bluuebunny/crossref_metadata_2025 huggingface dataset:
ASSESSMENT OF MICROVASCULAR REACTIVITY IN RANDOMLY SELECTED ADULT POPULATION EHUH STUDY CROATIAN SCIENTIFIC FOUNDATION
Authors: Jukic Ivana , Stupin Ana , Kolar Luka , Peric Leon , Vincetic Ivo , Susnjara Petar , Jelakovic Ana , Dika Zivka , Karanovic Sandra , Matasin Marija , Krtalic Branimir , Jelakovic Bojan , Drenjancevic Ines
Published: April 2021

Objective:

To assess the forearm skin microvascular reactivity and anthropometric parameters in randomly selected population and seek the differences between a group of people who had elevated blood pressure at the time of measurement and those who were normotensive.

Design and method:

Total of 148 randomly selected individuals (50 men/98 women) participated in this study. The exclusion criteria were less than 1l of urine collected at 24 h, and creatinine values below the reference values. Forthy eight individuals included in this study had arterial hypertension (HT) and 44 had normal arterial blood pressure values (NT). Post-occlusive reactive hyperemia (PORH) in skin microcirculation following 1 minute of vascular occlusion period was assessed using laser Doppler flowmetry. Anthropometric parameters, blood pressure, heart rate were measured, and 24-hour urine was collected to sodium excretion and creatinine measurement. P < 0,05 was considered statistically significant.

Results:

Sistolic (SBP), diastolic (DBP) and mean (MAP) arterial blood pressure were significantly higher, while PORH was significantly lower in HT group compared to NT individuals. HT had higher body mass index (BMI) and waist circumference, while there were no differences in heart rate between HT and NT group. In HT individuals, PORH was negatively associated with waist circumference (r = -0,438), and positively associated with heart rate (r = 0,316). Sodium excretion was positively associated with DBP (r = 0,361). In NT group, PORH was negatively associated with SBP (r = -0,362) and MAP (r = -0,37). SBP and MAP were positively associated with BMI (r = 0,484,r = 0,312) and waist circumference (r = 0,421,r = 0,319). Sodium excretion was positively associated with BMI (r = 0,546) and waist circumference (r = 0,523). Analyzes of all individuals together showed that PORH was negatively associated with BMI (r = -0,253), SBP (r = -0,274) and MAP (r = -0,24), while BMI was positively associated with SBP (r = 0,359), DBP (r = 0,219) and MAP (r = 0,312).

Conclusions:

High blood pressure attenuated microvascular function. Arterial blood pressure is related to obesity (BMI, waist circumference).
ASSOCIATION OF CARDIO-METABOLIC RISK FACTORS WITH ARTERIAL HYPERTENSION
Authors: Unurjargal Tsolmon , Erdenedagva Oyunsuren , Byambatsogt Bolortuul , Vanchin Byambasuren
Published: April 2021

Objective:

The main cardio-metabolic risk factors including arterial hypertension, hypercholesterolemia, tobacco consumption, diabetes mellitus and obesity prevalence are increasing. During the recent 20 years prevalence of cardiovascular disease increased 5 times and leading cause of mortality in Mongolia. Thereby, we aim to study cardio-metabolic risk factors’ prevalence and their association in hypertensive and non-hypertensive subjects.

Design and method:

Materials and method: The hospital based study was conducted by case-control design. The case group was consisted of patients who are between the age of 20–64 years, with arterial hypertension and without signs and symptoms of atherosclerotic cardiovascular diseases. But the control group was consisted of patients who are between the age of 20–64 years and without any signs and symptoms of atherosclerotic cardiovascular diseases as well as no history of hypertension. If blood pressure is = > 130/80 mm Hg, we defined as hypertensive. The serum lipid measurements and glucose were tested by “ChemWell®2910” full automated open-system analyzer of USA in “Express” diagnostic center. Data analysis was processed by using STATA 12.1 program.

Results:

Result: Total participants of the current study were 314 patients and 113 (36%) of them were male, 201 (64%) of them were female and average age were defined as 46.5 ± 10.4. Furthermore, 68.8% of total participants were diagnosed with dyslipidemia and 59.6% of them were diagnosed with arterial hypertension. In the case group, 187 of individuals were participated and 57.75% of them were with 2 of risk factors and in the control group, 127 of individual were participated and 43.31% of them were with 1 of risk factors. Moreover, in the arterial hypertension group, the average Body mass index was 28.97 ± 5.14 kg/m2, average waist circumference was 94.68 ± 13.17 cm, average of total cholesterol was 5.59 ± 1.53 mmol/l and the average level of LDL was 3.89 ± 4.32 mmol/l.

Conclusions:

Conclusion: According to our study, obesity, hyperlipidemia, hyperglycemia and more than two risk factors were associated with the hypertension (P < 0.01).
ASSOCIATION BETWEEN PERIRENAL ADIPOSE TISSUE AND OTHER VISCERAL FAT DEPOTS IN PATIENTS WITH ABDOMINAL OBESITY
Authors: Blinova Natalia , Azimova Marina , Zhernakova Yulia , Zheleznova Ekaterina , Azimova Makka , Shamshilina Vera , Saidova Marina , Ternovoy Sergey , Chazova Irina
Published: April 2021

Objective:

Perirenal adipose tissue is the fat pad surrounding the kidneys. It is proposed as new risk factor for cardiovascular diseases. The aim of study to assess the correlation between perirenal adipose tissue (PAT) volume with waist circumference, abdominal adipose tissue volume and epicardial adipose tissue (EAT) volume and thickness in patients with abdominal obesity.

Design and method:

The study included 104 patients (37,5% - men, 62.5% - women), mean age 38.59 ± 6.09 years with abdominal obesity (waist circumference (WC) > 80 cm in women and > 94 cm in men), without cardiovascular diseases and diabetes mellitus. Abdominal adipose tissue volume (visceral and subcutaneous), EAT volume and perirenal adipose tissue (PAT) volume were measured by multislice computed tomography (ToshibaAquillion 640, Japan). EAT thickness was determined using transthoracic echocardiography (Vivid 7, Vivid 9 (GE Healthcare, USA)) on the free wall of the right ventricle from both parasternal long- and short-axis views at end-systole and end-diastole during three cardiac cycles.

Results:

The mean BMI was 32,3 ± 5,3 kg/m2, the mean WC was 105,9 ± 13,6 cm. In all patients, the mean visceral abdominal adipose tissue volume was 144,9 ml (range: 36,2 to 367,2 ml), the mean subcutaneous adipose tissue volume was 225,3 ml (range: 101,8 to 425,3 ml), the mean PAT volume was 116,0 ml (range: 28,2 to 311,7 ml), the mean EAT volume was 90,1 ml (range: 21,0 to 284,0 ml). PAT volume was significantly correlated with intraabdominal visceral adipose tissue volume (r = 0,58; p < 0,05). There are no association between PAT and subcutaneous adipose tissue volume (r = 0,02; p < 0,05). PAT volume has strong correlation with EAT volume (r = 0,43; p < 0,05), EAT thickness (at end-systole r = 0,36; p < 0,05, at end-diastole r = 0,40; p < 0,05).

Conclusions:

This study showed strongly association between PAT with intraabdominal visceral adipose tissue, EAT. It confirms that PAD is one of the ectopic visceral fat depots and could indicated visceral obesity
CARDIOVASCULAR FEATURES OF PRADER-WILLI SYNDROME
Authors: Bertone Gianandrea , Bilo Grzegorz
Published: April 2021

Objective:

Prader-Willi syndrome (PWS) is a genetic disorder and the most common cause of syndromic obesity. With increased lifespan of the affected patients, an association of this syndrome with elevated cardiovascular morbi-mortality was observed, but the underlying mechanisms are not fully known. Aim of this study was to characterize the cardiovascular phenotype of PWS patients compared with obese controls, focusing on the possible presence of a number of cardiovascular risk factors.

Design and method:

A case control-study was performed including 20 PWS patients and 20 age and sex-matched obese controls. All participants underwent an extensive cardiovascular evaluation which included clinic blood pressure (BP; (measurements performed according to ESH guidelines, by a validated oscillometric device), 24-hour ambulatory BP monitoring (validated AND TM2430 device, with readings every 15 min during daytime and every 30 min at night), echocardiography, arterial tonometry (validated Pulse Pen device, Dia Tecne, Italy) and laboratory analyses.

Results:

We observed no significant differences between PWS patients (F/M 15/5) and controls (F/M 15/5) in terms of age (31.9 ± 6.2 vs. 33.1 ± 7.8 y), BMI (37.9 ± 9.3 vs. 35.6 ± 8.8 kg/m2), clinic BP (119.0 ± 11.7/75.15 ± 8.6 vs. 119.0 ± 8.5/75.15 ± 8.6 mmHg), echocardiographic variables, central systolic BP (110.6 ± 12.3 vs. 111.6 ± 11.7 mmHg) or carotid-femoral pulse wave velocity (6.6 ± 1.3 vs. 6.7 ± 1.2 m/s). Conversely, PWS was associated with higher ambulatory BP values, in particular with regard to nocturnal BP, increased BP variability, increased augmentation pressure (AP) and augmentation index (AIx); see Table. PWS patients had also higher prevalence of obstructive sleep apnea (OSA; 40% vs. 10%, p = 0.028) and diabetes (35% vs. 10%, p = 0.058). In multivariable analysis increased nocturnal systolic BP was independently predicted by PWS presence (p = 0.010) and greater BMI (p = 0.019) while increased nocturnal systolic BP variability only by PWS (p = 0.033).

Conclusions:

We provide for the first time evidence that, compared to obese controls, patients with PWS display distinct cardiovascular characteristics including higher nocturnal BP and BP variability, also after controlling for possible confounders such as OSA and diabetes. These differences, whose determinants need to be investigated, may contribute to the increased cardiovascular risk in this group.
INCIDENCE OF OBESITY AND ACCOMPANYING RISK FACTORS IN URBAN AREAS OF SINDH, PAKISTAN
Authors: Shaheen Sumera
Published: April 2021

Objective:

To analyze the occurrence of obesity and its connected risk factors among urban population.

Design and method:

This observational study was conducted for a period of about six months from April 2019 to September 2019 in urban areas of sindh province. Data was collected from 400 patients in a suitably designed form which included demographic details of the patients, their biochemical and physical examinations.

Results:

According to the results, 56.8% patients were found to be obsessed. Females being single, married, widow and eating more meat were generally suffering from obesity. The percentage of three types of obesity was as: General obesity only (3.0%), central obesity only (34.2%) and combined obesity (19.6%). It was further found that general obesity was generally associated with hypertension, diabetes and high levels of triglycerides and on the other hand combined obesity and central obesity only were found to be associated with high total cholesterol, low HDL cholesterol and high LDL cholesterol.

Conclusions:

This study concluded that there was more incidence of obesity in the population of urban areas of Sindh., Pakistan
NON-INTERVENTIONAL WEIGHT CHANGES AFFECT SYSTOLIC BLOOD PRESSURE IN NORMOTENSIVE INDIVIDUALS
Authors: Shlomai Gadi , Grossman Ehud , Klempfner Robert , Leibowitz Avshalom , Ovdat Tal
Published: April 2021

Objective:

The association between obesity and hypertension is well established. Weight loss has been shown to reduce blood pressure (BP) among hypertensive patients. Nevertheless, the effect of weight changes on BP in normotensive individuals is less clear. We explored the association between non-interventional weight alterations and BP changes in a large cohort of normotensive adults.

Design and method:

a retrospective analysis of normotensive individuals, between 2010–2018. All weight changes were non-interventional. Body mass index (BMI) and BP were measured annually. Patients were divided according to the change in BMI between visits: reduction of more than 5% (’large reduction’), between 2.5–5% (’moderate reduction’), reduction of less than 2.5% or elevation of less than 2.5% (’unchanged’), elevation between 2.5–5% (’moderate increase’) and elevation of more than 5% (’large increase’). The primary outcome was the change in systolic BP (SBP) between the visits.

Results:

The final analysis included 8,723 individuals. 20% of the subjects reduced their BMI by at least 2.5% and 24.5% increased their BMI by more than 2.5%. ’High reduction’ inferred an absolute decrease of 3.6 mmHg in SBP, while ’large increase’ resulted in an absolute increase of 1.9 mmHg in SBP. The proportion of individuals with at least 10 mmHg decrease in SBP progressively declined according to the relative decrease in BMI, and the proportion of patients with at least 10 mmHg increase in SBP progressively increased. This effect was more pronounced in individuals with higher baseline SBP.

Conclusions:

Among normotensive adults, modest non-interventional weight changes may have significant effects on SBP.
LATE GESTATIONAL TESTOSTERONE CAUSES REDUCED PLACENTAL MASS, ADIPONECTIN AND NRF2 IN WISTAR RATS
Authors: Olatunji Lawrence , Areola Emmanuel , Adewuyi Ifeoluwa , Ogunlade Ayodele
Published: April 2021

Objective:

Gestational excess androgen has been linked to preeclampsia-related intrauterine growth restriction and is associated with future cardiometabolic derangement in offspring. Excess androgen plausibly results in oxidative stress as one of the multiple mechanisms by which it may negatively impact the placental and fetal growth. Adiponectin, an anti-inflammatory/anti-oxidant adipocytokine is also expressed in the placenta. Therefore, this study investigated the effect of excess gestational testosterone on placental weight, adiponectin and nuclear erythroid-derived 2 factor 2 (Nrf2)-dependent antioxidant defense in Wistar rats.

Design and method:

Ten pregnant Wistar rats were grouped into two (n = 5) and treated with distilled water (p.o.) or testosterone (0.5 mg/kg; sc) from gestational day 14 to 19.

Results:

Results showed that testosterone-exposed pregnant rats during the third trimester had 4-folds increase in circulating testosterone (20.9 ± 2.8 vs 5.1 ± 1.7 ng/ml; p < 0.001) whereas testosterone levels in the placenta of both groups were comparable. Reduced placental weight, fetal number, fetal weight, adiponectin, Nrf2, SOD 1, SOD 2, catalase and aconitase activities were observed in rats exposed to excess late gestational testosterone. Data also showed increased placental xanthine oxidase activity, uric acid, triglyceride, free fatty acid, total cholesterol, lactate, lactate dehydrogenase activity and lipid peroxidation.

Conclusions:

Taken together, excess late gestational testosterone caused decreased placental adiponectine, disrupted Nrf2-dependent anti-oxidant defense and lipid deposition in the placenta, leading to poor fetal outcomes. Therefore adiponectin/Nrf2-dependent antioxidant defense pathway can be considered for further mechanistic elucidation and therapeutic target for testosterone-induced poor fetal development.
VASCULAR STATUS AND PHYSIOLOGICAL PREGNANCY
Authors: Evsevyeva Maria , Sergeeva Oksana , Prokhorenko-Kolomoytseva Irina , Frantseva Victiria
Published: April 2021

Objective:

Recently, there has been interest of researchers in assessing vascular stiffness in various complications of pregnancy (P). However, there is little data on profile of this parameter in healthy pregnants. Purpose: to assess the dynamics of the main indicators of vascular stiffness in physiological P.

Design and method:

Prospective longitudinal study was performed. 95 women with singleton pregnancies aged 18 to 23 years were examined. Exclusion criteria: BMI at beginning of pregnancy >25 kg/ m2; any somatic disease, all variants of hypertension (including those developed during pregnancy), smoking, infectious diseases, multiple pregnancy, as well as pregnancy resulting from assisted reproductive technologies. The control group consisted of 45 healthy young non-pregnant women, comparable in age and anthropometric data. Non-invasive assessment of vascular stiffness was performed by oscillometric method on apparatus BpLab Vasotens (Peter Telegin, Russia). The device complies with international accuracy standards for oscillometric BP recorders and is recommended for use in pregnant women. Estimated parameters such as augmentation index in brachial artery (AIX,%), augmentation index in aorta (AIXao,%), pulse wave velocity in aorta (PWVao, m/s). Measurements were taken several times at different gestation periods.

Results:

Parameters of vascular stiffness in healthy pregnants differed significantly from those in control. Thus, AIX in the brachial artery during P had significantly lower values regardless of gestation. Its dynamics has following features: the decrease of this indicator from very beginning of the P, maximum decrease was recorded between 25 and 30 weeks, then its value increased, but did not reach the control values. AIXao in healthy pregnant women was also significantly lower. Maximum reduction occurred at same time as for peripheral AIX. In healthy P, there was a lower RWVao. Dynamics of this indicator had more complex picture: lowest value was observed between 15 and 20 weeks, then RWVao increased, reaching maximum by 35 weeks, followed by slight decrease.

Conclusions:

There is clear dependence of vascular stiffness on timing of gestation, which is due to a whole complex of physiological changes occurring in body of pregnants. Obtained data are useful for improving system of cardiovascular support for pregnants.
ACE2 CONTRIBUTES TO THE NORMAL REGULATION OF ARTERIAL PRESSURE AND IMMUNITY IN FEMALES OF REPRODUCTIVE AGE
Authors: Colafella Katrina Mirabito , Vinh Antony , Tikellis Chris , Widdop Robert , Denton Kate
Published: April 2021

Objective:

Hypertension and cardiovascular disease are age and sex dependent. These differences may, in part, be mediated by the depressor/pressor balance of the renin angiotensin system. Here we determined the role of angiotensin converting enzyme 2 (ACE2) in the regulation of arterial pressure in females of reproductive age and investigated whether targeting deficits in ACE2-generated angiotensin (Ang)-(1–7) restores the normal regulation of arterial pressure during pregnancy.

Design and method:

Mean arterial pressure (MAP) was measured via telemetry in 14 week old wild-type (WT) and ACE2 knockout (ACE2-KO) male mice and WT and ACE2-KO female mice receiving vehicle or the MasR agonist, AVE-0991 (24 ug/kg/min s.c) prior to and during pregnancy. FACS analysis was used to determine circulating immune cell activation and infiltration into kidneys (baseline and Gd18) and placentae (Gd18).

Results:

Basal MAP was lower in WT females than ACE2-KO females, WT males and ACE2-KO males (91 ± 2 vs 100 ± 1, 98 ± 1 and 102 ± 2 mmHg, respectively; all P < 0.05 vs WT female). In ACE2-KO females, AVE-0991 lowered basal MAP by 5 ± 1 mmHg (P = 0.03). In WT females, MAP decreased during pregnancy reaching a nadir at Gd9 before returning to pre-conception levels during late gestation. In contrast, in ACE2-KO mice, MAP increased significantly during late gestation (P < 0.0001 vs WT) and this effect was prevented by AVE-0991 (P < 0.05 vs vehicle). This effect of AVE-0991 on MAP was due to changes in diastolic rather than systolic arterial pressure. ACE2-KO mice had smaller litters but greater birth/pup weight than WT mice. AVE-0991 normalised litter size and birth/pup weight in ACE2-KO mice to that observed in WT mice. Circulating and renal T-regulatory cells were lower in non-pregnant and pregnant female and male ACE2-KO mice than their WT counterparts. Treatment with AVE-0991 did not alter the proportion of T-regulatory cells.

Conclusions:

These data indicate that ACE2 plays an important role in the regulation of arterial pressure and immunity in females of reproductive age. A corollary of this is that deficits in ACE2-generated Ang-(1–7) may contribute to an increased risk of hypertension in non-pregnant and pregnant premenopausal females and therefore may be a novel therapeutic target.
ANTI-HYPERTENSIVE DRUGS AND PERINATAL OUTCOMES IN HYPERTENSIVE WOMEN ATTENDING A TERTIARY HOSPITAL
Authors: Hashmi Khamis Mohammed Al , Al-Ismaili Al Khattab , Dughaishi Tamima Al , Waili Khalid Al , Rasadi Khalid Al , Rajaibii Hajar Al
Published: April 2021

Objective:

This study was aimed to determine the impact of hypertension and the used anti-hypertensive medications on perinatal (maternal and fetal) outcomes and to determine the most commonly used anti-hypertensive medications in order to compare their maternal and fetal outcomes.

Design and method:

The medical records of 484 hypertensive pregnant women attending a tertiary hospital, were evaluated. Singleton pregnancies of the women who were on anti-hypertensive medications and delivered in the hospital were included in the study. Multiple pregnancies, molar pregnancies and the women who were not on anti-hypertensive medications or did not deliver in the hospital were excluded from the study. Based on inclusion and exclusion criteria, 210 women were included. The data of types of hypertension, the used anti-hypertensive drugs, fetal and maternal outcomes were gathered from patient's medical records.

Results: The mean age of the studied population was 32.4 +/-5.6 years and the mean BMI was 34 +/- 8.1 Kg/m2. The most prevalent sub-type of hypertension was preeclampsia (41.4%). Low birth weight, preterm delivery, intrauterine growth restriction (IUGR), small for gestational age (SGA), respiratory distress syndrome and neonatal care unit admissions were significantly higher in women with preeclampsia than in the women with other types of hypertension. Labetalol was the most common prescribed anti-hypertensive drug. There were 101 (48.1%) women on combined therapy. Preeclampsia was significantly more prevalent in women who received labetalol alone than women who received methyldopa alone (50% Vs 16%, P = <0.001)). Low birth weight, preterm delivery, IUGR, SGA, respiratory distress syndrome, absent end diastolic flow and neonatal care unit admission of newborns were significantly higher in the women who received combined therapy. Preeclampsia and high dependency unit admissions were also significantly higher in women who received combined therapy.

Conclusions:

This study showed that that pregnant women on combined anti-hypertensive medications had significantly higher maternal and fetal outcomes. This could be due to more severe or uncontrolled hypertension in these women. T
IS DEPRESSION A RISK FACTOR FOR DEVELOPING HYPERTENSION IN TWO DIFFERENT HEALTH UNITS?
Authors: Reina Luisa Neves , Sousa Joao Teixeira , Da Silva Ines Maia
Published: April 2021

Objective:

The aim was to evaluate if depression could be a risk factor for developing hypertension in two different health units.

Design and method:

We selected individuals from two different health units (USF Familias and USF Vale do Vouga) using the ICPC-2 codes for depression (P76) and for hypertension (K86/K87). Hypertension cases diagnosed before or on 2009 were excluded. On a second analysis we excluded patients with any of the following diagnoses: hypothyroidism, sleeping disorder, obesity, excessive weight and diabetes. The data were analyzed using the SPSS and Excel.

Results:

First we evaluated the effect of the covariates in the risk of developing hypertension, we used a logistic regression analysis in the 820 patients with depression without hypertension, and noted that having excessive weight, diabetes and sleeping disorder were significant (p < 0,05), and increased the risk of developing hypertension. When excluding all the covariates, we obtained 656 patients (83% are women) with depression of which 99 patients developed hypertension (mean age 54 years old) and 557 patients didn’t (mean age 44 years old). Using the t-test analysis (t = 7,39, p < 0,01) we found significant differences in age (T = 7,385, p < 0,001) between the group that developed hypertension and the group that didn’t develop hypertension. The group that developed hypertension was older (mean age 54) than the other group (mean age 44). The chi-square test found significant differences in gender (X2 = 5,510, p < 0,05), a higher ratio of women was noted in the group that didn’t develop hypertension. We selected a randomized sample of each health unit. Doing the analysis for each health unit, we didn’t find significant differences in those with depression (USF Familias: X2 = 1,16, p = 0,28; USF Vale do Vouga: X2 = 1,44, p = 0,23).

Conclusions:

We have to take in account the different methods of evaluating and therefore coding depression in 2009. We didn’t find depression as a risk factor for hypertension in this study. In further studies knowing the antidepressive treatment and if there was a history of alcohol and/or drugs abuse could be relevant.
AMBULATORY BLOOD PRESSURE MONITORING: ADVANTAGES AND OPPORTUNITIES
Authors: Amaral Teresa , Marinho José Carlos , Quina Cátia , Silva Mariana , Garcia José , Rua Inês
Published: April 2021

Objective:

Ambulatory Blood Pressure Monitoring (ABPM) is a procedure used to diagnose hypertension, detect white-coat effect, masked hypertension and monitor blood pressure (BP) control. It offers additional and important data in opposite to office BP, such as the dipping status and circadian variability of ambulatory BP, and it is a better predictor of cardiovascular outcomes and morbid or fatal events. In our country, ABPM has limited availability in Primary Health Care. With that in mind, the health care team of our Primary Health Care Unit created an ABPM protocol in August 2017 in order to provide this procedure to its patients.

Design and method:

Descriptive, cross-sectional and observational study. Data collected from August 2017 to December 2019 regarding the results of ABPM and patient data. The ABPM protocol was designed following the most recent European Society of Hypertension guidelines.

Results:

In the described period, our unit performed 136 ABPM exams. The average age of patients submitted to ABPM was 53 years and 54% were of the male gender. The majority (67%) were referred for diagnosis purposes and 33% to monitor BP control. With the ABPM protocol we were able to diagnose 60 patients with sustained hypertension and 36 patients with uncontrolled hypertension, from which 10 presented resistant hypertension. Regarding the dipping status, 55% were dipper, 23% extreme dipper, 19% non-dipper and 3% reverse dipper. In 63% of cases, the ABPM results led to direct clinical decision-making by the family physician, such as pharmacology intervention, clinical investigation and lifestyle advice.

Conclusions:

Overall the ABPM is an accurate, cost-effective protocol that provides important information for the prediction of cardiovascular risk. Consequently, ABPM protocol implementation has been observed to have a direct positive impact in the diagnosis, monitoring and clinical decision-making ability of the physician regarding hypertension. With this presentation we wish to share the positive impact of ABPM usage on our Health Care Unit and to inspire and motivate others to create a similar protocol.
IMPLEMENTATION OF THE 2018 ESC/ESH GUIDELINES FOR THE TREATMENT AND CONTROL OF HYPERTENSION IN PRIMARY CARE IN GREECE: THE HYPEDIA STUDY
Authors: Kollias Anastasios , Foukarakis Emmanouil , Karakousis Konstantinos , Stergiou George S.
Published: April 2021

Objective:

To evaluate office blood pressure (OBP) levels for antihypertensive drug treatment initiation/intensification, drug choices, and hypertension control in primary care in Greece.

Design and method:

A prospective nationwide non-interventional single-visit study was performed in consecutive untreated or treated hypertensives recruited by primary care doctors and hospital clinics. Participants’ characteristics, OBP measurements (triplicate; automatically transferred to PC; Microlife BPA3 PC) and treatment changes were recorded using an online cloud system. The study was supported by Menarini Hellas S.A.

Results:

A total of 3,122 patients were analyzed (mean age 64 ± 12.5 [SD] years, 52% males, 25% untreated). In untreated hypertensives (N = 772), drug treatment was initiated with monotherapy in 53% and with two-drug combination in 36%. ARB monotherapy was used for treatment initiation in 30%, ARB/CCB 20%, ARB/Thiazide 8%, ACEI-based 19%. Of the combinations used, single-pill were 97%. Among treated hypertensives aged <65 years (N = 977), 79% had OBP > = 130/80 mmHg (systolic and/or diastolic), whereas among those aged > = 65 years (N = 1,373) 66% had OBP > = 140/80 mmHg. ARBs were used in 69% of treated hypertensives, ACEIs 19%, CCBs 47%, diuretics 39%, b-blockers 19%. Single-pill combinations were administered in 85% of patients receiving drug combinations. Treatment intensification (mainly dose increase or drug addition) was performed in 54% of treated hypertensives aged <65 years with OBP > = 130/80 mmHg (systolic and/or diastolic), and in 62% of those > = 65 years with OBP > = 140/80 mmHg. Binary logistic regression in treated hypertensives aged <65 years showed that age (OR 3.2, 95% CI 1.0–9.9), BMI (OR 7.9, 2.8–22.8), male gender (OR 1.6, 1.1–2.2) and primary care (vs. hospital) setting (OR 1.5, 1.0–1.8) predicted OBP > = 130/80 mmHg. In treated hypertensives > = 65 years, BMI (OR 2.5, 1.1–5.7), primary care setting (OR 1.4, 1.0–1.7) and male gender (OR 1.3, 1.0–1.6) predicted OBP > = 140/80 mmHg.

Conclusions:

RAS blocker-based therapy, mainly ARBs, is the basis of antihypertensive drug treatment in the vast majority of patients in primary care, with single-pill combinations being widely used. In almost half of treated uncontrolled hypertensives treatment is not intensified (physician inertia), suggesting suboptimal implementation of the 2018 ESC/ESH targets in primary care.
USEFULNESS OF SHORTENED SALINE INFUSION TEST FOR PRIMARY ALDOSTERONISM DIAGNOSTICS
Authors: Yamashita Kaoru , Yatabe Midori , Seki Yasufumi , Bokuda Kanako , Watanabe Daisuke , Morimoto Satoshi , Ichihara Atsuhiro
Published: April 2021

Objective:

Primary aldosteronism (PA) is a frequent and remediable cause of endocrine hypertension. Saline infusion test (SIT) is one of the most widely-accepted confirmatory tests for PA, but some patients may not tolerate the standard loading volume of 2 L saline over 4 h. Shortened SIT, loading only 1 L saline over 2 h, has been suggested to be useful and would be more acceptable across wider population if the diagnostic utility proves to be comparable to the standard SIT. Therefore, we compared the diagnostic values of plasma aldosterone concentration after 2 hours of 1 L saline loading (2 h PAC) and those after 4 hours of 2 L saline loading (4 h PAC) for the prediction of unilateral aldosterone hypersecretion and postoperative outcome.

Design and method:

The retrospective, single-center study involved 555 PA-suspected patients who underwent recumbent SIT, 153 of whom subsequently underwent adrenal vein sampling (AVS). Postoperative blood pressure outcome was also examined in 37 patients. We calculated the defined daily doses (DDD) of anti-hypertensive drugs according to those set by the World Health Organization, and compared the values between before and 1 year after the surgery.

Results:

The Youden Index of 2 h PAC for receiver operating characteristic (ROC) curves of 4 h PAC > 60 pg/mL (The SIT was considered positive if 4 h PAC was over 60 pg/mL according to the Japan Endocrine Society 2009 guidelines) was 66 pg/mL. The areas under the ROC curves of 2 h and 4 h PAC were comparable (0.80 vs.0.85, 95% CI -0.1035 – 0.0109, P = 0.11) for unilateral aldosterone hypersecretion defined as lateralization index >4. Postoperative reduction of anti-hypertensive drug use and 2 h PAC was significantly correlated (P = 0.04). The areas under the ROC curves of 2 h and 4 h PAC were comparable (0.82 vs.0.78, 95% CI -0.0949 – 0.1706, P = 0.58) for postoperative reduction of anti-hypertensive drug use.

Conclusions:

Shortened SIT may be similarly useful as standard SIT to select PA patients for AVS and also to predict postoperative blood pressure outcome with reduced burden on patients.
SERUM SOLUBULE (PRO)RENIN RECEPTOR CONCENTRATIONS ASSOCIATED WITH PROGRESSION OF HEART FAILURE IN HEMODIALYSIS PATIENTS
Authors: Morimoto Satoshi , Amari Yoshifumi , Iida Takeshi , Okuda Hidenobu , Yurugi Takatomi , Oyama Yasuo , Aoyama Naoki , Nakajima Fumitaka , Ichihara Atsuhiro
Published: April 2021

Objective:

The (pro)renin receptor [(P)RR] is cleaved to generate soluble (P)RR [s(P)RR], which reflects the status of the tissue renin-angiotensin system. Hemodialysis (HD) patients have advanced atherosclerosis and a poor prognosis due to an increased prevalence of cardiovascular diseases. We have previously reported that serum s(P)RR levels were associated with arteriosclerosis independent of other risk factors. The present study aimed to investigate whether serum s(P)RR levels are associated with worsening of cardiac function.

Design and method:

A total of 258 maintenance HD patients were recruited and serum s(P)RR concentrations were measured. The patients were divided into lower (L) and higher (H) s(P)RR groups, and the background factors were compared between the two groups. Background factors were compared between those who survived (S) and who died (D group) during the 12-months-follow-up period. In the S group, the relationships between s(P)RR levels and changes in background factors including cardiac functions and atherogenic factors during the follow-up period were evaluated.

Results:

Serum s(P)RR concentrations were 29.8 ± 5.3 ng/ml. Age, CTR, TG, CRP, and visceral fat area (VFA) were significantly higher in H group than in L group. Twenty-four patients died during the follow-up period, and age, CTR, CRP, hANP, BNP, E/e’ were significantly higher and BMI, HDL-C, Cre, Alb, left ventricular ejection fraction (LVEF), subcutaneous fat area (SFA), and VFA were significantly lower in D group than in S group. In S group, changes in hANP or BNP were significantly higher in H group than in L group. Multiple regression analyses testing s(P)RR, LDL-C, LVMI, and LVEF, which were significantly correlated with changes in BNP, as independent variables revealed that s(P)RR was significantly positively correlated with changes in BNP.

Conclusions:

High serum s(P)RR levels were shown to be associated with increases in BNP independent of other risk factors, suggesting that increased expression of (P)RR may be associated with progression of heart failure in HD patients. Further studies are needed to determine whether serum s(P)RR levels are associated with prognosis in these patients.
SHORT-TERM VARIABILITY OF THE ALDOSTERONE-TO-RENIN RATIO IN AN ESSENTIAL HYPERTENSIVE POPULATION
Authors: Veldhuizen Gregory , Alnazer Rawan , Kroon Abraham , de Leeuw Peter
Published: April 2021

Objective:

The aldosterone-to-renin ratio (ARR) is a commonly used metric in the screening of primary aldosteronism. However, insufficient high-quality research evaluating its precision and accuracy is available. In particular, limited information is known with regard to intra-patient short-term variability in the ARR. Highly variable intra-patient values could severely hamper the ability of the ARR to effectively screen for primary aldosteronism.

Design and method:

68 unmedicated, essential hypertensive participants (female n = 26, male n = 42), had two blood samples taken in the morning measuring plasma aldosterone and active plasma renin concentration within a 2-hour time window under strictly standardised conditions and while consuming a regulated sodium intake (3 g/day). Bland-Altman plots, mountain plots and correlation analysis were performed, comparing the mean values per participant with the difference between their measurements.

Results:

Using Bland-Altman plots, we found that renin, aldosterone and the ARR become increasingly variable as their mean values increase. Correlation analysis of the absolute difference in aldosterone-to-renin ratio values between measurements and their mean resulted in an R-squared value of 34.7% (p-value < 0.000)). This trend was also noted for plasma aldosterone (R-squared 9.6%; p-value 0.010) and active plasma renin concentration (R-squared 7.9%; p-value 0.021) separately. Taking an ARR value above 30 as abnormally high, 29.4% of the participants with a mean value above 30, had one measurement below 30. Conversely, 3.9% of those with mean values below 30 had one measurement above 30.

Conclusions:

Based on our findings, it can be concluded that spot measurements of the aldosterone-to-renin ratio have acceptable short-term variability in the lower ranges, but have increasingly doubtful reliability as aldosterone-to-renin values rise. Thus, in a clinical context, great caution should be taken in interpreting spot measurements of moderate to high aldosterone-to-renin ratio values, in particular when values are mildly elevated.
EFFECT OF SEQUENTIAL NEPHRON BLOCKING IN COMPARISON WITH THE DOUBLE BLOCKADE OF THE RENIN- ANGIOTENSIN SYSTEM + BISOPROLOL ON CENTRAL SYSTOLIC BLOOD PRESSURE AND ARTERIAL STIFFNESS
Authors: Cestari Elizabeth do Espirito Santo , Mello Priscilla Galisteu de , Rubio Tatiane de Azevedo , Souza Maira Regina de , Gonzales Eliangela Gianini , Costa Larissa Morete Caieiro da , Martin Luciana Neves Cosenso , Tacito Lucia Helena Bonalumi , Moreno Heitor , Vilela-Martin Jose Fernando , Yugar-Toledo Juan Carlos
Published: April 2021

Objective:

The different classes of drugs routinely used in anti-hypertensive therapy promote different effects on markers of arterial stiffness and, consequently, on the central blood pressure. Arterial stiffness is the main determinant for the increase of the central blood pressure and considered an important predictor for myocardial infarction, stroke and congestive heart failure.

Objective:

The objective of this study was to compare the effect on the systolic central blood pressure and arterial stiffness in resistant hypertensive patients submitted to sequential nephron blockade (SNB) against double blockade of the renin-angiotensin-aldosterone system (DBRAS) plus Bisoprolol.

Design and method:

Fifty-five resistant hypertensive patients were recruited in the Hypertension Outpatient Clinic of FAMERP, twenty-nine in the SNB group (18F/11 M) and twenty-six in the DBRAS group (22F/4 M). Central systolic blood pressure (cSBP), incrementing index (AI) and AI75 were measured with Omron HEM9000-A. (Japan).

Results:

The main result showed significant reduction of the central systolic blood pressure in patients submitted to sequential blockade nephron treatment when compared with the double blockade of the renin-angiotensin system plus Bisoprolol group (128.8 ± 22.1 vs. 117.4 ± 17.9 mmHg - P = 0.03). Figure 1

Conclusions:

The sequential nephron blockade group, when compared with the double blockade of the renin-angiotensin-aldosterone system plus Bisoprolol, promotes significant higher reduction of the central systolic blood pressure in resistant hypertensive patients.
DIFFERENCE BETWEEN CLINICAL AND AMBULATORY BLOOD PRESSURE LEVELS CORRELATES WITH EMOTIONAL INTELLIGENCE SCALE SCORES IN PATIENTS WITH HYPERTENSION
Authors: Yana Koshelyaevskaya , Andreeva Galiya , Lyusin Dmitrij , Gorbunov Vladimir
Published: April 2021

Objective:

The aim of study was to define relationships between emotional intelligence, quality of life (QL) scale scores and the difference between clinical and ambulatory blood pressure (BP) in patients with hypertension.

Design and method:

We assessed 90 ambulatory blood pressure monitoring (ABPM) data of patients with stable hypertension and white coat hypertension without serious concomitant diseases. ABPM monitor (Spacelabs 90207) was applied after the washout period. We defined daytime period as 8.00–23.00, nighttime – 23.00–6.00. The clinical-ambulatory BP discrepancy was assessed as the difference between mean clinical BP and mean daytime BP levels. After ABPM session patients completed the emotional intelligence questionnaire (EmIn) (Lyusin D.) and QL questionnaire (J. Siegrist et al.). We analyzed the following EmIn scale scores: I - emotion self-awareness; II - management of one's own emotions; III - control of emotional expression; IV - understanding others’ emotions; V- management of others’ emotions. We used Pearson correlation coefficient for statistical analysis.

Results:

The initial mean (M ± SD) daytime systolic BP (SBP) was 140.1 ± 12.8; diastolic (DBP) - 86.1 ± 10.5 mm Hg, age - 51,3 ± 15,3 years. We found the following significant negative correlations between III scale scores (control of emotional expression scale, of EmIn) and the difference between clinical and ambulatory BP for SBP (r = -0,25, p < 0,05). QL components did not correlate with the difference between clinical and ambulatory BP.

Conclusions:

The emotional self-control scores (III scale of EmIn) was negatively associated with the difference between clinical and ambulatory BP levels. Probably, a high level of the emotional expression self-control may prevent blood pressure rise at the doctor's visit, and as a result can reduce the clinical BP level and decrease of the clinical- ambulatory BP difference.
PREVALENCE OF SECONDARY HYPERTENSION IN PATIENTS WITH RESISTANT ARTERIAL HYPERTENSION
Authors: Kvapil Tomas , Vaclavik Jan , Benesova Klara , Jarkovsky Jiri , Kocianova Eva , Kamasova Monika , Jelinek Libor , Vykoupil Karel
Published: April 2021

Objective:

Resistant hypertension is defined as blood pressure that remains above therapeutic goal despite concurrent use of three antihypertensive agents (at full or maximum tolerated doses) of different classes, one of which is a diuretic. The prevalence of secondary hypertension among patients with resistant hypertension is not exactly known.

Design and method:

We retrospectively analysed the hospital records of patients with resistant arterial hypertension, who underwent complete laboratory and imaging examinations to exclude the secondary etiology of arterial hypertension. Standard descriptive statistics, Mann-Whitney U test and Fisher's exact test were used for statistical evaluation.

Results:

Among the 432 patients with resistant hypertension, secondary etiology of hypertension was found in 135 (31.1%). The most frequent cause was primary aldosteronism in 85 cases (63% relatively), followed by renovascular hypertension (21 cases, 15.6%), renal parenchymal hypertension (20 cases, 14.8%). Less common causes were hyperreninism (3.7%), hypercortisolism (1.5%), pheochromocytoma (0.7%) and adrenogenital syndrome (0.7%). Obstructive sleep apnoea has been found in 63 (14.7%) patients. Patients with secondary hypertension were more frequently male (70.4% vs. 52.2%, p < 0.001), had a higher left ventricular mass index (LVMI 119 vs. 106 g / m2, P = 0.037) and lower estimated glomerular filtration rate (69 vs. 75 ml/min/1.73m2, P = 0.009). Both groups did not differ in age, office blood pressure or albuminuria.

Conclusions:

Secondary etiology was much more frequent (31%) in our group of patients with resistant hypertension than in non-selected hypertensive population (5–15%). Patients with secondary hypertension had more advanced target organ damage.

This work was supported by the grant UP - IGA_LF_2019_036 a IGA_LF_2019_035.

This work was supported by the grant IGA_LF_2020_039
RENAL DENERVATION MAY SLOW THE PROGRESSION OF SUBCLINICAL BRAIN DAMAGE IN DIABETIC PATIENTS WITH RESISTANT HYPERTENSION DURING 3 YEARS FOLLOW-UP
Authors: Falkovskaya Alla , Mordovin V. , Pekarskiy S. , Zyubanova I. , Manukyan M. , Lichikaki V. , Sukhareva A. , Baev A. , Moiseeva A. , Caraus A.
Published: April 2021

Objective:

Patients with resistant hypertension and type 2 diabetes mellitus (DM) accelerate the subclinical brain damage and the age-related brain atrophy, which leads to a more rapid decrease in cognitive functions. Brain MRI can detect expansion of liquor spaces and white matter lesions (PWMLs), which are patterns of brain atrophy. Renal denervation (RDN) is an effective treatment for resistant hypertension (RHTN), but the key question is whether RDN can slow the progression of brain damage. The aim of this study was to evaluate the effect of renal denervation on the MRI- sing of brain damage in patients with RHTN with type 2 DM over a 3-year follow-up.

Design and method:

The study included 17 diabetic patients with RHTN (mean age 61,3 ± 6.2 years; 9 males, mean 24 hour (systolic/diastolic) blood pressure (BP) 161.3 ± 19.4/82.2 ± 13.5 mmHg, HbA1c 7 ± 1,2%) from single-arm prospective interventional study (NCT02667912 on ClinicalTrial.gov) in whom 1.5T magnetic resonance imaging (MRI) of the brain and 24-hour BP monitoring were performed at baseline and an annually for 3 years follow up. We measured linear dimensions of liquor spaces (subarachnoidal spaces (SAS), lateral ventricles (LV), both III and IV ventricles) and calculated the number of focal white matter lesions. Periventricular white matter lesions (PWMLs) were evaluated semi-quantitatively on a scale of 0 to 4. On average, patients were taking 4.3 ± 1.0 antihypertensive drugs and were instructed not to change their medication regimen for the duration on the study. The mean number of ablations was 13 ± 1.8 (10–16).

Results:

Three years after RDN, there was a significant decrease in the average 24-hour systolic/diastolic BP by 14.1/8.6 mm Hg (p = 0.03/0.04). The linear dimensions of liquor spaces (SAS, LV, both III and IV ventricles), number of focal white matter lesions, as well as the mean PWMLs score did not change (p > 0.05).

Conclusions:

This is the first study to demonstrate that RDN can prevent progression of brain damage in diabetic patients with RHTN during 3 years follow-up and therefore has a potentially beneficial effect on the brain.
THE RELATION BETWEEN ANTIHYPERTENSIVE DRUGS AND SLEEP DISORDERS IN PATIENTS WITH HYPERTENSION
Authors: Shalimova Anna , Buriakovska Olena , Isayeva Ganna
Published: April 2021

Objective:

Sleep disorders are one of the most frequent non-cardiac complains in hypertensive patients. At the same time insomnia, short sleep duration and obstructive sleep apnea are well documented risk factors of hypertension and diabetes mellitus. However, the effects of antihypertensive drugs on sleep quality are little known. The aim of the study was to assess the impact of ACE inhibitors, ARB II and diuretics (indapamide) on sleep quality and duration.

Design and method:

Cross-section study included 118 patients aged 54.5 ± 9.7 years old. Insomnia was diagnosed according to criteria of International Classification of Sleep Disorders,3rd Edition. Epworth scale was used to assess day sleepiness. SOMNOcheck micro (WM 94500) was used to verify obstructive sleep apnea. Blood lipids (total cholesterol, low density lipoprotein (LDL) cholesterol, triglycerides, and high density lipoprotein (HDL) cholesterol), body mass index (BMI), waist and hip circumference were assessed. Physical activity was measured using Omron Walking Style III step counter HJ-203-EK. Patients with myocardial infarction or stroke in history, heart failure III-IV functional class (NYHA), treated with steroids hormones, thyroid disease and obesity grade II-III. Control group included 23 healthy subjects and 19 subjects without hypertension or cardiovascular disease but presence of insomnia. Data were analyzed by ANOVA test or Mann–Whitney U-test. Odd ratio was calculated for studied parameters.

Results:

Insomnia was diagnosed in 57 (48.3%) patients with hypertension; 24 (20.3%) had obstructive sleep apnea; circadian sleep disorders were diagnosed in 33 (27.9%) and moving disorders associated with sleep had 9 (7.6%). It was find out that therapy with ACE inhibitors (OR 0.26 (0.06–0.95; p = 0.04)) and diuretics (OR 0.23 (0.05–1.14; p = 0.03)) with better sleep quality. The effect was prominent in patients with high physical activity. ARBII neutrally impact sleep quality.

Conclusions:

In patients with hypertension therapy with ACE inhibiters and indapamide had positively effect on sleep quality.