bluuebunny/crossref_metadata_2025 huggingface dataset:
THE PROGNOSTIC ROLE OF CARDIAC HEMODYNAMIC RESERVES IN HEART FAILURE WITH PRESERVED EJECTION FRACTION
Authors: Ovchinnikov Artem , Filatova Anastasiia , Sobolevskaya Mariya , Potekhina Alexandra , Svirida Olga , Ageev Fail , Belyavskiy Evgeny
Published: May 2024

Objective:

Reduced cardiac reserves play an important role in poor exercise tolerance in heart failure with preserved ejection fraction (HFpEF). However, their prognostic role in HFpEF is not well defined. We aimed to evaluate the prognostic significance of key cardiac reserves in patients with HFpEF.

Design and method:

348 patients (164 men, median age 68 years) with stable heart failure in NYHA functional class II-III, preserved left ventricular (LV) ejection fraction (>=50%), and increased LV filling pressure at rest and/or during exercise (determined by echocardiography) were included in retrospective cohort analysis. The median follow-up period between the initial visit and the follow-up call was 5.4 (3.5-7.0) years. Primary outcome included a composite of all-cause mortality and hospitalizations for congestive heart failure (HF). Primary outcome occurred in 166 patients (73 patients died and 93 patients were hospitalized for exacerbation of HF); 182 patients survived without hospitalizations. The event-free survival rate between groups were analysed using the Kaplan-Meier method, and the significance was evaluated using log-rank tests.

Results:

Patients who experienced primary endpoint had a greater enhancement in the early mitral inflow to mitral annulus relaxation velocity ratio (E/e’ ratio) on exercise (reflecting LV filling pressure and diastolic reserve), as well as a lesser enhancement in left atrial reservoir strain (LA reserve) and tricuspid annular plane systolic excursion (right ventricular [RV] reserve) on exercise. There were no differences in global longitudinal strain enhancement on exercise (LV contractility reserve) between groups. Reserve dysfunction showed a strong association with poor HFpEF prognosis: LA reserve (RR 1.81 [95% CI 1.28-2.56], P<0.001), LV diastolic reserve (RR 1.62 (95% CI 1.25-2.27, P<0.01), and RV reserve (RR 1.47 (95% CI 1.05-2.05), P<0.05).

Conclusions:

Here, we demonstrated for the first time the high predictive accuracy of cardiac reserves (LV diastolic, LA, RV) in HFpEF.
CYSTATIN C IS DIAGNOSTIC AND PROGNOSTIC FACTOR OF THE DEVELOPMENT OF CARDIORENAL SYNDROME IN COMORBID PATIENTS WITH ARTERIAL HYPERTENSION
Authors: Dunaieva Inna , Bilovol Olexandr
Published: May 2024

Objective:

The purpose of the study was to determine the diagnostic and prognostic role of cystatin C in the development of cardiorenal syndrome in the case of arterial hypertension syndrome and maximum comorbid conditions.

Design and method:

111 patients with AH (men/women – 50/61) and 20 control subjects were examined. All patients with AH at the age of 54.37±1.18 During a thorough examination and follow-up of patients, they were classified into 4 groups depending on the comorbidities they had: patients with AH – group 1 – 22 persons; patients with AH in combination with obesity – group 2 – 30 persons; AH in combination with type 2 diabetes – group 3 – 31 persons; patients with AH, type 2 diabetes and obesity – group 4 – 28 persons.

Results:

According to the study, the Cys C level in the examined patients with AH and various comorbidities was significantly higher compared with the control group, with p < 0.0001.

We found that cardiotrophin-1, a versatile biomarker for the development and progression of cardiovascular disorders in patients with AH and various comorbidities, has a significant impact on this index (ρ=0.015). The first place among the properties of cardiotrophin-1 in the body is its role in the regulation of heart remodeling in patients with hypertension, heart failure, coronary heart disease in combination with T2DM and hypertension. The resulting relationship between cardiotrophin-1 and Cys C can testify to the latter's contribution to the development of cardiovascular complications in patients with AH, T2DM, and obesity.

Conclusions:

Serum cystatin C level is a reliable marker of glomerular filtration rate with high diagnostic accuracy, which improves risk stratification for the development of chronic kidney disease in comorbid patients with AH. Elevated cystatin C level may be associated with increased blood pressure, cardiotrophin-1 level, and serum catestatin value, which indicates its importance for the early development of cardiovascular complications in patients with AH and various comorbidities and proves the significance of adipose tissue hormonal activity for the development of glomerular and tubular dysfunctions.
PREDICTIVE FACTORS FOR ACHIEVEMENT OF TARGET SYSTOLIC BLOOD PRESSURE AND HEART RATE: SUB-ANALYSIS OF PRIDE STUDY
Authors: Khomitskaya Yunona , Kobalava Zhanna , Petrova Parvoleta , Kvasnikov Boris , Burtsev Yuriy
Published: May 2024

Objective:

To define predictors for achievement of target systolic blood pressure (SBP) and heart rate (HR) in the PRIDE study (NCT03730116).

Design and method:

It was a 12-week ambispective observational study to assess antihypertensive and antianginal effectiveness of Bisoprolol/ Perindopril (Biso/Per) single-pill combination (SPC) in outpatients with coronary artery disease (CAD), history of myocardial infarction (MI) and arterial hypertension (HTN). This analysis aimed to evaluate predictive values of baseline (BL) demographic and clinical characteristics to achieve target SBP and HR in study population.

Results:

Of 481 included patients, 154 (32.0%) were female, mean age 61.4 (8.9) years. Prevalence of type 2 diabetes mellitus (T2D) at BL was 24.1%. Proportions of patients with Grade I, II, III or isolated HTN (ISH) and those with controlled HTN (BP< 140/90 mm Hg) at BL were 55.3% (n=266), 10.8% (n=52), 5.0% (n=24), 5.0% (n=24), 23.9% (n=115), correspondingly. Mean duration of HTN and CAD were 12.8 (8.4) and 6.1 (6.3) years. Proportions of patients treated with 2,5/2,5, 5/5, 5/10 and 10/10 mg of Biso/Per SPC at BL were 12.1%, 33.5%, 34.3%, 20.2% correspondingly. Doses were changed in 1.6% of cases by week 12 of observation. At week 12, mean SBP, DBP and HR significantly decreased by 24.9 (16.4), 12.2 (11.0) mm Hg and 14.4 (11.7) bpm, respectively (p< 0.001 for all). Multivariable analyses revealed grade III HTN at BL was the only significant negative predictor for achieving SBP< 140 mm Hg, whereas grade III HTN, CAD with angina of functional class II and older age (more 65 y.o.) were negative predictors for achieving SBP < or equal 130 mm Hg at week 12 of observation. Grade III HTN at or presence of T2D at BL decreased the likelihood of achieving target HR (55-60 bpm), according to the data given in Table 2.

Conclusions:

Grade III HTN, concomitant T2D and symptomatic angina were negative predictors for achievement of the target SBP and HR in patients with HTN and a history of MI. There were no positive predictors for achievement of the target BP and HR explored.
HYPERTENSION RELATED NETOSIS IS STRONGLY DEPENDENT ON NIGHTTIME BLOOD PRESSURE IN A COHORT OF NEWLY DIAGNOSED, TREATMENT NAÏVE HYPERTENSIVE PATIENTS
Authors: Lazaridis Antonios , Malliora Anastasia , Natsi Anna -MARIA , Papadopoulos Vasilios , Antoniadou Christina , Gavriilidis Eustratios , Mastrogiannis Konstantinos , Kotsis Vasilios , Skendros Panagiotis , Gkaliagkousi Eugenia
Published: May 2024

Objective:

Over the last years, accumulating evidence has highlighted the key role of immunity in the inflammatory environment of essential hypertension (EH). Neutrophil extracellular traps (NETs) formation represents a protective innate immune mechanism of the neutrophils. However, excessive release of NETs (NETosis) has been shown to exert a potent pro-inflammatory and pro-thrombotic effect. Even though NETosis is increasingly implicated in the thrombo-inflammatory environment of cardiovascular disease, experimental and clinical data regarding the association between NETs and EH are scarce.

Design and method:

We recruited newly diagnosed, untreated hypertensives (UHTs) without overt cardiovascular disease and healthy, normotensive individuals (NTs). Office BP was measured according to guidelines. Ambulatory and central BP parameters were measured with the Mobil-O-Graph device. Plasma levels of NETs including myeloperoxidase (MPO)-DNA were determined by ELISA.

Results:

A total of 139 individuals including 99 UHTs and 40 NTs were included in the study. Levels of MPO-DNA were increased in UHTs compared to NTs (p<0.001). In multivariate analysis after adjustment for confounding variables (body mass index, hemoglobin, uric acid, high sensitivity c-reactive protein), hypertension was the strongest independent predictor of incident NETosis (p<0.001). Among the ambulatory BP indices, peripheral nighttime systolic BP (F:5.937; p=0.016) and central nighttime diastolic BP (F:4.751; p=0.031) were the strongest prognosticators of hypertension related NETosis (Optimal Scaling ANOVA; p=0.028).

Conclusions:

In a cohort of newly diagnosed, treatment-naïve hypertensive patients, nighttime BP indices are the strongest factors that can predict, independently, an increased NETosis, adding to the superior significance of nocturnal BP in cardiovascular prognosis. Further research is needed to clarify the association of NETs with hypertension as well as hypertension-mediated target organ damage.
EXPOSURE TO AIR POLLUTION FINE PARTICULATE MATTER (PM2.5) ALTERS SYSTEMIC AND TISSUE-SPECIFIC COMPONENTS OF THE RENIN-ANGIOTENSIN SYSTEM
Authors: Dominici Fernando , Pardo Jorge Andres Narvaez , Natalia Magnani , Andres Evelson Pablo , Bruno Bucholz
Published: May 2024

Objective:

Previous studies have implicated air pollution fine particulate matter (PM2.5) in various cardiovascular cardiometabolic and renal disease states. However, the molecular mechanisms by which these pollutants mediate these comorbidities have not been fully elucidated. Dysregulation of the renin-angiotensin system (RAS) may be one potential mechanism. This study aimed to investigate the participation of the RAS in air pollution-associated pathologies.

Design and method:

To study the impact of PM2.5 on systemic and tissue components of the RAS, male 8-week-old Balb/C mice were exposed to filtered air (FA) or urban air (UA) from Buenos Aires City, in whole-body exposure chambers for 14 weeks. Levels of main RAS components including angiotensin-converting enzyme (ACE) and ACE2, as well as AT1, AT2, and Mas receptors (R) abundance, were determined in kidney, heart, and lung tissue by Western Blotting (WB) and their corresponding mRNA expression was detected by RT-qPCR. Circulating angiotensin (Ang) II levels were determined by radioimmunoassay.

Results:

Exposure to air pollution resulted in increased mRNA levels of ACE and MasR, and increased protein levels of ACE in the kidney; upregulated mRNA and protein abundance of cardiac and pulmonary AT2R and MasR, together with increased levels of proteins nitrated at Tyr residues in both kidney and lung homogenates, indicative of nitrosative stress in these tissues. In addition, exposure to PM2.5 was associated with increased levels of circulating Ang II, indicative of an exacerbation of the RAS.

Conclusions:

Our findings indicate that chronic exposure to air pollution induces an altered expression of both tissue and systemic components of the RAS. Given that both the AT2R and the MasR have been ascribed to participate in tissue-repair mechanisms, the upregulation of these receptors detected in mouse heart and lung after chronic exposure to polluted air could represent a mechanism of tissue protection against damage induced by PM2.5.
CORTISOL CONCENTRATIONS AFTER DEXAMETHASONE SUPPRESSION TEST ARE RELATED TO THE ALDOSTERONE RESPONSE TO SALINE INFUSION TEST IN TREATMENT NAIVE ESSENTIAL HYPERTENSIVE PATIENTS
Authors: Bulfone Luca , Catena Cristiana , Da Porto Andrea , Brosolo Gabriele , Bortolin Giulia , Comand Jacopo , Sechi Leonardo
Published: May 2024

Objective:

The study of cortisol secretion and the response of plasma aldosterone concentration (PAC) to saline infusion test (SIT) are used to exclude some forms of secondary arterial hypertension. Some studies show a relationship between agents stimulating cortisol and aldosterone production, but the mechanisms have not yet been clarified, moreover the effects of cortisol concentration on PAC after a SIT test have never been studied.

Design and method:

In 112 essential hypertensive (EH) patients (age 48±13 years, 63 males, free of interfering hypertensive treatment) we evaluated clinical characteristics, plasma and urinary sodium and potassium, plasma cortisol at 8AM, 5PM, 11PM, 24-h urinary free cortisol, cortisol values after an overnight suppression test with 1 mg of dexamethasone (DST), and active renin and PAC before and after a saline infusion test.

Results:

PAC after SIT was significantly and directly related to PAC before SIT (r=0.349, P<0.001), ACTH level (r=0,233, P=0,021) and inversely related to post-DST cortisol level (r=-0.225, P=0.018), while being weakly related to GFR (r=-0,179, P=0,060). We performed a multivariate analysis with post-SIT PAC as dependent variable, including PAC before SIT test, post-DST cortisol, ACTH levels and GFR as independent variables. In this analysis post-SIT PAC was independently associated with pre-SIT PAC (B=0.225, P=0,024) and post-DST cortisol (B=-0.213, P=0.027).

Conclusions:

Although the physiological relationship between glucocorticoid and mineralocorticoid synthesis is not yet fully understood, these results indicate that a mild overproduction of cortisol, even if subclinical, might influence the PAC response to SIT test. We believe that this fact should be considered by the physician during the diagnostic work-up of secondary and resistant hypertension.
EFFECTS OF ANTIHYPERTENSIVE THERAPY ON MACRO- AND MICROCIRCULATION IN ADOLESCENTS WITH ARTERIAL HYPERTENSION – A PROSPECTIVE STUDY
Authors: Pac Michal , Rogowska Anna , Obrycki Lukasz , Feber Janusz , Litwin Mieczyslaw
Published: May 2024

Objective:

Our cross-sectional study showed that arterial hypertension (AH) in children not only leads to macrovascular remodeling but also to alterations in retinal microcirculation which correlates with subclinical injury in common carotid arteries. However, no studies evaluated antihypertensive therapy's effects on microcirculation.

The study aimed to prospectively evaluate hypertension-associated changes in retinal microcirculation and their correlation with hypertension-mediated organ damage (HMOD): carotid intima-media thickness (cIMT), pulse wave velocity (PWV) and left ventricular mass index (LVMi).

Design and method:

: 47/157 children (mean+-SD age = 14.74±3.1 years) enrolled in the cross-sectional study were observed for a mean+-SD period of 1.13±0.9 years while receiving pharmacological/non-pharmacological treatment for AH. All participants underwent ambulatory blood pressure monitoring (ABPM), HMOD assessment, and an ophthalmic examination assessing retinal vessel density (VD), foveal thickness, thickness of retinal nerve fiber layer, ganglion cell complex, and foveal avascular zone using optical coherence tomography at the start of the study and the end of follow-up.

Results:

At baseline, we observed a lower density of retinal vessels correlated with increased cIMT. 33/47 (70%) patients achieved normotension (24 systolic blood pressure <=95th percentile) at the end of follow-up, in whom the 24h systolic, diastolic, and mean arterial pressure (MAP) Z-scores decreased significantly by a mean of -0.70 to 0.94 Z-scores, significantly different (p<0.05) from 14 patients, in whom the BP increased/did not change during follow-up. Patients who achieved normotension significantly decreased serum cholesterol and LVMi (p<0.05) compared to patients with persistent hypertension. There were, however, no significant differences in other HMOD parameters (PWV, cIMT) and retinal VD parameters between patients achieving normotension and those with persistent hypertension. Similar results were obtained using 24h MAP or 24 diastolic blood pressure and lower BP cutoffs for normotension (90th and 75th percentiles).

A trend was observed in the association between a decrease in vascular density and an increase in cIMT-SDS (p=0,088; r=-0,28). No significant correlation with microvascular parameters was found for LVMi and PWV.

Conclusions:

Our results show that, despite normalization of blood pressure at the end of 1 year of follow-up, there was no significant improvement in retinal microcirculation.
ANTIHYPERTENSIVE THERAPY AND DYSLIPIDEMIA. SIAMESE TREATMENT!
Authors: Meireles-brandao Joaquim , Meireles-brandao Lucia , Coelho Rui , Rocha-goncalves Francisco
Published: May 2024

Objective:

Cardiovascular diseases are the leading cause of morbidity and mortality in industrialized countries. This was a retrospective observational study, evaluating clinical outcomes, metabolic consequences and survival rate resulting from prolonged intermediate-intensity statin therapy dosages for primary prevention

In this study we set out to analyze the importance of the repercussions of synergies anti-hypertension therapies in conditioning the results in the dyslipidemia profile.

Design and method:

Among the 1677 patients who attended a medical consultation between January 1995 and May 2015, a population-based sample of 516 patients were included in the study.

After signing the informed consent, data were collected from the patients’ medical charts. Selection criteria: 1) patients who had at least two personal and/or family-related CVRF: 2) regularly attended a quarterly consultation for a minimum of two years, 3) performed an annual biochemical examination, including cardiovascular complementary exams with clinical evaluation

Results:

Statins, angiotensin converting enzyme inhibitors (ACEI), ARB-II, oral antidiabetics (OAD), antiplatelets, calcium channels antagonists (CCA) and allopurinol were selected for the initial regression model, due to their clinical influence on LDLc variation (Table 3). Again, only patients under treatment and who have not died during the study were considered in this analysis.

Results from the optimized final model (Table 2, supplemental material) revealed that LDLc decreased in patients taking statins 51.780 mg/dL more than in those who did not, after adjustment for ACEI and ARB-II. LDLc decreased in patients taking ACEI 12.563 mg/dL more than in those who did not, after adjustment for statins and ARB-II. Moreover, LDLc decreased in patients taking ARB-II 8.221 mg/dL more than in those who did not, after adjustment for statins and ACEI.

Conclusions:

This study shows the benefits of an early and continued therapy with intermediate-intensity statins for primary prevention and highlights the synergic effects with other drugs for treatment of hypertension such as ACEI, ARB-II, CCA,
COMPARATIVE EFFICACY OF AMLODIPINE AND LERCANIDIPINE IN THE PREVENTION OF MAJOR ADVERSE CARDIOVASCULAR EVENTS IN HYPERTENSIVE PATIENTS
Authors: Joo Hyung Joon , Oh Seungmi , Hong Soon Jun , Yu Cheol Woong , Kim Yung Hyun , Kim Eung Ju
Published: May 2024

Objective:

Amlodipine is the most widely prescribed calcium channel blocker (CCB) for hypertension. Lercanidipine, a newer CCB, is reported to exhibit fewer side effects, such as peripheral edema, and is believed to have beneficial effects on myocardial ischemia and congestive heart failure. However, its impact on major adverse cardiovascular events (MACE) has not been comprehensively explored. This study aims to elucidate the clinical efficacy of Lercanidipine in the prevention of major adverse cardiovascular events to that of Amlodipine.

Design and method:

A retrospective cohort study was conducted by analyzing electronic health records from three tertiary hospitals in Korea. We identified patients who were administered Lercanidipine (n = 2,182) or Amlodipine (n = 45,458) for a minimum of 30 days from January 1, 2017, to November 30, 2021. The incidence of MACE, including cardiovascular death, myocardial infarction, stroke, heart failure hospitalization, and coronary revascularization, was assessed over a three-year follow-up period. A total of 4,680 Amlodipine and 1,570 Lercanidipine patients were evaluated, with propensity score matching at a ratio of 1:3 after excluding those with end-stage renal disease.

Results:

Patients in the Lercanidipine cohort had a higher prevalence of low socioeconomic status, diabetes, hyperlipidemia, and chronic kidney disease. The usage of more than three antihypertensive drugs was more common in this group. The cardiovascular risk estimated by SCORE2/SCORE2-OP was also higher in the Lercanidipine cohort. After the propensity score matching, the incidence of MACE was numerically lower in the Lercanidipine group (2.8%) compared to the Amlodipine group (4.1%), but the difference was not statistically significant (p = 0.11). No differences in blood pressure control were observed over the follow-up period.

Conclusions:

In patients with higher cardiovascular risk profiles, Lercanidipine was preferred to Amlodipine. The study found that Lercanidipine had comparable efficacy to Amlodipine in preventing cardiovascular events.
EFFECT OF NEBIVOLOL MONOTHERAPY OR COMBINATION THERAPY ON BLOOD PRESSURE LEVELS IN PATIENTS WITH HYPERTENSION: META-ANALYSIS OF 91 RANDOMIZED CONTROLLED TRIALS
Authors: Manolis Athanasios , Karakasis Paschalis , Patoulias Dimitrios , Kallistratos Manolis , Koutsaki Maria , Pittaras Antreas , Doumas Michalis
Published: May 2024

Objective:

The present study aimed to systematically appraise and quantitatively summarize the available evidence from published randomized controlled trials (RCTs) considering the effect of nebivolol on blood pressure (BP) levels in patients with hypertension.

Design and method:

The literature search was performed through Medline (via PubMed), Cochrane Library and Scopus until December 15, 2023. Double-independent study selection, data extraction and quality assessment were performed. Evidence was pooled with three-level mixed-effects meta-analysis.

Results:

In total, 7,737 participants with hypertension, who were treated with nebivolol, were analyzed across 91 RCTs. Most trials had a high risk of bias according to the Cochrane

Collaboration tool (RoB2). Nebivolol was associated with significantly greater reduction in office systolic and diastolic BP compared to placebo (MD = -6.01 mmHg; 95% CI= [-7.46, -

4.55] and MD = -5.01 mmHg; 95% CI= [-5.91, -4.11], respectively). Moreover, nebivolol resulted in a similar reduction in systolic BP (MD = -0.22 mmHg; 95% CI= [-0.91, 0.46]) and a significantly greater reduction in diastolic BP compared to active comparator (MD = -0.71 mmHg; 95% CI= [-1.27, -0.16]). When considering the effect of nebivolol on 24-hour ambulatory BP, notable reductions were observed compared to placebo. In contrast, compared to the active comparator, there was no significant difference in ambulatory systolic BP reduction, but a significant reduction in ambulatory diastolic BP favoring nebivolol was noted. Based on moderator analyses, the impact of nebivolol on the pooled estimates remained independent of the duration of RCTs, gender, age, body mass index, history of diabetes or heart failure.

Conclusions:

Our findings suggest that nebivolol resulted in a significant reduction in BP compared to placebo and seemed to be non-inferior to active comparator in terms of BP reduction. When considering the effect of nebivolol on 24-hour ambulatory BP, nebivolol was superior to placebo, while compared to the active comparator, there was no significant difference in ambulatory systolic BP reduction, but a significant reduction in ambulatory diastolic BP. Future, large-scale, and meticulously designed trials are necessary to further establish the place of nebivolol in the treatment algorithm of hypertension.
A PRESCRIPTION TREND ANALYSIS OF ANTIHYPERTENSIVE PHARMACOTHERAPY ACROSS DIFFERENT SPECIALTIES IN INDIA
Authors: Vishavadia Krunal , Solanki Sandip , Kulkarni Girish , Prajapati Hiren
Published: May 2024

Objective:

To evaluate the temporal trends in the prescription patterns of antihypertensive medications among healthcare practitioners in India.

Design and method:

The IQVIA (formerly Quintiles and IMS Health) prescription audit data came from prescriptions of a panel of 6000 private sector primary care clinicians for the different classes of antihypertensive drugs; beta-blockers (BB), calcium channel blockers (CCB), angiotensin receptor blockers (ARB), angiotensin-converting enzyme (ACE) inhibitors, and diuretics were examined. The analysis encompassed the period from 2014 to 2022. Additionally, combinations of these drug classes involving two or three medications were also subject to analysis.

Results:

Cardiologists’ prescription rates for antihypertensive medications stood at 21% in 2017 and decreased to 19% by 2023. In 2023, the highest rate of prescribing antihypertensive drugs was observed among consultant physicians, with a rate of 30%, followed by general practitioners at 27%. In addition, during COVID-19, the prescription share of general practitioners was highest (31%). Among anti-hypertensive medications, the prescription rates for BBs were highest (32%), followed by ARBs & CCBs (25% & 24% respectively). Single-drug formulation of antihypertensive medications was the most preferred (60%) among Indian clinicians. Prescription shares of fixed-dose combinations (FDC) of two antihypertensive drugs showed a slight decline (36% in 2017 to 34% in 2023) & FDCs of triple-drug exhibited an upward trend (3% in 2017 to 5% in 2023). Among the two drug FDCs, ARB & diuretics were most preferred (25% prescription share) & triple drug FDCs, CCB, ARB & diuretics were most preferred.

Conclusions:

Cardiovascular medications hold a prominent position in the Indian pharmaceutical market, with antihypertensives standing out as one of the most frequently prescribed treatments. Consultant physicians and general practitioners manage the majority of hypertension cases. Notably, there has been an observed rise in the preference for triple-drug combinations of antihypertensive medications, indicating a trend toward a more aggressive approach to hypertension management among Indian clinicians. The insights gleaned from this investigation can further assist healthcare professionals in crafting tailored treatment strategies for individuals grappling with hypertension. Such personalized approaches hold promise in enhancing treatment adherence and ultimately improving the QoL.
POOR ADHERENCE IS A CRUCIAL POOR PROGNOSIS FACTOR IN RESISTANT HYPERTENSION: RESULTS FROM A NATIONWIDE COHORT STUDY
Authors: Lee Chan Joo , Lee Ho Kyu , Seo Jiwon , Kang Dayoung , Hwang Jinseub , Park Sungha , Pyun Wook Bum
Published: May 2024

Objective:

Poor adherence is one of the most common causes of hypertension treatment failure. However, the prognostic significance of medication adherence in resistant hypertension is unknown.

Design and method:

We sampled 25% of hypertensive patients from the Korean National Health Insurance Service Database from 2013 to 2018 and selected patients without a history of cardiovascular disease who met the definition of resistant hypertension with a target blood pressure of 140/90 mm Hg. Adherence was calculated as the proportion of days covered (PDC) for one year after the index date and divided into the poor (PDC <0.6), suboptimal (0.6<= PDC <0.8), and optimal (PDC >=0.8) groups. The primary outcome was a composite of all-cause of death, myocardial infarction (MI), stroke, and heart failure during follow-up. Secondary outcomes were individual events of the primary outcome, end-stage renal disease (ESRD), and atrial fibrillation.

Results:

The poor group, suboptimal group, and optimal group were 3,852 (5.7%), 11,667 (17.3%), and 51,879 (77%), respectively. Compared to other groups, the poor group was younger, had a higher proportion of smokers and alcohol drinkers, exercised less, and had a lower prevalence of comorbidities. During 5.6 years of median follow-up, the incidence of the primary outcome in the poor group, suboptimal group, and optimal group were 30.7, 26.6, and 28.9/1,000 person-years, respectively. In a multivariable Cox proportional hazard model, the risk of the primary outcome was 1.47 times higher in the poor group and 1.31 times higher in the suboptimal group compared to the optimal group (all P values <0.001). In the poor group, the risk was 1.37 to 1.52 times higher for all-cause death, MI, and stroke and 1.9 times higher for hemorrhagic stroke. The suboptimal group showed similar results but with a lower increased risk than the poor group.

Conclusions:

Even in resistant hypertension, poor adherence is strongly associated with an increased risk of clinical events. Based on this study, prospective studies are warranted to see if improving medication adherence can lower the risk of clinical events in patients with resistant hypertension.
COGNITIVE FUNCTION, CAROTID STRUCTURAL CHANGES AND KIDNEY FUNCTION: ARE THERE RELATIONSHIP IN PATIENTS WITH RESISTANCE HYPERTENSION?
Authors: Gulkevych Oksana , Bezrodna Larisa , Logvinenko Alla , Bezrodnyj Volodymyr , Bozhenko Galyna
Published: May 2024

Objective:

To evaluate the relationship between cognitive function, carotid structural changes and kidney function in patients with resistance hypertension (RH).

Design and method:

In 98 pts with RH (average age 54,3±2,5; 55 males) we measure ultrasonographically carotid diameter (CD) and intima-media thickness (IMT). Cognitive function was assessed in all pts by Montreal cognitive assessment (MoCA) test. All patients underwent full clinical and laboratory screening evaluation. Kidney function was estimated by glomerular filtration rate (GFR) using the CKD-EPI creatinine equation. All pts were divided into 2 groups depending on the value of GFR: group I (n=59) - GFR > 60 (ml/min/1,73m2) and group II (n=39) – GFR < 60 (ml/min/1,73m2).

Results:

Patients with GFR < 60 (ml/min/1,73m2) had significantly greater carotid structural changes: pts of gr.I had CD 7,79±0,07 mm and IMT 1,22±0,02 mm vs pts of gr.II 8,92±0,08 mm (p<0,05) and 1,77±0,03 mm (p<0,05) accordingly. Cognitive function was more impaired in pts gr II: MoCA score of gr I pts was 25,3±1,8 and gr II pts – 22,1±1,4. GFR was significantly correlated with MoCA score and carotid structure (MoCA score: r=0,61, p<0,05, CD: r=0,55, p<0,05, IMT: r=0,68, p<0,05). Adjustment for age, blood pressure, BMI and gender did not abolish association between GFR and MoCA score, parameters of carotid structure.

Conclusions:

There is relationship between kidney function, carotid structure and cognitive function in pts with resistance hypertension. GFR may have prognostic value for cognitive function damage in patients with resistance hypertension.
BLOOD PRESSURE RESPONDERS TO RENAL DENERVATION BASED ON A NEW DEFINITION
Authors: Bytyqi Venera , Kannenkeril Dennis , Striepe Kristina , Bosch Agnes , Schiffer Mario , Schmid Axel , Uder Michael , Schmieder Roland E.
Published: May 2024

Objective:

Identifying predictors of blood pressure (BP) response to renal denervation (RDN) is an unmet need for patient selection. Any antihypertensive intervention follows the law of the inital value, which means that the baseline BP predicts the BP change, a phenomenon known as Wilder‘s Principle (European Heart Journal, 2015, 36, 576-579). Thus, any observed change in BP after renal denervation is the sum of the change in BP depending on the baseline BP and the specific BP reduction related to RDN. Based on this concept, we propose a new definition of BP responders.

Design and method:

In our center, a total of 127 patients with uncontrolled hypertension underwent RDN and 24h ambulatory BP was measured at baseline, 6- and 12 months after the procedure. According to the Wilder's principle, the decrease in the 24h ambulatory systolic BP (SBP) was related to the baseline 24h SBP (p=<0.001, r=-0.466, y=69.28–0.52∗x). Subsequently, we calculated the predicated decrease in 24h SBP and subtracted this from the the observed decrease in 24h SBP, thereby getting the specific or residual effect of SBP decrease. According to this RDN specific change of 24h SBP, the study cohort was divided into tertials: RDN responders, neutral responders and non-responders.

Results:

Our study population with mean of age of 59 years consisted of 74% males and 55% with type 2 Diabetes (T2D). The RDN specific (residual) 24-hour ambulatory blood pressure decreased by -14.4/-8.8mHg (responder group), 1.4/0.4mmHg (neutral group) und 15.7/8.5 mmHg (non-responder group) twelve months after RDN (see table). According to our new definition of BP-responders to RDN, the RDN responder group was characterized only by lower number of antihypertensive medication (p=0.002), low BMI (p<0.001), and the absence of T2D (p=0.013).

Conclusions:

We propose a new definition of responders to RDN, separating the BP- changes related to the baseline BP from those related to the reduction of the sympathetic nerve activity after RDN. Following this approach, we identified low BMI, less antihypertensive medication and absence of T2D as positive predictors for BP response to renal denervation.
ASSOCIATION OF INFLAMMATION AND ATHEROGENIC DYSLIPIDEMIA WITH INCIDENT CARDIOMETABOLIC DIASEASE: A LONGITUDINAL COHORT STUDY
Authors: Wang Chi , Zheng Mengyi , Chen Shuohua , Wu Shouling , Xue Hao
Published: May 2024

Objective:

Inflammation and atherogenic dyslipidemia promote each other establishing a vicious circle. This study aimed to examine their joint association with cardiometabolic disease (CMD) and whether the temporal relationship between them is associated with risk of CMD.

Design and method:

This study included 78,211 participants without history of cardiovascular disease and diabetes mellitus at baseline in 2006. We categorized the participants into six groups according to their C-reactive protein (CRP, <1,1–3, or >=3 mg/L) level and atherogenic index of plasma (AIP, <-0.08 or >=-0.08). Incident CMD was defined as the first occurrence of a CMD event during follow-up, including cardiovascular disease (including myocardial infarction, coronary revascularization, heart failure, ischemic stroke, and hemorrhagic stroke) and type 2 diabetes mellitus (T2DM). Cox regression models were used to estimate the risk of CMD across CRP-AIP groups. The temporal relationship between CRP and AIP was assessed by cross-lagged analysis in the 53,715 participants who attended the resurvey in 2010. The association of this temporal relationship with subsequent CMD risk was examined by mediation analysis.

Results:

After adjusting for potential confounders, increased CRP and elevated AIP were cumulatively associated with a higher risk of CMD, where participants with a CRP of >=3 mg/L and an AIP of >=-0.08 had a hazard ratio of 1.63 (95% confidence interval [CI], 1.55–1.71) for CMD, 1.43 (95% CI, 1.33-1.55) for cardiovascular disease, and 1.71 (95% CI, 1.60-1.82) for T2DM, compared with those with low CRP and AIP values. (Table 1). In cross-lagged analysis, the standard regression coefficient from baseline CRP to follow-up AIP was greater than that from baseline AIP to follow-up CRP (0.069 [95% CI, 0.061–0.077] versus 0.014 [95% CI, 0.005–0.023], P difference <0.001) (Table 2). Furthermore, AIP partially mediated the effect of CRP on incident CMD. The mediation effect was 15.56% (95% CI, 12.87–18.25) for CMD, 10.03% (95% CI, 6.19–13.88) for cardiovascular disease, and 18.82% (95% CI, 15.36–22.28) for T2DM (Figure 1).

Conclusions:

CRP and AIP were additively associated with risk of CMD. Increased CRP might precede elevated AIP, and AIP partially mediated the association between CRP and incident CMD.
TEN-YEAR FOLLOW-UP STUDY REGARDING TREATMENT COMPLIANCE AND CARDIOVASCULAR EVENTS IN YOUNG FIRST-DIAGNOSED AND NEVER-TREATED HYPERTENSIVES OF A HYPERTENSION-EXCELLENCE-CENTER
Authors: Triantafyllidi Helen , Benas Dimitrios , Sioula Konstantina , Fampri Anastasia , Birmpa Dionysia , Oikonomidis Ignatios
Published: May 2024

Objective:

Early-onset arterial hypertension (AH) is associated with increased risk for cardiovascular (CV) disease if left untreated. Treatment is based on CV risk estimation in each hypertensive. Compliance of each individual in proposed lifestyle changes and medical treatment is paramount. We aimed to investigate compliance in medical treatment and set as primary endpoint of the study the incidence of any CV events[CV death, acute myocardial infarction (AMI), stroke] and all-cause death of a cohort of young first-diagnosed and never-treated hypertensives of a European Society of Hypertension (ESH) Excellence Center.

Design and method:

We studied 220 young, non-diabetic (<=50 years) first-diagnosed and never-treated hypertensive patients[42±7years,70% males,41% smokers,BMI=29±5,24-h ambulatory blood pressure monitoring (ABPM)=142±10/91±9mmHg,low-density-lipoprotein cholesterol (LDL-C)=133±36mg/dl,49% had >=1 hypertension-mediated-organ-damage (HMOD)] visiting our ESH Excellence Center(2004-2021). All patients were apparently healthy with no co-morbidities. In each patient, the presence of HMOD was evaluated at baseline(aortic stiffness,left ventricular hypertrophy,coronary flow reserve,diastolic dysfunction). The cohort was re-evaluated at 10±4years post-medical treatment initiation regarding compliance as well as study primary endpoint.

Results:

191/220 (87%) young hypertensives[at baseline,42±7years,70% males,40% smokers,body mass index (BMI)=29.5,24-h ABPM=142±10/91±9 mmHg,LDL-C=133±36mg/dl,49% had>1 HMOD) participated in the follow-up study while 29 (13%) patients were lost. We found that 17/191 (9%) quit medical treatment. Home or office blood pressure (BP) was confirmed as controlled(<140/90mmHg) in 151/191 (79%) patients. Regarding CV events, 7/191 (4%) hypertensive patients (at baseline,44±4 years,6/7 males,71% smokers,BMI=30±4,24-h ABPM=142±13/89±11mmHg,LDL-C=175±33mg/dl,87% had>1 HMOD) had an AMI at 6±4 years post-treatment initiation while 1/191 (0.5%) patient died due to lung cancer. Hypertensives with CV events differed regarding increased LDL-C at baseline(175±33vs.131±36, p=0.007),more smokers (p=0.04) and HMOD>1 (p=0.02) compared to the rest of the young hypertensives.

Conclusions:

Compliance regarding medical treatment was sustained in 9/10 young hypertensives during the 10-year follow-up. Just 4% of the population, smokers with increased LDL-C and HMOD>1, suffered an AMI despite compliance in medical antihypertensive treatment. Subsequently, treating AH in young people needs both lifestyle changes (quit smoking) and medical treatment (hypertension plus hyperlipidemia) in order to prevent future CV events.
SERUM CALCIUM IS ASSOCIATED WITH PERIPHERAL AND CENTRAL BLOOD PRESSURE IN DIFFERENT SAMPLES
Authors: Sartorio Andrea , Giontella Alice , Dal Pont Chiara , Minuz Pietro , Melander Olle , Fava Cristiano
Published: May 2024

Objective:

Calcium homeostasis plays a crucial role in both contractility and relaxation mechanisms, determining the vasoconstriction and vasodilation of blood vessels. Some studies have reported a positive correlation between serum calcium and blood pressure (BP) levels, hypertension, metabolic syndrome, and type 2 diabetes, while others have not. Given these conflicting findings, we investigated the relationship between serum calcium and BP in three distinct samples. Our objective was to confirm the existence of a positive correlation between calcium levels and BP and to assess whether this relationship extends to central BP.

Design and method:

Serum calcium levels were measured in a restricted sample of patients referred to our ESH Excellence Center in Verona (n=56) with a suspicion of secondary hypertension, as well as in two large population-based studies from Sweden, the Malmö Preventive Project (MPP, n= 17,843) and from United Kingdom, the UK Biobank (UKB, n= 330,000). Central BP was estimated by tonometry performed with SphygmoCor Xcel.

Results:

In the Verona sample, the patients, predominantly receiving antihypertensive therapy based on calcium antagonists, serum calcium correlated with central systolic BP (r=0.37; p<0.01), and this association persisted even after adjusting for age, sex, and BMI. In the MPP, baseline serum calcium was associated with both systolic (beta 0.60, 95% CI 0.30-0.89; p<0.001) and diastolic BP (beta 0.44, 95% CI 0.26-0.62; p<0.001) after adjustment for age, sex, BMI, and antihypertensive therapy. Similarly, in the UKB, the association between both systolic (beta 1.79, 95% CI 1.74-1.85; p<10^15) and diastolic BP (beta 0.98, 95% CI 0.95-1.02; p<10 ^15) and serum calcium was confirmed after the same adjustments.

Conclusions:

In different samples, serum calcium consistently associates with increased BP. Further studies are warranted to elucidate whether this association is influenced by hormones regulating this electrolyte and/or by dietary calcium intake.
LP(A) IN HYPERTENSIVE PATIENTS AS A PREDICTOR OF CARDIOVASCULAR EVENTS
Authors: Renna Nicolás Federico , Ramirez Eliel Ivan , Tenuta Maria De Los Ang , Corral Pablo , Cobo Augusto Lavalle , Gimenez Sergio , Arrupe Matias , Diez Emiliano , Ramirez Jesica Magali
Published: May 2024

Objective:

This study aims to analyze the relationship between Lp(a) levels and HT, determining whether this association implies an increased risk. In this way, the goal is to assess the utility of this relationship as an effective tool for cardiovascular risk stratification.

Design and method:

A retrospective study with a history of recent coronary events was conducted from June 2020 to September 2023. Data were obtained from the computerized medical records. Demographic data, history of HT diagnosis, BMI, current tobacco use, family history, sedentary behavior, pharmacological treatment with statins and antihypertensives were collected. Additionally, serum levels of total cholesterol (Col-T), LDL-chol, HDL-chol and Lp(a) were documented. The nature of the event (first occurrence or readmission) was also recorded. Statistics analysis of regression and variance (ANOVA) was performed.

Results:

A total of 105 patients were included. Age average was 59.7±13, 60% were obese, 39% were current smokers, 31% were diabetic and 66% had sedentary habits (mean ± SD). Chol-LDL values was 136.4±44 and Lp(a) 89±113 (mg/dL mean ± SD). Lp(a) showed a significant correlation with readmissions due to ischemic heart disease, sedentary behavior, and LDL-C levels. Additionally, its value is independent of the other variables. When the regression analysis of Lp(a) (Lowess) was performed, adjusting for age, it became evident that patients with arterial hypertension and cardiovascular events have much higher levels of Lp(a) compared to those without events. Figure 1

Conclusions:

According to available studies, the guideline recommends a universal cutoff point of 100 nmol/L (approximately 50 mg/dL), which approximates the 80th percentile in Caucasian populations in the United States. However, the use of this cutoff point remains a topic of debate among many experts in the lipid community,. This study highlights that in a population of hypertensive patients with elevated Lp(a), early cardiovascular events are observed. The incorporation of this variable into the patients’ risk score could be a strategy for reducing cardiovascular events.
YOGIC EXERCISE- ITS EFFECT ON BLOOD PRESSURE AND DEPRESSION SCORE IN MYOCARDIAL INFARCTION
Authors: Prasad Avneesh
Published: May 2024

Objective:

1. To study the effect of yoga on blood pressure

2. To study the effect of yoga on Beck's depression score

Design and method:

Study was conducted on 200 patients randomized into test group (n=100), subjected to conventional treatment and yoga and control group (n=100),subjected to conventional treatment.

It was conducted on patients diagnosed as myocardial infarction aged >18 years and patient's consent. Patients with hemodynamic instability, heart failure, pregnancy, practiced yoga, arrhythmia, pacemaker, autonomic neuropathy and musculoskeletal disease were excluded.

Initially, assessment of clinical, biochemical parameters and routine investigations were performed. Blood pressure was noted and grading of hypertension was done. Beck's depression score was calculated by filling a questionnaire. Yoga was started on 4th day after MI and were encouraged to perform 10 minutes of pranayam, 15 minutes of shavasan and 15 minutes of transcendental meditation. Follow up after 18 weeks for assessment of blood pressure & depression score was done.

The primary outcome included change in blood pressure from baseline to end of study period and secondary outcome included change in BDI score.

Results:

After 18 weeks of intervention, a significant improvement (p=0.001)was seen for systolic as well as diastolic blood pressure in yoga as well as control group. A significant improvement was also noted for BDI score (p=0.001) among the yoga group as well as control group.

A statistically significant improvement in control group was seen for systolic blood pressure when compared to the yoga group (p=0.01) when both groups were compared after 18 weeks. An improvement was seen for diastolic blood pressure (p=0.44) and BDI score (p=0.304) among yoga group in comparison to control group that was not statistically significant.

Conclusions:

It was concluded from the study that when systolic blood pressure was compared between yoga and control group after 6 weeks, there was significant decrease among the controls. Rather, decrease was seen for diastolic blood pressure and BDI score among the yoga group but was not statistically significant.

Multi-center trials are needed with more sample size to ascertain the effect of yoga.
INFLUENCE OF VARIOUS FACTORS ON ANTI-XA LEVELS IN HOSPITALIZED MEDICAL PATIENTS RECEIVING PARENTERAL THROMBOPROPHYLAXIS
Authors: Papadakis Ioannis , Papazachariou Andria , Charizani Aikaterini , Malikides Vironas , Malikides Onoufrios , Anagnostakis Georgios , Zeniodi Maria -ELENI
Published: May 2024

Objective:

Venous thromboembolism (VTE) stands as a prevalent vascular disease, intimately linked to increased risk for morbidity and mortality. The aim of this study was to investigate the influence of various factors on anti-Xa levels in hospitalized medical patients receiving parenteral thromboprophylaxis.

Design and method:

This is a single-center cohort study encompassing patients admitted to the Internal Medicine Department of the University Hospital of Heraklion, from March to August 2023. These patients were placed on thromboprophylaxis due to a heightened risk of developing VTE. Data regarding demographics, past medical history, somatometric and laboratory findings as well as the type and dose of parenteral anticoagulant were recorded. The measurement of anti-Xa levels were conducted 4 hours subsequent to the third subcutaneous administration of anticoagulant.

Results:

In this study, we enrolled 150 individuals [91 women (60.7%)], with an average age of 80 years. Sixty-two (41.4%) patients exhibited non-therapeutic anti-Xa levels. The levels were subtherapeutic (<0.2units/mL) in 36 patients and supratherapeutic (>0.5units/mL) in 26 patients. Non-therapeutic anti-Xa levels were observed in all underweight patients and in 12 out of 13 obese class II and III patients. It's noteworthy that therapeutic anti-Xa levels were observed in more than half of healthy-weight and overweight patients.

A univariate logistic regression analyses was conducted to explore factors (age, sex, past medical history, somatometric and laboratory findings) that had impact on anti-Xa levels. Among these, only body weight emerged as independent factor influencing anti-Xa levels.

Conclusions:

In our study, we demonstrated that 41.3% of medical patients who were administered parenteral thromboprophylaxis exhibited non-therapeutic anti-Xa levels. This was more profound for underweight or obese class II and III patients. Body weight was emerged as independent factor influencing anti-Xa levels. Further studies on weight-based LMWH thromboprophylaxis dosing in this population are likely to yield new insights improving decisions in daily clinical practice.