bluuebunny/crossref_metadata_2025 huggingface dataset:
HEART RATE VARIABILITY IN RESISTANT HYPERTENSION WITH AND WITHOUT DISTURBANCE OF GLUCOSE METABOLISM
Authors: Manukyan Musheg , Shelemekhov Aleksey , Falkovskaya Alla , Mordovin Victor , Pekarskiy Stanislav , Zyubanova Irina , Lichikaki Valeriya , Kurlov Igor
Published: April 2021

Objective:

To evaluate the differences in heart rate variability (HRV) among patients with resistant hypertension (RHTH) with and without disturbance of glucose metabolism.

Design and method:

A total of 87 patients with RHTN were included in the study: 39 patients without disturbance of glucose metabolism (RHTN group) (mean age 51.2 ± 8.5years, 20 (51%) men, 24-hour (24 h) blood pressure (BP) (systolic/diastolic) 162.3 ± 19.4/99.6 ± 13.5 mmHg); 34 patients with type 2 diabetes mellitus (RHTN + DM group) (mean age 59.2 ± 7.8 years, 11 (32%) men, 24 h BP 157.8 ± 17.4/80.1 ± 12.4 mmHg, mean HbA1c 6.9 ± 1.4%) and 14 patients with impaired glucose tolerance (RHTN + IGT group) (mean age 54.0 ± 10.0 years, 3 (27%) men, 24 h BP 156.6 ± 14.3/89.5 ± 15.6 mmHg). ABPM and 24-h Holter monitoring with analysis of time and frequency domain-based HRV were performed in all patients.

Results:

Patients of three groups had a comparable systolic BP level and number of antihypertensive drugs. At the same time, patients of the RHTN + DM group was older and had significantly higher level of 24h- diastolic BP (DBP) than patients without disturbance of glucose metabolism (p = 0.001 for age, and p = 0.001 for DBP). Low frequency (LF), HRV parameters that mainly reflect sympathetic overactivity, was significantly higher in patient of the RHTN + DM group compared with the RHTN group (52 (38;61) vs 23.1 (15.0;61) respectively, p = 0.03). High frequency (HF), HRV parameters that mainly reflect parasympathetic overactivity, was significantly higher in patients with disturbance of glucose metabolism compared with patient without it (37 (30;50) for the RHTN + DM group and 31 (24;42) for the RHTN + IGT group vs 14,8 (8,6;24) for the RHTN group, p = 0,00/0,01, respectively). Other measured HRV parameters (mean NN, SDNN, SDNN-I, SDANN-I, r-MSSD, pNN50) were comparable in all groups (p > 0,05).

Conclusions:

The presence of diabetes mellitus in patients with RHTN is associated with greater autonomic imbalance in the form of an increase in both the sympathetic and parasympathetic tone of the autonomic nervous system, while IGT is characterized by a significant increase in the parasympathetic tonus only to the same extent as in diabetes mellitus.
FEATURES OF LEFT VENTRICULAR DIASTOLIC DYSFUNCTION IN PATIENTS WITH RESISTANT HYPERTENSION AND TYPE 2 DIABETES MELLITUS
Authors: Manukyan Musheg , Falkovskaya Alla , Mordovin Victor , Zyubanova Irina , Pekarskiy Stanislav , Lichikaki Valeriya , Shelemekhov Aleksey , Ryabova Tamara , Gusakova Anna
Published: April 2021

Objective:

To compare the features of diastolic function in diabetic and non-diabetic patients with resistant hypertension (RHTN) by tissue doppler echocardiography (TDE).

Design and method:

The study included 36 patients with RHTN and type 2 diabetes mellitus (DM) (mean age 61,4 ± 6,4 years, 14 men, mean 24-hour (24 h) blood pressure (BP) (systolic/diastolic) 158,6 ± 15,2/79,8 ± 12,7mmHg, mean HbA1c 7,2 ± 1,2%) and 33 age- and sex-matched patients with RHTN without DM - mean age 58.6 ± 5.6 years, 19 men, mean 24 h BP 159.2 ± 13.8 / 89.6 ± 10.9 mmHg. Office BP and ABPM, diastolic function aassessment (according to 2016 ASE/EACVI recommendations) and BNP level determination were performed in all patients.

Results:

Patients of two groups had a comparable systolic BP level despite of a more number of antihypertensive drugs in patients with RHTN + DM (4.5 ± 1.0 vs 4.0 ± 1.0). However, the mean level of 24 hour pulse BP was significantly higher in diabetic patients with RHTN than in the group without diabetes (79,8 ± 12,7 vs 89,6 ± 10,9 mmHg, p = 0.001). There were no significantly differences in the frequency of diastolic dysfunction (93,9 % vs100 %, p = 0,225) between two groups. At the same time, patients with RHTN and DM had significantly lower mean value of è lat (6.2 ± 1.7 vs 7.3 ± 2 p = 0.018) and significantly higher value of both Sep E/e (14.6 ± 4, 9 vs 12.5 ± 4.1; p = 0.049), Lat E / è (12.2 ± 4.3 vs 9.4 ± 3.4; p = 0.006) and the average ratio E / è (13, 4 ± 4.4 vs 10.9 ± 3.6; p = 0.014) than in patients with RHTN without DM. The difference in BNP level in patients with RHTN with and without DM was no significant (115.6 ± 96.5 vs 71.9 ± 54.5 pg/mL, p = 0.105).

Conclusions:

Patients with RHTN with DM had more pronounced diastolic function impairment than those without DM, which contributes the higher cardiovascular risk in this group.
DOUBLE PRODUCT CAN BE REDUCED BY CPAP IN SLEEP APNEA SYNDROME PATIENTS
Authors: Yamashita Sumiyo , Hashimoto Tomomi , Takase Hiroyuki , Mizoguchi Tatsuya , Sugiura Tomonori , Ohte Nobuyuki , Dohi Yasuaki
Published: April 2021

Objective:

Sleep apnea syndrome (SAS) is associated with increased cardiovascular mortality mediated by intermittent hypoxia, oxidative stress, endothelial dysfunction, and sympathetic nerve activation. Continuous positive airway pressure (CPAP) therapy has been established as the treatment of SAS. Double product (W-P = systolic blood pressure x heart rate) was reported to be a good predictor for cardiovascular disease. This study was designed to test whether CPAP could reduce W-P in SAS patients.

Design and method:

Patients diagnosed as SAS by polisomnography (PSG) examined in our hospital from April 2016 to April 2018 were enrolled (N = 67, male 78.3%, 60.4 ± 14.3 years). 11 cases of the subjects had examined PSG under wearing CPAP. W-P was calculated by casual blood pressure and heart rate measured on the PSG enforcement day. The association between W-P and parameters including age, sex, BMI, abdominal circumference, blood tests date, urine albumin, and various SAS indexes were examined.

Results:

Casual blood pressure and heart rate were 124.8 ± 19.2/79.1 ± 15.9 mmHg and 78.6 ± 13.4 bpm. W-P in the group with CPAP (8786.7 ± 1451.7) was significantly decreased compared with the group without CPAP (10127.7 ± 2826.5, p < 0.05). The urine protein level (R = 0.43, p < 0.05) and the plasma BNP level (R = 0.45, p < 0.005) were related to W-P. Multivariate regression analysis adjusted for known risk factors also indicated that the urine protein level was independent factor to determine elevated W-P (beta = 0.57, p < 0.05).

Conclusions:

W-P was related to a hypertensive target organ damage in SAS patient. The CPAP therapy can decrease W-P and may reduce the risk of future cardiovascular disease.
INTER-ARM BLOOD PRESSURE DIFFERENCE IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA
Authors: Shiina Kazuki , Tomiyama Hirofumi , Chikamori Taishiro
Published: April 2021

Objective:

Obstructive sleep apnea (OSA) is an independent risk for cardiovascular disease. On the other hand, inter-arm systolic blood pressure difference (IAD) is noted as a marker for future cardiovascular events. However, underlying mechanisms of IAD has not been fully clarified. The present study was conducted to examine whether OSA is associated with IAD.

Design and method:

In 2645 consecutive patients aged over 30 {age: 56 ± 13 years old, mean apnea-hypopnea index (AHI): 39 ± 23 /h}, who visited sleep clinic to perform polysomnography in 2005–2017, blood pressure in both arms were measured simultaneously by oscillometric methods. The IAD was defined as absolute value of the systolic blood pressure difference in both arms.

Results:

In all included patients, patients with IAD over 10 mmHg were noted in 3.7%. When patients were divided into two groups: severe OSA (AHI over 30) group and mild to moderate OSA (AHI < 30) group, the prevalence rate of IAD over 10 mmHg were higher in severe OSA group than those in mild to moderate group (4.6% vs 2.8%, P < 0.05)(Figure). Multiple linear regression analysis demonstrated that AHI was an independent (P < 0.05) determinant of IAD, even after the adjustments of age, gender, body mass index, hypertension, and another variables.

Conclusions:

OSA may be a risk for IAD. The plausible explanation is that pathophysiological abnormalities related with OSA, such as the negative intrathoracic pressure, may affect IAD.
OBSTRUCTIVE SLEEP APNEA AS A RISK FACTOR OF INSULIN RESISTANCE IN NONDIABETIC PATIENTS
Authors: Macek Piotr , Michalek-Zrabkowska Monika , Martynowicz Helena , Gac Pawel , Wojakowska Anna , Mazur Grzegorz , Poreba Rafal
Published: April 2021

Objective:

Obstructive sleep apnea (OSA) is a common sleep-breathing disorder characterised by collapsing of upper airway during sleep. The aim of this research was to assess relationship beetwen prevalence and severity of OSA and insulin resistance in nondiabetic individuals among patients with increased risk of OSA without diabetes mellitus.

Design and method:

Our study group estimated 102 individuals with suspected OSA, 71 men and 31 women, mean age 53.02 SD ± 12.37. We excluded individuals with diabetes mellitus and taking hypoglycemic drugs. All patients underwent standardized full night polysomnography in sleep laboratory to diagnose OSA. The Epworth Sleepiness Scale was used to assess daytime sleepiness. Serum insulin and glucose levels were analyzed by Laboratory. The HOMA index was calculated.

Results:

OSA was diagnosed in 85 patients. Mean AHI in whole study group was 25.78 ± 24.84, mean AHI in group with diagnosed OSA amount to 30.49 ± 24.64, mean AHI in nonapneic patients stands up to 2.23 ± 1.49. The difference was statistically significant p < 0.001. The oxygen desaturation index (ODI) in our study sample estimated about 25 (24.99 ± 23.25), the difference between group with OSA (mean ODI 29.31 ± 23.14) and group without OSA (mean ODI 3.38 ± 2.42) was statistically relevant p < 0.001. The statistically significant differences have occured between patients with (AHI = 15 or AHI > 15) and AHI < 15 taking into account level of insulin and the Homa index p < 0.05, but no statistically significant difference was observed between patients with (ESS = 9 or ESS > 9) and ESS < 9.

Conclusions:

Individuals with moderate to severe obstructive sleep apnea without diabetes mellitus have higher insulin resistance estimated with HOMA- IR index. This study revealed that there is no evidence if the evaluation of daytime sleepiness using Epworth Sleepiness Scale is a predicting factor of developing IR. Higher AHI and ODI levels beyond individuals from our study sample are independent risk factors for higher fasting insulin levels and higher HOMA index. Increased duration of desaturation time below 90% is an independent risk factor for higher fasting glucose levels.
EFFECT OF CONTINUOUS POSITIVE AIRWAY PRESSURE TREATMENT ON GLYCEMIC AND LIPID PROFILES IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Cattazzo Filippo , Pengo Martino F. , Giontella Alice , Soranna Davide , Karalliedde Janaka , Gnudi Luigi , Minuz Pietro , Lombardi Carolina , Parati Gianfranco , Fava Cristiano
Published: April 2021

Objective:

Continuous Positive Airway Pressure (CPAP) is the main therapy for obstructive sleep apnea (OSA); nevertheless, uncertainty remains about the effectiveness of CPAP not only in controlling OSA-related hypertension, but also in improving the metabolic dysregulation that characterizes OSA patients. This meta-analysis of randomized controlled trials (RCTs) aimed to investigate whether CPAP, compared to other control treatments (sham CPAP, oral placebo or standard care), could improve glucose metabolism (fasting plasma glucose [FPG] or glycated haemoglobin or fasting plasma insulin [FPI] or homeostasis model assessment [HOMA] of insulin resistance [IR]) and/or lipid metabolism (total, HDL, LDL-cholesterol or triglycerides) in OSA patients.

Design and method:

Relevant papers were searched in three different databases (MEDLINE, EMBASE and Web of Science) from inception to 31st Dec 2018 through specific search terms and selection criteria.

Results:

From 2,289 articles, 26 RCTs were included. Regarding glycemic metabolism, neither FPG nor glycated haemoglobin were reduced by CPAP. However, patients on CPAP showed an improvement in insulin sensitivity, as witnessed by a significant reduction of FPI (Standardized difference in means [SDM] = 0.205 [95%CI, 0.07–0.339], p = 0.003) and HOMA IR (SDM = 0.176 [95%CI, 0.056–0.296], p = 0.004). In sensitivity analysis the favourable effects of CPAP were maintained in prediabetic/type 2 diabetic patients and in those presenting an apnoea-hypopnea index > 30 events/h. Regarding lipid metabolism, OSA patients treated with CPAP showed a significant reduction in total cholesterol (TC; SDM = 0.138 [95%CI, 0.034–0.242], p = 0.009). In subgroups analysis, greater adherence to CPAP along with severe nocturnal oxygen desaturations at baseline (SpO2-nadir < 77%) was associated with a significant decrease of TC. Furthermore, dividing the primary studies according to the median TC at baseline (198 mg/dL), the positive effects of CPAP were maintained only in those that presented a TC above the median. Conversely, CPAP did not modify triglycerides, HDL- and LDL-cholesterol.

Conclusions:

CPAP treatment significantly improves insulin sensitivity and reduces TC in OSA patients but with a low effect size. The effectiveness of CPAP is higher in patients with greater CPAP usage, and with a greater number of apnoeic events and oxygen desaturations at baseline. Concerning TC, patients presenting higher levels at baseline benefit the most from CPAP.
FOREARM VASCULAR RESPONSES TO MENTAL STRESS AND DEVICE GUIDED BREATHING ASSOCIATE WITH PLASMA CONCENTRATIONS OF NORMETADRENALINES IN SUBJECTS WITH ESSENTIAL HYPERTENSION
Authors: Farukh Bushra , Faconti Luca , Mcnally Ryan , Chowienczyk Phil
Published: April 2021

Objective:

Forearm vasodilator responses to mental stress (MS) are impaired in hypertensive compared to normotensive individuals by a mechanism that may relate to peripheral alpha-adrenergic activity antagonising that of neuronal nitric oxide. We investigated whether the response to MS may be dependent on the level of basal sympathetic activity as measured by plasma concentrations of normetadrenaline (NM) and how responses to slowing respiratory rate by device guided breathing (DGB, which reduces sympathetic activity) vary according to NM concentrations.

Design and method:

Subjects with essential hypertension were stratified according to concentrations of plasma NM into those with low NM (< or = 500pmol/L) and high NM (> or = to 750pmol/L). Forearm blood flow (FBF) was measured by venous occlusion plethysmography after 15 minutes of rest, during MS elicited by the Stroop word-colour test and during supervised DGB with breathing rate < 10 breaths/minute.

Results:

Subjects with high NM (n = 30, 15 men) had greater body mass index than those with low NM (n = 30, 17 men): (mean ± SD) 31 ± 7 vs 27 ± 4 kg/m2 (P < 0.05), but the two groups were similar with respect to age and brachial blood pressure (BP). During MS and DGB, changes in BP were similar in subjects in both low NM and high NM groups. MS increased FBF in both groups but the response in high NM was impaired as compared to subjects with low NM (34 ± 3 vs. 49 ± 3 %, P < 0.05). DGB increased forearm vascular resistance to a lesser extent in subjects with high compared to low NM (1.21 ± 7.95 vs 5.50 ± 6.32 mmHg.100 mL/mL, P < 0.05).

Conclusions:

These results are consistent with greater sympathetic vascular tone in patients with higher NM that antagonises forearm vascular responses to MS. Circulating concentrations of NM may identify subjects with impaired neuronal nitric oxide signalling.
IMPACT OF MARATHON RUNNING ON ENDOTHELIAL FUNCTION AND SUBCLINICAL ATHEROSCLEROSIS
Authors: Terentes-Printzios Dimitrios , Vlachopoulos Charalambos , Kardara Despoina , Anastasakis Aris , Vogiatzi Georgia , Xaplanteris Panos , Georgakopoulos Christos , Lazaros Georgios , Tousoulis Dimitrios
Published: April 2021

Objective:

Aerobic exercise has beneficial effects on the cardiovascular system. Marathon running is both an aerobic but also an extremely vigorous exercise. Endothelial function and carotid subclinical atherosclerosis are independent predictors of cardiovascular risk. We sought to investigate the chronic alterations of these indices in marathon runners.

Design and method:

We studied 30 marathon runners and 20 age- and sex-matched recreationally active control subjects. Endothelial function was evaluated with brachial flow-mediated dilatation (FMD) and early atherosclerosis with carotid intima-media thickness (cIMT).

Results:

Marathon runners had significantly higher systolic and pulse pressure compared to controls. They also had reduced body-mass index, waist to hip ratio and heart rate compared to controls (p < 0.05, for all). Common cIMT was significantly lower in athletes than controls (0.56 ± 0.11 vs. 0.63 ± 0.07, p = 0.029), while there was no difference in carotid bulb IMT between groups. FMD was higher in marathon runners compared to controls and nitrate-mediated dilatation (NMD) was similar in the two groups (9.0 ± 3.7 vs. 6.4 ± 1.7 and 12.6 ± 5.7 vs. 12.3 ± 3.4; p = 0.002 and p = 0.821, respectively). (Figure) We also observed a reverse U-shaped curve between endothelial function and amount of exercise. FMD was significantly inversely associated with the number of training days per week (r = -0.430, p = 0.018).

Conclusions:

Marathon runners have higher FMD compared to controls, indicating better vascular endothelial function, and also have lower cIMT compared to controls. Increased amount of exercise training seems to eradicate the beneficial effect of exercise on endothelial function. These findings provide further insights in the effects of marathon running on cardiovascular risk.
ACUTE EXERCISE CHANGES THE FOURIER-TRANSFORM INFRARED SPECTRA PROFILE IN INDIVIDUALS WITH HYPERTENSION AND OTHER CARDIOVASCULAR RISK FACTORS: EFFECT OF THE SESSION DURATION
Authors: Teixeira Manuel , Lima Suiane , Gouveia Marisol , Duarte Ana , Ferreira Miriam , Simões Maria I. , Conceição Maria , Costa Mariana , Nunes Alexandra , Vieira Sandra I. , Ribeiro Fernando
Published: April 2021

Objective:

Evaluate the acute effects of two sessions of moderate exercise with different durations, on the metabolomic profile of adults with cardiovascular risk factors or established cardiovascular disease.

Design and method:

15 adults (age: 66.5 ± 7.6 years; BMI: 26.8 ± 3.7 kg/m2; 80% women) were recruited in a community exercise program of a primary health care centre. They performed two sessions of moderate intensity aerobic (endurance) exercise with different duration periods (30 versus 45 min). Venous blood was collected before and after each exercise session. Samples were centrifuged and the plasma was used for Fourier-transform infrared (FTIR) spectroscopy analysis. The spectra were acquired, and multivariate analysis applied.

Results:

FTIR analysis showed good discrimination between pre- and post- the 30 min session in the 1700–1600 cm-1 region (Amide I band) and 1500–900 cm-1 region (fingerprint region). Principal component analysis of the fingerprint region revealed that the post-exercise samples presented peaks related to glycogen (1079 cm-1) and collagen (1458 cm-1, 1339 cm-1), which reflect the exercise training. Pre-exercise samples had peaks related to ribose (996 cm-1) and carbohydrates (1045 cm-1) that are sources of energy that are ready to be used during the session. Partial least squares regression of the Amide I region also showed differences after exercise. In the baseline, the participants seem to have higher levels of antiparallel β-sheets (1690 cm-1) and side chains (1611 cm-1), which are linked with proteins prone to aggregate. However, after exercise, the participants showed a peak related to random coils (1639 cm-1), which may indicate a transitional state for the β-sheet rich protein to a more stable profile. In the 45 min session no differences were observed after the session in the amide I region.

Conclusions:

A single aerobic exercise, irrespective of the duration, does not induce deleterious changes in the metabolomic profile. Only the 30 min session promoted a positive alteration in the quality of the proteins; this change in the quality of the proteins and the fingerprint region indicates a possible alteration associated with the duration of the exercise.
EXERCISE TRAINING PROTECTED CARDIAC DAMAGE FROM DOXORUBICIN-INDUCED HEART FAILURE IN SPRAGUE-DAWLEY RATS
Authors: Pei Zuowei , Zhu Huolan , Yang Chenguang , Ren Yirong , Meng Xuyang , Li Yi , Wang Fang
Published: April 2021

Objective:

Heart failure is a complex end stage result of various cardiovascular diseases, and has a poor prognosis. Exercise training according to oxidative stress, myocardial fibrosis, inflammation pathways improve cardiac function. The aim of this study was to investigate the possible protective effects of exercise training against cardiac damage in doxorubicin (DOX)-induced heart failure in Sprague-Dawley Rats.

Design and method:

This study used 45 male Sprague-Dawley (SD) rats weighing 150 ± 20 g that were randomly divided into a control group (normal saline), doxorubicin (DOX) group and DOX plus exercise (DOX + E) group. Heart failure was induced experimentally by intraperitoneal injections of the cardiotoxic agent DOX. All groups received different treatment for 8 weeks. Blood samples were obtained from the inferior vena cava and collected in serum tubes; the blood samples were stored at minus 80°C until use. Heart tissues were fixed in 10% formalin and then embedded in paraffin for histological evaluation. The heart was stored in liquid nitrogen for immunoblotting or mRNA analysis.

Results:

Left ventricular fractional shortening and ejection fraction were higher in DOX + E group rats than in DOX group rats on an echocardiographic examination (Figure 1 and Table 1). Significant cardiac tissue damage (haematoxylin and eosin, Masson's trichrome staining) was seen in rats of the DOX group compared to those of the DOX + E group (Figure2). Exercise inhibited DOX-induced cardiac fibrosis (transforming growth factor, smooth muscle actin, collagen I, and collagen III) and oxidative stress (Nox4, p53) in an immunoblotting analysis (Figure 3 and 4).

Conclusions:

These results indicate that exercise training may be a potential therapeutic target for cardiac damage caused by DOX-induced heart failure.
BARRIERS OF BEING ACTIVE: GENDER DIFFERENCES IN YOUNG POPULATION
Authors: Rosselli Martina , Mascherini Gabriele , Boddi Maria , Stefani Laura , Toncelli Loira , Galanti Giorgio , Modesti Pietro Amedeo
Published: April 2021

Objective:

Regardless of any weight change. adopting and maintaining a healthy lifestyle has been shown to lead to meaningful improvements in cardiometabolic risk factors. including fasting insulin. and blood pressure. Although adolescent-specific lifestyle recommendations have been developed. many adolescents do not meet lifestyle behavior recommendations. The study aimed to investigate gender differences in perceived barriers to exercise in a young population.

Design and method:

A cross-sectional study was conducted among high school students (n = 368). Participants underwent measurements of anthropometric parameters (weight. waist. and hip circumferences). blood pressure. and administration of standardized questionnaire (Barriers to Being Active quiz and Mediterranean Diet Score quiz). Gender differences were assessed with multivariate logistic regression (adjusted for age and BMI).

Results:

Prevalence of overweight (BMI > 25 kg/m2) was lower among girls than among boys (3.9 % and 8.3%. OR.720; 95% CI 0.645 to 0.803) with no difference in the adherence score of Mediterranean diet (31.4 ± 4.0 and 30.8 ± 4.3. OR 1.036; 95% CI 0.984 to 1.090). The number of perceived barriers to physical activity was higher among girls than among boys (OR 1.519; 95% CI 1.286 to 1.793). Lack of energy for exercise and lack of willpower were the two barriers most frequently reported by girls (see table; n = 368 included in analysis; ∗adjusted also for age and BMI)

Conclusions:

Exercise professionals should be aware of the barriers that young girls can face during exercise prescription and be able to contrast them with useful individual strategies. Furthermore, analysis of young people life-style habits can help finding social strategies to promote healthy behaviors.
ARE PATIENTS WITH RESISTANT HYPERTENSION COMPLIANT WITH DAILY PHYSICAL ACTIVITY RECOMMENDATIONS?
Authors: Bastos Jose Mesquita , Lopes Susana , Garcia Catarina , Teixeira Manuel , Carvalho Pedro , Gonçalves Ana C. , Ribeiro Ilda P. , Melo J. Barbosa de , Oliveira Jose , Oliveira Daniela , Polonia Jorge , Alves Alberto J. , Ribeiro Fernando
Published: April 2021

Objective:

Objective: To describe the physical activity (PA) levels and relation with blood pressure, and endothelial function and inflammatory biomarkers in patients with resistant hypertension.

Design and method:

Design and Method: Sixty-six patients (age: 59 ± 1.0 yrs; gender: 50.7% men; BMI: 29.8 ± 0.6 kg/m2; number of antihypertensive medications: 4.6 ± 0.1) were recruited. Outcome measures included clinical data, ambulatory blood pressure, daily physical activity, cardiorespiratory fitness, circulating levels of hs C-reactive protein (hs CRP), and the levels of endothelial progenitor cells (EPCs), circulating endothelial cells (CECs) and hematopoietic stem cells (HSCs) quantified by flow cytometry. Sedentary time, and time spent at light and moderate-to-vigorous physical activity (MVPA) was assessed by accelerometers over 7 days. Correlation analysis was conducted to assess the association between variables; independent t-test was used for testing differences in blood pressure, VO2peak, hs CRP, EPCs, HSCs and CECs, according to the compliance with physical activity recommendations (< 150 versus > = 150 minutes/week of MVPA).

Results:

Results: Patients spent an average of 475.1 ± 75.7, 341.0 ± 35.8 and 46.4 ± 8.1 min/day in sedentary, light and moderate to vigorous PA, respectively. More than half (52.5%) of the patients met the recommended 150 min of moderate to vigorous physical activity per week. However, there were no differences regarding 24 h systolic and diastolic ambulatory blood pressure (p = 0.876) and (p = 0.130), VO2peak (p = 0.654), hs CRP (p = 0.381) and number of antihypertensive medications (p = 0.490) between patients that met and did not meet the PA recommendations. Sedentary time correlated positively with CECs (0.245, p = 0.05).

Conclusions:

Conclusions: The compliance with daily physical activity recommendations does not seem to have a major influence in blood pressure, hs CRP, and cardiorespiratory fitness of patients with resistant hypertension. Sedentary time is associated with higher endothelial injury/damage in patients with resistant hypertension.

This work is financed by FEDER Funds through the Operational Competitiveness Factors Program - COMPETE and by National Funds through FCT - Foundation for Science and Technology within the project PTDC/DTP-DES/1725/2014.
EXPLORING ASSOCIATIONS BETWEEN HEART RATE VARIABILITY AND EXERCISE TOLERANCE IN INDIVIDUALS WITH PERIPHERAL ARTERY DISEASE
Authors: Marçal Isabela Roque , Cornelis Nils , Buys Roselin , Fourneau Inge , Ciolac Emmanuel G. , Cornelissen Véronique A.
Published: April 2021

Objective:

Lower-extremity artery disease (LEAD) characterized by a progressive atherosclerotic build-up in leg arteries affects more than 200 million people worldwide. LEAD is often associated with autonomic dysfunction as evidenced by a reduced heart rate variability (HRV). We aimed to investigate whether the autonomic function is associated with ambulatory capacity and exercise capacity in patients with LEAD.

Design and method:

Thirty-four patients (age > 17 years) diagnosed with LEAD (ABI < 0.9 and/or 20% decrease after a maximal treadmill test) suffering from intermittent claudication (Rutherford I-III) were recruited in the PROSECO-IC trial. Patients were grouped based on beta-blocker medication (B-blocker and non-B-blocker). Intervals between R waves (i-RR) obtained by heart rate (HR) signal were acquired beat-to-beat (Polar®H10) during 15 min of supine rest and were used for 5-minute HRV analysis. Time-domain indexes (mean i-RR, SDDD)and frequency domains (high-frequency band (HF), low frequency (LF, very LF (VLF)), and the ratio (LF/HF). Ambulatory capacity was assessed by a submaximal treadmill test, graded maximal treadmill test using Gardner protocol (GTM), and 6 minutes walking test (6MWT); exercise capacity was assessed by graded maximal cardiopulmonary exercise test (HR, blood pressure (BP) and peak oxygen uptake (VO2peak)) at resting, 2 minutes and the peak of exercise.

Results:

Pearson test showed that sympathetic modulation indexes were moderately associated with pain-free distance in GTM (LF/HF: r = 0.52, p = 0.04) and pain-free time in 6MWT (LFlog: r = -0.62, p = 0.01; VLF: r = -0.52, p = 0.04), respectively, in patients without B-blocker. Similar HR associations with HRV (time and frequency domain) were observed during the submaximal treadmill test and cardiopulmonary exercise test (p < 0.05). Test-t demonstrated a significantly increased response intra-groups in HR and BP during both tests (p < 0.05). Average BP was positive associated with the earlier stages of the cardiopulmonary test (resting to 2 min) with LFlog (r = 0.70, p = < 0.001) in B-blocker while non-B-blocker were associated from 2 min to peak with LFabs (r = 0.67, p = < 0.001) and LF/HF (r = 0.52, p = 0.03).

Conclusions:

Sympathetic modulation was correlated with a longer pain-free walking capacity in non-B-blockers. Yet, individuals treated by -B-blockers showed an earlier sympathetic modulation through exercise pressor response during the first stages of cardiopulmonary exercise compared to non-B-blockers.
COMPARISON OF HOSPITALIZATION EVENTS AND ESTIMATION OF HAZARD RATIO FOR PATIENTS WITH HYPERTENSIVE EMERGENCIES AND HYPERTENSIVE URGENCIES AFTER 12 MONTH FOLLOW UP A GREEK REGISTRY
Authors: Fragoulis C. , Tsioufis K. , Tzorovili E. , Dimitriadis K. , Siafi E. , Leontsinis I. , Konstantinidis D. , Kakouri N. , Nihoyannopoulos P. , Tousoulis D.
Published: April 2021

Objective:

The purpose of our registry was to record the prevalence and clinical characteristics of patients with hypertensive urgencies (HU) and emergencies (HE) assessed in the emergency department (ED) and during hospitalizationand a 12 month follow-up to record new events in a Greek General Hospital.

Design and method:

The study population consisted of patients presenting at the emergency department with acute increase in blood pressure (BP)(systolic BP > or = 180mmHg and/or diastolic BP > or = 120mmHg) and depending on the presence or absence of acute hypertension-mediated target organ damage, participants weredivided into the HE and the HU group, respectively. In all patients the demographic andclinical parameters were recorded for 12 monthsand there was a 12 month follow-up for new hospitalizations.

Results:

Out of 38,589 patients assessed in the ED during a period of 12 months, 353 (0.91%) had HU and HE, out of which 256 (72.5%) hadHU and 97 (27.5%) had HE. The mean age of patients was 67.4 ± 12.9years, 49% were males and 80% had history of hypertension. Patients with HE compared to HU were older (72.7 ± 12.1 vs 61.4 ± 12.7years, p < 0.0001). At baseline 91 patients with HE and 25 with HU were admitted in the hospital and remained for 6.4 ± 5.6days. During the study period82 patients were excluded for not completing the follow-up. Comparing the 2 groups, 51 patients from HE and 39 from HUgroup were hospitalized (p < 0.0001, HR for HE 2.3,95% CI 1.5–3.7). 29patients from HE and 9 from HU group were hospitalized for cardiovascular disease (p < 0.0001, HR for HE 3.8,95%CI 1.7–8.6). 32 patients from HE and 34 from HU group were hospitalized for non cardiovascular disease (p < 0.05, HR for HE 1.7,95% CI 1.02–3.02). Cox regression models were adjusted for age, gender, cardiovascular disease, chronic kidney disease, heart failure and diabetes mellitus.

Conclusions:

Our registry emphasizes the elevated hazard ratio for hospitalizations in the group of HE compared with HU, the necessity for more intensive follow-up for the first group and the need for further research in this setting.
COMPARISON OF DEATH EVENTS AND ESTIMATION OF HAZARD RATIO FOR PATIENTS WITH HYPERTENSIVE EMERGENCIES AND HYPERTENSIVE URGENCIES AFTER 12 MONTH FOLLOW UP A GREEK REGISTRY
Authors: Fragoulis C. , Tsioufis K. , Tzorovili E. , Dimitriadis K. , Siafi E. , Leontsinis I. , Konstantinidis D. , Kakouri N. , Nihoyannopoulos P. , Tousoulis D.
Published: April 2021

Objective:

The purpose of our registry was to record the prevalence and clinical characteristics of patients with hypertensive urgencies (HU) and emergencies (HE) assessed in the emergency department (ED) and during hospitalizationand a 12 month follow-up to record new events in a Greek General Hospital.

Design and method:

The study population consisted of patients presenting at the emergency department with acute increase in blood pressure (BP) (systolic BP > or = 180mmHg and/or diastolic BP > or = 120mmHg) and depending on the presence or absence of acute hypertension-mediated target organ damage, participants weredivided into the HE and the HU group, respectively. In all patients the demographic andclinical parameters were recorded for 12 months and there was a 12 month follow-up for deaths.

Results:

Out of 38,589 patients assessed in the ED during a period of 12 months, 353 (0.91%) had HU and HE, out of which 256 (72.5%) hadHU and 97 (27.5%) had HE. The mean age of patients was 67.4 ± 12.9years, 49% were males and 80% had history of hypertension. Patients with HE compared to HU were older (72.7 ± 12.1 vs 61.4 ± 12.7years, p < 0.0001). At baseline 91 patients with HE and 25 with HU were admitted in the hospital and remained for 6.4 ± 5.6days.2 patients from HE group died from nosocomial infection. During the study period82 patients were excluded for not completing the follow-up. Comparing the 2 groups, 11 patients from HE and 3 from HUgroup died (p < 0.0001, HR for HE 4.8,95% CI 1.2–18.6). 8patients from HE and 1 from HU group died from cardiovascular disease (p < 0.0001, HR for HE 13.9,95%CI 1.6–121.1). 3 patients from HE and 2 from HU group died fromnon cardiovascular disease (p = 0.222, HR for HE 2.9,95% CI 0.5–17.3). Cox regression models were adjusted for age, gender, cardiovascular disease, chronic kidney disease, heart failure and diabetes mellitus.

Conclusions:

Our study highlights the elevated hazard ratio for deaths in the group of HE compared with HU, the commitment for more intensive follow-up for the first group and the requirement for further research in this pathological entity.
EFFECT OF A REFERRAL LETTER ON THE DAY OF THE HEALTH CHECKUP TO INCREASE THE CLINICAL FOLLOW-UP RATE IN JAPANESE HYPERTENSIVE EMPLOYEES: A CLUSTER-RANDOMIZED CONTROLLED TRIAL
Authors: Shima Azusa , Arima Hisatomi , Miura Katsuyuki , Tatsumi Yukako , Ohkubo Takayoshi , Kawatsu Yuichiro , Morino Ayumi , Kimura Takashi , Godai Kayo , Azuma Saori , Miyamatsu Naomi
Published: April 2021

Objective:

To investigate whether a referral letter to general physician given in workplace health checkup increased clinical follow-up rate in the employees who detected grade II or III hypertension.

Design and method:

We conducted a cluster randomized controlled trial at a retail company in which every employee who works for more than 6 hours a day had annual health checkup. A total of 107 supermarket stores were randomly assigned to the control arm (outpatient visit was recommended by a leaflet as usual) or the intervention arm (outpatient visit was recommended by a referral letter to a general physician together with the leaflet). Employees who met the following eligibility criteria were enrolled: (i) BP > = 140/90 mmHg in 2016, (ii) BP > = 160/100 mmHg in 2017, and (iii) not receiving medication in 2017. The primary outcome was the presence of clinical follow-ups for hypertension in outpatient visit within six months after the health checkup, which was assessed using health insurance claim data. Odds ratio (OR) and 95% confidence interval (CI) for the presence of clinical follow-ups in the intervention arm compared with the control arm was estimated using multilevel logistic regression, accounting for the store's level effect.

Study protocol was registered at the University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR, ID = 000025411)

Results:

We analyzed 273 participants (mean age was 50.3 years, 55% women) from supermarket stores (control: 135 patients in 52 stores, intervention: 138 patients in 55 stores). Mean systolic blood pressure (standard deviation) was 165 (10) mmHg in the control arm and 164 (10) mmHg in the intervention arm. Clinical follow-up rate was 19.3% (24/135) in the control arm and 34.1% (47/138) in the intervention arm. OR and 95% CI for the presence of clinical follow-ups in the intervention arm compared with the control arm was 2.33 (1.12–4.84).

Conclusions:

Among employees who detected grade II or III hypertension at their health checkups, giving a referral letter to a general physician on the day of the health checkup increased the clinical follow-up rate within six months.
SHORT-TERM SAFETY OF ANTIHYPERTENSIVE MEDICATION REDUCTION IN MULTI-MORBID PATIENTS WITH MILD HYPERTENSION: THE OPTIMISE RANDOMISED CONTROLLED NON-INFERIORITY TRIAL
Authors: Sheppard James , Burt Jenni , Lown Mark , Temple Eleanor , Lowe Rebecca , Fraser Rosalyn , Allen Julie , Ford Gary , Heneghan Carl , Hobbs Richard , Jowett Sue , Kodabuckus Shahela , Little Paul , Mant Jonathan , Mollison Jill , Payne Rupert , Williams Marney , Yu Ly-Mee , McManus Richard
Published: April 2021

Objective:

Deprescribing of antihypertensive medications is recommended in some elderly patients with polypharmacy and multi-morbidity. However, the evidence base for this strategy is limited. We aimed to establish whether antihypertensive medication reduction is possible without significant hazard or changes in systolic blood pressure (SBP) control at 12-week follow-up.

Design and method:

This study used a randomised, controlled, open label, non-inferiority trial design. Participants aged at least 80 years with SBP < 150 mmHg and receiving 2 or more antihypertensive medications, whose GP considered appropriate for medication reduction were recruited from 69 general practices across England. Those enrolled were randomised (1:1 ratio) to antihypertensive medication reduction (intervention) or usual care (control). The primary outcome was difference (<10%) in proportion of participants with clinically acceptable SBP (<150 mmHg) at 12-week follow-up. Secondary outcomes included difference in SBP and adverse events. Trial registration EudraCT (2016-004236-38), ISRCTN (97503221).

Results:

Of 569 participants who were randomised, 35 (6%) were lost to follow-up. Overall, 229 (86.4%) patients in the intervention group and 236 (87.7%) patients in the control group had clinically acceptable systolic blood pressure at follow-up (Adjusted RR 0.98, 95% CI 0.92 to 1.04). Since the lower 95% confidence interval was greater than 0.9, medication reduction was assumed to be non-inferior to usual care. Medication reduction was sustained in 187 (66.3%) participants in the intervention group who were taking 0.63 (95% CI 0.56 to 0.71) fewer antihypertensive medications than the control group at 12 weeks. Systolic blood pressure corrected for baseline was 3.5 mmHg higher (95% CI 1.1 to 5.9 mmHg) in the intervention group. Adverse events were higher in the intervention group but there was no significant difference in rates of serious adverse events.

Conclusions:

Antihypertensive medication reduction can be achieved in two thirds of older multi-morbid patients with systolic blood pressure remaining within clinically acceptable limits. However, potential benefits must be balanced against the possible harms from increased systolic blood pressure (and therefore cardiovascular risk) plus increased adverse events (although most were apparently unrelated).
COLLATERAL BENEFITS OF PARTICIPATION IN CLINICAL RESEARCH: INSIGHTS FROM A RESISTANT HYPERTENSION TRIAL SCREEN OUT POPULATION
Authors: Saxena Manish , Kermali Muhammed , Balawon Armida , Pheby Jane , Benu Elena , Piniera Brian , Low Deborah , Mathur Anthony , Lobo Melvin D.
Published: April 2021

Objective:

Patients with resistant hypertension (HTN) were invited to take part in an ongoing randomised, double-blind, sham-controlled, multi-centre, multi-national renal denervation trial. We evaluated the benefits for patients coming into research at our centre.

Design and method:

Male or female patients 18–75 years old with resistant HTN were invited to participate. Post consent, clinic blood pressure (CBP) measurements were recorded. Patients also had 24-hour ambulatory BP (ABP) to exclude pseudo-resistant HTN. All patients underwent screening for secondary causes of HTN. Antihypertensive medications were changed to a fixed dose combination pill (Sevikar/HCT). Ineligible patients had medication changes as per clinical judgement to improve BP control. Repeat CBP and ABP assessments were done at 4 weeks.

Results:

170 patients were assessed. The mean age was 59.6 ± 9.6 years, males (78%) and Caucasians (66%). The average number of anti-hypertensive medications was 4.1 ± 1.2. The mean CBP was 154/91mmHg, mean daytime ABP was 150/85mmHg. Following adjustments in medication after 4 weeks, the reduction in Clinic SBP was 14 ± 10 mmHg and DBP was 6.3 ± 6.2 mmHg (n = 145; p < 0.001 for both). The reduction in mean systolic daytime ABP was 8 ± 8.2 mmHg and DBP was 6 ± 7 mmHg (n = 91, p < 0.001 for both). The average number of anti-hypertensive medications reduced to 3.2 ± 1.3. Screening generated 74 new diagnoses and 34 newly detected cases of secondary hypertension (summarised below).

Conclusions:

High screen failure rate in studies could be considered a waste of time and resources. However, our findings demonstrate considerable collateral benefits for patients:

1. Accessing specialist care as part of the study.

2. Frequent new diagnoses and newly detected secondary HTN.

3. Medication optimisation resulting in clinically meaningful BP reduction and reduced medication burden.
EFFECTS OF BENZODIAZEPINES ON ORTHOSTATIC BLOOD PRESSURE IN OLDER PEOPLE
Authors: Rivasi Giulia , Kenny Rose Anne , Ungar Andrea , Romero-Ortuno Roman
Published: April 2021

Objective:

Older people taking benzodiazepines (BDZs) have higher risk of falling, which is mainly attributed to unfavorable drug-related effects on cognition and psychomotor functioning. BDZs may also have hypotensive effects, but evidence concerning their consequences on orthostatic blood pressure (BP) behaviour is scarce. We investigated the association between BDZs and BP response to an active stand test in older people.

Design and method:

We performed a retrospective analysis of data from an outpatient research clinic in an Irish university hospital, where people aged 60 or older underwent a comprehensive geriatric assessment between August 2007 and May 2009. Non-invasive beat-to-beat orthostatic BP was measured during an active stand, with systolic BP assessed at each 10-second interval. Information on regular BDZs use was collected. Factors independently associated with orthostatic systolic BP were investigated using multiple linear regression.

Results:

Of 538 participants (67.7% female, mean age 72.7 ± 7.2), 33 (6.1%) reported regular use of BDZs. During active stand, participants taking BDZs showed a significantly greater systolic BP drop 10 seconds after the posture change (“immediate” BP drop), while no significant differences were detected in orthostatic systolic BP in the latter phases of standing. After adjusting for possible confounders, BDZs use was independently associated with a mean immediate systolic BP drop of 12 mmHg after standing.

Conclusions:

Older people taking BDZs may have higher risk of an immediate systolic BP drop after standing, adding to other BZD-related falls risks. BDZs should be avoided in older people at risk of falling.
AEROBIC EXERCISE TRAINING REDUCES 24‐HOUR AMBULATORY BLOOD PRESSURE IN PATIENTS WITH RESISTANT HYPERTENSION: A RANDOMIZED CONTROLLED TRIAL (ENRICH TRIAL)
Authors: Lopes Susana , Mesquita-Bastos José , Garcia Catarina , Leitão Cátia , Ribau Verónica , Figueiredo Daniela , Bertoquini Susana , Oliveita José , Polónia Jorge , Alves Alberto J. , Ribeiro Fernando
Published: April 2021

Objective:

To assess the effect of aerobic exercise training in 24-hour ambulatory blood pressure (ABPM) in patients with resistant hypertension.

Design and method:

In this randomized-control trial (ClinicalTrials.gov: NCT03090529), 48 patients with resistant hypertension were allocated to either the exercise (EG, n = 26) or control group (CG, n = 22). Exercise training consisted of 40 min aerobic exercise at 50–70% of VO2peak, 3 sessions per week for 12 weeks. Ambulatory blood pressure (ABPM) was recorded at the same weekday at baseline and 48 hours after the last exercise session. The main outcome was the change in mean 24-hour ABPM.

Results:

Both groups were similar at baseline for: number of antihypertensive drugs (EG: 4.58 ± 0.86 vs.CG: 4.65 ± 0.56, p = 0.626), age (EG: 59.3 ± 8.3 vs CG: 59.6 ± 9.0 yrs, p = 0.897), body mass index (EG: 30.1 ± 4.9 vs CG:30.0 ± 4.9 kg/m2, p = 0.954), and VO2peak (EG: 34.5 ± 5.7 vs CG: 31.8 ± 6.6 mlO2.Kg-1.min-1, p = 0.138). No differences in ABPM were found between groups at baseline. The EG improved ABPM; there was a significant group∗time interaction in 24-hour mean systolic ABPM (EG: 127.4 ± 12.2 to 121.1 ± 12.6 mmHg vs. CG: 122.7 ± 14.4 to 124.0 ± 14.3 mmHg, p = 0.011), 24-hour mean diastolic ABPM (EG: 75.6 ± 7.8 to 71.4 ± 7.6 mmHg vs. CG: 73.1 ± 9.3 to 72.9 ± 8.6 mmHg, p = 0.015), daytime mean systolic ABPM (EG: 133.0 ± 12.3 to 125.8 ± 13.3 mmHg vs. CG: 128.2 ± 14.5 to 129.2 ± 13.2 mmHg, p = 0.010) and daytime mean diastolic ABPM (EG: 79.4 ± 8.1 to 74.8 ± 8.6 mmHg vs. CG: 77.1 ± 9.8 to 77.0 ± 8.5 mmHg, p = 0.019). No differences between groups were observed for night-time mean systolic (EG: 115.0 ± 15.0 to 111.1 ± 11.2 mmHg vs. CG: 112.0 ± 15.2 to 113.9 ± 17.7 mmHg, p = 0.131) and mean diastolic ABPM (EG: 67.3 ± 9.4 to 64.2 ± 5.6 vs. CG: 65.7 ± 8.6 to 65.4 ± 9.7 mmHg, p = 0.180).

Conclusions:

Aerobic exercise training decreases 24 h and daytime ABPM in patients with resistant hypertension. This decrease in 24-hour ABP is of the same magnitude as reported for individuals with non-resistant hypertension, suggesting that in patients with resistant hypertension aerobic exercise training may have the same positive effects as in patients with non-resistant hypertension.