bluuebunny/crossref_metadata_2025 huggingface dataset:
METABOLICALLY HEALTHY OBESITY AND RISK FACTORS. THE ROLE OF ADIPOSE TISSUE
Authors: Sanidas Elias , Velliou Maria , Papadopoulos Dimitrios , Anastasiou Theoharis , Michalaki Eftyhia , Golemati Spyretta , Barbetseas John
Published: June 2022

Objective:

Metabolically healthy obesity (MHO) is a benign condition commonly associated with lower cardiovascular (CV) risk. Adipose tissue might be implicated in this condition through bioactive hormones, so-called adipokines. The aim of this study was to compare cardioprotective (omentin-1, adiponectin) with non-cardioprotective (visfatin, resistin, chemerin) adipokines in MHO versus metabolically unhealthy obese (MUO) patients.

Design and method:

Overall, 200 obese patients were studied (100 MHO and 100 MUO). MHO were those with less than 3 of the following criteria: (1) waist circumference > 102 cm in males or > 88 cm in females, (2) triglycerides > 150 mg/dl or treatment for this abnormality, (3) HDL < 40 mg/dl in males or < 50 mg/dl in females or treatment for this abnormality (4) systolic blood pressure > 130mmHg or diastolic blood pressure > 85mmHg or treatment for hypertension and (5) fasting glucose > 100 mg/dl or treatment for type 2 diabetes mellitus. MUO were those with 3 or more of the above criteria.

Adipokines levels were measured by the Elisa method.

Results:

Omentin-1 and adiponectin were increased in MHO compared to MUO, whereas visfatin, resistin and chemerin were decreased. Statistically significant differences were observed only for omentin-1, visfatin and resistin.

Conclusions:

In healthy obese patients, cardioprotective omentin-1 was higher while non-cardioprotective visfatin and resistin were lower. This highlights a potential prognostic role of adipose tissue in classifying obese patients at decreased CV risk.
THE CONSEQUENCES OF METABOLIC SYNDROME, SEX AND AGE ON THE METABOLOME AND EPIGENOME MUTUAL REGULATION: THE EPIGENETIC DRIFT IN SEVERE OBESITY
Authors: Pisoni Serena , Maria Anna , Blasio Di , Gentilini Davide , Calzari Luciano , Marrachelli Vannina G. , Morales Jose Manuel , Monleón Daniel
Published: June 2022

Objective:

Metabolic syndrome (MetS) is the principal pathological consequence of obesity. Metabolome dysfunctions lead to multi-organ failure and cardiovascular complications, especially in the elderly. The metabolome is the output of genes-environment interaction and the epigenetic modifications act as their linker. So, it is reasonable a possible interplay between metabolomics and epigenetics. MetS prevalence increases sharply with age, especially in women, reaching in postmenopause a comparable prevalence to men of the same age. Our preliminary metabolomics results suggest stable significant differences between sexes in the global metabolic profiles. So, the aim is to study the interactions between metabolome and epigenome in subjects over 54 years old presenting metabolically healthy obesity (MHO) or severe MetS (MetS.5) to obtain a pathophysiological characterization of the most fragile patients.

Design and method:

96 subjects (48 cases MetS.5, 48 controls MHO; age 55–85) were selected from a cohort of 1350 adult subjects with extreme obesity (BMI> 40 kg/m2). MetS.5 indicated the presence of the 5 metabolic alterations according to the International Diabetes Federation (IDF) (2005). The cohort was extensively characterized for anthropometric and clinical outlines and NMR metabolomics profiles were previously measured. Global methylation levels were measured in serum using the Infinium MethylationEPIC BeadChip kit and specific statistical analyses were developed.

Results:

The global methylation levels between cases and controls didn’t appear different, although the epigenetic drift appeared higher in controls, due to the presence on average of a greater number of stochastic epigenetic variations (SEVs). The biological age, reflected by epigenetic age, appeared to be higher, on average, in men over women of similar chronological age, regardless of the pathological state, even if the last worsened the outcome.

Conclusions:

The epigenetics results, joint to the metabolomic data, may supply innovative knowledge and specific biomarkers involved in physiological mechanisms in healthy obesity and its pathological condition MetS. The results of the present study could add information and introduce new targets and biomarkers for better clinical treatment, a reduction in the risk of mortality and a better quality of life of extreme MetS patients.
ENDOTHELIAL COMPLICATIONS IN HYPERTENSIVE PATIENTS WITH OBESITY OR NORMAL BODY WEIGHT AFTER COVID-19
Authors: Kokaeva Izolda , Zhernakova Yulia , Blinova Natalia , Elfimova Eugenia , Pogorelova Olga , Tripoten Maria , Chazova Irina
Published: June 2022

Objective:

To study the contribution of a COVID-19 to endothelial dysfunction in hypertensive patients with obesity or normal body weight.

Design and method:

59 hypertensive patients, male and female, aged 20–50 years (40.2 ± 6.7 years), with blood pressure (BP) under control, without diabetes, non-smokers were included in the study. All of them were divided into three groups: I (n = 13) - patients with obesity (body mass index (BMI) > 30 kg/m2) and 1 month after COVID-19; II (n = 11) - patients with normal body weight (BMI < 25 kg/m2) and 1 month after COVID-19; III (n = 25) - patients with obesity (BMI > 30 kg/m2) without COVID-19. Patients of Ith and IIIth groups were comparable in BMI and BP levels. LDL-cholesterol and triglycerides levels, office systolic BP and diastolic BP, flow-mediated dilation (FMD) study to assessed endothelial function, were performed in all groups. Calculation was done with software STATISTICA 6.0.

Results:

Post-COVID-19 patients with obesity had significantly higher levels LDL-cholesterol and triglycerides, systolic BP and diastolic BP then in post-COVID-19 patients with normal body weight: 3.5 ± 0.7 mmol/l vs 3.02 ± 0.62 mmol/l (p < 0.05), 3.5 ± 2.9 mmol/l vs 1.10 ± 0.3 mmol/l (p < 0.05), 141 ± 9.6 mmHg vs 123 ± 10.3 mmHg (p < 0.05), 89.5 ± 10.01 mmHg vs 76 ± 8.8 mmHg (p < 0.05) respectively.

FMD were significantly lower in patients with obesity and COVID-19 (3.6 ± 2.9%, p < 0.05) then in patients with normal body weight and COVID-19 (8.7 ± 3.4%, p < 0,05) and in patients with obesity without COVID-19 (4.2 ± 3.6%, p < 0.05).

Conclusions:

Our study highlights that chronic impairment of systemic vascular endothelial function in patients with obesity, when intensified by the detrimental effects of SARS-CoV-2 over the endothelium, may explain their worse outcomes in COVID-19. However, obesity itself is one of important factors contributing to deterioration of endothelial function.
BENEFICIAL EFFECTS OF WEIGHT LOSS ON CENTRAL PRESSURE, ARTERIAL STIFFNESS AND SYMPATHETIC TONE IN OBESE SUBJECTS WITH OBSTRUCTIVE SLEEP APNEA
Authors: Cunha Michelle , Mattos Samanta , Klein Marcia , Neves Mario
Published: June 2022

Objective:

Obstructive sleep apnea (OSA) is known to be an independent cardiovascular risk factor. The presence of OSA and obesity may have synergistic effects on the progression of cardiovascular disease. To evaluate the effect of weight loss on vascular disease in obese patients with different OSA severity levels.

Design and method:

Individuals of both sexes, age between 40 and 70 years and body mass index (BMI) > = 30 and < 40 kg/m2 were submitted to nutritional intervention for 8 weeks with restriction of 800 kcal/day. Pulse wave velocity (PWV) and central hemodynamic parameters were evaluated by oscillometry (Mobil-O-Graph) and sympathetic tone by heart rate variability (HRV). The sleep study was performed using a portable home device (WatchPAT).

Results:

Patients (n = 70) were divided into two groups based on the apnea-hypopnea index (AHI): mild-absent (MA) group (AHI< 15 events/h, n = 25) with mean age 50 ± 6 years, BMI = 34.5 ± 2.8 kg/m2 and moderate-severe (MS) group (AHI> = 15 events/h, n = 45) with mean age 54 ± 8 years, BMI = 33.8 ± 2.6 kg/m2. After the intervention, weight loss was similar in both groups (-3.20 vs -3.32 kg). Both groups showed a significant reduction in anthropometric parameters. The MS group showed a significant reduction in peripheral systolic blood pressure (BP) (127 ± 15 vs 122 ± 15 mmHg, p = 0.007) and the MA group demonstrated a significant reduction in diastolic BP (78 ± 6 vs 75 ± 6 mmHg, p = 0.046). Central systolic pressure (116 ± 13 vs 107 ± 11 mmHg, p = 0.007), PWV (6.9 ± 0.6 vs 6.7 ± 0.6 m/s, p = 0.002) and vascular age (48 ± 6 vs 46 ± 6 years, p = 0.020) were significantly reduced only in the MA group. This group also demonstrated a significant increase in the RR interval (838 ± 225 vs 948 ± 130 ms, p = 0.032) with a reduction in heart rate (69 ± 5 vs 64 ± 8 bpm, p = 0.015).

Conclusions:

A small weight loss in a short period of time was able to promote more beneficial effects in obese individuals with non-severe sleep apnea including favorable outcomes on central hemodynamic parameters, arterial stiffness and autonomic activity.
BLOOD PRESSURE CONTROL IS BETTER IN PRIMARY CARE THAN IN THE GENERAL POPULATION: A CROSS-SECTIONAL STUDY IN A MULTI-PROFESSIONAL RURAL HEALTH CENTER (DOMFRONT, NORMANDY, FRANCE)
Authors: Humbert Xavier , Massenet Marc
Published: June 2022

Objective:

In 2015, more than 11 million patients treated for arterial hypertension in France. According to several studies in the general population, about 50% of hypertensive subjects are treated and about 20% are treated and controlled. There are very few data in general medicine. Our work have studied how these data may have differed in general medicine.

Design and method:

A cross-sectional observational study was carried out in a rural health center (Domfront, Normandy, France) on subjects aged 18 to 65 in 2018. A subject was considered to be hypertensive if his blood pressure (taken in the office in routine care) was greater than 140/90 or if it was treated with antihypertensive drugs.

Results:

Of 1,925 subjects, there were 54.3% women, aged 54.6 ± 7.1 years. The mean blood pressure was 127 ± 13/76 ± 8 mmHg, 60.6% (682/1127) were overweight and 5.0% (96/1925) were diabetic. 646 (33.6%) were hypertensive and 410 hypertensive (63.5%) were treated. 39.0% (252/646) were treated and controlled.

Conclusions:

In general medicine, blood pressure control seems to be better than in the general population, whereas the general practitioner is often the first contact with the healthcare system. Poor blood pressure control in the population can be explained by the lack of general medicine consultations for untreated hypertensive subjects.
INFLUENCE OF FACTORS ON SYSTOLIC BLOOD PRESSURE IN PATIENTS WITH HYPERTENSION IDENTIFIED DURING SCREENING
Authors: Bekbergenova Zhanagul , Derbissalina Gulmira , Umbetzhanova Ayagyoz , Batarbekova Sholpan , Masharipova Alexandra , Mauletbayeva Gulsum , Akhmetova Dina , Kelimberdiyeva Elmira
Published: June 2022

Objective:

Purpose: to assess the effect of various factors on systolic blood pressure (SBP) in patients with hypertension identified at screening.

Design and method:

A survey of 354 patients with hypertension identified at screening was carried out and the influence of various factors on SBP was assessed.

Results:

The average age of patients is 54 years [Q1-Q3: 50–54], of which 36.2% are men, 63.8% are women. Middle systolic blood pressure is 140 [Q1-Q3: 130–140] mm Hg. Most of the respondents have varying degrees of obesity. The average body mass index is 31.86 [Q1-Q3: 29.4–31.86]. The average waist is 95 [Q1-Q3: 92–95]. Mean values of total cholesterol. 5.8 [Q1-Q3: 5.6–5.8].

With an increase in age by 1 full years, an increase in SBP by 0.148 mm.Hg. should be expected. In accordance with the coefficient of determination R2 in the resulting model, 0.56% of the factors influencing the value of SBP were taken into account.

With an increase in body mass index by 1, a decrease in SBP by 0.059 mm Hg should be expected. In accordance with the coefficient of determination R2 in the resulting model, 0.04% of the factors influencing the SBP were taken into account.

With an increase in the waist by 1 cm, an increase in SBP by 0.059 mm Hg should be expected. In accordance with the coefficient of determination R2 in the resulting model, 0.09% of the factors influencing the SBP were taken into account.

With an increase in total cholesterol by 1 mmol/l. an increase in SBP by 24.466 mm Hg should be expected. In accordance with the coefficient of determination R2, the resulting model took into account 34.27% of the factors affecting the SBP. The effect of total cholesterol on SBP was statistically significant (p = 0.001) (methods used: Kruskal-Wallis test).

Conclusions:

The effect of total cholesterol on SBP is statistically significant (p = 0.001). With an increase in total cholesterol by 1 mmol/l. an increase in SBP by 24.466 mm Hg should be expected.
EVALUATION OF THE QUALITY OF SCREENING FOR HYPERTENSION
Authors: Bekbergenova Zhanagul , Derbissalina Gulmira , Umbetzhanova Ayagyoz , Batarbekova Sholpan , Masharipiva Alexandra , Mauletbayeva Gulsum , Akhmetova Dina , Kelimberdiyeva Elmira
Published: June 2022

Objective:

Background/Introduction. Hypertension is one of the most common causes of myocardial infarction and stroke in the Republic of Kazakhstan (RK). In RK, screening for hypertension is performed with 40-years of age.

Purpose: to assess the quality of the screening for hypertension.

Design and method:

A survey of 354 patients with hypertension identified at screening was carried out.

Results:

The average age of patients is 54 years [Q1-Q3: 50–54], of which 36.2% are men, 63.8% are women. In 66.7% of patients, heredity is burdened. According to the analysis of medical records, 117 (33.1%) patients smoke, while polling the same patients, 175 (49.4%) people smoke, which is 16.3% higher. According to the analysis, 38 (10.7%) patients drink, when we interviewed the same patients, 62 (17.5%) people drink, which is 6.8% higher. According to the analysis, 219 (61.9%) patients perform daily physical activity, according to our data, 111 (31.4%) people, which is 30.5% lower.

Middle systolic blood pressure is 140 [Q1-Q3: 130–140] mm Hg. Most of the respondents have varying degrees of obesity. The average body mass index is 31.86 [Q1-Q3: 29.4–31.86]. The average waist is 95 [Q1-Q3: 92–95]. Mean values of total cholesterol. 5.8 [Q1-Q3: 5.6–5.8]. During the electrocardiographic study, changes were identified in 69 patients (32 women, 37 men).

Conclusions:

During the initial questionnaire survey and clinical examination of patients with arterial hypertension at screening in 2015 and comparison with retrospective data, it became clear that such risk factors as tobacco smoking, alcohol consumption and daily physical activity were unreliable. Unfortunately, our work also has limitations and may be subject to subjective error, for example, we were unable to establish contact with the patient and a trusting relationship with the patient, or memory errors.
MALIGNANT HYPERTENSION HAMA COHORT: WHERE DO WE STAND IN 2021?
Authors: Boulestreau Romain , Lorthioir Aurelien , Persu Alexandre , Cremer Antoine , Rubin Sebastien , Tharaux Pierre Louis , Maier Benjamin , Mazighi Mikael , Paques Michel , Bonnin Sophie , Halimi Jean Michel , Gosse Philippe
Published: June 2022

Objective:

Malignant hypertension still exists. It is the deadliest form of hypertension, and has been forgotten. Guidelines are mainly based on consensus, without strong evidence supporting it.

French cohort HAMA is the first multicentric nationwide

Describe the characteristics of the 300 first patients included in the HAMA cohort, the substudies started and in preparation and the perspectives.

Design and method:

We set up a prospective, multicentre, observational cohort of patients with malignant hypertension. We collected at admission medical history, demographic data, ongoing treatment, clinical parameters, symptoms, care pathways, target organ status and at discharge and during follow up treatment administrated, adverse events, blood pressure level, target organ status. We aim to recruit 500 patients with malignant hypertension crisis in 5 years, with a 5-year follow-up. Our primary objective is to assess the 5 years prognosis of these patients.

Results:

We included 245 patients between September of 2019 and November of 2021, mainly men (66%), mean age 51,4 +/- 13,3 years, BMI 28 +/- 5,7, systolic and diastolic blood pressure at admission 228 +/- 23 and 124 +/- 25. Target organs damage included severe hypetensive retinopathy (87%), cardiac damage (52%), acute kidney injury (62%), cerebral damage (34%), thrombotic microangiopathy (15%).

Conclusions:

The findings of this cohort should help increasing the medical community awareness and disease screening. It should provide an up-to-date picture of the epidemiology of the disease, and help physician building guidelines based on high quality evidence, to improve the management of patients with malignant hypertension crisis. Subsequently, the knowledge gained from the HAMA cohort may be used to design controlled intervention and pathophysiological studies through biobank implementation. Next big step ahead is the inclusion of european centers.
DEVELOPMENT OF A TARGETED PROTEOMICS ASSAY FOR QUANTIFICATION OF ANGIOTENSIN PEPTIDES IN THE RENIN ANGIOTENSIN ALDOSTERONE SYSTEM
Authors: Bernieh Dennis , Lane Dan , Rufus Prabha , Osman Hanad , Salim Farah , Alghamdi Randah , Jenkins Sian , Gill Henry , Ng Leong , Jones Don , Gupta Pankaj
Published: June 2022

Objective:

The canonical renin–angiotensin aldosterone system (RAAS) has been extensively studied and methods are available for use clinically to assess hypertension. The non-canonical axis of the RAAS (consists of angiotensin 1–7, angiotensin 1–9, angiotensin-converting enzyme 2 and alamandine) counteract the effects of the canonical pathway. This reveals their role as potential therapeutic targets for cardiovascular disease but it has not been studied in detail in the clinical or research setting due to the difficulty in measuring its components. Furthermore, the functional balance between the two arms of RAAS has not been fully understood.

Design and method:

A multi-marker liquid chromatography coupled with triple quadrupole mass spectrometry (LC-MS/MS assay) was developed and optimised to simultaneously quantify 10 peptides (angiotensin II, Ang III, Ang IV, ACE2, Ang 1–5, Ang 1–7, Ang 1–9, Ang 1–12, Alamandine and Ang A) in the RAAS pathway.

For the preparation of calibration samples, 50 L of bovine serum albumin (BSA) was spiked with the 10 peptides standards and extracted by solid phase extraction using their respective internal standards. Chromatographic analyses were performed on an Acquity C18 Premier peptide column using gradient elution with a run time of 8 min. Identification was carried out using electrospray ionisation (positive) on a Waters Xevo TQ-XS triple quadrupole mass spectrometer. The developed assay is currently undergoing validation in line with international guidelines.

Results:

The method shows good linearity. The accuracy (relative error) and precision (coefficient of variation) values were within the pre-defined limits of within 15% at all tested concentrations for the target peptides. The assay sensitivity was sufficient to detect the peptides in plasma samples.

Conclusions:

The multimarker LC-MS/MS assay development was successful and following completion of validation has the potential to quantify the levels of these vasoactive peptides in patients with hypertension. This has been achieved, for the first time to the best of our knowledge on the entire RAAS pathway. This multimarker LC-MS/MS based proteomics assay could be used to study patients with hypertension in both research and clinical settings.
EFFECT OF SEVERE FOOD RESTRICTION ON BLOOD PRESSURE REGULATION IN THE FEMALE SPRAGUE DAWLEY RAT
Authors: Beck Steven , Souza Aline De , West Crystal
Published: June 2022

Objective:

Eating disorders have both short term and long term consequences that can be present years after recovery. However, the molecular mechanisms contributing to the increased cardiovascular risk for “recovered’’ individuals is still largely unknown. We have previously found that inbred female F344 rats have altered renin-angiotensin-aldosterone-system regulation of mean arterial blood pressure(MAP) following a 60% food restriction (to achieve a 15–20% body weight drop in F344). The purpose of this work was to see if these are robust changes that can be replicated in an outbred strain which is a better model of the human population.

Design and method:

Two-month-old female Sprague Dawley(SD) rats were divided into control(CON) that had access to food ad libitum and a food restricted(FR) that received a 56% food restriction (to achieve a 15–20% body weight drop in SD). After 2 weeks, CON (n = 5) and FR (n = 5) rats were sacrificed, the remaining FR (n = 4) and CON (n = 4) rats received chow ad libitum for 5 months. Prior to sacrifice, an acute MAP response to 200ng/kg Angiotensin II(ANGII) was recorded from the femoral artery under anesthesia by indwelling catheter.

Results:

We found that after 14 days of food restriction the FR rats had lower baseline MAP compared to CON rats (CON = 92 ± 3.0 vs. FR = 75 ± 0.4mmHG, p < 0.05), however, both groups had the same absolute response in MAP to ANGII infusion (CON = 19 ± 2.8 vs. FR = 18 ± 2.0 mmHG). After 5 months of refeeding we found that there were no statistical differences in baseline MAP between the groups (CON = 86 ± 2.2 vs. FR = 91 ± 4.8mmHg), however, there was a trend towards an increase in peak MAP response to ANGII (CON = 19 ± 1.5 vs. FR = 27 ± 3.0mmHg, p = 0.056).

Conclusions:

When compared to F344, we found similar trends in baseline MAP immediately following food restriction and months after refeeding. We did not detect a blunting of the ANGII response immediately following food restriction as in F344. We did find similarities between F344 and SD in response to ANGII months after refeeding. Food restriction appears to create a robust change in the response to ANGII months after refeeding, that is not strain specific.
LONG TERM EFFECT OF RESISTANT ARTERIAL HYPERTENSION ON RENAL FUNCTION IN COMPARISON TO NON-RESISTANT ARTERIAL HYPERTENSION
Authors: Ramik Zdenek , Vaclavik Jan , Kvapil Tomas , Jelinek Libor , Kocianova Eva , Kamasova Monika
Published: June 2022

Objective:

Arterial hypertension (AH) and its harmful effect on renal function is well known. Long term impact of resistant arterial hypertension (RAH) on renal function has not been evaluated yet. The aim of this study was to assess the long-term renal function decline in patients with RAH and non-resistant arterial hypertension.

Design and method:

We retrospectively reviewed records of 265 patients followed between May 2007 and January 2019 in an Hypertension Excellence Centre of a tertiary hospital. In all patients we assessed basic demographic characteristics, co-morbidities, laboratory findings, secondary causes of AH, medication, blood pressure including ambulatory blood pressure monitoring, studies and invasive procedures (CT, MRI, coronarography). We statistically evaluated differences in both groups and compared the decline of renal function.

Results:

137 patients had resistant and 128 patients non-resistant hypertension. Patients were followed for a mean of 6 years (minimum 2 years, maximum 10,6 years). Decline of renal function occurred more frequently in in patients with RAH (74.5%) than patients with non-resistant AH (65.6%). During the first 4 years of follow-up, patients with RAH had higher mean annual eGFR decline (-2.45 ml/s/1.73m2) compared to patients with AH (-1.825 ml/s/1.73m2) (Table 1). Patients with RAH were older (58.1 ± 10.8 years vs. 51 ± 13 years), more frequently diabetics (39.3 % vs. 8.7 %), had more frequent exposure to diagnostic studies and invasive procedures (86,5% vs. 64%), and more patients with RAH underwent renal denervation (15.3% vs. 1.3%), all with P < 0.001.

Conclusions:

Patients with resistant hypertension had faster decline of renal function in the course of first four years of follow-up in comparison to patients with non-resistant hypertension. The goal of the following studies will be to determine the key factors affecting renal function decline in both subgroups.
CARDIOVASCULAR AND KIDNEY OUTCOMES IN TREATED RESISTANT HYPERTENSIVE PATIENTS
Authors: Matova Olena , Mishchenko Larysa , Talaeva Tatyana
Published: June 2022

Objective:

To evaluate the incidence of cardiovascular (CV) and kidney outcomes and its predictors in treated resistant hypertensive (rHTN) patients.

Design and method:

We studied 117 rHTN patients and 114 controlled hypertensives (cHTN) patients on a triple fixed-dose combination of RAAS blockers / CCB / thiazide or thiazide-like diuretic. Patients with rHTN treated with the same type of triple fixed-dose combination in maximally tolerated doses plus the individually defined most effective fourth-line agent (spironolactone/eplerenone 56.1%, torasemide 26.8%, nebivolol 14.6%, moxonidine 2.5%); the fifth class of antihypertensive drug was added for 35.2 % of patients. A composite CV (CV death, myocardial infarction and/or revascularization, stroke, atrial fibrillation, and peripheral arterial disease) and kidney outcome (dialysis or GFR decline by 40% or greater) were estimated after five years (a mean follow-up 5.1 ± 0.1). The combined endpoint was defined as total CV and renal outcome events.

Results:

The goal office and 24-h BP were achieved at 49.6 and 34.2 % rHTN patients by the end of 5-year follow-up. During follow-up the incidence of all outcomes were higher at rHTN patients compared to cHTN pts: composite CV events (26.5 % vs 7 %, P = 0.001), kidney outcomes (4.3 % vs 0.9 %, P = 0.01), and diabetes (3.4 % vs 0.9 %, P = 0.02). The independent predictors of combined end point identified by multivariant logistic regression analysis were initial 24-h systolic BP ( = 0.099; OR = 1.10; 95 % CI 1.03 – 1.18; P = 0.008), blood concentration of endothelial progenitor cells (CD45+/CD34+) ( = - 0.89; OR = 0.41; 95 % CI: 0.21 – 0.79), P = 0.007) and citrulline ( = - 0.89; OR = 1.13; 95 % CI: 1.07 – 1.20; P < 0.001).

Conclusions:

Despite significant improvement in BP control the incidence of CV and renal outcomes in rHTN patients were higher than in cHTN patients. The independent predictors of combined CV and renal events were higher baseline systolic blood pressure, citrulline plasma level, and low concentration of endothelial progenitor cells.
VASCULITIS AND RENOVASCULAR HYPERTENSION – A CASE REPORT
Authors: Ferrão Diana , Silva Clara , Matos Mariana , Ferreira Susana , Tavares Sofia , Nogueira-Silva Luís , Lima Maria João , Almeida Jorge
Published: June 2022

Objective:

Vasculitides are a group of rare, systemic diseases that induce inflammatory reactions in blood vessels, causing a reduction of blood flow and ischemia. In the kidney, luminal narrowing reduces blood flow and activates the renin-angiotensin-aldosterone system, causing renovascular hypertension.

Design and method:

Clinical case report.

Results:

A 47-year-old male with previous intestinal tuberculosis and hypertension diagnosed two years prior (blood pressure around 220/110 mmHg) was referred to our Hypertension Clinic. He reported self-limited episodes of lumbar pain, tender erythematous nodules in the shins and arthralgias. His mean office blood pressure was 203/118 mmHg, confirmed in home blood pressure monitoring, without medication. He had left ventricular concentric hypertrophy and chronic kidney disease (eGFR 66 mL/min/1.73m2) with albuminuria (561 mg/24 h). Verapamil and clonidine were prescribed to search for secondary hypertension but he missed the following appointment. A few months later he was admitted to the Intensive Care Unit due to a hypertensive emergency, with acute kidney failure and a large peri-renal hematoma. A CT scan and an angiography showed bilateral renal scarring, intrarenal pseudoaneurysms and small irregularities in the renal arteries. The immunologic panel was negative. A PET scan showed a slight enhancement of the aorta walls and common carotid arteries and the diagnosis of large-vessel vasculitis was established. He was discharged with high-dose corticosteroids and lisinopril and returned to our Hypertension Clinic. His blood pressure remained uncontrolled despite full-dose amlodipine, chlorthalidone and nebivolol; lisinopril was stopped due to worsening kidney function. Due to doubts on the diagnosis, the CT scan was repeated, now showing also irregularities in the common hepatic artery and mesenteric artery, suggesting a medium-vessel vasculitis, namely polyarteritis nodosa, and cyclophosphamide was started. His blood pressure is now controlled with lisinopril 2.5 mg, amlodipine 10 mg bid, furosemide 40 mg bid, nebivolol 5 mg and clonidine 0,15 mg tid and his kidney function is stable.

Conclusions:

Renovascular hypertension is responsible for less than 1% of all cases of hypertension and, when present, it is usually caused by atherosclerotic disease or fibromuscular dysplasia. However, in more infrequent cases, an inflammatory systemic disease may be present and must be considered.
FACTORS ASSOCIATED WITH AN INCREASED RISK OF ADVERSE CARDIOVASCULAR EVENTS IN PATIENTS WITH ARTERIAL HYPERTENSION
Authors: Denisova Anastasiya , Solntseva Tatyana , Sivakova Olga , Chazova Irina
Published: June 2022

Objective:

To identify factors associated with an increased risk of adverse cardiovascular events in patients with arterial hypertension

Design and method:

We analyzed the results of 455 patient case files of patients with arterial hypertension included in the database in the period from January 2016 to May 2020. We made a phone call to all patients to identify new cases of adverse cardiovascular events (ischemic heart disease, stroke, transient ischemic attack, atrial fibrillation, chronic heart failure, death). 371 (81.5%) of 455 patients answered.

Results:

45 adverse cardiovascular events occurred in 371 patients with arterial hypertension. Such factors as the age of the onset of hypertension, the duration of hypertension, gender, obesity, dyslipidemia, hyperuricemia, left ventricular hypertrophy, and severe retinopathy were analyzed to assess the relationship with adverse cardiovascular events. According to the Kaplan-Meier survival analysis in the presence of severe retinopathy, the risk of complications after 36 months of follow-up was 50% (p = 0.018). The hazard ratio for complications in the presence of severe retinopathy was 7.88 (CI 1.05–58.98; p = 0.044). Besides only 8 (1.75%) of 455 studied patients with arterial hypertension had severe retinopathy (retinal hemorrhage, microaneurysm, cotton wool spot, hard exudates or optic disc swelling). All 8 patients had a resistant arterial hypertension. No other evidence of interaction was found between other factors and the risk of adverse cardiovascular events.

Conclusions:

Severe retinopathy is more common in patients with resistant hypertension. Severe retinopathy is associated with an increased risk of adverse cardiovascular events in patients with arterial hypertension
EFFECT OF LONG-TERM USE OF CONTINUOUS POSITIVE AIRWAY PRESSURE TREATMENT ON ARTERIAL STIFFNESS IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA AND RESISTANT HYPERTENSION
Authors: Roderjan Christian Nejm , de Souza Fabio , Chedier Bernardo , de Hollanda Cavalcanti Aline , Viegas Bianca , Carlos Fernanda Oliveira Carvalho , Santos Taissa Lorena dos , de Azevedo João Carlos Moreno , de Carvalho Fortes Carolina , de Jmello Barreto Bianca Zattar , de Melo Nolasco Vitor , do Nascimento Vallaperde João Gabriel , Silva João Gabriell Bezerra da , Muxfeldt Elizabeth Silaid
Published: June 2022

Objective:

To evaluate the impact of a long-term use of CPAP on arterial stiffness (AS) measured by pulse wave velocity (PWV) in patients with resistant hypertension (RHT) and moderate-severe obstructive sleep apnea (OSA).

Design and method:

An observational prospective study was performed in 121 patients (38% male, mean age 60.7 ± 7.8 years) with RHT and moderate/severe OSA (AHI> 15/hour) divided in 2 groups using CPAP (CPAP group – n = 62) and not using CPAP (control group – n = 59) and followed for at least 12 months. Pulse wave velocity and ABPM were measured before and after follow-up. Primary outcomes were changes in aortic stiffness. Intergroup comparisons of differences in PWV were assessed by a general linear model with allocation group (CPAP or control) as a fixed factor and adjusted for their respective baseline PWV values in addition to gender, age, and 24-hour SBP values. Per-protocol analysis was performed excluding patients with poor CPAP adherence.

Results:

Patients were followed-up for a median of 68 [49–81] months. They used a median of 5 [3–8] anti-hypertensive drugs and had mean PWV of 8.41 ± 1.52 m/s. CPAP and control groups were similar in their baseline demographic, anthropometric, office and ambulatory BP, PWV, and laboratory characteristics.

Control group had a mean increase in PWV of 0.88m/s (95% CI: 0.52–1.25 m/s, p < 0.001), whereas CPAP group had an average increase in PWV of 1.20 m/s (95% CI: 0.84–1.55 m/s; p < 0.001). After adjustment for initial PWV, gender, age and 24-systolic BP, the mean difference between CPAP and control groups was + 0.32 (95%CI: 0.17–0.83; p = 0.20). In a subgroup analysis with patients with higher PWV (>10m/s) the mean difference adjusted was -0.20 (95%CI: -2.17–1.75, p = 0.83).

Conclusions:

Long-term treatment with CPAP did not reduce aortic stiffness in RHT with moderate/severe OSA, but it may prevent its worsening in relation to control group in those with baseline increased arterial stiffness.
EFFECTS OF ISOMETRIC EXERCISE ON THE SPECTROMETRIC PROFILE OF OLDER ADULTS WITH HIGH BLOOD PRESSURE
Authors: Teixeira Manuel , Pinto Diogo , Rato Nuno Dias , Garcia Catarina , Marques Maria J. , Amaral Teresa , Amaral Leonor , Ruivo Pedro , Abreu Ricardo , Oliveira Ana P. , Carneiro Cristiana , Figueiredo Daniela , Polónia Jorge , Mesquita-Bastos José , Viana João L. , Pescatello Linda S. , Nunes Alexandra , Alves Alberto J. , Ribeiro Fernando
Published: June 2022

Objective:

A decline in protein homeostasis is associated with the development and progression of several cardiovascular diseases, including hypertension. Physical exercise is a promising intervention to counter defects in protein quality control. Isometric resistance training (IRT) promotes clinically relevant reductions in blood pressure (BP), however, its effects on protein homeostasis are not clearly defined. We determined the general proteomic profile in human plasma of older adults with high normal BP to hypertension and how it changes in response to IRT.

Design and method:

Older adults (n = 11, age: 73 ± 3 years) with high normal BP to hypertension participated in 8-weeks of IRT. IRT consisted of 4x45 sec contractions, alternatively with both hands, at an intensity of 50% of the maximum voluntary contraction, with a 1-min interval between sets, performed 3 times per week. Fourier-transform infrared (FTIR) spectroscopy assessed changes in the plasma after versus before IRT in the region of the spectra attributed to the secondary structure of proteins (1700–1600 cm-1).

Results:

Samples showed an excellent discrepancy before versus after IRT in the 1700–1600 cm-1 region. IRT induced a shift in the peak in the in the spectra region of 1622 cm-1; this region is attributed to intermolecular beta-sheets, which are common structures found in mature fibrils. Mature fibrils are prone to form toxic protein aggregates, especially amyloid aggregates. After IRT, participants appeared to have lower levels of intermolecular beta-sheets and samples were enriched with antiparallel beta-sheets (1696 cm-1) and beta-turns (1665 cm-1).

Conclusions:

The decrease in intermolecular beta-sheets may represent an improvement in the protein turnover and a better protein quality control in hypertension as a result of IRT. The differences in the antiparallel beta-sheets and beta-turns after IRT indicate IRT is modifying the protein profile. Further studies are needed to confirm these results and to address how exercise is influencing protein homeostasis.
TRENDS IN ANTIHYPERTENSIVE MEDICATION USE AFTER ISCHEMIC STROKE (1999–2020)
Authors: Castilla-Guerra Luis , Luque Linero Paula , Fernandez Moreno Maria Del Carmen , de la Serna Fito Macarena , Valenzuela Gonzalez Antonio , Alegre Albendea Maria , Ramirez Gurruchaga Pedro , Rico Corral Miguel Angel
Published: June 2022

Objective:

Hypertension (HT) is a major risk factor for stroke. The guidelines for the management of HT in stroke patients have been updated periodically and changed. We aimed to examine trends in antihypertensive medications use after ischemic stroke

Design and method:

Retrospective study on ischemic stroke patients discharged from 3 tertiary general hospitals, during the periods: 1999–2001, 2014–16 and 2019–2020. Data analysis was performed using SPSS statistical software (IBM SPSS Statistics 24; Chicago, IL, USA).

Results:

We included 1,806 patients, 753 (41.6%) women, mean age 69.7 (± 10) years.

Comparing the periods, the patients are now older (68.7–69.9–71.3; p = 0.003) and have a higher frequency of HT (67.3% vs. 73.8% vs. 75.4%; p = 0.0001). HT was the most prevalent vascular risk factor in all periods.

At discharge, more antihypertensive drugs were used progressively (in 56.4% vs 69.1% vs 84.7% of patients; p = 0.0001). There was a clear increase in the number of antihypertensive drugs used (mean 0.94 ± 0.8 vs 1.6 ± 1.05 vs 2.1 ± 0.5 drugs; p = 0.0001). Use of diuretics (14%-41.1%-63.8%; p = 0.0001), angiotensin-converting enzyme inhibitors (37.1%-43.8%-54%; p = 0.0001), and angiotensin receptor blockers (12.3%-24.3%-31.1%; p = 0.0001) increased progressively. On the contrary, use of calcium antagonists decreased (25%-22.5%-15.1%; p = 0.0001)

Conclusions:

The last 20 years has seen a significant increase in antihypertension medication use after ischemic stroke. At present, antihypertensive drugs are one of the most important medications in these patients.
IS HEADACHE AT ADMISSION ASSOCIATED WITH HIGHER RATE OF RECENT BRAIN MRI INJURY DURING MALIGNANT HYPERTENSION CRISIS?
Authors: Boulestreau Romain , Tillement Jeremie , Lucas Ludovic , Cremer Antoine , Doublet Julien , Rubin Sebastien , Sibon Igor , Gosse Philippe
Published: June 2022

Objective:

Reliable clinical signs associated with recent brain injuries in neurologically asymptomatic patients during malignant hypertension crisis are lacking. We aimed to compare the prevalence of brain MRI injuries between fully asymptomatic patients and those with isolated headache.

Design and method:

This single-center, cross-sectionnal observational study recruited patients with malignant Hypertension (MHT). MHT was defined by severe hypertension and severe hypertensive retinopathy OR subacute damage of three among the target organs: heart, kidney, brain, vessels (thrombotic microangiopathy). Patients under 18 years old, under chronic dialysis and not willing to participate were excluded. IBrain MRI was performed within 21 days following diagnosis and was reviewed by a stroke neurologist who recorded the following markers: acute ischemic stroke(DWI and FLAIR positive), acute intracerebral hemorrhage (T2* and FLAIR positive), acute brain edema with extensive posterior white matter hyperintensity suggesting a PRES, and small vessel disease including old lacunar infarct, white matter hyperintensities (WMH), presence of dilated perivascular spaces.

Primary endpoint was the prevalence of recent brain injury in both group.

Results:

92 patients were included. Among them, the average age was 47.8 years, 67 % were men, average admission systolic blood pressure and diastolic blood pressure were respectively 213 +/- 31 mmHg and 119 +/- 19 mmHg, 73 % had severe hypertensive retinopathy, median(IQR) creatininemia was 115 (92–180) mol/l and 11 % had systemic Hemolysis.

Patients with no clinical symptoms or isolated headache presented respectively 39.5 % and 40 % of recent brain MRI abnormalities (cerebral Hematoma, ischemic stroke or PRES, p = 0.96). Patients with neurological signs on admission tended to have a higher frequency of recent brain injury than patients with isolated headaches (64,5%, p = 0,06), and a higher prevalence of chronic lacunar infarct (70,5% vs 44%, p = 0,04). We found no difference regarding cerebral microangiopathy in the 3 groups.

Conclusions:

Prevalence of recent brain injuries among patients with isolated headache and fully asymptomatic patients at admission of malignant hypertensive patients are similar and high. This raises the question of systematically performing brain MRI in patients with malignant hypertensive crisis.
CONTROLLED-RELEASED ORAL MELATONIN SUPPLEMENTATION FOR HYPERTENSION: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Kam Eric , Lee Pui , Poon Paul , Yu Chun-Pong , Lee Vivian , Chung Vincent Ch , Wong Samuel Ys
Published: June 2022

Objective:

Oral melatonin is a potential alternative treatment for hypertension, but high-quality and relevant meta-analyses have not yet been conducted. This meta-analysis aimed to investigate whether oral melatonin supplementation could reduce daytime/asleep blood pressure, reduce cardiovascular risks, improve sleep quality, and if it is well-tolerated compared with placebo.

Design and method:

Relevant articles were searched in multiple databases, including MEDLINE, EMBASE, CINAHL Complete, and Cochrane Library, from their inception to June 2021. The included studies were randomized controlled trials that recruited patients with hypertension, using oral melatonin as the sole intervention, and investigated its effect on blood pressure. The mean out-of-office (including 24-h, daytime, and asleep) systolic blood pressure and diastolic blood pressure, sleep quality, and side effects were compared between the melatonin and placebo arms using pairwise random-effect meta-analyses. The risk of bias assessment was conducted using the Cochrane risk-of-bias tool.

Results:

Four studies were included; only one study was considered to have a low risk of bias. No study reported cardiovascular risk or outcomes. Only controlled-release melatonin (but not immediate-release preparation) reduced asleep systolic blood pressure by 3.57 mm Hg (95% confidence interval: -7.88–0.73; I2 = 0%). It might also reduce asleep diastolic blood pressure and awake diastolic blood pressure, but these differences did not reach statistical significance. Melatonin may improve sleep efficacy and total sleep time and is safe and well-tolerated.

Conclusions:

Due to the limited number of high-quality trials, the quality of evidence was low to very low high-quality and adequately powered randomized controlled trials on melatonin are urgently needed.
A RANDOMIZED CONTROLLED TRIAL OF INDIVIDUALIZED HOMOEOPATHIC TREATMENT TO REDUCE ANGER & THEREBY REDUCING HYPERTENSION
Authors: Bagadia Leena
Published: June 2022

Objective:

Despite improved detection and treatments, rates of hypertension (HT) are not decreasing. More and more people experience increased anger, anxiety, depression brought on by globalisation and stress leading to high-risk behaviours. There is the possibility that blood pressure (BP) may positively correlate with anger variables leading to essential hypertension (EHT). Homoeopathy works holistically, helping the patient to cope up with these changes. The study aims to demonstrate the efficacy of similimum on mild to moderate essential hypertension by modifying the underlying anger state, trait, and expressions, thus making the patient more capable of coping with the changing life situations than standard care treatment.

Design and method:

172 patients (108 males and 64 females) between 18–65 years were enrolled after consent. They were allocated to the placebo and intervention groups by simple randomisation. Thorough homoeopathic case-taking was done, and the STAXI-2 scale was applied at the beginning and after a 6-months study period to measure the change in anger. Regular follow up was done every two weeks to evaluate the subjective and objective parameters.

Results:

After six months, in the control arm 16%, had to be prescribed standard AHT. Whereas in the intervention arm, the BP of all patients were maintained on similimum. The patients on standard AHT, in the control arm 98%, continued with the same dose of their medicines. However, standard AHT stopped in 33% of patients in the intervention group, and in 28%, the dose was reduced. Reduction in blood pressure and anger variables at the end of the study period was statistically significant (p = 0.001) in both arms. However, the difference was significantly more in all variables in the intervention arm than in the control arm.

Conclusions:

Most hypertension patients, especially with a family history of HT, suppress their anger & hostile impulses.

Individualised homoeopathic treatment reduces anger & thereby have a reduction in elevated BP.

Also, it relieves associated ailments.
LONG-TERM ADHERENCE TO POSITIVE AIRWAY PRESSURE THERAPY IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA AND CARDIOVASCULAR DISEASES
Authors: Khachatryan Narine , Elfimova Evgenia , Mikhalova Oksana , Litvin Alexander , Chazova Irina
Published: June 2022

Objective:

to study long-term (more than 12 months) adherence to positive airway pressure (PAP) therapy and its effectiveness in OSA patients with arterial hypertension (AH) and to determine possible factors influencing adherence to PAP therapy

Design and method:

The study involved 194 patients with OSA and AH (156 men and 38 women), median age 64 [55; 69] years, who were on PAP therapy for more than 12 months. Patients had severe OSA (apnea-hypopnea index (AHI) - 49 [35,6; 63,2] events/h. The duration of the PAP-therapy usage - 2,0 years [1,0; 5,0]. Data from PAP therapy for the last year was downloaded from the device’s internal memory card, including effectiveness and adherence. The adherence criteria was the usage of PAP therapy for more than 4 hours per night for more than 70% of nights, effectiveness - residual AHI less than 5 events per hour. The main parameters of the disease and PAP-therapy were analyzed depending on the adherence to therapy.

Results:

All patients used PAP-therapy in auto regime with constant use of a humidifier. Average time of long-term PAP-therapy usage was 6,2 hours [4,8; 7,3] and 84,6% [61,2; 97,0] of nights. The criteria for adherence to PAP - therapy was met in 64,9% of patients. The residual AHI was 3,0 events/h [1,3; 6,0]. When comparing the clinical parameters of PAP-therapy, it was found that in the group of adherent patients, residual AHI was statistically significantly lower: 2,4 events/h [1,2; 5,0] versus 4,0 events/h [2,0; 6,4], p < 0,05. Usage of PAP therapy less than 70% of nights and less than 4 hours per night statistically significantly more often complained of daytime sleepiness (44%) and nocturia (19%) versus 24% and 8% respectively in the compared group. Adherent patients were statistically significantly more likely to use nasal masks in 81,7% of cases, compared with 64,7% of patients in the low-adherence group, p < 0,05.

Conclusions:

In patients with OSA and AH, 64,9% of patients meet the criteria for adherence to long-term PAP therapy. Residual daytime sleepiness and nocturia during prolonged PAP therapy are associated with low adherence.