bluuebunny/crossref_metadata_2025 huggingface dataset:
PREECLAMPSIA COMPLICATED WITH PULMONARY EDEMA IN NEWLY DIAGNOSED PERIPARTUM DILATED CARDIOMYOPATHY: CASE REPORT
Authors: Mitevska Irena , Stanojevic Verdi , Stojcevski Saso , Bosevski Marijan , Jovanova Silvana , Kostovska Elizabeta Srbinovska
Published: June 2022

Objective:

Pulmonary edema is one of the most serious complications of preeclampsia that should be ruled out in case of dyspnea in a pregnant woman. The prognosis is generally good, however it can indicate underlying unrecognized dilated cardiomyopathy.

Design and method:

We present a case of 30-year-old woman in 34 weeks of pregnancy was hospitalized at the Gynecology Clinic for preeclampsia.

Results:

This was the third pregnancy without any previous known cardiovascular disease or known hypertension. Cardiology examination was requested which showed conscious, severely dispnoic and tachycardic patient, with lower leg edema and bilateral pulmonary rales indicating acute pulmonary edema. Blood pressure was 170/100 mmHg, heart rate 130 bpm and saturation 89% with oxygen nasal mask. She reported the presence of headache. Patient was treated for three days with Metil dopa, Nifedipine and corticosteroid therapy of baby lung maturation. She received magnesium sulfate, Verapamil and intravenous Furosemide of 120 mg and the time of pulmonary edema. The patient was not in labor. The ultrasound revealed a monofetal pregnancy and amniotic fluid in normal quantity. Laboratory tests showed mild anemia with normal renal and liver function results. D-dimers were 1320 ng/ml. After stabilization of the patient, a C-section was performed, with the extraction of healthy newborn with an APGAR at 10/10th. There were no post-operative complications. There was marked disappearance of dyspnea within 72 hours, and stabilization of blood pressure. Patient was transferred to the cardiology clinic. Echocardiography showed signs of dilated cardiomyopathy with EF 30% and absent valvopathy. She was put on heart failure treatment with ACE inhibitor, beta blocker, MRA antagonist, furosemide, bromocriptine and LMWH. We received significant clinical improvement during the hospitalization. She was discharged after 6 days in NYHA class II.

Conclusions:

Acute pulmonary edema is a rare complication, but leading cause of death in women with pre-eclampsia. Diagnosis of peripartum cardiomyopathy requires heightened awareness among multidisciplinary patient care teams and a high degree of suspicion. Many patients with peripartum cardiomyopathy recover within 3 to 6 months of disease onset, but recovery might occur as late as 48 months postpartum
ARTERIAL STIFFNESS IN PATIENTS WITH HYPERTENSIVE CRISIS
Authors: Jug Juraj , Lang Valerija Bralic , Prkacin Ingrid
Published: June 2022

Objective:

The aim of this study was to determine if patients with the hypertensive crisis have higher pulse wave velocity compared to the patients with arterial hypertension without it.

Design and method:

In this case-control study which lasted from January 2020 to December 2021, 61 patients (36 males, 25 females) with the hypertensive crisis were analyzed at the Emergency department in Clinical Hospital Merkur, Zagreb. The hypertensive crisis was defined as a rapid increase in systolic blood pressure above 180 and/or diastolic above 120mmHg (SBP range 181–208mmHg). On the other hand, in the control group, we analyzed 45 patients (24 males, 21 females) with confirmed arterial hypertension by a 24h-ambulatory blood pressure monitor (BTL Cardiopoint, SBP > 130/80mmHg or taking antihypertensives) without evidence of hypertensive crisis (SBP range 115–156mmHg) in two family medicine practices. Elementary lab results and pulse wave velocity (by Agedio B900) were checked in all patients. Patients were divided into two additional groups by age (51–60, 42 patients and 61–70 years, 64 patients). Mann-Whitney U test was used for the analysis of non-parametric variables in Statistica v.10.0.

Results:

Patients with hypertensive crisis had a significantly higher heart rate (median 78 vs. 69 bpm, U = 714; p < 0.001), fasting glucose (median 5.5 vs. 6.0 mmol/L, U = 804.5; p < 0.01), body mass index (median 31.0 vs. 27.9 kg/m2, U = 889; p < 0.001), nocturnal SBP drop (median 15.5 vs. 9.8%, U = 386; p < 0.05), and augmentation index (median 42 vs. 19%, U = 686; p < 0.001). In both younger and older group, patients with hypertensive crisis had statistically significantly higher pulse wave velocity (median younger: 9.3 vs. 8.1m/s, U = 65.5; p < 0.001; older: 10.7 vs. 9.0m/s, U = 19; p < 0.001) shown in the Figure 1. In younger group patients with hypertensive crisis have 8.5 times higher chances of having pulse wave velocity above reference value (>8.0m/s; CI = 1.57–46.87, p < 0.001) while in older group that chance was 108 times higher than in controls (reference value >9.5m/s; CI = 13.83–843.33, p < 0.001).

Conclusions:

Patients with hypertensive crisis had statistically higher pulse wave velocity values, heart rate, fasting glucose, body mass index, and nocturnal SBP drop compared to patients with arterial hypertension without crisis.
ANTISENSE OLIGONUCLEOTIDES TARGETING HEPATIC ANGIOTENSINOGEN DOSE-DEPENDENTLY REDUCE ATHEROSCLEROSIS AND LIVER STEATOSIS IN HYPERCHOLESTEROLEMIC MICE
Authors: Ye Dien , Wu Congqing , Cai Lei , Howatt Deborah A. , Liang Ching Ling , Temel Ryan E. , Mullick Adam E. , Danser A.H. Jan , Daugherty Alan , Lu Hong S.
Published: June 2022

Objective:

Liver-derived angiotensinogen (AGT) is the substrate from which renin and ACE generate angiotensin (Ang) II. Ang II not only increases blood pressure, but also is a major determinant of atherosclerosis in hypercholesteremic mice. Here we investigated the effect of hepatocyte-specific (N-acetylgalactosamine-conjugated) antisense oligonucleotides targeting AGT (GalNAc AGT ASOs) on blood pressure and atherosclerosis in hypercholesterolemic mice.

Design and method:

Eight-week-old male LDL receptor deficient mice were fed a Western diet for 12 weeks, after receiving vehicle, GalNAc control ASO, or 1, 2.5 or 5 mg/kg of GalNAc AGT ASO on day 1, 3, 5 and 7 in the week prior the start of the diet (n = 6–10/group). Treatment was continued thereafter on a weekly basis. Systolic blood pressure (SBP) was monitored by tail cuff. After 12 weeks, mice were euthanized and plasma was collected. Plasma AGT concentration was measured by ELISA kit, and aortic atherosclerotic lesion area was measured by an en face method.

Results:

The 3 GalNAc AGT ASO doses decreased plasma AGT from 10.3 ± 0.8 to 1.4 ± 0.1, 0.9 ± 0.1 and 0.7 ± 0.1 g/mL, respectively. These decreases were paralleled by dose-dependent SBP reductions from 114 ± 3 to 96 ± 2, 92 ± 2, and 84 ± 2 mmHg, respectively, and atherosclerotic lesion area reductions from 27.4 ± 0.9 to 15.1 ± 1.4, 10.8 ± 1.2, and 7.7 ± 1.0%, respectively. Yet, the attenuation of liver steatosis (liver triglyceride/weight from 139.7 ± 35.7 to 26.8 ± 4.5, 19.9 ± 1.2 and 36.0 ± 3.6 g/mg, liver total cholesterol/weight from 19.8 ± 1.6 to 8.6 ± 0.9, 6.1 ± 0.6 and 8.2 ± 0.7 g/mg) was identical for each GalNAc AGT ASO dose. GalNAc control ASO did not have effects on plasma AGT, SBP, atherosclerosis lesion area, or liver steatosis vs. vehicle.

Conclusions:

In hypercholesterolemic mice, inhibition of hepatic AGT reduces systolic blood pressure and atherosclerosis dose-dependently, while liver steatosis was prevented in dose-independent manner.
THE RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM IN THE PREGNANT RAT
Authors: Speth Robert , West Crystal
Published: June 2022

Objective:

Preeclampsia is the leading cause of maternal and fetal morbidity and mortality in the United States, affecting ~2–5% of all pregnancies. Women with a history of preeclampsia have a 4-fold increased risk for developing hypertension, 2-fold increased risk for developing stroke, and 2-fold increased risk for developing ischemic heart disease later in life. Although it is known that intact renin-angiotensin-aldosterone system (RAAS) signaling is critical to a healthy pregnancy and that the RAAS is altered in preeclampsia the pathogenic mechanisms are largely unknown and a comprehensive examination of RAAS metabolism and receptor expression is lacking in the literature. The purpose of this study is to understand how the vasculature becomes refractory to the reported high circulating angiotensin II (ANGII) during pregnancy. This work provides basic information needed to understand blood pressure regulation and volume expansion in normal pregnancy, and why it fails to occur in women with preeclampsia, resulting in hypertension and fetal growth restriction.

Design and method:

We performed AT1 receptor autoradiography in kidneys of virgin (V) and late pregnant (LP) rats. We also performed equilibrium RAAS Fingerprinting in the plasma and kidneys of LP rats and V rats using a new LC/MS technique.

Results:

Using this new method, ANGII levels were decreased in the plasma and unchanged in the kidney of LP animals. This was surprising as it is inconsistent with historical data, however, other methods of measuring ANGII are problematic and often unreliable. There was a very high Aldosterone/ANGII-ratio (AA2) in both plasma and kidney of LP animals. The AA2-ratio provides information about the adrenal aldosterone-releasing response to ANGII. We also found that AT1R expression is decreased in the kidneys of LP compared to V rats.

Conclusions:

These results suggest a systemic down regulation of renal ANGII signaling with increased adrenal signaling. Continuing studies are assessing the RAAS signaling cascade to further validate these data, which may revolutionize the way we think about the RAAS in pregnancy, leading to improved treatment of women with preeclampsia.
THE EXPLORATION OF THE RENINE ANGIOTENSIN SYSTEM IN NEPHROLOGY: EXPERIENCE OF THE NEPHROLOGY DEPARTMENT OF THE HEDI CHAKER UNIVERSITY HOSPITAL CENTER OF SFAX
Authors: El Atigh Aminetou , Dammak Najla , Agrebi Ikram , Chaabouni Khanssa , Toumi Salma , Chaker Hanen , Yaich Soumeya , Kammoun Khawla , Ayedi Fatma , Hmida Mohamed Ben
Published: June 2022

Objective:

Plasma renin and aldosterone assays are useful in clinical practice for the aetiological assessment of arterial hypertension (hypertension) and / or a disturbance of the electrolyte balance. The objective of our work is to describe the main indications exploration of the renin aldosterone system, its results, its diagnostic and etiological impact.

Design and method:

We conducted a retrospective study of 40 patients who received a renin / aldosterone dosage, collected in the Nephrology department at the Hédi Chaker CHU in Sfax for a period of 6 years from January 2014 until December 2020.

Results:

These are 21 women and 19 men with a sex ratio of 1.1. Hypertension was present in 82.5% of cases. The dosage indication was: hypertension with hypokalaemia in 52.5%, hypertension in young subjects in 20%, resistant hypertension and hypertension with incidentaloma in each 7, 5% of cases, and incidentaloma without HTA in each 5% of cases and in one case hypokalaemia without HTA. Aldosterone was elevated in 52.5% of cases. Renin was normal in 67.5% of cases, low in 25% and high in 7.5% of cases. The aldosterone / renin ratio was normal in 60% of cases, elevated, decreased and invalid in respectively 27.5%, 2.5% and 10%. The etiological investigation revealed: primary hyperaldosteronism in 42.5% of cases secondary to a Conn adenoma in 20% of cases, to adrenal hyperplasia in 17.5% of cases and with normal imaging in 5% of cases. Secondary hyperaldosteronism was confirmed in association with Liddle syndrome and renal artery stenosis in 2.5% of cases each. The other etiologies were pheochromocytoma in 12.5% of cases, Takayusu’s disease, tubulopathy in 2.5% of cases each. The dosage was non-contributory in 7.5% of cases and normal in 25% of cases.

Conclusions:

The exploration of the renin angiotensin aldosterone system has several indications, mainly in hypertension with hypokalaemia. It can help make the etiological diagnosis and guide therapeutic management.
ANGIOTENSIN PROFILES IN PATIENTS WITH HYPERTENSION AND TYPE 2 DIABETES WITH COMBINATION THERAPY OF EMPAGLIFLOZIN AND LINAGLIPTIN VERSUS METFORMIN AND INSULIN GLARGINE
Authors: Bosch Agnes , Poglitsch Marko , Kannenkeril Dennis , Ott Christian , Pietschner Robert , Striepe Kristina , Schiffer Mario , Schmieder Roland E.
Published: June 2022

Objective:

The renin-angiotensin system (RAS) plays a key role in the physiological regulation of blood pressure. Patients with type-2-diabetes-mellitus (T2DM) and hypertension are known to have increased RAS activity. However, the precise role of RAS activation after SGLT2-inhibitor therapy is unknown. The classic RAS comprises the ACE-AngII-AT1R-axis (classic-axis) that promotes vasoconstriction. The Angiotensin-converting-enzyme-2-angiotensin-(1–7)-Mas axis (Mas-axis) with its components Angiotensin-(1–7) (Ang-1–7) and Angiotensin-(1–5) (Ang-1–5) is an endogenous negative regulatory pathway of the classic-axis, which can reduce its harmful effects.

Design and method:

Angiotensin profiles were determined in 55 patients with hypertension and T2DM from our double blind, randomized, placebo controlled clinical trial “Effects of Empagliflozin+Linagliptin (E+L) vs Metformin+Insulin Glargine (M+I) on Renal and Vascular Changes in Type 2 Diabetes’’ (ELMI) at baseline and three months after application of either E+L or M+I. An LC-MS/MS based approach was used to simultaneously quantify individual angiotensin metabolites (Attoquant Diagnostics, Vienna, Austria).

Results:

In the E+L group medication induced a rise in Ang-I, Ang-(1–7) and a trend to a rise in Ang-II between baseline and treatment, which was not present in the M+I group (table).

Comparison between the E+L and M+I group revealed that change between baseline and treatment was significantly different for Ang I (p = 0.002) and Ang-(1–7) (p = 0.002) between the groups. No difference in change between baseline and treatment was found for Ang II (p = 0.182) and Ang-(1–5) (p = 0.224) between the E+L and M+I group.

Conclusions:

In patients with hypertension and T2DM three months of therapy with E+L led to a rise of classic and protective components of the RAS, which was not present in the M+I group. The biological consequence of this complex RAS activation remains to be elucidated.
THE RENIN-ANGIOTENSIN SYSTEM INHIBITORS IN HAEMODIALYSIS: CARDIOPROTECTIVE? TO WHAT EXTENT?
Authors: Dammak Najla , Ben Brahim Rimeh , Agrebi Ikram , Chaker Hanen , Ghabi Faten , Toumi Salma , Yaich Soumaya , Jarraya Fayçal , Chaabouni Khanssa , Kammoun Khawla , Ayedi Fatma , Ben Hmida Mohammed
Published: June 2022

Objective:

The renin-angiotensin-aldosterone (RAAS) system is one of the most important systems in the pathogenesis of coronary heart disease. Its blockage constitutes a central pillar of cardiovascular therapeutics. Patients in end-stage renal disease or on dialysis are almost invariably excluded from trials evaluating antihypertensive treatments. Angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) are more cardioprotective than other antihypertensive agents in patients with chronic renal disease but whether this applies also to patients on dialysis is unknown.

This study followed a cohort of haemodialysis patients over a median of three years, we analysed all-cause mortality and cardio-vascular admissions for patients under RAAS inhibitors.

Design and method:

Twenty-seven HD patients were cross-sectionally analysed in the following groups: G1: patients with hypertension under ACE or ARB treatment (n = 10), G2: patients with hypertension under another class (n = 7), G3: non-hypertensive patients (n = 10). Associations with all-cause and cardiovascular mortality were assessed over a median of 3 years of follow-up.

Results:

Overall we had three homogeneous groups, there was no significant difference between median ages (46,3 vs52,7 vs49,9), initial nephropathy or dialysis vintage (5,9 years vs 5,1 vs 11,4). In G1: 4 patients experienced cardiovascular events (40%), but none of them died of cardiovascular causes/complications. In G2: 4 patients had cardiovascular events (57%) amongst whom two died of its complications. In G3: two patients had cardiovascular events (20%) amongst whom one died. There was statistically no significant difference between our groups in terms of cardiovascular morbidity or mortality and in all-causes mortality. Nevertheless, patients under SRA inhibitors presented the lowest number of cardiovascular mortalities.

Conclusions:

In the study, we observed that patients with SRA inhibitors experienced less cardio-vascular related death, although it is not enough to conclude its cardioprotective status. Larger studies need to be carried to unveil its utility among haemodialysis patients.
COMPOUND 21 STIMULATES THE ACTIVATION OF AKT AND ERK1/2 IN MOUSE ADIPOSE TISSUE IN VIVO
Authors: Dominici Fernando , Quiroga Diego
Published: June 2022

Objective:

To analyze signaling events triggered by in vivo stimulation of the AT2 receptor.

Design and method:

Male B57Bl/6 mice were used as model at the age of 3 month. Mice were subjected to a bolus in vivo intravenous injection (cava vein) of saline buffer containing either the AT2 agonist compound 21 (0.25 mg/Kg), a mixture of C21 (0.25 mg/Kg) and the AT2 antagonist PD123319 (2.5 mg/Kg) or saline for baseline assesment under anesthesia. A group of animals that received insulin (0.25 mg/Kg) were used as positive control. The heart and the inguinal adipose tissue were removed after 1 and 3 min respectively, flash-frozen and kept at -70 C until analysis. Proteins from heart and adipose tissue were solubilized in a buffer containing 1% Triton together withprotease and phosphatase inhibitors. Protein content was measured by the BCA method and homogenates were subjected to Western Blotting using specific anti-phospho Akt or anti-phospho ERK1/2 antibodies. The content of Akt and ERK content was detected through incubation with either anti-Akt or anti-ERK1/2 antibodies. Specific bands were detected by chemiluminescence. Protein loading control was checked by coomassie blue staining of every PVDF membrane employed.

Results:

Injection of C21 resulted in the activation of both Akt and ERK1/2 in mouse adipose tissue. The extent of activation of Akt and ERK1/2 attained was equivalent to approximately 30–40% of the levels of activation of these enzymes obtained after an injection of a dose of insulin known to generate maximum activation of these signaling components.

Co-infusion of C21 and PD123319 abolished the in vivo activation of Akt and ERK1/2, indicating that these events were mediated by the AT2 receptor.

Conclusions:

In vivo administration of the AT2 receptor agonist C21 resulted in the stimulation of the phosphorylation of both Akt and ERK1/2 at stimulatory sites indicative of activation of these enzymes. Co-infusion of C21 with the specific AT2 receptor antangonist blunted this effect.

It is concluded that the AT2 receptor is capable of recruiting both Akt as ERK1/2 as signaling molecules in mouse adipose tissue in vivo.
DISTURBANCES OF THE CIRCADIAN RHYTHM AND BLOOD PRESSURE LEVELS IN OBESE PATIENTS WITH TRUE AND PSEUDO-RESISTANT HYPERTENSION
Authors: Shalimova Anna , Isayeva Ganna , Buriakovska Olena , Vovchenko Maryna , Komir Iryna , Prosolenko Kostyantyn
Published: June 2022

Objective:

The aim was to conduct a comparative assessment of the circadian rhythm abnormalities and blood pressure (BP) levels between pseudo-resistant and true resistant hypertension (RH) in obesity.

Design and method:

The study included 302 patients with uncontrolled hypertension and obesity. Initial treatment efficacy was assessed 3 months after dual therapy was administered. Those patients who did not reach target BP in dual therapy were transferred to triple therapy. Among patients who received triple therapy, 69 people did not reach target BP. All patients were additionally examined 6 months after the initiation of antihypertensive therapy.

Results:

In the absence of a difference in BP, patients who subsequently become resistant, already at the stage of inclusion, significantly more often had a violation of the circadian rhythm with a predominance of the non-dipper rhythm. Despite the achievement of target BP after 6 months of therapy, in the majority (91.42%) of patients without resistance, the circadian rhythm normalized, while resistant patients had a normal circadian rhythm only in 60.87%.

At the stage of enrolling patients into the study and 3 months of therapy there was no significant difference in BP between true and pseudo-resistance, then after 6 months of therapy, patients with true resistance had significantly higher office SBP (p < 0.01) and 24 h average SBP according to ABPM data (p < 0.05) compared with pseudo-resistant patients. Already at the stage of inclusion in the study, the normal circadian rhythm in true resistance was significantly less common than in pseudo-resistance; during the prescribed therapy, a similar trend persisted: after 6 months of therapy, 71.05% of pseudo-resistant patients had a normal circadian rhythm, while with true resistance only about half of the patients had a normal circadian rhythm.

Conclusions:

Even when target BP levels in antihypertensive therapy are achieved, obese patients with RH are characterized by more pronounced disturbances of the circadian rhythm (most often non-dipper) and higher levels of office and out-of-office BP, compared with non-resistant patients. Compared with pseudo-resistant patients, the presence of true resistance in obesity is associated with higher SBP levels and a higher incidence of circadian rhythm disturbances.
CHANGES IN CLINICAL PROFILE OF REFRACTORY HYPERTENSIVES AFTER THE INTRODUCTION OF SPIRONOLACTONE
Authors: de Carvalho Fortes Carolina , Chedier Bernardo , Roderjan Christian Nejm , Viegas Bianca , Carlos Fernanda O. Carvalho , Santos Taissa Lorena dos , Alves Hugo Farah Affonso , Nemer Camila Bello , Silva Marcus Vinicius Serejo Borges V. da , de Sá Kimura Lucca Hiroshi , Lobo Sofia Luz Coutinho Botelho , de M. Barreto Bianca Zattar , de Melo Nolasco Vitor , Silva João Gabriell Bezerra da , do N. Vallaperde João Gabriel Rega , Muxfeldt Elizabeth Silaid
Published: June 2022

Objective:

To characterize prevalence and clinical profile of patients with RfHTN among a historical cohort of patients with RHTN in 2 moments: before and after the introduction of spironolactone.

Design and method:

A cross-sectional analysis was performed during the pre-spironolactone period (before 2005) with 1,048 participants with RHTN (72.3% women, average age: 61.2 ± 11.3 years). All of them were submitted to a standard protocol including clinical and laboratory tests, 24-hour ABPM, echocardiogram, and pulse wave velocity. In a second analysis, refractory patients were evaluated after the introduction of spironolactone (post-spironolactone period – after 2005). The statistical analysis included bivariate comparisons between patients with RHTN and those with RfHTN, as well as logistic regressions to assess independent correlations of RfHTN pre- and post-spironolactone.

Results:

In the initial cross-sectional analysis (pre-spironolactone), RfHTN prevalence was 14%. Age < 60 years, smoking, obesity and left ventricular hypertrophy (LVH) were independently correlated with RfHTN. After the introduction of spironolactone, prevalence increased to 17.6%. It was observed that refractory patients using spironolactone presented less aortic stiffness, lower prevalence of LVH, cerebrovascular disease and peripheral arterial disease (PAD), what might indicate a reduced cardiovascular risk despite the lack of blood pressure control. Refractory patients have also presented higher magnitude of white-coat effect, reflecting an exacerbated sympathetic activity. Age < 60 years and lower prevalence of PAD were correlated with RfHTN in the post-spironolactone period.

Conclusions:

The use of spironolactone seems to reduce cardiovascular risk despite the lack of blood pressure control.
SYSTEMIC VASCULAR RESISTANCE AS A PREDICTOR OF ANTIHYPERTENSIVE EFFICIENCY OF RENAL DENERVATION IN PATIENTS WITH RESISTANT HYPERTENSION AND TYPE 2 DIABETES MELLITUS
Authors: Manukyan Musheg , Falkovskaya Alla , Mordovin Victor , Zyubanova Irina , Tsoy Ekaterina , Pekarskiy Stanislav , Ryabova Tamara , Khunkhinova Simzhit , Vtorushina Anastasia , Dorzhieva Irina
Published: June 2022

Objective:

To identify predictors of the antihypertensive efficacy of renal denervation (RDN) in patients with resistant hypertension (RHTN) and type 2 diabetes mellitus (T2DM) based on the results of a 12-month follow-up.

Design and method:

The study included 56 patients with RHTN and T2DM (mean age 60.1 ± 7.9 years, 32 women, mean 24-hour (24-h) blood pressure (BP) (systolic/diastolic) 156.8 ± 15.2/82.2 ± 12.1 mm Hg, mean HbA1c 7.2 ± 1.5%). The prospective interventional study with RDN (NCT02667912 and NCT01499810 at ClinicalTrials.gov) enrolled all patients. Office BP and ABPM, calculation of systemic vascular resistance (SVR) assessment were performed at baseline and 12-months after RDN. Forty-one patients completed a 12-month follow-up.

Results:

RDN led to a significant reduction in systolic and diastolic 24-h BP (-10.6/-6.4 mm Hg, p = <0.001/<0.001). Depending on the degree of decrease in 24-h systolic BP, the patients were retrospectively divided into 2 groups: “responders’’ (persons with a decrease in 24-h SBP by 10 or more mmHg) and “non-responders’’ (with a lesser degree of decrease in 24-h SBP). The proportion of respondents to the intervention was 68.3%. Initially, the group of “responders’’ not differed from the group of “non-responders’’ by age, BP and HbA1c level. At the same time, responders had higher SVR indicators (2.22 ± 0.44 and 1.73 ± 0.28 dyn × s × cm-5, p = 0.001) than non-responders. A ROC analysis showed that the best cut-off value of the SVR is 19,7 dyn × s × cm-5 with 71% sensitivity and 85% specificity (AUC: 0.82; 95% CI: 0.68–0.95; p < 0.001).

Conclusions:

Estimation of the systemic vascular resistance allows predicting the antihypertensive efficacy of renal denervation in patients with resistant hypertension and type 2 diabetes mellitus after a year of intervention.
SHOULD ALL SECONDARY CAUSES OF HYPERTENSION BE SCREENED IN PATIENTS WITH RESISTANT ARTERIAL HYPERTENSION?
Authors: Kvapil Tomas , Vaclavik Jan , Kocianova Eva , Benesova Klara , Jarkovsky Jiri , Kamasova Monika , Taborsky Milos
Published: June 2022

Objective:

Secondary hypertension often presents as treatment-resistant hypertension. Patients with resistant hypertension therefore undergo an extensive workup to identify a potential secondary cause. We aimed to analyze whether it is necessary to screen all patients presenting with resistant arterial hypertension for all secondary causes of hypertension.

Design and method:

We retrospectively analysed the hospital records of patients with resistant arterial hypertension, who underwent complete laboratory and imaging examinations to exclude the secondary etiology of arterial hypertension. Standard descriptive statistics were used for statistical evaluation.

Results:

Among the 432 patients with resistant hypertension, secondary etiology of hypertension was found in 135 (31.1%). The most frequent cause was primary aldosteronism in 85 cases (63% relatively), followed by renovascular hypertension (15.6%), renal parenchymal hypertension (14.8%) and hyperreninism (3.7%). Obstructive sleep apnoea has been found in 14.7% patients. Less common causes were hypercortisolism (1.5%), pheochromocytoma (0.7%) and adrenogenital syndrome (0.7%). All patients with the last three rare causes presented with specific clinical symptoms (i.e. patient with pheochromocytoma was admitted for paroxysmal hypertension, adrenogenital syndrome was diagnosed in female patient with secondary male sex characteristics, patients with hypercortisolism had typical cushingoid signs).

Conclusions:

Secondary etiology was much more frequent (31%) in our group of patients with resistant hypertension than in non-selected hypertensive population (5–15%). We suggest that first line testing only for primary hyperaldosteronism and renovascular hypertension would be sufficient for patients with resistant hypertension without clinical clues suggestive of another particular secondary cause of hypertension.
PREVALENCE OF APPARENT-TREATMENT RESISTANT HYPERTENSION IN PERITONEAL DIALYSIS PATIENTS ASSESSED WITH THE USE OF 24-HOUR AMBULATORY BLOOD PRESSURE MONITORING
Authors: Vareta Georgia , Georgianos Panagiotis , Vaios Vasilios , Sgouropoulou Vasiliki , Roumeliotis Stefanos , Georgoulidou Anastasia , Dounousi Evangelia , Eleftheriadis Theodoros , Papagianni Aikaterini , Balaskas Elias , Zebekakis Pantelis , Liakopoulos Vassilios
Published: June 2022

Objective:

The prevalence of apparent-treatment resistant hypertension (aTRH) among patients with predialysis chronic kidney disease is 2–3 times higher than in the general population. The aim of the present study was to investigate the prevalence of aTRH in end-stage kidney disease (ESKD) patients undergoing peritoneal dialysis (PD).

Design and method:

A total of 140 ESKD patients treated with PD in 4 centers of Northern Greece underwent 24-hour ambulatory blood pressure monitoring with the oscillometric device Mobil-O-Graph (IEM, Stolberg, Germany). aTRH was defined as 24-hour ambulatory blood pressure (BP) equal or higher than 130/80 mmHg, despite the use of at least 3 antihypertensive medications of different categories or controlled hypertension in patients treated with at least 4 antihypertensives. Loop diuretics that are commonly prescribed in PD patients for long-term preservation of residual kidney function are generally ineffective in lowering BP and were not considered as a separate antihypertensive drug category in our analysis. To explore the association of volume overload with the severity of hypertension, the body composition of study participants was analyzed via bioimpendence spectroscopy (BCM, Fresenius Medical Care, Germany).

Results:

Of the 140 PD patients enrolled in the study, 42 (30%) had aTRH, 45 (32.1%) had uncontrolled hypertension under treatment with < 3 BP-lowering medications and the remaining 53 patients (37.9%) were either normotensives or had controlled hypertension with < 3 antihypertensives. The prevalence of aTRH among drug-treated hypertensives was 32.5%. Overhydration > 2.5L with the use of bioimpendence spectroscopy was detected in 38.1% of patients with aTRH, in 15.6% of patients with uncontrolled hypertension and in 18.9% of normotensives or patients with controlled hypertension (P< 0.05).

Conclusions:

The present study showed that aTRH affects approximately 30% of ESKD patients undergoing PD. However, the prevalence of true-resistant hypertension in this high-risk population is probably lower, since 38.1% of patients with aTRH had subclinical volume overload detected with the method of bioimpendence spectroscopy.
THE INFLUENCE OF SHORT-TERM EXERCISE TRAINING ON ARTERIAL BLOOD PRESSURE AND QT DISPERSION IN PATIENCE AFTER SURGICAL AORTIC VALVE REPLACEMENT
Authors: Stoickov Viktor , Ilic Marina Deljanin , Stoickov Milena , Tasic Ivan , Stoickov Ivan , Kostic Svetlana , Marinkovic Dragan , Simonovic Dejan
Published: June 2022

Objective:

The aim of this study was to establish the influence of short-term exercise training on arterial blood pressure and QT dispersion in patients after surgical aortic valve replacement (SAVR).

Design and method:

The study involved 103 patients after SAVR, in the sinus rhythm without AV blocks or branch blocks. Average age of patients was 60.8 years. Patients were randomly divided into the physical training group (training group: 85 patients) and control group (non-training group: 18 patients). Patients were similar as to age and baseline stress test duration. In all subjects clinical examination, standard ECG and exercise test on treadmill according to Bruce protocol were performed and after that training group patients were included in physical training program for three weeks. Training group patients were instructed to follow a training program using the bicycle ergometer (10 min, 2 times a day), gymnastic exercises and walking. The patients continued to take the same medicaments in same doses. From standard ECG corrected QT dispersion (QTdc) was calculated.

Results:

After three weeks, we have found significant reduction of QTdc from 79.1 ± 19.7 to 70.8 ± 20.4 ms; p < 0.02 in the training group. Also, in the training group, we have found significant reduction of heart rate from 78.6 ± 7.1 to 65.9 ± 6.1 beats/min (p < 0.001), of systolic blood pressure from 137.4 ± 13.1 to 127.7 ± 11.5 mmHg (p < 0.025), of diastolic blood pressure from 87.8 ± 8.9 to 84.2 ± 7.5 mmHg (p < 0.01) and of double product from 11996.7 ± 1162.4 to 10518.8 ± 794.3 beat/min x mmHg; p < 0.001. In contrast, the non-training group showed no significant changes.

Conclusions:

The study showed that short-term exercise training have favourable effects on arterial blood pressure and QT dispersion in patients after SAVR. Physical training led to the significant decrease of myocardial oxygen uptake at rest and probably decreased the possibility of arrhythmia events in patients after SAVR.
EVALUATION OF BLOOD PRESSURE CONTROL AND THE EFFECTIVENESS OF DIFFERENT ANTIHYPERTENSIVES BY MEANS OF THE STRESS TEST
Authors: Nuñez Urquiza Juan Pablo , Martí Araceli , Cervantes nez , Reza Ana Paula Sotelo
Published: June 2022

Objective:

To evaluate different antihypertensive drug regimens for the control of BP according to selected variables of the exercise stress test during cardiac rehabilitation

Design and method:

Observational, longitudinal, retrospective study in 419 debutant or uncontrolled hypertensive patients, between 18–87 years, treated at ‘El Instituto del Corazón de Querétaro’, from January 2015-December 2021, to which a stress test was performed. The statistical analysis was performed using the statistical software SPSS, Version 28.0.1.0, the comparison of the means between groups was made using the one-way analysis of variance (ANOVA) test. Three variables were considered to evaluate the response to exercise in blood pressure; the blood pressor response to exercise (hypertensive > 10, 7 -10 as normal, 0–7 as flat and < 0 as hypotensive), BP index (>1.22 were taken as normal) and recovery of systolic blood pressure (normal < 0.95)

Results:

When analyzing 75.5% were men and 24.5% were women, under hypertensive treatment includes Beta blockers (BB), calcium channel blocker (CCBs), angiotensin-converting enzyme (ACE) inhibitors, Angiotensin receptor blockers (ARBs), Loop diuretics and mineralocorticoid receptor antagonist (MCRA).

There was no significant difference in the pressor response under any antihypertensive treatment in monotherapy, however a better response was found in the BP index to exercise. In patients with two or more antihypertensive drugs, it was found a better response to the combined treatment with ARBs + MCRA, in the three variables evaluated

Conclusions:

The exercise stress test may represent a unique tool to assess the effective protection potential of drugs against an important increase in SBP in patients with hypertension during physical activity. The study design elements proposed have the potential to establish exercise testing as a valid tool to assess the efficacy of antihypertensive treatments during stress conditions. Cardiac rehabilitation can significantly improve the parameters assessed in the stress test. It will be useful to compare these data with a short- and long-term stress test and thus evaluate the effectiveness of antihypertensive therapy.
CARDIOPULMONARY TEST PARAMETERS USEFUL FOR ADDRESSING PATIENTS WITH PECTUS EXCAVATUM TO PROMOTION OF PHYSICAL ACTIVITY
Authors: Pellegrino Alessio , Casatori Lorenzo , Messineo Antonio , Ghionzoli Marco , Facchini Flavio , Modesti Alessandra , Modesti Pietro Amedeo
Published: June 2022

Objective:

Exercise training increases muscle VO2 by increasing O2 transport and O2 uptake positively affecting cardiac output. In subjects with pectus excavatum cardiac output increase during exercise might be limited by the conformation of the chest. In this condition, the psychological impact of the deformity can further reduce the propensity to physical activity, leading to a sedentary lifestyle. Surgery is the preferred choice in severe cases. However, many patients with milder deformities can benefit from exercise-based treatment. The choice of the therapeutic strategy is fundamental, but the functional parameters on which to base this choice are not yet well defined. Therefore, we investigated the relationships between habitual physical activity and functional physiological parameters obtained from the cardiopulmonary exercise test (exercise performance and stroke volume at peak exercise) in pectus excavatum.

Design and method:

A cohort of adolescents (15 with pectus excavatum and 15 age- and sex-matched healthy controls) underwent Cardiopulmonary Exercise Test to estimate exercise performance (VO2 max) and stroke volume at peak exercise (VO2/HR, O2 pulse). Habitual weekly physical activity, estimated with International Physical Activity Questionnaire – Short Form (IPAQ-SF), was expressed as METs h-1·week-1. Determinants of exercise performance and stroke volume at peak exercise were investigated in the whole group with multivariable linear regression analysis adjusted for sex, body mass index, forced expiratory volume in the first second, and presence of pectus excavatum.

Results:

When compared to healthy controls, subjects with pectus excavatum had lower VO2 max (37.2 ± 6.6 vs 45.4 ± 6.4 mL·kg-1·min-1, p < 0.05), and O2 pulse (12.1 ± 2.4 vs 16.2 ± 3.6 mL·min-1·bpm-1, p < 0.05). Importantly, physical activity level was a predictor of VO2 max (B = 0.085; 95% Cl 0.010 to 0.160) while it did not affect O2 pulse (B = 0.035; 95% Cl -0.004 to 0.074).

Conclusions:

Training programs should be encouraged to increase cardiopulmonary performance in subjects with pectus excavatum. A marked reduction in O2 pulse at peak exercise might be considered as a criteria to address a subject towards surgery.
COMPARING POST-EXERCISE HYPOTENSION AFTER A HIGH-INTENSITY INTERVAL TRAINING IN MATCHED YOUNGER AND OLDER ADULTS
Authors: Ketelhut Sascha , Möhle Martin , Gürlich Tina , Hottenrott Laura , Hottenrott Kuno
Published: June 2022

Objective:

An acute reduction in blood pressure (BP) can be observed after a single bout of exercise. Termed postexercise hypotension (PEH), this phenomenon has been well documented in different populations after exercise of various intensities, durations, and modalities. Even though PEH has been documented in young and older adults, no previous studies have directly compared different age groups. The present study aimed to compare the PEH effect after high-intensity interval training (HIIT) in matched older and younger adults. Furthermore, within-session oxygen consumption was assessed and compared.

Design and method:

Forty-three participants were recruited for this study. All participants performed baseline examinations assessing body mass index (BMI), resting BP, and maximum oxygen consumption (VO2max). Thereafter, twelve younger (24.4 ± 3.1 years) and 12 older (49.5 ± 7.4 years) participants matched for BMI, BP, and VO2max-percentiles were selected for further analysis. All participants completed a HIIT protocol consisting of 4x 30-seconds exercise bouts interspersed by 3 minutes of active recovery. Both before and throughout the 45 minutes after the training, peripheral systolic (pSBP) and diastolic (pDBP) blood pressure, central systolic (cSBP) and diastolic (cDBP) blood pressure, pulse wave velocity (PWV), and heart rate (HR) were assessed. Throughout the HIIT, oxygen consumption was continuously monitored, and time spent above 75%, 85%, 95%, and 100% of VO2max was computed.

Results:

Both groups revealed significant (p < .001) reductions over time in pSBP, pDBP, cSBP, cDBP, PWV, and HR. No significant group x time effects could be detected for pSBP (p = .581), pDBP (p = .937), cSBP (p = .691), cDBP (p = .965), PWV (p = .233), and HR (p = .711). There were no significant differences in times spent at different percentages of VO2max (p = .643).

Conclusions:

If matched for BMI, resting BP, and VO2max-percentiles, older and younger adults experience similar PEH effects after HIIT. Furthermore, within-session oxygen consumption was similar in both groups revealing comparable exercise intensities during the protocol. According to the present results, age does not affect PEH after HIIT.
EFFORT PERCEPTION AND HEMODYNAMIC RESPONSES TO THE 3/7 VS. 3X9 METHODS IN HEART FAILURE AND IN CORONARY ARTERY DISEASE PATIENTS: A RANDOMIZED-CROSS-OVER STUDY
Authors: Gillet Alexis , Chaumont Martin , Lamotte Michel , Roussoulieres Ana , Dewachter Celine , Forton Kevin , Deboeck Gael , Van De Borne Philippe
Published: June 2022

Objective:

Patient adherence to cardiac rehabilitation (CR) centers may be improved by shorter exercise time. The new ‘3/7-method’, which consists of 5 successive sets of exercise with an increasing number of repetitions (3 to 7) separated by brief inter-set rest intervals (15 s), has been proven to achieve a greater and faster strength gain in healthy subjects. Further characterization (i.e., Borg scale, blood pressure (BP) and heart rate (HR)) of the 3/7-method safety is needed before using it in CR in patients with reduced ejection fraction (HFrEF) and coronary artery disease (CAD).

Design and method:

Using a randomized and cross-over study design, we compared the variation of Borg scale, BP and HR in the ‘3/7-method’ vs ‘3X9 method’ (gold standard - .3 to 9 repetitions with a longer inter-set rest interval (1 min)) in 23 HFrEF (58 ± 9y-13% female) and 22 CAD patients (64 ± 10y-14% female). The strength training consisted in leg extension against a load of ~ 70% of 1 repetition maximal. Perceived exertion was assessed at the end of the last set by using the modified Borg Scale (0–10). HR and BP were assessed noninvasively beat by beat.

Results:

Baseline BP, HR and Borg scale at the end of exercise were similar within the two methods. HR was higher with the 3/7 method compared to the 3X9 method in the HFrEF (85 ± 11 vs. 83 ± 12 bpm,-p = 0.014) and CAD (90 ± 13 vs. 87 ± 14 bpm,-p = 0.03) patients. In the CAD patients, systolic BP increased more with the 3/7 method compared to the 3X9 method (143 ± 22 vs. 133 ± 20 mm Hg-(p < 0.001)).

Conclusions:

The 3/7 and 3X9 strength training protocols elicit similar effort perception in our patients. The 3/7 method increases slightly HR in both groups and induces minimal rise in systolic BP in CAD patients. Taken together, our study suggests that, compared to the 3x9 method, the new 3/7-method is well tolerated and time-saving, at the price of small and likely irrelevant HR and BP variations. These encouraging results warrants further investigation of the advantages (i.e, adherence, improve strength and exercise capacity) of the 3/7 method in CR.
WORK-BASED ISOMETRIC EXERCISES EFFECT ON BLOOD PRESSURE: THE EEFIT STUDY
Authors: Cohen Daniel D. , Aroca-Martinez Gustavo , Carreño-Robayo Javier , Chacon-Manosalva Maria A. , Lopez-Lopez Jose , Otero Johanna , Camacho-Lopez Paul , Herazo-Beltran Yaneth , Castañeda-Hernandez Alvaro , Lopez-Jaramillo Patricio
Published: June 2022

Objective:

To evaluate the effect of two workplace isometric exercise interventions on blood pressure in hypertensive adults.

Design and method:

A randomized controlled multicenter clinical trial conducted in hypertensive (>130 mmHg systolic blood pressure (SBP)) 35 to 65 years old in work places in Colombia. Participants were assigned to either of two interventions: isometric handgrip dynamometer training at 30% of maximum strength (HGD) or wall squat (WS), or to a control group following standard recommendations. The interventions were performed at the participant’s workplace and consisted of 4 sets of 2 minutes of sustained isometric contraction with 2 minutes’ rest between sets, 3 times per week for 12 weeks. SBP and diastolic blood pressure (DBP) were measured using an automatic device (Omron) with a standardized protocol before and after the 12-week intervention.

Results:

Pre and post measurements were completed by 105 hypertensive participants: mean age of 45 years (SD 9.5), 63.8% of which were men. In the HGD group (n = 38) there were significant decreases in SBP [Pre: 141 mmHg (SD 7.8), Post: 127 mmHg (SD 9.1) (p < 0.001)], and in DBP [Pre: 87 mmHg (SD 5.8), Post: 82 mmHg (SD 9.5) (p < 0.001)]. There were also significant decreases in the WS-group (n = 35) in SBP [Pre: 139 mmHg (SD 7.5), Post: 126 mmHg (SD 12.4) (p < 0.001)], and in DBP [Pre: 86 mmHg (SD 5.2), Post 82 mmHg (SD 8.1) (p < 0.001)]. In the control group (n = 32), there were no significant changes in either in SBP [Pre: 140 mmHg (SD 8.4), Post: 137 mmHg (SD 12.9)], or DBP [Pre: 86 mmHg (SD 5.0), Post: 85 mmHg (SD 8.0) (p = 0.71)].

Conclusions:

Both workplace isometric training interventions resulted in significant and clinically relevant reductions in blood pressure in subjects with high blood pressure. The combination of effectiveness, modest time commitment (42 minutes per week) and ease with which the interventions can be implemented in the workplace setting makes them both attractive and practical options with minimal barriers for participation. Furthermore, WS can be performed without any equipment.
EFFECT OF ACUPUNCTURE ON ATRIAL FIBRILLATION STRATIFIED BY CHA2DS2-VASC SCORE-CROSSTALK BETWEEN CONVENTIONAL AND MODERN MEDICINE
Authors: Syun Hu Wei
Published: June 2022

Objective:

This research aimed to make statements regarding the reduction in atrial fibrillation (AF) risk due to acupuncturE

Design and method:

The Kaplan-Meier method was performed to calculate cumulative incidence of outcomes for each group, and the log-rank test were performed to compare differences between groups.

Results:

In CHA2DS2-VASc scores of 0~1, 2~3, 4~5, and > 5, cases with acupuncture were all associated with decreased incidence of atrial fibrillation (aHR, 0.46 with 95% CI, 0.42–0.51; p-value, < 0.001 in the CHA2DS2-VASc scores of 0~1; aHR, 0.53 with 95% CI, 0.50–0.57; p-value, < 0.001 in the CHA2DS2-VASc scores of 2~3; aHR, 0.56 with 95% CI, 0.52–0.61; p-value, < 0.001 in the CHA2DS2-VASc scores of 4~5; and aHR, 0.64 with 95% CI, 0.55–0.74; p-value, < 0.001 in the CHA2DS2-VASc scores of > 5).

Conclusions:

Protective effect of acupuncture on AF in a relatively dose dependent manner was observed in this study.