bluuebunny/crossref_metadata_2025 huggingface dataset:
NEUROPROTECTIVE EFFECTIVENESS OF 12-MONTH COMBINED ANTIHYPERTENSIVE THERAPY IN HYPERTENSIVE PATIENTS WITH COGNITIVE IMPAIRMENT
Authors: Yusupova Khafiza , Abdullaeva Guzal , Khamidullaeva Gulnoz
Published: May 2024

Objective:

to determine the comparative effectiveness of combination antihypertensive therapy including nitrendipine in patients with essensial hypertension with cognitive impairment.

Design and method:

The study included 58 male and female patients with I–III AH degree (ESC/ESH, 2018). The average age of the patients was 54.6±10.8 years, the average duration of AH was 8.8±5.52 years. The patients were divided into 2 groups: 1 group – hypertensive patients with cognitive impairment, n=40, 2 group – hypertensive patients without cognitive impairment, n=18. Cognitive function was assessed using the Montreal Cognitive Assessment Scale (MOCA) and Mini-Cog test.

Results:

Analysis of neuroprotective effectiveness of combined AHT in patients with EH, taking into account the presence/absence of cognitive impairment, revealed that according to the MOCA scale, cognitive functions improved only in 1 st group of patients, initially 22.35± 2.46 points in dynamics - 24.47 ± 2.44 points (p<0.001), in comparison with the group of patients without cognitive impairment: initially 27.3±1.19 points versus 26.3±1.84 points, respectively (p>0.05). And also using the Mini-Cog test, it was determined that the scores significantly increased only in 1 st group of patients: initially amounting to 3.75± 1.12 points, over time - 4.35 ± 0.86 (p < 0.02), then as in group 2, there was no significant increase in score.

Conclusions:

Positive dynamics of cognitive functions against the background of 12 months of AHT with the inclusion of nitrendipine was noted in the subgroup of patients with cognitive impairment.
BLOOD PRESSURE VALUES ACCORDING TO HOME AND CLINIC MEASUREMENTS AND INTRACRANIAL WAVEFORM ASSESSMENT IN HYPERTENSIVE PATIENTS
Authors: Costa Matheus , Sousa Ana Luiza , Morangoni Bárbara , Correia Mikaelle , Barbosa Letícia , Vitorino Priscila , Frigieri Gustavo , Inuzuka Sayuri , Barroso Weimar
Published: May 2024

Objective:

Evaluate the Association between Non-Invasive Intracranial Pressure (ICP) Values and Blood Pressure (BP) Values According to Home and Clinic Measurements

Design and method:

Cross-Sectional Study evaluating the association of variables, including Age, Gender, Office Systolic Blood Pressure (OSBP), Office Diastolic Blood Pressure (ODBP), Home Blood Pressure Measurements (HBPM), Time since Hypertension Diagnosis, P2P1, TTP, Intracranial Hypertension (IC) (P2P1 >1.2), Office Hypertension (Office BP 140/90mmHg), and HBPM Hypertension (HBPM 130/80mmHg). Data collected from participants and medical records. Data analysis conducted using chi-square test, Mann-Whitney U test, and bivariate correlation analyses. Blood pressure values adjusted for hypertension diagnosis time; P2P1 and TTP values adjusted for age. Confidence interval of 95% and p<0.05.

Results:

240 patients were evaluated, with average age of 63.4 years (±11.8), 73.3% were female. The average time of diagnosis of arterial hypertension was 19.1 years (±11.9). Uncontrolled blood pressure - 54.2% (n=130) via HBPM and 42.1% (n=101) in the clinic. The proportion of IC was 67.9%, higher in women (71.6%). There was negative correlation between P2P1 and age (r=-0.261; p=0.037). Correlations between P2P1 and systolic blood pressure (HBPM) (-0.152, p=0.019) as well as with morning systolic blood pressure (HBPM) (-0.175, p=0.006). Correlation between P2P1 and morning systolic blood pressure (HBPM) (rho= -0.192, p=0.011), and evening systolic blood pressure (HBPM) (rho= 0.157, p=0.037) was found only among women. Correlation between TTP and systolic blood pressure (HBPM) (rho= -0.194, p=0.003), The correlation between TTP and clinic diastolic blood pressure (rho= 0.313, p=0.012) was found only among men. Correlation between TTP and systolic blood pressure (HBPM) (rho= -0.201, p=0.007), morning systolic blood pressure (HBPM) (rho= -0.237, p=0.002), clinic diastolic blood pressure (rho= 0.157, p=0.038), and nighttime systolic blood pressure (HBPM) (rho= -0.202, p=0.007) was found only among women.

Conclusions:

The blood pressure control rates were similar when evaluated by different methods. There was no association between blood pressure control rates and IC. P2P1 and TTP values correlated with home blood pressure values, but only with clinic diastolic blood pressure values. The associations of P2P1/TTP values and home blood pressure measurements exhibited different patterns between men and women.
DIETARY SODIUM/POTASSIUM INTAKE AND COGNITIVE IMPAIRMENT IN ELDERLY PATIENTS WITH HYPERTENSION: DATA FROM NHANES 2011-2014
Authors: Kou Chengkun , Zhao Xu , Fan Xin , Wang Qiongying , Yu Jing
Published: May 2024

Objective:

Salt is a widely used condiment throughout the world. Sodium chloride is the main salt component. Sodium is an essential macronutrient that maintains fluid balance and cellular homeostasis.

It is suggested that dietary sodium may influence cognition by cerebrovascular and cerebral blood flow. This study aimed to assess the relationship between dietary sodium/ potassium intake and cognition in elderly individuals with hypertension.

Design and method:

We designed a cross-sectional study based on the 2011–2014 National Health and Nutrition Examination Survey (NHANES). Cognitive performance was assessed using the Digit Symbol Substitution Test (DSST), Consortium to Establish a Registry for Alzheimer's Disease test (CERAD), and Animal Fluency Test (AFT). Multivariate logistic regression and restricted cubic spline (RCS) was used to assess the relationship between dietary sodium/ potassium intake and cognition.

Results:

After excluding participants with incomplete data, 1670 out of 2276 participants had confirmed hypertension. Compared with the lowest quartile of dietary sodium, the lowest weighted odds ratio (OR) of cognitive impairment in DSST was observed in Q4 (OR=0.45, 0.29–0.70), and a similar trend was observed in AFT (OR=0.34, 0.18–0.65). After adjusting the covariates, the lowest weighted multivariate adjusted OR of cognitive impairment in DSST were also observed in Q4 (OR=0.47, 0.26–0.84) compared with the lowest quartile of dietary sodium. The RCS results showed that dietary sodium was U-shaped and associated with the risk of cognitive impairment in the DSST (Pnon–linearity=0.0067). No significant association was observed between dietary potassium and cognitive performance.

Conclusions:

Too high and too low dietary sodium levels were associated with impairment of specific processing speed, sustained attention, and working memory for hypertension among the elderly in the United States. However, no association was observed between the dietary potassium intake and cognition.
NON-INVASIVE CENTRAL BLOOD PRESSURE AND INTRACRANIAL WAVEFORM ASSESSMENT IN HYPERTENSIVE PATIENTS
Authors: Inuzuka Sayuri , Costa Thiago , Correia Mikaelle , Costa Matheus , Vitorino Priscila , Piza Polyana , Frigieri Gustavo , Sousa Ana Luiza , Coca Antonio , Barroso Weimar
Published: May 2024

Objective:

Hypertension (HT) remains as the leading cause of death around the globe and brain diseases, such as cognitive decline. The association between HT and cerebrovascular diseases is strong, mainly with stroke and cognitive impairment, but the mechanistic bases remain to be established.

The objective of this study is to observe central blood pressure, arterial stiffness and intracranial pressure in long-term chronic hypertensive patients.

Design and method:

Patients above 18 years were assessed from November 2022 to August 2023 with non-invasive central blood pressure and intracranial pressure waveform measurements in a cross-sectional analysis. Peripheral and central blood pressure parameters were obtained using a validated oscillometric device (Mobil-O-Graph). Non-invasive intracranial pressure measurement was performed with the validated Brain4Care (B4C) sensor. Using the B4C non-invasive evaluation, the cut-off point identified to define ICHT by the P2/P1 ratio was > 1.2, and the cut-off for time to peak (TTP) was > 0.25 seconds. To compare P2/P1 and TTP values between the categories of quantitative variables, the chi-square test was used; the Mann Whitney or ANOVA tests were used for bivariate analyses; and for correlations, the Spearman test was used. It was adopted as significant at p < 0,05.

Results:

Non-invasive central blood pressure, arterial stiffness, and intracranial pressure waveform assessment were performed in 145 patients with essential long-term hypertension over a period of ten months. The median age was 69.0 (61.8 – 75.7) years, 77.9% were female, and the median BMI was 29.0 (25.4 – 33.1) kg/m2. The average time since the hypertension diagnosis was 20.0 years. The median value of P2/P1 ratio for all cohort was 1.4 (1.2 – 1.5) and TTP 0.24 (0.21 – 0.29) seconds. A bivariate analysis was performed considering ICHT or not and the parameters of central BP and PWV assessments, with findings of higher central SBP, central DBP, and peripheral DBP among patients with ICHT by the parameter of P2/P1.

Conclusions:

Central systolic blood pressure levels are more linked to intracranial hypertension, while diastolic blood pressure values are similar, raising questions about the most suitable blood pressure assessment method for brain disorders.
LONG-TERM SURVIVAL AFTER AN ISCHEMIC STROKE. THE ESH STROKE SURVEY
Authors: Cifkova Renata , Wohlfahrt Peter , Krajcoviechova Alena Hrubes , Mayer Otto , Vanek Jiri , Hlinovsky David , Kielbergerova Lenka , Lanska Vera
Published: May 2024

Objective:

Identification of factors affecting long-term survival following ischemic stroke is of utmost importance. The aim of the present study was to assess long-term survival and factors associated with increased mortality after an ischemic stroke.

Design and method:

Consecutive patients hospitalized between March 2009 and January 2012 for their first-ever ischemic stroke in 2 large university hospitals in the Czech Republic were enrolled in this survey. Baseline data were obtained from hospital medical records. The median follow-up was 10.2 years. Vital status was determined using the death registry on July 28, 2023.

Results:

In total, 736 patients (mean age 66 ±11 years; 58% men) were included in this analysis. The cumulative risk of death at 1, 3, 5 and 10 years was 13.6%, 20.8%, 29.3% and 48.4%, respectively. After adjusting for age and sex, patients with discharge systolic blood pressure between 110 and 150 mmHg had the lowest mortality risk (Figure 1). Increased age, higher NIHSS and increased functional impairment, diabetes, and current smoking were associated with higher mortality risk, while lacunar stroke subtype, reperfusion therapy, and renin-angiotensin system blockers were associated with a lower mortality (Figure 2).

Conclusions:

Despite several advances in stroke management, the mortality remains high. Timely reperfusion therapy applied together with renin-angiotensin system blockers may reduce the risk of mortality.
BRAIN LOCAL ANGIOTENSIN II FORMATION DEPENDS ON RENIN ACTIVITY
Authors: Rodrigues André Felipe , Domenig Oliver , Danser A.H. Jan , Alenina Natalia , Poglitsch Marko , Bader Michael
Published: May 2024

Objective:

The blood-brain-barrier limits the traffic of all components of the renin-angiotensin system. Brain-localized production of angiotensin II (Ang II) has been challenged because the rate-limiting enzyme, renin, is expressed at very low levels in the brain. Our group has developed a transgenic mouse line that selectively overexpresses rat angiotensinogen (Agt) in brain astrocytes (Agt-Tg) yielding detectable levels of Ang II.

Design and method:

To confirm that Ang II is locally produced in the brain, the endogenous mouse Agt gene was deleted from Agt-Tg (Agt-Tg/Agt-KO) by breeding Agt-Tg with Agt-deficient mice (Agt-KO). To determine if renin is involved in the local production of Ang II in the brain, the genes (Ren1d and Ren2) encoding for renin of Agt-Tg were genetically deleted by crossbreeding with renin-deficient mice (Ren-KO). The resulting mouse line overexpresses Agt specifically in the brain but globally lacks renin (Agt-Tg/Ren-KO). All lines were backcrossed to the FVB/N inbred background for at least 8 generations. Whole brains and blood were collected from males and females aging between 15-22 weeks. Angiotensin peptides (Ang I, Ang II, Ang III and Ang 1-7) were quantified using LC-MS/MS by Attoquant Diagnostics GmbH

Results:

Ang II was detected in the brain, but not in the blood of Agt-Tg/Agt-KO mice suggesting local synthesis. Interestingly, Ang II was not detectable in brain samples of Agt-Tg/Ren-KO in contrast to their littermates Agt-Tg indicating that renin is essential for brain Agt processing into Ang II. Moreover, Ang I, Ang II were not detected in the blood of Agt-Tg/Ren-KO as expected but detectable in Agt-Tg. Finally, FVB/N wildtype controls presented no detectable levels angiotensin peptides in brain samples but in the blood.

Conclusions:

Collectively, the results from mice with brain-specific Agt overexpression support the notion that the brain locally and renin-dependently produces Ang II. The specific involvement of central or peripheral renin remains to be determined.
EVALUATION OF CARDIOVASCULAR RISK FACTORS IN CHILDREN AGED 6-16 YEARS OLD AND THEIR EVOLUTION AT EARLY ADULTHOOD IN A 10-YEAR FOLLOW UP STUDY
Authors: Ntretsiou Helen , Benas Dimitrios , Trivilou Paraskevi , Pavlidis George , Oikonomidis Ignatios , Attilakos Achilleas , Iliodromitis Efstathios , Triantafyllidi Helen
Published: May 2024

Objective:

Objective: Obesity and arterial hypertension in children represent well recognized main risk factors for cardiovascular (CV) events during adult life. We aimed to investigate any changes regarding several CV risk (CVR) factors of children aged 6-16 years old after a 10-year follow-up period.

Design and method:

Design and method: A cohort of 143 healthy children 6-16 years old (79/64 boys/girls, aged 9±2 years) was initially evaluated regarding CVR factors [obesity, blood pressure (BP), aortic stiffness, lipid profile] plus food habits/sports activity. At 10-years follow-up, 62/143 (43%) young adults were re-evaluated (33/31 boys/girls, aged 20±2 years old).

Results:

Results: Obesity, found in 45% of children, was accompanied by increased BP (p<0.001) and a less favorable low density lipoprotein cholesterol (LDL-C)/triglycerides profile (p=0.001). In a 10-year follow-up, obesity and exercise improved (p<0.001 and p=0.005), BP was elevated (p<0.001) at levels of high normal (40% of young adults), aortic stiffness increased (p<0.001), LDL-C and high density lipoprotein cholesterol (HDL-C) decreased (p=0.004 and p<0.001), triglycerides increased (p=0.04), and food approached the western model of nutrition (less fish/fruits). In children and young adults, body mass index (BMI) was associated with age (Beta=0.47, p<0.001 and Beta=0.36, p=0.004), systolic BP (Beta=0.46 and Beta=0.52, p<0.001), and LDL-C (Beta=0.27 and Beta=0.44, p<0.001).

Conclusions:

Conclusions: An increased incidence of obesity associated with systolic BP and accompanied by a less favorable lipid profile was found in children. At 10-years re-evaluation, obesity was partly improved, systolic BP had reached the high-normal levels in a substantial number of young adults while lipid profile was less favorable compared to baseline evaluation. Our results highlight the evolution of CVR factors from childhood to early adulthood.
STRICTER AMBULATORY BLOOD PRESSURE CONTROL IS POSSIBLE IN PATIENTS AFTER KIDNEY TRANSPLANTATION AND IS ASSOCIATED WITH REGRESSION OF LEFT VENTRICULAR HYPERTROPHY: POST HOC ANALYSIS
Authors: Seeman Tomas , Gilik Jiri , Vondrak Karel , Feber Janusz
Published: May 2024

Objective:

The recently published analysis of the 4C-T study demonstrated an association of stricter cumulative office blood pressure (BP) control with lower left ventricular mass (LVM) in children after kidney transplantation. The aim of our study was to investigate whether stricter control of ambulatory BP is also associated with improved LVMI and regression of left ventricular hypertrophy (LVH) in pediatric kidney transplant recipients.

Design and method:

A post-hoc analysis of nineteen patients (median age at baseline 9.7 years, range 3.3–15.1, median time after transplantation 4.3 years, range 1.0-13.1) from our previous ESCORT trial who had echocardiography performed at baseline (T0), 1 (T1), 2 (T2) and 3 (T3) years was performed. Cumulative 24-hour mean arterial pressure (MAP) Z-scores (CMAPz) were calculated according to 4C-T study (Sugianto et al. 2023). Left ventricular hypertrophy (LVH) was defined as LVMi>40 g/m^2.7 in girls >9 yrs of age and LVMi>45 g/m^2.7 in boys >9 yrs of age; in children <=9 yrs the LVH was defined as LVMi >95th percentile (Khoury et al 2009).

Results:

The median CMAPz decreased from a median +0.27 (IQR=-0.09 to +0.38) in the 1st year down to -0.06 (IQR=-0.26 to +0.32) in the 2nd year (p=0.02) and to +0.05 (IQR=-0.32 to 0.27) in the 3rd year (p=0.04) of follow-up. The prevalence (number) of children with LVH was 26% (5/19) at T0, 16% (3/19) at T1, 23% (3/13) at T2 and 0% (0/11) at T3 (trend in proportions p=0.06). All 5 children with elevated LVMi>0.9 at T0 decreased / normalized their LVMi at T3 (p=0.07), on contrary children without LVH at baseline did not significantly change their LVMi during follow-up.

Conclusions:

This first prospective interventional study demonstrated an association between stricter cumulative ambulatory MAP and regression of LVH in patients after kidney transplantation. Our data suggest that aiming stricter ambulatory BP can improve the often unfavourable cardiac phenotype in these patients. However, randomized control trial is required to confirm our findings.
RELATIONSHIP BETWEEN NEW SURROGATE MARKS OF INSULIN RESISTANCEAND AND BONE MINERAL CONTENT IN CHINESE ADOLESCENTS
Authors: Tian Mei , Ma Xiaoyan , Liu Jianxi , Tong Lingling , Ding Wenqing
Published: May 2024

Objective:

To analyze the relationship between the new simplified insulin resistance index and bone mineral content (BMC) in adolescents and its evaluation effect on low bone mass, so as to provide scientific basis for early identification and prevention of skeletal-related diseases in adolescents.

Design and method:

A total of 1594 adolescents aged 12-18 years in Yinchuan were selected by stratified cluster sampling. Binary Logistic regression was used to analyze the relationship between insulin resistance index and low bone mass, and receiver operating characteristic (ROC) curve was constructed to analyze its evaluation effect on low bone mass.

Results:

After adjusting for confounding factors, the new simplified insulin resistance index was positively correlated with BMC level (TyG: r = 0.113, TyG-BMI: r = 0.576, TG / HDL-C: r = 0.205) (all P < 0.001). After further adjustment of obesity index, the relationship between IR index and BMC turned into negative correlation. Logistic regression results showed that IR was a protective factor for low bone mass (TyG: OR = 0.74, 95% CI: 0.54∼1.03, TyG-BMI: OR = 0.95, 95% CI: 0.94∼0.95, TG / HDL-C: OR = 0.40, 95% CI: 0.26∼0.62) (all P < 0.05). After adjusting the obesity index, the above results were completely reversed. IR was a risk factor for low bone mass in girls (TyG: OR = 4.95, 95% CI = 1.29∼18.95; TG / HDL-C: OR = 4.38,95% CI = 1.04∼18.50) (all P < 0.05). ROC curve showed that TyG-BMI had the best evaluation effect on low bone mass(AUC=0.80,95%CI: 0.769∼0.825)(P<0.001).

Conclusions:

TyG-BMI can be used to identify low bone mass, which is of great significance for early prevention of bone-related diseases in adolescents. The relationship between IR and BMC is affected by obesity indicators. It is necessary to understand the complex relationship between IR, fat and bone mass more clearly.
RHYTHMICITY IN 24 HOUR BLOOD PRESSURE MEASUREMENTS AFTER PEDIATRIC KIDNEY TRANSPLANTATION AND ITS RELATION TO CARDIOVASCULAR END ORGAN DAMAGE
Authors: Grabitz Carl , Svatovski Todor , Özmen Mahmut , Jabarulla Mohamed Yaseen , Oeltze-jafra Steffen , Memaran Nima , Schaefer Franz , Wühl Elke , Melk Anette
Published: May 2024

Objective:

Cardiovascular risk factors, especially arterial hypertension, are very common after kidney transplantation (KTx) during childhood. Ambulatory blood pressure monitoring (ABPM) is the gold standard of hypertension diagnostics. The present study analyzes circadian and ultradian rhythms in ABPM and their association with left ventricular mass and aortic pulse wave velocity as markers of cardiovascular end organ damage.

Design and method:

From a prospective international multicenter observational study ABPMs of 151 children and adolescents after KTx could be analyzed. They were compared to a healthy cohort of 299 schoolchildren matched for gender and body length. Partial Fourier analysis was used to examine oscillatory fluctuations at 24, 12, 8 and 6 hours (h) period lengths in order to detect rhythms in both mean arterial pressure (MAP) and heart rate (HR). These rhythms could be further characterized in their amplitude as well as their acrophase which is the time interval until maximum amplitude after midnight.

Results:

In patients after KTx, a 12h rhythm in the MAP (figure panel A) and an 8h rhythm in HR were significantly more frequent than in healthy children. No difference in rhythm frequency was found for the other period lengths. Amplitudes in MAP were significantly smaller after KTx (24h, 8h, 6h) and MAP acrophases were significantly longer (24h, 12h, 8h) than in the control group (figure panel B and C). Significantly smaller amplitudes and longer acrophases were observed in the KTx cohort for HR as well.

Data assessing cardiovascular end organ damage was available for children after KTx: We observed a positive correlation of 24h MAP amplitude with arterial pulse wave velocity (r=0.19; p=0.036) and a comparable trend with 8h MAP amplitude (r=0.31; p=0.053). Left ventricular mass did not correlate with any of the rhythm parameters after KTx.

Conclusions:

Our analysis demonstrates altered circadian and ultradian cardiovascular rhythmicity after KTx. Compared to healthy children, the described rhythms are flattened and delayed. Interestingly, there was a correlation of MAP amplitudes with vascular stiffness that warrants further investigation. Hence, we are going to analyze follow-up ABPM measurements in the described cohort after KTx.
FEASIBILITY OF SCHOOL-BASED SCREENING FOR HIGH BLOOD PRESSURE IN CHILDREN: THE HEALTHY HEARTS @ SCHOOL STUDY
Authors: Glenning Jonathan , Sheeran Freya , Quach Jon , Cheung Michael , Best Stephanie , Quinlan Catherine , Mynard Jonathan
Published: May 2024

Objective:

High blood pressure (BP) in childhood is associated with end organ damage and cardiovascular events in mid-adulthood. Community-based BP screening may improve equitable access and awareness, but robust methodology is required. Accordingly, our aim was to assess the acceptability and feasibility of a two-stage school-based BP screening program incorporating targeted 24-hour ambulatory blood pressure monitoring (ABPM).

Design and method:

One-hundred-ninety-eight children (59% male, 7.6–12.7 years) in grades 3-6 were recruited from three primary schools in Melbourne, Australia. Following an education session for all children in these grades, BP was measured five times in students after parental consent, using the auscultatory method, alternating between arms and after five minutes of rest. Those with an average BP >85th percentile (AAP thresholds) or a risk factor for high BP had these measurements repeated two weeks later, along with ABPM. Families and students also completed an optional questionnaire post-program.

Results:

At the first assessment, 11 (5.6%) and 10 (5.0%) had elevated or hypertensive BP respectively (14.6% combined if using just the first measure). Fifty-nine (29.8%) were selected for the second assessment (including 10 with obesity, 15 born premature, four with a history of congenital heart disease, and nine with BP >85th percentile, but <90th percentile), of which 52 attended. ABPM indicated that 11 (5.6%) and five (2.5%) had white coat hypertension based on assessment one and two respectively, three (1.5%) had sustained hypertension (based on either assessment stage), and two (1%) had masked hypertension. Three additional participants each had either high BPs during school assessment but did not undertake, or had inconclusive, ABPMs. Overall, 11 (5.6%) were referred to a doctor for medical follow-up. The majority of students (67%) reported that ABPM was tolerable (‘bothersome’ score <8/10 for day and/or night). 96% of families approved of the program and 90% welcomed it as part of their child's schooling.

Conclusions:

These data indicate that a school-based BP screening program is acceptable and feasible, and that measuring BP on multiple occasions, and with targeted ABPM, is pivotal for minimising false positives and unnecessary referrals.
PREVALENCE OF HYPERTENSION, OBESITY AND NUTRITIONAL BEHAVIORS IN PRIMARY SCHOOL STUDENTS
Authors: Aysegul Ilgaz
Published: May 2024

Objective:

Hypertension and obesity seen in childhood are among the important public health problems while creating risks for diseases in both childhood and adulthood. Nutritional habits are one of the important factors in the development of obesity. This study aimed to determine the frequency of hypertension, obesity and the nutritional behaviors in primary school students.

Design and method:

This descriptive research was conducted with 210 primary school students aged 6-9. The blood pressure was measured to determine the frequency of hypertension, the Feeding Behavior Scale was used to determine nutritional behaviors, height and weight were measured to identify obesity status.

Results:

The mean age of the children was 7.21±0.69, the systolic blood pressure was 98.2±8.69, the diastolic blood pressure was 64.30±7.25 and the body mass was 16.66±3.43. The nutritional behavior scale total score was found to be 2.48±4.18. It was detected that 12.4% of primary school students were slightly overweight and 5.2% were obese. Hypertension was detected in 4.8% of the children, isolated systolic hypertension in 2.4%, and isolated diastolic hypertension in 2.4%. It was determined that there was a relationship between body mass index and systolic blood pressure and diastolic blood pressure (p<0.05), but there was no relationship between nutritional behavior score (p>0.05).

Conclusions:

It was determined that obesity rates were higher in primary school students, and the higher the body mass index, the higher the blood pressure. It can be said that interventional studies are needed to reduce obesity and hypertension in childhood.
ARE ADOLESCENTS CONSUMING MORE SALT THAN RECOMMENDED?
Authors: Shah Kriya , Athavale Bahaar , Vijan Shradha , Kamat Shambhavi , Shah Hardik
Published: May 2024

Objective:

To study and compare the amount and pattern of sodium (Na) consumption in urban and rural school-going adolescents in Western India and identify high risk groups for conducting awareness programs.

Design and method:

1850 subjects (urban- 935; rural- 915; Males-1012, Females -838) aged 14 - 17 years were recruited with prior permission from 5 schools in and around Mumbai. Data pertaining to demography, anthropometry and eating habits was collected. A self-administered semi-quantitative Food Frequency Questionnaire was used to record consumption pattern of 22 high salt containing food items, divided into 5 categories (bakery, fried, packed, preserved and fast foods). Each participant‘s sodium consumption from these food items was calculated. Additional sodium consumption from regular meals was excluded. Data was analyzed using standard growth charts and MS Excel.

Results:

Only 13% of subjects added table salt. 67% and 81% brought homemade food for snacks and lunch respectively. Median Sodium consumption of the study population was 573 mg/day (∼ 1.5 g salt) (Q1-Q3:254 - 851 mg/day). There was no statistically significant difference (p> 0.05) in the Median Na consumption of girls (454 mg/day) and boys (489 mg/day). Daily Median Na consumption was not significantly different (p < 0.05) in urban students (624 mg/day) as compared to rural (592 mg/day). Bakery and fried foods together comprised 51% of sodium consumption among the rural population, whereas all five food categories had almost equal representation in the urban population. 54% subjects’ BMI (34% urban, 20% rural) was above the normal range. Higher BMI values correlated significantly with higher daily Na consumption (p =0.001, Mann-Whitney test).

Conclusions:

The salt intake over and above the usual dietary salt consumption was high (∼ 2 g per day for urban and ∼1.8 g/day for rural adolescents). Nearly half the study population was found to be either overweight or obese. This double whammy has a singular potential for producing future hypertensives. Thus, targeted awareness and counselling programs for salt reduction in adolescents is the urgent need of the hour.
OBSTRUCTIVE SLEEP APNEA REMAINS A RISK FACTOR FOR MAJOR ADVERSE CARDIOVASCULAR AND CEREBROVASCULAR EVENTS IN HYPERTENSVIE PATIENTS UNDER TREATMENT: THE UROSAH DATA
Authors: Yao Xiaoguang , Li Nanfang , Heizhati Mulalibieke , Wang Yingchun , Zhang Delian , Luo Qin , Hu Junli , Wang Menghui , Zhu Qing
Published: May 2024

Objective:

The impact of the co-occurrence of hypertension and obstructive sleep apnea (OSA) on the risk of long-term cardiovascular disease (CVD) outcomes has not been extensively studied in the Asian population, and the residual effect of OSA on CVD in patients under antihypertensive treatment is not clear. The study aimed to explore the impact of OSA on the risk of CVD outcomes in a large-scale Asian cohort under antihypertensive treatment using retrospective design.

Design and method:

Hypertensive patients who underwent polysomnography (PSG) test in January 2011 to December 2013 were recruited from the UROSAH cohort, which was conducted in Hypertension Center of People's Hospital. OSA was defined as apnea hypopnea index over 5. Outcomes were extended major adverse cardiovascular and cerebrovascular events (MACCE), including the first occurrence of nonfatal myocardial infarction, nonfatal stroke, revascularization, rehospitalization due to unstable angina or heart failure and all-cause death. Cox regression analysis was performed to explore the effect of OSA and hypertension coexistence on MACCE.

Results:

A total of 3329 hypertension patients were enrolled, of whom 2585 patients (about 77.7%) suffered from OSA. During a median follow-up period of 7.0 years, 415 patients developed extended MACCE. The incidence of extended MACCE was significantly greater in patients with OSA than those without OSA (hazard ratio [HR]: 1.59; 95% confidence interval [CI]: 1.27-1.99; P<0.001). Overall, patients with OSA had an increased risk of cardiac events of 57% compared to those without OSA [HR (95%CI): 1.57 (1.04-2.39), P=0.034] and the association did not change in further sensitivity analysis. Particularly in uncontrolled hypertension, OSA was found to have a 93% increased risk of cardiac events, compared with patients without OSA (P=0.036).

Conclusions:

Untreated OSA seemed to be a factor affecting the prognosis of cardiac events in hypertensive patients, although the association between OSA and cardiac events would be attenuated by the pharmacological-induced blood pressure control, which highlights the need to treat OSA.
INTERMEDIATE AND LONG-TERM BLOOD PRESSURE OUTCOMES IN POSTPARTUM HYPERTENSION – AN INTERIM ANALYSIS OF THE BASEL POSTPARTUM HYPERTENSION REGISTRY
Authors: Hotz Leana , Socrates Thenral , Wenker Céline , Subeedhja Subeedhja , Rana Alessandro , Piattini Leana , Strobel Noémie , Vorster Viviane , Menzinger Zoë , Eichler Sophia , Mayr Michael , Lapaire Olav , Mosimann Beatrice , Vischer Annina , Burkard Thilo
Published: May 2024

Objective:

Postpartum hypertension (PPHT) affects 10% of all pregnancies and has various aetiologies including chronic hypertension (CH), hypertensive disorders of pregnancy (HDP) including preeclampsia (PE), and de novo PPHT. Women with PPHT are at an elevated risk for persistent hypertension and for developing cardiovascular and renal disease, but most outcome data is based on PE. Here, we investigated mean 24-hour blood pressure (24hBP) and renal target organ damage using microalbuminuria as a surrogate marker in the intermediate and long-term postpartum period.

Design and method:

In total 370 participants were prospectively enrolled in the PPHT registry including women with HDP and/or PPHT. 24hBP measurement and urinary analysis were conducted 3 (V3) and 12 (V12) months after delivery. Normotensive 24hBP was defined as mean systolic/diastolic 24hBP <130/<80 mmHg and microalbuminuria was defined as albumin/creatinine ratio >= 3 mg/mmol.

Results:

The mean age was 34.0 (±5.4) years. The proportion of CH was 44/370 (11.9%), gestational hypertension 118/370 (31.9%), preeclampsia, eclampsia or HELLP 205/370 (55.4%) and de novo PPHT 68/370 (18.4%). Data regarding V3 and V12 was available in 246 and 114 participants. Antihypertensive treatment was prescribed at baseline, V3, and V12 in 85.4%, 18.7% and 18.4% of participants. Prevalence of microalbuminuria at baseline, V3, and V12 was 84.9% 29.9%, and 16.9% respectively. The mean (±standard deviation) systolic 24hBP at V3 was 121.7(11) mmHg and mean diastolic 77.3(8.6) mmHg respectively. At V12, mean systolic 24hBP was 119.5(8.5) mmHg and diastolic 24hBP 75.6 (6.9) mmHg. Detailed 24hBP values and proportions of systolic and diastolic blood pressure control in participants with and without antihypertensive treatment are presented in Table 1.

Conclusions:

One year after giving birth, elevated albumin/creatinine ratio as a surrogate for renal target organ damage persisted in approximately 1 out of 6 participants. Blood pressure control was documented in approximately 3/4 of the participants at the one-year postpartum follow-up. Nevertheless, a relevant number of participants were hypertensive or still under treatment one year after birth. Therefore, continued follow-up and cardiovascular risk assessment in this population should be warranted.
EFFECT OF ANTIHYPERTENSIVE DEPRESCRIBING ON SERIOUS ADVERSE EVENTS, MORTALITY, AND CARDIOVASCULAR DISEASE: LONG-TERM FOLLOW-UP OF THE OPTIMISE RANDOMISED CONTROLLED TRIAL
Authors: Sheppard James , Temple Eleanor , Wang Ariel , Smith Anne , Pollock Stephanie , Ford Gary , Hobbs Richard , Kenealy Nicola , Lown Mark , De Lusignan Simon , Mant Jonathan , Mccartney David , Payne Rupert , Williams Marney , Yu Ly -Mee , Mcmanus Richard
Published: May 2024

Objective:

Deprescribing of antihypertensive medications is recommended for some older patients with polypharmacy and frailty. The OPTIMISE trial showed that this can be achieved without affecting blood pressure control at 3-month follow-up. This longer-term follow-up study aimed to examine the impact on serious adverse events (SAEs), mortality and cardiovascular disease (CVD) outcomes after at least 3 years.

Design and method:

Participants aged 80 years or older, with systolic blood pressure <150 mmHg, and receiving at least 2 antihypertensive medications were randomised (1:1) to a strategy of antihypertensive medication reduction (removal of one antihypertensive) or usual care. Participants were followed-up via their primary and secondary care electronic health records, at least 3 years after randomisation. The primary outcome was SAEs, defined as hospitalisation or death from any cause. Secondary outcomes included mortality, stroke, myocardial infarction and major CVD events. Analyses were undertaken using Cox proportional hazards modelling.

Results:

Among 569 randomised participants (intervention=282; control=287) with a mean age 85 years (276 [48.5%] women), 564 (99.1%) were followed-up for a median of 3.9 years. Medication reduction was sustained in 109 participants (52.7% of those alive in the intervention group) at 3 years. Participants in the intervention group were prescribed fewer antihypertensives than the control group (mean difference -0.35, 95%CI -0.52 to -0.18). Overall, 202 (72.1%) patients in the intervention group and 218 (76.8%) patients in the control group experienced SAEs during follow-up (adjusted HR 0.93, 95%CI 0.76-1.12). There was no evidence of a difference in mortality (aHR 0.81, 95%CI 0.58-1.13), stroke (aHR 0.91, 95%CI 0.40-2.06), myocardial infarction (aHR 0.86, 95%CI 0.42-1.77) or CVD events (aHR 1.00, 95%CI 0.68-1.46).

Conclusions:

Medication reduction was sustained in half of those attempting it, with no evidence of harm from SAEs, mortality or CVD after almost four years. These findings suggest that deprescribing antihypertensive medication is safe in older patients living in the community with controlled blood pressure.
BASELINE CHARACTERISTICS IN A RANDOMIZED PLACEBO-CONTROLLED STUDY OF THE EFFECTS OF THE SIX PLANT EXTRACTS COMBINATION TOTUM-854 ON BLOOD PRESSURE MANAGEMENT: THE INSIGHT STUDY
Authors: Ripoche Doriane , Otero Yolanda F. , Bargetto Maxime , Sapone Veronique , Noblet Fanny , Cazaubiel Murielle , Peltier Sebastien , Sirvent Pascal , Bard Jean -MARIE
Published: May 2024

Objective:

Arterial Hypertension (AHT) is a major cause of premature death worldwide. Polyphenolic compounds have shown promising effects in hypertension management. TOTUM-854 (T-854), a polyphenol-rich composition derived from six plant extracts, has potential in reducing the risk of developing AHT. The primary aim of this study is to evaluate the efficacy of T-854 in reducing systolic blood pressure in individuals with moderately elevated blood pressure.

Design and method:

The INSIGHT clinical trial is a multi-center, multi-country, randomized, double-blinded study, evaluating T-854 in individuals with high-normal and grade I hypertension who are not on medication affecting blood pressure. This trial assesses the impact of 3.71g of T-854 daily over 12 weeks on systolic blood pressure (SBP) reduction (AOBP, Automated Office Blood Pressure). Secondary objectives include effects on diastolic AOBP, blood lipids, glucose levels, hsCRP and anthropometric parameters.

Results:

A total of 412 participants (men 60% and women 40%) have been recruited across 3 countries, with a mean age of 45 years. According to the inclusion criteria, the population consists of individuals with high-normal (47%) or grade I hypertension (53%). A significant proportion exhibits anthropometric abnormalities (45% overweight, 25% obese). Some participants also show moderate metabolic abnormalities, notably total cholesterol over 5 mmol/L (49%) and fasting blood sugar levels above 5.5 mmol/L (25%). These characteristics align with those typically found in the general population, where elevated blood pressure often coexists with metabolic disorders related to overweight and obesity.

Conclusions:

In conclusion, the recruited population meets the study's inclusion criteria and is well-suited to evaluate the efficacy of T-854 in managing moderately elevated blood pressure. The study results are anticipated in mid-2024.
IN ARTERIAL HYPERTENSION THE RIGHT VENTRICLE IS NO LONGER THE “FORGOTTEN CAVITY”
Authors: Nicolae Camelia , Paun Nicolae , Uscoiu Gabriela , Munteanu Andreea Madalina , Iliesiu Adriana Mihaela , Nanea Ioan Tiberiu
Published: May 2024

Objective:

The right ventricle showed late interest in the assessment and stratification of the severity of arterial hypertension. The complex systemic reaction in the context of arterial hypertension, represented in particular by the activation of the renin angiotensin aldosterone system and the increase in sympathetic activity would suggest an early impairment of diastolic and later systolic function also of the right ventricle. Echocardiography is the most accessible way to evaluate the right ventricle in medical practice.

Purpose of the study: to evaluate the precocity and the type of right ventricular function impairment in recently diagnosed hypertensive patients.

Design and method:

The patients were included after following the recommendations for the diagnosis of arterial hypertension according to the guide published by ESH in 2023. Personal biological data and parameters, cardiovascular risk factors, blood pressure values were recorded. Patients with other comorbidities, with secondary hypertension were excluded.Patients on antihypertensive treatment were also excluded.

We investigated echocardiographically by analyzing 2D diastolic parameters, Doppler spectral and mitral and tricuspid tissue parameters as well as the global longitudinal strain of both ventricles. We studied right ventricle global longitudinal strain (RVGLS), septal wall longitudinal strain (RVSWLS), right ventricle lateral wall longitudinal strain (RVLWLS).

Results:

we studied a group of 61 patients who presented with essential hypertension, recently diagnosed, with an average age of 68.1 +- 6.3 years and who were analyzed according to grade, gender, risk factors. The (RVGLS) was analyzed separately and comparatively for the lateral and septal wall and the values were RVGLS =19%+- 3.2%. RVSWLS=-13.1% +-2.9% and RVFWLS=-22.6%+- 3.4%. The filling ratio of the right ventricle E/e’ was 14.

Conclusions:

the diastolic function of the right ventricle is affected in recently diagnosed hypertensive patients in relation to the degree of hypertension, myocardial mass and the filling ratio of the left ventricle. Slightly increased values of RVLWGLS could be interpreted as a consequence of sympathetic activation
EFFECT OF HIGH DOSE APROCITENTAN IN PATIENTS WITH RESISTANT HYPERTENSION NOT CONTROLLED BY LOW DOSE
Authors: Narkiewicz Krzysztof , Danaietash Parisa , Gimona Alberto , Kania Grzegorz , Kantola Ilkka , Martinez-garcia Fernando , Sassi-sayadi Mouna , Schlaich Markus P , Toursarkissian Nicole , Wang Ji -GUANG , Weber Michael A
Published: May 2024

Objective:

The phase 3 PRECISION study in patients with resistant hypertension tested 12.5 mg and 25 mg aprocitentan during the 4-week DB placebo-controlled part, in addition to a fixed-dose combination of amlodipine, valsartan, hydrochlorothiazide. No differences in primary endpoint (SiSBP) were observed between the two doses. This post-hoc exploratory analysis evaluates the observed long-term benefit of increasing to a higher dose (25 mg) in patients not achieving a blood pressure control after 4 weeks on the lower dose (12.5 mg).

Design and method:

In PRECISION, after completion of the 4-week DB part 1, all randomized patients received 25 mg aprocitentan during the 32-week SB part 2. This subgroup analysis includes 93 subjects who were still uncontrolled at week 4 (SiSBP > 140 mm/Hg) in the 12.5 mg aprocitentan group (n=223). The % of patients achieving control (<140 or < 130 for SiSBP and < 90 or < 85 mm/Hg for SiDBP) or showing a response of >/= -10 or >/= -15 mmHg in SiSBP or >/= -5 or >/= -10 mm/Hg in SiDBP vs week 4 at week 6, 12 and 36 (i.e., after 2 to 32 weeks of treatment with 25 mg) were calculated.

Results:

Among the patients in the aprocitentan 12.5 mg group with uncontrolled SiSBP at 4 weeks, after 2 weeks of treatment with 25 mg (at study Week 6), 39.8% (37/93) of subjects achieved SiSBP < 140 mmHg. This increased to 49.3% (37/73) after 32 weeks of aprocitentan 25 mg treatment, at study week 36. The control rate set at the 130 mm Hg threshold and the response rates also increased over time. Also, for SiDBP the increase in the dose of aprocitentan resulted in a high proportion of patients being controlled (45% to 68% depending on the threshold) and responders (45 to 68%) after 32 weeks of treatment.

Conclusions:

These additional exploratory analyses show that switching from 12.5 mg to 25 mg aprocitentan can achieve further BP control or response not obtained with the lower dose.
EVALUATION OF THYROID FUNCTION AND THYROID DISEASES IN PATIENTS WITH PRIMARY ALDOSTERONISM
Authors: Maiturouzi Mayire , Zhu Qing , Zhang Delian , Li Nanfang , Wu Ting , Liu Shasha , Luo Qin , Wang Menghui , Heizhati Mulalibieke , Cai Xintian , Cai Li , Dang Yujie , Aimudula Adilakezi
Published: May 2024

Objective:

To explored the thyroid function and prevalence of thyroid diseases in primary aldosteronism (PA) and PA subtypes.

Design and method:

Patients with PA and Essential hypertension (EH) in our hypertension center between August 2011 to June 2022 were enrolled in this observational study. All PA patients underwent adrenal venous sampling (AVS), thus receiving the most accurate subtype diagnosis available. The differences of thyroid function and the prevalence of thyroid diseases between PA and EH patients were analyzed.

Results:

7161 participants were included in the study with a mean age of 48.20±8.83 years and a mean BMI of 26.52±3.45 kg/m2. Two groups: PA patients showed lower FT4, FT3, TT4, TT3, positive TPOAb and higher prevalence of thyroid nodules (22.5%) than EH patients. PA was significantly associated with thyroid nodules (OR: 1.245, 95%CI: 1.052-1.473, P= 0.011). Three groups: statistical differences in FT4, FT3, TT4, TT3, and positive TPOAb levels were found in APA, IHA and EH. Thyroid nodules are most prevalent in APA (26.00%), followed by IHA (20.80%) and EH (17.80%). APA showed a significant association with thyroid nodules (OR: 1.345, 95%CI: 1.015-1.781, P=0.039). Additionally, it was found that FT4, FT3, TT4, and TT3 were negatively correlated with the PAC levels in patients. The stratification analysis showed that the prevalence of thyroid nodules was higher in subjects with PAC levels great than or equal to 12ng/dL.

Conclusions:

Compared to EH groups, PA patients had lower thyroid function and higher prevalence of thyroid nodules.
TO EXPLORED THE THYROID FUNCTION AND PREVALENCE OF THYROID DISEASES IN PRIMARY ALDOSTERONISM (PA) AND PA SUBTYPES
Authors: Maiturouzi Mayire , Zhu Qing , Zhang Delian , Li Nanfang , Wu Ting , Liu Shasha , Luo Qin , Heizhati Mulalibieke , Wang Menghui , Cai Li , Cai Xintian , Dang Yujie , Aimudula Adilakezi
Published: May 2024

Objective:

To explored the thyroid function and prevalence of thyroid diseases in primary aldosteronism (PA) and PA subtypes.

Design and method:

Patients with PA and Essential hypertension (EH) in our hypertension center between August 2011 to June 2022 were enrolled in this observational study. All PA patients underwent adrenal venous sampling (AVS), thus receiving the most accurate subtype diagnosis available. The differences of thyroid function and the prevalence of thyroid diseases between PA and EH patients were analyzed.

Results:

7161 participants were included in the study with a mean age of 48.20±8.83 years and a mean BMI of 26.52±3.45 kg/m2. Two groups: PA patients showed lower FT4, FT3, TT4, TT3, positive TPOAb and higher prevalence of thyroid nodules (22.5%) than EH patients. PA was significantly associated with thyroid nodules (OR: 1.245, 95%CI: 1.052-1.473, P= 0.011). Three groups: statistical differences in FT4, FT3, TT4, TT3, and positive TPOAb levels were found in APA, IHA and EH. Thyroid nodules are most prevalent in APA (26.00%), followed by IHA (20.80%) and EH (17.80%). APA showed a significant association with thyroid nodules (OR: 1.345, 95%CI: 1.015-1.781, P=0.039). Additionally, it was found that FT4, FT3, TT4, and TT3 were negatively correlated with the PAC levels in patients. The stratification analysis showed that the prevalence of thyroid nodules was higher in subjects with PAC leve greater than or equal to 12ng/dL.

Conclusions:

Compared to EH groups, PA patients had lower thyroid function and higher prevalence of thyroid nodules.