bluuebunny/crossref_metadata_2025 huggingface dataset:
EFFECT OF RENAL DENERVATION ON RENAL FUNCTION OF PATIENTS WITH UNCONTROLLED HYPERTENSION: INSIGHTS FROM A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED, SHAM-CONTROLLED TRIALS
Authors: Stavropoulos Konstantinos , Katsimardou Alexandra , Patoulias Dimitrios , Imprialos Konstantinos , Bouloukou Sofia , Tegou Zoi , Bakaloudi Dimitra , Kerpiniotis Georgios , Dimitriadis Kyriakos , Papademetriou Vassilios , Tsioufis Konstantinos , Doumas Michael
Published: April 2021

Objective:

Renal denervation (RDN) has been studied extensively during the last decade. Its role in the management of resistant hypertension has been placed at the epicenter. Its effect on renal function however represents a major safety issue.

Design and method:

PubMed and CENTRAL, along with grey literature sources, were searched from their inception to May 2019 for randomized, sham-controlled trials primarily evaluating the efficacy and safety of RDN on the management of hypertension, irrespective of study blinding, setting and sample size. We extracted those data concerning the effect of RDN on renal function of enrolled participants.

Results:

Six randomized, sham-controlled trials were identified and included in the meta-analysis. In total, 981 patients with hypertension were randomized in all 6 trials to undergo either RDN (n = 585) or sham-procedure (n = 396). RDN was associated with a non-significant decrease in estimated glomerular filtration rate by 0.24 ml/min/1.73 m2 (95% CI: -1.95 to 1.47; I2 = 0%), compared to sham procedure. It was also observed that restriction of the analysis on second-generation trials did not alter significantly the observed effect estimate (mean difference = -0.02; 95% CI: -2.64 to 2.62; I^2 = 0%). Finally, no difference was detected in serum creatinine levels, when RDN was compared to sham (mean difference = 0.00; 95% CI: -0.02 to 0.02; I^2 = 0%).

Conclusions:

RDN constitutes a safe procedure, as far as renal function is concerned. It has to be admitted however, that all trials were relatively short-term (up to 1 year); thus, data from long-term studies are needed to confirm the renal safety of RDN.
NONINVASIVE 24-HOUR HEMODYNAMICS PREDICT BLOOD PRESSURE RESPONSE TO RENAL DENERVATION IN THE SPYRAL HTN-OFF MED PILOT AND PIVOTAL TRIALS
Authors: Weber Thomas , Wassertheurer Siegfried , Mayer Christopher C. , Hametner Bernhard , Townsend Raymond R. , Mahfoud Felix , Kario Kazuomi , Fahy Martin , Debruin Vanessa , Peterson Nicole , Negoita Manuela , Weber Michael A. , Boehm Michael
Published: April 2021

Objective:

To investigate whether hemodynamic measures obtained during regular 24-hour blood pressure (BP) monitoring may predict BP response to renal denervation (RDN) using the SYMPLICITY SPYRAL renal denervation system.

Design and method:

This was a post-hoc analysis from the SPYRAL HTN-OFF MED pilot and pivotal trials. We used the raw BP waveforms, obtained at baseline and 3 months during 24-hour BP monitoring with an oscillometric sphygmomanometer. Waveforms were acquired at diastolic BP level, underwent in-device and post-hoc quality control, and were processed with validated ARCSolver algorithms to derive parameters of pulsatile hemodynamics (Augmentation Index – AIx). AIx quantifies the impact of wave reflection on the central aortic waveform. Its main hemodynamic determinants are aortic stiffness, peripheral resistance, heart rate and left ventricular function. We investigated the relationship between 24-hour AIx at baseline and the change in 24-hour systolic and diastolic BP (SBP/DBP) at 3 months in the combined RDN groups from both trials. Data were adjusted for observed trends in the sham group. We defined a favorable response as a drop in 24-hour systolic BP of at least 5 mm Hg.

Results:

Raw pressure waveforms were available for analysis in 103 patients undergoing RDN and 104 sham controls. Baseline characteristics and 24-hour BP changes at follow-up were comparable to the original trials. The relationship between baseline AIx and change in 24-hour SBP/DBP in the RDN group was: -8.2/-6.6 mm Hg for AIx < = 50. percentile and -0.8/-0.8 mm Hg for AIx > 50. percentile (p < 0.001). In addition, a higher heart rate at baseline was associated with a larger BP drop at 3 months. Taking AIx and heart rate into account, a favorable BP response following RDN could be predicted with an area under the curve of 0.70. Interestingly, baseline BP was no longer associated with BP response to RDN after adjustments for the BP changes in the sham group.

Conclusions:

Our hypothesis-generating results for the first time suggest that hemodynamic measures, obtained during regular 24-hour BP monitoring in the workup before RDN, may predict BP response. Due to sample size, further investigation is needed.
THE EFFECT OF SYMPATHETIC RENAL DENERVATION ON ARRHYTHMIAS BURDEN IN PATIENTS WITH UNCONTROLLED HYPERTENSION
Authors: Papakonstantinou Panteleimon , Konstadinidis Dimitrios , Iiliakis Panayiotis , Dimitriadis Kyriakos , Tousoulis Dimitrios , Tsioufis Konstadinidis
Published: April 2021

Objective:

Increased tone of the autonomic sympathetic nervous system plays a dominant role in the pathophysiology of cardiac arrhythmias. Sympathetic Renal Denervation (RDN) is a minimally invasive, alternative method of treating drug resistant arterial hypertension (HTN) with recent data also showing its positive effect in patients with atrial fibrillation (AF), atrial and ventricular arrhythmias. The aim of this study was to evaluate the effect of RDN on the total arrhythmias burden in patients with uncontrolled HTN.

Design and method:

The present clinical study is a randomized, single-center study including thirty (30) consecutive patients (> 18 years) with uncontrolled HTN. Patients will be randomized (1: 1) either to RDN (n = 15) or to conventional treatment of HTN with drugs (n = 15) according to the current European guidelines for the treatment of HTN. Patients will receive a 24-hour ECG Holter monitoring upon enrollment. All persistent and non-persistent atrial and ventricular arrhythmias will be recorded. After randomization, patients will be monitored for six months. 24-hour ECG Holter monitoring will also take place at 3 months after the enrollment. Office blood pressure (OBP) measurements as well as a 24-hour ambulatory blood pressure monitoring (ABPM) will be recorded at baseline and 3 months.

Results:

The primary endpoint of the study is the change in the total arrhythmias ’burden’ from inclusion to 3 months (Number of supraventricular and ventricular arrhythmias, premature atrial and ventricular comlexes). Secondary endpoints will include the change in the symptomatic and asymptomatic ’burden’ of the arrhythmias, the change in the supraventricular and ventricular arrhythmias burden, and the change in the OBP and ABPM from baseline to 3 months.

Conclusions:

This is the first study in the literature which aims to provide additional evidence for the pleotropic effect of RDN in patients with uncontrolled HTN and the total both symptomatic and asymptomatic atrial and ventricular arrhythmia burden. The relationship between the level of arterial hypertension reduction and arrhythmias will also be studied.
ASSOCIATION BETWEEN PRE-TRANSPLANT MEDIAL ARTERIAL CALCIFICATION AND EARLY POST-KIDNEY TRANSPLANT HYPERTENSION FROM A PROPENSITY SCORE WEIGHTING ANALYSIS
Authors: Tantisattamo Ekamol , Leelaviwat Natnicha , Polpichai Natchaya , Lopimpisuth Chawit , Saowapa Sakditad , Vutthikraivit Possawat
Published: April 2021

Objective:

Medial arterial calcification (MAC) detected by mammography (MG) is exclusively in the medial layer of the arteries and associated with cardiovascular (CV) outcomes in end-stage renal disease (ESRD) patients. Association between MAC and hypertension (HTN) after successful kidney transplantation (KT) is unclear.

Design and method:

Female KT patients with pre-KT MG was divided into MAC and non-MAC groups. Baseline characteristics including age, race, and pre-KT diabetes were balanced by propensity score weighting (PSW). Association between MAC and systolic HTN (SBP <130 mmHg) and diastolic HTN (DBP <80 mmHg) at a 24-week post-KT is examined by multiple logistic regression.

Results:

Of 51 KT candidates, mean age ± SD was 50.08 ± 10.47 years old and 18 patients (35.29%) were Black and the remaining non-Black were 33 (64.71%). Twenty patients (39.23%) had MAC and 21 patients (41.18%) had diabetes. Among 20 patients in MAC group, 14 and 7 patients had SHTN and DHTN at a 24-week post-KT, respectively; whereas, 17 out of 30 patients (missing 1 patient) in non-MAC group had both SHTN and DHTN (MAC vs. non-MAC for SHTN p 0.341 and for DHTN p 0.133). Compared to non-MAC group, MAC group had higher mean SBP (137.45 ± 18.52 vs. 130.70 ± 17.67; p 0.2060); whereas, its mean DBP was lower (74.15 ± 14.17 vs. 78.73 ± 10.55; p 0.2253). By using generalized boosted modeling-based PSW to balance baseline characteristics (Figure 1A&B) and adjusting for potential confounders including age, race, cause of kidney disease, pre-KT diabetes, serum albumin, corrected calcium, phosphorus, dialysis modality, type of KT, donor age, induction immunosuppressive medications, MAC group had 89% lower the odds of having DHTN compared to non-MAC group (OR 0.11; 95%CI 0.02 to 0.84). However, MAC group appeared to have higher, but not significant, risk for SBP (OR 2.24, 95%CI 0.35 to 14.46).

Conclusions:

KT patients with pre-KT MAC had lower the risk of developing DHTN during early post-KT period. DHTN, which indicates vascular stiffness and increases risk of CV mortality in ESRD, may not explain CV risk in KT recipients. Pathophysiology of DHTN and CV diseases in KT patients after successful KT may be different from ESRD population.
URINARY AMMONIUM EXCRETION BY ALDOSTERONE THROUGH THE REGULATION OF RH C GLYCOPROTEIN IN THE INTERCALATED CELLS OF THE RENAL COLLECTING DUCT
Authors: Izumi Yuichiro , Eguchi Koji , Ono Makoto , Hiramatsu Akiko , Inoue Hideki , Nakayama Yushi , Nonoguchi Hiroshi , Kakizoe Yutaka , Kuwabara Takashige , Mukoyama Masashi
Published: April 2021

Objective:

Aldosterone is a key hormone that regulates sodium reabsorption in the principal cells (PCs) of the renal collecting duct, maintaining blood pressure. Alternatively, aldosterone is involved in urinary acid excretion mainly via ammonia as ammonium ions in the intercalated cells (ICs) of the collecting duct, although its mechanisms are obscure. Rh C glycoprotein (Rhcg), an ammonia transporter, is expressed mainly in the intercalated cells. Direct regulation of ammonium excretion by aldosterone through the Rhcg in metabolic acidosis was investigated.

Design and method:

C57BL/6J mice were divided into four groups: 1) sham-operation, 2) sham and NH4Cl drinking (Sham-NH4Cl), 3) adrenalectomy and NH4Cl drinking (ADX-NH4Cl), and 4) adrenalectomy with continuous administration of aldosterone and NH4Cl drinking (ADX-Aldo-NH4Cl). Mice were sacrificed three days after NH4Cl drinking. Urinary ammonium excretion and localizations of Rhcg and ubiquitin were examined. For in vitro experiments, IN-IC cells, an intercalated cell-derived cell line, that stably express flag-tagged Rhcg (Rhcg-flag) were generated. The effects of aldosterone, spironolactone, Go6983 (a PKC inhibitor) and MG132 (a proteasome inhibitor) on the expression of Rhcg-flag were examined.

Results:

NH4Cl-induced urinary ammonium excretion was inhibited by adrenalectomy in ADX-NH4Cl mice. Aldosterone replacement restored ammonium excretion in ADX-Aldo-NH4Cl mice. Immunohistochemical study revealed that NH4Cl drinking increased the accumulation of Rhcg at apical and basolateral membranes and subapical sites of the ICs in sham-NH4Cl mice. Adrenalectomy and aldosterone replacement decreased and increased the accumulation of Rhcg at apical membrane of the ICs in ADX-NH4Cl and ADX-Aldo-NH4Cl mice, respectively. Ubiquitin expression was not changed between in PCs and ICs of sham-NH4Cl mice, while it was less in ICs than in PCs in ADX-NH4Cl mice. Aldosterone restored the ubiquitin expression in ICs. In IN-IC cells, Western blotting showed that aldosterone increased the expression of Rhcg-flag in the membrane fraction. Spironolactone and Go6983 each inhibited the expression of Rhcg-flag. Treatment with MG132 increased the expression of Rhcg-flag in whole cell lysate. Immunoprecipitation revealed the association of Rhcg with the ubiquitin.

Conclusions:

Aldosterone could directly regulate Rhcg expression through the mineralocorticoid receptor-PKC pathway. Furthermore, aldosterone could modulate Rhcg expression through the ubiquitin-proteasome pathway.
AMBULATORY BLOOD PRESSURE PROFILE AND BLOOD PRESSURE VARIABILITY IN PERITONEAL DIALYSIS COMPARED TO HEMODIALYSIS AND CHRONIC KIDNEY DISEASE PATIENTS
Authors: Alexandrou Maria-Eleni , Loutradis Charalampos , Kouris Nikolas , Sarris Dimitrsi , Schoina Maria , Tzanis George , Dimitriadis Chrisostomos , Sachpekidis Vasileios , Papadopolou Dorothea , Gkaliagkousi Eugenia , Papagianni Aikaterini , Parati Gianfranco , Sarafidis Pantelis
Published: April 2021

Objective:

Hypertension in ESRD patients is highly prevalent and poorly controlled. Data on ambulatory blood pressure (BP) profile and BP variability (BPV) in peritoneal dialysis (PD) patients are absent. This study examined the BP profile and BPV of patients undergoing PD in comparison to hemodialysis (HD) and pre-dialysis CKD patients.

Design and method:

Thirty-eight PD patients were matched for age, gender and dialysis vintage with 76 HD patients and for age and gender with 38 patients with CKD stage 2–4. Patients under PD and HD underwent 48-hour and CKD patients 24-hour ambulatory BP monitoring. BP levels and BPV indexes were compared for the 48hour, 1st and 2nd 24hour, daytime and nighttime periods. Two-way mixed ANOVA analysis for repeated measurements was used to evaluate the effect of dialysis modality and time on ambulatory BP in PD and HD.

Results:

During all periods studied, SBP and DBP were numerically higher but not statistically different in PD than in HD patients. Systolic BP was significantly higher in PD or HD compared with predialysis CKD (PD:138.38 ± 20.97; HD:133.75 ± 15.5; CKD:125.52 ± 13.4, p = 0.003), a difference evident also during daytime and night-time periods. Repeated-measurements analysis showed no effect of dialysis modality on ambulatory BP during all periods studied. All BPV indexes studied were similar between PD and HD patients and higher than CKD individuals (1st-24hour systolic-ARV: PD: 11.86 ± 3.19; HD:11.23 ± 3.45; CKD:9.81 ± 2.49, p = 0.016).

Conclusions:

Average BP levels and BPV indices are similar between PD and HD patients and higher compared to CKD counterparts. The dialysis modality has no effect on ambulatory BP profile. These results suggest that PD is no better than HD with regards to overall BP control or BP fluctuations over time.
EGFR-CYSTATINC/EGFR-CREATININE RATIO AS A POTENTIAL MARKER OF EARLY VASCULAR AND KIDNEY AGEING
Authors: Agne Laucyte-Cibulsk , Anders Christensson , Peter Nilsson
Published: April 2021

Objective:

Much of the research up to now has observed a link between cystatin C and pulse wave velocity (PWV) in patients with no or mild chronic kidney disease (CKD) that leads us to think that cystatin C is also related to arteriosclerosis. In fact, the relation between heart and kidney may be caused by common vascular changes giving rise to different elimination patterns for small and large molecules in kidneys. With this knowledge we propose that lower eGFRcystatin C/eGFRcreatinine ratio is potentially associated with early vascular aging (EVA). This relationship might be bidirectional, also incorporating early structural changes in glomerular filtration barrier, as a component of so-called “Shrunken pore syndrome” (SPS), further leading to CKD.

Design and method:

Data were extracted from the population based Malmö Diet and Cancer (MDC) study (n = 28 449) cardiovascular cohort (MDC CC) that enrolled a random sample of study subjects invited to participate in carotid artery disease epidemiological analysis (n = 6103) during the year 1991–1994. Our study sample consisted of 2685 subjects (1542 women, 834 men) who had carotid-femoral pulse wave velocity measurements and cystatin C available. Estimated glomerular filtration rate (eGFR) according to Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 2012 creatinine-cystatin C equation was calculated. Carotid-femoral pulse wave velocity (cfPWV) and central hemodynamics were measured by applanation tonometry (SphygmoCor).

Results:

Study subjects were classified according eGFR-cystatinC/eGFR-creatinine ratio: 6% (n = 159) of subjects with lower that 0.7 ratio, representing SPS, 59% (n = 1591) – as ratio between 0.7 to 1.0, and 35% (n = 935) – as ratio >1.0. There was pronounced sex specific trend because SPS group consisted mainly from women. We found that cfPWV was associated with the eGFR-cystatinC/eGFR-creatinine ratio, representing the decreased arterial stiffness at the ratio >1.0 and stiffer arteries at the ratio lower than < 0.7. We have identified factors that are related to early vascular ageing and on the opposite are related to better kidney function and lower arterial stiffness.

Conclusions:

The ratio of eGFR-cystatinC/eGFR-creatinine is a potential marker of early vascular ageing encompassing also early kidney function deteriorating.
AUTOMATED BRACHIAL-ANKLE VERSUS CAROTID-FEMORAL PULSE WAVE VELOCITY: SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Kyriakoulis Konstantinos , Kollias Anastasios , Chatzopoulos Michail , Stergiou George S.
Published: April 2021

Objective:

Carotid femoral pulse wave velocity (cfPWV) is the gold standard for measuring large artery stiffness. Automated brachial ankle pulse wave velocity (baPWV) is an alternative observer-independent method for assessing arterial stiffness at the level of both large (elastic) and small (muscular) arteries.

Design and method:

A systematic review and meta-analysis of PubMed and EMBASE studies was performed aiming to compare cfPWV and baPWV in terms of (i) absolute numerical difference, (ii) correlation coefficient and (iii) correlations with target organ damage (TOD).

Results:

Among 486 retrieved studies 44 were analyzed (n = 32.064, weighted age 59.4 ± 11.6 years, 48% hypertensives). Meta-analysis of 41 studies (n = 23.145, weighted age [SD] 60.2 ± 13.6 years, pooled cfPWV 9.4 [95% CI 8.8, 10.1] m/s) showed pooled baPWV-cfPWV difference at 4.6 m/s (95% CI 3.1, 6.1). There was considerable heterogeneity among the studies (I2 = 100%). Meta-analysis of 21 studies (n = 16.429) showed pooled correlation coefficient between baPWV and cfPWV at 0.67 (0.60, 0.74). Sensitivity analyses based on the technology used for cfPWV assessment showed baPWV minus cfPWV difference at (i) 6.5 (5.6, 7.5) m/s with the SphygmoCor (10 studies), and (ii) 3.8 (1.9, 5.6) m/s with the Omron VP1000/2000 Vascular Profiler (26 studies). Analysis of 16 high quality studies (n = 5.877) showed baPWV-cfPWV difference at 3.8 (2.9, 4.7) m/s. Three studies (n = 2,003) compared the correlation of left ventricular mass index with cfPWV (pooled r = 0.16, 95% CI 0.09, 0.23) vs. baPWV (r = 0.21, 95% CI 0.07, 0.35) (p < 0.05 for comparison).

Conclusions:

The current evidence indicates that baPWV gives higher values than cfPWV, which is probably due to the fact that these two indices assess the stiffness at different parts of the arterial tree. The two methods appear to be closely correlated and are associated with left ventricular mass.
THE ROLE OF MATRIX METALLOPROTEINASE (MMP)-2 TO TYPE I COLLAGEN TURNOVER CONTRIBUTING TO HYPERTROPHIC ARTERIAL REMODELING IN RENOVASCULAR HYPERTENSION
Authors: Neves Viviano Gomes de , Mello Marcela Maria Blascke de , Silva Pedro Henrique L , Pernomian Laena , Parente Juliana Monteneg , Castro Michele Mazzaron
Published: April 2021

Objective:

Type I collagen proteolytic products contribute to VSMC proliferation via integrin receptor and focal adhesion kinase (FAK) activation. We then evaluated whether the early activation of MMP-2 in hypertension induces VSMC proliferation, due to type I collagen proteolysis, which may activate integrin and FAK to develop hypertrophic arterial remodeling.

Design and method:

Sprague Dawley rats were submitted to 2K1C surgery to induce hypertension and they were orally treated with doxycycline or vehicle (five days at first week (acute) and eight weeks at ten weeks of hypertension (chronic)); (CEUA-USP 165/2019). In the aorta, we evaluated the expression of MMP-2 and type I collagen by Western blotting; MMP-2 activity by gelatin and in situ zymography, arterial morphology by HE, and collagen deposition by picrosirius red. All statistical analyzes used two-way ANOVA followed by Tukey post hoc test with p < 0.05.

Results:

Our results showed that 2K1C rats developed high systolic blood pressure at the first week (156 ± 13 mmHg vs. Sham (p < 0,001)), which was progressively higher at ten weeks (219 ± 6 mmHg, p < 0,0001). Moreover, there was a significant increase in the MMP-2 expression and activity in the 2K1C rats at the first and tenth weeks of hypertension (p < 0.05). Treatment with doxycycline reduced MMP-2 activity only in the acute situation (p < 0.05). The 2K1C showed increased levels of type I collagen as well as its potential degradation products (p < 0.05) in the aorta during the first week of hypertension. However, the deposition of collagen was notably resynthesized in the aortas of chronic 2K1C rats (p < 0.05).

Conclusions:

Treatment with doxycycline reduced such effects in hypertensive rats. At this moment, we concluded that increased activity of MMP-2 may contribute to type I collagen proteolysis in aortas at early stages of hypertension, with its potential re-synthesis at late stages. This proteolytic effect of MMP-2 on collagen may contribute to stimulating VSMCs proliferation through integrins and FAK, mechanisms that we are currently investigating.
EFFECT OF 24-WEEK ATORVASTATIN THERAPY IN STEMI PATIENTS ON ARTERIAL STIFFNESS
Authors: Oleynikov Valentin , Matrosova Irina , Borisova Natalia , Babina Anastasia
Published: April 2021

Objective:

To study the parameters of regional arterial stiffness in patients after acute myocardial infarction with ST segment elevation (STEMI) depending on the achievement of the target level of low-density lipoprotein cholesterol (LDL-C) during 24-week therapy with atorvastatin 40–80 mg.

Design and method:

The study included 80 STEMI patients (mean age 51.8 ± 8.2 years) in the first 24–96 hours from the disease onset. The diagnosis was confirmed by biomarkers of myocardial necrosis, electrocardiography, coronary angiography. All patients received treatment for STEMI. On 7th-9th day from the disease onset and after 24 weeks of follow-up, the regional arterial stiffness was assessed by volume sphygmography (VaSera-1000, “Fukuda Denshi”, Japan). The following indicators were determined: the pulse wave velocity in the aorta (PWV), in the arteries of elastic type on the right and left (R/L-PWV), cardio-ankle vascular index - CAVI (CAVI-1 and L-CAVI-1). CAVI-1- reflects the true arterial stiffness between the heart valve and the leg artery, L-CAVI-1 - between the groin area and the leg artery. The patients were divided into two groups depending on the LDL-C level after 24 weeks. Group 1 included 39 patients who did not reach the LDL-C < 1.4 mmol/L and/or decrease by 50% from the initial. The second consisted of 41 people who reached the target LDL-C level.

Results:

After 24 weeks of therapy in patients of group 1, there was no significant dynamics in all studied parameters. While in the 2nd group, there was a statistically significant decrease in almost all characteristics of vascular rigidity: PWV - from 8.1 ± 1.8 to 7.1 (5.6;7.3) m/s - by 21.7% (p = 0.01); R-PWV - from 13.1 (12.5;14.2) to 12.0 ± 0.84 m/s - by 8.1% (p = 0.03); L-PWV- from 6.8 (12.5;15.1) to 12.2 (11.2; 12.9) m/s - by 6.8% (p = 0.001). No significant changes were observed in CAVI-1. L-CAVI-1 decreased from 7.8 (7.3;8.4) to 7.4 ± 0.9 - by 4.6% (p = 0.03).

Conclusions:

Achievement of the LDL-C target level in patients after STEMI during 24-week therapy with atorvastatin 40–80 mg was accompanied by a significant improvement in the structural and functional properties of arteries according to volume sphygmography.
ADHERENCE TO ANTI-HYPERTENSIVE TREATMENT ON THE COVID-19 PANDEMIC
Authors: Guimaraes Mayra Cristina Luz Pádua , Coelho Juliana Chaves , Dos Santos Juliano , Higa Camila Braga De Oliveira , Florido Carime Farah , Lee Renata Jae Won , Soares Grazielli Pessoa , Silva Giovanio Vieira Da , Pierin Angela Maria Geraldo
Published: April 2021

Objective:

To evaluate the adherence to antihypertensive treatment during the COVID-19 pandemic and associated variables.

Design and method:

Cross-sectional study was performed with outpatient, from a Hospital in São Paulo, Brazil. Inclusion criteria were: age >18 years old, telephone number, in treatment for at least six months. Pregnant women were excluded. The period defined to characterize the assessment of social distance due to the COVID-19 pandemic was from March, 24 until August, 31. Hypertensive patients were interviewed by telephone. The adherence to treatment was assessed by Morisky and Green scale and the BP control was systolic BP < 140 mmHg and diastolic BP < 90 mmHg. Biosocial data, habits and lifestyles and attitudes towards social distancing measures were evaluated. The study was approved by the Research Ethics Committee. The significance level was p< = 0.05.

Results:

The sample was 281 hypertensive patients: 62.3% women; 66 (14) years old; 348,7 (255,8) $USA monthly income; 43.8% completed high school; 60.5% white; 47.0% married; and 59.1% retired. It was found that 58.7% were adherent to antihypertensive treatment and BP control was 51.6%. The systolic BP was 138.5 (22.7) mmHg and diastolic BP was 77.3 (14.4) mmHg. As for drug treatment, 55.2% of hypertensive patients received the drugs sent by the hospital pharmacy via mail, 63.9% reported that during the COVID-19 pandemic there was a problem in receiving the drugs and 10% was without antihypertensive sometime at home. The variables associated with treatment adherence were: race black (OR 0.40; 95% CI: 0.21 – 0.73), education elementary school II (OR 2.97; 95% CI: 1.24 – 7.06), stayed without antihypertensive at home someday from quarantine (OR 0.40; 95% CI: 0.17 – 0.95) and diastolic BP (OR 0.98; CI: 0.96 – 0.99). During the period of the pandemic evaluated, it was also observed that 77.6% reported leaving home, 13.5% had contact with people with the disease and 91.8% reported not feeling safe to leave the house after the end of quarantine.

Conclusions:

The rate of non-adherence to antihypertensive treatment during the COVID-19 pandemic was high and was associated with unfavorable biosocial variables.
EFFICACY OF A PSYCHOTHERAPEUTIC GROUP ON PATIENTS WITH OBESITY AND HYPERTENSION
Authors: Gabos Priscila , Watanabe Danielle , Bortolotto Luiz Aparecido
Published: April 2021

Objective:

OBJECTIVE: A) To evaluate the effects of a brief psychotherapeutic group for patients with obesity and hypertension of a Psychology Ambulatory Service over clinical parameters. B) To evaluate the viability and efficacy of a brief group psychoterapy program these patients regarding the learning of new coping responses to daily stressful situations.

Design and method:

DESIGN AND METHOD: It was a clinical trial, which the independent variable was the psychotherapic group with 12-weekly session conducted by a psychologist. The dependent variables were: weight and BMI, blood pressure and glucose, cholesterol and triglycerides; coping strategies measured by the Brief-COPE. All data was collected before and after the intervention. For variable comparison, it was used the non-parametric T-Student and Wilcoxon test.

Results:

RESULTS: A total of 19 patients with mean age of 57 years participated in 3 groups. After the sessions we observed significant reductions in BMI (kg/m2) (before = 39 ± 6, after = 34 ± 7; p < 0.05); weight (kg) (before = 102 ± 22, after = 91 ± 24; p < 0.05); systolic blood pressure (mmHg) (before = 149 ± 24, after = 132 ± 13; p < 0.05); and LDL (mg/dL) ((before = 134 ± 44, after = 90 ± 22; p < 0.05). Patients also developed an increase in the frequence of healthier coping strategies with active coping, planning, positive reframing and acceptance; and a decrease of unhealthy coping strategies, such as denial and behavioral disengagement.

Conclusions:

CONCLUSIONS: The brief psychotherapeutic group was effective for improvement of BMI, weight,blood pressure, and LDL, as well as the development of new coping strategies for the patients, facilitating self-care and treatment adherence.
HYPERURICEMIA IN PATIENTS WITH HYPERTENSION AND OBESITY: PREVALENCE AND CORRELATIONS WITH METABOLIC SYNDROME
Authors: Faria Nathalia , Cardoso Bruna , Duenhas-Berger Ana Luíse , Bortolotto Luiz Aparecido
Published: April 2021

Objective:

Describe hyperuricemia prevalence in people diagnosed with hypertension and obesity attended in a Hypertension ambulatory and co-related the metabolic syndrome with hyperuricemia.

Design and method:

A retrospective cross-sectional study in which data comes from patients’ electronic medical records watched between January 2018 to December 2019 in a Cardiovascular Hospital in Sao Paulo, Brazil. Sex, age, arterial systolic and diastolic blood pressure, abdominal circumference, uric acid, fasting glycemia, HDL-c, and triglycerides were collected from the latest result during that period. The National Cholesterol Education Program's Adult Treatment Panel III (NCEP-ATP III) as a reference to metabolic syndrome definition. Pearson and Spearman correlation test to describe the correlation between uric acid and metabolic syndrome requirements, according to p < 0.05 as a statistical significance.

Results:

31 patients watched with 54 ± 11 years old; most were women (64,5% n = 20). In addition, 45,2% (n = 14) shows hypertension diagnostics and all had metabolic syndrome. It was observed linear positive correlation between uric acid values and abdominal circumference (r = 0,493; p = 0,005), triglycerides (r = 0,467; p = 0,008). It was not found correlation between glycemia (r = 0,202; p = 0,276), SBP (r = 0,295; p = 0,107), DBP (r = 0,273; p = 0,335) and HDL-c (r = 0,194; p = 0,295).

Conclusions:

Hyperuricemia is prevalent between individuals’ diagnostics with hypertension and obesity, and also shows relation with metabolic syndrome, introducing the importance of the nutritional actions to prevent and minimize hypertension and obesity-associated, including the acid uric diet control.
STUDY ON THE DISTRIBUTION OF FAT FREE MASS OF SCHOOL-AGED CHILDREN AND ADOLESCENTS IN YINCHUAN CITY
Authors: Dong Yangyang , Cai Rongrong , Ma Ping , Yang Qingmei , Jia Leina , Ding Wenqing
Published: April 2021

Objective:

To understand the changing trend of fat free mass distribution with age and gender differences among school-age children and adolescents in Yinchuan city, China, and to provide scientific basis for healthy development and prevention of chronic diseases of children and adolescents and formulation of intervention measures

Design and method:

Using the method of convenient cluster sampling, 1175 school-age children and adolescents aged 10 to 20 years in Yinchuan, China were randomly selected for questionnaire survey and physical examination, and their body composition was measured by bioelectrical impedance analysis(BIA).

Results:

At the age of 12 to 18 years old, the fat free mass (FFM) and fat free mass percentage (FFMP) of boys increased with age (39.78 to 52.63 kg, 77.51% to 83.80%, respectively), the age trends of body parts FFM and FFMP were the same as the general trend, and were significantly higher than those of girls (all P < 0.05). In girls, the FFM reached the peak of 40.96 kilogram at 15 years old and decreased slightly at 15 to 18 years old, the age trend of body parts FFM were the same as the general trend; the FFMP and FFMP of left and right legs decreased with the increase of age, while the FFMP of left and right arms increased with age; the FFMP of trunk reached a minimum of 29.93% at 15 years old and increased at 15 to 18 years old (all P < 0.05).

Conclusions:

For school-age children and adolescents aged 12 to 18 years old in Yinchuan city, China, the fat free mass changed with age and gender differences, which accorded with the characteristics of their growth and development.
CLINICAL CHARACTERISTICS OF PEDIATRIC HYPERTENSION BASED ON THE HOSPITAL RECORDS: A MULTICENTER RETROSPECTIVE STUDY
Authors: Chen Yijun , Dong Hongbo , Mi Jie
Published: April 2021

Objective:

To understand the clinical characteristics and causes of HTN among pediatric inpatients in China.

Design and method:

Medical records were collected from 10 medical centers during 2016 to 2018 in China. Hypertensive inpatients were defined as patients who were under 18 years old and discharged with HTN diagnosis. For patients with multiple admissions during the study period, first admission records were included for analysis.

Results:

A total of 3,875 hypertensive discharge records were extracted from the 10 centers. After excluding multiple admission records, 2,394 hypertensive inpatients were included for analysis. The proportion of primary HTN, secondary HTN and unclear types of HTN were 24.4%, 46.5%, and 29.2%, respectively. Male patients accounted for a higher proportion than females among the three types of HTN. Compared with primary hypertensives, children with secondary HTN and unclear types were younger (0∼5 ages), especially for inpatients with unclear HTN, 41.0% were under 3 years old. In addition, most of patients with primary or secondary HTN were distributed in the eastern and developed regions (74.3% and 65.0%), while those with unclear HTN were mostly distributed in the western and undeveloped areas (74.6%). In patients with secondary HTN, renal diseases were the leading causes (54.5%), followed by rheumatic autoimmune diseases (15.5%).

Conclusions:

Secondary HTN was the most common type in Chinese hypertensive children. However, due to the high proportion of inpatients with unclear types, careful examinations should be mandatory in children with underlying disease for differential diagnosis.
THE IMPACT OF COVID-19 PANDEMIC LOCKDOWN ON HYPERTENSIVE INDIVIDUALS WITH COMORBIDITIES OF A LONGITUDINAL COHORT IN INDIA
Authors: Chakraborty Kaushik , Chakraborty Nilanjana , Mitra Ramendra Nath , Mitra Dipra
Published: April 2021

Objective:

The study objectives are to assess the challenges faced, individual awareness of pandemic, attitudes, and compliance of guidelines during lockdown.

Design and method:

This telephonic survey of 404 adult individuals were administered among hypertensive population with and without comorbidities of a longitudinal cohort in Barrackpore, West Bengal, India in Aug-Sept’2020. Comorbidities comprised with cardiovascular diseases, diabetes, asthma, OSA, BMI, epilepsy, stroke, arthritis, and cancer. Convenience sampling was considered to outline socio-demographics; chronic illness status; knowledge, attitude and practices; mood changes; and difficulties faced during lockdown. Association between variables have been conformed through multivariate logistic regression.

Results:

A total of 404 respondents, lone hypertensive 6.4%, hypertensive with other comorbidities 93.6%. Overall mean score of knowledge was 18.4 ± 5.2 (Range 1–23), practices 6.1 ± 1.1 (Range 2–8). Direct impacts on income 25.7%. Compliance of prescribed handwashing 93.3%, frequently hand sanitization 82.9%, using mask appropriately 91.1%, physical distancing 95.1%. Awareness of pandemic being contagious respiratory virus infection 97.8%, dispersion from human-to-human close contact 97.2%, curable 13.6%, could be fatal 4.5%, regarding symptoms 94.6%.

Adverse impact due to the non-availability of medicine at home 4.5%, in pharmacy 2.2%; absence of doctors 9.4%; procured medicine at higher cost 6.2%; inaccessibility of transport 2.7%. On 3 or more drugs 33.2%, stored drugs 34.7%. Required and received medical advice due to polypharmacy 2.5%.

Inadequate knowledge regarding 14-days isolation 4.5%; isolation and treatment reduce spread 2.7%; Lockdown was not an effective measure 11.4%; unconcerned regarding family members protection 34.2%; vaccine available in market 12.4%; and non-compliance of personal hygiene 6.2%. Pandemic still uncontrolled 14.4%.

Multiple physical and sedentary activities less among hypertensive with comorbidities compared to lone hypertensives (AOR = 0.96, CI: 0.95, 0.97, p < .0001). Hypertensives with comorbidities expressed better knowledge and practices compared to lone hypertensives.

Conclusions:

Short term impact during lockdown on hypertensive with or without comorbidities individuals was not significant.

For effective control of the pandemic each and every individual of the cohort needs fully to comply with the prescribed isolation regime, personal protective measures and physical distancing beside real understanding of preventive function of safe-effective vaccine for everyone when available.
EFFECT OF MAT PILATES ON RESPONSES OF BLOOD PRESSURE REACTIVITY IN NORMOTENSE AND HYPERTENSIVE POST MENOPAUSE SUBMITTED TO PSYCHOLOGICAL STRESS
Authors: Carrijo Victor Hugo Vila , Conçalves Ludimila Ferreira , Batista Jaqueline Pontes , Tavares Júlia Buiatte , Mariano Igor Moraes , Souza Tállita Cristina Ferreira de , Amaral Ana Luiza , Puga Guilherme Morais
Published: April 2021

Objective:

To analyze the effect of Mat Pilates training on blood pressure reactivity responses during psychological stress and resting blood pressure in normotensive (NT) and hypertensive (HT) postmenopausal women.

Design and method:

Forty-seven postmenopausal women participated in the study (24 normotensive and 23 hypertensive) (age: NT = 57.8 ± 4.4 years, HT = 58.9 ± 5.2 years). The intervention was carried out with Mat Pilates training three times a week for 12 weeks. Blood pressure reactivity was measured three times during the Stroop color stress test, using the auscultatory method. Resting systolic blood pressure (SBP) and diastolic blood pressure (DBP) was measured using the OMRON HEM-7113 automatic monitor, after 15 minutes of rest in a sitting position. Statistics performed with normality test by Shapiro-Wilk and Levene's homogeneity. The analysis of variance was performed using the ANOVA test (two way), for variables in relation to time (T), group (G) and time and group interaction (I), and the Newman Keuls post hoc test. The level of significance was set at p < 0.05.

Results:

After 12 weeks of Mat pilates, the results show that in BP reactivity I (p = 0.036) was found in the PAS variation, but there were no differences in T (p = 0.378) and G (p = 0.784), in the variation of PAS PAD results show significant differences in T (p = 0.003) and I (p = 0.001), but not in G (p = 0.264), in the variation of PAM the results show T (p = <0.001) and I (p = <0.001) and G (p = 0.709). For resting SBP there was a significant difference in variable T (p = <0.001) and resting DBP, difference in T (p = <0.001). However, in mean arterial pressure (MBP) there were significant differences in T (p = <0.001), and there were no differences in G (p = 0.075) and I (p = 0.434).

Conclusions:

Training with 12 weeks of Mat Pilates was able to generate positive responses in blood pressure reactivity during psychological stress and in resting blood pressure. Hypertensive women had better results than normotensive women.
EFFECTS OF MAT PILATES TRAINING ON BODY COMPOSITION AND CARDIOMETABOLIC MARKERS IN POSTMENOPAUSAL WOMEN WITH MULTIMORBIDITY
Authors: Amaral Ana Luiza , Batista Jaqueline , Goncalves Ludimila , Tavares Julia , Souza Tallita Cristina , Mariano Igor , Rodrigues Mateus , Junior Jair Cunha , Araujo Karine , Ribeiro Paula , Puga Guilherme
Published: April 2021

Objective:

The aim of this study was to evaluate the effects of Mat Pilates training on body composition, resting blood pressure, and lipids, glucose, and adiponectin levels in postmenopausal women with cardiometabolic multimorbidities.

Design and method:

Forty-seven postmenopausal women between 50 and 70 years were allocated into two groups based on the number of comorbidities: no more than 1 (COM n = 23) and at least 2 comorbidities (MULT n = 24). Both groups performed Mat Pilates three times a week for 12 weeks. Before and after the intervention, resting blood pressure, body composition, and blood samples (lipidogram, adiponectin, glucose, glycated hemoglobin, and uric acid) were evaluated. A two-factor Generalized Estimated Equation was used to compare groups, time, and their interaction (groups∗time).

Results:

Women in MULT presented higher body mass, body mass index, fat mass, and abdominal circumference than COM (p < 0.01). Blood pressure was reduced (p < 0.05) in both groups. Triglycerides decreased (p < 0.05) in COM and increases in MULT (p < 0.05) over time with no changes in total cholesterol, HDL, or LDL. Uric acid increases (p < 0.01) over time in both groups. Adiponectin had higher (p < 0.01) levels in the COM group and glycated hemoglobin decrease (p < 0.05) over time in both groups without changes in blood glucose. No interaction was found in any analyzed variable.

Conclusions:

These results suggest that 12 weeks of Mat Pilates training can improve blood pressure and glycated hemoglobin independent of the number of morbidities of cardiometabolic disease, but may not change body composition, lipids, glucose, or adiponectin levels in postmenopausal women.
ASSOCIATION BETWEEN THE DIFFERENCE OF BILATERAL BRACHIAL-ANKLE PULSE WAVE AND CARDIOVASCULAR EVENTS, ALL-CAUSE MORTALITY
Authors: Zheng Mengyi , Zhang Xinyuan , Wu Shouling
Published: April 2021

Aims:

To assess whether an elevated bilateral pulse wave velocity difference (BPWVD) is associated with a higher risk of cardiovascular disease (CVD) and allcause mortality.

Methods and Results:

We included 38512 participants from the community-based longitudinal Kailuan Cohort. These participants underwent measurements of the brachial-ankle pulse wave velocity (baPWV) from 2010 to 2011, and were followed to 2018 for CVD outcome and to 2019 for mortality. During a mean followup of 4.30 years of CVD and 5.23 years of all -cause mortality, 815 CVD cases (cerebral infarction, n = 556; intracerebral hemorrhage, n = 70; myocardial infarction, n = 179) and 952 mortalities were identifi ed. The mean BPWVD was 63.0?8.8 cm/s (median:43 cm/s; inter-quartile range:19,80 cm/s), and 9,708 (25.2%) participants were categorized as the high BPWVD group with a BPWVD in the highest quartile (≥80 cm/s). In the multivariable Cox proportional hazard model, compared with the normal BPWVD group, the high BPWVD group had a signifi cantly higher risk of myocardial infarction and all-cause mortality, with adjusted HRs (95%CI) 1.43 (95% CI: 1.04–1.96) and 1.18 (95%CI: 1.03–1.35), respectively. A higher BPWVD by one standard deviation was associated with HRs of 1.06 (95% CI: 1.02–1.10) for incident CVD, 1.10 (95% CI: 1.02–1.17) for incident myocardial infarction and of 1.07 (95% CI: 1.04–1.10) for all-cause mortality.

Conclusion:

Higher BPWVD was positively associated with the risks of CVD and all-cause mortality. Our fi ndings emphasize the importance of assessing BPWVD to identify high-risk individuals for CVD and mortality.
Individual-Level and Neighborhood-Level Risk Factors for Severe Maternal Morbidity
Authors: Meeker Jessica R. , Canelón Silvia P. , Bai Ray , Levine Lisa D. , Boland Mary Regina
Published: April 2021

OBJECTIVE:

To investigate the association between individual-level and neighborhood-level risk factors and severe maternal morbidity.

METHODS:

This was a retrospective cohort study of all pregnancies delivered between 2010 and 2017 in the University of Pennsylvania Health System. International Classification of Diseases codes classified severe maternal morbidity according to the Centers for Disease Control and Prevention guidelines. Logistic regression modeling evaluated individual-level risk factors for severe maternal morbidity, such as maternal age and preeclampsia diagnosis. Additionally, we used spatial autoregressive modeling to assess Census-tract, neighborhood-level risk factors for severe maternal morbidity such as violent crime and poverty.

RESULTS:

Overall, 63,334 pregnancies were included, with a severe maternal morbidity rate of 2.73%, or 272 deliveries with severe maternal morbidity per 10,000 delivery hospitalizations. In our multivariable model assessing individual-level risk factors for severe maternal morbidity, the magnitude of risk was highest for patients with a cesarean delivery (adjusted odds ratio [aOR] 3.50, 95% CI 3.15–3.89), stillbirth (aOR 4.60, 95% CI 3.31–6.24), and preeclampsia diagnosis (aOR 2.71, 95% CI 2.41–3.03). Identifying as White was associated with lower odds of severe maternal morbidity at delivery (aOR 0.73, 95% CI 0.61–0.87). In our final multivariable model assessing neighborhood-level risk factors for severe maternal morbidity, the rate of severe maternal morbidity increased by 2.4% (95% CI 0.37–4.4%) with every 10% increase in the percentage of individuals in a Census tract who identified as Black or African American when accounting for the number of violent crimes and percentage of people identifying as White.

CONCLUSION:

Both individual-level and neighborhood-level risk factors were associated with severe maternal morbidity. These factors may contribute to rising severe maternal morbidity rates in the United States. Better characterization of risk factors for severe maternal morbidity is imperative for the design of clinical and public health interventions seeking to lower rates of severe maternal morbidity and maternal mortality.
Association of Patient Sex and Pregnancy Status With Naloxone Administration During Emergency Department Visits
Authors: Forbes Lauren A. , Canner Joseph K. , Milio Lorraine , Halscott Torre , Vaught Arthur Jason
Published: April 2021

OBJECTIVE:

To evaluate the association of sex and pregnancy status with rates of naloxone administration during opioid overdose–related emergency department (ED) visits by using the Nationwide Emergency Department Sample.

METHODS:

A retrospective cohort study was conducted using the Nationwide Emergency Department Sample 2016 and 2017 data sets. Eligible records included men and women, 15–49 years of age, with an opioid overdose–related ED visit; records for women were stratified by pregnancy status (International Classification of Diseases, Tenth Revision O codes). A multivariable logistic regression model was used to assess the primary outcome of naloxone administration (Current Procedural Terminology code: J2310). Secondary outcomes included subsequent admission and mortality. A subgroup analysis compared pregnant women who did receive naloxone compared with those who did not receive naloxone.

RESULTS:

Records from 443,714 men, 304,364 nonpregnant women, and 25,056 pregnant women were included. Nonpregnant women had lower odds for naloxone administration (1.70% vs 2.10%; adjusted odds ratio [aOR] 0.86 [95% CI 0.83–0.89]) and mortality (2.21% vs 2.99%; aOR 0.71 [95% CI 0.69–0.73]) but higher odds of subsequent admission (30.22% vs 27.18%; aOR 1.04 [95% CI 1.03–1.06]) compared with men. Pregnant women had lower odds for naloxone administration (0.27% vs 1.70%; aOR 0.16 [95% CI 0.13–0.21]) and mortality (0.41% vs 2.21%; aOR 0.28 [95% CI 0.23–0.35]) but higher odds of subsequent admission (40.50% vs 30.22%; aOR 2.04 [95% CI 2.00–2.10]) compared with nonpregnant women. Pregnant women who received naloxone had higher odds of mortality (14% vs 0.39%; aOR 6.30 [95% CI 2.11–18.78]) compared with pregnant women who did not receive naloxone. Pregnant women who did not receive naloxone were more likely to have Medicaid as their expected insurance payer, be in the lowest quartile of median household income for residence ZIP codes, and have a concurrent mental health diagnosis compared with pregnant women who did receive naloxone.

CONCLUSION:

Reproductive-aged women who are nonpregnant and pregnant were less likely to receive naloxone during opioid overdose–related ED visits compared with reproductive-aged men. Naloxone administration for reproductive-aged women should be prioritized in the efforts to reduce opioid- and pregnancy-related morbidity and mortality in the United States.