bluuebunny/crossref_metadata_2025 huggingface dataset:
ANGIOGENIC MARKERS AS PROGNOSTIC TOOLS IN PATIENTS WITH COVID-19: CRACOV-HHS STUDY
Authors: Stolarz-skrzypek Katarzyna , Olszanecka Agnieszka , Wojciechowsa Wiktoria , Kusak Piotr , Bednarek Agnieszka , Rusinek Jakub , Kusnierz-cabala Beata , Wizner Barbara , Surdacki Andrzej , Sanak Marek , Grodzicki Tomasz , Rajzer Marek
Published: May 2024

Objective:

The course of COVID-19 can be altered by different comorbidities and arterial hypertension (HT) is one of them. Angiogenic markers are already used to establish the prognosis of acute conditions related to HT. The aim of our study was to assess the prognostic impact of soluble fms-like tyrosine kinase 1 (sFLT1), angiopoietin 2 (Ang2) and vascular endothelial growth factor (VEGF) on the severity of COVID-19 course. The study was a part of CRACoV project.

Design and method:

It was a prospective cohort study including the patients hospitalized due to COVID-19. Patients were assigned to severe or non-severe COVID-19 group based on National Institutes of Health criteria on admission. The serum concentration of sFLT1, Ang2 and VEGF was measured 5 times: twice during hospitalization: on 1st and 7th day, and 3 times after hospitalization – 28 days, 180 days and a year after discharge.

Results:

The study included 229 patients – 120 (52.4%) in severe and 109 (47.6%) in non-severe COVID-19 group. The median age (Q1-Q3) was 59 (48-67) years and 81 (35.4%) of patients were female. There were 57 (52.8%) patients with HT in non-severe and 70 (58.3%) in severe group (p=0.399). The groups differed significantly in terms of median body mass index (kg/m2), waist circumference (cm) and the prevalence of diabetes mellitus which were higher in severe group (30.03 (26.77 - 33.22) vs. 28.65 (25.82 - 31.83), p=0.015; 105 (97 - 115) vs. 100 (89 - 108), p=0.001 and 24.4% vs. 13.3%, p=0.036; respectively). Area under the curve for COVID-19 severity prediction for VEGF concentration on 1st day was: 0.687 (p<0.001), while it was not significant for other angiogenetic factors. In both groups median VEGF concentration (pg/ml) was the highest on 7th day but significantly higher in the severe group (229.22 (128.02 – 334.62) vs. 160.63 (100.85 – 281.59), p=0.010). The sFLT1 and Ang2 concentrations did not differ significantly between the groups at any time point.

Conclusions:

Serum VEGF concentration might be considered as additional predictive factor for severe COVID-19 course while sFLT1 and Ang2 cannot be used to anticipate COVID-19 severity.
HIGHER BASELINE SYSTOLIC BLOOD PRESSURE IS ASSOCIATED WITH GREATER BLOOD PRESSURE REDUCTIONS FOLLOWING RADIOFREQUENCY RENAL DENERVATION IN A POOLED COHORT OF OVER 3900 PATIENTS
Authors: Schmieder Roland E , Mahfoud Felix , Mancia Giuseppe , Townsend Raymond R , Kandzari David E , Bakris George , Bhatt Deepak L , Kario Kazuomi , Whitbourn Robert , Fahy Martin , Böhm Michael
Published: May 2024

Objective:

Uncontrolled hypertension (HTN) is the leading global risk factor for cardiovascular disease, and higher systolic blood pressure (SBP) increases this risk. Radiofrequency renal denervation (RF RDN) has been shown to reduce BP effectively in patients with uncontrolled HTN. We investigated the relationship between increasing baseline SBP and its change after RF RDN.

Design and method:

Patients undergoing RF RDN (N=3974) were pooled from global clinical trials in patients on antihypertensive drugs: SPYRAL First-In-Man, SYMPLICITY HTN-3, HTN-Japan, SPYRAL HTN ON-MED, and the Global SYMPLICITY Registry DEFINE. Office and 24-h ambulatory SBP at baseline and 6 months after RF RDN were evaluated. Linear regression analysis was performed to evaluate the correlation between baseline and SBP change after 6 months (SBP change=intercept+slope∗baseline SBP).

Results:

The baseline SBP for office and 24-h ambulatory BP were 167±24mmHg and 154±18mmHg, respectively. Patients were prescribed 4.4±1.5 antihypertensive drugs at baseline. After 6 months, prescribed antihypertensive drugs decreased to 4.3±1.5 (p<0.0001).

In both office and 24-h ambulatory SBP, baseline SBP correlation with SBP change after 6 months was statistically significant; every 1mmHg increase in baseline office SBP was associated with a 0.59mmHg (r2=0.30; p<0.001) reduction in SBP, and every 1mmHg increase in baseline 24-h ambulatory SBP was associated with a 0.45mmHg (r2=0.19; p<0.001) reduction in SBP at 6 months.

According to this linear regression, a baseline office SBP of 160mmHg, 170mmHg and 180mmHg were associated with 6 months office SBP reduction by -9.2mmHg, -15.1mmHg and -21.0mmHg, respectively (Figure). Reductions in SBP of this magnitude have previously been shown to correspond with substantial reductions in the risk of cardiovascular events.

Conclusions:

A continuous and inverse relationship was observed between baseline SBP and 6 months SBP change in patients with uncontrolled HTN undergoing RF RDN. Higher baseline SBP led to a greater reduction in SBP and may derive greater benefit from an RDN procedure. These findings may help clinicians and patients in their shared decision making regarding their BP management. However, this is a retrospective analysis which needs further prospective validation.
SIGNIFICANT NIGHTTIME BLOOD PRESSURE REDUCTIONS AFTER RADIOFREQUENCY RENAL DENERVATION IN PATIENTS WITH UNCONTROLLED HYPERTENSION: POOLED ANALYSIS OF THE SPYRAL HTN TRIALS
Authors: Kazuomi Kario , Mahfoud Felix , Townsend Raymond , Kandzari David E , Weber Michael A , Schmieder Roland E , Tsioufis Konstantinos , Fahy Martin , Böhm Michael
Published: May 2024

Objective:

Elevated nighttime systolic blood pressure (SBP) is more strongly associated with risk for cardiovascular events than daytime or office SBP. We assessed whether radiofrequency renal denervation (RF RDN) reduces nighttime SBP, in addition to other times of the day.

Design and method:

We pooled data from patients with uncontrolled hypertension undergoing RF RDN using the latest-generation Spyral multi-electrode catheter, from the published, SPYRAL HTN-OFF and -ON MED clinical trials. Office and 24-ambulatory SBP were evaluated at baseline and at 12 months. Different time ranges were evaluated including nighttime (1am-6am), morning (7am-9am), and daytime (9am-9pm). The number of antihypertensive drugs and drug burden (determined by number of classes and prescribed dosage) from urinary drug testing, where available, was assessed at baseline and at 12 months.

Results:

Data from 388 patients undergoing RDN were pooled. Patients were 54±10yrs old, 26.8% female, BMI 31.3±6.0, 45.1% with >10yrs diagnosis of hypertension, 7.7% type 2 diabetes, 9.8% obstructive sleep apnea, 16.2% current smoker. The baseline nighttime SBP was 139±11mmHg, and 92.5% had nocturnal hypertension (BP greater than or equal to 120/70 mmHg). Patients took 1.0±1.2 antihypertensive drugs with drug burden of 1.6±3.1 at baseline.

12 months after RDN, 30.6% of patients no longer had nocturnal hypertension (p<0.0001). The overall 24-h ambulatory SBP reduced by -11.9±12.4mmHg, nighttime -10.8±15.4mmHg, morning -12.8±20.4mmHg, daytime -12.2±13.6mmHg, and office -17.7±15.4mmHg (Figure). Patients took 1.8±1.1 antihypertensive drugs with drug burden of 2.9±3.0 at 12 months.

Conclusions:

In this pooled cohort of RDN patients with uncontrolled hypertension, nocturnal hypertension was highly prevalent. RF RDN achieved clinically meaningful reductions throughout the 24-hr circadian cycle including the nighttime SBP, when CV risk is highest. RF RDN, in addition to pharmacotherapy, may help to reduce this risk.
SPONTANEOUS, INDEPENDENT, SINGLE-CENTER RDN REGISTRY OF A RESISTANT HYPERTENSION MULTIDISCIPLINARY TEAM
Authors: Galuppi Enrico , Galli Verdiana , Trento Laura , Casal Matteo , Fezzi Simone , Gambaro Alessia , Pesarini Gabriele , Scarsini Roberto , Tavella Domenico , Ribichini Flavio Luciano
Published: May 2024

Objective:

Uncontrolled resistant hypertension (URH) is defined as Systolic Blood Pressure above 140mmHg despite at least 3 maximally tolerated doses of antihypertensive drugs including a diuretic. Renal sympathetic denervation (RDN) has proved efficacy in the sponsored SPYRAL and RADIANCE studies. However, little evidence is available from independent studies. Furthermore, patients with glomerular filtrate rate <45ml/min have been systematically excluded. This study aims to evaluate the safety and the efficacy of catheter-based radiofrequency RDN in patients with URH, including those with renal impairment.

Design and method:

Consecutive unselected patients with URH undergoing RDN were enrolled, assessed in a multidisciplinary team involving cardiologist, nephrologist and hypertension specialists, that excluded secondary forms. Efficacy was defined as change of office (OBP) and ambulatory blood pressure monitoring (ABPM) after RDN, safety as the absence of device-related major complication (BARC classification), end-stage renal disease, stroke, acute myocardial infarction and any cause of death within 1 month. 107 patients underwent RDN from 2012 to December 2023. The population had multiple comorbidities: 45% were smokers, 43% diabetic, 35% had peripheral artery disease, 30% coronary artery disease, 57% CKD. The average number of antihypertensive medications was 4.83±1.2 Baseline ABPM and OBP were 151.18±20,97/87,88±14,39mmHg and 155,92±24/85,25±15,5 mmHg, respectively

Results:

. At 12-month a significant reduction of systolic OBP and ABPM, respectively by -17.51±3.70 mmHg (P=0.001) and -7.03±3.37 mmHg (P=0.04) was noticed. BP reduction at 12-month follow-up was observed also among eGFR <45 ml/min, with a reduction by -18.73±7.14mmHg (P=0.02) in systolic OBP and by -17.81±7.49 (P=0.03) in ABPM. The therapeutic burden was slightly reduced baseline to 4 (3-5) at follow-up (p<0.01). No major complications were observed and renal function was stable up to 12 months, compared to baseline (1.87±2.37 vs. 2.44±3.56; -0.57±0.32; p=0.08).

Conclusions:

RDN on top of medical therapy is safe and feasible in patients with URH, even in a high-risk CKD population with multiple comorbidities. A significant reduction of SBP also in this subgroup up to 12 months was reported without undesired effects. Furthermore, our experience underlines the central role of multidisciplinary team evaluation for the appropriate management of URH.
EFFECT OF RENAL DENERVATION ON THE PLASMA ADIPOKINES CONCENTRATIONS IN PATIENTS WITH RESISTANT ARTERIAL HYPERTENSION
Authors: Adamczak Marcin , Czerwienska Beata , Lelek Michal , Gojowy Damian , Mizia-stec Katarzyna , Wiecek Andrzej
Published: May 2024

Objective:

Adiponectin, leptin and visfatin are synthesized by adipocytes. Adiponectin has anti-diabetic, anti-atherosclerotic, anti-thrombotic, anti-inflammatory, and cardioprotective properties. Leptin has hypertensinogenic properties. Visfatin seems to be a useful marker of endothelial dysfunction and vascular damage. Renal denervation (RDN), is proposed as method of treatment in patients with resistant arterial hypertension. This single-center, interventional clinical study aimed to assess the effect of RDN on plasma adipokines (adiponectin, leptin and visfatin) concentration in patients with resistant arterial hypertension.

Design and method:

Eighteen patients (9 women, 9 men) aged 53.2±6.5 years with resistant arterial hypertension who underwent RDN using Simplicity catheters (Medtronic, Inc., Northridge, CA) were enrolled in the study. Plasma adiponectin, leptin and visfatin concentration was determined before and 6 months after RDN using: the Human Adiponectin ELISA Kit (Otsuka Pharmaceutical Co, Tokyo, Japan), the Human Leptin RIA HL-81K (Linco Research, Inc., Missouri, USA) and Visfatin c-terminal ELISA Kit (Phoenix Pharmaceuticals Inc., Karlsruche, Germany), respectively.

Results:

Systolic and diastolic blood pressure was reduced 6 months after RDN (mean ± standard deviation; 196.6±28.2 and 162.9±15.6; p<0.001 as well as 117.9±26.4 and 90.7±8.6 mmHg; p<0.001), respectively). Body mass index (BMI) before and 6 months after RDN was similar (mean ± standard deviation, 31.0 ± 4.4 and 31.3±4.4 kg/m2; p=0.8). Plasma adiponectin concentration increased significantly 6 months after RDN (median with interquartile range; 5.78 (3.70;10.47) and 7.58 (5.60;10.64) μg/mL, p=0.009). Plasma leptin and visfatin concentration measured before and 6 months after RDN did not change significantly (median with interquartile range; 5.78 (95% CI 27.5 (14.0;39.0) and 22.5 (12.0;32.0) ng/mL; p=0.13, as well as 4.45 (3.70;5.00) and 4.70 (4.10;6.00) ng/mL; p=0.23, before and 6 months after RDN, respectively).

Conclusions:

1. Renal denervation which successfully decreases systolic and diastolic blood pressure may also increase plasma adiponectin concentration but did not influence plasma leptin and visfatin concentration in patients with resistant arterial hypertension. 2. Increased plasma adiponectin concentration may participate in the cardiovascular benefits in these patients, however long term clinical consequences of this observation need further investigations.
ROLE NEUTROPHIL GELATINASE-ASSOCIATED LIPOCALIN (NGAL) IN THE DIAGNOSIS OF RENAL DYSFUNCTION IN HYPERTENSIVE PATIENTS WITH CONCOMITANT TYPE 2 DIABETES AND OBESITY
Authors: Dunaieva Inna , Kravchun Nonna , Kravchun Pavlo
Published: May 2024

Objective:

The diagnostic significance of NGAL as a marker of renal dysfunction, as well as its prognostic value in terms of the further prognosis of the course of renal pathology has now been confirmed. The purpose of the study: to determine the role of NGAL in the development of renal dysfunction in hypertensive patients with comorbid type 2 diabetes (T2D).

Design and method:

111 patients with hypertension (50 men, 61 women) aged 54.37 ± 1.18 years and 20 controls were examined. During the examination, they were divided into 4 groups depending on the presence of comorbid pathology: hypertension — the first group (n = 22); hypertension combined with obesity — the second group (n = 30); hypertension combined with T2D — the third group (n = 31); hypertension, T2D and obesity — the fourth group (n = 28). In all patients, body weight and height were measured, body mass index was calculated, levels of glycated hemoglobin, lipid metabolism.

Results:

The level of NGAL in all patients included in the study was significantly higher compared to the control group (p < 0.01). However, it was highest in comorbidity of hypertension, T2D and obesity, which, in turn, indicates a high risk of interstitial fibrosis in these patients. A significant correlation was found between the level of NGAL and the concentration of cardiotrophin (p < 0.032), catestatin (p < 0.001), β2-microglobulin (p < 0.001), cystatin (p < 0.021), atherogenic coefficient (p < 0.011), NT-proBNP (p < 0.014), vitamin D (p < 0.004). The obtained data demonstrate the significant role of NGAL in the development of early cardiovascular and renal complications in our patients.

Conclusions:

A significant increase in the level of NGAL was found in patients with hypertension, hypertension with T2D, hypertension with obesity, hypertension with T2DM and obesity compared to healthy individuals (p < 0.01). A significant correlation of the NGAL level with the serum concentration of cardiotrophin, catestatin, cystatin C, β2-microglobulin, atherogenic coefficient, NT-proBNP, and vitamin D in the examined patients was proved.
PERINATAL AND POSTNATAL COMPLICATIONS OF CHILDREN OF MOTHERS WITH HYPERGLYCEMIA DURING PREGNANCY. SYSTEMATIC REVIEW 2022
Authors: Rodero Eulalia Amador , Montealegre Leslie , Ardila Laura , Rebolledo Roberto , Arteta Martha , Barba Areli , Sanchez Tania , Montaño Luis
Published: May 2024

Objective:

To identify, through a systematic review, the prevalence and/or risk of peri- and postnatal complications in children of mothers with gestational diabetes mellitus

Design and method:

To answer the PICO question: What is the prevalence/risk of peri- and postnatal complications in children of mothers with gestational diabetes mellitus? An exhaustive review of scientific articles was carried out based on the PRISMA methodology, between June 16 and July 26, 2022, in the Pubmed, Scopus, Cochrane, Google Scholar, ScienceDirect and Lilacs databases. The Mesh terms, gestational diabetes, hyperglycemia, infant complications, diabetes mellitus, newborn, observational study, systematic review and overweight. They were combined with Boolean operators AND and OR and entered into the database search engines. The established limits were type of study, type of document, language, date of publication. Articles referring to children of mothers with pre-existing diseases were excluded. After passing the established filters, the methodological quality was assessed with Strengthening the Reporting of Observational Studies in Epidemiology STROBE and PRISMA. Those preselected underwent an assessment of the level of evidence with Sackett's proposal; those that obtained a high level and degree of recommendation were included in the present review, a total of 6 studies.

Results:

The main findings were: Probability of death of 56.8%; jaundice 8.7 vs. 2.1%; p < 0.000; RR: 3.1; 95% CI: 1.9-5.9; respiratory distress 4.9 vs. 1.3%; p < 0.009; RR: 2.9; 95% CI: 1.4-6.7 and asphyxiation 2.9 vs. 0.4%; p < 0.005; RR: 4.3; 95% CI: 1.8-11.1); relative risk of macrosomia OR 1.32 1.02–1.72; Macrosomia 2.9% 0.024; Hypoglycemia 5.1%0.013

Conclusions:

Diabetes Mellitus associated with pregnancy continues to be an important event, causing morbidity and mortality in the mother and perinatal and postnatal effects if it is not adequately treated. The success of the treatment is based on the control of patients with GDM, from a metabolic point of view, from before conception and continuing throughout the course of pregnancy.
EFFECT OF SEMAGLUTIDE VERSUS OTHER GLP-1 RECEPTOR AGONISTS ON OFFICE BLOOD PRESSURE LEVELS AMONG SUBJECTS WITH TYPE 2 DIABETES: A META-ANALYSIS
Authors: Patoulias Dimitrios , Stavropoulos Konstantinos , Koufakis Theocharis , Imprialos Konstantinos , Karakasis Paschalis , Varouktsi Anna , Zografou Ioanna , Katsimardou Alexandra , Petidis Konstantinos , Doumas Michael
Published: May 2024

Objective:

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have emerged as a cornerstone treatment for type 2 diabetes (T2D). The aim of the present meta-analysis was to assess whether semaglutide exerts greater effects on office blood pressure (BP) levels compared to other commercially available GLP-1RAs in patients with T2D.

Design and method:

We searched PubMed and Cochrane Library databases, along with grey literature sources, from inception to February 2023, in order to retrieve head-to-head, phase 3 randomized controlled trials (RCTs) assessing the effect of semaglutide versus other GLP-1RAs on office systolic and diastolic BP (SBP and DBP, respectively) levels in patients with T2D.

Results:

We finally pooled data from 5 RCTs in a total of 3,760 randomized participants with T2D. Subjects treated with semaglutide versus other GLP-1RAs experienced a significantly greater reduction in office SBP by 1.20 mm Hg (p = 0.006), and in office DBP by 0.67 mm Hg (p = 0.01). Regarding office SBP, the results were primarily driven by the comparison between semaglutide and exenatide, while, regarding office DBP, the results were mainly driven by the comparison between semaglutide and dulaglutide. However, no significant subgroup difference for none of the above-mentioned comparisons was shown.

Conclusions:

It is evident that semaglutide use is accompanied with a greater reduction in both office SBP and DBP, compared to other GLP-1 RAs, in patients with T2D. Therefore, its use should be prioritized for patients with T2DM and concomitant hypertension or other cardiovascular risk factors.
CORRELATION BETWEEN CAROTID-FEMORAL PULSE WAVE VELOCITY (PWV) AT ONE MEASUREMENT AND 24-HOUR PWV IN MEN AND WOMEN ASSESSED BY TWO DIFFERENT METHODS IN A POPULATION-BASED STUDY
Authors: Nilsson Peter , Johansson Madeleine
Published: May 2024

Objective:

Aortic stiffness can be assessed by pulse wave velocity (PWV) using golden standard applanation tonometry (SphygmoCor; SC) or a 24-hour ambulatory oscillometric method (Arteriograph; AG). We aimed to compare AG with SC in a population-based study for PWV in men and women.

Design and method:

We used data from subjects (n= 1545; 748 men, 797 women; mean age 50 years, SD: 9.3) with complete data on both AG and SC from a population-based cohort. Correlations (Pearson's rho) were analyzed for PWV between carotid-femoral PWV using SC and aortic PWV (24-hours, daytime, nighttime) using AG stratified by sex. In addition, correlations with fasting plasma glucose (FPG) were analyzed after adjustment for covariates.

Results:

Study characteristics are displayed in the Table. Mean PWV was higher in men and women when assessed by 24-hour AG (men: 9.1± 1.8 and women: 9.2± 1.5 m/s p=0.10) compared with SC (men: 7.9±1.5 and women: 8.3±1.6 m/s p<0.001). In women, SC-PWV was moderately correlated with 24-hour AG-PWV (r=0.43, p<0.001, Figure 1A), daytime AG-PWV (r=0.40, p<0.001), and nighttime AG-PWV (r=0.40, p<0.001). In men, SC-PWV was moderately correlated with 24-hour AG-PWV (r=0.41, p<0.001, Figure 1B) and nighttime AG-PWV (r=0.43, p<0.001), but less correlated with daytime AG-PWV (r=0.38, p<0.001). PWV also correlated with FPG levels.

Conclusions:

Mean PWV was lower when assessed by SphygmoCor compared with 24-hour Arteriograph in men and women. The methods were moderately correlated. Both measures of arterial stiffness were independently associated with fasting glycaemia in men, but significant only for SC-PWV in women, after full adjustment. Further studies are needed for prediction of cardiovascular endpoints comparing the methods.
CLINICAL ASSOCIATIONS AND ON-TREATMENT CHANGES OF CENTRAL SYSTOLIC BLOOD PRESSURE AND AR TERIAL STIFFNESS IN PATIENTS WITH DECOMPENSATED HEART FAILURE
Authors: Chudarova Irina , Troitskaya Elena , Kozlova Anna , Andreeva Ekaterina , Galochkin Svyatoslav , Tereshchenko Ekaterina , Kobalava Zhanna
Published: May 2024

Objective:

Heart failure (HF) remains one of the major causes of cardiovascular mortality worldwide. The results of studies on arterial stiffness (AS) and central blood pressure (cBP) in HF are contradictory.

The aim of this study was to evaluate clinical associations of cBP and parameters of AS and their on-treatment changes after 6 months of stable guideline-directed medical therapy (GDMT) in patients with acute decompensated HF (ADHF).

Design and method:

In 54 patients (61% males, 69.6±10 years, HTN 100%, median (med) EF 51% (IQR 38;55%), NTproBNP 623 (500;1842)pg/ml; HFrEF 37%, HFmrEF 13%, HFpEF 50%), apart from routine tests (including congestion assessment by bioimpedance vector analysis, lung ultrasound, liver density by FibroScan, and venous excess ultrasound) we assessed cBP and AS with applanation tonometry (SphygmoCor) within 3-4 days after admission and after 6 months. cSBP>/=individual reference values, carotid-femoral pulse wave velocity (cfPWV)>10 m/s and >individual reference values, AS gradient (cfPWV/carotid-radial PWV) >/=1 were considered abnormal. p<0.05 was considered significant.

Results:

At admission and after 6 months med brachial (b)BP was 117(106;130)/70 (68;80) mmHg 116 (108;130) mmHg, bPP 47 (37;56) mmHg and 47 (39;55) mmHg (p>0.05); cBP 109.5(96;120.5)/71.5 (68;80) mmHg and 106.5(95;113)/73 (65;79) mmHg (p=0.02 for cSBP), cPP 35 (25;43) mmHg and 32.5 (24;38) mmHg (p>0.05), cfPWV 9.9 (6.8;13) m/s and 11.4 (8.5,14.4), m/s (p=0.04), augmentation index (AI@HR75) 20% (13;33%) and 24.5% (18;29%), (p=0.05), PP amplification 129 (120;146) mmHg and 126 (121;136) mmHg, (p=0.02), AS gradient 1.2 (0.9;1.8) and 1 (0.8;1.4) (p>0.05), respectively. Elevated cSBP at admission was observed in 33%, at 6 months – in 38.1%, PWV>10 m/s-in 48.1% and 61.9% respectively, cfPWV>individual reference values–in 33.3% and 66.7% respectively, AS gradient>/=1–in 70.3% and 95.2% respectively. There were no differences in parameters of AS and cSBP and frequencies of their elevation across EF phenotypes and no differences between groups with normal and elevated AS by characteristics of congestion.

Conclusions:

Patients admitted with ADHF had high frequency of CBP elevation and abnormal AS gradient. The significant increase in cSBP, cfPWV and decrease in PP amplification on stable GDMT needs further evaluation.
AORTIC STENOSIS AND ULTRASOUND EVALUATION OF RENAL VESSELS IN HYPERTENSIVE PATIENTS
Authors: Puato Massimo , Furlanis Giulia , Bardelli Moreno , Bernardi Stella , Grillo Andrea
Published: May 2024

Objective:

Aortic stenosis (AS) and arterial hypertension often clusterize and increase cardiovascular disease burden. Renal artery (RA) stenosis, the main form of secondary hypertension, can act as an upstream factor of resistance at the same way of AS. Aim of the study: to investigate if the presence of AS is able to interfere with the ultrasound (US) parameters in the diagnosis of RA stenosis.

Design and method:

In hypertensive subjects with AS we evaluated US indirect parenchymal parameters: resistive index (RI) and index of maximal systolic acceleration (AImax: the maximal acceleration of flow waveform in early systole divided by the peak systolic velocity), and US direct RA parameters: peak systolic velocity (PSV) and Renal/Aortic Ratio (RAR).

Results:

We compared hypertensive patients (mean age 74 years) with preserved left ventricular function with severe AS (n=18) or mild AS (n=21). No statistically differences were detected between groups regarding gender, age, smoke, ABI, CV risk factors, lipids, and renal function.

Direct US parameters of RA did not differ significantly between patients with severe or mild AS (mean PSV 113 vs 127 cm/sec; mean RAR 1.3 vs 1.6). RI showed the same behavior (0.75 vs 0.73). AImax was significantly lower in patients with severe vs mild AS (8.74 vs 15.56 1/sec, p<0.0005). We found an inverse correlation between AImax and the mean (r2=0.435) and peak (r2=0.424) transvalvular gradient.

Among 14 patients with severe AS underwent correction of valvular disease. At 6 months, US showed a significant increase in AImax (from 10.0 to 19.8 1/sec, p<0.005), while RI did not differ significantly (0.74 vs 0.73).

Conclusions:

Severe AS act as a proximal resistance that can attenuate the systolic acceleration phase of the flow profile of the renal intraparenchymal vessels, in particular of AImax, which is restored after surgical correction of the valve defect. Presence of AS may affect the diagnostic workup of RA stenosis.
ASSOCIATION BETWEEN CHINESE VISCERAL ADIPOSITY INDEX AND RISK OF CARDIOMETABOLIC MULTIMORBIDITY IN MIDDLE-AGED AND ELDERLY CHINESE POPULATION: EVIDENCE FROM A NATIONAL COHORT STUDY
Authors: Yang Fuli , Jin Junguo , Lu Xiaoqin , Jiang Huyi , Tan Huixin
Published: May 2024

Objective:

This cohort study was designed to investigate the associations between Chinese visceral adiposity index (CVAI) and Cardiometabolic multimorbidity (CMM) among middle-aged and elderly Chinese population.

Design and method:

A national cohort study that consisted of 6419 participants was conducted during a median follow-up time of 4 years. Three obesity- and lipid-related indices, including visceral adiposity index (VAI), Chinese visceral adiposity index (CVAI), lipid accumulation product (LAP) were recorded. Our study used multivariate adjusted Cox proportional hazard models, sensitivity analysis and restricted cubic spline analysis to investigate the associations of the Chinese visceral adiposity index with Cardiometabolic multimorbidity. Results were reported in log-relative hazard ratios and associated 95% CIs.

Results:

Of the 6686 participants included in the analysis, 6419 participants did not develop CMM and incident CMM occurred in 267 participants during the study period. Using multivariable-adjusted restricted cubic spline analyses, it was found that there was a significant nonlinear relationship between the levels of CVAI and the incidence of cardiometabolic multimorbidity (P<0.0001). The risk of CMM gradually increased when the CVAI increased, and rapid upward after exceeding 91.2. After adjustment of multiple covariates, a U-shaped association between CVAI and CMM was evident in all participants. The HR of CVAI gradually increases and is positively correlated with the increase of CVAI.

Conclusions:

The CVAI are independent predictors of CMM in the middle-aged and elderly Chinese population. Higher CVAI is positively associated with CMM risk.
NATIONAL EXAMINATION SURVEY ON BLOOD PRESSURE OF OLDER AND VERY OLD PEOPLE IN GERMANY 2022-2023: WHY SELF-REPORTS, MEASUREMENTS AND MEDICATION DATA ARE NEEDED
Authors: Neuhauser Hannelore , Bueschges Julia , Sarganas Giselle , Gaertner Beate , Perlitz Hanna , Fuchs Judith
Published: May 2024

Objective:

The National Study on Health of Older People in Germany “Gesundheit 65+” aimed to provide up-to-date information on the health of older adults in Germany including blood pressure (BP) measurements at home by a study nurse.

Design and method:

Nationally representative examination survey of the population aged 65 years and older residing in Germany and with sufficient German language skills, using two-stage population registry sampling from 128 sample points from June 2022 to April 2023. Participation of physically or cognitively impaired persons was possible via proxy interviews and consent from legal representatives. Recruitment and data collection used a mixed-mode design. Three standardized blood pressure measurements at two-minute intervals were taken after 5 minutes rest with an oscillometric device (Mobil-O-Graph) using one of five cuffs according to upper arm circumference. The mean of the second and third measurement was used for analysis. Hypertension was defined as mean systolic BP (SBP) at or above140 mm Hg, or mean diastolic BP (DBP) at or above 90 mm Hg, or the use of antihypertensives (ATC-codes C02 antihypertensives, C03 diuretics, C07 beta-blockers, C08 calcium-channel blockers or C09 ACEI and ARB) in participants with self-reported hypertension diagnosis. Provisional weights account for unequal sampling and participation probabilities.

Results:

The “Gesundheit 65+” examination survey included 1,493 participants and 1,475 (98.8%) had successful BP measurements (763 men and 712 women aged 65 to 100 years). External quality control showed very good standardization of BP measurements in the home environment. Central BP data were available from 1,356 participants. Based on self-reported diagnoses alone the prevalence of hypertension would be 58.3% [95% CI 53.2-63.3] in men and 59.5% [53.8-64.9] in women. However, overall hypertension prevalence was estimated at 70.4% [65.8-74.7] in men and 72.3% [66.9-77.1] in women based on the study definition which combines self-reported physician diagnoses, standardized BP measurements and medication.

Conclusions:

Our study shows very good feasibility, acceptability and data completeness of standardized BP measurements using home visits. The prevalence of hypertension would be greatly underestimated in the absence of examination survey data with standardized measurements and detailed recording of medication.
THE INVESTIGATION OF TRANSFERABILITY OF DEFINITIONS OF CARDIOMETABOLIC AND VASCULAR AGING PHENOTYPES ACROSS MULTIPLE COHORTS
Authors: Moguchaia Ekaterina , Usoltsev Dmitrii , Boiarinova Maria , Alieva Asiyat , Vasilyeva Elena , Rotar Oxana , Konradi Aleksandra , Shlyakhto Evgengy , Artomov Mykyta
Published: May 2024

Objective:

According to the European guidelines for the prevention of cardiovascular diseases (CVD) (2021), Russia was identified as a country with a very high CV risk. We aimed to investigate the applicability of the standardized definitions of vascular aging phenotypes (VP) in Russian population and align them with the existing reference datasets.

Design and method:

In 2012-2013 1,600 residents of St. Petersburg (age 21-67) were randomly examined as a part of the multicenter epidemiological study. Anthropometry, blood pressure measurement, blood biochemistry analysis were taken. Subjects completed questionnaires describing their lifestyle, current health condition and medication usage. 618 patients (42% men) from initial cohort with a mean age of 48 [37;55] years were randomly subsampled for carotid-femoral pulse wave velocity assessment (Sphygmocor). The VP were defined using the ‘Reference Values for Arterial Stiffness’ Collaboration database which included 16,867 measurements from eight European countries populations15 to 97 years. According to the criteria, patients with overt CVD, diabetes mellitus and the use of antihypertensive, lipid-lowering therapy were excluded from the analysis of VP.

Results:

The Russian cohort had significantly higher prevalence of CVD (11,4% compared to 6,9% in the Nreference population, p=5.65x10-5), intake of antihypertensives (28,1% compared to 14,3% in the reference, p<1x10-16) and lipid-lowering therapy (6,1% compared to 4,1%, p=0.025, Figure 1A). Additionally, our cohort had significantly higher prevalence of optimal BP (40,2% vs 28%, p=4.6x10-7) and lower prevalence of first-degree (p=0.048) and second degree (p=0.00084) hypertension (Figure 1B). Comparison of the prevalence of VP between the European and Russian cohorts showed a significant decrease of the early vascular aging (EVA) phenotype with age in the Russian population (p=0.011). The prevalence of the supernormal vascular aging phenotype (SUPERNOVA) in the group of 60-69 years old was higher in the Russian population (p=0.0035)

Conclusions:

A higher prevalence of CVD was demonstrated in the study cohort despite lower hypertension burden and higher CV drugs intake compared to the European cohort. Multidirectional trajectories of EVA and SUPERNOVA VP with age were detected in Russian population, potentially indicating the presence of the clearing selection pressure at the older age (Agreement No 075-15-2022-301).
PREVALENCE, PATTERNS OF TREATMENT AND CONTROL OF INTERDIALYTIC AMBULATORY HYPERTENSION IN HEMODIALYSIS PATIENTS
Authors: Leonidou K , Georgianos P , Kollias A , Vaios V , Roumeliotis S , Kontogiorgos I , Leptokaridou E , Kourtidou C , Stergiou G , Zebekakis P , Liakopoulos V
Published: May 2024

Objective:

Studies using routine predialysis or postdialysis blood pressure (BP) recordings have provided considerably variable estimates of the prevalence and control of hypertension in the hemodialysis population. The aim of the present study was to investigate the epidemiology of hypertension in hemodialysis patients using the reference-standard technique of interdialytic ambulatory BP monitoring (ABPM).

Design and method:

A total of 70 hemodialysis patients underwent ABPM over an entire 44-hour interdialytic period (BP measurements at 20-minute intervals; Microlife WatchBP O3 device). Hypertension was defined as 44-hour ambulatory BP equal or higher than 130/80 mmHg or current use of antihypertensive medications.

Results:

The study included 70 patients (45 males and 25 females) with a mean age of 65.3±13.3 yeas and a median dialysis vintage of 15 months (range: 6, 33). Interdialytic ambulatory hypertension was prevalent in 90% of patients. Notably, isolated nocturnal hypertension was diagnosed in 27.1% of patients, whereas just 1.4% of patients had abnormal BP levels only during the daytime period. In all, 61 out of 63 hypertensives (96.8%) were receiving treatment with an average of 1.5±0.6 BP-lowering medications daily. Beta-blockers (75.4%) were the most commonly prescribed antihypertensive drug class, followed by dihydropyridine calcium-channel-blockers (42.6%) and renin-angiotensin-system inhibitors (8.2%). Lack of adequate ambulatory BP control was identified in 28.5% of hypertensives.

Conclusions:

This study shows that among patients on hemodialysis, the burden of interdialytic ambulatory hypertension is very high. The use of interdialytic ABPM enables the identification of isolated nocturnal hypertension, which is a very common BP phenotype in this patient population.
CARDIOMETABOLIC RISK FACTORS AND LIFESTYLE HABITS IN THE GENERAL POPULATION: RESULTS OF AN AWARENESS-RAISING EDUCATIONAL CAMPAIGN FOR HEALTH EMPOWERMENT
Authors: Del Pinto Rita , Serio Leandra , Campanozzi Elena , Marrone Enrica , Moronti Veronica , Santilli Jessica , Martini Cecilia , Bellisario Federico , Santilli Federico , Di Ruscio Evy , Altieri Piera , Baldini Gianluca , Di Gregorio Nicoletta , Ferri Claudio
Published: May 2024

Objective:

Most individuals have little awareness of their health status and do not engage in prevention measures to reduce the risk of future cardiovascular diseases (CVD. We conducted an observational study to assess the prevalence of common cardiometabolic risk factors and modifiable lifestyle measures in the general population.

Design and method:

During an awareness-raising educational campaign for cardiovascular prevention (October 10th, 2023), a cross-sectional study on consecutive volunteer individuals was conducted. Participants self-presented at local sites and accepted to undergo standard blood pressure (BP) measurement with automated devices and to complete a questionnaire on self-reported demographic and clinical features and lifestyle habits. Open seminars were held to educate on cardiovascular risk factors and related non-pharmacological preventive measures (including diet, physical exercise, smoking cessation). As part of the prevention of peripheral artery disease (PAD), participants received education on how to perform arterial pulses autopalpation. Here, stratification based on self-reported symptoms suggestive of PAD is reported. Descriptive analysis was performed with R.

Results:

A total of 160 participants took part in the survey, of whom 154 (113 F; mean age 38.5(18.7) years; 83.3% <=70 years) with no PAD symptoms. Their mean BP was 120/3(14.2)/76.2/(11.5) mmHg. Of them, 16.7% had DM2, 40% had hypertension, 50% had hypercholesterolemia, 49.3% were current/former smokers; 67% reported to exercise >=150’/week; 9.1% never/rarely consumed vegetables/fruit. Only 3.7% participants (mean age 56.5(15.5) years) declared symptoms compatible with PAD. Their mean BP was 145(18.7)/89.6(5) mmHg; 83.3% reported having hypertension, diabetes, high cholesterol, and/or never or rarely eating vegetables/fruits; 50% were smokers; 33.3% were sedentary; approximately 4 in 5 had measured their BP in the previous month. All participants were educated on the prevention of common cardiometabolic risk factors and self-examination of peripheral pulses.

Conclusions:

In the examined relatively young sample of the general population, cardiometabolic risk factors were common in individuals with and without symptoms of PAD, and lifestyle habits could be largely improved. Awareness-raising educational campaign represent a powerful opportunity for health empowerment.
COMPARATIVE ANALYSIS OF ATRIAL FIBRILLATION EPIDEMIOLOGY IN YOUNG ROMANIAN ADULTS IN SEPHAR II-IV SURVEYS
Authors: Cojocaru Cosmin , Vijiiac Aura , Gheorghe-fronea Oana , Dorobantu Maria
Published: May 2024

Objective:

Atrial fibrillation (AF) is increasingly prevalent in all European countries, particularly in those strongly associated with high cardiovascular risk. We sought to evaluate AF epidemiology in Romanian adults recruited in three consecutive editions of the SEPHAR national survey (Study for Evaluation of Prevalence of Hypertension and Cardiovascular Risk in an Adult Population in Romania) aged eighteen to fifty years.

Design and method:

We performed a post-hoc analysis of 5422 subjects randomly recruited to ensure a nationally representative distribution by age, sex and area of residence during three consecutive editions of a cross-sectional national survey assessing hypertension epidemiology in Romania. AF prevalence and potentially contributing factors to AF burden were assessed in all subjects aged 18 to 50 years. The presence of AF was defined either by study EKG diagnosis or by documented medical history of AF.

Results:

There were 52.4% (n = 2845) subjects aged less than fifty years (mean 35.4 ± 8.64 years, 45.5% males, 57.5% from urban areas). AF prevalence was 1.7% (n = 49) and significantly increased throughout the study (1% (n = 11) vs. 1.6% (n = 17) vs. 3.3% (n = 21), p = 0.001). AF prevalence was similar in males vs. females (1.9% vs. 1.6%, p = 0.47) and in urban vs. rural areas (1.7% vs. 1.8%, p = 0.77). There was a two-fold higher prevalence in hypertensives vs. normotensives (2.8% vs. 1.4%, p = 0.01). AF was significantly more frequent in diabetic subjects (4.3% vs. 1.4%, p = 0.02). The mean CHA2DS2-VASc score was significantly higher in AF patients (1.32 ± 1.21, p < 0.001) and was higher than 2 points in 49% (n = 24) of AF patients.

Conclusions:

Based on data stemming from three consecutive editions of SEPHAR, AF prevalence seems to have demonstrated a two-fold increase in Romanians aged less than fifty years and is significantly more frequent in diabetics and hypertensives.
ASSOCIATION OF TOTAL MORTALITY AND CARDIOVASCULAR ENDPOINTS WITH THE TIMING OF THE FIRST AND SECOND SYSTOLIC PEAK OF THE AORTIC PULSE WAVE
Authors: Cheng Yi -BANG , An De -Wei , Aparicio Lucas S. , Huang Qi -Fang , Li Yan , Staessen Jan A.
Published: May 2024

Objective:

Prognostic significance of the timing in the cardiac cycle of the first (TP1) and second (TP2) systolic peak of the central aortic pulse wave is ill defined.

Design and method:

Incidence rates and standardized multivariable-adjusted hazard ratios (HRs) of adverse health outcomes associated with TP1 and TP2, estimated by the SphygmoCor software, were assessed in the International Database of Central Arterial Properties for Risk Stratification (n=5529). Model refinement was assessed by the integrated discrimination (IDI) and net reclassification (NRI) improvement.

Results:

Over 4.1 years (median), 201 participants died and 248 and 159 patients experienced cardiovascular or cardiac endpoints. Mean TP1 and TP2, standardized for cohort, sex, age and heart rate, were 103 and 228 ms. Shorter TP1 and TP2 were associated with higher mortality and shorter TP1 with higher risk of cardiovascular and cardiac endpoints (trend P<0.004). The HRs relating total mortality and cardiovascular endpoints to TP2 were 0.82 (95% CI: 0.72-0.94) and 0.87 (0.77-0.98), respectively. The HR relating cardiac endpoints to TP1 was 0.81 (0.68-0.97). For total mortality and cardiovascular endpoints in relation to TP2, NRI was significant (P<0.010), but not for cardiac endpoints in relation to TP1. IDI was not significant for any endpoint. The HRs relating total mortality to TP2 were smaller (P<0.026) in women than men (0.67 vs 0.95) and in older (>60 years) vs younger (<60 years) participants (0.80 vs 0.88).

Conclusions:

Our study adds to the evidence supporting risk stratification based on aortic pulse analysis by showing that TP2 and TP1 carry prognostic information.
TRENDS AND DISPARITIES BY AGE, SEX, REGION, AND SOCIOECONOMIC STATUS IN HYPERTENSION PREVALENCE, AWARENESS, TREATMENT, AND CONTROL IN CHINA, 2012-2020
Authors: Cao Xue , Tian Yixin , Wang Xin , Zhang Linfeng , Zheng Congyi , Hu Zhen , Gu Runqing , Yu Xue , Pei Xuyan , Turdi Nurgul , Zhang Yujie , Wang Zengwu
Published: May 2024

Objective:

Hypertension has consistently maintained a high prevalence rate in China, however, comprehensive evidence for recent hypertension trends across specific population subgroups was limited. Our study aimed to examine trends in prevalence, awareness, treatment, and control of hypertension in China.

Design and method:

Data was derived from two cross-sectional nationally representative surveys, which enrolled 455770 participants aged 18 years or older in the 2012-2015 and 297065 participants in the 2020-2022. Hypertension was defined as a systolic blood pressure >= 140 mmHg, and/or a diastolic blood pressure >= 90 mmHg, and/or taking antihypertensive medication. The main outcome were prevalence of hypertension and awareness, treatment, and control rates for hypertension. We classified regions by socioeconomic status using the human development index (HDI). We also decomposed changes in hypertension prevalence into population growth, shift in population age structure, and changes in age-specific rate.

Results:

The mean age[SD] were 45.5 (17.6) years in 2012-2015, and 47.9 (18.1) in 2020-2022 in China. The weighted prevalence of hypertension increased from 23.2% (95% confidential interval [95%CI] 22.2%-24.3%) in 2012-2015 to 31.9% (95%CI 30.3%-33.4%) in 2020-2022, with the prevalence among 25-34 years old more than doubling. The gap in hypertension prevalence between urban and rural areas has widened, and the prevalence in rural areas exceeded that in urban areas in 2020-2022. In both surveys, the highest age-standardised prevalence was observed in very-high HDI region, north and northeast China, with the largest increase areas with upper-middle HDI level. In 2020-2022, the awareness, treatment, and control of hypertension were 43.8% (95%CI 41.4%-46.1%), 38.3% (95%CI 36.0%-40.6%), and 13.6% (95%CI 11.9%-15.5%), respectively. Higher age-standardised awareness, treatment, and control rates was observed in high and very-high HDI region in 2020-2022, and improvements were noted in very-low HDI and high HDI region. Nationally, changes in age-specific hypertension prevalence were the primary driver of increased prevalence of hypertension.

Conclusions:

Hypertension prevalence was still high in China, with an upward trend from 2012 to 2022. Awareness, treatment, and control of hypertension remained low. Findings in this study highlight the necessity for a more targeted strategy in addressing hypertension management.
PREVALENCE AND RISK FACTORS OF ALTERED CONTROL OF BP DURING THE NIGHT IN A LARGE HEMODIALYSIS POPULATION INVESTIGATED BY 48 HOURS ABPM
Authors: Torino Claudia , Mallamaci Francesca , Sarafidis Pantelis , Papagianni Aikaterini , Ekart Robert , Hojs Radovan , Balafa Olga , Del Giudice Antonio , Aucella Filippo , Morosetti Massimo , Tripepi Rocco , Marino Carmela , Tripepi Giovanni , Zoccali Carmine
Published: May 2024

Objective:

Altered BP control during the night (non-dipping, reverse dipping and nocturnal hypertension) is recognised as a powerful risk factor for death and CV events in the hemodialysis (HD) population. However, these alterations have been described in relatively small studies, and the epidemiology and risk factors for the subtypes of non-dipping and nocturnal hypertension are still poorly characterised in the current literature. We investigated the problem in the large EURECAM registry, the sole that has adopted state-of-the-art 48h ABPM recording in the HD population.

Design and method:

We included in this analysis 534 HD patients enrolled in 7 centres, led by members of the EURECA-m working group in 3 European countries. 48h ABPM was measured using validated instruments (AAMI/ESH/ISO). As the European Society of Hypertension guidelines recommended, recordings were made at 15-minute intervals during the day and 30 minutes at night. Hypertension was defined as 48h blood pressure (BP)>130/80, nocturnal hypertension as a nighttime BP>120/70 mmHg, non-dipping as a night/day systolic BP fall <10%, and reverse dipping as a night/day ratio >1.

Results:

Among 534 HD patients, 317 were hypertensive and. 217 normotensive. As many as 274 patients were non-dippers (51%), 32% were reverse dippers, and 381 (71%) had nocturnal hypertension. Of note, forty-one per cent of non-dippers, 37% of reverse dippers and 19% of patients with nocturnal hypertension were normotensives. As expected, most reverse dippers (87%) had frank nocturnal hypertension. In a combined analysis of non-dippers and reverse dippers, as compared to dippers, these patients more frequently exhibited atrial fibrillation and had lower Heart Rate both pre-dialysis (72±11 vs 77±13 bpm, P=0.004) and post-dialysis (74±13 vs 78±14 bpm, P=0.03) and lower serum albumin (3.9±0.4 vs 4.0±0.3 g/dL, P=0.02) but did not differ for age and gender.

Conclusions:

In a large cohort of HD patients investigated by the state-of-the-art technique, 48hABPM alterations in the nocturnal BP profile were almost universal, and nocturnal hypertension was the more prevalent alteration, followed by non-dipping and reverse dipping. These alterations were independent of age and gender. Long-term, granular follow-up analyses are warranted to identify the prognostic value of these alterations.