bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagnostic value of computed tomography myocardial perfusion to detect coexisting microvascular dysfunction in patients with obstructive epicardial coronary disease
Authors: Hada M , Hoshino M , Sugiyama T , Misawa T , Nagamine T , Ueno H , Matsuda K , Sayama K , Yonetsu T , Sasano T , Kakuta T
Published: October 2022

Background

The usefulness of computed tomography myocardial perfusion (CTP) to assess hemodynamically significant epicardial coronary artery lesions has been previously reported. However, the diagnostic value of quantitative evaluation of absolute coronary flow by CTP to detect microvascular dysfunction remains unknown.

Purpose

The aim of study is to assess the diagnostic value of CTP to evaluate coronary microvascular dysfunction (CMD) in patients with significant epicardial coronary stenosis, and to analyze the predicting factors for lesions with CMD.

Methods

Sixty-eight chronic coronary syndrome patients with de novo single functionally significant stenosis (Fractional flow reserve [FFR] <0.80) were investigated. CMD was defined by the index of microcirculatory resistance (IMR) ≥25. Clinical characteristics and CTP findings were compared between the two groups with and without CMD (CMD, n=29, non-CMD, n=39, respectively). The computed tomography angiography (CCTA) assessment included CTP findings and quantitative and qualitative assessment of plaques.

Results

In wire-based analysis, FFR, coronary flow reserve (CFRwire) and IMR were 0.68 (0.59–0.74), 1.71 (1.24–2.88), and 22.6 (15.1–34.5), respectively.

In CTP analysis, culprit territory regional absolute myocardial blood flow (MBF) at rest (rest-MBF) and hyperemia (hyperemic-MBF) were evaluated semi-automatically. CTP-derived CFR (CFRCTP) was calculated as hyperemic-MBF divided by rest-MBF. Rest and hyperemic-MBF and CFRCTP were 0.83 (0.64–1.03) ml/min/g, 2.14 (1.30–2.92) ml/min/g, and 2.19 (1.44–3.37).

In the lesions with CMD, hyperemic-MBF was significantly lower than those without CMD (1.68 [0.84–2.44] vs 2.31 [1.67–3.34] ml/min/g, p=0.015) and the prevalence of CFRCTP<2.0 was higher in the lesions with CMD than those without CMD (62.1% vs 28.2%, p=0.007).

CCTA analysis showed that fibrofatty and necrotic core component (FFNC) volume was greater in the lesions with CMD than in the lesions without CMD (31.8 [19.0–48.9] vs 25.1 [17.2–32.1] mm3, p=0.045). The multivariable logistic regression analysis, hyperemic-MBF and FFNC volume were independent predictors for lesions with CMD (Odds ratio [OR] 0.583 [0.355–0.958], p=0.033 and OR 1.040 [1.010–1.070], p=0.018).

Conclusion

Quantitative assessment of absolute coronary flow by CTP and comprehensive plaque analysis by CCTA may help detect coexisting subtended microvascular dysfunction in patients with functionally significant epicardial coronary lesions. Further studies are needed to elucidate the clinical significance of coexisting CMD in CCS patients.

Funding Acknowledgement

Type of funding sources: None.
Artificial intelligence-based opportunistic screening for the detection of arterial hypertension through ECG signals
Authors: Angelaki E , Barmparis G , Kochiadakis G , Maragkoudakis S , Tsiavos A , Kalomoirakis P , Kampanieris E , Zervakis S , Plevritaki A , Savva E , Kassotakis S , Vardas P , Tsironis G , Marketou M
Published: October 2022

Background

Hypertension is a major risk factor for cardiovascular disease (CVD) which often escapes the diagnosis or should be confirmed by several office visits. The electrocardiogram (ECG) is one of the most widely used diagnostic tools and could be of paramount importance in patients' initial evaluation.

Purpose

To detect whether a person is hypertensive using features from the ECG, as well as basic anthropometric features such as age, sex, and body mass index (BMI).

Methods

We used machine learning (ML) techniques based features derived from the electrocardiogram for detecting hypertension in a population without CVD. We enrolled 1091 subjects who were classified into hypertensive and normotensive group. We trained 3 ML models, specifically logistic regression, k-nearest-neighbors, and random forest (RF), to predict the existence of hypertension in patients based only on a few basic clinical parameters and ECG-derived features. We also calculated Shapley additive explanations (SHAP), a sophisticated feature importance analysis, to interpret each feature's role in the random forest's predictions.

Results

Our RF model was able to distinguish hypertensive from normotensive patients with accuracy 84.2%, specificity 66.7%, sensitivity 91.4%, and area under the receiver-operating curve 0.86. Age, BMI, BMI-adjusted Cornell criteria (BMI multiplied by RaVL+SV3), R wave amplitude in aVL, and BMI-modified Sokolow-Lyon voltage (BMI divided by SV1+RV5), were the most important anthropometric and ECG-derived features in terms of the success of our model. Figure 1 shows the results in detecting hypertension by the Random Forest.

Conclusions

Our ML algorithm is effective in the detection of hypertension in patients using ECG-derived and basic anthropometric criteria. Our findings open new horizon in the detection of many undiagnosed hypertensive individuals who have an increased cardiovascular disease risk.

Funding Acknowledgement

Type of funding sources: None.
Effects of targeted therapy on blood gas analysis in pulmonary arterial hypertension – a retrospective analysis
Authors: Kramer T , Limper U , Kramer M , Jordan J , Tank J , Hellmich M , Stehle R , Baldus S , Rosenkranz S
Published: October 2022

Background

In pulmonary arterial hypertension (PAH), there is an excessive respiratory drive, which leads to inefficient ventilation with subsequent hypocapnia. Changes in blood gas analysis (BGA) may correlate with symptom severity and outcome. Data on impact of targeted PAH therapy on BGA are scarce and it remains unclear if these values can be used for risk stratification purposes.

Purpose

To assess capillary BGA in PAH at diagnosis and to evaluate the effect of targeted therapy on classical and calculated BGA parameters.

Methods

147 patients (62.3±17.1 years; female/male ratio: 66.7/33.3%) with newly diagnosed PAH were treated with targeted PAH therapy. 12-month follow-up included assessment of capillary blood gases and clinical variables. Patients underwent repeat RHC after 15.9±15.5 months.

Results

At diagnosis, both pcO2 (66.8±1.3 mmHg) and pcCO2 (32.7±0.5 mmHg) were slightly reduced. At 12-month follow-up, pcCO2 increased significantly to values within normal range (35.3±0.4 mmHg), while pcO2 showed no significant changes. After using the formula to calculate standard pcO2, baseline values were even lower, but there were significant improvements at 12-month follow-up, also reaching normal values. Changes in pcCO2 and standard pcO2 at diagnosis correlated with hemodynamics and survival at follow-up. Repeated RHC demonstrated significant reductions in mean PAP (48.9±1.2 to 39.9±1.0 mmHg; −18.4%), and PVR (11.3±0.7 to 6.2±0.3 WU; −45.1%), and an increase in cardiac index (2.1±0.04 to 2.6±0.1 ml/min/m2; +23.8%) (all p<0.05). Hemodynamic improvements correlated with improved clinical parameters, including 6-minute walking distance (344±9 to 393±9 m), NTproBNP serum levels (2.163±219 to 772±84 ng/l, both p<0.05) and WHO-FC at 12 months, resulting in improved risk status.

Conclusions

Targeted PAH therapy leads to significantly improved cardiopulmonary hemodynamics with subsequent increase in pcCO2, presumably due to less hyperventilation. Changes in pcCO2 and standard pcO2 (but not pcO2) correlate with hemodynamics and survival, potentially serving as non-invasive parameters for risk assessment and therapeutic response. The discrepancy between pcO2 and standard pcO2 at diagnosis suggests that pcO2 is upregulated by the hyperventilatory state. Standard pcO2 represents an easy-to-calculate parameter that can help more accurately identify PAH patients requiring O2 therapy in addition to targeted therapy. Further studies are needed in this context.

Funding Acknowledgement

Type of funding sources: None.
Biomarkers associated with prevalent hypertension and higher blood pressure in a population-based cohort: a proteomic approach
Authors: Dieden A , Holm H , Melander O , Pareek M , Molvin J , Rastam L , Lindblad U , Daka B , Leosdottir M , Nilsson P M , Olsen M H , Gudmundsson P , Jujic A , Magnusson M
Published: October 2022

Background

Globally, hypertension represents an enormous health issue as it is a major, yet modifiable risk factor for developing cardiovascular disease. Recently, chitinase-3-like protein 1 (CHI3L1) was shown to be positively associated with the incidence of hypertension among prehypertensive subjects, and variants of CHI3L1 gene were associated with both CHI3L1-levels and hypertension.

Purpose

To explore associations between prevalent hypertension and blood pressure, and 92 proteins with involvement in inflammation and cardiovascular disease.

Methods

Plasma samples from 1713 individuals from a Swedish population-based cohort (mean age 67.3±6.0 years; 28.9% women) were analysed with a proximity extension assay panel, consisting of 92 proteins. Prior to all analyses, subjects with prevalent cardiovascular disease, defined as having a history of prevalent coronary or stroke event, were excluded (n=189). Univariate logistic regression models were carried out exploring associations between each of the 92 proteins and prevalent hypertension, defined as systolic blood pressure ≥140 mmHg and/or a diastolic blood pressure ≥90 mmHg, or use of antihypertensive treatment (n=1168, 76.4%). Bonferroni-corrected significant associations between proteins and hypertension were further analysed using stepwise selection of covariates, namely age, body mass index, diabetes status, and cystatin C, in logistic regression models. Proteins with significant adjusted associations with prevalent hypertension were further analysed for associations with systolic and diastolic blood pressure individually in stepwise linear regression models. Complete data on all variables were available in 1527 subjects.

Results

Sixteen proteins were significantly associated with prevalent hypertension in univariate analyses. After adjustment, three proteins remained significantly associated with prevalent hypertension (i.e., CHI3L1, low-density lipoprotein receptor (LDL receptor) and tissue plasminogen activator (tPA); Table 1). In analyses of associations with systolic blood pressure, CHI3L1 and LDL receptor showed significant associations. In analyses of associations with diastolic blood pressure, CHI3L1, LDL receptor and tPA showed significant associations (Table 1).

Conclusions

Higher CHI3L1, tPA and LDL receptor levels were positively associated with prevalent hypertension after multivariable adjustment, among 1527 elderly subjects without established cardiovascular disease. Furthermore, higher CHI3L and LDL receptor levels were positively associated with mean systolic, as well as mean diastolic blood pressure in multivariable analyses.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): The Swedish Medical Research Council and The Swedish Heart and Lung Foundation
New definition of hypotension in patients with reflex syncope using 24-hour ambulatory blood pressure monitoring (SynABPM Study)
Authors: Rivasi G , Brignole M , Groppelli A , Soranna D , Zambon A , Sutton R , Kenny R A , Ungar A , Fedorowski A , Parati G
Published: October 2022

Background

Diagnostic criteria for ambulatory blood pressure monitoring (ABPM) in patients with suspected reflex syncope are lacking.

Purpose

We hypothesized that patients with reflex syncope have a higher prevalence of systolic blood pressure (SBP) drops on ABPM than control subjects and we aimed to define the SBP cut-off values that allow identification of patients with hypotensive susceptibility.

Methods

We compared ABPM data from reflex syncope patients and controls, matched by average 24-hour SBP, age, sex and hypertension. Patients with constitutional hypotension, orthostatic hypotension, predominant cardioinhibition or competing causes of syncope were excluded. Daytime and night-time SBP drops (<110, 100, 90, 80 mmHg) were assessed. Findings were validated in an independent sample.

Results

In the Derivation cohort, daytime SBP drops were significantly more common in 158 syncope patients than 329 controls. One or more daytime drop <90 mmHg provided the best diagnostic yield (91% specificity, 32% sensitivity, Odds Ratio [OR]=4.6, p=0.001). Two or more-daytime drops <100 mmHg achieved 84% specificity and 40% sensitivity (OR=3.5, p=0.001). Results were confirmed in the Validation cohort: one or more daytime SBP drop <90 mmHg provided 94% specificity and 29% sensitivity (OR=6.2, p<0.001), while two or more daytime SBP drops <100 mmHg achieved 83% specificity and 35% sensitivity (OR=2.6, p<0.001) (Figure 1).

Conclusion

SBP drops during ABPM are more common in reflex syncope patients than in controls. Cut-off values that may be applied in clinical practice are defined. This study expands the current indications for ABPM to patients with reflex syncope.

Funding Acknowledgement

Type of funding sources: None.
Additional opportunities for antihypertensive therapy improvement in young patients with arterial hypertension and concomitant obesity
Authors: Chernyshova K , Yakimenko O , Bondar V , Chernyshova H , Kolomiets S , Oliynyk D , Tbileli V , Maznichenko I E
Published: October 2022

The high prevalence of arterial hypertension (AH) and concomitant obesity in young patients is not only a medical but also a social problem. It is important to develop additional modern approaches to the management of young patients with AH and obesity, which will increase the effectiveness of existing antihypertensive (anti-AH) medical therapy and prevent early damage of target organs and complications.

The purpose of the research was to evaluate the antihypertensive efficacy of the proposed complex treatment and its impact on quality of life in young patients with AH and obesity (or overweight).

Material and methods

123 patients with AH (ESC 2018), of young age 18–44 (mean age 32.81±0.58) y.o. were examined, among them the overweight was in 40 patients, obesity - in 42 patients. The average BMI was (28.34±0.45) kg/m2. All patients were divided into 2 groups depending on the treatment: Group 1 – standard anti-AH treatment, Group 2 – modified combined therapy, which included on the background of standard anti-AH medications the dosed controlled physical exercises with its obligatory registration, a modified DASH diet with increased intake of Ca-containing products and Metformin in the presence of insulin resistance according to the HOMA index (with correction of dose depending on BMI). In dynamics the patients were performed daily blood pressure monitoring (BPM) was performed and the SF-36 questionnaire was used to assess the quality of life (QOL).

Results and discussion

According to BPM data in the Group 1 the average 24-hour value of SBP decreased by 12.5% (p=0.01), in Group 2 – by 20.2% (p=0.001), DBP - by 11.2% (p=0.03) and by 18.8% (p=0.01) respectively (the difference between the groups for SBP and DBP was p=0.032 and p=0.041, respectively). Assessing the degree of nocturnal blood pressure decreasing, in the Group 1 the percentage of patients with insufficient nocturnal blood pressure decreasing (non-dipper) and stable increasing (night peaker) decreased non-significantly (p=0.086), unlike the Group 2, where there was a significant (p=0.02) positive dynamics in relation to these unfavorable types of blood pressure profile. Evaluating the indicators of QOL according to SF-36, the physical component of health in the Group 1 increased by 16.7%, in Group 2 – by 33.4% (p=0.001), the mental component of health – by 13.5% and 28.9%, respectively (p=0.001).

Thus, the additional use of the proposed treatment complex with the inclusion of dosed registered exercises, increased consumption of Ca-containing products and correction of insulinresistance significantly increases the effectiveness of antihypertensive medical therapy and has a positive effect on physical and mental components of QOL in young patients with AH and obesity or overweight.

Funding Acknowledgement

Type of funding sources: None.
Differentiated approach to the treatment of uncomplicated hypertensive crisis
Authors: Sadulloeva M , Khamidullaeva G A , Ataniyazov K H H , Ibragimova I A , Yuldasheva A D
Published: October 2022

Background

In primary health care, especially in rural areas, non-standard treatment of hypertensive crises is still used. In the present research study, we wanted to implement proven standards for uncomplicated hypertensive crisis management based on baseline blood pressure.

Purpose

To explore the clinical and hemodynamic efficiency of urapidil and captopril for the purpose of a differentiated approach to the treatment of uncomplicated hypertensive crisis.

Methods

The research includes 132 patients with a diagnosis of “Uncomplicated hypertensive crisis” in an average age All patients underwent physical examination, ECG, ECHOKG, ultrasound examination of the brachiocephalic arteries, biochemical analyzes, determination of microalbuminuria to exclude acute damages of organs and systems on account of HCR. All investigations were carried out within 10–15 minutes after the initial address of patients, according to the recommendations of the European Society of Hypertension/European Society of Cardiology (ESH/ESC 2018). Office blood pressure (BP) was measured on admission, 15, 30, 60 and 120 minutes after taking the antihypertensive drug

Results

The antihypertensive efficacy of urapidil and captopril in uncomplicated hypertensive crisis was assessed by the dynamics of average BP, a decrease in ABP by 10% at the first 30 minutes and by 20–25% within 120 minutes was considered as a positive antihypertensive effect. In the urapidil's group (n=104), BP before treatment corresponded to the 3rd grade of arterial hypertension (AH): 202.33±22.06/105.3±7.82 mm Hg. Urapidil at an average dose of 44.6 mg significantly reduced the BP by −27.27±4.7% by 120 minutes. In the captopril's group (n=28), BP also corresponded to the 3rd grade of AH (192.5±23.76/103.53±6.85 mm Hg), whereas systolic BP was significantly lower than systolic BP in the urapidil's group. Despite this, captopril at an average dose of 33.2 mg did not show a sufficient decrease of average BP by the 120 minutes, and an intergroup significant difference in the degree of decrease in BP was revealed: −16.94±5.25% in the captopril group versus −27.27±4.7% in the urapidil group, p<0.005. But captopril showed sufficient antihypertensive efficacy in 7 patients with 2nd grade of AH (172.71±8.08/101.85±1.8 mm Hg), reducing the BP by −21.19±3.03%.

Conclusion

A differentiated approach to the reduction of uncomplicated hypertensive crisis with urapidil and captopril showed a high clinical and hemodynamic efficacy of urapidil in patients with the 3rd grade of arterial hypertension. The effectiveness of captopril was limited in patients with the 3rd grade of hypertension, while in patients with the 2nd grade of hypertension, captopril showed a significantly clinical and hemodynamic effects.

Funding Acknowledgement

Type of funding sources: None.
Blockade of the renin-angiotensin system as a therapeutic target of NAFLD: results of an experimental model of hypercholesterolemia
Authors: Soares Sturzeneker M C , Precoma D B , De Noronha L , Oliveira P G M , Viechineski F N , Koscianski A M , Dlugosz A C , Karas B , Calixto C M , Hessman J H , Busnello L A
Published: October 2022

Background/Introduction

Non-alcoholic fatty liver disease (NAFLD) is often associated with metabolic syndrome (MS) and its components, including systemic arterial hypertension (SAH). In a recently published meta-analysis, the estimated prevalence of SAH in patients with NAFLD was 39.34%. Recently published observational studies have shown that the presence of NAFLD is independently associated with an increased risk of identifying SAH. Therefore, we can infer that we will often have to treat SAH in patients with NAFLD and that potential beneficial effects of the antihypertensive drug, in this context, may influence the choice of the respective drug.

Purpose

To evaluate the effects of olmesartan in an animal model of NAFLD (hypercholesterolemic rabbits).

Methods

34 rabbits divided into 3 groups: control group (CG) n=13, olmesartan group (OG) n=12 and normal control group (NCG) n=9. The NCG received standard chow for laboratory rabbits, the CG and OG received standard chow plus 1% cholesterol. The OG was medicated with olmesartan 1 mg/kg/day throughout the study period (8 weeks), and the three groups were euthanised in the eighth week. Serum levels of glucose, total cholesterol, triglycerides, creatinine, aspartate aminotransferase (AST) and alanine aminotransferase were evaluated at baseline and euthanasia, and liver tissue samples were taken in the euthanasia from the three groups. Haematoxylin-eosin stained slides were analysed based on the histological scoring system for NAFLD, Gomori,s trichrome stained slides were used for further evaluation of fibrosis, and immunostained slides with antibodies anti-nitric oxide synthase inducible (iNOS) for hepatic oxidative stress analysis.

Results

The steatosis (p=0.013), lobular inflammation (p<0.001), ballooning (p=0.039), and fibrosis (p=0.015) scores were significantly lower in the OG compared to the CG. Similarly, NAFLD activity scores were significantly lower in OG compared to CG. The hepatic expression of iNOS was significantly lower in OG than CG (P=0.001). The serum variables results suggest no direct effect of olmesartan in any of them.

Conclusion(s)

Olmesartan significantly attenuated hepatic oxidative stress, the development of steatosis, lobular inflammation, ballooning, fibrosis and steatohepatitis. Therefore, it suggests that olmesartan may be considered a potentially suitable option for hypertensive patients with NAFLD.

Funding Acknowledgement

Type of funding sources: None.
Comparative effect of 3 different fix-combination antihypertensive treatments in fasting glucose, fasting insulin, OGTT and HbA1c levels, in prediabetic hypertensive patients
Authors: Liontos A , Biros D , Papathanasiou A , Papagiannopoulos C , Klouras E , Veliani C , Kolios N G , Pappa C , Liberopoulos E , Elisaf M , Milionis H , Liamis G
Published: October 2022

Introduction

The effect of various antihypertensive drugs on the glucose homeostasis has been discussed extensively. Dual combination treatment is advised with current guidelines. We present comparative data of the effect of delapril/manidipine versus valsartan/amlodipine versus telmisartan/amlodipine combination treatments, in fasting glucose, fasting insulin, OGTT and HbA1c levels, before and after the 3-month treatment, in hypertensive prediabetic patients.

Methods

Data were collected from 154 patients from the outpatient clinic for patients with lipid disorders, hypertension and diabetes of our hospital, during the period 2014–2018. A number of 53 persons was randomized in the delapril/manidipine group 30/10 mg per day while 51 persons had been randomized in the group of telmisartan/amlodipine 80/5mg per day and 54 patients in the valsartan/amlodipine 160/5 mg per day. All patients successfully completed the study. Baseline characteristics are presented in Table 1A.

Results

The resulting alternations in glucose, insulin, OGTT and HbA1c levels, before and after the 3-month treatment are presented on Table 1B for the 3 groups of treatment.

Conclusions

In the comparison between the groups, a statistically significant difference was found in the change in INS values from the beginning of treatment until 3 months, for the TEL/AMLO treatment group, where a statistically significant difference from the DEL/MANI treatment group (p-value<0.01) and a strong statistically significant difference from the VAL/AMLO treatment group (p-value<0.001) were noted. The TEL/AMLO group had the only decrease in insulin levels compared to the other treatment groups where an increase was observed, after the treatment. The change in OGTT levels showed a statistically significant difference (p-value<0.05) between the DEL/MANI treatment group (a decrease of 6.63%) compared to the TEL/AMLO treatment group (an increase of 1.53%) after 3 months of treatment.

Funding Acknowledgement

Type of funding sources: None.
Device and non-device-guided slow breathing to reduce blood pressure in hypertensive patients: a systematic review and meta-analysis
Authors: De Freitas Goncalves K S , Queiroz Godoy Daniel A C , Tatagiba Lamas J L , Ceretta Oliveira H , De Campos Pereira Silveira R C , Cloutier L , Velludo Veiga E
Published: October 2022

Backgroud

Hypertension (HTN) is a multifactorial chronic disease. Considering the high prevalence rates of this disease, treatment of HTN is necessary, not only to reduce BP levels, but also to prevent the development of cardiovascular, cerebrovascular and kidney diseases. This treatment can be medication and/or non-farmacological, like device-guided slow breathing (DGSB) or non-device-guided slow breathing (NDGSB).

Purpose

The aim of this systematic review and meta-analysis is to summarize the effects of DGSB and NDGSB on blood pressure levels of patients with hypertension.

Methods

This study is systematic review and meta-analysis of randomized clinical trials, about hypertensive patients, with or without comorbidity, over 18 years old, of both sexes, with or without hypertensive medication. The selected studies showed comparisons between groups that performed DGSB and/or NDGSB with control conditions. The primary outcome was the value of systolic blood pressure (SBP) and diastolic blood pressure (DBP) after the interventions.

Results

Twenty-two studies involving 17,214 participants were included in the quantitative analysis. Considerable heterogeneity was revealed between studies. Using random effect model, it was found that DGSB did not significantly reduce SBP and DBP compared to usual care, both in terms BP values and in relation to their variations (SBP, MD −2.13 mmHg, [95% CI −12.71 to 8.44], 288 individuals; I2=93%, high heterogenity: DBP, MD −0.90, 95% CI −3.97 to 2.11, 288 individuals; I2=63%, substantial heterogenity. SBP variations MD −2.42, 95% CI −7.24 to 2.40, 443 individuals; I2=85% high heterogenity/DBP variations MD −1.67, 95% CI −4.57 to 1.24, 443 individuals; I2=80%, high heterogenity).

Conclusion

Based on these results it appears that DGSB did not reduce blood pressure in hypertensive patients and NDGSB is a new path for future.

Funding Acknowledgement

Type of funding sources: None.
Blood pressure alterations in recently COVID-19 vaccinated patients
Authors: Sanidas E , Papadopoulos D , Anastasiou T , Velliou M , Michalaki E , Fotsali A , Golemati S , Mantzourani M , Barbetseas J
Published: October 2022

Background

A non-immediate hypertensive response short after COVID-19 vaccination has been reported. Mild to moderate elevated arterial blood pressure (BP) levels have been documented few days after a single or two-doses vaccine. This study sought to investigate this observation as a potential side effect in patients with known hypertension and healthy controls.

Methods

A total of 100 vaccinated patients between the age of 50 to 70 years old were studied. They were randomly assigned to one of the approved and available vaccines (Pfizer, Astra Zeneca, Moderna, Johnson & Johnson). Half of them were hypertensives under medical treatment and half of them were not. All participants had systolic BP <140mmHg and diastolic BP <90mmHg before vaccination and volunteered for standard daily home BP measurements (HBPM) and ambulatory BP measurements (ABPM) between the 1st and the 21st day after considered fully COVID-19 vaccinated.

Results

All patients, hypertensives or not, had at some point a recorded hypertensive response for both systolic (SBP) and diastolic (DBP) BP after considered fully vaccinated. Hypertensives were older and with higher body mass index (BMI). Some of the hypertensive patients received additional medication whereas some of the non-hypertensive patients started life modification changes and systematic BP measurements for a possible diagnosis of hypertension.

Conclusions

Vaccination for COVID-19 seems to be related with a short period of hypertensive response. This phenomenon was partial and mostly observed in older overweight hypertensives.

Funding Acknowledgement

Type of funding sources: None.
Prescriptive appropriateness in primary cardiovascular prevention: data from our hospital
Authors: Maloberti A , Ceruti D , Gualini E , Colombo V , Giani V , Milani M , Sun J , Alloni M , Giannattasio C
Published: October 2022

Background

The main cause of waste of health resources is represented by overuse of diagnostic and therapeutic procedures. Given its high prevalence and the importance of identifying hypertensive-mediated organ damage, management of patients with arterial hypertension can lead to a lack of appropriateness. The aim of this study was to evaluate the prescriptive appropriateness of non-invasive diagnostic tests (Echocardiography, Carotid ultrasound, ECG exercise testing, 24h Ambulatory blood pressure monitoring) in outpatients referring to an ambulatory of primary cardiovascular prevention.

Methods

559 specialistic ambulatory visits were retrospectively analysed and appropriateness of every prescription was evaluated. An integration of different Italian and European guidelines was used to define appropriateness. Moreover, we evaluated the correlation between prescriptions, appropriateness and clinical characteristics of the population.

Results

During the 559 ambulatory visits analysed, 449 prescriptions were made, including 198 echocardiographies, 148 carotid ultrasound, 85 24h ABPM and 18 ECG exercise testing. The global percentage of appropriate prescriptions was 40.3%. Focusing on each test, appropriateness rate was 49.4% in 24h ABPM, 43.9% in echocardiography, 38.9% in ECG exercise testing and 30.4% in carotid ultrasound. A significant correlation was identified between the age and cardiovascular risk category of patients and the appropriateness of echocardiography, 24h ABPM and carotid ultrasound, and a correlation between appropriateness of echocardiography and the duration of hypertension and the presence of valvular heart disease.

Conclusions

Our study shows a relevant percentage of inappropriate prescriptions of non-invasive cardiologic exams; moreover, there might be a greater lack of appropriateness in young and low risk patients.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): Niguarda Hospital, Milan, Italy
Resting heart rate and arterial stiffness: a longitudinal prospective study in a population of hypertensive patients
Authors: Maloberti A , Fumagalli S , Garofani I , Ghidini S , Leidi F , Ruzzenenti G , Bombelli M , Giannattasio C
Published: October 2022

Background

The role of resting Heart Rate on the progression of arterial stiffness has not yet been extensively evaluated. The aim of this study is to investigate the relationship between resting HR and baseline arterial stiffness (evaluated by cfPWV) as well as its progression in a population of hypertensive patients over a 3.7 years follow-up period.

Methods

We enrolled 572 hypertensive outpatients 18–80 aged, followed by one hospital in Northern Italy. Anamnestic, clinical and laboratory data, BP and cfPWV were assessed at baseline and after a median follow-up time of 3.7±0.5 years

Results

At baseline the mean age was 53.9±12.7 years, SBP and DBP were 141.2±17.8 and 86.5±10.5 mmHg, HR was 65.6±10.9 bpm and PWV was 8.6±2.0 m/s. Despite an improvement in BP values (from 141.2/86.5 to 132.6/79.2 mmHg, p<0.001), during follow-up, PWV increased (ΔPWV 0.5±2.2 m/s). In patients with a ΔHR above as compared to those under the median value (9 bpm), ΔPWV was significantly higher (0.82±2.22 vs. 0.27±2.25 m/s, p=0.003). At multivariate analysis, HR was among the significant determinants of both baseline PWV and its progression (β = 0.031, p<0.001). Furthermore, ΔHR was a significant determinant of ΔPWV (β = 0.019; p=0.017).

Conclusions

in hypertensive patients there is a significant relationship between basal resting HR and basal PWV as well as between the increase of HR and the increase of PWV during the follow-up period. Beyond age and BP, resting HR must be considered as an independent determinant of arterial stiffness. This represents a possible mechanism through which HR contributes to the increase in CV risk.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): Niguarda Hospital, Milan, Italy
How would we evaluate hypertension if we had hypertension norms created from population data same as we evaluate hypertension in children?
Authors: Smida J
Published: October 2022

When we evaluate blood pressure in adolescent children, at 18 years we look at adult hypertension classification. Some of limits in paediatrics can be slightly higher. In some cases, the limits for hypertension can be more than 10 mmHg lower than in adult population. We wanted to compare adult classification with percentile-based limits calculated from population data (Graph 1).

Tables for paediatric hypertension published by European society of hypertension, that are based on report published by US national health institute, were used for constructing paediatric part of the graph. To match general population limits for 50th height percentile were used. With data from Czech post-MONICA study, we have calculated percentiles to match algorithm in paediatric population.

Difference in normal blood pressure between young men and woman can be observed, corresponding with paediatrics norms. For 17 years old boy with height over 95th percentile limit for hypertension is 140 mmHg in contrast for 17 years old girl under 5th percentile limit for hypertension is 125 mmHg. To match general population, we are comparing data for 50th percentile of height for 17-year-old and percentile for age group 25–34 (Table 1). For boys limits for hypertension are 136 and 141,5 mmHg. For girls limits for hypertension are 125 and 127,9 mmHg. Average blood pressure rises with age and there is difference between blood pressure in young population for men and women.

The purpose is not to change limits in older population, but we believe that connection between blood pressure norms for paediatrics and adult population should be addressed in next guidelines. Big technological advances in personal devices for blood pressure monitoring will probably bring lot of data and technological companies will offer our patients comparison with others. Graphical comparison of blood pressure will be available for everyone on mobile phone, so we should focus on publishing population norms in format, which software developers can use for graphs. Graphical comparison especially for young population is easier to use than complex tables.

Funding Acknowledgement

Type of funding sources: Private company.
Determinants of left atrioventricular coupling index: the multi-ethnic study of atherosclerosis (MESA)
Authors: Pezel T , Ambale Venkatesh B , De Vasconcellos H , Kato Y , Post W P , Wu C , Heckbert S , Bluemke D , Cohen-Solal A , Logeart D , Henry P , Lima J
Published: October 2022

Background

Recent studies have described a novel left atrioventricular coupling index (LACI), which had a better prognostic value than individual left atrial (LA) or left ventricular (LV) parameters measured separately to predict cardiovascular events.

Purpose

To identify the determinants of the LACI and its 10-year annual change (ΔLACI), measured by cardiovascular magnetic resonance (CMR), and to better understand the parameters governing this left atrioventricular coupling.

Methods

In the Multi-Ethnic Study of Atherosclerosis (MESA), 2,112 study participants, free of cardiovascular disease at baseline, had LACI assessed by CMR imaging at baseline (LACIBaseline, 2000–2002) and 10 years later (2010–2012). The LACI was defined as the ratio of LA to LV end-diastolic volumes. Linear regression analyses were performed to identify independent determinants of LACIBaseline or ΔLACI.

Results

In the 2,112 participants (58.8±9.1 years, 46.6% male), after adjustment for all covariates, age was independently associated with both LACIBaseline (R2=0.10, slope=0.16) and ΔLACI (R2=0.15, slope=0.008, both p<0.001). African Americans had the highest LACIBaseline value (18.0±7.7%). Although there was no difference in LACIBaseline between women and men (p=0.19), ΔLACI was higher in women than in men (1.0±1.1 vs. 0.8±1.0%/year, p<0.001). Diabetes and a higher BMI were independently associated with LACIBaseline (both p<0.001). LACIBaseline was independently associated with LV myocardial fibrosis markers (native T1: R2=0.11, slope = 0.09, p=0.038; and extra-cellular volume: R2=0.08, slope = 0.28, p=0.035) and NT-proBNP levels (R2=0.10, slope = −1.11, p<0.001) but was not associated with IL-6 or hsCRP.

Conclusions

Age, sex, ethnicity, diabetes, and BMI were independent determinants of LACI. LACI was independently associated with LV myocardial fibrosis markers and NT-proBNP levels.

Funding Acknowledgement

Type of funding sources: None.
Additive predictive value of low testosterone level in hypertensive men with hypercholesterolemia
Authors: Ioakeimidis N , Terentes-Printzios D , Antonopoulos A , Dima I , Gourgouli I , Solomou E , Aznaouridis C , Chatzistamatiou E , Lazaros G , Kalfountzos D , Tsioufis C , Vlachopoulos C
Published: October 2022

Purpose

Hypercholesterolemia is common in hypertensive patients and its presence increases the risk of cardiovascular (CV) complications. Decreased concentration of testosterone appears commonly in men with hypertension, and is an independent predictor of CV events. We investigated the utility of testosterone concentration measurement as an aid in the risk prediction of CV events in men with arterial hypertension and high LDL levels.

Methods

A cohort of 321 men with arterial hypertension and without known diabetes or atherosclerotic CVD (mean age: 54±9 years) were followed for the occurrence of major adverse cardiovascular events (MACE), (CV death, coronary artery disease, stroke). Total testosterone (TT) and LDL levels were measured in all patients. We used Cox proportional hazards regression to analyze the associations between LDL, serum testosterone and CV outcomes.

Results

During a mean follow-up of 6 years (range: 1–11 years), 31 (9.5%) patients demonstrated a MACE. Patients in the CV-event group were older and they had higher LDL and lower baseline TT levels compared to subjects in the event-free survival group (all P<0.01) while BMI, systolic blood pressure and smoking exposure (pack-years) were similar. Based on the observed distribution of baseline LDL levels the study cohort was divided in two groups: low LDL (<130 mg/dl) and high LDL (≥130 mg/dl). According to baseline TT level distribution the study cohort was divided in two groups: normal TT (>4.0 ng/mL) and low TT (≤4.0 ng/mL). Subjects in the high LDL group, had no increased risk of MACE compared to subjects in the low LDL group (HR 1.35; 95% CI 0.75–2.04) in the multivariable model. Moreover, there was no statistically significant association between low TT and risk of MACE. HR for low TT vs high TT was 1.48 (95% CI 0.85–2.16). We then subdivided the two LDL (high vs low) groups into subgroups according to presence of low or normal TT. Cox regression analysis revealed that the subgroup of men with both low TT and high LDL had an almost 2-fold higher risk of MACEs compared to the other three LDL/TT subgroups (adjusted hazard ratio: 2.07; 95% CI 0.94–3.56, P=0.035). Figure 1 shows the cardiac event-free survival curve of males with both baseline low TT and high LDL level with that of males in the other three LDL/TT subgroups (log rank: 11.3, P=0.008).

Conclusion

Low testosterone concentration is associated with a shorter event-free period in hypertensive patients with higher LDL levels. The measurement of testosterone concentration may be useful to further stratify the risk of middle-aged men with arterial hypertension and hypercholesterolemia.

Funding Acknowledgement

Type of funding sources: None.
Real-world data in the management of hypertension for patients with sleep disordered breathing after initiating continuous positive airway pressure treatment
Authors: Takama N , Kato T , Shiina T , Fujii T , Amanai S , Ishibashi Y , Ishii H
Published: October 2022

Introduction

There are many reports that patients with cardiovascular diseases including hypertension have already suffered from sleep disordered breathing (SDB). Furthermore, Continuous Positive Airway Pressure (CPAP) is effective for hypertension for improvement of sympathetic nervous activity reason. Previously, we reported that SDB is just as, if not more, important as common classical risk factors (hypertension, dyslipidemia, diabetes mellitus) for patients with cardiovascular diseases (Figure 1).

Purpose

Our aim in this study is to estimate the real-world data in the management of hypertension for patients with SDB after initiating CPAP treatment.

Methods

All patients were conducted full night polysomnography. One-hundred ninety-five patients showed obstructive SDB {apnea hypopnea index (AHI) >20/hour}, and CPAP treatment were initiated. According to Japanese society of hypertension guidelines for the managements of hypertension 2019 (JSH2019), we estimated the blood pressure and presence of blood pressure-lowering agents to assess effectiveness of CPAP treatment after six-month follow up.

Results

The study group consisted of 195 SDB patients (166 males, 29 females). The mean age was 59±7 years. Figure 2 showed the blood pressure and presence of blood pressure-lowering agents after initiating CPAP treatment. Group A which showed systolic blood pressure (SBP) <130 mmHg without intake of blood pressure-lowering agents was 20.9%. Group B which showed SBP <130 mmHg with intake of blood pressure-lowering agents was 9.6%. Group C showed SBP≥130 mmHg without intake of blood pressure-lowering agents was 30.5%. Group D showed SBP≥130 mmHg with intake of blood pressure-lowering agents was 39.0%.

Conclusion

We could estimate that there were high prevalence of hypertension for patients with SDB after initiating CPAP treatment. It is true that CPAP treatment have a beneficial effect on hypertension, but 70% patients (Group C and D) still remain inadequately treated. We need the strict blood pressure follow up for patient with SDB before and after initiating CPAP treatment.

Funding Acknowledgement

Type of funding sources: None.
Relationship between systolic blood pressure and renal function on clinical outcomes in patients with atrial fibrillation: a report from the AF-GEN-UK registry
Authors: Shantsila A , Lip G Y H , Lane D A
Published: October 2022

Background

European guidelines on AF management recommend a systolic blood pressure (SBP) target of 120–129 mmHg as this level is associated with the lowest risk of poor outcomes. Elevated blood pressure and AF both negatively affect renal function, but the interactions between SBP and renal function in patients with AF remains unclear. In the UK extension of the EURObservational Research Programme (EORP) Long-term Registry of patients with atrial fibrillation (AF) [AF-GEN-UK study], we assessed the combined impact of BP levels and renal (dys)function on mortality, thromboembolic and haemorrhagic events.

Methods

1580 patients (60.1% males, mean (SD) age 70.6 (11.2) years) from the AF-GEN-UK registry had SBP available at baseline and were stratified into groups based on SBP: 120–129 mmHg (reference group, n=289), <100 mmHg (n=165), 110–119 mmHg, (n=254), 130–139 mmHg (n=321), 140–159 mmHg (n=385), and ≥160 mmHg (n=166). Impact of SBP, renal function and their interaction on 1-year outcomes were assessed using Cox regression analysis, adjusted for age, oral anticoagulation (OAC) use and CHA2DS2-VASc score. SBP groups were compared by ANOVA (continuous data) and Chi-square test (categories) with two tailed p<0.05 deemed significant (STATA Corp, version 13).

Results

Overall OAC use was 84% and was similar between all SBP groups. Renal function (eGFR), was preserved across SBP groups; those with SBP 110–119 mmHg had the lowest level. Prevalence of heart failure was highest in those with SBP <110 mmHg. Patients with uncontrolled SBP (>140 mmHg) were older, more likely female and higher rates of hypertension, with correspondingly higher CHA2DS2VASc scores. SBP <100 mmHg (Hazard Ratio (HR) 2.36; 95% confidence intervals (CI) 1.20–4.64) and lower eGFR (HR 0.99; 95% CI 0.98–0.996) were associated with all cause-death in univariate analyses.

Adjusted Cox regression revealed that SBP <100 mmHg and OAC use were independent predictors of all-cause death (Table). No interaction between BP groups and eGFR was evident. OAC use (aHR 0.31; 95% CI 0.11–0.92) was associated with a reduced risk of thromboembolic events.

Conclusion

In anticoagulated patients with AF, SBP <110 mmHg was independently predicted of all-cause death, with no interaction with kidney function. No independent association of SBP groups with haemorrhagic and thromboembolic events was evident. OAC therapy was associated with a significant reduction in all-cause death and thromboembolic events.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): This project was supported by the BMS/Pfizer European Thrombosis Investigator Initiated Research Program