bluuebunny/crossref_metadata_2025 huggingface dataset:
THE EFFECT OF PHYSICAL EXERCISE ON CENTRAL VASCULAR FUNCTION IN OVERWEIGHT AND OBESE NORMOTENSIVE ADULTS: INTERIM ANALYSIS OF LONGITUDINAL BEFORE-AND-AFTER STUDY SPANNING 14 WEEKS
Authors: Podrug Mario , Koren Pjero , Stijanovic Ana , Russo Andrea , Pezelj Luka , Mudnic Ivana , Boban Mladen , Jeroncic Ana
Published: June 2022

Objective:

Physical activity is a relevant modifier of cardiovascular risk and is recommended to control BP levels in obese hypertensive patients. This study is aimed at assessing its effect on central vascular function (CVF), a potential preventive target known to impact high-flow end-organs, in overweight and obese normotensive participants.

Design and method:

We enrolled normotensive overweight and obese (classes 1–3) participants who joined lifestyle modification programme at a local gym. The programme includes two 7-week cycles of 1-hour mixed cardio and strength training, 5 sessions/week. CVF parameters (arterial stiffness and hemodynamics) were measured with the SphygmoCor XCEL device at 4 timepoints: baseline and after 3, 7, and 14 weeks of training; on a day when participants had not exercised for at least 24 hours. We used the Friedman test for repeated measures in data analysis.

Results:

An interim analysis included 15 participants (median BMI 33, range 27–43). Their median age was 35 years (25–49) and were predominantly women (n = 11). We observed a significant improvement after initiation of physical activity in all assessed parameters of CVF (P < 0.05 for all). The greatest improvement was observed at 3 weeks, which continued to 7 weeks but to a lesser extent. At 14 weeks, parameter values deteriorated, likely due to 8 participants not adhering to the 8–14 week schedule, but values were still significantly better than baseline. The median improvement at 7 weeks included a 0.5 m/s reduction in carotid-femoral pulse wave velocity, a 9% reduction in central augmentation index corrected for changes in HR, and a 5 and 6 mmHg reduction in cSBP and cDBP, respectively. The median weight lost from baseline was 1.8, 2.4 and 5.8 kg at 3, 7, and 14-weeks respectively.

Conclusions:

Physical activity induced non-trivial improvement in CVF in people at increased risk of CVD. While training was accompanied with weight loss, this likely did not affect CVF outcomes as median body mass loss up to 7 weeks was small (2.8%) and direction of the effect on CVF at week 14 was aligned with exercising, not weight loss.
METABOLICALLY HEALTHY OBESITY IN A YOUNG POPULATION ASSISTED BY THE FAMILY HEALTH STRATEGY
Authors: Fernandes Ana Cristina Tenório C. , Monteiro Daniela Fiuza G. , Grune Christina , Cervasio Ana Rachel Bucar , Tostes Felipe Rey C. , Velho Junior Ivan Costa , Klen Mariana Stutz , Da Silva Guimarães Karine , De Souza Mello Tomás , Borges Rodrigo Eugenio Vinuto , Mazzoli Ana , Muxfeldt Elizabeth Silaid
Published: June 2022

Objective:

To evaluate the prevalence and cardiovascular (CV) risk factors associated with metabolically healthy obesity (MHO) in a young population assisted by a Family Health Care unit in a large urban center.

Design and method:

A cross-sectional population study for CV risk assessment in adults aged 20–50 years old from a Family Health Care unit. Demographic, anthropometric data and CV risk factors were recorded. All underwent office blood pressure (BP) measurements, laboratory evaluation (lipid and glycidic profile). Obesity was defined as a body mass index (BMI) > 30 kg/m2 and MHO are those who have less than 3 of the following criteria for metabolic syndrome: office BP higher or equal to 130 x 85 mmHg, hypertension, fasting blood sugar higher or equal to 100 mg/dL, HDL < 40 mg/dL (men) and 50 mg/dL (women), triglycerides > 150 mg/dL and waist circumference > 102 cm (men) and > 88 cm (women).

Results:

A total of 632 individuals were evaluated (60% female; mean age 37 ± 9 years). The prevalence of obesity was 26%, of which 73% were classified as MHO.

Obeses are older, with a higher prevalence of physical inactivity (51% vs 41%, p = 0.03), hypertension (44% vs 19%, p < 0.001), dyslipidemia (50% vs 36%, p = 0.002), and diabetes (7% vs 2%, p = 0.001) with higher systolic OBP.

MHO compared to unhealthy ones are significantly younger and smoke less. Despite being obese, they have lower BMI (33.6 vs 35.2 kg/m2, p = 0.02) and abdominal circumference (102 vs 110 cm, p = 0.03), with lower diastolic BP.

Conclusions:

MHO was more prevalent in this young population and seems to have a lower CV risk, however it is not clear whether these younger and less obese individuals are only at an earlier stage of the disease. Perhaps the CV diseases onset is postponed for a few years. Even so, these individuals should not be excluded from public health policies as a form of primary prevention
THE EFFECT OF DIETERY CHANGES ON WEIGHT AND BLOOD PRESSURE IN MIDDLE AGE PATIENTS WITH OVERWEIGHT/OBESITY AND HIGH NORMAL BLOOD PRESSURE
Authors: Molchanova Olga
Published: June 2022

Objective:

To evaluate the effects of dietary weight loss intervention in middle age with high normal blood pressure and overweight/obesity.

Design and method:

Men and women aged 25–54 was from working population were observed within the prospective epidemiological study: in subjects with BMI more than 25 kg/m2and BP 130–139/85–89 mm Hg. Was found a strong correlation of systolic BP and BMI was revealed: p = 0.0001 in women and p = 0.0045 in men. The same was true for diastolic BP: p = 0.0001 in women and p = 0.0001 in men. Two groups were formed and followed for 3 years: Intervention and Control groups consisted of 455 subjects (203 and 252 respectively). Dietician’s consultations were used in intervention group.

Results:

An increase of BMI by 1 kg/m2was associated with increase of systolic BP in women and men (by 1.3 and 0.7 mmHg respectively), (p < 0.05). For diastolic BP increase of BMI by 1 kg/m2was associated with increase in men and women (by 0.7 and 0.9 mm Hg respectively). In stepwise regression analysis body mass explains 27% of systolic BP variability and 11% of diastolic BP variability in men. In women it was 19% and 17% respectively. Last follow up visit attended more than 76% of the participants. After 3 years of intervention a weight loss was noted in the intervention group on an average at 1.17 kg in women (p < 0.05) and 0.63 kg (p < 0.05) in men. In controls body weight increased in women and in men (at 3.08 and 2.89 kg respectively) (all p < 0.05). BP decreased in the intervention group - 3.27 for systolic BP and – 2.09 mm Hg for diastolic BP in women; - 1.92 and – 1.91 mm Hg in men respectively. In control group BP increased: 2.97 mm Hg systolic BP and 1.29 mm Hg for diastolic Bp in women and 2.56 mm Hg and 2.39 mm Hg in men respectively (all p < 0.05).

Conclusions:

Dietary approach to weight loss is effective tool in middle age men and women with high normal BP and overweight/obesity for prevention of hypertension.
AQUAPORIN-3 AND HEPARANASE GENETIC POLYMORPHISMS MAY MODULATE ANGIOGENESIS INFLUENCING THE RISK OF HYPERTENSIVE DISORDERS IN WOMEN
Authors: Da Silva Ines Vieira , Santos Ana Carolina , Matos Andreia , Ferreira Joana , Da Silva Alda Pereira , Soveral Graça , Bicho Maria Clara , Rebelo Irene , Bicho Manuel
Published: June 2022

Objective:

Preeclampsia (PE), a pregnancy complication triggered by oxidative stress and hypoxia, compromises mother and baby health and changes mother’s blood vessels increasing the risk for hypertension(HT). Aquaporin-3 (AQP3) is a water/H2O2/glycerol channel with implications in redox signaling. Heparanase (HPSE) has a role in extracellular matrix remodeling during angiogenesis. So far, no relation between AQP3 and HPSE genetic polymorphisms in PE subjects has been addressed. Thus, we aimed to investigate the association of AQP3(rs2231231) and HPSE(rs4693608) polymorphisms with the development of hypertensive disorders in women.

Design and method:

We investigated the distribution of AQP3 and HPSE genetic variations in a cohort of 150 normotensive (NT) or PE women, along with intermediate phenotype and anthropometric parameters. In a prospective study, women were reclassified 2–16 years after being PE or NT during pregnancy as NT or HT and genetic associations were reevaluated. Data was analyzed using SPSS software, P-values < 0.05 were statistically significant.

Results:

No differences were found in the distribution of the studied polymorphisms in PE. Allele A of AQP3 was more prevalent in HT after pregnancy(P = 0.014) and correlated with subjects with increased systolic(P = 0.017) and diastolic(P = 0.008) blood pressures. Moreover, allele A was considered the allele of risk, associated with a 3.53-fold higher risk(P = 0.018) to develop HT after pregnancy. In this cohort, serum myeloperoxidase (MPO) higher levels correlated with PE (P = 0.000) and HT (P = 0.024) and were associated with HT after a NT pregnancy(P = 0.000). Although HPSE did not correlate with PE or HT, Allele A carriers were associated with increased Apolipoprotein A(ApoA;P = 0.027), uric acid(P = 0.027) and MPO(P = 0.005) in PE. In HPSE, PE subjects with allele G correlated with increased number of leucocytes(P = 0.048) while the presence of allele A was associated with decreased serum uric acid(P = 0.028). When the 4 groups were reevaluated, allele A of HPSE was associated with decreased blood glucose levels(P = 0.05) and increased pulse pressure(P = 0.003) and uric acid(P = 0.05) in women that had PE. Allele G was more frequent with lower levels of leucocytes(P = 0.024) in women that had PE and later HT.

Conclusions:

The AQP3 polymorphism is a promising biomarker for HT. HPSE polymorphism predicts PE-associated variations in the intermediate phenotype.
MET235THR POLYMORPHISM IN THE AGT GENE AS THE DEVELOPMENT FACTOR OF SEVERE PREECLAMPSIA
Authors: Kurbanov Bakhodir
Published: June 2022

Objective:

Every year, as a prediction risk of developing preeclampsia, experts are attracted by polymorphisms of some genes involved in the regulation of vascular tone and endothelial function.

The purpose - to establish the features of Met235Thr polymorphism in the AGT gene in the development of severe preeclampsia.

Design and method:

We examined 139 pregnant women in the third trimester of gestation which were divided into 2 groups: The main group - 56 pregnant women with severe preeclampsia. The control group is 83 conditionally healthy women. The age of the pregnant women was 19–37 years.

The material for the study was DNA samples from pregnant women.

Isolation of DNA from blood and PCR analysis were performed with kits of reagents and test systems from Ampli Prime Ribot-prep.

Results:

The shares of the Thr allele, being at very close levels in values, were insignificantly less in the control group, where they were 36.9%, versus 38.4% among patients with severe preeclampsia.

The detection rate of the homozygous wild Met / Met genotype of the Met235Thr polymorphism of the AGT gene was also insignificantly higher in the control group, being at the level of 43.0% (x2 = 0.15; p = 0.70; RR = 0.92; 95% CI: 0.33–2.54; OR = 0.87; 95% CI: 0.42–1.79), which was insignificantly higher than among patients with severe preeclampsia 39.5%.

The heterozygous Met / Thr genotype, also relatively evenly distributed between the groups, was insignificantly less frequently detected in the control group, amounting to 40.2% (x2 = 0.20; p = 0.67; RR = 1.1; 95% CI: 0.41–2.97; OR = 1.18; 95 % CI: 0.58–2.41), versus 44.2% among patients with severe preeclampsia.

The homozygous mutant Thr / Thr genotype, also being at a comparable level, prevailed statistically insignificantly in the control group (16.8%), relative to the group of patients (16.3%) (x2 = 0.01; p = 0.94; RR = 0.97; 95% CI: 0.25–3.72; OR = 0.96; 95% CI: 0.38–2.44)

Conclusions:

We can conclude that the Met235Thr polymorphism in the AGT gene in women with severe preeclampsia has clinical prognostic significance.
COURSE OF PREECLAMPSIA IN CHRONIC KIDNEY DISEASE (CKD)
Authors: Alekseeva Maria , Demyanova Ksenia , Kozlovskaya Natalya , Korotchaeva Yulia , Chegodaeva Ayana , Apresyan Sergey , Kobalava Zhanna
Published: June 2022

Objective:

The aim of the study is to analyze the incidence and characteristics of PE in patients (pts) with CKD.

Design and method:

A retrospective analysis of 60 case histories of pregnant women with CKD 1–4 stages followed in the nephrology center for pregnant women from 2018–2021 was carried out. 20 of them developed PE: CKD 1 – 7/23 (30,4%), CKD 2 – 3/10 (30%), CKD 3 – 7/23 (30,4%), CKD 4 – 3/4 (75%), then the course of their pregnancy was analyzed. Indicators of proteinuria (PU) and blood pressure (BP) were assessed at the time of the first visit to the center and further, at the time of PE.

Results:

In the group of pts with PE and CKD (n = 20), the mean age was 29.3 (± 6) years. The causes of CKD were: glomerulonephritis - 13 (65%); tubulointerstitial nephritis 2 (10%); aHUS 2 (10%) and one each - polycystic kidney disease, diabetic nephropathy, APS-associated nephropathy. The mean term of gestation at the time of first visit to the dedicated center was 15.5 weeks. The mean RU was 1.4 (± 0.8) g/l. Arterial hypertension had 9 pts.The mean BP at the first visit was: SBP 129 (± 15)/DBP 85 (± 10) mm. Hg. PE before 34 weeks of gestation developed in 13 (65%) pts, and the mean term for the development of PE was 31.8 weeks [24; 38]. The mean BP at the moment of PE was 139 (± 16.6)/89 (± 10) mm Hg, so in 45% (n = 9) of cases, BP did not meet the criteria for PE. The majority of women showed an increase in PU 3,6 ± 2,9 g/l. The mean value of the sFLT1/PLGF ratio in PE was 135, that for a given gestational term (31.8 weeks) corresponds to severe ischemic damage to the placenta.

Conclusions:

We believe that the main features of PE in pts with CKD are its earlier onset and lower blood pressure values than those provided by modern criteria for PE. In this regard, it is important to monitor the angiogenic coefficient in dynamics in pregnant women with CKD.
BLOOD PRESSURE MANAGEMENT WITH THE ESH CARE APP – PRELIMINARY RESULTS
Authors: Siafi Eirini , Konstantinidis Dimitrios , Andrikou Ioannis , Polyzos Dimitrios , Drogkaris Sotiris , Manta Eleni , Tatakis Fotis , Zammanis Ioannis , Grigoriou Kalliopi , Dimitriadis Kyriakos , Leontsinis Ioannis , Tsioufis Konstantinos
Published: June 2022

Objective:

Main issues in the treatment of hypertension are the low level of blood pressure (BP) control and the economic burden for health care systems. Mobile application with telemonitoring of BP could contribute to better control and lower costs by reducing office visits. This could be useful nowadays with difficult access to health system due to covid-19. The purpose of this study was to investigate if an innovative management strategy of hypertension, such as the use of ESH care application for smartphones combined with a dedicated platform, could improve hypertension control and replace frequent office visits.

Design and method:

30 uncontrolled hypertensive patients, treated or untreated [mean age 53 ± 9 years, mean office BP (OBP) 146.3 ± 6.2 / 92.5 ± 9 mmHg, 53% men, 33% smokers, 23% with hypercholesterolemia] were randomized to the application assisted strategy (AAS) (17 patients), where a mobile phone application was offered to communicate home BP measurements (HBPm), or to regular office visits (13 patients). Patients’ BP measurements (HBPm for AAS and OBP for standard care group) were evaluated in 1 and 3 months with treatment titration if uncontrolled. In all patients OBP and ambulatory BP measurement (ABPM) were evaluated in 6 months.

Results:

In both groups the reduction in OBP and ABPM was significant in 6 months. In the AAS group the reduction in systolic/diastolic OBP and 24 h systolic/diastolic BP in 6 months was -26.5 ± 5.6 / -19.4 ± 8.2 mmHg (p < 0,001) and -19.6 ± 7.7 / -13.8 ± 4.8 mmHg (p < 0.001), respectively. In the standard care group, the reduction in systolic/diastolic OBP and 24 h systolic/diastolic BP in 6 months was -22.6 ± 9.7 / -9.6 ± 11 mmHg (p < 0.005) and

-18.4 ± 6.0 / - 8.8 ± 4.4 mmHg (p < 0.001). In AAS group compared to standard care group there was a greater reduction in 24 h diastolic BP (-13.8 ± 4.8 mmHg vs -8.8 ± 4.4 mmHg, p = 0.016) and in diastolic OBP (-19.4 ± 8.2 mmHg vs -9.6 ± 11.0 mmHg, p = 0.04)

Conclusions:

The present results indicate that the monitoring of patients through a mobile health tool could be useful in hypertension management as it is correlated with better BP control compared to office visits. The trial is still enrolling patients.
THE INFLUENCE OF HEREDITY ON LIFESTYLE CHANGES AND PARTICIPATION IN SCHOOL OF CHRONIC PATIENTS IN PATIENTS WITH HYPERTENSION
Authors: Bekbergenova Zhanagul , Derbissalina Gulmira , Umbetzhanova Ayagyoz , Batarbekova Sholpan , Masharipova Alexandra , Mauletbayeva Gulsum , Akhmetova Dina , Kelimberdiyeva Elmira
Published: June 2022

Objective:

Background / Introduction. Hypertension is one of the most common causes of myocardial infarction and stroke in the Republic of Kazakhstan. One of the unmodifiable risk factors is heredity.

Purpose: evaluating the impact of heredity on lifestyle changes, taking basic therapy, and participating in school for a chronic patient.

Design and method:

A survey of 354 patients with hypertension identified at screening was carried out.

Results:

The average age of patients is 54 years [Q1-Q3: 50–54], of which 36.2% are men, 63.8% are women. In 66.7% of patients, heredity is burdened.

According to the data obtained, when assessing heredity depending on lifestyle changes, significant differences were revealed (p = 0.004) (methods used: Fisher’s exact test).

The chances of changing the lifestyle in the group with a burden of heredity were 2.11 times lower than in the group of non-burdened heredity, the differences in the chances were statistically significant (OR = 0.48; 95% CI: 0.28 - 0.82).

According to the data obtained, when analyzing heredity, depending on the intake of basic therapy and the participation of chronic patients in school, we found statistically significant differences (p = 0.003) (methods used: Fisher’s exact test).

The chances of receiving basic therapy and participation in school of chronic patients in the group with burdened heredity were 1.97 times higher than in the group of non-burdened heredity, the differences in chances were statistically significant (95% CI: 1.22 - 3.19).

Conclusions:

According to the data obtained, persons with a burdened heredity change their lifestyle less often, but more often they take basic therapy and participate in the school of chronic patients.
CLOFIBRATE TREATMENT IMPROVED THE STRUCTURAL DAMAGE ELICITED BY MYOCARDIAL ISCHEMIA THROUGH MODULATION OF RENIN-ANGIOTENSIN SYSTEM
Authors: Aguilar Maria Sanchez , Lara Luz Ibarra , Mondragon Leonardo Del Valle , Castro Elizabeth Soria , Perez Luz Graciela Cervantes , Hernandez Gustavo Pastelin , Mendoza Alicia Sanchez
Published: June 2022

Objective:

Myocardial ischemia is an acute condition that, if not treated in a timely manner, produces the loss of heart tissue which can lead to heart failure or death of the patients. Our group has studied fibrates, exogenous ligands of PPAR, as an alternative to reduce processes associated with inflammation and we interested to know the exogenous ligand effect over damage in the cardiac tissue by RAS system.

To study the effect of PPAR alpha ligand; clofibrate, on renin angiotensin system and on the structural morphology of the heart in myocardial infarcted subjects.

Design and method:

Male Wistar rats were separated in two groups: 1.- Sham, 2.- Myocardial infarct by coronary artery ligation. Seven days after, the rats were subdivided in vehicle (Vh)- or clofibrate treatment (Clof 100 mg/kg/day) administered for seven more days. At the end of the treatment (14 days in total), serum and left ventricle were analyzed.

Results:

Angiotensin converting enzyme (ACE), AT1 receptor and Ang II decreased in MI-Clof vs. MI-Vh, whereas non-classic RAS system components: ACE2, AT2 receptor, bradykinin, and Ang-(1–7) augmented in MI-Clof with respect to MI-Vh. VEGF also raised in clofibrate-treated animals. Clofibrate treatment preserved the structure of the sarcomere (fiber).

Conclusions:

Clofibrate treatment to MI rats exerts an antifibrotic effect and augmented the expression of non-classical axis of RAS system.
PERMISSIVE ROLE OF ANGIOTENSIN II IN MANTENANCE OF ENDOTHELIUM-DEPENDENT VASODILATION IN CEREBRAL MICROCIRCULATION
Authors: Mihaljevic Zrinka , Jukic Ivana , Matic Anita , Stupin Ana , Kolobaric Nikolina , Kozina Natasa , Susnjara Petar , Mihalj Martina , Drenjancevic Ines
Published: June 2022

Objective:

A number of data suggest, rather controversial, permissive role of angiotensin II (ANGII) in maintaining vasodilator responses in microcirculation, via its interaction with AT1 receptors (AT1R). This study aimed to determine the role of ANGII and AT1R in the mechanisms of flow-induced dilation (FID) in middle cerebral arteries (MCA) and incidence of oxidative stress at the functional, cellular and molecular level in the cerebral vasculature and in the serum of Sprague-Dawley (SD) rats fed high salt diet (HS).

Design and method:

Eleven-week old, male SD rats were randomly assigned to control group (CTRL, 0.4% NaCl in rat chow); Losartan group (rats on a standard diet given the AT1R blocker losartan (1 mg/mL) in drinking water); HS group (7 days 4% NaCl in rat chow) or HS+ANGII group (7 days HS with 3 days ANGII administration via osmotic minipumps (100 ng/kg/min on days 4–7)). FID of MCA was determined in absence/presence of the NOS inhibitor L-NAME, the non-selective cyclooxygenases inhibitor indomethacin, and the superoxide dismutase mimetic TEMPOL. Gene and protein expression of antioxidative enzymes and enzymes involved in FID mechanisms were determined by RT-qPCR and western blot. Vascular NO and superoxide/ROS levels were assessed by direct fluorescence. Serum systemic oxidative stress parameters was measured by spectrophotometry. All experimental procedures conformed to the EU Directive 2010/63/EU.

Results:

HS or AT1R blockade impaired FID and increased oxidative stress. Supplementation of ANGII restored the mechanisms of FID in MCA of rats fed HS diet to the ones present in CTRL rats without affecting arterial blood pressure by decreasing systemic oxidative stress and decreasing superoxide/ROS levels and increased NO bioavailability in the vascular wall of HS treated rats. The AT1R blockade resulted in significantly attenuated endothelium-dependent dilation, changed mechanisms of FID, increased vascular and systemic oxidative stress and decreased expression/ activity of antioxidative enzymes.

Conclusions:

ANGII is crucial in the preservation of vascular oxidative stress-antioxidant system balance and via AT1R, in maintenance of physiological vasodilation mechanisms of MCA. Suppression of ANGII is a key link between HS intake and development of endothelial dysfunction, and impaired regulation of cerebral blood flow.
RENIN ANGIOTENSIN SYSTEM BLOCKADE AT BEDTIME VERSUS ON AWAKENING TO PREVENT ALDOSTERONE BREAKTHROUGH
Authors: Laurain Audrey , Lemoine Sandrine , Fauvel Jean-Pierre , Sampol Jerome , Fontas Eric , Zorzi Kevin , Esnault Vincent , Favre Guillaume
Published: June 2022

Objective:

Aldosterone breakthrough (AB) is defined by an increase of serum aldosterone levels over baseline values before starting blockers of renine angiotensine system (RAS) treatment by angiotensin converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB). AB may limit the efficacy of these drugs. We hypothesized that short-acting blockers taken on awakening may not inhibit the aldosterone peak occuring at the awakening. To address this hypothesis, we compared the incidence of AB in patients randomized to take their medications either on awakening or at bedtime.

Design and method:

participants had chronic kidney disease stage 3 or 4 and a urinary protein over creatinine ratio above than 0.5 g/g. Blood pressure, renal function, urinary sodium excretion, levels of aldosterone and renin were measured at baseline and after 1 year exposure to RAS blockers. Incidence of AB was tested with Chi-square test and the variables associated with AB were searched with Mann-Whitney-Wilcoxon tests.

Results:

among 105 participants, 97 were randomized and 77 completed the study. The incidence of AB was not significantly different between subjects having their treatment on awakening or at bedtime (43% versus 41%, p = 0.83). AB was associated with the decrease of systolic blood pressure (-1 ± 14 vs 5 ± 19 mm Hg, p = 0.05), the decrease of urinary sodium excretion (-31 ± 52 vs 1 ± 59 meq/d, p = 0.007), or the increase of serum creatinine levels (-0.2 ± 0.36 vs -0.10 ± 0.30 mg/dl, p = 0.018). As expected, AB was also associated with the increase of plasma levels of renin (42 ± 125 vs -1 ± 65 ng/L, p = 0.04) and the increase of urinary aldosterone excretion (4 ± 13 vs -1 ± 3, p = 0.0003). The independent factors associated with AB were systolic blood pressure (p = 0.03) and urinary aldosterone excretion (0.03).

Conclusions:

the intake of a short half-life RAS blockers at bedtime does not prevent AB in CKD patients with macroproteinuria. Mineralocorticoid receptor antagonists may be required to prevent the deleterious consequences of AB.
CHANGES OF THE ZONA GLOMERULOSA IN HUMAN ADRENALS FROM BIRTH TO 40 YEARS OF AGE
Authors: Baz Amir-Hossein Chaman , Van De Wiel Elle , Küsters Benno , Mukai Kuniaki , Bonzel Lidia Van , Erp Merijn Van , Langenhuijsen Johan , Deinum Jaap
Published: June 2022

Objective:

Antibodies to CYP11B2 (aldosterone synthase) allow imaging of the zona glomerulosa (zG) by immunohistochemistry. Studies demonstrate that the area and continuity of the zG decreases with aging and accumulations of aldosterone-producing cell clusters occur. Research on age-related changes in the zG in younger patients and comparison of both adrenals is limited. Therefore, the objective of this study was to elucidate age-related changes of the zG by quantifying CYP11B2 expression in adrenals of patients below the age of 40 years.

Design and method:

We collected human adrenals from autopsy cases, that were anonymized except for age, sex and medical history. We excluded adrenal glands of patients with premature birth, hypertension, cardiovascular disease, adrenal tumors, use of steroids. In case of two available adrenals in one patient, one was randomly selected of the two. We validated software for automated quantification by comparing manually outlined CYP11B2 expressing area with automated outlined area. We then used this automated method to quantify CYP11B2 expressing area, CYP11B2 continuity and mean and maximum CYP11B2 depth. If the zG was discontinuous, mean length of ‘gaps’ between ZG tissue was calculated. We also determined the structural similarity between both adrenals of the same case. The study was approved by the local Medical Ethics Committee.

Results:

There was a negative correlation between age and CYP11B2 expressing area (rs = -.63); negative correlation between age and CYP11B2 continuity (rs = -.80); positive correlation with age and mean gap length (rs = 0.71); positive correlation between age and maximum CYP11B2 depth (rs = .30, P = <0.001) and no correlation between age and mean CYP11B2 depth (rs = .01, p = <0.001). The intraclass correlation coefficient between both adrenals of one subject for CYP11B2 expressing area was 0.78 (95%CI = 0.56–0.89), for CYP11B2 continuity 0.94 (95%CI = 0.88–0.97) and for mean gap length 0.76 (95%CI = 0.32–0.81).

Conclusions:

We demonstrate a decrease in CYP11B2 area and continuity, whilst the mean gap length and maximum CYP11B2 depth increases, which we consider as involution and clustering of the zG. This is seen in both adrenals and therefore suggests a common process. The relation with the development of aldosterone-producing adenoma remains to be determined.
STATE OF TARGET ORGANS DAMAGE AND PREVALENCE OF CLINICAL ASSOCIATED CONDITIONS IN PATIENTS WITH A HYPERTENSIVE CRISIS AND UNCONTROLLED HYPERTENSION. (PILOT STUDY)
Authors: Solntseva Tatyana , Denisova Anastasia , Sivakova Olga , Chazova Irina
Published: June 2022

Objective:

To assess the state of target organs damage and prevalence of clinical associated conditions in patients with a hypertensive crisis and uncontrolled arterial hypertension.

Design and method:

The pilot study included 20 patients hospitalized at the National Medical Research Center of Cardiology over the period from September 2019 to September 2021. The all patients had uncontrolled hypertension (BP < 140/90 mmHg while taking antihypertensive drugs). Among them there are 11 men (55%), 9 women (45%) aged 34 to 80 years old (the average age is 60.9 years). The examination was carried out according to the standard examination protocols for patients with hypertension. After the patients had been followed up to 1 year, the damage of target organs (left ventricular hypertrophy, chronic kidney disease, carotid atherosclerosis), as well as the presence of associated clinical conditions (myocardial infarction, stroke, chronic heart failure, aortic aneurysm, retinal haemorrhages) were assessed.

Results:

10 patients formed a group with a hypertensive crisis (BP increased > 140/90 mmHg 1 per week), another 10 patients formed a comparison group (BP increased less than 1 per week without pronounced clinical symptoms). The level of LVMI in patients of the study group was 125.5 ± 52.4 g/m2, and in the comparison group was 93.8 ± 16.0 g/m2. Calculated GFR (using the CKD-EPI formula) in the study group was 69.1 ± 18.4 ml/min/1.73 m2, and in the comparison group was 75.9 ± 21.5 ml/min/1.73 m2, carotid atherosclerosis was 44.5 ± 22.8% and 37.5 ± 13.6% respectively. Associated clinical conditions occurred in 43% of patients with a hypertensive crisis, and in the group of patients with uncontrolled hypertension in only 29%. But future randomized control studies are necessary to proof our preliminary results.

Conclusions:

Patients with hypertensive crisis have more pronounced damage of target organs, as well as the most frequent prevalence of associated clinical conditions.
BLOOD PRESSURE REDUCTION AFTER CATHETER-BASED RENAL DENERVATION IN PATIENTS WITH CARDIOVASCULAR DISEASE IN THE GLOBAL SYMPLICITY REGISTRY
Authors: Mahfoud Felix , Schmieder Roland , Schlaich Markus , Narkiewicz Krzysztof , Ruilope Luis , Williams Bryan , Fahy Martin , Mancia Giuseppe , Bohm Michael
Published: June 2022

Objective:

To evaluate the efficacy of catheter-based renal denervation (RDN) to lower blood pressure (BP) in patients with a history of myocardial infarction or stroke in the Global SYMPLICITY Registry (GSR).

Design and method:

GSR is a prospective, global, all-comers registry to evaluate the safety and efficacy of catheter-based RDN to lower BP. Patients are enrolled with the intention to receive RDN using either the Symplicity Flex or Symplicity Spyral catheter. Patients are followed at 3, 6, and 12 months, and then annually up to 3 years post-procedure. Office and ambulatory BP are measured at each follow-up and any adverse events are collected. The current post-hoc analysis compares systolic BP (SBP) reduction in patients with and without a history of myocardial infarction as well as with and without history of stroke. Differences in SBP reduction between groups were adjusted for baseline SBP using ANCOVA methods.

Results:

In March 2021 in GSR, there were 267 patients (10%) with a history of myocardial infarction and 2579 without, and 294 patients with a history of stroke (10%) and 2539 without. Patients with and without a history of myocardial infarction had similar baseline office and ambulatory SBP measurements, whereas patients with a history of stroke had similar office SBP measurements but significantly higher ambulatory SBP (159 ± 22 vs. 154 ± 18, p = 0.005) compared to patients without history of stroke. Office and ambulatory SBP reductions from 6 months to 3 years were similar for patients with and without a history of myocardial infarction after adjusting for differences in baseline SBP (Figure). SBP reductions were also similar for patients with and without a history of stroke except at 6 months for office and ambulatory SBP and at 12 months for ambulatory SBP, when patients with a history of stroke had less BP reduction.

Conclusions:

Patients with and without a history of stroke or myocardial infarction had similar office and ambulatory SBP reductions after catheter-based RDN, suggesting efficacy of RDN regardless of baseline cardiovascular history.
EFFECTS OF LEFT VENTRICULAR MASS INDEX AND LEFT VENTRICULAR GEOMETRY ON 6 MINUTE STEPPER TEST RESULTS IN PATIENTS WITH HYPERTENSION
Authors: Sener Yusuf Ziya , Durukan Beyza Nur , Ozcan Emine Burcu , Kutukcu Ebru Calik , Saglam Melda , Yagli Naciye Vardar , Ince Deniz Inal , Tokgozoglu Lale
Published: June 2022

Objective:

Exercise has effects on blood pressure (BP) and while systolic blood pressure increases with exercise, diastolic blood pressure is expected to remain in same values or decrease due to vasodilatation. Left ventricular concentric remodelling develop in patients with uncontrolled or undertreated hypertension and it results in deterioration in diastolic functions. Six-minute stepper test (6MST) is a simple test for evaluating performance status of patients. We aimed to evaulate effects of ventricular remodelling and left ventricular mass index (LVMI) on results of 6MST in patients with hypertension.

Design and method:

Adult patients with hypertension were enrolled after taking informed consent. Patients with significant valvular disease, coronary artery disease, malignancy, lung diseases and disabling orthopedic disorders that makes performing 6 MST difficult were excluded. Beta blockers were stopped 48 hours before the test. All patients underwent transthoracic echocardiography just before 6MST in order to assess LVMI and left ventricular geometry.

Results:

A total of 40 patients were included. Mean age of the population was 47.5 ± 6.5 years and 24 (60%) of them were female. Baselince characteristics were presented in Table-1. Left ventricular geometry was normal in 13 patients and left ventricular concentric remodelling was present in remaining cases. Number of steps during 6MST were similar between patients wih concentric remodelling and normal geometry. Difference between both systolic and diastolic BP values of at the end of test and beginning were recorded. Both systolic and diastolic BP differences were similar between patients with concentric remodelling and normal geometry. However, LVMI was significantly positively correlated with diastolic BP difference (r = 0.389,p = 0.03) while there was not any correlation with systolic BP difference.

Conclusions:

Left ventricular geometry has no relationship between change of blood pressure during exercise however, LVMI is correlated with change in diastolic BP. Large scale studies are required for evaluating effects of left ventricular geometry on changes of blood pressure during exercise.
STATINS, BUT NOT PCSK9 INHIBITORS, REDUCE THE ADIPOKINE CHEMERIN IN FAMILIAL HYPERCHOLESTEROLEMIA: FOCUS ON LIPOPROTEIN SUBFRACTIONS
Authors: Tan Lunbo , Wang Na , Van Vark Van Der Zee Leonie , Van Lennep Jeanine Roeters , Mulder Monique T. , Lu Xifeng , Jan Danser A.H. , Verdonk Koen
Published: June 2022

Objective:

Familial hypercholesterolemia (FH) is characterized by severe elevations in circulating LDL-cholesterol, and an increase in the risk of dyslipidemia-related cardiovascular disease (CVD). Chemerin, as a newly identified adipokine, is considered as an additional risk factor for CVD. Here we investigated whether it can be modified by cholesterol-lowering therapy.

Design and method:

Lipoprotein subfractions were isolated by density gradient ultracentrifugation. Lipids and chemerin concentrations were determined both before and after cholesterol lowering with either a statin (atorvastatin, simvastatin, rosuvastatin, or fluvastatin) or a PCSK9 inhibitor (PCSK9i; alirocumab or evolocumab).

Results:

At baseline chemerin levels were 113 ± 46 (statin group) and 95 ± 44 (PCSK9i group) ng/ml, while triglyceride (TG) levels were 1.9 ± 1.6 and 2.6 ± 1.7 mmol/ml, high-density lipoprotein cholesterol (HDL-c) levels were 1.3 ± 0.4 and 1.2 ± 0.4 mmol/ml, and low-density lipoprotein cholesterol (LDL-c) levels were 5.7 ± 1.5 and 4.9 ± 1.4 mmol/ml (P = ns for difference between 2 groups). Chemerin correlated positively with triglycerides (r = 0.45, P < 0.005) and negatively with HDL-c (r = -0.33, P < 0.01). Both statins and PCSK9i reduced LDL-c (by 41 and 62%, P < 0.0001), triglycerides (by 13 and 19%, P < 0.01), and increased HDL-c (by 8 and 23%, P < 0.01), but only statins additionally reduced chemerin (by 35%, P < 0.005). The lipoprotein subfraction profile revealed that chemerin accumulated particularly in the HDL3 fraction (containing > 60% of all chemerin in lipoprotein subfractions), with approximately 30% being present in the HDL2 fraction, and approximately 3% in the LDL fraction. Statins reduced HDL3-c and HDL3-TG, and the level of chemerin bound to all subfractions. PCSK9i reduced HDL3-c but did not affect HDL3-TG or the level of chemerin bound to HDL3 and HDL2.

Conclusions:

Circulating chemerin occurs in different lipoprotein subfractions, accumulating particularly in the HDL3 fraction. Statins, but not PCSK9i, lowers chemerin, possibly by interfering with its levels across lipoprotein subfractions. This may represent a novel cardiovascular protective function of statins.
THE ASSOCIATION BETWEEN ANTIHYPERTENSIVE TREATMENT AND SERIOUS ADVERSE EVENTS BY AGE AND FRAILTY: AN OBSERVATIONAL COHORT STUDY OF 3.8 MILLION PATIENTS FOLLOWED UP FOR 10 YEARS
Authors: Sheppard James , Koshiaris Constantinos , Stevens Richard , McManus Richard
Published: June 2022

Objective:

Antihypertensives are effective at reducing the risk of cardiovascular disease, but limited data exist quantifying their association with serious adverse events (SAEs), particularly in older people with frailty. This study examined this association using data from a large database of electronic health records.

Design and method:

This was a retrospective observational cohort study, utilising data from the Clinical Practice Research Datalink in England. Patients were eligible if they were aged 40 years or older, with a systolic blood pressure reading between 130–179 mmHg and not previously prescribed antihypertensive treatment. Outcomes were defined as hospitalisation or death within 10 years due to hypotension, syncope, falls, fractures, acute kidney injury (AKI), electrolyte abnormalities and gout. The association between antihypertensive treatment and SAEs was examined by cox regression, using propensity score adjustment to adjust for confounding. Subgroup analyses were undertaken by age and frailty.

Results:

A total of 3,834,056 patients, aged 57 ± 12 years, were eligible for the study. Of these, 484,187 (12.6%) were prescribed antihypertensive medication in the 12 months prior to the index date. Over a median follow-up of 7.1 years, antihypertensives were associated with an increased risk of hypotension (HR 1.32, 95%CI 1.29–1.35), syncope (HR 1.20, 95%CI 1.17–1.22), falls (HR 1.23, 95%CI 1.21–1.26), AKI (HR 1.44, 95%CI 1.41–1.47), electrolyte abnormalities (HR 1.42, 95%CI 1.43–1.48) and gout (HR 1.32, 95%CI 1.46–1.52). The absolute risk of SAEs with treatment was very low, ranging from four syncope events to twelve AKI events per 10,000 patients treated per year. In older patients and those with severe frailty, this risk was increased up to 116–120 events per 10,000 patients treated per year.

Conclusions:

Antihypertensive treatment is associated with an increased risk of SAEs, but the absolute risk of harm is very low. However, in older patients and those with severe frailty, this absolute risk is increased and physicians should take this risk into consideration when making prescribing decisions.
META-ANALYSIS OF THE EFFECT OF DUAL GIP AND GLP-1 RECEPTOR AGONISTS ON BLOOD PRESSURE LEVELS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS
Authors: Patoulias Dimitrios , Katsimardou Alexandra , Boulmpou Aristi , Imprialos Konstantinos , Stavropoulos Konstantinos , Toumpourleka Maria , Papadopoulos Christodoulos , Karagiannis Asterios , Doumas Michael
Published: June 2022

Objective:

Hypertension and type 2 diabetes mellitus (T2DM) are common co-morbidities, with hypertension being twice as frequent in patients with T2DM compared to those without. Blood pressure (BP) control is of utmost importance for subjects with T2DM, in order to minimize the risk for development of cardiovascular and chronic kidney disease. High on treatment BP levels also correlate with the incidence of major adverse cardiovascular outcomes and all-cause death. Recently, novel dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonists have been developed for patients with T2DM. Therefore, we sought to determine whether dual GIP and GLP-1 receptor agonists have a significant effect on BP in subjects with T2DM.

Design and method:

We searched PubMed and Cochrane Library databases for relevant published randomized controlled trials up to 13th November 2021. We assessed the change in office systolic BP (SBP) and diastolic BP (DBP) with dual GIP and GLP-1 receptor agonists compared to placebo or active comparator in subjects with T2DM.

Results:

We finally pooled data from 5 trials for a total of 5,060 patients with T2DM. We demonstrated that dual GIP/GLP-1 receptor agonists compared to control induced a significant decrease in SBP by 3.6 mm Hg (MD = -3.6, 95% CI; -5.54 to -1.65, I2 = 83%, p = 0.0003), along with a significant decrease in DBP by 1.29 mm Hg (MD = -1.29, 95% CI; -2.30 to -0.28, I2 = 74%, p = 0.01).

Conclusions:

Dual GIP/GLP-1 receptor agonists might provide a significant decrease, and thus a better control of BP in patients with T2DM. Whether this preliminary observation is translated into a significant cardiovascular benefit has to be further confirmed in well-designed trials, such as the forthcoming SURPASS-CVOT (NCT04255433). Moreover, the effects of dual agonists on out-of-office BP values need to be evaluated.
REASONS OF NON-COMPLIANCE TO OFFICE VISITS IN HYPERTENSIVE PATIENTS: RESULTS FROM THE REGISTRY OF SPECIALIZED HYPERTENSION CLINICS
Authors: Youssef Ghada , Mohamed Marwa , Remisy Dalia El , Hamid Magdy Abdel
Published: June 2022

Objective:

Hypertensive patients’ compliance to the clinic’s follow up visits was found to be associated with a better blood pressure control and a better compliance to antihypertensive medications. The aim was to detect reasons of non-compliance to office visits in hypertensive patients included in the registry of the specialized hypertension clinics

Design and method:

Patients were enrolled from the registry of the specialized hypertension clinics of 9 university hospitals. Those who attended less than 3 office visits were considered non-compliant and were contacted through the phone. A simple questionnaire was prepared, and it included pre-specified questions about the reasons of dropping out the office visits. They were also asked about compliance to their antihypertensive medications and salt restriction, and whether they experienced any drug side effects.

Results:

There were 3014 patients eligible for inclusion in this study but only 689 patients (34.6%) completed the questionnaire. The reasons of non-compliance to the follow up visits in the specialized hypertension clinics were either that patients preferred to follow up elsewhere (n = 546, 79.2%) mostly in pharmacies, 129 patients (18.7%) claimed that the healthcare service was unsatisfactory, 118 patients (17.1%) were asymptomatic and they thought that absence of symptoms meant a well-controlled blood pressure, 136 patients (19.7%) said that the clinic was far from their homes, and 74 patients (10.7%) said that they were referred to the clinic for other comorbidities. Despite non-compliance to office visits, 455 patients (66.0%) were compliant to their antihypertensive medications and 264 (38.3%) patients were compliant to salt restriction. Patients’ reasons for non-compliance to medications were because of side effects (n = 14, 6.9%), financial restrains (n = 13, 6.4%), or because their BP was controlled (n = 20, 9.9%). About 42% of patients used herbs, mainly hibiscus, as adjuvant to their antihypertensive medications.

Conclusions:

Reasons for non-compliance to office visits were either patient-related or healthcare-related. To improve patients’ compliance, physicians need to allocate more time to educate their patients about hypertension, patients need to follow their doctors’ instructions as regard medications, salt restriction and scheduled office visits, and governments need to provide better and cheaper healthcare services.
ASSESSMENT OF ADHERENCE TO ANTIHYPERTENSIVE MEDICATION IN A POPULATION OF ARGENTINA DURING THE COVID-19 PANDEMIC
Authors: Renna Nicolas , Diez Emiliano , Vissani Sergio , Farez Beder , Sorasio Viviana , Camaño Belen , Alcorta Martha , Miatello Roberto , Ramirez Jesica
Published: June 2022

Objective:

The objective was to assess the adherence to antihypertensive treatment and its determinants in patients during the pandemic by COVID-19

Design and method:

A multicenter, prospective, observational cohort study included outpatients from the Cuyo region of Argentina from March to July 2021 that met the following inclusion criteria: 1- patients over 16 years old under antihypertensive treatment; 2- informed consent signature 3- complete 35-dimensional questionnaire.

Results:

From 512 enrolled patients, 468 met the inclusion criteria. The average age was 50.1 ± 0.1 years, 56.8% were women. At least 39% had 1 CV risk factor. COVID-19 was documented in 35% and 3.6% presented a severe form. The most widely used vaccine was Sputnik V and 70% had at least 1 dose of vaccination for COVID-19. Average adherence was 69%. The average of systolic blood pressure was 139.3 ± 1.0 mmHg and diastolic blood pressure was 85.9 ± 0.6 mmHg. The average number of antihypertensive drugs was 1.26. Table 1 shows the results of multivariate analysis.

Conclusions:

In a population with intermediate cardiovascular risk, adherence was low, and blood pressure control was suboptimal. The most important predictive variables of low adherence were age, the number of antihypertensive drug tablets, level of education, and smoking.