bluuebunny/crossref_metadata_2025 huggingface dataset:
HEART-TO-ANKLE PULSE WAVE VELOCITY AS USED IN CARDIO-ANKLE VASCULAR INDEX (CAVI) AND CAVI_0 IS A NEARLY DIASTOLIC WAVE SPEED METRIC
Authors: Giudici Alessandro , Khir Ashraf W. , Reesink Koen D. , Delhaas Tammo , Spronck Bart
Published: June 2022

Objective:

Cardio-ankle vascular index (CAVI) and CAVI_0 are arterial stiffness indices based on the heart-to-ankle pulse wave velocity (haPWV). haPWV is derived from the heart-to-ankle transit time (haTT = tb+tba) as haPWV = L/haTT, with L an estimated transit distance. tb is the time difference between aortic valve closure (causing the aortic dicrotic notch) and the dicrotic notch in the brachial pressure waveform; tba is the time difference between the diastolic feet in the brachial and ankle pressure waveforms. CAVI and CAVI_0 aim to normalise haPWV for blood pressure at the time of measurement. As tb and tba are determined at different pressures — tb at dicrotic notch pressure (P_notch); tba at diastolic blood pressure (DBP; Fig. C) — determining the pressure that governs haPWV (P_haPWV) and hence should ideally be used for normalisation of haPWV is not trivial. CAVI uses P_m = (SBP+DBP)/2 to normalise haPWV, whereas CAVI_0 uses DBP (SBP: brachial systolic blood pressure). We aim to analytically estimate P_haPWV and compare this to the normalisation pressures used in CAVI and CAVI_0.

Design and method:

Consistent with CAVI/CAVI_0 assumptions, the arterial tree was assumed to consist of tubes with exponential pressure-diameter relationship and uniform stiffness index beta_0, allowing us to calculate PWV at P_notch (PWV_notch) and at DBP (PWV_DBP; Fig. A). P_notch was calculated as 0.55DBP+0.45SBP [Adji et al.,J Hypertens 2012;30:1540–1551]. The resulting PWVs, together with heart-to-ankle (L_ha=170 cm) and heart-to-brachial (L_hb=38 cm) path lengths [Alastruey et al.,11th Int Conf Press Surges 2012;401–442] (Fig. B), allowed analytically estimating tb and tba: tb=L_hb/PWV_notch and tba=(L_ha-L_hb)/PWV_DBP. P_haPWV was finally estimated as the weighted average of P_notch and DBP using tb and tba as weights.

Results:

Choosing SBP/DBP=120/80 mmHg (and hence P_m=100 mmHg) and beta_0 = 10 yielded tb = 0.048 s and tba = 0.187 s, giving P_haPWV = 84 mmHg. This implies that P_haPWV was much closer to DBP (as used in CAVI_0) than to P_m (as used in CAVI). This result was only marginally influenced by blood pressure: e.g., SBP/DBP = 160/90 mmHg (P_m = 125 mmHg) yielded P_haPWV = 96 mmHg.

Conclusions:

DBP offers a more accurate estimate of P_haPWV than Pm, supporting the utility of CAVI_0 as an enhancement of CAVI.
AORTIC REACTIVITY IN VITAMIN D DEFICIENCY IN A RAT MODEL OF POLYCYSTIC OVARY SYNDROME
Authors: Masszi Gabriella , Várbiró Szabolcs , Tarszabó Robert , Bányai Bálint , Péterffy Borbála , Lajtai Krisztina , Gerszi D. , Ruisanchez Éva , Szíva Réka , Korsós-Novák Ágnes , Benko Rita , Hadjad Leila , Benyó Zoltán , M-Horvath Eszter
Published: June 2022

Objective:

Polycystic ovary syndrome (PCOS) and vitamin D deficiency are associated with elevated cardiovascular risk, whereas vitamin D deficiency is a common comorbidity in PCOS that may contribute to the pathogenesis and complications of the disease. Our aim was to investigate the role of vitamin D status on the aortic function of hyperandrogenic female rats showing the symptoms of PCOS.

Design and method:

Female Wistar rats received an 8-week-long transdermal Androgel treatment to induce hyperandrogenism, another group remained untreated. Half of each group was fed with vitamin D reduced rat chow, while the other half received normal chow with further supplementation of vitamin D. Norepinephrine-induced contraction, acetylcholine, insulin, and estrogen-induced relaxation of thoracic aortae was examined by wire myography. Elastic fiber density was evaluated on resorcin-fuchsin stained tissue sections. Estrogen receptor alpha, endothelial nitric oxide synthase (eNOS), and cyclooxygenase 2 (COX-2) density and protein tyrosine nitration (NT) was measured by immunohistochemistry.

Results:

There was no difference in the norepinephrine-induced contraction of the aortas between experimental groups. Reduced acetylcholine-, insulin- and estrogen-evoked relaxation was observed in vitamin D deficient groups. A lower level of resorcin-fuchsin staining and elevated 3- nitrotyrosine immunostaining was observed in non-hyperandrogenic vitamin D deficient rats. eNOS staining intensity was reduced by vitamin D deficiency, while COX-2 density was increased by testosterone treatment. Estrogen receptor alpha density was increased by testosterone treatment but reduced by vitamin D deficiency.

Conclusions:

We demonstrated an early endothelial dysfunction in a rat model of vitamin D deficient polycystic ovary syndrome. Vitamin D supplementation could prevent vascular damage. On the other hand, vitamin D deficiency itself led to decreased endothelium-dependent relaxation and increased nitrative stress. Vitamin D deficiency also led to decreased estrogen receptor alpha and eNOS density independently from hyperandrogenism. Vitamin D deficiency found in approximately 80% of PCOS women may have a significant role in the development of vascular dysfunction and may contribute to their increased cardiovascular risk.
SHORT-TERM HIGH SALT INTAKE ADVERSELY AFFECTS PARAMETERS DERIVED FROM RESERVOIR-EXCESS PRESSURE ANALYSIS AND CENTRAL ARTERY HAEMODYNAMICS IN OVERWEIGHT/OBESE ADULTS
Authors: To Cynthia , Aizawa Kunihiko , Gates Phillip E. , Parker Kim H. , Hughes Alun D. , Shore Angela C.
Published: June 2022

Objective:

The association between high salt intake and blood pressure is well-recognised. In overweight/obese individuals, obesity-associated hyperinsulinaemia augments renal sodium reabsorption and in combination with high salt intake this may alter blood pressure and arterial haemodynamics. We determined whether short-term high salt intake altered reservoir-excess pressure and central artery haemodynamic parameters in overweight/obese individuals.

Design and method:

We studied 15 middle-aged and older adults (59.3 ± 6.4 yrs, 5F) who were overweight/obese with elevated systolic blood pressure (130 < SBP < 159 mmHg). In a double-blind cross-over design, they were randomly assigned to seven days of low salt diet (LSD: 50 mmol/day) or high salt intake (HIS: LSD with 200 mmol/day of sodium tablets) separated by a two-week washout period. The parameters derived from reservoir-excess pressure analysis including reservoir pressure integral, peak reservoir pressure (MAXPR), excess pressure integral (INTXSP), peak excess pressure (MAXXSP), systolic rate constant and diastolic rate constant (DRC) were obtained by radial artery tonometry. Additionally central artery haemodynamic parameters including aortic systolic pressure (aSBP), diastolic pressure (aDBP), pulse pressure (aPP) and subendocardial viability index (SVI) were derived from ensemble-averaged radial pulse waveform using generalised transfer function. Aortic pulse wave velocity (aPWV) was estimated as proposed by Hughes et al (Front Physiol. 2020).

Results:

MAXPR (111.0 ± 10.9 vs 105.4 ± 10.4 mmHg), MAXXSP (41.7 ± 12.0 vs 36.6 ± 5.7 mmHg) and DRC (2.0 ± 0.4 vs 1.8 ± 0.3 s-1) were higher following HIS compared to LSD (p < 0.05). There was no convincing evidence that INTXSP was greater following HIS than LSD (6.9 ± 3.2 vs 5.8 ± 1.6 mmHg s, p = 0.055). aSBP (126.3 ± 15.4 vs 117.6 ± 10.1 mmHg), aDBP (76.3 ± 6.2 vs 73.1 ± 6.3 mmHg) and aPP (50.0 ± 17.4 vs 44.5 ± 10.8 mmHg) were also higher following HIS compared to LSD (p < 0.05). SVI was similar between HIS and LSD (162.7 ± 29.6 vs 171.6 ± 25.0 %, p = 0.143). A greater aPWV was observed following HIS compared to LSD (5.6 ± 1.6 vs 4.9 ± 0.8 m/s, p = 0.034).

Conclusions:

Short-term HIS adversely alters reservoir function and central artery haemodynamics in overweight/obese adults. These observations suggest a potential mechanism that may increase cardiovascular disease risk associated with HIS in this population.
CHANGES IN BLOOD LIPIDS AFTER 2-MONTH OUTPATIENT AEROBIC TRAINING FOLLOWED BY 6-MONTH HOME-BASED TRAINING WITH HEART RATE MONITORING IN PEOPLE WITH METABOLIC SYNDROME
Authors: Zupkauskiene Jurate , Laucevicius Aleksandras
Published: June 2022

Objective:

The objective was to evaluate the changes in blood lipids after the 2-month outpatient aerobic exercise program (aEP) followed by the 6-month home-based aEP using a heart rate (HR) monitor in people with metabolic syndrome (MetS).

Design and method:

A total of 132 people with MetS were included to the prospective study (mean age 52.4 ± 6.26 years, 54.5% female). At first, training HR was evaluated for each participant by performing an incremental cardiopulmonary exercise test on the cycle ergometer. Initially, all study subjects participated in the 2-month outpatient aEP, which consisted of 40 individual aerobic training sessions on a cycle ergometer 5 times/week for 40 min. During all training sessions, HR was maintained at the targeted level (ERS-2 Ergoline bicycle). All participants received recommendations for home-based training and were randomly allocated to the intervention (n = 66) or control group (n = 66). Then only the intervention group participated in the 6-month home-based aEP using a HR monitor (Polar-H10), which was connected to the smartphone via Bluetooth. Special smartphone application enabled participants to keep their training HR during home-based exercises. Blood lipids, such as total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C) and triglycerides (TG) were assessed in all participants at baseline and after 8 months. Blood samples were obtained at rest, between 7 AM and 12 PM after overnight fast and abstinence from caffeine and at least 2 hours after smoking.

Results:

After 8 months, LDL-C level significantly reduced in the intervention and control groups (-0.30 ± 0.84 vs. -0.57 ± 1.12 mmol/L, p = 0.011 and p = 0.002, respectively). The significant reduction of TC level was present only in the control group (-0.58 ± 1.32 mmol/L, p = 0.001), but between-group difference was not significant (p = 0.475). After 8 months, HDL-C level significantly increased only in the intervention group by 6.3% (0.08 ± 0.22 mmol/L, p = 0.011) with significant between-group difference (p = 0.047). No statistically significant reduction of TG was observed in any of the groups (all p > 0.05).

Conclusions:

People with MetS, who participated not only in the 2-month outpatient aEP but also in the 6-month home-based aEP using a HR monitor, reached a greater increase of HDL-C.
THE ROLE OF DIETARY APPROACHES TO STOP HYPERTENSION (DASH DIET) ON BLOOD PRESSURE IN PATIENTS WITH HYPERTENSION
Authors: Pratistita Putu Tasya Pradnya , Marbun Maruhum Bonar
Published: June 2022

Objective:

The objective of this study is to determine the role of the DASH diet on blood pressure in patients with hypertension.

Design and method:

Online literatures were search through 3 databases, namely PubMed, Cochrane, and Scopus. The literatures were selected based on clinical questions, inclusion criteria, and exclusion criteria. Articles that have successfully passed the selection stage will then be subjected to a critical review process.

Results:

There are two systematic review/meta-analysis of RCT literatures that have successfully passed the critical review, the study by Filippou, et al (2020) and Gay HC, et al (2016). Both studies have shown that the DASH diet intervention can significantly lower blood pressure.

Conclusions:

The DASH diet is effective in lowering blood pressure in patients with hypertension.
THE ROLE OF MICROCIRCULATION ON BLOOD PRESSURE AND HEART RATE RESPONSE DURING EXERCISE STRESS TESTING IN HYPERTENSIVE PATIENTS
Authors: Zammanis Ioannis , Konstantinidis Dimitrios , Tatakis Fotis , Drogkaris Sotirios , Kariori Maria , Polyzos Dimitrios , Manta Eleni , Siafi Eirini , Thomopoulos Costas , Andrikou Ioannis , Kakouri Niki , Dimitriadis Kyriakos , Tsioufis Konstantinos
Published: June 2022

Objective:

Exercise stress testing is regularly used to assess cardiovascular risk and a hypertensive response during exercise has been associated with adverse cardiovascular outcomes. On the other hand, the microcirculation is the major site of control of vascular resistance and thus has a key role in the etiopathogenesis of hypertension. The aim of our study was to investigate the presence of a possible correlation between blood pressure and heart rate response during exercise with a microcirculation index (capillary rarefaction) in a cohort of hypertensive patients.

Design and method:

We studied 105 untreated patients with stage I-II essential hypertension (70% men, mean age: 59.5 years, mean office blood pressure: 150/92mmHg). Patients with diabetes mellitus, secondary hypertension, atherosclerotic cardiovascular disease, heart failure, significant chronic renal or pulmonary disease and any other systemic illness or orthopedic problems that would not allow maximal effort on a treadmill were excluded. All participants underwent maximal exercise testing, using the Bruce protocol, as well as nail-fold videocapillaroscopy assessment by using VideoCap 3.0 videomicroscope.

Results:

A significant negative correlation between diastolic BP at minute-1 of the recovery phase and capillary density expressed in capillaries/mm was revealed (Pearson’s r = -0.365, p = 0.043). A significant negative correlation was also observed between capillary density and peak heart rate (Pearson’s r = -0.364, p = 0.024) as well as between heart rate increase from stage 1 to 2 and capillary density (Pearson’s r = -0.746, p = 0.013). Our study shows that in a small cohort of hypertensive patients, capillary rarefaction was associated with a steeper increase in heart rate during exercise, as well as with a higher peak heart rate and higher diastolic blood pressure values during the recovery phase.

Conclusions:

These findings could imply that new indices such as capillary rarefaction may provide insights into possible autonomic dysfunction and could also be taken into account in the assessment of hypertensive patients.
CHANGES OF VASCULAR REACTIVITY TO ADENOSINE A1 AND A2A RECEPTOR AGONISTS AFTER HYPERBARIC OXYGENATION
Authors: Djambic Vedran , Mihaljevic Zrinka , Drenjancevic Ines , Jukic Ivana , Kibel Aleksandar
Published: June 2022

Objective:

Hyperbaric oxygenation (HBO) affects vascular reactivitiy, which plays an important role in the pathophysiology of hypertension and other cardiovascular diseases. New data suggest important effects of HBO on oxidative stress and alteration of production of vasoactive metabolites in blood vessels; however, the role of adenosine A1 and A2a receptors is still underinvestigated.This study aimed to determine the functional role of adenosine A1 and A2a receptors in changes of vascular reactivity in isolated middle cerebral arteries (MCA) of Spague-Dawley rats, after acute and intermittent HBO.

Design and method:

Male and female healthy Sprague-Dawley rats aged 8–10 weeks were divided into 3 groups: CTRL (control non HBO), A-HBO (single animals exposed to HBO for 2 hours) and 4D-HBO (animals exposed to HBO at a pressure od 2 bars for 2 hours daily for 4 days, with vascular experiments conducted on the fifth day). The rats were anesthetized with ketamine-chloride (3 ml/kg) and midazolam (0,5 ml/kg) and decapitated. The MCA were isolated, cannulated and pressurized for 60’at 80 mmHg to assess basal diameter using pressure myograph Danish Myo Technology. A1 adenosin receptor selective agonist CCPA or A2a adenosin receptor agonist CGS in concentrations from 10–5 to 10–10 M were added to the vessel chamber, and blood vessel diameter was measured after incubation of the drug for 15 minutes. Statistical analyses were performed with Two-way ANOVA tests; p < 0.05 was considered significant.

Results:

The vasoconstriction in response to A1 agonist administration was similar between the CTRL and 4D-HBO group, while it was significantly reduced in A-HBO compared to the CTRL and 4D-HBO groups. The vasodilation in response to A2a stimulation was significantly reduced in rats exposed to A-HBO and I-HBO compared to CTRL at higher drug concentrations (10–7 to 10–5 M).

Conclusions:

Acute exposure of rats to HBO leads to decrease in the vasoconstrictive response to adenosine A1 receptor stimulation, while acute and intermittent exposure of rats to HBO is associated with a decrease in the vasodilatory response of MCA to adenosine A2a receptor activation, suggesting that HBO alters sensitivity to or expression of receptors.
CUT-OFF VALUES OF FAT DEPOTS TO PREDICT CAROTID ATHEROSCLEROTIC PLAQUES
Authors: Zheleznova Ekaterina , Zhernakova Yu , Pogorelova O. , Tripoten M. , Balakhonova T. , Blinova N. , Shariya M. , Chazova I.
Published: June 2022

Objective:

The main aim of study was to investigate the cut-off values subcutaneous (SF), visceral (VF), periaortic (PF), epicardial (EF) fat associated with carotid atherosclerosis in young adult with abdominal obesity (AO), or with metabolic syndrome (MS).

Design and method:

There were 132 adult 18–45 y.o. in the study. We formed 3 groups: health (n = 16, M - 43,8%, av.ag. 32 [27; 35]); AO plus 1 or less sing of MS (AO) (n = 46, men(M) – 37,0%, av.ag. 40 [34; 43]), and MS (n = 70, M – 81,4%, av.ag. 40[35; 44]). Height, weight, BMI, waist circumference, blood tests (fast glucose (FG) and glucose tolerance (GT), lipid profile, insulin were measured. MS was defined as AO (cut-off of > 80 cm in women (W) and > 94 cm in M) plus > 1 sign: HDL < 1,30(w)/1,04(m)mmol/l; triglycerides> 1,7mmol/l; FG> 5,6mmol/l; violation GT; BP> 140/90mmHg. SF, VF, PF, EF (range: -150 to -30 HU) was measured by computed tomography. We calculated ratio subcutaneous to visceral fat (RSV). Carotid plaque was defined by ultrasound as a focal structure that encroaches into the arterial lumen of at least 0.5 mm or 50% of the surrounding Intima-media thickness value or demonstrates a thickness> 1.5 mm. The number of ABPs in the carotid arteries was determined as the total number of all plaques in 6 segments - along both common carotid arteries (CCA), both bifurcations of the CCA, and both internal carotid arteries (ICA).

Results:

We found significant week relationship amount of carotid plaques with VF (r = 0,25, p < 0,01), PF (r = 0,24, p> 0,01), EF (r = 0,21 p> 0,05). We estimated cut-off levels of fat depots associated with carotid atherosclerosis (tab.1). Values of PF> = 7,8 cm3 was associated with an almost five-fold increase in the risk of having atherosclerotic plaques (p < 0.01). Values of VF> = 136,8 cm2 was associated with an almost 2.5-fold increase in the risk of having atherosclerotic plaques (p < 0.01). Values of EF> = 88,2 cm3 was associated with an 1.9-fold increase in the risk of having atherosclerotic plaques (p<0.01).

Conclusions:

Values of perivascular, visceral, epicardial fat depots may be considered as a markers of carotid atherosclerosis in young adults.
AIRWAY INFLAMMATION IS ASSOCIATED WITH PULMONARY FUNCTION IN OBESE ASTHMATIC INDIAN CHILDREN
Authors: Yadav Rashmi , Kabra Sushil Kumar , Lodha Rakesh
Published: June 2022

Objective:

Obesity and asthma are related conditions, however, the underlying mechanism between the two is not understood. This study aims to determine the correlations between fractional exhaled nitric oxide (FeNO) and spirometry parameters in obese asthmatic children.

Design and method:

In this study, 47 overweight/ obese asthmatic children (physician-diagnosed children with partly/ uncontrolled asthma as per Global Initiative forAsthma guidelines) were recruited from Pediatrics Chest Clinic, Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi, India. The measured height and weight were used to calculate BMI. BMI derived was categorized by using Z score tables of WHO-BMI for age standards for boys and girls between 5 and 19 years. Children were assessed using measurement of FeNO(NIOX1; Aerocrine, Solna, Sweden), and spirometry parameters were assessed using Superspiro MK2 Micro Medical Ltd, UK. Correlation between FeNO levels and spirometry parameters were investigated using Spearman’s correlation coefficients.

Results:

The mean ± SDage was 11.3 ± 2.5 years (males, n = 37), BMI = 24.91 ± 7.05 Kg/m2 and median (interquartile range) FeNO levels were 22.0 (17.0, 65.0) ppb. The mean ± SD predicted forced expiratory flow (FEF25–75) predicted was 83.5 ± 16.3%. The mean age of onset of asthma was 6.3 years. Twenty-four children had partly controlled asthma and 23 children had uncontrolled asthma. FeNO was significantly and inversely correlated with predicted FEF25-75 (r = -0.378, p < 0.001).

Conclusions:

FeNO an easily measurable indicator of airway inflammation in combination with lung function may prove a useful tool in the asthma assessment and management in obese Indian asthmatic children.
RELATION BETWEEN TELOMERE DYNAMICS AND METABOLIC DISORDERS IN EARLY AGE
Authors: Toupance Simon , Kassari Penio , Labat Carlos , Soulis Georges , Manou Maria , Hollander Allyson , Charmandari Evangelia , Benetos Athanase
Published: June 2022

Objective:

In adults, short leukocyte telomere length (LTL) is associated with metabolic disorders such as diabetes and obesity. The causality remains unclear since longitudinal studies do not show influence of metabolic disorders on LTL attrition. These associations could stem from early life interactions between telomere dynamics and metabolic disorders. To test this hypothesis, we measured, in obese children and their controls, LTL and its evolution over time and their associations with metabolic parameters.

Design and method:

73 children aged 2–10 years (mean 7.6 ± 2.0) at inclusion were followed between 2 and 4 years (one visit/year). Anthropometric measurements (weight, height, waist and hip circumferences), a body composition analysis and a complete biology were performed annually. LTL was measured by Southern blot and LTL attrition was calculated. Scores for metabolic parameters were created based on the mean value of the parameter throughout the study.

Results:

Mean LTL attrition was 67 ± 8 bp/year. Baseline LTL correlated negatively with BMI score (p = 0.02), fat percentage score (p = 0.01), glycemia score (p = 0.0007), and insulinemia score (p = 0.02). These associations persisted after adjustment for age and sex. Trends for negative associations were observed between baseline LTL and waist/hip score (p = 0.07), and Hb1Ac score (p = 0.07). No association was found between LTL attrition and any of the metabolic parameters.

Conclusions:

In young children, metabolic parameters are negatively associated with LTL but not with LTL attrition. These results indicate that either short TL is the cause of metabolic disorders or that these metabolic disorders increased LTL attrition very early in life probably before the age of 5 years.
PECULIARITIES OF TREATMENT OF ARTERIAL HYPERTENSION IN PATIENTS WITH METABOLIC SYNDROME
Authors: Gaspar Ludovít , Mesarosova Dasa
Published: June 2022

Objective:

The Metabolic syndrome (MS) is characterized by a collection of risk factors, that increase the chance of developing cardiovascular complications. Classifications and definitions of the MS indicate that on its pathogenesis, as well as on resulting complications, five fundamental componets do participate – obesity, insulin resistance, endothelial dysfunction, aggregation of other components and diurnal pattern loss.

The aim of our study was to detect changes in diurnal trait depending on the presence of metabolic syndrome.

Design and method:

Under the conditions of hospitalization we examined 56 persons with the presence of metabolic syndrome (average age 66 years) and 51 persons without metabolic syndrome (average age 61 years). To control the effectiveness of antihypertensive treatment, we used ambulatory blood pressure monitoring (ABPM) (Meditech and Marquette-Hellige devices) with oscillometric blood pressure measurement.

Results:

In the group of patients with MS dipping was present in 37.5 %, while in the group without MS in 57.1 %. Non dippers and risers where in the group with MS present in 58.9 %, while in the group without MS in 33.3 %. Monotherapy in patients with MS was present in 19.6 %, while in the group of patients without MS in 36.4 %. Four-combination of antihypertensives was in the group with MS in 23.2 %, while in patients without MS in 9.1 %. The mean blood pressure values in the group with MS were 134/79 mmHg and in the group without MS 132/83 mmHg. These blood pressure values were justifiably achieved due to differences in antihypertensive medication – monotherapy versus combination therapy.

Conclusions:

ABPM plays an important role in monitoring the effectiveness of antihypertensive treatment. In patients with MS achieving blood pressure targets is often a therapeutic problem, which usually requires a combination of three or more antihypertensives. Also presence of orthostatic hypotension, as a manifestation of cardiovascular autonomic neuropathy, may affect the treatment of arterial hypertension. Frequent loss of diurnal pattern in patients with MS is also of prognostic significance.
SEX DIFFERENCES IN ARTERIAL FUNCTION IN OBESITY: THE FAT-ASSOCIATED CARDIOVASCULAR DYSFUNCTION STUDY
Authors: Eikås John Glad , Gerdts Eva , Midtbø Helga , Cramariuc Dana , Kringeland Ester A.
Published: June 2022

Objective:

Obesity has been associated with increased arterial stiffness, but sex differences in this association have been less explored. We compared different measures of arterial stiffness between women and men with obesity and free of clinical cardiovascular disease participating in the FAT associated dysfunction (FATCOR) study.

Design and method:

We performed a cross-sectional analysis in 351 women and 233 men with mean age 48 ± 9 years and body mass index (BMI) 32 ± 4 kg/m2. Arterial function was assessed by applanation tonometry as aortic augmentation pressure (AP), augmentation index (AIx), and pulse wave velocity (PWV). Covariables of arterial function were identified in linear regression in the total cohort and in sex-specific analyses. Multivariable models were adjusted for age, body height, BMI, 24-hour systolic blood pressure (BP), heart rate (HR), diabetes, serum low-density lipoprotein, estimated glomerular filtration rate (eGFR), and smoking habit.

Results:

Women had higher AP and AIx, and lower PWV compared to men (all p < 0.005). Women also had higher BMI and HR, while men had higher BP (all p < 0.05). In the total study cohort, female sex remained independently associated with higher AP (=0.35) and AIx (=0.45) after adjustment for significant confounders including age, BP, HR, and eGFR (all p < 0.02). Male sex was associated with higher PWV (=0.15) independent of age, BP, HR, and smoking habit (all p < 0.02). In sex-specific analyses, higher AP was associated with higher age and BP, and lower HR in women (all p < 0.001), and with higher age, BP, and eGFR in men (all p < 0.01). Similarly, higher AIx was related to higher age and BP, and lower BMI and HR in women (all p < 0.05), and with higher age and eGFR in men (all p < 0.02). Finally, in women, higher PWV correlated with higher age, BP, and HR (all p < 0.05). In men, higher PWV was associated with higher age, HR, and with smoking habit (all p < 0.005).

Conclusions:

In obese subjects free of clinical cardiovascular disease, measures of arterial stiffness differed between women and men. AP and AIx were higher in women, while PWV was higher in men, independent of important confounders like age and BP.
EFFECTS OF WEIGHT LOSS ON VASCULAR FUNCTION AND CENTRAL HEMODYNAMIC PARAMETERS IN OBESE INDIVIDUALS WITH POOR CARDIOVASCULAR HEALTH
Authors: Cunha Michelle , Mattos Samanta , Klein Marcia , Neves Mario
Published: June 2022

Objective:

To evaluate the effect of weight loss on vascular function and central hemodynamic parameters in obese individuals with different classifications of cardiovascular health according to the American Heart Association

Design and method:

Prospective intervention study with patients of both genders, aged 40 to 70 years and body mass index (BMI) > = 30 and < 40 kg/m2, instructed to follow a low-calorie diet (reduction of 800 kcal/day) for 8 weeks. They were submitted to clinical and nutritional assessment, analysis of central hemodynamic parameters using Mobil-O-Graphâ, and the endothelial function by post-occlusive reactive hyperemia using Laser Spectre Contrast Image. The patients (n = 71) were divided into two groups, iCVH (n = 31) and pCVH (n = 40).

Results:

The patients had a mean age of 51 years, 79% and 73% were female in iCVH and pCVH, respectively. After 8 weeks of nutritional intervention, there was a reduction in body mass index (iCVH, 34.2 ± 2.5 vs 32.9 ± 2.6 kg/m2, p< 0.001) (pCVH, 33.8 ± 2.8 vs 32.8 ± 2.7 kg/m2, p < 0.001), waist-height ratio (iCVH, 0.62 ± 0.05 vs 0.60 ± 0.01, p = 0.005) (pCVH, 0.62 ± 0.04 vs 0.60 ± 0.04, p = 0.001) and fat weight (iCVH, 36 ± 7 vs 32 ± 6 kg, p = 0.013) (pCVH, 35 ± 6 vs 33 ± 6 kg, p < 0.001). Compared to the baseline, peripheral systolic blood pressure (BP) (126 ± 14 vs 119 ± 15mmHg, p = 0.001), diastolic BP (80 ± 9 vs 76 ± 8mmHg, p = 0.004) and pulse pressure (46 ± 10 vs 42 ± 10mmHg, p = 0.025) was significantly decreased only in pCVH. In this group, central systolic pressure (117 ± 14 vs 112 ± 11mmHg, p = 0.014) was also decreased. Pulse wave velocity did not change in iCVH (7.2 ± 0.9 vs 7.2 ± 1.0m/s, p = 0.926) and was reduced in pCVH (7.5 ± 1.1vs7.2 ± 1.0m/s, p = 0.080), although not reaching statistical significance. In this same group, cutaneous vascular conductance in post-occlusive reactive hyperemia (1.07 ± 0.27 vs 1.17 ± 0.28, p = 0.003) increased compared to the baseline.

Conclusions:

In this sample of obese patients, the intervention with a low-calorie diet resulted in improvement of peripheral and central pressure and functional vascular parameters more evident in subjects with poor cardiovascular health.
METABOLIC SYNDROME IN POLYCYSTIC OVARY SYNDROME TUNISIAN WOMEN
Authors: Smaoui Fatma , Chaabouni Khansa , Elleuch Aida , Boudaya Mariem , Mezghani Chema , Chaabene Kais , Frikha Madiha , Ayadi Fatma
Published: June 2022

Objective:

Polycystic ovary syndrome (PCOS) is known to reproduce metabolic syndrome (MS) features. This association seems to be heterogeneous.

To investigate the profile of MS in patients with PCOS in Tunisia.

Design and method:

Our study was conducted on women diagnosed with PCOS in 2020 and age matched controls. PCOS and MS diagnosis were made according to the Rotterdam criteria and the definition of the International Diabetes Federation (IDF) respectively. Biochemical tests were analysed via an automated method (Cobas-Roche).

Results:

Our study was conducted on 96 patients and 108 controls. The median age in patients was at 25 years vs 27 in controls. Only 19.7% of patients met the criteria of MS. However, in controls the prevalence of MS was 12.6%. All MS criteria were more prevalent in PCOS patients compared to controls. We observed in decreasing order: android fat distribution, followed by elevated fasting glucose and decreased HDLc, followed by hypertension, and finally hypertriglyceridemia.

Conclusions:

In the literature, the prevalence of MS in PCOS was estimated between 22% and 42%. The relatively low prevalence of MS in Tunisian PCOS could be explained by age and geographical heterogeneity of MS distribution. Since, these patients are likely at risk of chronic comorbidities we suggest initiating a specific management.
ASSOCIATION BETWEEN PERIRENAL ADIPOSE TISSUE, METABOLIC PARAMETERS AND BLOOD PRESSURE PROFILE IN PATIENTS WITH ABDOMINAL OBESITY
Authors: Azimova Makka , Azimova Marina , Blinova Natalia , Zhernakova Yuliy , Chazova Irina
Published: June 2022

Objective:

Perirenal adipose tissue is considered as new marker of cardiometabolic risk, as particular visceral fat depot, can leads to metabolic decoders and organ damage. The aim of study to assess the effects of perirenal adipose tissue on metabolic parameters and 24-hours profile of blood pressure in patients with abdominal obesity.

Design and method:

The study included 104 patients (37,5% - men, 62.5% - women), mean age 38.59 ± 6.09 years with abdominal obesity (waist circumference (WC) > 80 cm in women and > 94 cm in men), without cardiovascular diseases and diabetes mellitus. Perirenal adipose tissue (PAT) volume was measured by multislice computed tomography (MSCT) (ToshibaAquillion 640, Japan). Blood sampling and measurements of lipid levels, fasting glucose, insulin, HOMA index, 24-hour ambulatory blood pressure monitoring were performed.

Results:

PAT volume was associated with WC (r = 0,70; p < 0,05) in participants with abdominal obesity. A positive correlation was found between PAT and triglyceride (r = 0,35; p < 0,05), insulin (r = 0,37; p < 0,05), HOMA-index (r = 0,38; p < 0,05); creatinine (r = 0,30; p < 0,05) and a negative correlation - with HDL-cholesterol (r = -0,40; p < 0,05). There was no association between PAT and LDL-cholesterol. PAT was associated with day (r = 0,29; p < 0,05) and night (r = 0,39; p < 0,05) systolic blood pressure and with day (r = 0,30; p < 0,05) and night (r = 0,30; p < 0,05) systolic blood pressure.

Conclusions:

PAT is associated with metabolic disorders, insulin resistant index and blood pressure profile in patients with abdominal obesity.
MATERNAL SALT INTAKE AND MICROVASCULAR ENDOTHELIAL FUNCTION DURING THE THIRD TRIMESTER OF HEALTHY PREGNANCY
Authors: Vulin Martina , Metzger Ana-Maria , Magusic Lucija , Drenjancevic Ines , Jukic Ivana , Sijanovic Sinisa , Juric Iva , Muller Andrijana , Stupin Ana
Published: June 2022

Objective:

Even in healthy individuals, high-salt (HS) loading leads to endothelial dysfunction, a hallmark of cardiometabolic diseases, independently of the changes in blood pressure (BP). Still, the effect of the amount of daily salt intake during healthy pregnancy on maternal endothelium-dependent vascular reactivity has not yet been investigated. Thus, this study aimed to assess the effect of the amount of daily salt intake during third trimester of pregnancy on maternal microvascular reactivity to stimuli in healthy pregnant women.

Design and method:

The present study was designed as a cross-sectional study in which all the data for each pregnant woman were obtained at one-time point between 37 and 40 weeks of gestation. Daily salt intake was estimated based on 24-h urinary sodium excretion using appropriate formula [1-g salt (NaCl) = 393.4 mg Na = 17.1 mmol Na]. Microvascular endothelium-dependent vasodilation in response to vascular occlusion (PORH), iontophoresis of acetylcholine (AChID) and local heating (HEAT), as well as endothelium-independent vasodilation in response to iontophoresis of sodium nitroprusside (SNP) was assessed by Laser Doppler flowmetry (LDF).

Results:

Preliminary results of the present study involve data obtained from 27 healthy pregnant women. According to the amount of daily salt intake, pregnant women were divided in low-salt (LS, < 5 g of salt/day, N = 4), normal-to-high salt (NHS, 5.0–7.5 g of salt/day, N = 12) and high-salt (HS, > 7.5 g of salt/day, N = 11) group. All pregnant women were normotensive, and BP values did not differ between groups. HEAT was significantly lower in HS compared to LS and NHS group, while PORH and AChID tended to be lower in HS compared to LS and NHS group, but without statistical significance. SNPID did not significantly differ between the groups. There was weak to moderate negative correlation between daily salt intake and functional markers of microvascular endothelium-dependent vasodilation (PORH, AChID and HEAT).

Conclusions:

The amount of daily salt intake significantly affects maternal endothelium-dependent microvascular reactivity during third trimester of healthy pregnancy, i.e. the increased salt intake significantly reduces the endothelium-dependent dilatation of the skin microcirculation, especially responses mediated by nitric-oxide (NO).
FEASIBILITY, ACCEPTANCE AND SAFETY OF A HOME BASED TELEMONITORING STRATEGY IN WOMEN WITH POSTPARTUM HYPERTENSION. INTERIM ANALYSIS OF THE SWISS REGISTER FOR WOMEN WITH PPHT
Authors: Socrates Thenral , Wenker Céline , Blaschke Christina , Vischer Annina , Meienberg Andrea , Mayr Michael , Hösli Irene , Lapaire Olav , Burkard Thilo
Published: June 2022

Objective:

Postpartum hypertension (PPHT) is elevated blood pressure that persists or develops after pregnancy. PPHT affects 10% of all pregnancies and is the most common cause for re-hospitalization. PPHT stems from hypertensive disorders of pregnancy (HDP) which include preexisting and gestational hypertension, preeclampsia (PE), and eclampsia. Although the National Institute for Health and Care Excellence suggests tight controls there is no global consensus. The aim of the current analysis was to determine the feasibility, acceptance, and safety of a home-based telemonitoring strategy in women with PPHT.

Design and method:

Enrollment began in June 2020 at the University Hospital Basel Maternity Ward and Hypertension Clinic. Those with preexisting hypertension, HDP, and de novo PPHT were enrolled. A nested substudy allowed the participants to choose either a home-based telemonitoring approach or standard of care. The telemonitoring strategy was defined as a smartphone application provided by the study team or a programmed spreadsheet to report blood pressure followed by telephone consultations. Standard of care was hospital-based visits after discharge. All participants were assessed three months postpartum with a standardized hospital visit including a 24-hour blood pressure measurement, blood, biomarker and urine analysis.

Results:

112 participants were prospectively enrolled from Jun 2020. Mean age was 33.5 ± 5.1 years, 8.9% had preexisting hypertension, 26.8% gestational hypertension, 55.4% preeclampsia (PE) 0.9% eclampsia, 6.9% HELLP and 17.9% had de novo PPHT. Family history of cardiovascular disease was seen in 50%, 8.9% had a family history of PE, and 20.5% were high risk for PE. The most common type of delivery was C-Section (74%), mean hospital stay was 6 days (±2.88) and IUGR was seen in 75.9% of the newborn babies. 98% of participants choose a home-based strategy. At 3 months, 97.8% reported a feeling of safety with home-based telemonitoring and would use the same approach in the future. There were zero re-hospitalizations due to high blood pressure.

Conclusions:

This analysis demonstrated that a home-based telemonitoring plan is feasible, well-accepted, and safe in terms of re-hospitalizations or blood pressure complications. This is relevant for the direct postpartum period and even more pertinent during a pandemic.
TREATMENT OF PERSISTENT RENAL DYSFUNCTION AFTER PREECLAMPSIA WITH BENAZEPRIL: A RANDOMIZED, DOUBLE-BLIND TRIAL
Authors: Pechère-Bertschi Antoinette , Dufey Anne , Wuerzner Gregoire , Jaques David , Burnier Michel , Tejada Begonia Martinez De , Seigneux Sophie De , Ponte Belén
Published: June 2022

Objective:

Preeclampsia increases the long-term cardiovascular and renal risk of women. Guidelines recommend to closely follow pre-eclamptic women in the post-partum (PP), but there is no consensus about treatment in women with early persistent kidney damage and high blood pressure after delivery. Objectives: to assess the efficacy of benazepril in improving surrogate markers of renal function of the PP period.

Design and method:

This was a double blind randomized controlled trial (benazepril 10 mg or placebo) in women with persisting microalbuminuria and/or blood pressure > 140/90 mmHg, and/or ongoing antihypertensive treatment 6–8 weeks PP. The primary outcome was to assess the efficacy of benazepril on GFR, albuminuria, CRP and blood pressure at 3 and 6 months.

Results:

We included 120 preeclamptic women, mean age was 34.1 ± 5.4 y, BMI before pregnancy was 25.7 ± 5.4 kg/m2; 6 weeks after delivery mean GFR was 114.5 ± 17.6 ml/min/1.73m2, microalbuminuria/urine creatinine ratio was 9.4 ± 13.9 mg/mmol, CRP was 9.3 ± 14. mg/L, SBP was 130.6 ± 13.1, and DBP was 90.4 ± 11.4 mmHg. At 3 months (resp. 6 months) postpartum, microalbuminuria and blood pressure improved in both groups but both parameters were significantly lower with benazepril than with placebo group (Table).

Conclusions:

Our study shows that benazepril was effective to improve renal surrogates in women having suffered from preeclampsia. The clinical benefits of maintaining the treatment beyond 6 months remain to be demonstrated.
WOMEN WITH HYPERTENSIVE STATES OF PREGNANCY FOLLOW IN NEPHROLOGY: CHARACTERISTICS AND EVOLUTION AFTER DELIVERY
Authors: Guimil Paula Delgado , Herranz Ester Domenech , Gonzalez Esther Rubio , Testillano Lucia Martin , Pujol Javier Relea , Perez Jose Maria Portoles
Published: June 2022

Objective:

Descriptive analysis of the profile of pregnant women who develop some type of hypertensive disorders of pregnancy (HDP). Review the possible factors involved in its appearance, know the maximum proteinuria at the time of diagnosis and how it evolves after delivery, and the medication used for its control.

Design and method:

An observational, prospective study of pregnant women with HDP referred to nephrology consultation after hospital discharge post-delivery in 2020.

Results:

We recruited 55 patients with a mean age of 35.5 years, BMI of 26.12, 18.2% met obesity criteria. 54.7% were primiparous and of the multiparas, 17.4% had had previous HDP. 18.9% were in vitro pregnancies, 5.7% were twins and 47.2% required cesarean section. The average weight of the newborn was 2858.82 gr. 94.3% of the women were not diabetic and 18.9% developed gestational DM. 86.8% started breastfeeding.

Regarding the type of HDP (Graph 1): 81% presented a clinical profile of pre-eclampsia (PE) / eclampsia; 3.8% chronic hypertension, 13.2% chronic hypertension with superimposed PE and 1.9% gestational hypertension. The diagnosis of PE was in 90.6% of the cases due to the appearance of proteinuria, 1.9% due to plaquetopenia, 1.9% due to neurological alterations and 5.7% due to only BP figures > 160/110 (Graph 2). No acute renal failure was recorded. The average proteinuria was 1345.52 mg/gr, which decreased to 65.62 mg/gr after one month of treatment, persisting with proteinuria in only 18.8% of the patients.

The average number of antihypertensive drugs taken at the moment of the diagnosis was 1.77, and 0.9 at 10 days. 100% go home with medication but in the 10-day control, 28.3% no longer needed any. As concerns the evolution of medication intake, see (Graph 3).

Conclusions:

Hypertensive disorders during pregnancy are the most frequent medical complication, affect 5–10% of pregnant women and continue to be an important cause of fetal and neonatal morbidity and mortality throughout the world, due to low birth weight or prematurity. Maternal complications can range from acute kidney failure to HELLP syndrome, liver failure, cerebral edema, seizures, or death
PLASMA STEROID PROFILE IN WOMEN WITH FIBROMUSCULAR DYSPLASIA - THE ARCADIA-GYN STUDY
Authors: Aniszczuk-Hybiak Anna , Florczak Elzbieta , Dobrowolski Piotr , Teliga-Czajkowska Justyna , Prejbisz Aleksander , Dobrowolska-Redo Agnieszka , Was Joanna , Rucinska Karolina , Lutynska Anna , Kosinski Przemyslaw , Grabowska-Derlatka Laretta , Januszewicz Magdalena , Papaccoggli Marco , Persu Alexandre , Januszewicz Andrzej
Published: June 2022

Objective:

Fibromuscular dysplasia(FMD) mostly affects women in reproductive age. It has been suggested that FMD might be related to female hormone levels or contraceptive use. Therefore, the aim of the ARCADIA-POL substudy ARCADIA-GYN was to perform detailed, prospective obstetrics and gynaecological evaluation of women with FMD.

Design and method:

We enrolled in the ARCADIA-GYN study 42 women with FMD, ages between 18–46 years old and 45 age-matched healthy, normotensive women who have regular menstruation. By means of LC-MS/MS we analysed plasma steroid profile: estrogen, progesterone, testosterone, aldosterone, cortisol, 18-oxo-cortisol, 18-hydrocortisol, cortisone, 11-deoxycortisol, 21-deoxycortisol, corticosterone, 11-deoxycortisone, progesterone, 17-OH progesterone, pregnenolone, androstenedione, DHEA, DHEA-SO4. Blood samples in all subjects were collected in luteal phase while women stayed without any hormonal contraceptive. FMD was diagnosed based on ARCADIA-POL protocol as published previously. No signs of arterial lesions and/or disturbances in blood flow were found in Doppler duplex evaluations of carotid and renal arteries in control subjects.

Results:

42 patients with FMD (34.2 ± 8.1years), predominantly with renal FMD, were compared to 45 healthy, normotensive women (34.0 ± 5.4years; p = 0.88). Hypertension was diagnosed in 88.1% (37) women with FMD. In women with FMD we found lower plasma levels of progesterone (5.1 inter quartile range [IQR] 2.0–8.2 vs 7.6 IQR 3.3–12.5ng/ml;p = 0.017),testosterone (0.20 IQR 0.15–0.28 vs 0.25 IQR 0.18–0.36ng/ml; p = 0.036), DHEA (3.6 IQR 2.6–4.3 vs 4.5 IQR 2.9–6.6ng/ml;p = 0.012), DHEAS04 (1167 IQR 819–1535 vs 1579 IQR 1197–1980ng/ml;p = 0.04) and 11-deoxycortisol (0.09 IQR 0.05–0.12 vs 0.14 IQR 0.09–0.18ng/ml;p = 0.002) as compared to control group. There were no significant differences in other analyzed hormones. There were no differences in steroid profile evaluations between patients with unifocal and multifocal FMD.

Conclusions:

Women with FMD as compared to healthy controls are characterized by hormonal alterations including lower plasma progesterone level. Taking into consideration previous findings of abnormal balance between estrogen and progesterone receptors in renal artery samples of FMD our results suggest that female hormonal disturbances may have a role in FMD development.
ANTIHYPERTENSIVE TREATMENT INITIATION IN FRANCE: WHAT DID GENERAL PRACTITIONERS PRESCRIBE IN 2021?
Authors: Mourad Jean Jacques , Jamet Philippine , Huguet Michael , Suhl Jaehyo , Voisin Olivier , Azria Philippe , Ferreira Emmanuel , Antakly Yara
Published: June 2022

Objective:

Hypertension (HT) is the leading reason for visits to general practitioners (GPs). The diagnosis of HT and the decision to initiate drug treatment form an integral part of their natural field of practice. The recent national and international guidelines have made proposals that are specifically dedicated to this sequence of care. The objective of this study is to analyse the prescribing behaviours of GPs when initiating treatment for patients newly diagnosed with hypertension.

Design and method:

Data from the IQVIA Longitudinal Patient Database (LPD) France were used. LPD France is a permanent observatory to which a nationally representative panel of physicians – including GPs (n = 1200) – contribute anonymised electronic medical records (EMR). This analysis included all antihypertensive drug prescriptions made by the GPs from July 2020 to June 2021, which were then extrapolated to the entire population of mainland France. Initiation was defined by the establishment of an antihypertensive treatment for a patient already registered with the GP and who was receiving antihypertensive treatment for the first time in 24 months.

Results:

Over the 12-month period analysed, 869 283 patients had received an initial antihypertensive drug prescription following consultation with a GP. Monotherapy was prescribed in 71.5% of cases (versus 67.3% the previous year) and dual therapy in 21.5% of cases (versus 23.2% the previous year). Fixed-dose combinations accounted for 62% of the dual therapies.

The therapeu tic classes of the prescribed monotherapies were distributed as follows:

Conclusions:

These findings reveal prescriptions that appeared to be consistent with the latest guidelines in which the first-line use of renin-angiotensin system blockers and calcium channel blockers is preferred. It is also interesting to note that treatment initiation with dual therapies was much less common, with a use rate of fixed-dose combinations slightly higher than that of the free-dose combinations.

*IQVIA EMR LPD Médecins Généralistes / Cardiologues Libéraux’. EMR = Electronic Medical Records, LPD = Longitudinal Patient Data