bluuebunny/crossref_metadata_2025 huggingface dataset:
ESTIMATED VERSUS MEASURED AORTIC STIFFNESS IN DIALYSIS POPULATION: IMPLICATIONS OF SEX, AGE AND DIABETES
Authors: Cote Nadege , Fortier Catherine , Agharazii Mohsen
Published: June 2023

Objective:

Aortic stiffness is measured through determination of carotid-femoral pulse wave velocity(cfPWV). More recently, authors have proposed to estimate PWV (ePWV) with age and brachial mean blood pressure (MBP) using an equation for the normal population and another for subjects with cardiovascular risk factors. However, patients with end-stage kidney disease are at extremely high risk of cardiovascular disease and have an altered circulatory system due to no perfusion of the kidneys. Therefore, the aim of this study was 1)examine the reliability of the ePWV as compared to measured cfPWV, and 2)examine if sex, age and diabetes have an impact on the relationship between ePWV and cfPWV in this population.

Design and method:

This is a cross-sectional study of 317 adults treated by chronic hemodialysis(n = 252) or peritoneal dialysis(n = 65). cfPWV was measured using second derivative algorithm through simultaneous recording of carotid and femoral arteries in triplicates(CompliorSP) using 80% of the direct distance between the carotid and femoral arteries. ePWV was calculated using the formula for subjects with cardiovascular risk factors from the Reference Values for Arterial Stiffness Collaboration.

Results:

In 317 patients(68%men), with a mean age of 65 ± 15 years, 43% had diabetes, 91% had hypertension and 52% had cardiovascular disease. MBP, cfPWV and the difference between ePWV and cfPWV(↗PWV) were respectively 92 ± 17mmHg, 10.8 ± 3.2m/s and 0.36(-5.87 – 11.84) in the overall group.

Male sex, first and second age tertiles, and diabetes were associated with a negative ↗PWV. ePWV underestimated cfPWV in men (-0.80, 95%CI: -1.17 – -0.43, p < 0.001), in patients from the first (18-60 years)(-0.64, 95%CI: -0.94 – -0.32), p < 0.001) and second (60 - 73 years)(-0.50, 95%CI: -1.01 – 0.01,p = 0.053) tertiles of age, and in patients with diabetes(-1.08, 95%CI: -1.55 – -0.60, p < 0.001). ePWV was relatively accurate to estimated cfPWV in women (0.28, 95%CI: -0.09 – 0.66, p = 0.132) and in patients from the last age tertile(73 - 89 years)(0.05, 95%CI: -0.51 – 0.66,p = 0.866).

Conclusions:

These findings suggest that sex, age tertiles and diabetes impact the relationship between ePWV and cfPWV in our cohort of patients on dialysis; therefore the formula used to estimate PWV may benefit from better integrating these determinants for a more accurate ePWV.
INTRACRANIAL PRESSURE WAVEFORM AND HYPERTENSION
Authors: Costa Matheus Martins Da , Lima Lucas Monteiro , Costa Thiago Oliveira , Alves Ana Carolina Rodrigues , Correia Mikaelle Costa , Vitorino Priscila Valverde O. , Sousa Ana Luiza Lima , Frigieri Gustavo , Barroso Weimar Kunz Sebba
Published: June 2023

Objective:

Noninvasive intracranial pressure waveforms for estimation of intracranial hypertension have been previous validated and a P2/P1 ratio over 1,2 shows a good correlation with this damage. 1,2,3 In animal models, with induced hypertension, it has been observed a significative increase in P2/P1 ratio 2 weeks later. 4 Our objective, as a proof of concept, was to observe followed treated hypertensive patients concerning the rate of P2/P1 behavior.

Design and method:

The evaluation procedure of noninvasive intracranial pressure waveforms have been performed in 62 treated hypertensive patients with 7 minutes length. First and last minutes were discarded as well any test with poor quality wave signal at any moment. Data concerning systolic and diastolic blood pressure (BP) measured with OMRON automatic device HBP 1100 were obtained at the same moment as well the variables of age, body mass index (BMI), anti-hypertensive drugs and a history of diabetes (DM), stroke (ST) or myocardial infarction (MI). Descriptive statistics tests were used through the measurement of central tendency (mean), dispersion (standard deviation) and frequency (percentage). T Student and ANOVA as parametric tests and qui squared for categorical variables.

Results:

Data from 52 patients were validated. Mean age of 64,6 years, 63,5% female, BMI 28,4 +- 5,4 Kg/m2, 48,1% with diabetes. Mean systolic and diastolic office BP measurements of 141,6 +- 25,4 mmHg and 85,2 +- 14,7 mmHg respectively and 53,8% with controlled hypertension (systolic BP < 140 mmHg and diastolic BP < 90 mmHg). P2/P1 ratio over 1,2 has been found in 75% of the sample and there were no differences concerning controlled and non-controlled hypertension, number of anti-hypertensives drugs, or comorbidities as DM, ST or MI but at this moment we have to consider the small size of the sample to achieve enough power to detect these differences or correlations.

Conclusions:

The prevalence of 75% of P2/P1 ratio over 1,2 (equivalent to intracranial hypertension) deserves attention from scientific community since it raises a question about blood-brain barrier protection and can help to explain the huge association between hypertension and cerebrovascular diseases.
CLINICAL AND DEMOGRAPHIC DETERMINANTS OF PULSE WAVE VELOCITY TRAJECTORIES IN HYPERTENSIVE PATIENTS: A RETROSPECTIVE STUDY
Authors: Eula Elisabetta , Khettab Hakim , Pappaccogli Marco , Rabbia Franco , Boutouyrie Pierre , Bruno Rosa Maria
Published: June 2023

Objective:

Arterial stiffness (AS) is a strong predictor of cardiovascular disease and all-cause mortality. Its behaviour over time, assessed through repeated measurements, is still largely unexplored. The aim of this study was to assess the clinical and demographic determinants of trajectories of carotid-femoral pulse wave velocity (cf-PWV) in a cohort of French hypertensive adults.

Design and method:

From a population of 7806 patients referred to HEGP Pharmacology Unit (Paris, France) from 1981 to 2022, we selected those who had at least 3 cf-PWV recordings over time. Those with missing treatment information or rare vascular diseases were excluded. Cluster of trajectories analysis was performed and multinomial regression was used to detect differences in baseline characteristics between the identified clusters.

Results:

564 patients were included in the analysis (median follow-up was 4.2 [3.2-6.4] years). Four clusters of stiffness trajectories were identified: low-stable (A, n = 199), medium-stable (B, n = 184), high-increasing (C, n = 127), and high-low-high (D, n = 54) clusters (Figure 1). Mean BP (MBP) and cf-PWV at baseline were progressively higher in the medium-stable, high-increasing, and high-low-high clusters compared to the stable one (MBP was 96 ± 12, 99 ± 12 and 101 ± 15 mmHg in clusters B, C, and D vs 92 ± 12 mmHg in cluster A; cf-PWV was 9.7 ± 1.2, 11.6 ± 1.6 and 15.3 ± 2.7 m/s in clusters B, C, and D vs 7.7 ± 1.0 m/s in cluster A; all p < 0.001).

On multinomial regression analysis, older age, higher MBP, and diabetes were associated to increased probability of belonging to either C or D clusters when compared to the stable one. Anti-hypertensive treatment with blockers of renin-angiotensin system (RAS) was associated with a decreased probability of belonging to the C or D clusters (Table 1).

Conclusions:

This real-life data obtained by repeated cf-PWV assessments on a large time span shows that patients who will experience PWV worsening over time are characterized by older age, higher MBP and diabetes at baseline. The use of RAS blockers has a protective effect on PWV trajectories.
URINE SODIUM-TO-POTASSIUM RATIO DOES NOT ACCURATELY REFLECT DIETARY SODIUM-TO-POTASSIUM RATIO
Authors: Vliet Myrthe van , Zwager Charlotte , Rauh Manfred , Titze Jens , Engberink Rik Olde
Published: June 2023

Objective:

High sodium intake is associated with an increased risk of cardiovascular disease, whereas a high potassium intake is associated with a reduced risk. Dietary counselling requires accurate estimation of sodium and potassium intake, but 24-hour urine sodium and potassium excretion demonstrated not to reflect actual intake. Urine sodium-to-potassium (Na/K) ratio is a promising alternative as it may be less affected by aldosterone-induced rhythmic changes in total body sodium and potassium content, is less influenced by incomplete urine collections, and incorporates both the effect of sodium and potassium. Our study assesses whether 24-hour urine Na/K ratio is superior in predicting dietary intake compared to 24-hour urine sodium or potassium excretion.

Design and method:

A post-hoc analysis was performed on data from the long-term sodium balance studies Mars105 and Mars520. Ten healthy participants received a diet with a known sodium and potassium content and collected 24-hour urine samples for 105 or 205 days. We calculated the log fold difference between dietary intake and urine content of sodium, potassium and Na/K ratio. We compared these estimates of accuracy using a mixed-effects model with a random intercept per subject. We analysed whether the accuracy differed among 6, 9 and 12 grams salt intake or was affected by the number of 24-hour urine collections.

Results:

Urine Na/K ratio underestimated dietary Na/K ratio with a median difference of -0.21 (IQR -0.47 to 0.09). Compared to sodium and potassium assessment, the Na/K ratio was significantly less accurate in predicting intake (Figure 1A). Only for the 6 gram salt phase the Na/K ratio did not perform significantly worse than sodium measurements. Increasing the number of 24-hour urine measurements to three or seven improved accuracy of the Na/K ratio, although it remained inferior to separate assessment of sodium and potassium excretion (Figure 1B).

Conclusions:

The 24-hour urine Na/K ratio is less accurate than 24-hour urine sodium excretion for estimation of dietary intake in a controlled setting.
PROMOTING PATIENT HYPERTENSION SELF-MANAGEMENT BEHAVIORS WITH THE EVIDENCE-BASED PROGRAM, HEALTH COACHES FOR HYPERTENSION CONTROL
Authors: Dye Cheryl , Williams Joel , Evatt Janet
Published: June 2023

Objective:

To improve patient self-management of hypertension with a peer-led, community-based educational program which activates participants to make lifestyle changes by delivering personally relevant and meaningful information addressing psychosocial determinants of self-management behaviors.

Design and method:

The eight-session educational curriculum, Health Coaches for Hypertension Control (HCHC), was developed using the US National Institute of Health Stage Model approach to behavioral intervention development. In Stage II and III it was tested for efficacy through implementation with 146 participants using a pre- and posttest evaluation design including process, impact, and outcome measures. In Stage IV, it was evaluated for changes in knowledge and psychosocial measures using a batch randomization to intervention or wait-control group with 185 participants.

Results:

Stage IV research revealed that compared with control group participants, a higher proportion of treatment group participants moved from the cognitive to behavioral stages of motivational readiness for being physically active (P < .001), practicing healthy eating habits (P = .001), handling stress well (P = .001), and living an overall healthy lifestyle (P = .003). They also demonstrated a greater average increase in perceived competence for self-management, F(1.134) = 4.957, P = .028, and a greater increase in mean hypertension-related knowledge, F(1.160) = 16.571, P < .0005. The US Department of Health and Human Services, Administration for Community Living designated HCHC as an Evidence-Based Program in 2018. Since that time, Stage V (“implementation and dissemination”) research has demonstrated that HCHC has been successfully disseminated both in-person and on-line in 15 US states.

Conclusions:

HCHC is recommended as an extension of clinical patient education to support increasing health system interest in promoting sustainable patient outcomes through effective self-management. An agency wishing to disseminate HCHC would need to secure a license agreement to use copyrighted materials and arrange for certification of Master Trainers by the HCHC program manager. Master Trainers may then offer HCHC themselves or train lay leaders to offer the program.
BRD4 INHIBITION ATTENUATES OBESITY-RELATED MICROVASCULAR DYSFUNCTION: ROLE OF ENDOTHELIUM AND PERIVASCULAR ADIPOSE TISSUE
Authors: Mengozzi Alessandro , Costantino Sarah , Duranti Emiliano , Mohammed Shafeeq , Gorica Era , Armenia Silvia , Cappelli Federica , Taddei Stefano , Masi Stefano , Paneni Francesco , Virdis Agostino
Published: June 2023

Objective:

Bromodomain and extraterminal (BET) proteins, particularly BRD4, are epigenetic readers modulating transcriptional programs implicated in inflammation, cancer and renal disease. Though several findings suggest that BET proteins’ inhibition might be particularly relevant in the cardiometabolic field, an apparent evidence gap hinders its therapeutic potential. We aimed to define the impact of BRD4-related inflammatory response in the early stages of obesity to exploit the therapeutic potential of its inhibition.

Design and method:

Healthy controls (n = 13) and patients with obesity without other comorbidities (n = 13) were included in a case-control study. Small arteries from visceral fat depots were mounted on a pressurised myograph to assess vasorelaxation to acetylcholine and inhibition to L-NAME at baseline and after incubation with RVX-208 (an FDA-approved BRD4 inhibitor), canakinumab (targeting IL-1beta), tocilizumab (targeting IL-6 receptor) and infliximab (targeting TNF-alpha). The experiments were conducted, in parallel, on two vessels, one mounted with perivascular adipose tissue (PVAT) and the other without PVAT. Vascular- and PVAT-specific levels of NAPDH-derived ROS, mtROS and nitric oxide availability were assessed by confocal microscopy. Gene expression was evaluated by qPCR.

Results:

In patients with obesity, microvascular function and nitric oxide availability were reduced, where NADPH- and mtROS were increased. BRD4, TNF-alpha, IL-1beta and IL-6 expression levels were higher in the vessel wall and the PVAT of patients with obesity. In these patients, RVX-208 substantially attenuated microvascular dysfunction. The effect was more significant in vessels with intact PVAT, implying a restoration of the PVAT anti-contractile phenotype (Figure). The exploration of the distinct inflammatory pathways showed that the amelioration observed with BRD-4 inhibition was higher than with canakinumab, tocilizumab or infliximab. Peculiarly, anti-IL-1beta restoration of microvascular function was not affected by the presence of the PVAT, while the ones observed with the targeting of IL-6 receptor and TNF-alpha were.

Conclusions:

The inhibition of BRD4 restores microvascular dysfunction in patients with obesity by modulating pan-inflammatory response involving distinct IL-1beta, IL-6 and TNF-alpha pathways and restoring PVAT anti-contractile properties. Epigenetic drugs might represent a promising therapeutic strategy to rescue microvascular dysfunction, a hallmark of early cardiometabolic disease.
TRENDS IN PREVALENCE OF HYPERTENSION IN PREGNANCY IN THE CZECH REPUBLIC BETWEEN 2012-2021
Authors: Vaclavik Jan , Jarkovsky Jiri , Pohlova Radka , Jirova Jitka , Zouharova Anna
Published: June 2023

Objective:

Arterial hypertension affects about 5-10% of pregnancies and has detrimental effects on pregnancy outcomes in both the mother and fetus. The aim of this study was to analyze the trends of the prevalence of hypertensive diseases in pregnancy in the Czech Republic during the past decade.

Design and method:

Nationwide data on all births and abortions in the period 2012-2021 in the Czech Republic were obtained from the National Registry of Reproductive Health (NRRZ) and the National Registry of Reimbursable Health Services (NRHZS). Women who had the diagnosis I10 whithin one year before pregnancy and were prescribed an antihypertensive drug from selected ATC groups (C02, C03, C07, C08, C09) were classified as pre-existing hypertension. Women diagnosed with O13 or I10 during pregnancy and prescribed a drug from selected ATC groups were classified as pregnancy induced hypertension. Descriptive statistics were used to evaluate the prevalence.

Results:

There were 105,790 births in 2012 and 108,350 births in 2021. The proportion of women with pre-existing hypertension was almost unchanged between 2012 - 2021, between 0.86 - 0.94%. The overall proportion of women with hypertension in pregnancy and lifebirth delivery was also stationary and oscillated between 5.6% - 5.9% (Table 1). A higher prevalence of hypertension was found in women with deliveries of children with lower gestational age. The number of abortions decreased from 37,897 to 28,547 between 2012 - 2021. The proportion of women with abortion/stillbirth and hypertension detected before pregnancy increased from 1.05% to 1.38% in this period, the overall proportion of women with hypertension in pregnancy terminated by abortion/stillbirth increased from 1.2% to 1.6% (Table 2). For all pregnancies, the prevalence of hypertensive diseases in pregnancy remained relatively unchanged and oscilated between 4.44% - 4.74% (Table 3) during the reporting period.

Conclusions:

The prevalence of hypertension in pregnancy in the Czech Republic remained almost unchanged in the period 2012 - 2021 and was similarly high as in other Western countries.
SERUM COPEPTIN AS A PROGNOSTIC MARKER IN PRE-ECLAMPSIA
Authors: Jaques David , Dufey Anne , Wuerzner Grégoire , Othenin-Girard Véronique , Tejada Begona Martinez De , Pechere Antoinette , Ponte Belen
Published: June 2023

Objective:

Pre-eclampsia (PE) is as a risk factor for subsequent cardiovascular and kidney disease. Serum copeptin correlates with adverse kidney outcomes in the general population and is increased during PE as compared to healthy pregnancy. We describe the association between copeptin and subsequent kidney outcomes in pregnant women.

Design and method:

We enrolled 372 patients with PE and 82 with healthy pregnancy in this prospective cohort study. Serum copeptin was measured at 6 weeks post-partum (PP). Office blood pressure (BP), eGFR and albuminuria were measured at 6 weeks as well as at 1 year PP in a sub-group of 110 patients. Interaction effect was tested using likelihood ratio test (LRT).

Results:

As compared to healthy controls, patients with PE were less frequently Caucasian, more likely smokers and had higher body mass index (p < 0.05). At 6 weeks PP, copeptin levels were similar between groups. At one year PP, systolic BP (SBP), diastolic BP (DBP) and albuminuria were higher in PE as compared to control patients (p < 0.05) while eGFR was similar between groups. A significant interaction existed between copeptin and PE status regarding DBP at 1 year PP (p = 0.045 for LRT). A similar but borderline interaction existed between copeptin and PE status for albuminuria at 1 year PP (p = 0.126 for LRT).

Conclusions:

At 6 weeks PP, women who suffered from PE do not have increased copeptin levels as compared to healthy controls. However, in case of PE only, copeptin levels are associated with subsequent adverse kidney outcome. Whether this association is causal and would represent a potential therapeutic target remains to be tested.
PREGNANCY-RELATED COMPLICATIONS IN PRIMARY ALDOSTERONISM: A EUROPEAN SURVEY
Authors: Forestiero Vittorio , Landau Ester , Roa Juan Solorzano , Riancho Julien , Burrello Jacopo , Sconfienza Elisa , Monticone Silvia , Reincke Martin , Quinkler Marcus , Azizi Michel , Boulestreau Romain , Mulatero Paolo , Amar Laurence
Published: June 2023

Objective:

Hypertensive pregnancy disorders, affecting 4 - 25% of pregnancies according to countries’ income, represent a major cause of maternal and fetal morbidity and mortality. Data on pregnancy's complications in patients with primary aldosteronism (PA) are scarce, despite PA being the most frequent cause of secondary hypertension. We did an international survey to collect maternal and fetal pregnancy-related complications in a cohort of women with PA recruited from 5 Hypertension Excellence Centers in Europe.

Design and method:

We included consecutive women aged 18 - 45 years who were pregnant either after or <1-year before diagnosis of PA and excluded those who were pregnant after unilateral adrenalectomy for PA. PA diagnosis was made in each center according to guidelines. Information on maternal and fetal issues was obtained through medical records and patients’ interviews.

Results:

We included 78 women aged 30 ± 6 years, 33% nulliparous, 14% with past pre-eclampsia, 53% with hypokalemia, 4% smokers, 7% with type II diabetes, 4% with chronic kidney disease. They had 97 pregnancies, of which 43 occurred <1 year before PA diagnosis and 54 after a median of 18 months from PA diagnosis. All women had either chronic or new onset gestational hypertension (12%). Excluding 7 spontaneous miscarriages, pregnancy-related complications occurred during 43 out of 90 pregnancies (44%), including proteinuria in 36 (40%), pre-eclampsia in 27 (30%), placental abruption in 2 (2%) and intrauterine fetal death in 6 pregnancies (7%). There was a high rate of delivery morbidity including 30% of pre-term births occurring at a median of 34 weeks of gestational age, and 35% of cesareans sections. A total of 23 out of 84 (27%) newborns had a low birth weight (<2500 g) and 22 (26%) underwent neonatal intensive care. When compared to historical control cases from a systematic review, women with PA showed similar rates of maternal complications vs women with essential chronic hypertension, but higher rates of fetal complications (Figure 1).

Conclusions:

Our data emphasize the importance of PA screening in young hypertensive women prior pregnancy, to ensure 1) appropriate and early treatment of PA, and 2) strict follow-up during pregnancy.
FREQUENCY OF MEDICAL OUT-PATIENT VISITS AND USE OF HOME BLOOD PRESSURE MONITORING IN HYPERTENSIVE PATIENTS IN FIVE EUROPEAN COUNTRIES
Authors: Burnier Michel , Azizi Michel , Persu Alexandre , Prejbisz Aleksander , Cunha Vitoria , Gupta Pankaj , Vaclavik Jan , Versmissen Jorie , Kreutz Reinhold
Published: June 2023

Objective:

We assessed the frequency of out-patient visits for hypertension and the use of home blood pressure monitoring (HBPM) in 5 European countries.

Design and method:

We used the data of a web-based questionnaire developed by the Working group on Lifestyle, Cardiovascular Therapy and Adherence to investigate patients’ perspectives on hypertension management. Eligible participants were adult men and women, living in France, Germany, Italy, Spain and UK, with a confirmed diagnosis of hypertension. Data were collected through patients’ organizations and internet from January to March 2022.

Results:

From January to March 2022, we included 2757 participants, 46% women, 94% older than 60 y, 71% with hypertension duration >5y, 95% (91% for >3 months) treated with a mean of 1.7 antihypertensive pills /day (all medications: 4.1 pills/day). The out-patient visit frequency was monthly in 3% of the participants, once every 1 to 3 months in 23%, once every 3 to 6 months in 28%, once every 6 to 12 months in 30%, and less than once a year in 13%. There was large between-country variability in visit frequency (e.g., once every 1 to 3 months: 5% in UK, 21% in Germany, and 42% France; once every 6 to 12 months: 47% in UK, 23% in Germany, and 13% in France). Overall, 67% of participants performed HBPM themselves and 13% with an external help. HBPM was done on a regular basis in most patients (17% every day, 26% several times a week, 35% several times a month) while 8% did HBPM only when not feeling well. HBPM was performed more frequently in Germany and less in UK. Patients at higher cardiovascular risk did HBPM more frequently.

Conclusions:

There are no strong evidence-based recommendations on the frequency of out-patient visits for hypertension during long-term follow-up. Our survey shows a large variability between European countries in the way patients are followed. Moreover, strong implementation of HBPM is found in all countries, but the ESH protocol is not strictly followed. Therefore, studies are needed to define the most cost-effective hypertension follow-up and ESH recommendations for HBPM should be reinforced.
HELLENIC CARDIORENAL MORBIDITY SNAPSHOT (HECMOS). HIGH PREVALENCE OF DIFFICULT-TO-CONTROL HYPERTENSION IN CARDIOLOGY INPATIENTS WITH COMORBIDITIES
Authors: Iliakis Panagiotis , Ntalakouras Ioannis , Valatsou Aggeliki , Kakouri Niki , Papaioannou Nikos , Sawafta A. , Lambropoulos S. , Vlad Id , Moschos N. , Albanis G. , Koudounis G. , Koufou E. , Chatzieleutheriou C. , Foukarakis E. , Thomopoulos Costas , Marketou Maria , Stamatelopoulos K. , Zarifis I. , Vasilikos V. , Tsioufis Konstantinos
Published: June 2023

Objective:

Uncontrolled hypertension (HTN) remains a major public health problem, especially among older people with multiple comorbidities. We aimed to show the prevalence of uncontrolled HTN among the HECMOS participants.

Design and method:

HECMOS was a nationwide crossection survey of cardiorenal morbidity among 923 cardiology inpatients on the 3rd of March 2022 via an electronic case report form. Uncontrolled HTN was defined under the current ESH/ESC HTN guidelines, while patients with an estimated glomerular filtration rate below 60 ml/min/1.73m2 were considered as cases of chronic kidney disease (CKD).

Results:

HTN prevalence was linearly related to patients’ age, whereas difficult-to-control HTN showed a similar trend, found to be higher among patients older than 80. There was a statistically significant difference (p = 0,001) in HTN prevalence between patients aged over 60 years (60 - 69:71,1%, 70 - 79:74,1%, >OR = 80:79,0%) and younger participants (<40:3,1%, 40 - 49:33,3%, 50 - 59: 48,5%). HTN history was similarly reported among cases of Heart Failure (HF), Diabetes Mellitus (DM), Atrial Fibrillation (AF), and CKD, the four more prevalent morbid conditions in our sample. Nevertheless, HTN prevalence was higher in CKD and DM patients than in others without CKD or DM (76.6% vs. 63.6%, 77.6% vs. 61.4%, respectively, p = 0.001).

Conclusions:

In this nationwide opportunistic survey, HTN and difficult-to-control HTN was highly prevalent among cardiology inpatients of older age, CKD, and DM.
PROFILE OF ELDERLY HYPERTENSIVE PATIENTS IN NEPHROLOGYCONSULTATION: ABOUT 61 CASES
Authors: Triqui Chifa , Khadhar Mariem , Hadded Sarra , Jerbi Mouna , Aoudia Raja , Gaied Hanene , Goucha Rim
Published: June 2023

Objective:

Hypertension is a cardiovascular risk factor and a cause of morbidity and mortality, especially in elderly population.

The aim of this work was studying the profile of elderly hypertensive patients, the associated risk factors and the proposed therapeutic modalities.

Design and method:

It was a retrospective descriptive study conducted in nephrology consultation from January 2020 to January 2022. Hypertensive patients over 65 years old were included. Cardiovascular risk was stratified according to the ESC 2019 recommendations. Chronic kidney disease (CKD) stage was defined according to the KDIGO classification. Therapeutic target was defined as Systolic Blood Pressure (SBP) <150mmHg.

Results:

Sixty-one patients were included,mean aged 72.5 years with a sex ratio M/F 1.25. The average age at the time of discovery of hypertension was 60.12 years [38-85]. Fifty-five patients were followed for nephropathy (90.16%). The dominant stages of CKD were 3 and 4 (in 28 and 12 patients respectively).

Among our population, thirty-four patients were diabetic (55.73%), 21 were dyslipidemic (34.42%), 12 patients had coronary disease (19.67%) and seven patients were active smokers (11.47%).

Among the diabetic patients, hypertension was considered as a diabetic macroangiopathy in 15 patients (44.11%). Metabolic syndrome was found in 21 patients (34.42%). Thirteen patients were classified as very high cardiovascular risk, 34 as high risk, and 9 as moderate risk. The mean SBP was 140mmHg+/-24.28. Vascular nephropathy was found in 28 patients (45.9%) and left ventricular hypertrophy in 3 patients (4.91%).

The therapeutic target was achieved in 42 patients (68.85%) of whom 24 were on a calcium channel blocker, 28 were on a Renin-angiotensin-aldosterone (RAAS) blockers, 15 on a combination containing a loop diuretic and 10 on a central antihypertensive.

Treatment complications requiring a change in therapy were orthostatic hypotension in 3 patients on a central antihypertensive and hyperkalemia with acute renal failure in five patients on a RAAS blockers.

Conclusions:

Hypertension in the elderly is associated with multiple comorbidities mainly diabetes. Regular follow-up of this population with adaptation of treatment is necessary to reduce mortality rate and prevent complications related to hypertension and treatment.
PREVALENCE AND DETERMINANTS OF VASCULAR AGING IN AUSTRIA – A HOLISTIC VIEW: THE LEAD STUDY
Authors: Danninger Kathrin , Weber Thomas , Asgar Shervin , Breyer Marie-Kathrin , Breyer-Kohansal Robab , Kaufmann Christoph , Boutouyrie Pierre , Bruno Rosa Maria , Mayer Christopher , Hartl Sylvia , Burghuber Otto C.
Published: June 2023

Objective:

Vascular aging (VA) is an important and prognostically relevant aspect of biological aging. Its determinants are incompletely understood, and a holistic view is missing.

Design and method:

The LEAD (Lung, Heart, Social, Body) study is an ongoing, longitudinal, population-based observational study, which started in 2011 in Vienna and six villages from Lower Austria. As part of the study, carotid-femoral pulse wave velocity (cfPWV) was measured non-invasively using applanation tonometry. In a predefined healthy normal population (non-smokers without known hypertension, diabetes, hyperlipidemia or cardiovascular disease, free from antihypertensive and lipid-lowering medication, blood pressure below 130/85 mmHg), age-specific Z-scores for cfPWV were calculated. Healthy (HVA), normal (NVA) and early (EVA) VA was defined as cfPWV value < 10th, 10th-90th, and >90th percentile, respectively.

Results:

In the overall population (n = 7924, 54.2% women, age 6-82 years), the prevalence of HVA/NVA/EVA was 7.3/70.3/22.4%, respectively, with EVA prevalence increasing in older age. NVA and EVA, as compared to HVA, were independently associated with age, hemodynamic parameters (blood pressure, heart rate), metabolic factors (diabetes), body composition (lean mass index), psychosocial (marital status), and socio-economic (socioeconomic status score, income, educational level) factors.

Conclusions:

In this large population-based study we observed a high percentage of early vascular aging in Austria. Besides age itself, hemodynamic factors and diabetes, body composition, psychosocial and socio-economic factors play an independent role in vascular aging. Cardiovascular prevention clearly needs to be improved and should be targeted towards high blood pressure on the one hand, but be holistically oriented on the other side.
PSYCHOSOCIAL STRESSORS AT WORK AND ATRIAL FIBRILLATION INCIDENCE: A 18-YEAR PROSPECTIVE STUDY
Authors: Trudel Xavier , Tiwa-Diffo Edwige , Milot Alain , Brisson Chantal , Lavigne-Robichaud Mathilde , Gilbert-Ouimet Mahée , Vézina Michel , Talbot Denis , Trudel Xavier
Published: June 2023

Objective:

Psychosocial stressors at work are generally defined according to the job strain and the effort-reward imbalance at work (ERI) models. These work stressors were shown to increase coronary heart disease risk, with a higher risk among workers exposed to both stressors. The effect of combined exposure to both work stressors on atrial fibrillation (AF) incidence is not known. The aim of the present study was to examine the separate and combined effect of job strain and effort-reward imbalance at work on atrial fibrillation incidence.

Design and method:

The study design was a prospective cohort study. A total of 5,926 white-collar workers (3,021 women and 2,905 men) free of cardiovascular disease at baseline were followed for 18 years. Psychosocial stressors at work were measured according to the job strain and ERI models using validated instruments. AF events were identified in medical databases with universal coverage. Hazard ratios (HR) with 95% confidence intervals were estimated using Cox regression models, adjusting for socioeconomic characteristics, lifestyle-related factors and clinical factors.

Results:

During the follow-up, 186 AF events were identified. Workers exposed to job strain (HR = 1.8; 95% CI 1.1-2.9) or effort-reward imbalance at work (HR = 1.4; 95% CI 1.1-2.0) had a higher risk of AF, following adjustment for socioeconomic characteristics, lifestyle and clinical risk factors. Combined exposure to job strain and ERI was associated with a two-fold AF risk increase (HR = 2.0; 95% CI 1.3-3.1) in fully adjusted models.

Conclusions:

Workers exposed to job strain or effort-reward imbalance at work, separately and in combination, were at increased AF risk. Prevention strategies targeting psychosocial stressors at work should be considered to decrease the burden associated with AF.
THE IMPACT OF HYPERTENSION IN PATIENTS PRESENTING HEART FAILURE WITH AND WITHOUT ATRIAL FIBRILLATION
Authors: (Pogacean) Manuela -Claudia Lacatusu , German-Sallo Marta , Tatar Maria Cristina
Published: June 2023

Objective:

Both atrial fibrillation and heart failure represent etiological factors for each other, while hypertension does the same for them.

Our aim consisted in identifying the degree of which the presence of hypertension contributed as a risk factor for developing atrial fibrillation in patients suffering from heart failure.

Design and method:

We analysed 129 patients with heart failure in sinus rhythm and 158 patients with heart failure and atrial fibrillation, both group patients being randomly selected from year 2019 to 2021. The study included patients admitted to a chronic patient care unit.

Results:

We performed a Fisher's exact test based on a contingency table including N = 132 patients with heart failure and atrial fibrillation exposed to the presence of hypertension, as well as N = 105 patients with heart failure in sinus rhythm without hypertension (nominal values of the groups are shown in Fig. 1). With the risk for the exposed (R1) being 0.557 and the risk for the unexposed (R0) 0.52, we obtained an RR of 1.071, meaning that patients with hypertension have a 1.071-fold increased risk of developing atrial fibrillation in patients with heart failure. Also, there is an association between atrial fibrillation and hypertension (RR>1).

Conclusions:

The link between atrial fibrillation, heart failure and hypertension is a well-debated topic in the medical world. In this study, we illustrated that although hypertension represents a frequent comorbidity, in patients with heart failure it encounters more often in association with atrial fibrillation, rather than in patients with sinus rhythm. This finding has led us to believe that our aim as medical practitioners would consist in a better blood pressure control, as well as improved treatment adherence, in order to prevent the development of atrial fibrillation and heart failure pathogenesis.
MACHINE LEARNING IN HYPERTENSION DETECTION: A STUDY ON WORLD HYPERTENSION DAY DATA
Authors: Pengo Martino , Montagna Sara , Ferretti Stefano , Bilo Grzegorz , Borghi Claudio , Ferri Claudio , Grassi Guido , Muiesan Maria Lorenza , Parati Gianfranco
Published: June 2023

Objective:

Many modifiable and non-modifiable risk factors have been associated with hypertension. However, current screening programs are still failing in identifying individuals at higher risk of hypertension. Given the major impact of high blood pressure on cardiovascular events and mortality, there is an urgent need to find new strategies to improve hypertension detection.

We aimed to explore whether a machine learning (ML) algorithm can help identifying individual predictors of hypertension.

Design and method:

We analysed the data set generated by the questionnaires administered during the World Hypertension Day from 2015 to 2019. Demographic information (age, sex, BMI), self-reported information on cardio- vascular risk factors (hypertension, diabetes, smoking, high cholesterol, kidney disease, family history of cardiovascular diseases), sleep complaints (snoring, witnessed apneas, daytime sleepiness) and prior cardiovascular diseases (previous cardio and cerebrovascular events, previous myocardial infarction) as well as information about the awareness of hypertension and its health consequences were collected through the questionnaire. We computed the performance (sensitivity and specificity) of standard screening programmes as recommended by World Health Organisation and of five different ML algorithms, exploiting different balancing techniques (oversampling and undersampling).

Results:

A total of 20206 individuals (mean age 50.89 years, 51.65% females) have been included for analysis. Results show that a gain of sensitivity reflects in a loss of specificity, bringing to a scenario where there is not an algorithm and a configuration which properly outperforms against the others (Table 1). However, Random Forest provides the most interesting balance between sensitivity and specificity with a greater Area Under the Curve compared to the standard screening programs (Table 1).

Conclusions:

Detection of hypertension at a population level still remains challenging and a machine learning approach could help in making screening programs more precise and cost effective, when based on accurate data collection. More studies are needed to identify new features to be acquired and to further improve the performances of ML models.

Table 1: Performance in the test set of the three experimented schemes, original, oversampling and undersampling the training set, and of the medical protocol evaluation.
COMPARISON OF CLINICAL BENEFITS BETWEEN TELMISARTAN AND OTHER ANGIOTENSIN RECEPTOR BLOCKERS IN HYPERTENSION PATIENTS WITH COMBINATION THERAPY: MULTICENTER REAL-WORLD STUDY
Authors: Joo Hyung Joon , Yum Yunjin , Kim Yong Hyun , Kim Eung Ju
Published: June 2023

Objective:

Background Telmisartan have potent blood pressure lowering effect as well as the other pleiotrophic effects including PPAR-??/?? dual activation. In large clinical studies, telmisartan demonstrated the comparable clinical benefits with angiotensin converting enzyme inhibitor. However, there were few studies of direct comparison between telmisartan and the other angiotensin receptor blockers (ARBs). This study aimed to compare the cardiovascular and renal protective effect between telmisartan and the other ARBs in patients with the advanced hypertension who required two or more anti-hypertensive drugs.

Design and method:

This study used the Observation Medical Outcomes Partnership-Common Data Model database of three tertiary hospitals in Korea. 19,247 Patients were prescribed at least two antihypertensive drugs including ARBs, were selected from January 1, 2017 to December 31, 2019. 3,437 patients in the telmisartan group and 15,810 patients in the other ARB group were matched 1:1 through propensity score matching. Major adverse cardiovascular event (MACE), heart failure (HF) hospitalization and new-onset dialysis were compared for 3,386 patients in each group.

Result: Before the matching, there was a higher proportion of patients with a history of myocardial infarction (MI) in the telmisartan group compared to the other ARB group. After the matching, average on-treatment blood pressure was similar between two groups. Over a three-year period, the incidence of MACE and HF hospitalization did not differ significantly between the two groups. Compared to the other ARB group, the telmisartan group had a lower incidence of new-onset dialysis (1.3% vs 1.9%, p-value = 0.04). However, this difference was not statistically significant in the multivariable Cox regression model.

Conclusions:

Telmisartan has similar cardiovascular and renal protective effects to other ARBs in patients with advanced hypertension who are taking at least two anti-hypertensive medications.

Figure. Kaplan-Meier curves showing the incidence of MACE and dialysis in the telmisartan group and the other ARB group.
INCREASED IONIZED CALCIUM-MAGNESIUM RATIO IN ELDERLY HYPERTENSIVES
Authors: Kisters Klaus , Groeber Uwe , Kisters Lukas
Published: June 2023

Objective:

Alterations in the metabolism of calcium and the biofactor magnesium can be involved in the pathogenesis of essential hypertension. Serum magnesium concentrations only insufficiently reflect disorders in magnesium handling in humans, as only about 1% of total body magnesium stores are in blood. The calcium and magnesium flux across the external membrane is regulated by a calcium pump (calcium-magnesium-ATPase), calcium and magnesium (TRPM 6 and 7) channels and a sodium magnesium antiport. An increased calcium-magnesium ratio is known to be involved in the development of atherosclerosis. Early onset of this disorders are known in hypertension.

Design and method:

We present a study in 18 hypertensive elderly concerning ionized magnesium concentrations and ionized calcium-magnesium ratio in blood measured by a Prime Plus apparatus by NOVA Medical, Andover, USA.

Results:

In 18 elderly hypertensives (9 male/9 female with normal renal function) ionized magnesium was measured 0.55 +/- 0.04 mmol/l (normal range: 0.54 - 0.80 mmol/l).

The ionized calcium-magnesium ratio was 2.33 +/- 0.18 (normal range below 2.40)(p< 0.05). Data are means +/- SD. ANOVA was used for statistical evaluation.

About 40% of elderly hypertensives showed an significantly increased ratio of ionized calcium and magnesium, which is well known to be a marker for the development of arteriosclerosis.

Conclusions:

As described earlier, a deficiency in the biofactor magnesium can be involved in the pathogenesis of essential hypertension. Ionized magnesium data, as presented here, are rare, but ionized magnesium is the active magnesium in the body regulating about 600 enzymatic reactions.

The significantly increased ratio of ionized calcium and magnesium is important in the development of arteriosclerosis often resulting in stroke or heart insufficiency in hypertension.
AGE AND ANDROGENS IN POLYCYSTIC OVARY SYNDROME
Authors: Chaabouni Khansa , Jallouli Dana , Khanfir Fatma , Makhlouf Rihab , Chaari Asma , Baccouch Hanene , Moalla Chokri , Frikha Madiha , Chaabene Kais , Elleuch Aida , Ayadi Fatma
Published: June 2023

Objective:

Hyperandrogenemia is a feature of polycystic ovary syndrome (PCOS). It was always linked to PCOS comorbidities and cardiovascular risk.

Objective:

analyze androgen levels across age groups in PCOS and controls.

Design and method:

age-matched PCOS and controls were recruited. PCOS diagnosis was made according to Rotterdam criteria. An age above 30 years was considered old reproductive age. Testosterone and estradiol were dertemined by cobas 6000-Roche. Androstenedione and dehydroepiandrosterone sulfate were assessed using ELSA-DRG kits.

Results:

A total of 80 participants were included: 40 PCOS and 40 controls. No difference was noted in body mass index between PCOS patients vs controls and young PCOS patients vs old ones. All sex steroid hormone levels were increased in PCOS patients compared to controls. Negative correlations were observed between age and androgens in all participants. One-quarter of PCOS patients were at old reproductive age. Their androgens levels were significantly lower compared to younger PCOS patients.

Conclusions:

as women grow older hyperandrogenemia would be less pronounced. An age-specific androgen cut-off would be considered for the diagnosis of hyperandrogenemia and help in the assessment of cardiovascular risk.
AGE-DEPENDENT INCREMENTAL PREDICTIVE VALUE OF CENTRAL BLOOD PRESSURE TO PREDICT CARDIOVASCULAR OUTCOMES: A COHORT STUDY INVOLVING 34,289 PARTICIPANTS USING THE UK BIOBANK
Authors: Wang Shuqi , Wong Samuel Ys , Yip Benjamin Hk , Lee Eric Kp
Published: June 2023

Objective:

It remained unclear whether central blood pressures (BP) provided incremental prognostic information on cardiovascular disease (CVD) over brachial BP in different age groups. This study aimed to investigate the age-stratified association of CVD with brachial and central BPs, and to evaluate the corresponding improvement in risk prediction.

Design and method:

This longitudinal cohort study included 34,289 adults without baseline CVD from the UK Biobank dataset. Baseline characteristics were collected from May 2014 to March 2020 (last follow-ups, September 2021). Participants were categorized into middle-aged and older aged groups using the cut-off of age 65. Brachial systolic blood pressure (SBP) and pulse pressure (PP) were measured by digital oscillometric technique using the Vicorder system, and central SBP and PP were obtained from pulse wave analysis. The primary endpoint was a composite cardiovascular outcome consisting of cardiovascular mortality combined with non-fatal coronary events, heart failure and stroke. Multivariable-adjusted hazard ratios (HRs) expressed the risk of CVD events associated with BP increments of 10 mmHg. Akaike Information Criteria (AIC) was used for model comparisons.

Results:

In middle-aged (N = 17,383, median age = 57.5) and older adult (N = 16,906, median age = 70.4) group, 243 and 566 experienced a CVD event over the median follow-up of 42.4 and 36.9 months respectively. In both groups, CVD events were associated with brachial or central SBP (p< = 0.002). Model fitness was better for central SBP in middle-aged adults (AIC 4427.2 vs 4429.5), but model fitness was better for brachial SBP in older adults (AIC 10246.7 vs 10247.1). Central SBP remained significantly associated to CVD events (HR = 1.05; 95% CI: 1.0-1.1) and improved model fitness (AIC = 4426.6) after adjustment of brachial SBP only in the middle-age adults. These results were consistent for PP.

Conclusions:

In middle-aged adults, higher central BP were associated with greater risks of CVD events, even after adjusting for brachial BP indexes. For older adults, the superiority of central BP was not observed. Therefore, central BP may be considered as important measurement for estimating primary CVD risks for middle-aged individuals.