bluuebunny/crossref_metadata_2025 huggingface dataset:
CENTRAL AND BRACHIAL PULSE PRESSURE PREDICTS CARDIOVASCULAR AND RENAL EVENTS IN TREATED HYPERTENSIVE PATIENTS
Authors: Takenaka Tsuneo
Published: May 2024

Objective:

Central blood pressure is a stronger predictor of cardiovascular prognosis rather than brachial blood pressure. Reflection wave reaches abdominal aorta sooner than ascending aorta. Thus, the contribution of central pulse pressure (cPP) to renal events may differ from that to cardiovascular events.

Design and method:

The subanalysis of ABC-J II study was performed. Subjects were 3434 treated hypertensive patients with mean follow-up of 4.7 years. Left ventricular hypertrophy, an index of cardiovascular risk, correlated with cPP better than central systolic blood pressure in this cohort. The contribution of brachial pulse pressure (bPP) and cPP to cardiovascular and renal events were analysed.

Results:

Results: Cox proportional-hazard analysis revealed that sex (p<0.001), height (p<0.05), history of cardiovascular diseases (p<0.001), numbers of antihypertensive drugs (p<0.05) and cPP (p<0.05) contributed to cardiovascular events. However, Cox proportional-hazard analysis disclosed that baseline serum creatinine (p<0.001) and bPP (p<0.05) predicted renal events.

Conclusions:

The present findings support our previous data that the absence of cardiovascular or renal diseases is an important determinant for event-free survival, and suggest that cPP and bPP contribute to cardiovascular and renal events in treated hypertensive patients.
NON-INVASIVE PRESSURE GRADIENT ESTIMATION OF STENOTIC LESIONS IN RENAL MULTIFOCAL FIBROMUSCULAR DYSPLASIA: A PILOT STUDY
Authors: Robberechts Tom , Giudici Alessandro , Kadziela Jacek , Stoenoiu Maria S , Donkers Kim M. , Van Leeuwen Jojanne E. , Januszewicz Andrzej , Januszewicz Magdalena , Spronck Bart , Persu Alexandre
Published: May 2024

Objective:

Currently, there is no validated method to assess the haemodynamic significance of renal artery stenosis in fibromuscular dysplasia (FMD) patients. A translesional pressure gradient >10 mmHg during catheter-based angiography has been proposed as a cut-off for considering angioplasty. However, for reasons of invasiveness, time, accessibility and cost, this approach is seldom used. Therefore, development of a non-invasive method to evaluate the hemodynamic impact of FMD lesions is urgently needed.

Design and method:

We developed a computer application to quantify FMD-related stenoses and estimate the resulting pressure gradient based on angiography images. Based on analysis of images of 55 patients from the FEIRI database, the application allows 1) binary segmentation (vessel vs. background) of the image, 2) identification of vessel centreline through skeletonisation, 3) tracking of vessel diameter, and 4) quantitative characterisation of beads and stenoses. We used empirical fluid dynamics laws and the obtained vessel geometry to estimate pressure drops across lesions, also accounting for turbulences and vessel tortuosity. Retrospective image analysis and subsequent gradient estimation were performed blinded for clinical data and in vivo pressure gradients. Calculated pressure gradients were validated against those measured in vivo through invasive catheterisation in 9 patients from the ARCADIA-POL study.

Results:

We analysed angiographic images from FMD-related lesions of n=9 female patients aged 27–59 years, in whom translesional pressure gradients were available. n=18 distinct images were obtained: thirteen pre-angioplasty (four patients with bilateral lesions) and five post-angioplasty. Predicted pressure gradients showed a strong correlation with in vivo pressure gradients (r=0.88, Figure 1). Furthermore, in 11/13 (85%) pre-angioplasty images, the software correctly discriminated between significant (>10 mmHg) vs. non-significant pressure gradients. Our software also reliably predicted the decrease in pressure gradients pre-to-post-angioplasty.

Conclusions:

We show for the first time the feasibility of pressure gradient prediction based on the anatomy of renal FMD lesions. The next steps will consist in expanding our study population and adapting our approach (currently depending on catheter-based angiography), to non-invasive imaging such as CT- or MR-angiography. Finally, we will correlate estimated pressure gradients with clinical outcomes such as blood pressure response to angioplasty.
RENAL SAFETY ASSESSMENT OF TELMISARTAN/S-AMLODIPINE SINGLE-PILL COMBINATION IN KOREAN HYPERTENSIVE PATIENTS: A MULTICENTER RETROSPECTIVE OBSERVATIONAL STUDY
Authors: Cho Hyuk , Han Seung Seok , Kim Hee -Seok , Min Soung -Jun , Kwon Sung Uk , Kim Hyung -Kwan , Hyon Min -Su
Published: May 2024

Objective:

Telmisartan/S-Amlodipine (TEL/S-AML) single-pill combination (SPC) may effectively lower blood pressure (BP) lowering and exhibit renal protective effects, as angiotensin receptor blockers are acknowledged for such benefits. However, there is a scarcity of studies validating these effects in real-world settings. Herein, we assessed the BP-lowering effects and safety, with a specific focus on renal function, after over 6 months of administration in Korean hypertensive patients.

Design and method:

This study constitutes a non-interventional, multicenter, retrospective observational investigation that includes individuals diagnosed with essential hypertension and treated with the TEL/S-AML SPC for a period exceeding 6 months. We analyzed the serial changes in BP, serum electrolytes, and creatinine-based estimated glomerular filtration rates (eGFRs). We additionally collected data on serious and other adverse events (AEs) and assessed their relationship to TEL/S-AML SPC.

Results:

A total number of 4,934 patients were enrolled in this study. Following the administration of TEL/S-AML SPC, both of systolic and diastolic BPs showed a significant decrease throughout the study period (Ps <0.05). AEs were reported in 352 cases among 282 subjects (5.72%), while serious AEs were reported 74 cases among 62 subjects (1.26%). Serious AEs with a potential relation to TEL/S-AML SPC were reported in 3 subjects (0.06%). No change in eGFR was observed over the study period.

Conclusions:

The study findings suggest that the TEL/S-AML SPC is effective in lowering BP and may contribute to the preservation of renal function, showing a low incidence of renal complications after over 6 months of administration in Korean hypertensive patients. These results provide support for the assertion that this agent is well-tolerated.
ROLE OF ANGIOTENSIN CONVERTING ENZYME 2 FOR ANGIOTENSIN-(1-7) SIGNALING IN HUMAN PODOCYTES EXPOSED TO FLUID FLOW SHEAR STRESS
Authors: Bolbrinker Juliane , Kaiser-graf Debora , Domenig Oliver , Poglitsch Marko , Kreutz Reinhold
Published: May 2024

Objective:

Glomerular hyperfiltration is linked to increased fluid flow shear stress (FFSS) on podocytes, potentially causing irreversible podocyte impairment and subsequently altering the permeability and integrity of the glomerular filtration barrier. Angiotensin II (AngII) plays a significant role in chronic kidney disease. The adverse effects of AngII are partially countered by alternative signaling pathways in the renin-angiotensin system (RAS), comprising angiotensin-converting enzyme 2 (ACE2), angiotensin-(1-7) (Ang-[1-7]), and the Mas1 receptor (MAS1). This antagonistic pathway might confer renoprotective effects, e.g. by facilitating anti-inflammatory processes. Given the incomplete understanding of the pathomechanisms and signaling pathways triggering podocyte damage due to FFSS, our objective is to elucidate the influence of ACE2 in human podocytes in the context of glomerular hyperfiltration.

Design and method:

Gene expression analyses and immunofluorescence staining of ACE2 and MAS1 were conducted on conditionally immortalized human podocytes (hPCs). For mechanistic studies, hPCs were cultured on collagen IV-coated Culture Slips®, placed in a Streamer® Shear Stress Device and subjected to FFSS of 1 dyne/cm2 for 2 hours. Control cells remained unexposed to FFSS. Subsequently, the rate of spiked AngII conversion to Ang-[1-7] in presence and absence of the specific ACE2 inhibitor MLN-4760 was assessed in whole cell lysates and at the cell surface.

Results:

In vitro, hPCs express ACE2 and MAS1 as central elements of the alternative RAS-signaling pathways. RNA-expression levels of ACE2 did not exhibit significant alterations under FFSS compared to the control. FFSS exposure elevated the rate of AngII conversion to Ang-[1-7] in cell lysates compared to control conditions, while the conversion rate at the cell surface remained unaltered. The formation of Ang-[1-7] at the cell surface was diminished by MLN-4760, whereas the inhibitor displayed no significant effect in whole cell lysates.

Conclusions:

Our findings show an increased rate of AngII conversion to Ang-[1-7] in hPC lysates following FFSS, which is independent of ACE2. On the cell surface, Ang-[1-7] formation is mediated by ACE2 but remains unchanged under FFSS. These results indicate that ACE2 regulation does not play a central role for Ang-[1-7] formation upon FFSS in human podocytes.
PULSE WAVE VELOCITY IS CORRELATED WITH PLASMA CREATININE LEVELS AND GLOMERULAR FILTRATION RATE IN PATIENTS WITH CARDIOVASCULAR RISK FACTORS
Authors: Baba Mirela , Bucur Adina , Maris Mihaela , Jianu Daniela , Luca Constantin Tudor , Moroz Simina Mariana , Stoian Dana , Mozos Ioana
Published: May 2024

Objective:

Scientific evidence suggests that the kidneys’ role in hypertension is mostly linked to the association between mean arterial pressure (MAP) and vascular resistance. In recent publications, two key indicators of arterial stiffness, pulse pressure (PP) and pulse wave velocity (PWV) have been found to be important predictors of the cardiovascular risk and decline in glomerular filtration rate (GFR). We aimed to study the relationship between variables of pulse wave analysis and renal function in patients with cardiovascular risk factors.

Design and method:

Our cross-sectional, descriptive study included patients referred to the clinic within a National Screening Programme for cardiovascular risk factors. The patients underwent anthropomorphic measurements, office blood pressure measurements, pulse wave analysis using a Mobil-O-Graph and standard blood tests such as lipids, glucose and creatinine.

Results:

76 patients entered the study aged 63±10 years, 53% males, 47% females, mean systolic blood pressure (SBP) of 133.8 mmHg (±18.8), mean diastolic blood pressure (DBP) of 84.1mmHg (±11.5), mean arterial pressure (MAP) of 105.6mmHg (±17.7), mean pulse pressure (PP) of 49.8mmHg (±13.2), mean pulse wave velocity (PWV) of 9.3m/s (±1.5) and mean augmentation index (AI) of 24.7 (±16.2). In linear regression analysis, blood creatinine level was significantly correlated with PWV (r= 0.328, p= 0.004), PP (r= 0.249, p= 0.03), MAP (r= 0.297, p= 0.009), SBP (r= 0.337, p= 0.003) and DBP (r= 0.267, p= 0.02). Glomerular filtration rate (GFR) was significantly negatively correlated with PWV (r= -0.465, p= 0.0001) and SBP (r= -0.227, p= 0.049). Multiple regression analysis revealed significant associations of creatinine with PWV and SBP (multiple correlation coefficient (MCC) = 0.402, p=0.0016) and GFR with PWV after adjusting for SBP (MCC = 0.468, p<0.0001).

Conclusions:

Pulse wave velocity can predict blood creatinine and glomerular filtration rate in patients with cardiovascular risk factors.
PRIMARY CARE PHYSICIAN'S APPROACH TOWARDS LIFESTYLE CHANGES IN HYPERTENSIVE PATIENTS
Authors: Nahdi Ghaida , Merghni Syrine , Arfaoui Farah
Published: May 2024

Objective:

The role of lifestyle and diet changes in hypertension management is very well known. Economic constraints, additional benefits, and few or almost no side effects have made it an attractive option for hypertension control. However, it is still not widely used in primary care.

This study was conducted to assess the knowledge and approach of primary care physician (PCP) towards the D.A.S.H (Dietary approaches to stop hypertension) in Tunisia.

Design and method:

We surveyed 132 PCPs among the 148 PCPs. We used a questionnaire on Google forms, with 16 questions assessing practices regarding the D.A.S.H, its use and source of information about it.

Results:

The participants had a mean duration of practice of 9.2 years (+/-3.4SD). They all receive hypertensive patients daily with an average of 6.12 (+/-2.7SD). Most of the PCPs (60.7%, n=80) recommend the lifestyle changes. However only 82.5% (n=65) of them based their recommendations on guidelines. The D.A.S.H is used by 60% (n=48), these participants knew the D.A.S.H diet through internet. Weight loss, low salt intake, daily physical activity and stop smoking were recommended by most of the PCPs. For the low salt intake, few (35%, n=28) precised that it includes sauces and cold cuts. Limiting foods that are high in saturated fat, such as fatty meats, full-fat dairy products, and tropical oils such as coconut and sugar-sweetened beverages and sweets was recommended by only 12 PCPs. Most (74%) said that lifestyle changes can alone, if well conducted, help to lower the blood pressure. Ninety percent (90%) said that they are more effective with the medication, and it could help lowering the number and the doses of the drug used. All the PCPS(n=132) said that their informations about the DASH diet and others heart-healthy diets are incomplete which may lead to the failure of the lifestyle changes.

Conclusions:

PCPs’ knowledge and management of lifestyle in hypertensive patients is poor in Tunisia. Our data point to a need for continually updating about the non-pharmacological treatment of hypertension
THE SENOLYTIC QUERCETIN PREVENTS AGE-ASSOCIATED VASCULAR STIFFENING, REDUCES BLOOD PRESSURE AND IMPROVES COGNITIVE FUNCTION IN DAHL SALT-SENSITIVE RATS CONSUMING A NORMAL SALT DIET
Authors: Fedorova Olga , Dos Santos Carla Rocha , Barnett Mackenzie , Mcdevitt Ross , Wei Wen , Zernetkina Valentina , Juhasz Ondrej , Morrell Christopher , Lakatta Edward
Published: May 2024

Objective:

Quercetin (QRC), a flavonoid with anti-oxidant, anti-inflammatory and senolytic effects, reduced BP in salt-induced hypertension in Dahl salt-sensitive (DSS) rats. The increases in central arterial stiffness (CAS) and blood pressure (BP) occur, as manifestation of early vascular aging (EVA), in DSS rats even consuming a normal salt (NS) diet, moreover, EVA is associated with cognitive impairment in humans. We hypothesized that as age advances, a decline in cognitive function will accompany EVA in DSS rats consuming a NS diet, and that QRC will not only retard EVA, but also will improve cognitive function.

Design and method:

A NS diet (0.5% NaCl), supplemented with QRC (100 mg/kg BW/day) was administered to male DSS rats at 6-mo of age (n=24) for a 3-month period. DSS without QRC supplementation served as a control group (n=12). Systolic and diastolic BP (SBP, DBP), pulse wave velocity (PWV, an index of CAS), echocardiography, and a visuospatial attention test were assessed prior to and following QRC treatment.

Results:

At 6-mo of age none of the measured parameters differ between control and QRC rats. During aging from 6- to 9-mo in the control group, SBP, DBP and PWV significantly increased, ESLV.vol showed a statistically borderline trend to increase, HR and EF showed a statistically borderline trend to decrease, and attention behavior did not change. QRC treatment reduced SBP, PWV, and ESLV.vol, and increased EF and attention (Table). The QRC effect to increase the number of correct attention test responses was inversely correlated with PWV (Pearson r=-0.420, P=0.02) but not with BP or cardiac parameters, indicating that CAS but not BP is linked to cognitive function.

Conclusions:

QRC reduces EVA and improves cognition assessed as an attention behavior. Although both BP and CAS are manifestations of EVA, a positive association between attention decline with PWV, but not BP, suggests that CAS is linked to cognitive function via mechanisms that are not directly related to BP. Further studies are required to determine whether the effects of QRC on EVA in DSS rats, consuming a NS diet, are linked to its anti-oxidant, anti-inflammatory or senolytic properties.
ASSOCIATION OF OXIDATIVE BALANCE BURDEN WITH ALL-CAUSE MORTALITY AMONG PATIENTS WITH HYPERTENSION: A PROSPECTIVE COHORT STUDY FROM NATIONAL HEALTH AND NUTRITION EXAMINATION
Authors: Jia Shanshan , Huo Xingwei , Liu Lu , Chen Xiaoping
Published: May 2024

Objective:

Oxidative stress assumes a crucial role throughout the entire trajectory of hypertensive patients. This study aimed to evaluate the association between oxidative balance score (OBS) and all-cause mortality among hypertensive patients.

Design and method:

We conducted a cohort study, including 9,735 hypertensive patients from the NHANES spanning from 2007 to 2018. Relevant mortality data were linked until December 2019. The burden of oxidation balance was derived through computation of the OBS. It was obtained by assessing the levels of 15 antioxidants and 5 pro-oxidants for each gender. Survey-weighted multivariable Cox proportional hazards regression and Kaplan-Meier survival curves were employed to examine the association between OBS and all-cause mortality. Restricted cubic spline was used to investigate whether there is a nonlinear relationship between OBS and all-cause mortality in hypertensive patients. Moreover, we conducted a subgroup analysis taking into consideration age, gender, BMI, and history of diabetes. Patients who died within two years of follow-up were excluded for sensitivity analysis to verify the robustness of the results.

Results:

After a median follow-up period of 79 months, 973 hypertensive patients experienced all-cause deaths (9.99%). We found that every 5 scores increment in OBS was associated with an 11% reduction in the risk of all-cause mortality (HR = 0.89, 95% CI: 0.82-0.98). Restricted cubic spline failed to yield evidence supporting a nonlinear association between OBS and all-cause mortality (P nonlinear = 0.181). After stratifying the OBS into tertiles, it was found that the highest OBS group had a significantly lower risk of all-cause mortality compared to the lowest group (HR=0.72, 95% CI: 0.54 to 0.96, p for trend=0.025). Subgroup analysis revealed a significant negative correlation between OBS and all-cause mortality among individuals aged 60 years and above, males, with BMI<25kg/m2 and those without diabetes. Sensitivity analysis suggested that our results remained stable.

Conclusions:

Higher OBS was significantly associated with decreased all-cause mortality in adults with hypertension. OBS could serve as a prognostic assessment tool in ameliorating prognosis and enhancing survival outcomes. increasing antioxidant levels is an effective strategy to prevent the risk of all-cause mortality in hypertensive patients.
BODY ROUNDNESS INDEX IMPROVES THE PREDICTIVE VALUE OF CARDIOVASCULAR DISEASE RISK IN HYPERTENSIVE PATIENTS WITH OBSTRUCTIVE SLEEP APNEA: A COHORT STUDY
Authors: Song Shuaiwei , Cai Xintian , Hu Junli , Li Nanfang
Published: May 2024

Objective:

Obesity, especially visceral obesity, plays an important role in the progression of cardiovascular disease (CVD). The body roundness index (BRI) is a new measure of obesity that is considered to reflect visceral obesity more comprehensively than other measures. This study aims to evaluate the relationship between BRI and CVD risk in hypertensive patients with obstructive sleep apnea (OSA) and explore its superiority in predicting CVD.

Design and method:

The Cox proportional hazards model was used to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) for incident CVD. The area under the curve (AUC), continuous net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were used to assess which measures of obesity had the best predictive value for CVD risk.

Results:

During a median follow-up period of 6.8 years, 324 participants suffered a CVD event. After multivariable adjustment, compared with the reference group (the first tertile), the HRs (95% CI) of CVD were 1.25 (95% CI, 0.93-1.70) and 1.74 (95% CI, 1.30-2.33) for subjects in the tertile 2 and tertile 3 groups, respectively. Compared with other measurement indicators, BRI has the highest predictive value for CVD risk [AUC: 0.627, 95% CI: 0.593-0.661]. The addition of the BRI to the fully adjusted multivariate model improved the predictive power for CVD, which was validated in the continuous NRI and the IDI (all P < .05).

Conclusions:

BRI was significantly associated with the risk of CVD in hypertensive patients with OSA. Furthermore, BRI may improve CVD risk prediction in hypertensive patients with OSA.
THE IMPACT OF OBESITY ON CARDIOVASCULAR RISK IN PATIENTS WITH PRESERVED EJECTION FRACTION: INSIGHTS FROM CENTRAL BLOOD PRESSURE ANALYSIS
Authors: Kim Geehee
Published: May 2024

Objective:

The classic concept of heart failure (HF), pump failure, has now faded and the preserved pump function in HF with preserved ejection fracture (HFpEF) has received more spotlight as we enter an aging society. HFpEF is a syndrome that represents a variety of phenotypes caused by various factors, and recently, its relationship with obesity has drawn attention. In this study, we evaluated the impact of obesity and blood pressure (BP) on cardiovascular (CV) risk in patients with HFpEF.

Design and method:

From June 2011 to December 2016, a total of 2,910 patients were enrolled and followed up until August 2022. Radial tonometry was used by measurement of central BP (CBP), and skilled personnel who completed validation for inter- and intra-observer variability performed echocardiography examinations. The primary endpoint was a composite outcome of CV disease.

Results:

A total of 1,993 patients with an EF of 50% or more were included during a median follow-up period of 7.4 years. As body mass index (BMI) increased from normal levels, the occurrence of CV events tended to increase (less than 25 of BMI; 627[61, 9.7%], 23 to 25 of BMI; 511[57, 11.2%], 25 to 28 of BMI; 572 [47, 8.2%], more than 28 of BMI; 283 [35, 12.4%]) and as a result, CBP also tended to increase sequentially. According to the univariate Cox proportional hazard model, the increase of 10 mmHg in CBP was shown to increase the risk of CV events by 20% in patients with a BMI of less than 23, while it was shown to decrease the risk by 18% in patients with a BMI between 25 and 28. However, statistical significance was not achieved for patients with a BMI between 23 and 25 or those with a BMI of 28 or more.

Conclusions:

In this study, we evaluated that there is an increasing trend in the incidence of CV events with increasing BMI, especially, that patients with lower BMI are important to control BP and CBP.
RELATIONSHIP BETWEEN OBESITY, WEIGHT CHANGE AND LONG-TERM BLOOD PRESSURE VARIABILITY IN PATIENTS WITH HYPERTENSION
Authors: Ilic Marina Deljanin , Stojanovic Sanja , Krstic Ivana , Ilic Stevan , Stojanovic Milovan
Published: May 2024

Objective:

To examine the interaction between obesity, weight change and long term visit-to-visit systolic blood pressure variability (SBPV) in patients with hypertension.

Design and method:

Study involved 270 randomly selected hypertensive patients (132 men and 138 women, average age 67.54±9.64y). At first visit appropriate diet was recommended, and patients were followed for 60 months. The study comprised three visits during the follow up period. Obesity was evaluated through body weight (BW), body mass index (BMI), and waist circumference (WC). Visit-to-visit SBPV for each patient was defined using the standard deviation from 3 values of systolic blood pressure (SBP). High SBPV was defined as standard deviation of SBP (SBP-SD) above the 4th quartile.

Results:

Values of SBP and SBPV were significantly higher (p< 0,009 and p<0,002) in the group of obese (n= 61 pts), than in the group of non-obese patients (n=209 pts). During follow-up period of 60 months, average decrease of BP for 31/3 mmHg, SBPV for 8.2 mmHg, BMI for 3.8 kg/m2, WC for 10.2 cm and BW for 10.7 kg in examined hypertensive pts were recorded, but the reduction in BW and SBPV was higher in obese than in non-obese group: BW 12,28 vs 9,24kg; SBPV 8,92 vs 7,74 mmHg (P<0,05 for both). The highest SBPV, was recorded in the 4th quartile of distributions of SBP-SD in the group of obese patients compared to the non-obese patients (41.02±5.76 vs 35.48±0; p<0,001). There was statistically stronger correlation between SBP-SD and BMI as parameter of total obesity compared to large waist circumference as parameter of central obesity (p<0.01).

Conclusions:

Results of the study, showed that obesity is strongly associated with higher SBPV across study visits. During 60-months follow-up, reduction of body weight was associated with reduction of blood pressure values and long term visit-to-visit systolic blood pressure variability.
VALIDITY OF AMBULATORY BLOOD PRESSURE MONITORING RESULTS IN OBESE INDIVIDUALS WITH AND WITHOUT ARTERIAL HYPERTENSION AND OBSTRUCTIVE SLEEP APNEA SYNDROME
Authors: Jug Juraj , Matovinovic Martina , Jelakovic Ana , Jelakovic Bojan
Published: May 2024

Objective:

Ambulatory blood pressure monitoring (ABPM) in obese patients can be very challenging. Cuff size and thickness of the subcutaneous adipose tissue are usually the main limiting factors for performing an accurate measurement. The aim was to analyze whether there is a higher number of invalid ABPMs in obese patients with comorbidities: arterial hypertension and obstructive sleep apnea (OSAS) compared to obese normotensive patients and without OSAS.

Design and method:

The cross-sectional study included 161 obese patients (123 female, 38 male) who visited the daily hospital of the Reference Center for obesity treatment during 2023. Used ambulatory blood pressure monitor (ABPM) device was Mobil-o-graph ng 24h APBM, version 20. ABPM was considered valid if the patient had > 70% correct measurements and lasted > 20 hours. Anthropometric measures were measured in all patients: body weight, height, body mass index (BMI), neck, waist, and hip circumference. OSAS was confirmed by polysomnography with an apnea-hypopnea index > 30 events/h. Spearman's chi2 test and Student's t-test were used in statistical processing in Statistica v.12.0.

Results:

The share of valid APBM findings deteriorated with higher BMI (r = -0.625, p < 0.001). 28.95% of men and 46.67% of women had valid ABPM, mostly significantly lower BMI (37.88 vs. 44.26 kg/m2, p < 0.001) and younger age compared to those with incorrect measurement (51.79 vs. 46.31 years, p = 0.027). Hypertensive patients (n=101) had statistically significantly less valid ABPM findings than normotensive patients (chi2 = 4.468, p < 0.05). There were fewer correct measurements with a larger neck circumference of the patient (r= -0.3897, p < 0.01), with no correlation for waist and hip circumference. Obese patients with OSAS had significantly fewer valid ABPMs than those without OSAS (chi2 = 4.961, p < 0.05), with even worse results if they also suffered from hypertension (chi2 = 10.783, p < 0.01).

Conclusions:

The validity of ABPM was significantly lower in obese men, hypertensive patients, and OSAS patients. It also depended on the neck circumference of patients regardless of waist and hip circumference. Larger multicentric studies are needed to confirm these findings.
COMPARISON BETWEEN 2021 NATIONAL HYPERTENSION GUIDELINES AND 2023 EUROPEAN SOCIETY OF HYPERTENSION GUIDELINES
Authors: Artero Melania Priego , Salgueiro Maria Cecilia , Borrell Joan Torras , Bonet Jordi Rosinach , Nadal Oriol Rebaglliato , Camps Mencia Benítez , López Beatriz Arnal , Costa Mar Serrat , Vila Laura Camps , Pineda Mireia Gibrat , Bacardit Núria Soldevila , Blanco Carles Albaladejo , De Tuero Gabriel Coll , Bargallo Ernest Vinyoles , Coll Maria Antònia Vila , Von Wichman Mariano De La Figuera
Published: May 2024

Objective:

After the recent publication of the 2023 European Society of Hypertension (ESH) guidelines, it became necessary to evaluate the need to updating our national guidelines, which were based on the prior 2018 ESH guidelines published.

The objetive was to compare our national guidelines and 2023 ESH guidelines and describe the differences.

Design and method:

Fifteen hypertension specialists from our working group and members of national society of family doctors reviewed both guidelines. Afterwards, in different meetings, updates to our guidelines were discussed and eventually agreed. Here we present some of the major changes in this update.

Results:

Some of the changes to highlight would be the description of the diagnosis of isolated diastolic hypertension (SBP<140mmHg and DBP>90mmHg), the disappearance of the metabolic syndrome, the incorporation of serological and genetic biomarkers in the initial evaluation, and a new goal for alcohol intake (abstinence compared to the previous goal of <20mg/day). The control objectives have not changed, except for patients with chronic kidney disease, who are now recommended to lower their blood pressure to 130/80mmHg (if tolerated in under 80 years-old patients), compared to prior recommendation of 140/80mmHg.

We have decided to maintain our proposal for the integration of in-person and virtual visits, as well as the specific chapters that describe high blood pressure (HBP) management in special situations such as in HIV patients, mental health and urinary incontinence. However, new ESH guidelines describe new approaches such as the inclusion of non-medical healthcare professionals for the HBP follow-up, which endorses the importance of the BP measurements out of the clinic, and specific management for transgender and gender-diverse individuals.

Both guidelines highlight how useful can be the use of the technology, even though some changes are yet to be validated.

Conclusions:

After reviewing the guidelines, we believe there is a trend towards a new healthcare model, which can be better implemented with a wider vision of the current situation and trends, informed by both sets of guidelines. It is worth highlighting the trend towards greater patient empowerment in the management and monitoring of hypertension supported by new technologies.
OBSTRUCTIVE SLEEP APNEA AND TARGET BP VALUE IN NON-OBESE HYPERTENSIVE PATIENTS
Authors: Mikhailova Oksana , Elfimova Eugenia , Ershov Alexey , Litvin Alexander , Chazova Irina
Published: May 2024

Objective:

To assess obstructive sleep apnea impact on the target blood pressure (BP) value achievement in non-obese hypertensive patients.

Design and method:

In this prospective cross-sectional study were included 305 patients (mean age 60.0 years old [48.0; 67.0], 203 men) with different stages and grades of arterial hypertension (AH). All patients have been receiving antihypertension therapy, prescribed by their cardiologist, for at least 3 weeks before inclusion in the study. During the study, office systolic and dyastolic blood pressure (SBP and DBP resp.) were assessed (oscillometric method, Omron, Japan) and home sleep respiratory monitoring (SomnoChek, Weinmann, Germany) was done in all patients.

Results:

Two groups were formed: non-target BP group (BP>140/90 mm Hg, n=164) and target BP group (BP<140/90 mm Hg, n=141). Comparative data analysis included such indicators as: age, body mass index (BMI), apnea/hypopnea index (AHI), desaturation index (DI) and minimum oxygen saturation (min SaO2), revealed only differences between age (61.0 years old [50.0; 68.0] versus 57.0 years old [47.0; 66.0] resp., p=0.03) and BMI (32.5 kg/m2 [29.7; 38.1] vs. 31.6 kg/m2 [27.8; 35.5] resp., p=0.02).

The analysis of non-obese patients’ data (BMI <30 kg/m2, n=100) didn’t reveal differences by age, but a higher value of AHI and DI were determined in patients with non-target BP, as well as higher BMI; similar differences were not found in obese patients (BMI>30 kg/m2, n=205) (Table 1). In two-factor logistic regression analysis (included AHI and BMI) AHI was the only predictor of non-target BP in patients without obesity, while BMI had no predictive value (Table 2).

Conclusions:

Even mild or moderate obstructive sleep apnea may be an important negative factor in achieving BP targets in non-obese patients, unlike the other clinical cases with AH.
MASKED HYPERTENSION IN PATIENTS WITH METABOLIC DYSFUNCTION-ASSOCIATED STEATOTIC LIVER DISEASE – AN UNDERESTIMATED RISK?
Authors: Martin Anna , Lang Sonja , Demir Münevver , Goeser Tobias , Steffen Hans -Michael , Kasper Philipp
Published: May 2024

Objective:

Metabolic dysfunction-associated steatotic liver disease (MASLD) and hypertension are major cardiovascular risk factors sharing a bi-directional relationship. Although nearly half of MASLD patients are suffering from arterial hypertension, data on the prevalence of different hypertension phenotypes (e.g. masked hypertension) in this patient population are scarce. Masked hypertension, which is defined by normal office blood pressure but elevated blood pressure in the ambulatory 24-hour blood pressure measurement (24-h-ABPM), often remains undetected, although it has a comparable risk for adverse cardiovascular events as sustained hypertension. Therefore, the identification of this hypertension phenotype in MASLD patients seems highly relevant.

Design and method:

To analyze the prevalence of masked hypertension and to improve hypertension management in MASLD patients we integrated a 24-h-ABPM-based hypertension screening and control program among MASLD patients in our outpatient liver department. A total of 226 MASLD patients were recruited during regular follow-up visits and recording of office blood pressure and 24-h-ABPM measurements were performed according to a standardized protocol.

Results:

For the final analysis, 218 data sets were evaluated. The median age of the included 218 patients was 51 years, 48.2% were female. 101 (46.3%) MASLD patients had prior history of hypertension.

At the time of ABPM 93 (92.1%) of these patients received antihypertensive treatment. Masked hypertension was identified in 46 (21.1%) MASLD patients, 20 (43.5%) of whom were receiving antihypertensive treatment (masked uncontrolled hypertension). Interestingly, 14 (30.4%) MASLD patients with masked hypertension had isolated nocturnal masked hypertension. Furthermore, a non-dipping blood pressure pattern was recognized in 28 (60.9%) MASLD patients with masked hypertension.

Conclusions:

Due to the high rates of masked hypertension and abnormal nocturnal blood pressure dipping, which both represent important risk factors for adverse cardiovascular events, the establishment of hypertension screening and management programs in this high-risk population seems urgently needed. Controlled hypertension reduces the risk of cardiovascular events in this vulnerable population and, due to the strong link between MASLD and hypertension, possibly also slow the progression of MASLD to advanced liver fibrosis or cirrhosis.
BELIEFS, RECOMMENDATION, AND INFLUENCING FACTORS OF CARDIOVASCULAR PROFESSIONALS ON CARDIAC REHABILITATION IN CHINA: A CROSS-SECTIONAL STUDY
Authors: Hu Xuechen , Zang Jiabin
Published: May 2024

Objective:

This study aims to understand the values, attitudes and beliefs of cardiovascular healthcare staff in China, along with the current landscape and influencing factors regarding the recommendation of cardiac rehabilitation (CR).

Design and method:

A nationwide cross-sectional study of 1096 cardiovascular doctors, nurses and rehabilitation therapists was included by convenience sampling from December 19, 2023 to January 9, 2024 through an online survey platform. Questions on personal information, knowledge on CR, recommendation, and the Chinese version of the Recommending Cardiac Rehabilitation(ReCaRe) Scale were administered. Descriptive, univariable analyses and multivariable logistic regressions were conducted.

Results:

A total of 1096 valid questionnaires were collected. Among the surveyed individuals, 626 had recommended CR to patients (56.9%). The ReCaRe scale's total score was 58.7±6.4, with scores in three dimensions: perceived severity and susceptibility 28.9±4.2 (average 4.0±0.6), perceived service accessibility 8.1±2.9 (average 2.7±1.0), and perceived benefit and barriers 22.7±2.4 (average 3.8±0.4). The results show that healthcare professionals’ perceive severity and susceptibility was the primary decision-making factor in recommending cardiac rehabilitation, followed by perceived benefits and barriers, while perceived service accessibility was the least impact factor. The influencing factors for medical professionals to recommend CR include: age(age>40 vs age<=40: OR=1.75, 95%CI=1.12-2.71, P=0.013), professional title(specialist or higher vs resident: OR=2.44, 95%CI=1.69-3.54, P<0.001), work type(doctor vs nurse: OR=2.11, 95%CI=1.48-3.00, P<0.001; rehabilitation therapist vs nurse: OR=2.28, 95%CI=0.47-11.04, P=0.308), hospital type(general hospital vs community healthcare center: OR=2.38, 95%CI=1.36-4.14, P<0.002; specialized hospital vs community healthcare center: OR=7.21, 95%CI=1.03-50.32, P=0.046), department(cardiac department vs general medicine department: OR=9.22, 95%CI=1.44-58.87, P=0.019; rehabilitation department vs general medicine department: OR=15.92, 95%CI=1.94-130.27, P=0.010), resources available of cardiac rehabilitation(yes vs no: OR=3.78, 95%CI=2.57-5.54, P<0.001), and knowledge of CR (knowing a little vs unfamiliar: OR=3.57, 95%CI=2.52-5.05, P<0.001; familiar vs unfamiliar: OR=18.26, 95%CI=11.26-29.61, P<0.001). Unexpectedly, ReCaRe score had no effect on medical staff's recommendation of CR (all P>0.05).

Conclusions:

Healthcare professionals’ perceive severity and susceptibility was their primary decision-making factor in recommending CR. The influencing factors for their recommendation of CR include: age, professional title, work type, hospital type, department, resources available of cardiac rehabilitation and knowledge of cardiac rehabilitation.
ONE-YEAR CHANGES IN ARTERIAL STIFFNESS AND CENTRAL AORTIC PRESSURE IN HYPERTENSIVE PATIENTS WITH AORTIC ANEURYSM AFTER ENDOVASCULAR ANEURYSM REPAIR
Authors: Gurevich Aleksandra P. , Sagynbaeva Ay-churek O. , Emelyanov Igor V. , Ionov Mikhail V. , Vanyurkin Almaz G. , Belova Julia K. , Chernyavskiy Mikhail A. , Konradi Aleksandra O.
Published: May 2024

Objective:

To assess the dynamics of arterial stiffness and central blood pressure (CBP) and investigate the factors affecting them in thoracic and abdominal aortic aneurysms patients with hypertension one year after [thoracic] endovascular aneurysm repair ([T]EVAR).

Design and method:

Patients older 18 y.o. without clinically significant arrhythmias were included. Before [T]EVAR and a year later, the following examination was performed: measurement of peripheral blood pressure and CBP, heart rate (HR), augmentation index (AIx), central pulse height at the point of maximum rise of direct pulse wave (PT1h), timing of reflected pulse wave (Tr) and carotid-femoral pulse wave velocity (cfPWV) by SphygmoCor (AtCor Medical, Australia).

Results:

Fifty patients were included (mean age 68±9 y.o., 41 males, 16 thoracic aortic aneurysms patients, 34 abdominal aortic aneurysms patients), and 23 were examined again onsite. At one year after [T]EVAR, there was an increase in cfPWV (+2.6 m/s, p<0.001), PT1h (+5 mm Hg, p=0.026), peripheral pulse pressure (+7 mm Hg, p=0.039), HR (+5 bpm, p=0.025). CBP and AIx did not change. The graft length directly affected (β=0.42), and HR exerted inverse (β=-0.52) association with the lengthening of Tr. Six cardiovascular complications were registered during follow-up.

Conclusions:

Implantation of the graft is associated with increased cfPWV, irrespective of the aneurysm location. The rise of PT1h one year after [T]EVAR may reflect a decrease in aortic compliance and a deterioration in the damping function of the aorta. The absence of CBP and AIx dynamics is probably explained by the features of the reflected wave postoperatively. Decreased HR and implantation of more extended grafts are predictors of increased Tr.
DECIPHERING THROMBOTIC MICROANGIOPATHY: A CASE-BASED EXPLORATION OF DISTINGUISHING FEATURES BETWEEN MALIGNANT HYPERTENSION AND THROMBOTIC THROMBOCYTOPENIC PURPURA
Authors: Chadachan Veerendra , Pandit Nihar , Chin Brendan Jonathan
Published: May 2024

Objective:

Patients with severe hypertension can present with systemic signs of thrombotic microangiopathy (TMA), i.e., thrombocytopenia and microangiopathic hemolytic anemia (MAHA), and/or renal failure. Determining the underlying disease causing TMA is essential for selection of the optimal therapy. We aim to elucidate key factors for distinguishing TMA due to malignant hypertension from TMA due to thrombotic thrombocytopenic purpura (TTP).

Design and method:

We present here a case study focussing on a challenging clinical scenario involving TMA. Through detailed examination of the patient's presentation, laboratory findings, and response to treatment, the report takes you through a diagnostic journey emphasising the unique aspects of TMA in malignant hypertension as compared to TMA in TTP.

Results:

A 44 year old male was admitted with 2 weeks history of exertional breathlessness, orthopnea and severe headache with vomiting. On examination his BP was severely elevated at 253/150 mmHg and he had features of acute pulmonary edema (APO). Initial investigations Significant anemia (hemolytic picture with elevated LDH, low haptoglobin and Indirect hyperbilirubinemia) with thrombocytopenia. Peripheral blood film revealed fragmented RBCs(2-4/hpf), Severe renal failure Creatinine 757umol/L urea 30.9mmol/L Na 129mmol/L, K 2.6mmol/L. MRI Brain revealed features suggestive of Posterior reversible encephalopathy syndrome (PRES). He was diagnosed with hypertensive emergency complicated by APO, PRES and Acute kitney injury from MAHA. He was admitted to ICU and treated with IV GTN infusion, hydralazine and diuretics. He was also started on hemodialysis. Renal failure work-up-HbA1c 4.4, nonreactive viral markers, negative autoimmune serology (C3/C4 normal, Anti-dsDNA <25, ANA <80, ANCA negative). Secondary Hypertension work-up - negative for Renal artery stenosis, Conns, Cushings, Phaeochromocytoma and Thyroid disorders. ADAMTS-13 Activity: 28%, DCT Negative. He was closely monitored, continued on hemodialysis and his blood pressure well-controlled with consequent improvement in LDH, bilirubin, Hemoglobin, and thrombocytopenia. He did not require to be treated with plasma exchange.

Conclusions:

The report contributes valuable insights into the differentiation of these two related yet clinically distinct entities, providing guidance for clinicians to appropriately tailor the therapeutic interventions. Further research is essential for refining diagnostic criteria to enhancie the precision of therapeutic strategies in these complex medical scenarios.
HUMAN UMBILICAL MESENCHYMAL STEM CELL-DERIVED MITOCHONDRIA AMELIORATE MATERNAL PHENOTYPE BY IMPROVING PLACENTAL MITOCHONDRIAL FUNCTION IN ANGIOTENSIN II-INDUCED RAT PREECLAMPSIA MO
Authors: Zhang Yin Hua
Published: May 2024

Objective:

Preeclampsia (PE) is one of the primary contributors of neonatal and maternal morbidity and mortality. Clinical manifestations of PE include elevated blood pressure and renal dysfunction (albuminuria), 20 weeks into the gestation. Presently, preterm labor, intravenous MgSO4 for vasospasm relief or termination of pregnancy remain the treatments for PE. There is an urgent need to develop effective strategies to prevent PE-associated abnormalities to secure maternal and neonatal health. Here, we investigated the efficacy of mitochondrial transplantation (derived from human umbilical cord mesenchymal stem cells, hUC-MSC) on a rat model of PE.

Design and method:

A rat model of PE was established by infusing angiotensin-II (Ang II, 1 microg/kg/min) to pregnancy rats (from gestation day 8 for 2 weeks). Mitochondria from hUC-MSC was administered (100microg / l) via jugular vein on gestation day 14.

Results:

Blood pressure was increased in Ang II-rats, accompanied by reduced glomerular capillaries, impaired fetal weight and placental vascular development. Soluble fms-like tyrosine kinase 1 (sFlt-1) content was increased in the plasma of Ang II rats, confirming the establishment of PE. Mitochondria from hUC-MSC reversed both fetal and maternal manifestations of PE (fetal weight was increased and blood pressure, glomerular abnormalities and placental vasculature were restored to normal). Mitochondrial biogenesis markers (PGC-1α, NRF1, Tfam) were improved, mitophagy markers (PINK1, BNIP3, BNIP3L, FUNDC 1) and mitochondrial fission markers (DRP1, FIS1) were reduced and mitochondrial fusion markers (OPA1, MFN1, MFN2) were increased in the mitochondria from placental tissue. Reactive oxygen species (ROS) was reduced, activities of ATP synthase and citrate synthase were increased. Further investigations into trophoblast cells and placental tissue revealed elevated sFLT-1 mRNA and protein levels in PE. Additionally, calcineurin protein content and nuclear factor of activated T cells (NFAT) in the nucleus were increased in placental trophoblasts of PE, hUC-MSC reversed the effects.

Conclusions:

In summary, mitochondria from hUC MSC can be an effective therapeutic modality for the treatment of PE in our rat model. This study sheds light on novel therapeutic options for PE targeting angiogenesis.
EFFECTS OF ANGIOTENSIN RECEPTOR-NEPRILYSIN INHIBITOR (ARNI) ON HOME BLOOD PRESSURE AND BAPWV IN ESSENTIAL HYPERTENSIVE PATIENTS
Authors: Yamagishi Toshio
Published: May 2024

Objective:

Sacubitril/valsartan sodium hydrate (Entresto) is classified as an ARNI and has a novel mechanism of action that simultaneously inhibits neprilysin and angiotensin II receptors. We investigated the effects of Entresto on blood pressure (BP), baPWV, and carotid arterial intima-media thickness (IMT) and elasticity in essential hypertension.

Design and method:

Fifty-two hypertensive patients (twenty-six males, average age 67 years) who had insufficient BP reduction (home systolic 135 or diastolic 85 mmHg or higher) after receiving ARBs (azilsartan 26 or valsartan 26) for more than 6 months, were assigned to receive Entresto for 12 months (200-400mg/day, gradually increase depending on the condition). Changes in home BP, biochemical data, baPWV, central blood pressure (cSBP) were evaluated. The carotid arterial IMT and elastic modulus in the circumferential direction (Eθ) were simultaneously measured by the high-resolution Doppler technique, “Phased Tracking Method”.

Results:

Home morning BP (mmHg) after administration of Entresto significantly (p<0.05) decreased from 142.9±11.3/80.0±12.1 to 125.7±7.4/70.9±12.0, and home heart rate (HR, bpm) also significantly decreased from 75.1±11.3 to 72.2±11.9. There were no differences in BP and HR changes between ARBs. Furthermore, baPWV (m/sec) significantly decreased from 1542.4±259.8 to 1438.4±222.41, and cSBP (mmHg) significantly decreased from 141.0±9.1 to 133.2±8.4. Urine protein (mg/g/Cr) decreased significantly from 319.6±473.6 to 213.1±376.4, but there were no significant changes in eGFR (45.6±14.1 to 44.5±14.5 mL/min/1.73m2) nor serum potassium (4.2±0.4 to 4.0±0.9mEq/L). Eθ (kPa) was reduced significantly from 301±141 to 163±41 without changes in IMT. The histogram analysis of the Eθ data revealed the drug decreased harder components of the elasticity distribution, suggesting improvement of endothelial dysfunction.

Conclusions:

These data demonstrate that the ARNI, Entresto provides potent antihypertensive and antiatherosclerotic effects.