease > 5 mmHg.
EVALUATION OF CHORIORETINAL VASCULARIZATION WITH OCT AND ANGIO-OCT IN PRIMARY ALDOSTERONISM
Authors: Rossi Federico , Giacomo Rossitto , Perozzo Elena Veronica , Bagordo Domenico , Seccia Teresa Maria , Bini Silvia , Galan Alessandro , Rossi Gian Paolo
Published: May 2024

Objective:

Primary aldosteronism (PA), the most common cause of secondary hypertension, is associated with excess cardiovascular damage and, when unilateral, is amenable to surgical cure. Our objective was to determine whether the chorioretinal microvasculature is also affected.

Design and method:

Ocular CT-scan (OCT) and angio-OCT images of the superficial and deep retinal plexi were obtained in PA patients at diagnosis, in wash-out from RAAS-confounding drugs (WO), and again during mineralocorticoid receptor antagonist (MRA) therapy and 4-6 months after surgical cure (PS).

The images were analysed for choroidal thickness and, upon automated ImageJ processing, for indexes of total vascular area density (VAD) and length fraction (VLF), a surrogate for the number of open vessels.

Results:

We enrolled 11 patients with PA (51±10 yrs; 27%F); of these, 10 who had unilateral PA underwent curative surgery (p<0.05 for BP, sK+ and ARR). We found that MRA therapy had no effect on any of the investigated parameters. At variance, curative surgery determined a reduction of VAD in both superficial and deep plexi (-6.4% retinal area, p=0.017 and -3.5%, p=0.023, respectively) and of VLF in the superficial plexus (-2.2%, p=0.033). Moreover, choroidal thickness (on average: -21μm, p=0.003 at 2-way ANOVA) decreased after adrenalectomy.

Conclusions:

OCT and angio-OCT images, which can accurately track changes in choroid- retinal vascularization, highlighted a decrease of retinal microvascular area and choroidal thickness in patients with unilateral PA, who were cured from PA.