bluuebunny/crossref_metadata_2025 huggingface dataset:
ENDOVASCULAR RADIOFREQUENCY RENAL DENERVATION IN DIFFICULT TO TREAT ARTERIAL HYPERTENSION: A SINGLE CENTER EXPERIENCE
Authors: Grasselli Chiara , Guiducci Vincenzo , Pignatelli Gianluca , Negro Aurelio , Ghirarduzzi Angelo
Published: May 2024

Objective:

To assess safety and effectiveness of catheter-based renal denervation (RDN) for reduction of blood pressure (BP) in patients with difficult to treat arterial hypertension.

Design and method:

Thirtyfive patients selected with difficult to treat arterial hypertension, underwent RDN. Secondary forms of hypertension were excluded, and an appropriate renal artery anatomy was confirmed in all patients. Every patient underwent follow-up at 30 days, and then every 12 months, consisting in clinical examination, office BP measurements, ambulatory blood pressure monitoring, and biochemical analysis. At 12 months tansthoracic echocardiography and renal duplex sonography were performed.

Results:

The median value of systolic clinic BP decreased from 161 mmHg (25th-75th percentiles 158 - 191) at baseline to 144 mmHg (25th-75th percentiles 136 - 153) at follow up (p= 0.012), and the median value of diastolic clinic BP decreased from 102 mmHg (25th-75th percentiles 94 - 122) at baseline to 90 mmHg (25th-75th percentiles 78 - 99) at follow-up (p= 0.012). The number of medications changed from 5 (range 2-8) at baseline to 3.3 (range 0-6) at follow up. A significant decrease of left ventricular mass index from a median of 160 g/m2 (25th-75th percentiles 147 - 151) at baseline to 126 g/m2 (25th-75th percentiles 107 - 151) at follow-up (p= 0.043) was detected. The renal function did not demonstrate significant changes, however plasma renin activity and HOMA index were significantly reduced. No periprocedural or long term complications were observed.

Conclusions:

Our data confirm that RDN may constitute an effective and safe therapeutic choice for the treatment of difficult to treat hypertension.
ROLE OF 2-MICROGLOBULIN IN THE DEVELOPMENT OF CARDIORENAL SYNDROME IN COMORBID PATIENTS WITH ARTERIAL HYPERTENSION
Authors: Dunaieva Inna
Published: May 2024

Objective:

This study was aimed at evaluating the role of β2-M in the development of renal complications in patients with AH with type 2 diabetes mellitus.

Design and method:

90 patients with AH (men/women – 48/42) and 20 control subjects were examined. All patients with AH aged 54.37±1.18. During a thorough examination and follow-up of patients, they were classified into 3 groups: patients with AH – group 1 – 31 people; group 2 – AH in combination with T2DM – 31 people; group 3 – patients with AH, T2DM, and obesity (OB) – 28 people.β2-M in the development of renal complications in patients with AH with type 2 diabetes mellitus. β2-M in the development of renal complications in patients with AH with type 2 diabetes mellitus. β2-M levels in the patients’ serum were determined by enzyme-linked immunosorbent assay using a Labline-90 analyzer (Austria) and a commercial test system manufactured by Orgentiec (ELISA, Germany) according to the instructions provided with the kit.

Results:

β2-M level in patients with AH was 3.09±1.08, in patients with AH and T2DM it was 3.10±0.97, in patients with AH+T2DM+obesity it was 3.14±0.84, in healthy subjects it was 1.98±0.52. p<0.001.

Therefore, a significant increase (p<0.001) in the concentration of β2-M in the blood serum was noted in patients of different groups compared with the control group. An increase in β2-M concentration allowed us to confirm the presence of tubular renal dysfunction, which was not diagnosed by conventional methods. All examined patients were divided into 2 groups depending on the β2-M level (Table 1). Our data prove the role of β2-M as an independent biomarker of renal dysfunction, as well as the development of early cardiovascular complications.

Conclusions:

β2-microglobulin is an early independent biomarker of renal dysfunction, namely, renal tubular dysfunction in patients with hypertension and type 2 diabetes mellitus. It is advisable to determine β2-microglobulin in the diagnosis and prognosis of early manifestations of cardiorenal syndrome.
AGE AND BLOOD PRESSURE DEPENDENCY OF THREE DIFFERENT METHODS TO MEASURE PULSE WAVE VELOCITY
Authors: Da Silva Marco Antonio Vieira , Owen Jacqueline , Cosenso-martin Luciana N , Vilela-martin Jose F
Published: May 2024

Objective:

evaluate how much age and blood pressure (BP) explains carotid-femoral pulse wave velocity (cf-PWV), estimated PWV by Mobil-o-Graph, and an equation derived from the Reference Values for Arterial Stiffness Collaboration.

Design and method:

We included individuals with at least one risk factor, elevated BP (> 139 or 89 mmHg), previous hypertension, dyslipidemia, diabetes, smoking, body obesity (BMI > 29.9 kg/m2), abdominal waist risk (waist circumference male > 102 cm in female > 88 cm). All individuals have taken three accurate BP (OBP) measurements using a Microlife BP A200 AFIB, and three sequential measurements of cf-PWV using a Complior Analyze device. We calculated the average from them. Also, they record 24 hours of brachial pulse wave velocity (ba-PWV) and ambulatory blood pressure monitoring using the Mobil-O-Graph device. Also, we calculated PWV by utilizing age and mean OBP (MBP) from Eq. (1) derived by the Reference Values for Arterial Stiffness Collaboration. We used five multilevel regression models to determine how much cf-PWV, ba-PWV, and e-PWV depend on age and BP. We used the Forkman test to compare the coefficient of determination (R2).

Results:

Table 1 shows the main clinical characteristics of the sample. Table 2 demonstrates the results of R2 for cf-PWV, ba-PWV and e-PWV. All PWV is significantly determined by age than BP; p < 0.001.

Age determines 88.4% of ba-PWV, 72.8% of e-PWV, and 21.9% of cf-PWV; p < 0.001. There is no difference in R2 for model 1 between ba-PWV and e-PWV; p = 0.14. Likely, in model 4, there are no differences for cf_PWV and e-PWV comparisons, p = 1.0. Age and BP determined 93.6% of ba-PWV and 94% of e-PWV; p = 0.97 even though they explain only 21.9% of cf-PWV, p < 0.001 for comparisons with e-PWV and ba-PWV.

Conclusions:

Age and BP explain equally almost the overall variance of e-PWV and ba-PWV. However, cf-PWV is significantly less dependent on age and BP than them.
IS THERE A CORRELATION BETWEEN OVERNIGHT WEIGHT LOSS AND NIGHTTIME BLOOD PRESSURE DIPPING? A SINGLE CENTER, OBSERVATIONAL STUDY
Authors: Pruijm Menno , Borges Alex , Corre Tanguy
Published: May 2024

Objective:

Everyone loses weight at night. This nocturnal weight loss (NWL) is due to respiration, metabolism and perspiration (sweating). NWL varies largely between persons, principally due to variations in nocturnal sweating, which is stimulated by the sympathetic nervous system (SNS). Like nocturnal sweating, decrease in blood pressure at night (dipping) is influenced by the SNS. Whether NWL correlates with blood pressure (BP) dipping, and possibly identifies non-dippers is unknown. The aim of this study was to assess whether there is a correlation between nocturnal weight loss and the degree of blood pressure dipping.

Design and method:

We proposed the study to patients who were scheduled for 24-hour ambulatory blood pressure monitoring (ABPM) in our department. The day of the ABPM, participants received a high-precision scale (Seca®, model 877) and a transpiration-oriented questionnaire that they completed at home. Participants measured their body weight with the scale before going to bed and again the following morning. Voided urine during the night was collected in a recipient and weighed separately.

Results:

We included 39 people in our study (aged 53±14, 46% women, 85% with arterial hypertension, eGFR 88±25 ml/min/1.73m2). Mean and median NWL were respectively 367±183g and 300g (min-max 100-850g), for a room temperature of 22°C (min-max 20-23). There was no statistically significant correlation between NWL and dipping of systolic (Spearman's r = -0.1240, p=0.45) or diastolic BP (r = -0.1054, p=0.52). No correlation was found between dipping and night-time sweating as estimated with the questionnaire (r = -0.0154, p = 0.93). NWL was positively associated with mean arterial blood pressure (r = 0.35, p= 0.028), alcohol consumption (r = 0.34, p=0.033) and body height (r = 0.3601, p=0.024). In multivariable analysis including these variables, only alcohol consumption remained associated with NWL.

Conclusions:

There was no correlation between nocturnal weight loss and systolic or diastolic dipping in our sample. Therefore, NWL cannot be used as a screening test for dipping. Alcohol consumption is the strongest predictor of nightly weight loss.
SURVEY ON DETERMINATION OF ALBUMINURIA BY FAMILY PHYSICIANS
Authors: Jelakovic Bojan , Lang Valerija Bralic , Fucek Mirjana , Jelakovic Ana , Josipovic Josipa , Domislovic Marija , Capak Krunoslav , Bubas Marija
Published: May 2024

Objective:

Albuminuria is an established marker of cardiovascular (CV) risk which has a role in pathogenesis of cardio-renal diseases, and it is questioned whether it should also be a therapy target. In all relevant guidelines it is listed as a routine laboratory method for all patients with hypertension and increased CV risk regardless they have diabetes or not. Croatian Hypertension League successfully negotiated with Croatian National Health Insurance company, and since last February determination of albumin-to-creatinine ratio - ACR is reimbursed for all patients with hypertension, and not only hospital specialist, but also family physicians (FP) are allowed to use this method. We announced this important novelty through our newsletters, website and media. The aim was to analyze how this method was implemented by family physicians in regular work.

Design and method:

A digital structured questionnaire was prepared and placed at the website of the Croatian Hypertension League. Using our regular monthly newsletter, we have invited FP, members of the League to participate in this survey. So far, 135 FP participated (83.7% women) from all parts of Croatia.

Results:

All physicians believe that determination of ACR is very important. Before this survey, 34% have not heard about this possibility, and from those who were informed 31% have not yet started. The most important reason was incapability of local laboratory (51%) followed by the answer that they have not had proper patient for these analyses (17.8%). When asked whether their laboratory provide them with values of estimated glomerular filtration rate, 51% answered negatively.

Conclusions:

Croatian Hypertension League made a big step forward enabling determination of ACR for all hypertensive patients by all physicians. However, there are still several gaps which should be eliminated. One is increasing awareness of FP and encouraging them to determine ACR more frequently, and the other one is to convince medical biochemistries to allow regular determination of ACR in all laboratories, but also of reporting eGFR. Survey, like this are very important and could be helpful in reaching final success, and we will use results for evidence-based negotiation with Croatian Biochemistry Chamber.
PRENATAL DIAGNOSTIC OF PREECLAMPSIA
Authors: Valdes Daniela , Andersen Louise B. , Christesen Henrik , Jorgensen Jan Stener , Nonn Olivia , Kräker Kristin , Müller Dominik N. , Dechend Ralf , Herse Florian
Published: May 2024

Objective:

Preeclampsia is a major cause of morbidity and mortality in pregnancy and still lacking an early prediction. Oxylipins, auto- and paracrine signaling molecules derived from polyunsaturated fatty acids (PUFAs), are implicated in the pathogenesis. We performed oxylipin profiling and developed a novel prediction model for preeclampsia.

Design and method:

We measured eighty-one free circulating oxylipins derived from linoleic-, eicosapentaenoic-, docosahexaenoic- and arachidonic acids by Triple-Quad-Tandem mass spectrometry in serum collected at gestational week (GW) 7-12 in a cohort study (total, 90 cases, 608 matched controls) before clinical onset of maternal syndrome. The later arising preeclampsia phenotype was heterogeneous with predominantly mild, late-onset disease. Using a machine learning regression-decision tree approach, prediction models incorporated clinical data, angiogenic markers and oxylipins, compared with a model including only standard clinical variables in combination with sFlt-1 and PlGF, bio markers used to diagnose PE late in pregnancy.

Results:

A regression tree approach for predicting preeclampsia in first trimester including X (number) specific oxylipins demonstrated good predictive capacity in early pregnancy with sensitivity 71, specificity 99 and AUC 87.

Conclusions:

Placentally derived PUFA metabolites (oxylipins) substantially add to the known clinical and biochemical predictive parameters for preeclampsia. A regression-tree based approach including known clinical and biochemical parameters, blood pressure and key oxylipins is a promising tool for predicting preeclampsia already in the first trimester.
FEATURES OF MYOCARDIAL DEFORMATION PROPERTIES IN RELATION TO LEFT VENTRICULAR REMODELING TYPES IN PATIENTS WITH ARTERIAL HYPERTENSION
Authors: Bekmetova Sevara , Abdullaeva Guzal , Khamidullaeva Gulnoz , Yusupova Khafiza
Published: May 2024

Objective:

to determine the features of myocardial deformation properties in relation to left ventricular (LV) remodeling types in patients with arterial hypertension (AH).

Design and method:

The study included 62 patients of both sexes, with I–III degrees AH (ESC/ESH, 2018), who are undergoing outpatient treatment at the Republican Specialized Scientific and Practical Medical Center of Cardiology. The average age of patients was 53.1 ± 11.3 years, and the average duration of AH was 6.7 ± 6.5 years. Speckle-tracking EchoCG was performed to obtain an objective and quantitative assessment of global and regional myocardial function using SIEMENS's ACUSON x700 PV 2.0 system. Deformation properties of the LV myocardium were analyzed using the TOMTEC-ARENA Software system (TTA2.40.00). Among parameters for assessing longitudinal deformation of the LV we selected: global longitudinal strain -GLS (%); Strain Rate-SR (s-1). To study the segmental LV contractility, we analyzed the apical 4-chamber, 3-chamber, and 2-chamber section, the LV section along the short axis at the level of the mitral valve cusps, papillary muscles, and apex. Results are presented as M±SD.

Results:

The examined patient sample revealed three groups of LV geometric models: group I, n=27 (45.3%) patients with normal geometry; group II, n=27 (45.3%) patients with concentric remodeling; group III, n=8 (12.9%) patients with concentric hypertrophy. The absolute GLS values of the LV were: in group I - 20.0 ± 2.95%, in group II - 15.2 ± 2.99%, and in group III - 13.5 ± 1.87%. Inter-group analysis revealed that in the group with normal geometry, myocardial deformation properties of the LV were not impaired compared to II and III groups, as indicated by the GLS value within the normal range in group I patients (p < 0.001). The lowest values of LV deformation were found in the group with concentric geometry, possibly influenced by factors such as the degree of hypertrophy, the presence of fibrosis in the myocardium, and diastolic dysfunction of the LV.

Conclusions:

Thus, in patients with AH and the presence of concentric hypertrophy, significant impairments in myocardial deformation properties of the LV are formed.
ENGAGEMENT AND ATTRITION IN A TELEHEALTH SERVICE FOR HYPERTENSIVE PATIENTS. A SINGLE CENTER EXPERIENCE
Authors: Ionov Mikhail , Yudina Yulia , Sagynbaeva Ay -Churek , Konradi Alexandra
Published: May 2024

Objective:

To investigate engagement with blood pressure telemonitoring and counselling (BPTM) in patients with hypertension (HTN) and its predictors.

Design and method:

Patients with uncontrolled HTN (office systolic (S) BP >140 mm Hg) were recruited consecutively in a large reference center. Only patients who were motivated and willing to participate were included. The telehealth system consisted of a home BP telemonitoring service and an on-demand text chat with the patient's attending physician. The BPTM continued for 3 months with mandatory baseline and follow-up visits, as well as completion of the HYPE (HYpertension imPact quEstionnaire) to assess quality of life. Patients who did not report BP readings for 2 weeks + after 2 alerts were termed ’quit’. Others comprised the ’continued’ group.

Results:

A total of 92 patients were included in the final analysis (median age 43 years, 69 men, 49 at low-intermediate CVD risk). At baseline, median office SBP was 155 mm Hg (150;162) and office diastolic (DBP) was 95 mm Hg (90;102). Over the 3 months, SBP and DBP decreased significantly (-16 and -11 mm Hg, respectively; p <0.001 for both). There was a greater reduction in SBP at home (-8 mm Hg from 1 week to 3 months, p <0.001). A total of 43 patients continued BPTM and 48 patients discontinued BP telemonitoring (85% of them after 1 month). The groups were well matched for age, sex, and baseline BP. The δSBP did not differ between the two groups, nor did the median number of questions (3 consultations/patient). Higher baseline office SBP (β = 0.03, p = 0.043) and male sex (β = 1.15, p = 0.041) were predictors of high engagement with the telehealth service after adjustment for other covariates. Quality of life at 3 months was higher in the ’continuing’ patients. (δ+8 points HYPE).

Conclusions:

Telemonitoring and remote counseling are effective in patients with HTN. Even when patients are motivated to use telehealth, more than half of them discontinue during the first months, predominantly female patients with mild uncontrolled HTN. Patients who continue BPTM experience a higher quality of life.
INTEREST FOR HEALTH APPLICATIONS FOR SMARTPHONES IS DETERMINED WITH SOCIOECONOMIC AND EDUCATIONAL STATUS
Authors: Alagic Marieta , Abramovic Inga , Andelic Ana Marija , Horvat Petra , Ivankovic Iva , Zdilar Ana Marija , Domislovic Marija , Glavic Mihaela Marinovic , Jelakovic Bojan
Published: May 2024

Objective:

The aim of the study was to evaluate viewpoints on the usage of health applications for smartphones and to determine which application patients would consider most useful.

Design and method:

This study included 1780 participants (random sample of general adult population in Croatia included in the ’Epidemiology of Hypertension in Croatia -2’ project). They completed a questionnaire which included questions about smartphone possession, opinion on health applications, monthly income and duration of education. Participants were then divided into two groups based on whether they considered usage of the health applications useful. Those who deemed them useful were further questioned about their opinion on three types of applications: reminder, keeping a blood pressure log, daily and weekly advice.

Results:

Out of 1780 participants, 1101 (61.9%) own a smartphone; 437 (24.6%) consider smartphone health applications not useful; 668 (37.5%) consider smartphone health applications useful. The prevalence of finding health applications useful varies by average monthly income: 24.8%, 41.9%, and 57.3% for the group with income < €467, with income €467–€667, and with income > €667, respectively. The prevalence of finding health applications useful varies by education duration: 15.7%, 38.4% and 53.3% in the group with < 8 years of education, in the group with 8–12 years, and in the group with > 12 years of education, respectively. Out of 668 participants who consider health applications useful, 215 (32.2%) would use an application for keeping blood pressure log; 295 (44.2%) would use a reminder application; 355 (53.1%) would use an application which offers daily and weekly advice.

Conclusions:

Our results show that interest in health applications is higher among those with higher monthly income and longer education. The biggest interest is shown for the application which would offer advice. However, the prevalence of smartphone possession may limit the utilization of health applications as part of the new healthcare approach.
BLOOD PRESSURE AND WEIGHT CHANGES AND INCIDENCE OF ARTERIAL HYPERTENSION 3 YEARS AFTER SWITCHING TO DOLUTEGRAVIR IN TREATMENT-EXPERIENCED HIV-INFECTED PATIENTS IN LILONGWE, MALAWI
Authors: Steffen Hans -Michael , Viola Evelyn , Mahanani Melani Ratih , Rambiki Ethel , Thawani Agness , Kasper Philipp , Wallrauch Claudia , Neuhann Florian , Heller Tom
Published: May 2024

Objective:

The increased survival of people living with HIV (PLHIV) is accompanied by a rising number of aging patients at risk of cardiovascular disease. Dolutegravir (DTG), recommended in WHO guidelines, was reportedly associated with excess gain in body weight (BW). We evaluated changes in BW and blood pressure (BP) of PLHIV who had initiated tenofovir/lamivudine/efavirenz (TLE) and were followed for 36 months during the LighTen Cohort Study (ClinicalTrials.gov NCT02381275). As per Malawian National protocols, patients were switched almost universally to tenofovir/ lamivudine/dolutegravir (TLD) and medical care continued after completion of the study.

Design and method:

We retrieved data on BW, BMI, systolic and diastolic BP (sBP, dBP) of the LighTen Cohort study participants (age =>18 years) from the electronic medical record system at the Lighthouse Clinic for those, who were still in care at the clinic over a 36±4 months period after initiation of TLD. Student's t-test was used to compare changes (δ) in sBP, dBP, BW, and BMI between baseline (0m) and month 36 (36m) on TLE vs. TLD, respectively. Incident hypertension was defined as office blood pressure =>140/90 mmHg using =>2 measurements on =>2 consecutive visits.

Results:

Within the defined time frame, data of 590 PLHIV (348 females; 59%) could be analyzed. At the DTG switch their age (mean±sd) was 41.3±8.9 years with a median CD4 count of 467 cells/μl (interquartile range 325-623 cells/μl) and suppressed viral replication in 95% of cases. Incident hypertension was confirmed in n=24 of 497 and n=53 of 473 initially normotensive PLHIV during TLE and TLD periods, respectively (4.8% vs. 11.2%; p<0.001). The increase in BW and BMI was significantly higher on TLE compared to TLD while the changes in BP were significantly higher with TLD (see table; ∗p<0.001 TLE vs. TLD).

Conclusions:

Following the initial increase in BW on TLE, a higher risk of hypertension among PLHIV was associated with a switch from efavirenz to dolutegravir with only modest additional weight gain. In view of their inherent high cardiovascular risk, regular BP control with lifestyle counselling and timely initiation of antihypertensive drug treatment seem clearly indicated.
ASSOCIATION BETWEEN OFFICE BLOOD PRESSURE AND LONG-TERM CLINICAL EVENTS IN PATIENTS WITH CORONARY ARTERY DISEASE AFTER PERCUTANEOUS CORONARY INTERVENTION
Authors: Shin Jeong -HUN , Kim Byung Sik , Shin Jinho , Lim Young -Hyo
Published: May 2024

Objective:

The optimal blood pressure (BP) target for patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) remains unclear. This study aimed to identify the optimal BP target by investigating the association between average office BP and future clinical events after PCI in patients with CAD.

Design and method:

Consecutive patients undergoing PCI from 2012 to 2016 were included. They were divided into five groups according to the average follow-up BP after discharge. The co-primary outcome was major adverse cardiac and cerebrovascular event (MACCE: all-cause death, non-fatal myocardial infarction, non-fatal stroke, or any revascularization) and net adverse clinical events (NACE: MACCE, or major bleeding) up to 5 years.

Results:

A total of 2,845 patients were included in the analyses, and among them, 787 (27.7%) experienced the NACE during the follow-up period. Patients in the highest SBP group (adjusted hazard ratio [HR] 1.495, confidence interval [CI] 1.189–1.880) and lowest SBP group (adjusted HR 1.625, CI 1.214–2.176) had a significantly higher risk of 5-year NACE. Similar associations were observed between SBP and the risk of MACCE, and similar results based on DBP categories were also observed. There was a J-curve relationship observed between SBP and DBP with respect to 5-year NACE and MACCE. The nadir point of risk for NACE and MACCE was found at 121.4/74.8 and 120.4/73.7 mmHg.

Conclusions:

In patients underwent PCI, there is a significant correlation between office BP level and clinical events, which indicates the importance of efforts for optimal BP control to reduce ischemic and bleeding events.
HIGH PREVALENCE OF THE CARDIOVASCULAR-KIDNEY-METABOLIC SYNDROME
Authors: Tian Zhejia , Schmidt-ott Kai , Melk Anette , Schmidt Bernhard
Published: May 2024

Objective:

The cardiovascular-kidney-metabolic (CKM) syndrome has defined recently as the clinical picture characterized by obesity, diabetes, chronic kidney disease (CKD) and the cardiovascular (CV) sequelae including coronary heart disease, stroke, peripheral arterial disease, heart failure and atrial fibrillation. The continuum of CKM reaches from stage 0 with no risk factors to stage 4 with clinical CV disease. The aim of this study was to define the prevalence of the stages 0 – 2 of the CKM syndrome in the general population, according to age and sex and to explore the development of the prevalence over the last twenty years.

Design and method:

We used data provided by NHANES. NHANES is a biannual survey, which is representative for the non-institutionalized, civil population of the United States of America. We included non-pregnant participants aged 18 or older from 10 NHANES cycles between 1999 and 2020. We accounted for the complex survey design, as specified in the National Center for Health Statistic analytic guideline. All analyses were conducted using R version 4.3.2.

Results:

7.9% of US adults were without any CKM risk factors and fulfilled the inclusion criteria for CKM Syndrome Stage 0, with the majority being female, comprising 64% of this subgroup. A higher percentage of younger participants were categorized in this group, with 74.9% being under the age of 45. 18.3% of the population encountered issues related to excess or dysfunctional adiposity (Stage 1) with a similar distribution between sexes. Over half of the US adult population (56.5%) exhibited either metabolic risk factors, CKD, or a combination of both and met the criteria for inclusion in stage 2. 49.3% were female and 50.7% were male. Older individuals were more prevalent in Stage 2.

Conclusions:

CKM syndrome is highly prevalent in the general population. Its prevalence rises with age and is modified by sex. Given the high prevalence of the CKM syndrome, especially in stage 2, reflecting patients at varying risk without subclinical or clinical CV disease, additional risk assessment is mandatory to tailor preventive measures on the population level to efficiently reduce cardiovascular morbidity and mortality.
TRUE REFRACTORY HYPERTENSION IN 2023- LESSONS LEARNED FROM A NATIONAL REGISTRY OF 1.82 MILLION ADULTS
Authors: Leiba Adi , Lencovsky Ori , Azran Carmil , Hadad Orpaz , Rappoprt Vladimir , Niddam Naomi Nakash , Korman Avital Angel
Published: May 2024

Objective:

Refractory hypertension (refHTN) is defined as blood pressure that remains uncontrolled on maximal therapy, which is defined as the use of 5 or more antihypertensive agents of different drug classes.

We aimed to define the prevalence of apparent and true refHTN in a real life national registry of an Health Maintenance Organization (HMO).

Design and method:

In this real-life observational study we utilized the Maccabi Healthcare Services (MHS) database during 2023. Data includes pharmacy prescriptions and purchases.

Apparent refHTN was defined as patients included in the Maccabi “Hypertension Registry” during 2023 and taking 5 different antihypertensive medications of different classes, of which four were from pre-specified groups (diuretics, CCB, RAAS inhibitors and MRAs).

True refHTN (unlike apparent refHTN) was defined as being fully adherent to the antihypertensive medication regimen with at least 6 prescriptions and purchases (refills) during 2023 as well as blood pressure which was not optimally controlled during the year (less than 80% of blood pressure measurements equal or below the well-defined target of 130/80mmHg).

Results:

Out of 1,821,685 adult members of Maccabi HMO during 2023, 361,721 patients were defined as hypertensive patients (20%) and included in the registry. 0.5% (1750) of the hypertensive population were at some stage during 2023 on at least 5 anti-hypertensive medications (i.e., apparent refHTN). Of those only 264 patients (15%) were adherent to their medications during the whole year. Mean age was 71.3 years. Of the well adherent group, 205 patients (77%) were not optimally controlled and thus regarded as true refHTN.

Therefore in total, true refHTN was evident in 0.056% of hypertensive population in Maccabi HMO.

Conclusions:

In an “optimal world” which lacks physician inertia, four medication regimen is prescribed (Diuretics, CCB, RAAS inhibitors and MRAs) and there is willingness to prescribe a fifth and a sixth medication, if needed (alpha blockers, beta blockers, central alpha-2 agonists or direct vasodilators). In the unlikely case of full adherence to all medications, true refHTN is extremely rare (0.056% of hypertensive patients). This suggests that most hypertensive patients can be well controlled using the current anti hypertensive armamentarium.
PREVALENCE, AWARENESS, TREATMENT AND CONTROL OF DYSLIPIDEMIA (LDL-CHOLESTEROL > 3.0 MMOL/L) IN CROATIA – EHUH 2 STUDY PRELIMINARY REPORT
Authors: Jelakovic Bojan , Pecin Ivan , Bilajac Lovorka , Bilobrk Matea , Domislovic Marija , Gellineo Lana , Jelakovic Ana , Leskovar Dunja , Glavic Mihaela Martinovic , Paponja Kristina , Perica Drazen , Capak Krunoslav , Bubas Marija , Reiner Zeljko
Published: May 2024

Objective:

Cardiovascular mortality is leading cause of death in Croatia. Beside hypertension, high prevalence and poor control of dyslipidemia is the main cause for this shameful medical failure. Our aim was to analyze prevalence, awareness, treatment and control of dyslipidemia (defined here as LDL cholesterol > 3.0 mmol/l) in general adult population.

Design and method:

EHUH-2 study is nationwide study in which representative random sample of adult population was enrolled. Structured questionnaire was applied, subjects were clinically examined, fasting blood was drawn and urine samples were collected. In this preliminary analyses from the EHUH-2 study we are reporting data collected from 1313 subjects.

Results:

Prevalence and awareness on high dyslipidemia were non-significantly higher in women than men (65.6% vs 63.4%; 34.6 vs 33.7%). On contrary, treatment and control were higher in men than in women (29.0% vs 24.1%, 88.4% vs 77.7.%; p< 0.05). Dyslipidemia was treated in only 25.2%, 29.9% and 33% patients with diabetes, hypertension and chronic kidney disease, respectively. In treated and controlled hypertensive patients, targets of LDL cholesterol were achieved in only 30.2% pointing on poor adherence to statin therapy. In untreated hypertensive patients dyslipidemia was treated in only 16.3% indicating on common clinical inertia. We observed significant differences in the prevalence, treatment, and control of dyslipidemia between urban and rural areas (58.7% vs. 74.5%, 29% vs. 19.7%, 25.6% vs, 14.4%, respectively, all p<0.001).

Conclusions:

Dyslipidemia (LDL > 3.0 mmol/l) is highly prevalent in Croatia. Poor control (less than 30% in high risk population) is mostly due to poor adherence and clinical inertia. Rural population has higher prevalence and lower rates of treatment and control. Medical scientific community including public health experts and health care providers have to work harder at first place increasing health literacy which will hopefully improve adherence and diminish clinical inertia. Special focus should be on remote areas where medical care is lacking.
HIGH PREVALENCE OF METABOLIC SYNDROME AND HIGH INCIDENCE OF NEW ONSET HYPERTENSION IN RURAL POPULATION WITH NORMAL BLOOD PRESSURE RISE THE QUESTION WHETHER NORMAL IS REALLY NORMAL
Authors: Prlic Margareta Fistrek , Brinar Ivana Vukovic , Dika Zivka , Kos Jelena , Jelakovic Ana , Ivandic Ema , Fucek Mirjana , Ivkovic Vanja , Knezevic Tamara , Jelakovic Bojan
Published: May 2024

Objective:

High blood pressure (BP) is an independent risk factor for cardiovascular (CV) disease. The current ESH guidelines consider normal BP from 120-129/80-84 mmHg, and high-normal BP 130-139/85-89 mmHg. Metabolic profile, kidney function, and other risk factors determine the global CV risk which is important for proper treatment tailoring. We aimed to analyze the metabolic profile, white blood cell (WBC) count and high-sensitive C-reactive protein (hs-CRP), albuminuria (ACR), as well as endothelial damage marker; hepatocyte growth factor (HGF) in subjects with optimal BP, normal, and high-normal BP.

Design and method:

Data from 612 subjects (a random sample of adult rural population included in the ENAH study; 58% women, average age 41±14 years) were analyzed. Fasting blood and urine samples were collected. BP was measured using oscillometric device according to the ESH guidelines. Subjects were divided into two groups: OBP (optimal BP<120/80 mmHg, N=295), NHN (normal BP - normal and high-normal BP 120/80-140/90 mmHg, N=317).

Results:

Subjects in NHN group are older than subjects in OBP group (p<0.001). A significantly higher number of subjects with metabolic syndrome were observed in the NHN group (p < 0.001). There was no difference in inflammatory markers (WBC, hs-CRP) between groups. Albuminuria (ACR) was not higher in the NHN group. We found a positive correlation of HGF concentration and BP only in the NHN group. At the end of 7-years-follow up period 12.6% and 48.2% developed AH in the OBP and the NHN group, respectively (p< 0.001). The average annual incidence of AH for subjects with OBP was 2%, and for NHN subjects was 8%.

Conclusions:

Metabolic disturbances are significantly more frequent in subjects with NHN compared with those with OBP. In addition, in this group, we found a positive correlation between endothelial damage and BP. There is a higher incidence of new-onset AH in NHN the group during the follow-up period. Lifestyle changes should be implemented in all subjects with NHN BP aiming to reduce the risk of developing sustained AH, and drug therapy should be considered particularly in those with other risk factors.
PREVALENCE OF PA IN OSA AND HYPERTENSION, AND THEIR EFFECTS ON MACE WHEN CO-EXISTENT, UROSAH COHORT
Authors: Heizhati Mulalibieke , Li Nanfang , Zhu Qing , Zhang Delian , Yao Xiaoguang , Luo Qin , Aierken Xiayire
Published: May 2024

Objective:

To explore 1) the prevalence of PA in OSA and hypertension, and 2) whether the risk of MACE is increased in co-existent PA and OSA, compared to those without the both or with either alone

Design and method:

Participants were the patients in UROSAH cohort, adults who visited the Hypertension Center between Jan 2011 and Dec 2013 and followed up until Jan 2021. Prevalence of PA between without OSA and OSA groups was compared in total patients and in sex-specific patients. MACE encompassed cardiac and cerebrovascular events, and death from CV causes. We performed Cox proportional hazard regression models to evaluate HR and 95% CI for MACE, and cardiac and cerebrovascular events in coexistent PA and OSA group by setting non-PA and OSA group, and PA or OSA group as the reference.

Results:

We included 3306 patients with hypertension. PA prevalence was significantly higher in hypertensives with OSA in total participants (13.2 vs 10.0%, P = 0.018) and in men participants (13.8 vs 7.7%, P = 0.001). PA prevalence was significantly higher in hypertensive men with OSA aged <45 years (12.7 vs 7.0%), 45–59 years (16.6 vs 8.5%), and with overweight and obesity (14.1 vs 7.1%) than did their counterparts (P < 0.05). For OSA severity, men participants showed increased PA prevalence from non to moderate OSA and a decrease in the severe OSA group (7.7 vs 12.9 vs 15.1 vs 13.7%, P = 0.008). Per 1000 person-year incidence of MACE was the highest in the co-existent OSA and PA group (18.8), followed by OSA or PA (17.8), and the lowest in those without the both (11.0). In Cox regression, patients with co-existent PA and OSA showed 1.61- and 1.99- fold risk for MACE and for cardiac events, compared to those without both PA and OSA, and consistent in PSM.

Conclusions:

Cardiovascular risk in co-existent PA and OSA is higher than that of non-OSA and PA but similar to that of OSA or PA alone in patients with hypertension, suggesting clues for specific treatment of OSA, specially when co-existent with PA.
CARDIOVASCULAR RISK FACTORS AND ARTERIAL HYPERTENSION IN QOM (TOBA) POPULATIONS OF TWO PUBLIC INSTUTIONS IN NORTHERN ARGENTINE
Authors: Romano José René , Yegros Olga , Anair Fernandez , Elieen Ynfante Maira , Camilo Cerruti , Carmen Flores , Ines Perez , O. Marañon Rodrigo
Published: May 2024

Objective:

To evaluate cardiovascular risk factors and control of high blood pressure in Qom (indigenous) populations of northern Argentina.

Design and method:

A descriptive, prospective and observational study was carried out through a survey directed at patients who attended 2 public institutions in the Province of Formosa: one carried out in the city of Formosa (Capital) and another in the town of Las Lomitas, in the interior of the province. It was carried out between the months of July and December 2023. A survey was carried out based on the risk factor variables of the Heart study and others useful for the population studied. The study was carried out under local and international ethical standards and under signed informed consent.

Results:

Of 34 patients surveyed (80% women), 25% were from the capital of Formosa and 75% from the rural area of Las Lomitas. Of the CVRFs, it was observed that 50% had high blood pressure (HTN) at some point, although 22% assumed that they currently had it and the rest did not know it. 97% of the population took their blood pressure at some point and 61% did so in the last year. 51% of hypertensive patients take medication regularly, using one (1) drug in 14%, two (2) drugs in 28% and three (3) drugs in 42%. Regarding the body mass index, it was observed that 55% were obese, having values above provincial and national surveys. In addition, it was found that 8% are active smokers, 23% are diabetic and the same percentage (23%) had cholesterol alterations. 2.9% had chronic renal failure and 5.9% had atrial fibrillation.

Conclusions:

The present study highlights adherence to treatment, the high proportion of diabetes and the lack of cholesterol controls, taking into account the percentage of obese individuals. Although the number of patients is limited, the present study retrieves valuable information to continue with future research that can improve the cardiovascular quality of life of this specific population.
MISSION 70/26 PROJECT: IMPROVING BLOOD PRESSURE CONTROL IN PORTUGAL, THE NUMBERS AFTER ONE YEAR OF ACTIVITY
Authors: Pinho Rosa , Ribeiro Heloisa , Damião Pedro , Viana Manuel , Nogueira José Lima , Abecasis Francisca , Cunha Vitoria , Gonçalves Fernando Martos
Published: May 2024

Objective:

To describe the evolution of the proportion of controlled hypertensive patients under Primary Care after one year of the implementation of a multifaceted program.

Design and method:

We have designed a multifaceted program to promote health literacy and awareness for the prevention, management and control of cardiovascular diseases and health conditions associated with hypertension. The actions are aimed at healthcare professionals and population and includes governmental and organizational intervention. We used the Primary Care national database to address the proportion of hypertensive patients (18-65 years) with blood pressure < 140/90 mmHg and the proportion of hypertensive patients with at least one blood pressure recorded in the last semester.

Results:

In december 2022 there were 52,8% of patients aged 18-65 years with blood pressure <140/90 mmHg in Primary Care following. In december 2023, this number rised slightly to 55,3%. Along the year there were variations, with a peak control level of 61,5% in september 2023. In this last year there was an increase in the number of observed patients and a reduction in the asymmetry of the geographic distribution of the degree of control.

Conclusions:

There has been an improvement in the blood pressure control in hypertensive patients under Primary Care since the beginning of the program. A seasonal variation of the control levels were noted which will require a specific approach.
LOWER MIR-126 PLASMA CONCENTRATIONS IN HUMAN PULMONARY ARTERIAL HYPERTENSION
Authors: Babiak Emil , Vysocanský Samuel , Luknár Milan , Goncalvesova Eva , Pivácková Lenka Bies , Dóka Gabriel , Stollárová Natália , Klimas Ján
Published: May 2024

Objective:

Pulmonary arterial hypertension (PAH) is a fatal incurable disease with complicated and lengthy diagnosis. However, its early detection is a prerequisite for better treatment and longer survival of patients. Therefore, the goal is not only to find new treatment procedures, but also ways to diagnose PAH faster and easier by biomarkers specifically involved in disease progression.

Tissues of the cardiovascular system produce, among others, hsa-mir-126-3p (endothelium) and hsa-mir-423-5p (cardiac muscle). These microRNAs are specific for these tissues and therefore we expect a change in their concentration in patients with PAH. The choice of these molecules was conditioned by a literature search and their sufficient occurrence in human plasma.

Design and method:

MicroRNAs were obtained from the plasma of patients (n = 29) undergoing right ventricular catheterization with observed suspected deteriorated heart conditions in a specialized center (NÚSCH a.s). The samples were processed by modified isolation of nucleic acids using Trizol reagent, transcribed into a DNA sequence by reverse transcription and their expression was determined by PCR reaction.

Results:

In our research, we observed in the plasma of patients with pulmonary hypertension (n = 18, mPAP = 34.61 ± 1.75, PAWP = 22.49 ± 1.72, PVR = 3.21 ± 0.26) and PAH (n = 11, mPAP = 43.73 ± 3.21, PAWP = 9.04 ± 1.04, PVR = 8.29 ± 1.55) a trend of decrease in hsa-mir-423-5p and a statistically significant decrease in hsa-mir-126-3p (p = 0.0188) in patients with PAH.

Conclusions:

The results may indicate that change in expression may be caused by dysregulation of endothelial cells in patients suffering from PAH.
INSIGHTS INTO CHRYSIN'S PROTECTIVE MECHANISTIC PATHWAYS AGAINST ISOPROTERENOL-INDUCED CARDIAC HYPERTROPHY AND FIBROSIS IN RATS
Authors: Srivastava Arti , Verma Vipin Kumar , Bhatia Jagriti , Arya Dharamveer Singh
Published: May 2024

Objective:

Cardiac hypertrophy is associated with the enlargement of cardiomyocytes in response to the persistent release of catecholamine, leading to cardiac fibrosis. Chrysin is a natural flavonoid, present in plants, honey, and propolis, with multifarious properties like antioxidant, anti-inflammatory, anti-fibrotic, and antiapoptotic. This study aims to determine the cardioprotective potential of chrysin against isoproterenol (ISO)-induced cardiac hypertrophy and fibrosis in rats

Design and method:

The male Wistar rats were divided into seven groups (n=6): normal control (carboxymethyl cellulose at 0.5% p.o; normal saline), experimental control (ISO 3mg/kg; s.c), Treatment control (Chrysin 15 mg/kg,30 mg/kg and 60 mg/kg + ISO at 3mg/kg; s.c respectively), perse control (chrysin 60mg/kg) and standard control (losartan 10mg/kg p.o+ ISO at 3mg/kg; s.c) treated for 28 days. On the 29th day, rats underwent surgery and hemodynamic parameters were recorded after sacrificed blood and heart were excised for biochemical, histological, ultrastructural, and molecular evaluations.

Results:

Our findings show that ISO administration significantly increases heart weight: body weight ratio, pro-oxidants, inflammatory and cardiac injury markers. In addition, histopathological, ultrastructural, and molecular studies showed deteriorative changes. While, pre-treatment with chrysin 60mg/kg ameliorated ISO-induced myocardium damage and protected cardiac hypertrophy and fibrosis through anti-inflammatory, anti-apoptotic, anti-antioxidant, and anti-fibrotic pathways

Conclusions:

Data suggest that chrysin mitigates myocardial hypertrophy and prevents fibrosis via activation of the transforming growth factor-beta /Smad signaling pathway
THE RELATIONSHIP BETWEEN CIRCADIAN BLOOD PRESSURE PROFILE AND LEFT ATRIAL MECHANICS, ARTERIAL STIFFNESS AND LEFT VENTRICULAR PERFORMANCE IN HYPERTENSIVE PATIENTS
Authors: Olszanecka Agnieszka , Stopa Marek , Jamros Jan , Jakubowski Wojciech , Sordon Krzysztof , Dadanski Emil , Rajzer Marek
Published: May 2024

Objective:

Background: The left atrium plays a crucial role in managing left ventricular filling and contractility through its functions as a reservoir, conduit, and boost pump. Consequently, the interaction between the left atrium(LA), left ventricle(LV), and the arterial system appears as a critical determinant of comprehensive cardiovascular performance. Non-dipping profile of blood pressure(BP) in 24-hr monitoring(ABPM) is associated with increased cardiovascular mortality and morbidity, including atrial fibrillation and stroke.

We aimed to investigate the association between LA mechanics, LV performance, arterial stiffness and circadian rhythm of BP in essential hypertension.

Design and method:

Hypertensive patients without overt cardiovascular disease were recruited. In all subjects 24-hr ABPM and extended echocardiographic image acquisition protocol were performed(Vivid E95, GE). Carotid-femoral pulse wave velocity(PWV) was measured with the SphygmoCor device(Atcor Medical). All analyses, including LV global longitudinal strain(GLS) and LA reservoir strain(LAR), LA conduit strain(LACD), LA booster pump strain(LACT) were performed off-line. The related factors were evaluated by multivariate linear regression analysis to find the independent factors. Statistical analysis was conducted using SPSS statistics software

Results:

Study group included 219 patients(age 55.3±13.5 years, 55% females). According to BP patterns patients were divided into two groups: non-dippers(n=53), presenting with <10% reduction in both systolic and diastolic BP at nighttime, and dippers(n=166). Non-dippers were older(61.3±11.3 vs 54.2±13.7 years, p<0.01) and exhibited higher BMI(30.2±4.9 vs 28.6±4.5 kg/m2 p<0.01). There were no differences between groups in office BP(non-dippers 128.3±13.3/72.9±9.5 vs 128.1±14.6/75.8±10.8 mmHg in dippers), neither 24hr BP(124.2±13.3/73.5±9.6 vs 121.4±11.5/74.2±7.1 mmHg, respectively). After adjustments for age and BMI, in the non-dipper group higher PWV(8.3±1.2 vs 7.9±1.2, p=0.05) and LACD(-14.7±5.7 vs -17.0±6.7, p<0.001) were observed, with no-differences in LV GLS(-20.7±3.3 vs -19.8±3.9; NS). Multivariate linear regression analysis revealed that age(p<0.001), office(p<0.001) and nighttime SBP(p=0.008)(but not dipping status, p=0.50), diabetes(p=0.02) and creatinine level(p=0.02) were independently corelated with PWV. LACD was independently corelated with age(p<0.001), LV mass(p=0.04) and LV GLS(p=0.03)

Conclusions:

Arterial stiffness and left atrial performance are associated with circadian rhythm of BP. Nocturnal systolic BP but not dipping profile is the independent risk factor of worse arterial and left atrial performance.