bluuebunny/crossref_metadata_2025 huggingface dataset:
BLOOD PRESSURE LOWERING PATTERNS DURING HOSPITALIZATION AND RISK OF REHOSPITALIZATION FOR ANGINA IN PATIENTS WITH CORONARY ARTERY DISEASE AND HYPERTENSION
Authors: Xin Qian , Wang Chi , Xue Hao
Published: May 2024

Objective:

The present study aimed to examine the association of blood pressure (BP) lowering patterns during hospitalization with rehospitalization for angina in patients with coronary artery disease (CAD) and hypertension.

Design and method:

This prospective cohort study was conducted in PLA General Hospital, Beijing, China. We included 730 patients with CAD and hypertension, who were hospitalized between August 2020 and September 2022. The lowering patterns of systolic blood pressure (SBP)/diastolic blood pressure (DBP) during hospitalization were identified according to BP level on admission, BP level on discharge, and the difference between them: normal-stable, more-intensive reduction, less-intensive reduction, and non-reduced (Figure 1). The outcome was rehospitalization for angina, which was obtained from telephone interview. We used Cox proportional hazards regression to estimate the risk of rehospitalization for angina according to the BP lowering patterns.

Results:

We identified 90 cases of rehospitalization for angina in a median 22.5-month follow-up. Patients with more-intensive SBP reduction had the lowest incidence rate of rehospitalization for angina, followed by those with normal-stable SBP, less-intensive SBP reduction, and non-reduced SBP (Table 1). After adjusting for potential confounders, we found that compared with patients with more-intensive SBP reduction, the hazard ratios and 95% confidence intervals of rehospitalization for angina were 1.39 (0.73-2.62) for patients with normal-stable SBP (P =0.32), 2.32 (1.13-4.77) for patients with less-intensive SBP reduction (P =0.02), and 2.82 (1.38-5.75) for patients with non-reduced SBP (P =0.004) (Table 1). However, analysis on lowering patterns of DBP did not generate statistically significant results (Table 1).

Conclusions:

SBP lowering patterns during hospitalization in patients with CAD and hypertension were associated with the risk of rehospitalization for angina. These results highlighted the importance of intensive in-hospital BP control in patients with CAD and hypertension.
“SEEK, AND YOU WILL FIND” - IMPLICATIONS OF PULMONARY HYPERTENSION DIAGNOSIS AND TREATMENT OF PATIENT WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND LEFT HEART FAILURE
Authors: Wilk-sledziewska Katarzyna , Zimnowski Mateusz , Czajkowski Mateusz , Anikiej Katarzyna , Piotrowska Weronika , Zbroch Aleksandra , Wawierna Julia , Zdanska Adrianna , Wysocka Anna , Malinowska Dominika , Baranowska Magdalena , Cabaj Marta , Gawryluk Mateusz , Nazarko Weronika , Panas Zuzanna , Zbroch Edyta
Published: May 2024

Objective:

The case report presents a patient with multimorbidity. A diagnosis of pulmonary hypertension was made during multiple hospitalizations due to bad compliance. The objective of this case report is to describe the difficulties involved in diagnosing pulmonary hypertension in a patient with chronic obstructive pulmonary disease and left heart failure.

Design and method:

Case report of patient with pulmonary hypertension, chronic obstructive pulmonary disease, left heart failure and multiple comorbidities.

Observation of the patient's health condition during many hospitalizations led to further diagnosis of pulmonary hypertension and forced the modification of current treatment.

Results:

Patient went through many hospitalizations because of bad compliance to chronic obstructive pulmonary disease and left heart failure pharmacotherapy.

The patient was hospitalized in our ward for chest pain. He also presented combination of nonspecific symptoms such as dyspnoea (including resting dyspnoea), exercise intolerance and peripheral oedema. Chest x-ray showed signs of pneumonia. Therefore, the diagnosis of pulmonary hypertension was not made during the first hospitalisations. Echocardiography was planned to exclude chronic coronary syndrome. It revealed patent ductus arteriosus, right ventriculum and pulmonary trunk dilation, tricuspid regurgitation and high probability of pulmonary hypertension (mean pulmonary artery pressure 46,5mmHg), without regional cardiac wall dysfunction. The next hospitalization was scheduled, during which cardiac catheterization was performed (pulmonary capillary wedge pressure 14,5 mmHg) and precapillary pulmonary hypertension was confirmed. After many consultations, excluding other causes, such as thromboembolic changes, chronic obstructive pulmonary disease was considered the most likely cause of precapillary pulmonary hypertension. Treatment of basal diseases has been modified, off-label treatment with sildenafil was started, and then due to ineffective treatment (deterioration of the patient's condition resulted in a transition from WHO functional class II to III) the patient was qualified for the bosentan clinical drug treatment program.

Conclusions:

Diagnosis of pulmonary hypertension can be difficult when symptoms of diseases from other systems are overlapping. This case shows the necessity of watchful observation of patients with multimorbidity, but also difficulties in maintaining good medical compliance. Pulmonary hypertension is still a rare diagnosis, but we should stay alerted about it.
HYPERURICEMIA AND ITS RELATIONSHIP WITH METABOLIC DISORDERS IN HYPERTENSIVE PATIENTS
Authors: Srojidinova Nigora , Duysenbaeva Aziza , Khafizova Lola
Published: May 2024

Objective:

To study the prevalence of hyperuricemia and its role in the development of metabolic disorders in hypertensive patients.

Design and method:

We analyzed 188 hypertensive patients. 109 were female and 79 were male, for a mean age of 62.8±10.2 years. Uric acid, glucose, creatinine, and blood lipids were determined using the RANDOX Daytona autoanalyzer (UK). Microalbuminuria (MAU) in the morning urine was determined using a quantitative enzymatic method. Hyperuricemia was established when the level of uric acid was >7 mg/dl in men and >5.7 mg/dl in women. Statistical analysis was conducted using SPSS 24.0.

Results:

Patients were divided into two groups: the first group consisted of patients with hyperuricemia (n = 103), and the second group consisted of patients with normal levels of uric acid (n = 85). The average level of uric acid in the 1st group was 7.44±1.33 mg/dl, and in the 2nd group, it was 5.06±0.98 mg/dl, p<0.00001. The compared groups were comparable in terms of age, office SBP, and DBP. Body mass index (BMI) and waist circumference (WC) also did not differ between groups: BMI-32.96±5.84 kg/m2 vs 31.24±5.00 kg/m2, p = 0.44; OT-105.44±13.75 cm vs 102.76±12.06 cm, p =0.16. Patients with hyperuricemia had a significantly higher level of MAU: 63.24±104.06 vs. 39.33±36.42 mg/l, p = 0.044. Patients with hyperuricemia had more pronounced dyslipidemia. Thus, total cholesterol was significantly high in group 1: 198.31±49.41 mg/dl vs. 181.75±49.1 mg/dl, p = 0.04, and LDL-C was 111.83±42.46 mg/dl vs. 100.56±37.99 mg/dl, p = 0.04. TG and HDL-C did not differ between the groups. TG: 223.39±130.76 vs. 189.69±122.18, p = 0.057. HDL-C: 41.92±13.54 mg/dl vs. 43.30±12.87 mg/dl, p = 0.48. Patients with hyperuricemia had a significantly high level of glucose compared with patients with normal levels of uric acid: 9.71±04.35 mmol/l vs. 6.51±3.06 mmol/l, p = 0.0001. The creatinine level was also high in patients with hyperuricemia: 98.45±36.75 μmol/l vs. 85.06±17.21 μmol/l, p = 0.003.

Conclusions:

Hyperuricemia should be considered as an additional cardiovascular risk factor in patients with hypertension. Hyperuricemia is associated with another metabolic disorders in hypertensive patients.
URIC ACID SIGNIFICANTLY CORRELATES WITH THE PRESENCE OF LOW-VOLTAGE AREAS AT THE ENDOCARDIAL MAPPING IN PATIENTS WITH NON-VALVULAR ATRIAL FIBRILLATION
Authors: Maloberti Alessandro , Baroni Matteo , Fortuna Matteo , Tognola Chiara , Algeri Michela , Intravaia Rita Cristina My , Leidi Filippo , Colombo Valentina , Ciampi Claudio Mario , Carbonaro Marco , Gigli Lorenzo , Mazzone Patrizio , Giannattasio Cristina , Garofani Ilaria
Published: May 2024

Objective:

Interest in the role of atrial substrate in maintaining Atrial Fibrillation (AF) is growing. Fibrosis is the culprit in the electrical derangement of the myocites. Many cardiovascular risk factors are known to be linked to atrial scarring; among them Uric Acid (UA) is emerging. The purpose of our study is to evaluate whether UA is associated with atrial fibrosis in AF patients.

Design and method:

81 patients who underwent radiofrequency transcatheter ablation for nonvalvular AF at the cardiological department of the Niguarda Hospital were enrolled. UA levels were analysed before the procedure as well as known predictors of atrial fibrosis. High density electroanatomic mapping of the left atrium was performed and patients were divided according to the presence or not of areas of pathological substrate (bipolar voltage < 0.5 mV in sinus rhythm).

Results:

19 patients showed a pathological atrial substrate. The population of patients with pathological atrial substrate was older (64.7±1.6 vs 58.2±10.9 years, p=0.032) and had more often a persistent phenotype of AF (84.3 vs 35.8%, p<0.001). UA levels were significantly higher in the pathological group (6.8±1.9 vs 5.3±1.4, p<0.001) as well as the prevalence of hyperuricemia (26.5 vs 6.5%, p=0.021). The association between uric acid and pathological atrial substrate remains significant even after correction for confounding factors (age, left ventricular dysfunction, valvular disease, AF phenotype and furosemide use).

Conclusions:

In a population of patients who underwent atrial fibrillation's ablation, higher uric acid's levels were significantly associated with pathological left atrium's substrate at electro-anatomical mapping.
INADEQUATE CARE OF HYPERTENSION AND OTHER NON-COMMUNICABLE DISEASES DURING THE COVID-19 PANDEMIC IN SOUTH AFRICA
Authors: Peer Nasheeta , Mashiane Tshephang , Sureshkumar Sugitha , Oris Michel , Mwangi Kibachio Joseph , Kengne Andre -Pascal
Published: May 2024

Objective:

In the setting of an already overburdened healthcare system, South Africa has a high burden of hypertension and other non-communicable diseases (NCDs), and the country experienced a high COVID-19 caseload. The aim of this study was to examine the perceptions and experiences of 1) healthcare professionals (HPs) on the preparedness of health systems to provide NCD care and of NCD management during the COVID-19 pandemic, and 2) people living with NCDs (PLWNCDs) on the care they received for hypertension and other NCDs during the COVID-19 pandemic in South Africa.

Design and method:

Across the country, we recruited a convenience sample of 1) HPs who worked in healthcare management i.e., public health officials and healthcare workers who provided care and engaged with patients in any healthcare capacity, and 2) PLWNCDs with at least 1 NCD. Questionnaires included quantitative and open-ended follow-up questions. Quantitative analyses were conducted using SPSS. The qualitative open-ended questions were evaluated using content analysis with inductive reasoning.

Results:

There were 31 HPs and 79 PLWNCDs (59 with hypertension) included in this cross-sectional study. HPs perceived COVID-19 care to be adequate, while NCD care was poor during the pandemic. There were service disruptions including for emergency and specialised NCDs care. Strategies for the care of non-COVID-19 illnesses during the pandemic were absent. This would have serious long-term consequences for PLWNCDs and the healthcare system. Perceptions of inadequate hypertension and other NCD care were reiterated by PLWNCDs; 49% felt they received ’very little’ or no adequate care. 18% had a scheduled appointment cancelled. Additionally, many PLWNCDs (52%) felt anxious, lonely, or frightened during the pandemic and 15% felt their mental health had deteriorated. The utility of digital health in future was positively perceived by both HPs and PLWNCDs and may be able to improve health provision during crises.

Conclusions:

Policies are required 1) so that NCD care will not be overlooked during future crises and 2) to encourage PLWNCDs to timeously access healthcare services during such periods. Such strategies may incorporate digital health apps to improve care and target the mental healthcare needs of PLWNCDs.
THE INFLUENCE OF CORONAVIRUS INFECTION ON THE DEGREE OF NOCTURNAL BLOOD PRESSURE ELEVATION IN PATIENTS WITH ARTERIAL HYPERTENSION
Authors: Abdullayeva Go’Zal , Atoyeva Munisa , Yusupova Khafiza , Masharipov Shukhrat , Khamidullayeva Gulnoz
Published: May 2024

Objective:

effect of COVID19 on the degree of nocturnal decrease in blood pressure (BP) initially and in dynamics against the background of antihypertensive therapy (AHT) in patients with arterial hypertension (AH).

Design and method:

Studied 74 male and female patients with I-III degree of AH according to the classification (ESH/ESC, 2018). Age was 53.54±1.92 years, duration of AH was 8.61 years. were divided: group I - AH patients who had undergone COVID19 no more than one month before inclusion in the study (n=42) and 2nd group - AH patients who had not undergone COVID19 (n=32). The diagnosis of COVID19 was confirmed by PCR test. All patients at the stage before treatment and 6 months of therapy had their office BP measured according to Korotkoff method, in order to study the daily arterial pressure profile (DAPP) we performed daily monitoring arterial pressure (DMAP) (BR-102 plus recorder (SCHILLER, Switzerland)). The daily rhythm of blood pressure was determined based on the degree of nocturnal decrease in SBP (DND SBP). An DND of 10 to 20% was considered optimal. All patients were prescribed two-component or three-component AHT.P<0.05. The results are presented as μ±SD.

Results:

2nd group in SBP (DND SBP), which initially amounted to 5.31±5.88% in dynamics - 11.6±3.81% (p<0.001). Whereas in 1stgroupDND SBP was initially 4.8±5.8% and over time – 6.3±4.4% (p > 0). In 1stgroup the number of non-dippers predominated - 53.8%, night pickers were 15.40%, dippers - 30.8%. A similar picture was observed in 2ndgroup: 50.0%: 20.0%: 30.0%. (ξ2=0.086, p=0.958). No overdippers were identified in both groups.in 1stgroup of patients the number of non-dippers increased significantly, amounting to 77%, dippers decreased to 23%. On the contrary, in 2ndgroup of patients, the number of non-dippers and non-dippers decreased slightly to 40%, and the number of dippers significantly increased by 2 times, amounting to 60% of patients. At the same time, the intergroup difference approached significance (ξ2= 3.23, p = 0.072).

Conclusions:

The previous COVID19 made a negative contribution to the antihypertensive effectiveness in terms of the dynamics of the degree of nocturnal reduction in blood pressure.
THE EFFECT OF COVID-19 ON NOCTURNAL BLOOD PRESSURE ELEVATION IN PATIENTS WITH ARTERIAL HYPERTENSION
Authors: Atoeva Munisa , Abdullaeva Guzal , Yusupova Khafiza , Masharipov Shukhrat , Khamidullaeva Gulnoz
Published: May 2024

Objective:

to evalute the effect of COVID-19 on the degree of nocturnal decrease in blood pressure (BP) against the background of antihypertensive therapy (AHT) in patients with arterial hypertension (AH).

Design and method:

74 male and female patients with I-III degree of AH(ESH/ESC, 2018) were studied. The mean age of patients was 53.54±1.92 years,duration of AH was 8.61 years. 2 groups of patients were identified: I – patients with AH who had suffered COVID19, (n=42) and 2nd group – patients with AH who had not suffered COVID-19 (n=32). All patients before and 6 months of therapy measured office BP and DBPM. The daily rhythm of blood pressure was determined based on the degree of nocturnal decrease in SBP (DND SBP). Based on the DND SBP data, patients were divided into: “dippers”, “non-dippers”, “over-dippers”, “night pickers”. All patients were prescribed dual or triple AHT. The results are presented as M±SD.

Results:

Significant improvement in the circadian rhythm of BP with a high degree of reliability in 2nd group of patients initially amounted to 5.31±5.88% in dynamics - 11.6±3.81% (p<0.001). In 1nd group DND SBP initially was 4.8±5.8% versus– 6.3±4.4% (p > 0.01). In 1st group of patients, the number of non-dippers predominated - 53.8%, while night pickers were 15.40%, dippers - 30.8%. A similar picture was observed in group II of patients: 50.0%: 20.0%: 30.0%. Intergroup differences were not significant (χ2=0.086, p=0.958). Analysis of the dynamics of DND SBP in both groups during therapy revealed that 1st in group of patients the number of non-dippers increased significantly, amounting to 77%, while the number of dippers decreased to 23%. On the contrary, in group II of patients, the number of non-dippers and non-dippers decreased slightly to 40%, and the number of dippers significantly increased by 2 times, amounting to 60% of patients. At the same time, the intergroup difference approached significance (χ2 = 3.23, p = 0.072)

Conclusions:

The previous COVID-19 made a negative contribution to the antihypertensive effectiveness in terms of the dynamics of the degree of nocturnal reduction in BP.
RENAL DENERVATION RESULTS IN SUBSTANTIAL NOCTURNAL BP REDUCTION IN PATIENTS WITH A REVERSED DIPPING PATTERN
Authors: Mahfoud Felix , Schlaich Markus , Narkiewicz Krzysztof , Ruilope Luis , Williams Bryan , Schmieder Roland , Mancia Giuseppe , Sharif Faisal , Ribichini Flavio , Fahy Martin , Böhm Michael
Published: May 2024

Objective:

We characterized patients with reverse blood pressure (BP) dipping pattern and uncontrolled hypertension (HTN) at baseline referred for radiofrequency renal denervation (RF RDN), and their subsequent BP changes.

Design and method:

Patients with HTN were enrolled into the Global SYMPLICITY Registry (GSR) DEFINE and underwent RF RDN. Patients were grouped into different BP dipping patterns defined by night/daytime BP ratio: dippers (ratio 0.9 or below), non-dippers (ratio 0.9 to 1.0 or below), reverse dippers (ratio >1.0). Baseline characteristics and BP changes through 3yrs were compared between groups based on dipper patterns. Statistical significance was defined as p<0.05.

Results:

As of March 2023, 3331 patients with uncontrolled BP were enrolled, 2276 of whom had 24-h BP measures and could be categorized by dipping patterns. Majority of the patients were non-dippers (44.3%), followed by dippers (34.6%) and reverse dippers (21.1%). Reverse dippers (n=480) were the oldest (62±12yrs; p=0.0024), more likely to have cardiac disease (54.2%; p<0.0001), diabetes (48.1%; p<0.0001) and renal disease (38.9%; p<0.0001). Reverse dippers had the highest baseline 24-h ambulatory systolic BP (SBP) (156±19mmHg; p<0.0001) and nighttime SBP (163±21; p<0.0001). In contrast, they had the lowest daytime SBP (153±19mmHg; p<0.0001) and heart rate (66±11bpm; p<0.0001). Reverse dippers were prescribed the most antihypertensive drugs (5.2±1.7; p=0.0058).

3yrs after RF RDN, significant overall 24-h ambulatory SBP reduction from baseline was observed within all dipping patterns, and the largest reduction was observed within reverse dippers (-11.8±25.1mmHg; Figure), particularly in the nighttime (-21.1±23.8mmHg).

Conclusions:

Reverse dippers with uncontrolled HTN referred for RDN were prescribed more antihypertensive drugs and had more comorbidities compared to patients with other dipping patterns. After RF RDN, significant SBP changes from baseline were observed irrespective of dipping status. The largest BP reduction was observed in nighttime BP in patients with reverse dipping pattern. RF RDN may offer an effective adjunctive therapy to drugs to lower nighttime BP patients with a reverse dipping pattern, who have the highest risk of cardiovascular events.
LONG-TERM PROGNOSIS OF THE DEVELOPMENT OF HEART FAILURE WITH LOW EJECTION FRACTION IN ACUTE CORONARY SYNDROME IN YOUNG AND MIDDLE-AGED PATIENTS WITH ARTERIAL HYPERTENSION
Authors: Zbyshevskaia Elizaveta , Butaev Tamerlan , Wang Zheming , Makeeva Tatiana
Published: May 2024

Objective:

To determine the prognosis and dynamics of the development of heart failure with low ejection fraction (HFrEF) after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) in young and middle-aged patients with arterial hypertension (AH) and type 2 diabetes mellitus (DM)

Design and method:

The study included 191 hypertensive patients aged 36-59 years with ACS after PCI. Group 1 - 76 patients with hypertension in combination with DM, group 2 - 115 patients with hypertension without DM. In 35 (46%) people of the 1st group and in 56 (48.7%) of the 2nd group, myocardial infarction (MI) of the anterior wall of the left ventricle (LV) was determined. The incidence of non-anterior MI (posterior and lateral walls) of the LV was 54% and 51.3% respectively. Patients in both groups were comparable. Observation was carried out for 12±1 months. Ejection fraction (EF), indices of LV end-systolic volume (LVESVI), LV end-diastolic volumes (LVEDVI), and index of impaired local contractility (ILCI) were determined over time.

Results:

On the first day after PCI, LVEF <40% (36%, 27-39%) in 14 of 76 (18.4%) in group 1; LVESVI - 43 ml/m2 (40-48 ml/m2); LVEDVI - 77 ml/m2 (67-87 ml/m2); ILCI 1.81 (1.63-2.0). After 12 months, LVEF decreased to 33% (28-39%) in 26 of 76 (34.2%) patients. The progression of HFrEF was indicated by an increase in initial LVESVI by 29-30% and LVEDVI by 23-35%. In group 2, on the first day after myocardial reperfusion in 8 out of 115 (7%) patients, LVEF was 38% (37 - 39%), LVESVI 44 ml/m2 (40-46 ml/m2), LVEDVI 69 ml/m2 m2 (64-76 ml/m2), ILCI 1.75 (1.13-1.88). After 12 months, HFrEF was detected in 10 of 115 (8.7%) patients with an increase in initial LVESVI values by 28%, LVEDVI by 31% and a decrease in LVEF to 36% (35-39%) (p = 0.0242).

Conclusions:

In young and middle-aged patients with hypertension in combination with DM, during the first 12 months after MI, in 34.2% of cases, there is a significant deterioration in the course of HFrEF, which requires an early decision on the timing of complete myocardial revascularization.
DETERMINANTS AND ASSOCIATIONS OF COMMON CAROTID INTIMA-MEDIA ROUGHNESS IN PATIENTS WITH HYPERTENSION AND TYPE 2 DIABETES
Authors: Kyriakoulis Konstantinos , Menti Ariadni , Komnianou Aikaterini , Ntousopoulos Vasileios , Stathopoulou Panagiota , Theodosiadi Aikaterini , Stergiou George , Kollias Anastasios
Published: May 2024

Objective:

Carotid atherosclerosis, including increased intima-media thickness (IMT) and plaque, is associated with increased cardiovascular (CV) risk. The role of the irregularity of the carotid intima-media surface in terms of total CV risk has been insufficiently investigated. This study investigated determinants and associations of common carotid intima-media roughness in patients with type 2 diabetes and hypertension.

Design and method:

Adults with type-2 diabetes and hypertension were evaluated with (i) 24h ambulatory blood pressure (ABP) monitoring (20 min intervals, Microlife WatchBPO3), (ii) carotid ultrasonography for the calculation of the common carotid IMT (use of automated software that allows the calculation of the average value of multiple measurements), carotid plaque score (CPS), and standard deviation (SD) of the common carotid intima-media (derived for the multiple measurements performed for the calculation of the IMT), and (iii) ultrasound estimation of left ventricular mass index (LVMI).

Results:

Ninety-five individuals were analyzed [age 66.3±8.9 years, 61 men, body mass index (BMI) 30.8±4.8 kg/m2, HbA1c 6.6±0.8%, 24-hour ABP (systolic/diastolic) 123±13/69.4±7.3 mmHg, IMT 0.83±0.16 mm, SD IMT 0.07±0.03 mm, CPS 5.5±4.8 mm]. SD IMT was correlated with IMT (r=0.49, p<0.001), nighttime systolic ABP (r=0.21, p<0.05), 24h weighted SD of systolic ABP (r=0.26, p<0.05), CPS (r=0.30, p<0.01) and LVMI (r=0.39, p<0.001). In stepwise multivariable regression analysis with age, nighttime systolic ABP, 24h weighted SD of systolic ABP, total number of IMT measurements and IMT as independent variables, the SD IMT was determined by IMT (β=0.08, p<0.001) and 24h weighted SD of systolic ABP (β=0.003, p<0.05).

Conclusions:

These preliminary data suggest that in patients with type-2 diabetes and hypertension, carotid intima-media roughness is determined by IMT and the variability of 24h systolic ABP, and is associated with the severity of carotid atherosclerosis and left ventricular hypertrophy.
ARTERIAL HYPERTENSION AND INSULIN RESISTANCE IN OBESE PATIENTS
Authors: Papanastasiou Anastasios , Tsounis Dimitrios , Skoufis Fotios , Krallis Ioannis , Karkamanis Achilleas , Pitsariotis Thomas , Lapatsani Maria , Tsiachri Maria , Karinos Dimitrios , Kalpakos Dionisios , Bouras Georgios
Published: May 2024

Objective:

Diabetes and Hypertension are two of the most common conditions connected to obesity, the development of cardiovascular disease and higher mortality rates. However, the relationship of these two conditions remains unclear. Obesity is an independent risk factor for insulin resistance, a hallmark of prediabetes. The aim was to study insulin resistance in obese hypertensive patients.

Design and method:

120 obese outpatients (BMI>30, 57% males) without Diabetes Mellitus (DM) when included in the study, where compared to 80 obese hypertensive patients (56% males), without DM. Homeostatic Model Assessment for Insulin Resistance Index (IR-HOMA) was used as an insulin resistance marker.

Results:

Hypertensive and obese patients showed a significant increase of IR-HOMA (5,17 vs 3,2 p=0,022), as well as increased fasting glucose, insulin and HBA1c levels, in contrast to obese normotensive patients.

Conclusions:

Hypertension may be another independent risk factor for DM in obese patients.
LINKING ULTRASOUND ASSESSMENT OF RENAL ARTERIES TO THE BIOLOGICAL PROFILE OF INFLAMMATION AND COAGULATION AT HYPERTENSIVE PATIENTS WITH OR WITHOUT DIABETES MELLITUS
Authors: Adrian Gavrila , Mehedintu Anca
Published: May 2024

Objective:

The objective of the study was to estimate how the ultrasound parameters of the renal arteries correlate with the proinflammatory and prothrombotic imbalances at hypertensive patients (pts) with or without diabetes mellitus (DM).

Design and method:

40 hypertensive pts (mean age = 58.5 ± 9.6 years, 52.5% males) – group 1 and 40 hypertensive pts with DM, matched for age and sex (mean age = 60.4 ± 10.3 years, 55% males) – group 2.

Vascular ultrasound parameters performed in renal arteries were: peak systolic velocity (PSV), resistance index (RI), end-diastolic velocity (EDV), systolic acceleration time (SAT), renal versus aortic systolic velocity ratio (RAR). The inflammatory profile was estimated by serum measurement of C reactive protein (CRP) and fibrinogen (F). The prothrombotic profile was determinated by serum measurement of von Willebrand factor (vWf), antithrombin III (AT III), and plasminogen activator inhibitor (PAI-1).

Results:

In group 1, a higher RI was significantly associated with a higher level of CRP (0.81 ± 0.09 vs 0.52 ± 0.12, p = 0.02). In group 2, a higher level of CRP was significantly more frequent at pts with greater RI (0.83 ± 0.08 vs 0.54 ± 0.11, p = 0.01) and with higher RAR (3.6 ± 0.3 vs 2.2 ± 0.2, p = 0.03). In the same group, pts with greater level of vWf have longer SAT in a significantly higher proportion (76 ± 8 ms vs 40 ± 4 ms, p = 0.02), and a greater proportion of PAI-1 is significantly associated with higher RAR (3.7 ± 0.2 vs 2.1 ± 0.1, p = 0.04).

Conclusions:

Higher RI in renal arteries seems to reflect a proinflammatory status at hypertensive pts, especially with DM. Moreover, greater RAR and longer SAT at hypertensive pts with DM appear to express both proinflammatory status and prothrombotic imbalance.
ARTERIAL HYPERTENSION PROFILE IN PATIENTS WITH KIDNEY DISEASES
Authors: Ramdani Sara , Haddiya Intissar
Published: May 2024

Objective:

Arterial hypertension is a global public health worldwide. It is a risk factor for cardiovascular events which represent major cause of morbidity and mortality as it contributes to the development and progression of kidney diseases.

The aim of the study was to investigate the profile of arterial hypertension in patients with kidney diseases.

Design and method:

It is a prospective study that entails young hypertensive patients aged between 18 and 65 years old in the course of six months from 1st January 2022 to June 30th 2022 within the nephrology department in which we assessed an array of parameters.

Results:

Hypertension prevalence represented 75% (81 patients) among 107 hospitalized patients with a male predominance of 59%, a sex ratio of 1.45 and was widespread among patients aged from 55-65 years old. The mean age of our patients was 48.98±14.066 years.

History of hypertension was observed in 85,2% followed by diabetes in 40,7%. 14,8% among hypertensives were newly detected. The main cardiovascular risk factors were diabetes (65%), obesity (15%) and sedentary lifestyle (11%). Systolo-diastolic hypertension was present in 57% whereas grade 2 hypertension affected 30% of patients aged from 18 to 34 years old.

Our patients presented left ventricular hypertrophy in 19,61% of the cases while 80% manifested renal failure which was chronic in 50% of the patients.

58% of the patients were on monotherapy, followed by dual (35%) and triple therapy (7%).

The most prescribed treatment was either calcium channel blockers in monotherapy or combined with angiotensin receptor blockers/angiotensin-converting enzyme inhibitors inhibitor in dual therapy or with angiotensin-converting enzyme inhibitors + diuretic/beta-blocker in triple therapy. Control rate was 54.3%, majorly, observed among women and patients who belong to the 55- 65 years old age category.

Conclusions:

In order to reduce the hypertension prevalence and prevent the occurrence of its renal complications. The application of an intensive management of hypertension as well as the cardiovascular risk factors should be integrated into primary care systems. Beside treatment, lifestyle modifications should be implemented in the first line as they exert blood pressure lowering effects additionally to therapeutic treatment.
ASSESSMENT OF THE PREVALENCE OF ARTERIAL HYPERTENSION IN YOUNG NON-ORGANISED POPULATION OF THE REPUBLIC OF KAZAKHSTAN
Authors: Mukhtarkhanova Dilayra , Junusbekova Gulnara , Tundybayeva Meiramgul , Baglanova Lyazat , Samitova Sabina , Chigis Medet , Torzhan Ulbolsyn
Published: May 2024

Objective:

Arterial hypertension is defined as increasing of office systolic blood pressure higher 140 mmHg and/or diastolic blood pressure higher 90 mmHg. Prevalence of hypertension is high and continue to increase, especially in young population. The purpose of the study is to assess the prevalence of arterial hypertension in young non-organized population of Republic of Kazakhstan.

Design and method:

Prospective cross-sectional studies were conducted in 2021 in Kazakhstan, included 1110 young adults of both sexes (670 women (60%) and 440 men (40%)) of mean age - 31±8 years (95% CI 31-32). Special survey, including cardiovascular risk factors assessment, blood pressure and heart rate measurement were performed. Statistical test was performed by the StatTech, Russia

Results:

349 (31%) had never their blood pressure measured before. 255 respondents were identified with pre-existing and newly diagnosed arterial hypertension during screening (23%), of which 103 people at the time of the study knew about their diagnosis (40%). The newly diagnosed arterial hypertension was identified in 14%.

Conclusions:

According to the screening the prevalence of arterial hypertension – 23% in young non-organized population of Kazakhstan. It is clear that majority of respondents did not know the high levels of blood pressure before. This fact emphasizes the necessity of screening and annual assessment of hypertension prevalence, especially in young population.
INCREASED BURDEN OF PATIENTS WITH HYPERURICEMIA IN THE ERA OF NEW RISK SCALE SCORE-2 IMPLEMENTATION
Authors: Ilyanova Irina , Rotar Oxana , Boiarinova Maria , Moguchaia Ekaterina , Kolesova Ekaterina , Vasilieva Elena , Usoltsev Dmitrii , Artomov Mykyta , Konradi Alexandra
Published: May 2024

Objective:

Hyperuricemia is an independent, modifiable risk factor for the development and progression of cardiovascular disease. According to recent expert consensus (Borghi C., 2021), a target uric acid (UA) level that should be achieved with urate-lowering therapy was defined based on the cardiovascular risk: <360 μmol/L in case of low and moderate risk and <300 μmol/L in case of high and very high risk.

We aimed to assess the prevalence of elevated uric acid levels for different cardiovascular risk groups and scales in the Russian population-based sample.

Design and method:

A random population sample of 4,800 participants from three regions (age 25-64 years) was examined as a part of the Russian epidemiologic study ESSE-RF. All patients signed informed consent and completed a questionnaire about behavioral risk factors, comorbidities and therapy, standard anthropometry, laboratory examination (creatinine, glucose, lipids, uric acid), anthropometry. Blood pressure (BP) was measured on the right arm in the sitting position after 5-minute rest by automatic tonometer OMRON (Japan). SCORE (European guidelines on dyslipidemia 2019) and SCORE2 (European guidelines on cardiovascular prevention 2021) were used to assess cardiovascular risk. Participants under 40 years of age were excluded from the analysis (n=1551). Statistical analysis was performed using IBM SPSS Statistics 23.

Results:

A total of 3216 individuals with complete data were included in the analysis - 1175 (36,5%) males and 2041 (63,5%) females (Table 1).

Conclusions:

Implementation of a new risk approach - SCORE-2 results in a 3-fold increase in a number of patients with high and very high risk. As a result, population prevalence of elevated uric acid level raises by 32%. Prescription of urate-lowering therapy as a risk-decreasing strategy to 44,4% of population might lead to polypharmacy and needs more evidence (Agreement No. 075-15-2022-301).
CAROTID ATHEROSCLEROSIS AS A MEDIATOR OF THE RELATIONSHIP BETWEEN LIPOPROTEIN(A) AND ISCHEMIC STROKE
Authors: Chien Kuo -LIONG , Hsu Hsin -Yin , Fan Hsien -Yu , Hwang Lee -Ching , Lin Hung -Ju , Su Ta -Chen , Hsu Hsiung -Ching
Published: May 2024

Objective:

Lipoprotein(a) is a known risk factor for ischemic stroke, driven by its hereditary nature. Understanding potential mediators in the association between lipoprotein(a) and ischemic stroke is crucial for improved monitoring and prevention, yet mediation analysis in this context is limited. This study aims to explore the cardiovascular pathophysiological changes that mediate the link between lipoprotein(a) and ischemic stroke risk.

Design and method:

This study utilizes data from the Chin-Shan Community Cardiovascular Cohort in Taiwan, a community-based cohort initiated in 1990-1991, which enrolled participants aged 35 years and older and followed them until 2005. Participants with established ischemic stroke and those lacking lipoprotein(a) or carotid sonography data were excluded. Lipoprotein(a) levels greater than the 90th percentile were categorized as higher lipoprotein(a), while levels below this threshold were classified as normal lipoprotein(a). The study employed inverse propensity score-weighted Cox regression to investigate the association between lipoprotein(a) and ischemic stroke, considering carotid atherosclerosis (defined by the presence of carotid artery plaque or intima thickness >= 1mm) and left ventricular hypertrophy (defined by an increased left ventricular mass index) as potential mediators. Causal mediation analysis divided the total effects into direct and indirect components.

Results:

A total of 2572 participants (average age, 53.8 years; women, 54.6%) were enrolled. In the higher lipoprotein(a) group, participants were more likely to be women and had elevated levels of low-density lipoprotein and hypertension when compared to the normal lipoprotein(a) group. After a 49,958 person-year follow-up, 167 events of ischemic stroke were documented. Compared with the normal lipoprotein(a) group, the higher lipoprotein(a) group had a higher risk of ischemic stroke (adjusted hazard ratio: 1.60, 95% confidence interval: 1.30-1.95). Carotid atherosclerosis was a significant mediator, accounting for 6.8% (p=0.049) of the relationship between lipoprotein(a) and ischemic stroke.

Conclusions:

Carotid atherosclerosis was a significant mediator, accounting for 6.8% of the relationship between lipoprotein(a) and ischemic stroke. Monitoring carotid atherosclerosis is a potential preventive strategy to disrupt the association between high lipoprotein(a) and ischemic stroke. Further, a two-step Mendelian randomization analysis is warranted for confirming a causal relationship in this mediation model.
HYPERTENSION - ARE WE DIAGNOSING AND TREATING IT? - ANALYSIS OF A CAMPAIGN DAY
Authors: Cestario Elizabeth Do Esp , Garcia Beatriz Ferreira , Measso Camila Hares , Dolci Carlos Eduardo Martinez , Oliveira Gabrielle E. S. , Viana Giovana Pretto , Da Silva Isac , Morandin Vitória Lio , Telini Wagner Moneda
Published: May 2024

Objective:

This study aimed to assess knowledge and control of hypertension in a random sample during a one-day campaign.

Design and method:

This study was an observational, cross-sectional, descriptive, population-based study with a random sample and information collected on a campaign day in a city northwest of São Paulo, with 315 participants, 177 women and 138 men. Variables analyzed:

Three blood pressure measurements (systolic, diastolic, and mean), heart rate, pulse pressure, and their respective means; Previous diagnosis of SAH and use of antihypertensive medication.

Results:

Average age: Men=53.99 +/- 15.57 Women= 53.93 +/- 16.08(NS). We used the mean comparison test for independent, non-parametric variables to compare the means of the variables between the male and female sexes. Using the T-test, in the analysis of systolic blood pressure (SBP) in the group that reported not using antihypertensive drugs, men had higher blood pressure levels (SBP men= 135.28 mmHg +/- 17.52 and SBP women= 124.20 +/- 24.82, with P=0.001). In the group that reported using 1 or 2 antihypertensive drugs, both men and women had higher SBP (138.17 mmHg +/- 20.17), with men tending to have higher SBP than women (P=0.02). In the group that used three or more antihypertensive drugs, there was no statistical difference in SBP levels. Both had more controlled SBP (134.34 mmHg +/- 15.64), with no statistical difference between the groups (P=0.71). In the analysis of mean arterial pressure, the group treated with three or more drugs had a significantly lower MAP (MAP 1 or 2 drugs 98.62 mmHg +/- 14.50 and MAP 3 or + drugs 94.90 mmHg +/- 11.06).

Conclusions:

Despite the small sample size, in this study, we can see the presence of undiagnosed and untreated hypertension. In treated hypertensive patients, poor control of blood pressure levels, especially in individuals taking only 1 or 2 drugs, highlights the need for health policies aimed at primary care, reinforcing early diagnosis and effective treatment, and bringing patients as quickly as possible within the recommended targets.
SEX DIFFERENCES IN HYPERTENSION PREVALENCE, TREATMENT AND CONTROL IN OLDER PEOPLE IN GERMANY: RESULTS OF THE NATINAL EXAMINATION SURVEY GESUNDHEIT 65+
Authors: Büschges Julia Charlotte , Sarganas Giselle , Gaertner Beate , Perlitz Hanna , Fuchs Judith , Neuhauser Hannelore
Published: May 2024

Objective:

As hypertension is closely linked to cardiovascular events, blood pressure (BP) levels and management in populations are a vital public health concern. A gender gap with higher awareness, treatment and control of hypertension in women, especially in younger women, has been repeatedly reported. We analyze recent national BP data of the Gesundheit 65+ study in older and very old men and women in Germany 2022-2023.

Design and method:

Nationally representative examination survey of the population aged 65 years and older residing in Germany. We analysed self-reported hypertension diagnoses, the mean of the second and third standardized oscillometric BP measurements (Mobil-O-Graph) with one of five cuffs according to upper arm circumference and Anatomical Therapeutic Chemical- (ATC) coded medication in the past 7 days. Hypertension was defined as mean systolic BP (SBP) at or above 140 mm Hg, or mean diastolic BP (DBP) at or above 90 mm Hg, or use of antihypertensives (ATC-codes C02 antihypertensives, C03 diuretics, C07 beta-blockers, C08 calcium-channel blockers or C09 ACEI and ARB) in participants with self-reported hypertension diagnosis. Awareness was defined as self-reported BP diagnosis in those with hypertension according to study definition. Provisional population weights were used.

Results:

BP was measured and hypertension status defined in 743 men and 686 women aged 65 to 100 years. The prevalence of hypertension according to our study definition was 58.3% [95% CI 53.2-63.3] in men and 59.5% [53.8-64.9] in women. There were no sex differences in awareness among hypertensives (men 81.7%, women 81.2%), nor in treatment among aware hypertensives (97.5% in men and women). However, control among treated hypertensives differed considerably: while 75.7% [69.2; -81.2] of men with treated hypertension had BP at or below 140/90, control among treated in women was only at 61.4% [54.2-; 68.1].

Conclusions:

Our 2022-2023 national blood pressure data of people aged 65 years and older in Germany suggest a new gender gap with less hypertension control in older women compared to older men which was not yet apparent a decade ago and stands in contrast to findings in younger adults across many studies.
COMPARISON OF COMPONENTS OF CENTRAL AORTIC AND PERIPHERAL BLOOD PRESSURE FOR PREDICTION OF CARDIOVASCULAR EVENTS IN A 2-YEAR AND 14-YEAR FOLLOW-UP OF A HYPERTENSIVE COHORT
Authors: Zuo Junli , Chang Guili , Hu Yueliang , Chu Shaoli , Avolio Alberto
Published: May 2024

Objective:

The aim of this study was to assess components of central aortic pressure, brachial blood pressure and indices of arterial stiffness for prediction of cardiovascular events in a hypertensive cohort.

Design and method:

Noninvasive measurements of central aortic blood pressure (SphygmoCor), brachial pressure, central augmentation index (cAIx), augmented pressure (cAP) and carotid intima-media thickness (IMT) were obtained in 681 hypertensive patients (age 61 ± 9 years, 425 males). The primary endpoints were defined as cardiovascular disease (CVD) events or death from CVD. An initial analysis was conducted at mean 2-year follow-up and a second analysis is currently being conducted at mean 14-year follow-up.

Results:

Total events were 59 (8.7%) for the 2-year follow-up and 265 (38.9%) for the 14-year follow-up. Major cardiovascular events were 49 (83.1%) and 178 (67.2%) respectively. The analysis of the 2-year follow-up suggested that central systolic (cSBP) and pulse pressure (cPP) showed higher hazard ratios (HR/10 mmHg) for cardiovascular events compared to peripheral pressure indices (pSBP, pPP) at age >60 years (cSBP: HR = 1.18, pSBP: HR = 1.17, p = 0.034; cPP: HR = 1.28, pPP: HR = 1.2, p = 0.019). Each SD increase in IMT and in cAP was associated with 1.4 times higher risk of increased total events in elderly patients (age >60 years). Males showed that each SD increase in cAP was associated with significantly higher risk of increased total events than females. The complete data for the 14-year follow-up analysis has only recently become available and the analysis will be completed for the conference presentation.

Conclusions:

Preliminary analysis in a short-term (2-year) follow-up study of a large hypertensive cohort has shown that central aortic pressure and its components can improve prediction of CVD compared to peripheral pressure. The final analysis of the long-term (14-year) follow-up will determine which components are robust predictors and will provide important information on the clinical and epidemiological relevance of central aortic pressure.
POOR MENTAL HEALTH AND ADVERSE PSYCHOSOCIAL EXPERIENCES AND PERCEPTIONS ARE ASSOCIATED WITH HYPERTENSION IN CAPE TOWN
Authors: Peer Nasheeta , Mashiane Tshephang , Hill Jillian , Kengne Andre -Pascal
Published: May 2024

Objective:

To determine any differences in mental health (depression and anxiety traits) and poor psychosocial well-being by hypertension status, in adults at high-risk for diabetes.

Design and method:

In a population-based cross-sectional study, socio-demographic characteristics, lifestyle behaviours (cigarette smoking, alcohol misuse, physical inactivity), and mental health and psychosocial information were collected via administered questionnaires. Depression and anxiety traits were investigated using the Patient Health Questionnaire-9 (PHQ-9) and Generalised Anxiety Disorder (GAD-7) screening questions. Blood pressures (BP) were measured, and hypertension defined as systolic BP >=140 mmHg and/or diastolic BP >=90 mmHg, self-reported hypertension diagnosis or on antihypertension medication. Multivariable logistic regressions determined the associations with hypertension; the basic model comprised socio-demographic and lifestyle behaviours. Mental health and psychosocial variables were entered individually in separate models.

Results:

Among 678 participants, median age among those with (n=384) and without (n=290) hypertension was 54 vs. 49 years (p<0.001). Prevalence of depression scores >=10 (17.4% vs. 10.0%, p=0.004) and anxiety scores >=10 (11.7% vs. 8.2%, p=0.392) were higher in participants with than without hypertension but were only significant for depression. In the basic regression model, only increasing age was significantly associated with hypertension. Participants with depression score >=10 vs. <=4 were twice as likely to have hypertension (OR: 2.07, 95%CI: 1.23-3.46, p=0.006). Increasing anxiety scores were related to hypertension (OR: 1.05, 95%CI: 1.01-2.64, p=0.034). Poor psychosocial well-being, defined as 1) decreasing social support (OR: 1.03, 95%CI: 1.01-1.06, p=0.039), 2) physical health or emotional problems interfering with social activities all/most of the time (OR: 2.07, 95%CI: 1.02-4.17, p=0.043), 3) perception of worsening health (OR: 1.06, 95%CI: 1.02-1.11, p=0.002), and 4) a serious ongoing health problem (OR: 1.52, 95%CI: 1.01-2.30, p=0.048), was associated with hypertension in separate models. Quality of life and increasing number of adverse life events experienced were not significantly associated with hypertension.

Conclusions:

The high burden and associations of depression and anxiety traits, and poor psychosocial well-being with hypertension suggest a need for strategies to mitigate the effects of these conditions on hypertension.