bluuebunny/crossref_metadata_2025 huggingface dataset:
Single‐cell sequencing reveals microglia induced angiogenesis by specific subsets of endothelial cells following spinal cord injury
Authors: Yao Chun , Cao Yuqi , Wang Dong , Lv Yehua , Liu Yan , Gu Xiaosong , Wang Yongjun , Wang Xuhua , Yu Bin
Published: June 2022

Spinal cord injury (SCI) results in dynamic alterations of the microenvironment at the lesion site, which inevitably leads to neuronal degeneration and functional impairment. The destruction of the spinal vascular system leads to a significant deterioration of the milieu, which exacerbates inflammatory response and deprives cells of nutrient support in the lesion. Limited endogenous angiogenesis occurs after SCI, but the cellular events at the lesion site during this process are unclear so far. Here, we performed single‐cell RNA sequencing (scRNA‐seq) on spinal cord tissues of rats at different time points after SCI. After clustering and cell‐type identification, we focused on vascular endothelial cells (ECs), which play a pivotal role in angiogenesis, and drew the cellular and molecular atlas for angiogenesis after SCI. We found that microglia and macrophages promote endogenous angiogenesis by regulating EC subsets through SPP1 and IGF signaling pathways. Our results indicate that immune cells promote angiogenesis by regulating specific subsets of vascular ECs, which provides new clues for exploring SCI intervention.
THE DANTON STUDY - DISCONTINUATION OF ANTIHYPERTENSIVE TREATMENT IN OLDER PEOPLE WITH DEMENTIA LIVING IN A NURSING HOME: RESULTS OF A RANDOMIZED CONTROLLED TRIAL
Authors: Bogaerts Jonathan , Gussekloo Jacobijn , De Jong-Schmit Bianca , Achterberg Wilco , Poortvliet Rosalinde
Published: June 2022

Objective:

Neuropsychiatric symptoms (NPS), such as apathy and agitation, are highly prevalent in nursing home (NH) residents with dementia. Literature suggests an association of both cerebral hypoperfusion and antihypertensive treatment (AHT) with NPS in patients with dementia. Therefore, we investigated whether discontinuation of AHT in NH residents with dementia reduces NPS and improves quality of life (QoL).

Design and method:

Randomized, single-blinded trial conducted in 26 Dutch NH organisations. Residents with moderate-severe dementia and a systolic blood pressure < 160 mmHg during AHT were randomized in an intervention (semi-protocolized discontinuation) and control (continuation) group during a period of 8 months. Exclusion criteria were heart failure NYHA-class-III/IV, angina pectoris, a recent cardiovascular event/reperfusion procedure, or a life-expectancy < 4 months. Co-primary endpoints were NPS (Neuropsychiatric Inventory-Nursing Home version) and QoL (Qualidem) at 4 months. Secondary endpoints include cognitive function, care dependency, general daily functioning and falls.

Results:

Between December 2018 and May 2021, 205 NH residents with dementia (median age 86 years-79.5% women) were randomized, of which 177 (86.3%) reached the primary endpoint at 4 months. During trial, 63 severe adverse events occurred in 61 residents. On advice of the Data Safety Monitoring Board, the study was preliminary finished in December 2021 due to futility based on the co-primary endpoints. Definitive results for all endpoints measured at 4 and 8 months follow-up will be available in April 2022.

Conclusions:

This is, to our knowledge, the largest AHT deprescription trial in NH residents with dementia. Based on preliminary results of this study, the benefits of deprescribing AHT in NH residents with dementia for reduction of NPS and improvement of QoL, are unclear and may not be without any potential risk.
ASSOCIATIONS BETWEEN PLASMA METABOLOMICS AND BLOOD PRESSURE ACROSS ETHNICITIES: THE HELIUS STUDY
Authors: Verhaar Barbara , Mosterd Charlotte M. , Collard Didier , Galenkamp Henrike , Van den Born Bert-Jan H. , Muller Majon , Rampanelli Elena , Nieuwdorp Max , Van Raalte Daniël H.
Published: June 2022

Objective:

Blood pressure (BP) is regulated by plasma metabolites from different neurohumoral and cardiometabolic systems. Since there are well-established differences in hypertension pathogenesis and treatment response between ethnicities, we hypothesized that plasma metabolites may be differently associated with BP across ethnic groups.

Design and method:

From the HELIUS study, 369 subjects (mean age 52 ± 11 years, 51%F) of African and non-African descent were included. Office systolic and diastolic BP levels were recorded. Plasma metabolites were measured with untargeted LC-MS from fasting plasma samples. Associations between metabolite profiles and BP were assessed with machine learning prediction models. Associations between the resulting best predictors and BP were assessed with linear regression models while adjusting for age, sex, renal function and diabetes, and interactions with ethnicity were tested.

Results:

Plasma metabolite profiles explained 14.1% of systolic BP variance and 10.6% of diastolic BP variance. Top predictors for both systolic and diastolic BP included N-formylmethionine, several acylcarnitines and polyunsaturated fatty acids such as hexadecadienoate. These metabolites were significantly associated with higher systolic BP with estimates ranging from 3.0–4.5 mmHg per 1 SD increase in the adjusted models. Associations with hexadecadienoate, dihomolinoleate and catecholamine metabolites, including vanillactate had significant interactions with ethnicity and were only significant in subjects of non-African descent. The top predictor N-formylmethionine was the most consistent predictor across ethnicities and sex. This metabolite was associated with higher levels of nitric oxide (NO)-related metabolites, including dimethylarginine (r = 0.42, p < 0.001) and citrulline (r = 0.24, p < 0.0001).

Conclusions:

Plasma metabolome composition explained a large proportion of BP variance, but best predicting metabolites were differently associated with BP across ethnicities. N-formylmethionine was the most consistent predictor for BP across ethnicities and sex. This metabolite was associated with metabolites in the NO-pathway. We hypothesize that formylmethionine affects BP through the inhibition of endothelial NO formation.
ESTIMATES OF CARDIOVASCULAR DISEASES BURDEN ATTRIBUTABLE TO HIGH SODIUM INTAKE FROM 1990 TO 2019: A SYSTEMATIC ANALYSIS OF DATA FROM THE GLOBAL BURDEN OF DISEASE STUDY
Authors: Wang Keke , Liu Jing , Bu Xiang , Mu Jianjun
Published: June 2022

Background:

Sodium intake shows a positive correlation with blood pressure, resulting in an increased risk for cardiovascular diseases (CVDs). This study is aimed at evaluating global CVDs burden due to high sodium intake (HSI) from 1990 to 2019.

Methods:

Data on high dietary sodium attributable CVDs burden were extracted from the Global Burden of Disease (GBD) study 2019. The numbers and age-standardized rates (ASRs) of mortality and years of living with disability (YLDs), stratified by location, sex, and socio-demographic Index (SDI), were used to assess the high sodium intake attributable CVDs burden from 1990 to 2019.

Results:

Globally in 2019, the deaths and YLDs numbers caused by high sodium related CVDs were 1.72 million and 3.57 million, respectively, increasing by 41.1% and 93.4% from 1990. Meanwhile, the corresponding mortality and YLDs rates dropped by 35.2% and 5.0%. The relationship between CVDs burden and SDI exhibited an inverted V-shaped curve. Middle SDI countries bore the greatest burden and experienced the greatest increase, while high SDI countries had the lowest mortality rate and low SDI countries had the lowest YLDs rate. Men had a higher risk suffering CVDs from high dietary sodium. And the leading cause of high sodium attributable deaths and YLDs burdens was ischemic heart disease.

Conclusions:

From 1990 to 2019, the global deaths and YLDs rates of high sodium intake attributable CVDs decreased with spatiotemporal and sexual heterogeneity. However, CVDs burden attributable to high sodium still remains a major public health challenge because of the increasing absolute numbers of deaths and YLDs. The regional socioeconomic status needs to be considered when establishing the targeted controls to reduce the high sodium related CVDs burden.
HIGH MOBILITY GROUP BOX-1 IS INCREASED IN NEWLY DIAGNOSED ESSENTIAL HYPERTENSIVES AND CORRELATES WITH HYPERTENSION-MEDIATED TARGET ORGAN DAMAGE
Authors: Lazaridis Antonios , Gavriilaki Eleni , Dolgyras Panagiotis , Koletsos Nikolaos , Triantafyllou Areti , Anyfanti Panagiota , Pavlidou Olga , Goulas Kyriakos , Douma Stella , Gkaliagkousi Eugenia
Published: June 2022

Objective:

Chronic immune-mediated inflammation is increasingly recognized as an important contributor to target organ damage (TOD) in essential hypertension (EH). High mobility group box-1 (HMGB1) is a damage-associated molecular pattern (DAMP) molecule which stimulates innate immunity, hence exerting significant proinflammatory properties including vascular inflammation and thrombosis. So far, no clinical data exist regarding the role of HMGB1 in EH and its association with vascular damage. Our objective was to measure HMGB1 levels in newly diagnosed, untreated patients with EH (UHTs) compared to normotensive controls (NTs) and correlate them with indices of macro- and microvascular dysfunction, which play a core role in the pathogenesis of TOD in EH.

Design and method:

HMGB1 was measured in serum with ELISA. Ambulatory and central blood pressure (BP) parameters, and pulse wave velocity (PWV), were measured by using the Mobil-O-Graph device. Skin microcirculation was assessed with Laser Speckle Contrast Imaging (LSCI) coupled with post-occlusive reactive hyperemia (PORH). Results are expressed as a percentage increase between peak and baseline perfusion (%), and the amplitude of PORH response defined as peak Cutaneous Vascular Conductance (CVC) minus baseline CVC. The CVC was calculated as the flux in each period divided by mean arterial pressure [(PUs)/mmHg].

Results:

We consecutively enrolled 55 UHTs and 25 NTs matched for age and sex. HMGB1 levels were significantly higher in UHTs compared to NTs. HMGB1 showed a significant positive association with measures of macrocirculation including 24 h central systolic (0.325, p < 0.01) and diastolic BP (0.371, p < 0.01), day central systolic (0.353, p < 0.01) and diastolic BP (0.402, p < 0.01), and 24 h PWV (0.224, p < 0.05) and day PWV (0.230, p < 0.05) in the total study population. In addition, HMGB1 presented a significant negative association with skin microvascular parameters including base to peak flux (-0.247, p < 0.05) and PORH amplitude (-0.225, p < 0.01).

Conclusions:

HMGB1 is significantly increased in UHTs compared to NTs and correlates with indices of macro- and microvascular damage. These results reinforce the concept that immune system activation contributes to hypertension-mediated TOD from the very early stages and point towards intense research in order to investigate novel potential therapeutic targets related to EH.
PATIENTS WITH PSORIASIS PRESENT IMPAIRED MICROVASCULAR REACTIVITY INDEPENDENTLY OF TRADITIONAL CARDIOVASCULAR RISK FACTORS
Authors: Margouta Anastasia , Anyfanti Panagiota , Nikolaidou Barbara , Dolgyras Panagiotis , Lazaridis Antonios , Vakalopoulos Nikolaos , Lazaridou Elizabeth , Patsatsi Aikaterini , Douma Stella , Gkaliagkousi Eugenia
Published: June 2022

Objective:

Psoriasis is associated with increased rates of cardiovascular complications. Altered microvascular responses in divergent vascular beds are considered as an early precursor of cardiovascular disease and have been well-described in patients with cardiovascular risk factors and chronic inflammatory diseases. Laser Speckle Contrast Imaging (LSCI) has emerged as a novel, non-invasive and highly reproducible technique for the in vivo, real-time evaluation of microvascular perfusion.

Design and method:

We aimed to assess real-time skin microvascular function in patients with psoriasis free from established cardiovascular disease, in comparison with controls matched for cardiovascular risk factors. Microvascular function was evaluated dynamically using LSCI coupled with a post-occlusive reactive hyperaemia (PORH) protocol. Well-established markers of arterial stiffness, i.e. pulse wave velocity (PWV) and augmentation index (AIx), were assessed as surrogate markers of cardiovascular disease through a whole 24 h period using the Mobil-O-Graph device.

Results:

We studied 90 patients with psoriasis and 45 control individuals. Traditional cardiovascular risk factors and surrogate markers of cardiovascular disease did not differ between groups. By contrast, several indices of microvascular responses assessed with LSCI were found impaired in patients with psoriasis compared to controls, specifically baseline flux [45.7 (11.7) vs 36.2 (7.5) LSPUs, p < 0.001], occlusion flux [11.6 (7.1) vs 7.4 (4.6) LSPUs, p < 0.001], peak-to-baseline magnitude [128.9 (46.4) vs 179.0 (62.0) %, p < 0.001], and baseline cutaneous vascular conductance (0.50 ± 0.13 vs 0.39 ± 0.10 LSPUs/mmHg, p < 0.001). 24 h PWV significantly correlated with nearly all LSCI parameters, including time-to-peak flux, baseline perfusion, occlusion flux, peak flux, peak-to-baseline magnitude, and baseline cutaneous vascular conductance (p < 0.05 for all). 24 h AIx significantly correlated only with occlusion flux (r = 0.223, p = 0.011). The latter was significantly associated with psoriasis duration (r = 0.300, p = 0.015).

Conclusions:

Our study shows for the first-time impaired microcirculation dynamics in patients with psoriasis using LSCI, in the absence of established cardiovascular disease and regardless of cardiovascular risk factors. A cross-talk between micro-macrovascular dysfunction apparently exists even at these early stages, before the establishment of clinically evident cardiovascular manifestations.
CATHETER-BASED RENAL DENERVATION – LONG TERM SAFETY AND BLOOD PRESSURE REDUCTION IN PATIENTS WITH RESISTANT HYPERTENSION
Authors: Schlaich Markus , Sesa-Ashton Jonathon , Lee Rebecca , Lambert Elisabeth , Lambert Gavin , Nolde Janis , Walton Antony , Esler Murray
Published: June 2022

Objective:

Recent sham-controlled andomised clinical trials have confirmed the safety and efficacy of catheter-based renal denervation (RDN) with clinically meaningful blood pressure (BP) reductions in hypertensive patients on or off antihypertensive medication. Longer-term safety and efficacy data have so far only been documented out to 3 years. Here we provide a first report on safety and efficacy outcomes in a cohort of patients with resistant hypertension beyond 5 years of follow up.

Design and method:

We recruited patients with resistant hypertension who were previously enrolled in various RDN trials applying radiofrequency energy to ablate the renal nerves using the Symplicity Flex® system. All participants had baseline assessments prior to RDN and repeat assessment at current long term follow up including medical history, automated office and ambulatory BP measurement, and routine blood and urine tests.

Results:

A total of 60 participants (age: 70.0 ± 10.3 years (mean ± SD), 76.3% male) have completed long-term follow up investigations with an average of 6.8 (range 6–10) years post-procedure. Ambulatory systolic BP was reduced by 12.0 ± 21.6mmHg (from 145.7mmHg to 132.8mmHg; p < 0.001) and diastolic BP by 8.3 ± 12.8mmHg (from 81.6 mmHg to 72.0 mmHg; p < 0.001). This BP reduction occurred despite participants being on less antihypertensive medication with a reduction in the average defined daily dose, the assumed average maintenance dose per day for a drug used for its main indication in adults, from 4.91 ± 0.37 to 4.02 ± 0.27 (p < 0.01). eGFR remained stable at long-term follow up with no statistically significant difference in participants with pre-existing CKD from baseline.

Conclusions:

Our investigation indicates a significant and robust reduction in ambulatory systolic and diastolic blood pressure, despite reduction in antihypertensive medications, in the long-term following catheter-based renal denervation without evidence of adverse consequences on renal function.
GLOMERULAR PROSTAGLANDIN E2 IS UPREGULATED DURING ONSET OF ALBUMINURIA THAT IS SUPPRESSED AFTER DUAL BLOCKADE OF ITS EP2 AND EP4 RECEPTORS IN A RAT MODEL OF GLOMERULAR HYPERFILTRA
Authors: Schulz Angela , Mangelsen Eva , Kourpa Aikaterina , Kaiser Debora , Rothe Michael , Panakova Daniela , Bolbrinker Juliane , Kreutz Reinhold
Published: June 2022

Objective:

Glomerular hyperfiltration (GH) is an important mechanism in the development of albuminuria in hypertension. Recent in vitro data indicated an activation of an autocrine/paracrine cyclooxygenase 2 (COX2)/prostaglandin E2 (PGE2) pathway resulting in podocyte injury in GH by using fluid flow shear stress exposure. This was mediated by concerted ignalling via both prostaglandin E2 receptors (EP), EP2 and EP4. Here, we explored the role to target this pathway in vivo by using a rat model with GH and albuminuria.

Design and method:

We used the Munich Wistar Frömter (MWF) rat model with an inherited nephron deficit as a model of GH and albuminuria. Because analysis of PGE2 levels in vivo is limited by conventional methods, we developed a modified liquid chromatography tandem mass spectrometry (LC/ESI-MS/MS) protocol to quantify PGE2 levels in glomerular tissue. We then assessed glomerular PGE2 during the onset of albuminuria in young MWF at 4 to 8 weeks of age. Furthermore, the renoprotective effects of either separate or combined pharmacological blockade of EP2 (by PF-04418948) and EP4 (by ONO-AE3-208) in MWF was explored. Treatment started at the onset of albuminuria at 4 weeks and was continued for 8 weeks.

Results:

During the onset of albuminuria, PGE2 levels were significantly elevated in isolated glomeruli of MWF at both 4 and 8 weeks of age (p < 0.01, respectively) as compared to albuminuria resistant spontaneously hypertensive rats (SHR). At 12 weeks of age, untreated MWF developed pronounced albuminuria, which was significantly, although modestly, reduced by separate EP2 or EP4 blockade. Remarkably, combined EP2 and EP4 blockade resulted in a significant suppression (-71%) of albuminuria in MWF at 12 weeks. Importantly, this pharmacological treatment did not affect systolic blood pressure and creatinine clearance (Figure 1).

Conclusions:

We demonstrated the activation of glomerular PGE2 in vivo in the setting of hyperfiltration and albuminuria in the MWF rat model. Dual EP2 and EP4 receptor blockade exhibited a marked suppression of albuminuria without affecting systemic blood pressure and glomerular filtration rate. These data support further translational research to explore this therapeutic option for renoprotection.
THE VALUE OF MULTIPLE 24-HOUR URINE SAMPLES FOR ESTIMATING SODIUM INTAKE
Authors: Van Maaren Jolan , Esseghir Malik , van den Born Bert-Jan , Vogt Liffert , Engberink Rik Olde
Published: June 2022

Objective:

A single 24-hour urine collection is frequently used to estimate daily sodium intake. Long-term balance studies, however, observed large discrepancies between 24-hour sodium intake and sodium excretion. In a controlled setting with stable sodium intake, the use of up to 7 consecutive 24-hour urine samples has been shown to increase the accuracy of sodium intake estimates. The value of multiple 24-hour urine collections for estimation of sodium intake has not been investigated in the clinical setting with uncontrolled intake, use of natriuretic medication and comorbidities that may affect sodium excretion.

Design and method:

In a retrospective cohort study, we included adult subjects who collected an outpatient 24-hour urine sample between 1998 and 2000, and had collected at least 6 additional 24-hour urine collections during follow-up. Mean sodium excretion was calculated for 2, 3, 4, 5, 6, and 7 consecutive 24-hour urine collections. We calculated the absolute change in 24-hour urine sodium excretion with each added urine sample. We considered a 0.4-gram change in sodium (1 gram salt) intake clinically relevant.

Results:

We included 316 subjects with an average age of 44 years, and 46% were male. 50% of the subjects had a history of hypertension, 30% had diabetes and 9% had a history with a cardiovascular event. Diuretics were used by 22% of the subjects and 44% used ennin-angiotensin-aldosterone system inhibitors. The median follow-up period was 16.4 years. The median time to collection of 7 urine samples was 2.5 years (IQR 1.3–4.8). Mean sodium excretion was 159 mmol/day (SD 62). With addition of a second 24-hour urine sample, individual estimated sodium intake changed with 0.43 gram sodium (IQR 0.17–0.90) and changed > 0.4 gram in 52% of the subjects. When a fifth or seventh collection was added, estimated sodium intake changed > 0.4 gram in 14% and 7% of our cohort (Figure).

Conclusions:

Collection of multiple 24-hour urine samples substantially changes estimated individual sodium intake in the clinical setting. The added value of collecting > 5 24-hour urine samples is limited and changes sodium intake estimations only in 14% of the subjects.
CLINICAL CHARACTERISTICS OF PATIENTS WITH FIBROMUSCULAR DYSPLASIA ASSOCIATED WITH ANEURYSMS (ARCADIA-POL STUDY)
Authors: Talarowska Paulina , Januszewicz Magdalena , Jozwik-Plebanek Katarzyna , Dobrowolski Piotr , Prejbisz Aleksander , Florczak Elzbieta , Gasecki Dariusz , Zylkowski Jaroslaw , Michalowska Ilona , Kabat Marek , Persu Alexandre , Januszewicz Andrzej
Published: June 2022

Objective:

To assess the prevalence and distribution of aneurysms among patients with fibromuscular dysplasia (FMD) and to compare clinical characteristics of FMD patients with and without aneurysms.

Design and method:

Out of 435 patients enrolled into ongoing ARCADIA-POL study FMD was confirmed in 281 cases. A standardized FMD data form was used for data collection. All patients underwent detailed clinical evaluation including ABPM, biochemical evaluation, biobanking and imaging, duplex Doppler of carotid and abdominal arteries and whole body angio-CT.

Results:

Among 281 patients with FMD enrolled into study the presence of at least one aneurysm was documented in 92 patients. Mean age was 52,3 ± 12,0 years. Most of patients were women (91.3%). Hypertension was found in 81.4% and hyperlipidemia in 51.2% patients. Almost one third (27.3%) of subjects were active smokers during time of admission. History of use of contraceptive pills was reported by 20.7% women. Among patients with aneurysms FMD lesions were classified as multifocal in 89.1% patients. Single-site FMD was observed in 66.3% patients. The most frequent localization of FMD lesions were renal, cervical and intracranial arteries. In almost half of patients (45.7%) with FMD and aneurysm the presence of two or more aneurysms was confirmed, giving the total number of 124 aneurysms. Aneurysms were most frequently documented in renal arteries (14.6%), intracranial arteries (11.7%), splenic artery (10.7%) and cervical arteries (3.9%). Among 70 patients with newly diagnosed aneurysms 72.9% subjects were qualified for interventional treatment. Two out of 92 patients with FMD and aneurysm presented severe complications caused by ruptured aneurysm. FMD patients with aneurysms as compared to those without aneurysms were more often female, were older, had more often history of contraceptive use and hyperlipidemia. There were no significant differences in other clinical parameters between analysed groups.

Conclusions:

Among FMD patients we confirmed high prevalence of aneurysms (32.7%). This supports the concept that FMD is generalized arteriopathy and all patients should be systematically evaluated and if needed qualified for interventional treatment.
EFFECT OF RENAL DENERVATION ON CARDIO ANKLE VASCULAR INDEX IN SUBJECTS WITH RESISTANT HYPERTENSION
Authors: Postadzhiyan Arman , Tochev Sotir , Andreeva Lora , Rifai Nizar , Finkov Bojidar
Published: June 2022

Objective:

The aim of the study was to determine the clinical characteristics of patients with increased arterial stiffness (AS) undergoing renal sympathetic denervation (RSD) and to examine the role of CAVI measurement as a surrogate for AS in predicting the outcome of RSD.

Design and method:

Consecutive patients with resistant hypertension who underwent RSD workout at the University Hospital Saint Anna, Sofia, ESH Excellence center of hypertension, between January 2014 and December 2020 were included. RSD was performed on the grounds of resistant hypertension defined as mean daytime systolic BP = > 135 mmHg or diastolic BP = > 85 mmHg in 24-hr ambulatory blood pressure measurement (ABPM) despite the intake of at least three antihypertensive agents, including a diuretic. CAVI was measured using the VaSera system (Fukuda Denshi Co, Japan). RSD was performed with the Symplicity Flex catheter (Medtronic, Minneapolis, MN, USA) according to a standardized protocol.

Results:

The study included 62 patients with treatment-resistant hypertension, after out of office blood pressure measurement and intensification of therapy, renal denervation was performed in 32 (51.6%). Patients with increased arterial stiffness, defined as CAVI> median of 8.3, were older, with a larger waist circumference and previous cardiovascular events. A long-term effect of the RSD, reported as a reduction in 24-hour systolic blood pressure above 10 mmHg at month 12, was found in 22 patients (68.8%). The median of the observed reduction of the 24-hour systolic blood pressure was -16 mmHg at 95% confidence interval -9.1 to -21 mmHg. Despite similar baseline out-of-office and office blood pressure and concomitant antihypertensive therapy, patients with lower arterial stiffness had a more significant blood pressure effect of renal denervation, a result that persisted within 12 months of follow-up. In contrast, the effect of the procedure was clinically insignificant among patients with baseline CAVI values above 8.3.

Conclusions:

These findings hold the promise that AS might be used as a selection criterion for RSD, thereby improving outcome following RSD.
PATIENT PREFERENCES FOR PHARMACEUTICAL AND INTERVENTIONAL HYPERTENSION TREATMENTS: RESULTS FROM A DISCRETE CHOICE EXPERIMENT
Authors: Pathak Atul , Weber Michael , Poulos Christine , Coulter Joshua , Cohen Sidney , Debruin Vanessa , Jones Denise , Kandzari David
Published: June 2022

Objective:

To quantify patient benefit-risk preferences for interventional and pharmaceutical treatments for hypertension (HTN) using discrete choice experiment (DCE) methods.

Design and method:

A DCE is an established survey method commonly used to quantify preference for selected treatment attributes in hypothetical profiles, allowing estimation of tradeoffs that are acceptable when evaluating several attributes together. Respondents with physician confirmed uncontrolled HTN were presented with a series of questions with hypothetical HTN treatments with differing levels of treatment risk and benefit. Respondents could also choose no HTN treatment. A random parameters logit analysis of the survey treatment choices was used to estimate the relative preferences and importance for each attribute.

Results:

400 patients completed the survey, with 52% female, mean age 59 ± 13 years, systolic blood pressure (BP) 155 ± 12 mmHg and 1.8 ± 0.9 average prescribed antihypertensive medications. Reduction in office systolic blood pressure (BP) was the most influential treatment attribute. The remaining attributes were less impactful on respondents’ treatment choice (i.e., duration of effect, whether treatment was interventional, number of daily pills, risk of vascular injury, risk of medication side effects, and risk of temporary pain and bruising). When given a choice between no HTN treatment and an interventional treatment with a 20% risk of procedure side effects, the likelihood of selecting the interventional treatment increased with the magnitude of blood pressure reduction. No more than a 2.5 mmHg reduction in office systolic BP was sufficient to offset treatment risks associated with an interventional procedure like RDN.

Conclusions:

Among U.S. patients with HTN, a DCE study demonstrated that BP reduction was the most important driver of choice, risks were less important, and a minimal BP reduction was sufficient to offset treatment risks associated with an interventional procedure like RDN.
ACUTE POST-DYNAMIC, ISOMETRIC AND COMBINED RESISTANCE EXERCISE HYPOTENSION IN PATIENTS WITH HYPERTENSION: A RANDOMIZED STUDY
Authors: Forjaz Claudia Lucia De Moraes , Oliveira-Silva Laura G , Silva-Junior Natan D. , Pio-Abreu Andrea , Silva Giovanio V. , Drager Luciano L. , Sousa Julio S. , Fecchio Rafael Y.
Published: June 2022

Objective:

American guidelines included dynamic resistance exercise (DRE) and isometric handgrip (IH) in hypertension treatment. A single session of DRE decreases blood pressure (BP) during the recovery period, which has been described as post-exercise hypotension (PEH). However, the occurrence of PEH after a session of IH is controversial and the post-exercise effects of the association of DRE and IH, in a combined resistance exercise (CRE), has not been evaluated. Thus, this study investigated the effects of DRE, IH and CRE on post-exercise BP and its hemodynamic, autonomic and vascular mechanisms.

Design and method:

Seventy medicated hypertensive men (52 ± 8 years) were randomly allocated to perform 1 of 4 interventions: DRE (8 exercises, 3 sets, 50%1RM, repetitions until moderate fatigue), IH (4 sets, 2 min-unilateral contraction, 30% MVC), CRE (DRE + IH) and control (CO - seated resting). Office BP, systemic hemodynamics (CO2 rebreathing technique), cardiovascular autonomic modulation [spectral analysis of heart rate (HR) and BP variabilities] and brachial vascular parameters (ultrasound) were evaluated before and after the interventions. Thus, the responses to interventions (post – pre-intervention values) were calculated and compared among the groups by ANOVAs with significance level set at P < 0.05.

Results:

Responses to IH were similar to CO, showing that a single session of IH did not promote PEH, and did not affect any of the BP mechanisms. On the other hand, DRE and CRE induced responses significantly different from IH and CO. DRE and CRE significantly decreased systolic BP, diastolic BP, mean BP, stroke volume and cardiac baroreflex sensitivity, while they significantly increased HR, brachial artery diameter, blood flow and vascular conductance during the post-exercise period. Additionally, DRE significantly decreased post-exercise cardiac vagal modulation (HFR-R, nu) and increased cardiac sympathovagal balance (LF/HF).

Conclusions:

DRE, but not IH, elicits PEH, which is accompanied by vasodilation and increased HR, via a higher sympathovagal balance and lower baroreflex sensitivity. The addition of IH to DRE, in a CRE, does not potentiate PEH and did not change its mechanisms.
AGE AS A RISK FACTOR FOR CARDIOVASCULAR EVENTS IN PATIENTS WITH HYPERTENSIVE CRISES AFTER 12-MONTH FOLLOW-UP: A GREEK REGISTRY
Authors: Fragkoulis Christos , Polyzos Dimitrios , Mavroudis Andreas , Dimitriadis Kyriakos , Kariori Maria , Leontsinis Ioannis , Andrikou Ioannis , Kakouri Niki , Kouremeti Maria , Grigoriou Kalliopi , Thomopoulos Costas , Konstantinidis Dimitrios , Tsioufis Konstantinos
Published: June 2022

Objective:

Few data have been published regarding the long-term prognosis of patients with hypertensive crises (HC). The aim of our study was to record the prevalence and clinical phenotype of patients with hypertensive urgencies (HU) and emergencies (HE) assessed in the emergency department (ED) and during ospitalisation and a 12-month follow-up to record new events in a Greek tertiary hospital.

Design and method:

The registry population consisted of patients admitted to the ED with acute increase in blood pressure (BP) (systolic BP> or = 180mmHg and/or diastolic BP > or = 120mmHg) and depending on the presence or absence of acute hypertension-mediated target organ damage they were divided into the HE and the HU group, respectively. In all patients the demographic and clinical parameters were recorded for 12 months and there was a 12-month follow-up for new end points.

Results:

Out of 38,589 patients assessed in the ED during a period of 12 months, 353(0.91%) had HC, out of whom 256(72.5%) had HU and 97(27.5%) had HE. The mean age of all patients was 67.4 ± 12.9 years, 49% were males and 80% had a history of hypertension. During the study period 81 patients were excluded for not completing the follow-up. We stratified the total population of HC by age separating patients into two groups, e.g. > or = 65 and < 65 years old, and ospital the composite end point consisting of deaths or ospitalisations caused by cardiovascular disease. Patients > or = 65years old presented more composite events (36 vs 8 events, p = 0.019, HR for patients > or = 65years 2.68, 95% CI 1.18–6.12). Cox regression models were adjusted for age, gender, cardiovascular disease, chronic kidney disease and diabetes mellitus.

Conclusions:

Our study implies that age > or = 65years is an independent risk factor for deaths or ospitalisations caused by cardiovascular disease in patients with HC. There is an arising necessity for more intensive follow-up of these patients and the need for further research in this setting.
PATIENT PERSPECTIVES ON TREATMENT ADHERENCE IN HYPERTENSION: PRELIMINARY RESULTS OF AN ESH SURVEY IN FIVE COUNTRIES
Authors: Burnier Michel , Persu Alexandre , Azizi Michel , Prejbisz Aleksander , Cunha Vitoria , Gupta Pankaj , Vaclavik Jan , Versmissen Jorie , Kreutz Reinhold , Kjeldsen Sverre E.
Published: June 2022

Objective:

The ESH Working group on Lifestyle, Cardiovascular Therapy and Adherence, in partnership with Servier, has developed a web-based questionnaire in different languages to investigate patients’ perspectives on hypertension and treatment adherence. The objective of this survey was to decipher patients’ perception, motivations and barriers to drug treatment adherence in hypertension.

Design and method:

Eligible participants were men and women aged > 18 years, living in France, Germany, Italy, Spain and UK, with a diagnosis of hypertension made by a physician and internet access. Data were collected through patients’ websites and organizations from January to March 2022.

Results:

We included 595 participants (329 women, 55.3%, mean age 65 y); 72% were hypertensive for > 5 years, 93% were treated with antihypertensive medications for > 3 months and 50% had uncontrolled (140/90 mmHg) office BP at 3 months. The median number of all medications taken every day was 4 of which 2 were antihypertensive drugs. On a 10-point Likert scale, participants reported a modest impact of hypertension on their quality of life (3) or social and family life (3.1). The median level of stress was 5.2. In 76.6% of participants home BP was measured several times weekly (25%) or monthly (31%) or more. Antihypertensive medications were stopped unintentionally by 40% or taken irregularly by 44% of patients. The reasons for non-adherence to medications were forgetfulness (45%), side effects (17%) and running out of medications (15%). In 50% of cases, patients do not inform their physicians when stopping medications. The most useful approaches to support adherence reported by participants were single-pill combinations and smaller and cheaper pills. Information on hypertension and its treatment were considered sufficient for 33% of patients.

Conclusions:

In patients with internet access and willing to participate, our survey shows that despite having an uncontrolled office 3 month BP in 50% of them, participants report: 1) a modest impact of hypertension on their quality of life and a moderate level of anxiety, 2) frequent and usually non intentional non-adherence to prescribed antihypertensive medications, and 3) the necessity to improve the information provided to them.
AMBULATORY BLOOD PRESSURE MEASUREMENT AS A PREDICTOR OF HYPERTENSION MEDIATED TARGET ORGAN DAMAGE IN VERY ELDERLY POPULATION: THE MAPACHESS STUDY
Authors: Sanchez Marcos Sanchez , Qin Jiwei Chen , Viñas-Esmel Esther , Mas Miriam Costafreda , Torres Manuel , Ferre Rosa Martinez , Benitez Cristina , Benito Cristina Sierra , Payeras Antonio Coca , Babkowski Miguel Camafort
Published: June 2022

Objective:

International guidelines recommend Ambulatory Blood Pressure Monitoring (ABPM) in the diagnosis and follow-up of hypertensive patients based on the superior reliability prognostic value compared to office BP. Our objective was to analyze the relationship between ABPM control and target organ damage (TOD) in the elderly population.

Design and method:

Observational, retrospective, longitudinal study of a cohort of treated hypertensive patients older than 75 years. A baseline ABPM was obtained in all patients and was repeated after 6 months follow-up. Clinical data on associated CVRF, TOD, cardiovascular events, and emergency room visits were collected at baseline and 6 months of follow-up.

Results:

A total of 39 consecutive patients were included, 38.5% women, mean age 80 years (75–89), 30% diabetic, 50% obese and 58% dyslipidemic. Previous stroke was observed in 5.6% patients and 9% had a previous acute myocardial infarction (AMI). The mean in-treatment office BP was 142 (± 22) / 71 (± 14) mm Hg and 30.8% were controlled (BP < 140/90 mmHg). The mean in-treatment 24-hour BP was 141 (± 15) / 70 (± 11) mm Hg. New CV events were observed in 19.7 during follow-up. When we compared the characteristics between the group with good ABPM (defined as mean 24 h BP < 130/80 mm Hg) and the group with poor control, only left ventricular mass index (LVMI) was significantly higher in the latter (170 g/m2 (poor control) vs. 128 g/m2 (good control); Anova p 0.044).

Conclusions:

In treated elderly hypertensive patients, poor BP control by 24h-ABPM is significantly correlated with a greater degree of LVH. Considering the retrospective design of this pilot study in a very limited number of patients, these findings need to be confirmed in larger studies.
PILATES METHOD IMPROVES PHYSICAL CAPACITY AND ANTI-OXIDATIVE SYSTEM IN ELDERLY WOMEN
Authors: Lacchini Silvia , De Oliveira Patrick Rodrigues , Alves Tatiana Pereira , Da Silva Dias Danielle , Busse Alexandre Leopold , De Angelis Katia , Filho Wilson Jacob
Published: June 2022

Objective:

The decline in physical capacity in humans occurs as a consequence of ageing. It is well established that oxidative mechanisms play a role in ageing process, leading to oxidative accumulation in tissue damage. Regular physical exercise can minimize the physiological changes that occur during aging and also contribute to improving the individual’s health and well-being. The aim of the present study is to verify the effects of resistance physical training on oxidative damage and physical capacity in elderly women who practice Pilates (P) or Strength Training (ST).

Design and method:

Elderly volunteer were evaluated and divided into P (68 ± 4 years age) or ST (66 ± 3 years age) groups (n = 20 per group), according to individual choice for the modality. The training protocol (moderate intensity) lasted 12 weeks, with 2 sessions of 60 minutes per week. All volunteers underwent dual-energy x-ray absorptiometry (DXA) and handgrip strength (HGS) for physical and functional assessment. Blood sample was collected for the analysis of oxidative stress markers (TBARS, Carbonilated proteins, NOX and SOD activities and Frap).

Results:

The results show that resistance exercises in P and ST modalities are effective in inducing changes in physical composition (body weight, fat percentage and bone density did not change). On the other hand, ST was effective in reducing fat mass in upper and lower limbs and increasing HGS (+40%), while P increased lean mass in limbs and trunk. Pilates method was more efficient in increasing muscle mass throughout the body, while strength training was more efficient in allowing fat loss. Finally, Pilates method was effective in increasing SOD activity (+20%), reducing protein oxidation (17%). On the other hand, strength training implemented an increase in the antioxidant system at the end of the ROS production cascade, which seems not to have been effective in reducing lipid oxidation (Frap increased 37%, while TBARS and NOX maintained 50% and 30% higher compared to Pilates, respectively).

Conclusions:

The results allow us to conclude that Pilates method, for a period of 12 weeks, is effective in bringing anti-oxidative capacity and in the quality of life of sedentary elderly women.
SERUM AND IONIZED MAGNESIUM IN ELDERLY HYPERTENSIVES
Authors: Kisters Klaus Kisters , Sophia Kisters , Uwe Gröber
Published: June 2022

Objective:

Magnesium is involved in about 600 enzymatic and metabolic reactions. In patients at risk, e.g. elderly, a magnesium deficiency has to be taken into account. This can result in a variety of diseases, e.g. cardiovascular disorder and hypertension.

Diagnosis can be made by laboratory, anamnesis (drugs) or clinical symptoms. Especially elderly (up to 30 %) or hypertensives are risk patients for a magnesium deficiency. In these patients a magnesium supplementation is then often of benefit.

Design and method:

In our study 45 elderly hypertensives with normal renal function were investigated (serum creatinine was 1.1+/-0.1 mg/dL). All patients were older than 60 years. None of our patients took magnesium supplements. All patients had an essential hypertension grade 1 and 2 according to ESH guidelines classification. Anti-hypertensive treatment was performed using usual drugs (e.g. betablockers, calcium antagonists or Renin-Angiotensin-Aldosterone System (RAAS) blockers), no diuretics for at least 4 weeks before start of the study.

Serum magnesium concentrations were measured by a Cobas Apparatus, Roche, Germany. The analysis of the measurements of ionized magnesium concentrations was carried out with a Prime Plus system from NOVA Medical Devices Corp., Rödermark, Germany. This is a point-of-care unit device with a high precision standard. The tests use either capillary blood or about 1 mL of whole blood and the complete measurement process takes about only 1 minute.

Results:

In serum magnesium content only 1 patient was below normal range of 1.7 md/dl. Mean+/- s.d. was 1.96+/- 0.16 mg/dl. In contrast in 12 of 45 patients ionized magnesium was significantly below the normal range (27%, 0.54+/-0.06 mmol/l). There was no correlation between serum or ionized magnesium concentrations (n.s., Pearson’ s or Spesrmann rank test, p value 0.91 and 0.41). Bood pressure was controlled.

Conclusions:

In conclusion normal serum magnesium values do not exclude a magnesium deficiency in elderly hypertensive patients. The determination of ionized magnesium might be a better tool in this context. A magnesium deficiency is often observed in elderly and has to be substituted in a sufficient amount to avoid cardiovascular and other diseases.
THE CHANGE IN QUALITY OF LIFE IN DRUG TREATED HYPERTENSIVE PATIENTS AFTER 10 YEARS OF ANTIHYPERTENSIVE TREATMENT
Authors: Kantola Ilkka M. , Kantola Taru
Published: June 2022

Objective:

To study the change in quality of life in Finnish drug-treated hypertensive patients after ten years of antihypertensive treatment.

Design and method:

In the beginning the patients participated in a six-month study where their antihypertensive treatment was titrated either by using home or 24 hour ambulatory measurement. Thereafter they have been in the ordinary out-patient care.

SF-36 questionnaire was filled out by 44 patients (23 females and 21 males, aged 66.1 (6.1), 55–77 years) in the beginning and after 10.6 (2.9) (6–13) years of antihypertensive treatment. All of them used at least one antihypertensive agent.

Results:

The mean (SD) SF-36 questionnaire scores after about 10 years of antihypertensive treatment were (maximum 100): Physical functioning 78.5 (19.9), role-physical 72.6 (34.0), bodily pain 68.1 (22.2), general health 64.5 (16.2), vitality 68.6 (15.8), social functioning 90.1 (19.0), role-emotional 76.0 (35.9), mental health 84.5 (14.4) and general health 3.2 (0.7). Compared to the same age Americans social functioning and mental health were higher (better) in our treated hypertensive patients.

During 10 years of antihypertensive treatment physical functioning decreased significantly 4.8 (14.4) (p = 0.039). Instead, vitality 6.3 (18.6) (p = 0.032), social functioning 6.1 (17.5) (p = 0.028) and mental health 4.5 (11.7) (p = 0.030) increased significantly. Other parameters did not change significantly.

Conclusions:

According to our results physical functioning decreased and vitality, social functioning and mental health increased during 10 years of antihypertensive treatment. The decrease in physical functioning is probably explained by aging, because physical function decreases in normal population about 0.5/life year. Perhaps, good antihypertensive treatment explains the increase in those three mental parameters. Thus, it seems that according to the SF 36 questionnaire quality of life in Finnish treated hypertensive patients is quite good and do not decrease significantly during ageing.
3D-PRINTING FOR ABLATION PLANNING IN PATIENTS UNDERGOING ATRIAL FIBRILLATION ABLATION (3D-GALA TRIAL)
Authors: Xydis Panagiotis , Printzios Dimitrios Terentes , Gourgouli Ioanna , Tampakis Konstantinos , Andrikopoulos George , Vlachopoulos Charalampos
Published: June 2022

Objective:

Atrial fibrillation (AF) remains one of the major causes of cardiovascular morbidity. Ablation techniques are becoming more appealing after latest results of andomised trials showing the overall clinical benefit. On the other hand imaging techniques and the frontier application of 3D printing are emerging as valuable ally for cardiac procedures. However, no andomised trial has directly assessed the impact of preprocedural imaging and especially 3D printing guidance for AF ablation.

The present study is designed to investigate for the first time the effect of 3D-printing of the heart on the safety and effectiveness of the ablation procedure.

Design and method:

The 3D-GALA trial is a andomised, open- label, controlled, multicentre clinical trial of 2 parallel groups designed to enrol a total of 100 patients undergoing ablation using cryo-balloon for paroxysmal and persistent AF. Patients will be andomised with a patient allocation ratio of 1: 1 to preprocedural MRI scan of the heart and 3D printing of left atrium and pulmonary veins and cryoablation versus standard cryoablation without imaging. Patients will be followed up to 6 months after the index procedure

Results:

The primary outcome measure is the reduction of radiation dose and contrast amount during pulmonary veins isolation. Secondary endpoints will include the percentage of atrial fibrillation relapse at 24h-Holter electrocardiogram monitoring at 6 months after initial treatment.

Conclusions:

To our knowledge, the 3D-GALA trial will be the first study to provide evidence about the clinical impact of preprocedural imaging and 3D printing before cryoablation.