bluuebunny/crossref_metadata_2025 huggingface dataset:
PATIENTS WITH CKD SECONDARY TO GLOMERULAR DISORDERS HAVE DECREASED ARTERIAL STIFFNESS, AS COMPARED TO HYPERTENSIVE AND DIABETIC CKD
Authors: Lencovsky Ori , Leiba Adi , Angel-korman Avital
Published: May 2024

Objective:

To compare pulse wave velocity (PWV), a marker of arterial stiffness, between CKD patients of different etiologies: hypertensive and diabetic nephrosclerosis. vs. CKD secondary to glomerular disorders.

Design and method:

Clinical data were collected on 56 patients followed at the Nephrology and Hypertension Institute in Samson Assuta Ashdod University Hospital. All patients had at least one visit at our Nephrology clinics prior to recruitment. All patients with a glomerular disorder had a clinical-pathological diagnosis based on a recent kidney biopsy.

Pulse wave velocity (PWV) was measured using a validated Sphygmocor XCEL® device. Univariate and multivariate analyses were performed to compare PWV between hypertensive/diabetic CKD and CKD secondary to glomerular disorders.

Results:

PWV was significantly higher in the hypertensive/diabetic CKD group, compared to the CKD-GN group, with an average of. 12.2 m/s vs 8.3 m/s, respectively.

In a multivariate linear regression model, having CKD secondary to glomerulonephritis was associated with a significantly lower PWV, compared with CKD secondary to hypertension and diabetes, with adjustment of age, creatinine, and comorbidities.

Conclusions:

CKD Patients secondary to glomerulonephritis, have lower PWV when compared to CKD patients with diabetes and/or hypertension, even after adjusting for age, renal function, and the presence of comorbidities. It is intriguing to further study the possible protective role of immunosuppression on the arterial properties of CKD patients.
LIPOPROTEIN ASSOCIATED PHOSPHOLIPASE A2 ACTIVITY IS NEGATIVELY ASSOCIATED WITH DECREASED BAROREFLEX SENSITIVITY IN HIGH NORMAL BLOOD PRESSURE
Authors: Celovska Denisa , Janeckova Katarina , Gonsorcik Jozef
Published: May 2024

Objective:

The relationship between baroreflex sensitivity (BRS) and inflammatory vascular biomarker Lipoprotein associated phospholipase A2 (Lp-PLA2) in subjects with high normal blood pressure (HNBP, prehypertensives) with a positive family history of hypertension (FHH+) to hypertension history free control subjects (FHH-) was evaluated.

Design and method:

A total of 24 HNBP participants (age 39.5 ± 2.5 years, 18 male/ 6 female) were studied. 14 HNBP subjects FHH+ were compared to 10 HNBP participants FHH-, being of similar age and body mass index. BRS (ms/mmHg) and BRSf (Hz/mmHg) were determined by the sequence and spectral methods (five-minute non-invasive beat-to-beat recording of blood pressure and inter-beat interval, controlled breathing at a frequency of 0.1 Hz). Venous blood was analysed for Lp-PLA2 biomarker of vascular inflammation and atherothrombotic activity.

Results:

A significant negative correlation between spontaneous BRS obtained by both methods and blood pressure (BP) was present (BRS spect r = –0.54, p<0.001, BRS seq r = –0.59, p<0.001). BRS obtained by sequence and spectral methods were reduced in HNBP FHH+ compared to group of HNBP without history of hypertension (P= 0.0317 BRS seq, P = 0.0395 BRS spect). There was no difference between both groups of HNBP subjects in BRSf values. Lp-PLA2 was significantly higher in HNBP FHH+ compared to FHH- controls (P = 0.025). Lp-PLA2 was negatively correlated with BRS obtained by sequence method (r = - 0.6758, P = 0.00028) and BRS obtained by spectral method (r = - 0.5935, P = 0.00031).

Conclusions:

Lipoprotein associated phospholipase A2 is negatively associated with decreased baroreflex sensitivity in subjects with high normal blood pressure and positive family history of hypertension. These findings demonstrate that reduced baroreflex sensitivity as marker of autonomic dysfunction is linked with vascular inflammation predominantly in otherwise healthy participants with positive history of hypertension that could predispose to increased risk of hypertension. Further research is needed.
BAROREFLEX SENSITIVITY AND HEART RATE VARIABILITY PREDICT INCIDENT HYPERTENSION AND SYSTOLIC BLOOD PRESSURE INCREASE IN A MULTI-ETHNIC COHORT: THE HELIUS STUDY
Authors: Bouwmeester Thomas , Collard Didier , Vriend Esther , Galenkamp Henrike , Westerhof Berend , Van Den Born Bert -Jan
Published: May 2024

Objective:

Cross-correlation baroreflex sensitivity (xBRS) and heart rate variability (HRV) provide valuable insight into neurocardiovascular control. However, their prospective utility in predicting new-onset hypertension and increases in systolic blood pressure (SBP) over time within the general population has not yet been demonstrated.

Design and method:

Data was collected from participants of the HEalthy Life In an Urban Setting (HELIUS) study. A non-invasive continuous finger blood pressure (BP) measurement at baseline was used to calculate xBRS, standard deviation of the normal-to-normal interval (SDNN) and the squared root of mean squared successive differences between normal-to-normal intervals (RMSDD). In the normotensive individuals at baseline, we used logistic regression models to calculate the odds ratio (OR) of developing hypertension at follow-up, and in the full cohort we assessed the change in SBP, corrected for the use of antihypertensive medication, between baseline and follow-up using linear regression with tertiles and splines where appropriate. A subgroup analyses was performed in the younger (aged < 50 years) and older (aged > 50 years) part of the cohort. Both the logistic and linear regression models were corrected for demographic and confounding factors.

Results:

Follow-up data from 4,910 participants were available, mean follow-up time was 6.6 years (SD 1.1 years). A 50% reduction in xBRS was associated with an OR of 1.31 (95% CI 1.09–1.57) for developing hypertension at follow-up, with no significant difference between the younger and older subgroups of the cohort. No significant association between SDNN or RMSDD and new-onset hypertension was found. Splines depicting the relation between delta SBP and xBRS, SDNN and RMSDD are depicted in Figure 1. Compared to the lowest tertile, an xBRS in the highest tertile was associated with a 3.61 mmHg (95%CI 2.50-4.71) higher change in SBP over time, whereas this was 1.11 mmHg (95%CI 0.12-2.09) and 1.76 mmHg (95%CI 0.73-2.79) for SDNN and RMSDD, respectively.

Conclusions:

In the general population, a lower xBRS is associated with increased odds of developing hypertension, and a steeper increase in SBP over time.
THE RELATIONSHIP BETWEEN LUNG MIBG UPTAKE AND CLINICAL RESPONSE TO RENAL DENERVATION
Authors: Leo Andrea , Piludu Sara , Ubaldini Giulia Mori , Dalpiaz Hermann , Sciarrone Paolo , Buralli Simona , De Carlo Marco , Taddei Stefano , Masi Stefano , Gimelli Alessia , Bacca Alessandra
Published: May 2024

Objective:

Renal denervation (RDN) attenuates the sympathetic nervous system overactivity that characterizes patients with elevated blood pressure (BP). Given that accurate predictors of BP response to RDN remain to be identified and that metaiodobenzylguanidine (MIBG) scintigraphy allows non-invasive assessment of sympathetic nerve activity, we explored if the kidney, heart and lung MIBG uptake predict BP response to RDN.

Design and method:

Thirteen patients with difficult-to-treat hypertension underwent radiofrequency-based RDN. Before the procedure, clinical and pharmacological history, office and ambulatory BP values and cardiovascular risk factors were recorded. Patients also underwent preprocedural rest echocardiography and MIBG scintigraphy. After RDN, a follow-up visit was performed at 3 months, with registration of office and ambulatory BP values. We considered as responders (R) those patients showing a reduction of office BP values on unchanged BP-lowering treatment and those who reduced the number and/or dosage of BP-lowering medications while maintaining optimal control of office BP.

Results:

Seven patients were classified as R (1 woman, mean age 48±11 years), while 6 were non-responders (NR) (2 women, mean age 50±8 years). The reduction in office systolic and diastolic BP values from baseline to 3 months was significantly larger in R vs NR (p=0.01). Furthermore, the burden of BP-lowering medications after the procedure was reduced more significantly in R (-44%) than NR (-16%), p<0.01. Baseline heart rate was the only clinical parameter significantly different between R (median 82, IQR [67-98]) bpm vs NR (median 62, IQR [60-72]) bpm, p<0.05. In early MIBG acquisitions, the lung/mediastinum ratio on both sides showed higher MIBG uptake in R vs NR (p<0.05). In late acquisitions, only the left side showed a significant difference between R and NR (p<0.05). There was a higher MIBG uptake in the right vs. left lung in the whole population and in R vs NR. All other MIBG scintigraphy parameters were similar between groups.

Conclusions:

Among patients with difficult-to-treat hypertension, those responding to RDN showed a higher lung/mediastinum ratio at MIBG scintigraphy and a higher heart rate before the procedure. Further studies are needed to confirm these preliminary results.
MORIN ATTENUATES INFLAMMASOME-DEPENDENT MYOCARDIAL INJURY IN DIABETIC RATS: MODULATION OF THE SIGNALING PATHWAY
Authors: Arya Dharamvir , Verma Vipin Kumar , Bhatia Jagriti
Published: May 2024

Objective:

Diabetes is a risk factor that predisposes to atherosclerotic cardiovascular diseases. The risk of myocardial infarction in diabetes is higher and this warrants investigation into exploring new drugs that can attenuate myocardial injury. In diabetes, high blood glucose levels lead to vascular inflammation which accelerates atherosclerosis. Morin, a plant flavonoid, was found effective for septic shock, cancer, cardiovascular, and renal complications and acts as an agonist for insulin secretion. This study aims to evaluate the mechanism involved in the cardioprotective action of Morin in diabetic rats.

Design and method:

In male Wistar rats, streptozotocin (70 mg/kg; i.p.) was administered to induce diabetes. Diabetes-confirmed rats (blood glucose >400mg/dl) were divided into 4 groups (n=8), i.e., Diabetic-control; Diabetes+Isoproterenol (ISO); Diabetes+ISO+Morin and Diabetes+Morin, in addition to this, one control group was also included in the study. Morin was orally administered at the dose of 40 mg/kg for 28 days and on the 27th and 28th day of morin administration, ISO was administered to designate groups at the dose of 85mg/kg s.c., to induce myocardial injury. After 24 hours of the second dose of ISO administration, the rat was sacrificed after collection of blood, and heart was excised to do the biochemical, histopathological and molecular investigations.

Results:

ROS rush following ISO administration leads to the activation of the intrinsic and extrinsic pathways of apoptosis. Morin significantly reduced oxidative stress, cardiac injury markers levels, inflammation, and apoptosis. In addition, it also reduced serum insulin and blood glucose levels. Histopathology showed cardio-protection with morin. Akt/eNOS, Nrf2/HO-1, MAPK signaling pathways, and Insulin signal transduction pathways were positively modulated by Morin pre-treatment. It also significantly modulated NLRP3 inflammasome formation.

Conclusions:

Morin attenuated oxidative stress and inflammation and also modified the activity of various molecular pathways to mitigate cardiomyocyte damage during ISO-induced MI in diabetic rats.
THE REDUCTION OF MONACOLIN K DOSAGE FROM 10 TO 2.9 MG RESULTS IN A LOSS OF EFFECTIVENESS OF THE LIPID-LOWERING THERAPY
Authors: Napolitano Brunella , Trenta Eva Azzurra Li , Napolitano Valentina , Pulicanò Martina , Ruffolo Andrea Domenico , Vena Evelina , Balsano Mario , Spagnuolo Vitaliano
Published: May 2024

Objective:

Nutraceuticals can be a valid therapeutic alternative in certain classes of patients. Since June 2023, European Union has mandated a reduction in the dosage of monacolin (<3 mg/day). There is currently no literature data regarding maintenance of therapeutic effectiveness on LDL levels with this dosage.

Design and method:

We evaluated efficacy [percentage reduction in LDL and percentage of achieving the therapeutic goal (<100 mg/dl) of a nutraceutical containing 2.9 mg of monacolin K (MK) in patients with moderate cardiovascular risk (SCORE >0.9 <5% at 10 years)], who were unwilling to take statins, compared to treatment with nutraceutical containing 10 mg. We evaluated 55 patients (35 females) consecutively attending outpatient clinic for dyslipidemia. All patients had been under treatment, for at least nine months (average 14.4±4.8 months), with a nutraceutical containing 10 mg of MK (Colenorm Plus®) and, since June 2022, they started taking nutraceutical containing 2.9 mg of MK. Before any lipid-lowering treatment, the values were: mean age 62.2±8.5 years, BMI 25.5±0.7, TC 202.6±29.3, HDL 53.2±10.7, LDL 125.4±31.7, TG 123±39.2.

Results:

At baseline: BMI 26.7±3.7, TC 167.5±37.2, HDL 50.9±13.4, LDL 92.4±37.5 (-26% compared to no therapy), TG 120.3±59.7. The 63.64% of patients reached target <100 mg/dl. Six weeks after starting new therapy: BMI 26.9±3.5, TC 185.5±43.4, HDL 52.4±10.1, LDL 111.5±33.8, TG 126.5±31.8. LDL values decreased by 11.2% compared to no therapy but increased by 20.7% compared to 10 mg. Patients reaching the goal decreased to 27.27%.

Conclusions:

Reduction of MK to 2.9 mg results in a significant lost in the efficacy on LDL levels and the achievement of the therapeutic goal compared to 10 mg. A new strategy for lipid-lowering nutraceuticals, based on the combination of 2.9 mg of MK with other lipid-lowering molecules, is necessary to achieve a good therapeutic response.
ANTIPLATELET THERAPY IN PRIMARY PREVENTION. OBSERVATIONAL STUDY AND SURVIVAL ANALYSIS IN HIGH CARDIOVASCULAR RISK PATIENTS.
Authors: Meireles-brandao Joaquim , Meireles-brandao Lucia , Coelho Rui , Rocha-goncalves Francisco
Published: May 2024

Objective:

Cardiovascular diseases are the leading cause of morbidity and mortality in industrialized countries.

This was a retrospective observational study, evaluating clinical outcomes, metabolic consequences and survival rate resulting from prolonged antiplatelet therapy for primary prevention in patients with high CVR.

Design and method:

Overall, 516 patients were randomly selected from cardiovascular risk and metabolism consultations in a single center in Porto (Portugal). Sociodemographic, lifestyle and clinical characteristics were collected at baseline, including biochemical parameters, vascular risk scores and tests for heart and cardiovascular evaluation. In this follow-up with a median of 11 years, 287 patients received adjuvant antiplatelet therapy in primary prevention. Association between sex, observation time and treatments with LDLc and HDLc variations were assessed. Multiple linear regression was performed to evaluate which factors could explain the differences in HDLc and LDLc levels. Kaplan-Meier survival analysis was also conducted.

Results:

Therapy with statins was initiated early for metabolic compensation of dyslipidemia, according to clinical practice. Statistically significant reductions were found for almost all biochemical parameters, mean carotid intima-media thickness and lipid metabolism parameters, including triglycerides, total cholesterol and the respective fractions. Patients taking statins showed greater increased HDLc values and reduced LDLc values than those who were not. Additionally, women showed a more favorable evolution regarding HDLc increase compared to men.

Survival rate was estimated at 77.5% with 22 years as the maximum observed time. The median time of survival was not computed, since more than half of the patients (77.5%) were alive after 22 years. No bleeding episodes were recorded during this long period of observation.In fact, 99.0% of patients were alive after 10 years and the percentage of patients alive remained over 90% at 17 years. After 18 years of observation, 88.6% of patients were alive, and at 20 years 77.5% were alive without major cardiovascular events (MACE).

Conclusions:

Antiplatelet therapy should always be considered in primary prevention in patients with high CVR.

There were no cases of hemorrhage or MACE. The survival rate estimated for the study population was 77.5% over 22 years.
MULTIDRUG RESISTANT DYSLIPIDEMIA: A CASE REPORT
Authors: Maloberti Alessandro , Daus Francesca , Pavanello Chiara , Toscani Giorgio , Riccio Alfonso , Fabbri Saverio , Ciampi Claudio Mario , Caccia Andrea , Tognola Chiara , Algeri Michela , Intravaia Rita Cristina My , Merlini Piera , Mosca Lorena , Cavallari Ugo , Giannattasio Cristina , Morelli Marco
Published: May 2024

Objective:

Recently introduced lipid-lowering agents (PCSK9-i, bempedoic acid) can efficiently treat statin-intolerant patients, who couldn’t reach LDL target before. Nonetheless, there are still cases where the pharmacological management may have strong limitations.

Design and method:

A 71 year-old woman, with multiple cardiovascular risk factors (diabetes, hypertension and familial dylipidemia, LDL-C 276) underwent heart transplantation for a hypertrophic cardiomyopathy with an evolution towards a dilated phenotype in 2005. Before the transplant, she was on low-dose statin treatment (pravastatin 10 mg/die) that was suspended years later owing to hyper-CKemia (600 U/L), despite her being totally asymptomatic.

A second attempt with simvastatin/ezetimibe 40/10 mg resulted again in elevation of CK levels, associated with significant muscular pain. Thus, just ezetimibe was continued.

In 2020, 15 years after the transplant, the patient underwent a coronary angiography showing a moderate coronary allograft vasculopathy (ISHLT CAV2). Specifically, a sub occlusive ostial left main coronary artery lesion was treated by percutaneous angioplasty and stent implantation.

Since a lower LDL target was needed (LDL-C 55 mg/dL),

Results:

Alirocumab was introduced. However, 6 months later, no significant LDL levels reduction had been observed. The shift to evolocumab led to the same result, although the patient reported full therapeutic compliance.

In the suspicion of anti-drug antibodies development, we opted for Inclisiran without achieving a significant decrease in LDL-C levels.

In parallel with the search for genetic mutations in the PCSK9 gene and other genes involved in cholesterol metabolism (including LDLR, APOB, and LDLRAP1 and resulting positive only for common variants in LDLR receptor), therapy with bempedoic acid was initiated, again without substantial benefit (LDL-C 118 mg/dL).

Conclusions:

Despite cholesterol management has been simplified by the introduction of new drugs, it may still be complex in patients requiring very low LDL-C levels in some specific cases. Drugs with a LDL receptor-independent mechanism of action (e.g., evinacumab) may allow the achievement of therapeutic goals suggested by clinical guidelines.
HEART RATE REDUCTION WITH BETA-BLOCKERS REDUCED LEFT ATRIAL FUNCTION IN HYPERTENSIVE PATIENTS WITH RECURRENT ATRIAL FIBRILLATION
Authors: Kokhan Elizaveta , Kiyakbaev Gayrat , Kobalava Zhanna
Published: May 2024

Objective:

Higher resting heart rate (HR) has been shown to be an independent cardiovascular risk factor. However, some retrospective studies suggest that beta-blockers (BBs)-associated reduction in HR worsens left atrial (LA) function and increases the risk of stroke in hypertensive patients.

Purpose: to assess the impact of HR reduction with BBs on LA function in hypertensive patients with paroxysmal or persistent mild symptomatic atrial fibrillation.

Design and method:

In this open prospective trial, we randomly assigned 91 patients with hypertension, elevated HR (>70 bpm, sinus rhythm) and recurrent atrial fibrillation with rare paroxysms to receive BBs with a target HR (sinus rhythm) of less or greater than 70 bpm.

All patients underwent an echocardiogram at baseline and at the end of the study. Conventional echo measures and extended LA measures, including the minimal and maximal LA volumes (LAVmin and LAVmax) and LA emptying fraction (LAEF), were performed. The primary endpoint was the median LAEF measurement at the end of the study.

Results:

47 patients were randomized to group with a target HR of =<70 bpm and 44 patients to >70 bmp. Among them, 44 and 41 patients completed the study. The mean follow-up was 4.4 months.

At the end of the study, median HR was 62 bmp in =<70 group and 73 bpm in >70 group (p<0.001). Both groups received similar antihypertensive therapy and there were no intergroup differences in systolic (129 vs 130; p=0.32) and diastolic (78 vs 78; p=0.53) blood pressure.

Patients in =<70 group had significantly lower LAEF compared with >70 group (37 vs 42%; p=0.02). Both groups had similar indices of LAVmin (22 vs 19ml/m2; p=0.66) and LAVmax (38 vs 37ml/m2). E/E’ and left ventricle mass index did not differ between study groups at the end of the study, but E’ was significantly lower in the =<70 group.

Conclusions:

Beta-blockers treatment with strict HR reduction (=<70 bpm) significantly reduced LA function as compared to lenient target HR (>70 bpm). Although higher HR is a risk factor for hypertensive patients, its excess reduction with BBs could be harmful in this group.
RETROSPECTIVE, OBSERVATIONAL, LONGITUDINAL STUDY OF DRUG UTILIZATION FOR THE TREATMENT OF UNCOMPLICATED ESSENTIAL HYPERTENSION IN BULGARIA
Authors: Gruev Ivan , Stoyanova Sefka , Hristov Emil , Yordanov Emanuil , Parvova Iva
Published: May 2024

Objective:

To evaluate drug utilization and assess rational drug use in the treatment of patients with uncomplicated essential hypertension in Bulgaria, using quantitative and qualitative measures at national level.

Design and method:

Retrospective, observational, longitudinal study of data from the public registers of the National Health Insurance Fund for the period 2017-2021 using the WHO ATS/DDD methodology and descriptive statistical methods.

Results:

The analyzed population included 129 312 patients with uncomplicated essential hypertension /I10/ - 11.09% of all hypertensive patients in Bulgaria. The average cost per year was 8 229 567.10 BGN (1 Euro=1.95583 BGN) - respectively the cost per patient per year was 63.64 BGN, the monthly cost was 5.30 BGN and the cost per day was 0.17 BGN. The amount of 8 229 567.10 BGN was divided into two groups - costs for mono-products (67.73%) and costs for combined products (32.27%).

The analysis of the actual therapeutic practice in Bulgaria showed that the most prescribed products for this indication were beta-blockers Nebivolol and Bisoprolol, calcium channel blocker Lercanidipine and centrally acting anti-adrenergic agents Moxonidine and Rilmenidine. Sartans were represent predominantly by Telmisartan. In all cross-sectional analyses, the significant use of Lercanidipine was very prominent.

Regarding the fixed-dose combinations, medicinal products, containing AT1-blocker and thiazide diuretic were preferred choice for treatment - the most prescribed combination was Valsartan with Hydrochlorothiazide (15.93% of the reimbursement costs for fixed-dose combinations).

Conclusions:

Despite of the clear recommendation in the guidelines, monotherapy was still preferred treatment for uncomplicated essential hypertension /I10/ in Bulgaria, during the studied period /2017-2021/. We must persist with the continuous education of the GPs, in order to improve the therapy and control of the arterial hypertension in Bulgaria.
IMPACT OF THIAZIDES AND DIHYDROPYRIDINES ON HEART FAILURE AMONG HYPERTENSIVE PATIENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMISED CONTROLLED TRIALS
Authors: Alsanosi Safaa Mohammed , Alshanberi Asim M , Alhindi Yosra Z , Mccallum Linsay , Padmanabhan Sandosh
Published: May 2024

Objective:

Background: Hypertension (HTN) can lead to heart failure (HF) if left uncontrolled or poorly managed over time. Thiazide diuretics have a more significant antihypertensive effect than loop diuretics and are commonly prescribed for managing fluid retention in HTN. In contrast, dihydropyridine calcium channel blockers predominantly have peripheral vasodilatory actions that primarily target blood vessels to control HTN. However, there is a lack of sufficient data when it comes to evaluating the cardiovascular clinical outlook (including HF) for hypertensive patients treated with calcium channel blockers and diuretics.

Objective To review the literature systematically and perform meta-analyses on impact of thiazides and dihydropyridines on HF incidents among hypertensive patients.

Design and method:

We searched the four major databases of MEDLINE, EMBASE, Web of Science and Cochrane (from 1993 – October 2023) for randomised controlled trials (RCTs) of thiazides or dihydropyridines. We included RCTs with at least 100 hypertensive participants and a minimum follow-up period of one year. Two authors independently selected the included RCTs, assessed the risk of bias, and collected data on HF. Meta-analyses were performed to summarise the pooled risk ratios (RRs) of HF between treatment arms.

Results:

The initial literature search identified 1896 records. After duplicates were removed, 1653 records were left, and a full-text review of the 403 eligible studies led to the exclusion of 396 RCTs. In the end, seven RCTs with a total of 49,409 participants were included in our meta-analysis. As to the effect of thiazides and dihydropyridines on HF, the point estimate for statins was less than 1, but it did not reach statistical significance in the overall analysis (the pooled RR in the fixed-effect model was 0.77 [95% CI: 0.70,0.84; I2=53%; X2 p < 0.00001]).

Conclusions:

There is a statistically significant difference between thiazides and dihydropyridines in terms of HF incidents among hypertensive patients, but there are positive implications for clinical guidance. Further research and analytical investigations are necessary to corroborate and reinforce the findings gathered from various studies.
LONG-TERM EFFECTS OF CPAP THERAPY FOR SUPPRESSING CAROTID ATHEROSCLEROSIS IN HYPERTENSIVE PATIENTS WITH OBSTRUCTIVE SLEEP APNEA SYNDROME
Authors: Sawayama Yasunori
Published: May 2024

Objective:

To examine the long-term effect of CPAP on carotid artery intima-media thickness (IMT) in hypertensive patients with Obstructive Sleep Apnea Syndrome (OSA).

Design and method:

This study conducted over three years at a teaching hospital included 54 patients newly diagnosed with OSA who received either CPAP or conservative treatment(CT). In total, 24 patients received CPAP, while 30 received conservative treatment, with no significant differences observed in age, BMI, ESS, AHI, arousal index, or minimum SaO2. CPAP usage averaged 4.6±0.3 hours per night over the three years. Carotid IMT was assessed with B-mode Doppler ultrasound from both carotid arteries, using images of the far wall of the distal 10 mm of the common carotid arteries at baseline and after 3 years.

Results:

During the 3-year follow-up, there was a more significant decrease in blood pressure in the CPAP group compared to the CT group. Mean blood pressure at 36 months was 120/71 mm Hg in the CPAP group and 131/82 mm Hg in the CT group. The IMTs at 36 months were 1.13±0.31 mm (-14.5% vs. baseline, p=0.0034) and 1.27±0.36 mm (+1.1% vs. baseline, p=0.05) in the CPAP and CT groups, respectively. There was a significantly greater decrease in the CPAP group compared to the CT group (p=0.0014).
RESISTANT HYPERTENSION: WHEN DRUG THERAPY IS THE CULPRIT
Authors: Ambrosino Ilaria , Rivasi Giulia , Capacci Marco , Ceolin Ludovica , Rossi Lorenza , Bisignano Francesca , Liccardo Alessandra , D’Ambrosio Giuseppe , Ceccarelli Greta , Ungar Andrea
Published: May 2024

Objective:

Resistant Hypertension is not uncommon in clinical practice. The causal role of medical therapy is often underestimated.

Design and method:

We describe a case of (pseudo)Resistant Hypertension where medications contributed to (pseudo)resistance.

Results:

An 83-year-old male patient was referred to our Hypertension Clinic in July 2020 for poor blood pressure (BP) control despite polytherapy (Valsartan 320 mg/die, Nebivolol 5 mg/die, Doxazosin 4 mg/die, Clonidine patch 5 mg/die, Lercanidipine 20 mg). Medical history included recent stroke (June 2020), hypercholesterolemia, hyperuricemia, hypothyroidism, and previous right nephrectomy for renal carcinoma (2010), on treatment with the Tyr-kinase receptor inhibitor Sunitinib (2 weeks/month) at the time of assessment.

He reported a recent Emergency Department visit for high BP (210/105 mmHg), with no target organ damage. Mean home BP was 160/70 mmHg.

Lercanidipine was stopped due to poor tolerability (ankle swelling) and Canrenone 50 mg/die was introduced. A month later, 24-hours Ambulatory Blood Pressure Monitoring (ABPM) showed persistence of inadequate BP control (mean 24h BP 151/68 mmHg, mean daytime BP 152/70 mmHg).

As Doxazosin (α1-receptors antagonist) and Clonidine (α2-receptors agonist) both act on alfa-adrenergic receptors, but in opposite way, Doxazosin was progressively reduced and then withdrawn, with subsequent improvement of BP control.

However, high BP variability persisted. Home BP diary showed higher values while on Sunitinib treatment and lower BP during washout periods (Figure 1).

Indeed, Sunitinib is associated with a 15-25% incidence of hypertension. Moreover, some studies demonstrate a correlation between Sunitinib treatment and marked BP increases. Therefore, patient's treatment was modulated increasing BP medications during Sunitinib cycles and reducing antihypertensive treatment intensity during washout periods.

Conclusions:

The present case report highlights the clinical relevance of iatrogenic resistant hypertension, that is often overlooked in clinical practice, particularly if related to non-routine medications, e.g. antiangiogenic agents.

Moreover, this case report draws attention to pseudoresistant hypertension caused by inappropriate antihypertensive associations such as Doxazosin and Clonidine. Indeed, these drugs are highly specific for α1 and α2-receptors, respectively, but they can also bind other receptor subclasses, thus potentially interfering each other due to competitive binding.
EFFECT OF RENAL DENERVATION ON 24H BLOOD PRESSURE PATTERN
Authors: Ponsa Lara , Fasano Chiara , Rabbia Franco , Rossato Denis , Pappaccogli Marco , Bertello Chiara , Veglio Franco
Published: May 2024

Objective:

Endovascular renal denervation (DRN) is a therapeutic approach for resistant arterial hypertension (RH). The aim of this study was to assess the effects of RDN on 24h blood pressure.

Design and method:

A retrospective evaluation of ABPM data at baseline and after 6 months from RDN in patients undergoing DRN between 01/01/2011 and 31/12/2021 in the Arterial Hypertension Center of Turin. Mean 24h, Daytime, Nighttime BP and HR values and short term 24h, daytime and nigthtime BP and HR varability parameters (standard deviation, dipping and coefficient of variation) were calculated.

Results:

The series included 14 subjects, of which 8 (57%) were female and with an average age 54±10 years. The number of antihypertensive drugs before renal denervation was 5.7±1.0. At baseline office BP was 188/113±22±18 mmHg and ABPM 24h BP was 150/92±21±16 mmHg. Patients were considered as responders if a reduction of least 10 mmHg in systolic blood pressure (PAS) at 24h Blood Pressure Monitoring at six months from RDN was obtained. From a safety point of view, there were no short-term or long-term complications. The responders at six months were 66%. Non-responders showed an increased blood pressure variability compared to responders at baseline and only one was dipper. The responders had a statistically significant redution of SD24h after DRN, an increased average nocturnal blood pressure drop and a lower pressure variability. While in non-responders no redution in SDnight, SDday and coefficient of variation was found, by contrast all of them become dippers because mean daytime SBP increase.

Conclusions:

In conclusion, pressure variability (SD24h and coefficient of variation) is globally reduced in the denerved patients, this trend is particularly present in responders. The non-responders have an increased BP variability at baseline without decreasing after DRN. These results suggest that, when effective, DRN can reduce both BP levels and BP variability, thus may have an important effect in reducing cardiovascular risk.
IT'S TIME FOR NEW INSIGHTS INTO RENOVASCULAR HYPERTENSION AT THE CELLULAR LEVEL
Authors: Duric Ljiljana Fodor
Published: May 2024

Objective:

Ischemic nephropathy underlying atherosclerotic renal artery stenosis (ARAS) gradually induces a decrease in tissue perfusion, ultimately resulting in pronounced tissue hypoxia and inflammatory kidney injury.

Administration of mesenchymal stem cells (MSC) has emerged in preclinical studies as a potential choice to repair the renal microcirculation, attenuate inflammatory injury, and restore kidney function.

Recent data in humans suggest that the infusion of autologous MSC can be safely performed in subjects with ARAS, leading to increased tissue oxygenation when the MSC are infused into a single renal artery.

Design and method:

Design and Method:In this open-label, single center, study perspective, will be enrolled adult patients with significant ARAS estimated by renal artery Doppler ultrasound velocity acceleration (average peak systolic velocity >300 cm/s) and magnetic resonance/computed tomography angiography with evident atherosclerotic stenosis (>60% lumen occlusion), and hypertension (systolic hypertension >155 mmHg and/or the use of at least two BP drugs) and/or with declining kidney function. The intervention group (n=5) will received a single infusion of MSC (2.5 × 105 cells/kg) plus standardized medical treatment; the medical treatment only group (n=5) included subjects matched for age, kidney function, and stenosis severity. We will measured cortical and medullary volumes, perfusion, and RBF using multidetector computed tomography. Tissue oxygenation will be assessed by blood oxygen level–dependent MRI and GFR by iothalamate clearance. We plan to determine the levels of the following laboratory parameters: vascular endothelial growth factor,inflammatory cytokines,Monocyte chemoattractant protein-1 and TGF at the baseline, three and six months after MSC infusion. The determination of NGALwill provide valuable insights into the safety of MSC infusion for the patient.

Results:

Study perspective

Conclusions:

Conclusion: We hypothesize that this study perspective will provide evidence regarding the safety of intra-arterial infusion of autologous MSCs in patients with ARAS. MSC infusion without revascularization of the main renal artery is associated with increased renal tissue oxygenation and cortical blood flow as well.
THE EFFECT OF URIC ACID ON COGNITIVE FUNCTION IN PATIENTS WITH ESSENTIAL HYPERTENSION
Authors: Yusupova Khafiza , Abdullaeva Guzal , Khamidullaeva Gulnoz
Published: May 2024

Objective:

To analyze the effect of uric acid on cognitive functions in patients with essential hypertension

Design and method:

The study included 111 male and female patients with I–III AH degree (ESC/ESH, 2018). The average age of the patients was 54.6±10.8 years, the average duration of AH was 8.8±5.52 years. The patients were divided into 2 groups depending on the level of uric acid: group 1 - with elevated uric acid levels (6 mg/dl and more) n=48, 2nd group – with normal uric acid levels, n=59. The level of uric acid in blood serum was measured using the enzymatic method on a Daytona TM biochemical analyzer from Rendox (UK). Cognitive function was assessed using the Montreal Cognitive Assessment Scale (MOCA).

Results:

Analysis of cognitive functions in hypertensive patients taking into account the level of uric acid revealed that according to the MOCA scale, cognitive impairment was more pronounced in 1st group of patients compared to the group of patients whose uric acid level was normal: 23.4±3,02 points versus 24.7±2,79 points, respectively (p=0.023). The delayed reproduction function was significantly worse in first group of patients compared to the group with normal uric acid levels: 2.6±1.17 points versus 3.08±1.23 points, respectively (p=0.04). It should be noted that there is a tendency towards anxiety disorders also in the group with elevated uric acid levels than in the group with normal uric acid levels: 7.06±3.73 points versus 5.57±3.98 points, respectively (p=0.05).

Conclusions:

Analysis of the distribution of patients with and without cognitive impairment in the groups of patients with elevated and normal levels of uric acid showed that the number of patients with cognitive impairment significantly prevailed by almost 1.8 times in the group with uric acid levels exceeding normative values, amounting to 64. 6% versus 35.4% of patients, respectively (χ2= 8.16, p=0.004).
EFFECTS OF DIFFERENT SEX HORMONES ON CARDIOVASCULAR DISEASE: A META-ANALYSIS AND SYSTEMATIC REVIEW
Authors: Wang Wenting , Yu Jing
Published: May 2024

Objective:

Sex hormones play different roles in cardiovascular risk of male and female patients. Especially for postmenopausal women, sex hormone disorder is the main reason for their increased risk of cardiovascular disease. This study mainly explores the effects of different sex hormone levels on cardiovascular diseases in men and postmenopausal women.

Design and method:

This study included 16 studies with 404,474 patients, including 387,361 male patients and 17,113 female patients. Hazard ratio (HR) and 95%CI results of studies on sex hormones and cardiovascular disease risk in the included literature were extracted as research data. The main outcome events are: cardiovascular disease (CVD), heart failure (HF), cardiovascular death, major cardiovascular adverse events (MACE) and all-cause death. This paper mainly researches the effects of sex hormones on cardiovascular risk and the differences of cardiovascular events between men and women.

Results:

1. DHT is a protective factor of cardiovascular risk in male patients, HR = 0.83, 95% CI (0.72, 0.96).

2. For postmenopausal women, SHBG and cFT are the risk factors of CVD in postmenopausal women, with HR 95%CI of 1.06(1.01,1.11) and 1.11 (1.04, 1.19) respectively.

3. DHEA and TT is a risk factor for heart failure in postmenopausal women, which can increase the risk by 17% (HR = 1.17, 95% CI (1.09, 1.24)) and HR = 1.07, 95% CI (1.03, 1.12), while the SHBG and DHEA had no significant effect on the occurrence of chronic heart failure.

Conclusions:

DHT is a protective factor of cardiovascular disease risk in men, and the increase of androgen level is an important risk factor of cardiovascular disease risk in postmenopausal women.
HIGHER FATTY LIVER INDEX VALUES AT SIMILAR BLOOD PRESSURE CLASSIFICATION INDICATE HIGH INSULIN RESISTANCE AND POTENTIAL INFLAMMATION
Authors: Takahashi Atsuhiko , Ohiwa Kojo , Suzuki Yasuyuki , Tani Shigemasa
Published: May 2024

Objective:

The relationship between fatty liver, which is visceral fat accumulation, and insulin resistance and inflammation as seen in hypertension classification is not clear. The Fatty Liver Index (FLI) is an established score for metabolic dysfunction-associated fatty liver disease (MASLD), which is associated with a risk of diabetes and cardiovascular disease. FLI is derived from a formula based on body mass index, waist circumference, and triglyceride and gamma-glutamyltransferase values.

Design and method:

A cross-sectional study enrolling consecutive individuals was conducted at a health checkup center in Japan from January 2022 to November 2022. A total of 3553 men (mean Age 50.6), excluding those with diabetes mellitus and those undergoing treatment for inflammatory diseases, were included in the study, and divided according to the Classification of hypertension in the ESH guideline.

Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) and C-reactive protein (CRP) levels were divided into two groups by FLI (<26 (group L) and > or = 26 (group H)) and compared by Mann-Whitney U test. The cutoff value for fatty liver by FLI was determined by prior abdominal ultrasonography, and was set at 26(sensitivity 0.82, specificity 0.72).

Results:

Results of single regression analysis with FLI showed significant correlations in systolic blood pressure(r=0.31, p < 0.0001), diastolic blood pressure(r=0.36, p < 0.0001), HOMA-IR(r=0.36, p < 0.0001), and CRP(r=0.08, p < 0.0001). Optimal blood pressure(n=1783, mean FLI; 23.1, mean HOMA-IR; 1.28, mean CRP; 0.098mg/dL), Normal blood pressure(n=807, 33.9, 1.61, 0.14), High-normal blood pressure(n=535, 37.8, 1.90, 0.12), Grade 1 hypertension(n=124, 44.8, 2.0, 0.14), Grade 2 hypertension(n=53, 49.0, 1.71, 0.09), Grade 3 hypertension(n=18, 54.6, 2.89, 0.22), Isolated systolic hypertension(n=118, 36.2, 1.59, 0.09), Isolated diastolic hypertension(n=115, 44.1, 1.94, 0.12). HOMA-IR and CRP of H group were significantly higher than L group (all p < 0.001).

Conclusions:

Higher FLI values at similar blood pressure levels may indicate high insulin resistance and potential inflammation, suggesting the need for strict management.
ASSOCIATION BETWEEN PERCEIVED STRESS AND VASCULAR ELASTICITY: AN OBSERVATIONAL STUDY FROM SOUTH-WESTERN SWEDEN
Authors: Szalo Gabor , Hellgren Margareta , Lindblad Ulf , Daka Bledar
Published: May 2024

Objective:

The association between perceived stress and arterial stiffness has yet to be fully explored. This study aims to determine the associations between perceived mental stress and arterial elasticity.

Design and method:

Our observational study was based on the Vara- Skövde Cohort. Between 2012 and 2014, a total of 1327 individuals were examined for risk factors for the development of cardiovascular disease. Known hypertension, missing information on mental stress and artery elasticity were exclusion criteria. In total, 785 individuals (men=379) were included. Body height, weight, heart rate, and blood pressure were measured, while data on medical history and lifestyle factors such as alcohol consumption, smoking, and physical activity were collected through validated questionnaires. Perceived stress was evaluated with the PSS-10 (Perceived Stress Scale), which contains ten questions with 0 - 4 points per item and focuses on the perceived stress in the last month. Small artery elasticity (C2) was estimated using an applanations tonometer (Pulsewave CR-2000, Hypertension Diagnostics Inc.) over the arteria radialis. Logistic regression was used in our analyses. In model 1, we adjusted for age, sex, systolic blood pressure and heart rate. In model 2, we adjusted for the variables in model 1 plus waist-hip ratio, LDL-cholesterol, and C-reactive protein. In model 3, we included model 2 plus lifestyle factors such as smoking, alcohol consumption, and physical activity.

Results:

The mean age was 54.5 (±10) years. There were no significant sex differences in the association between stress and vascular elasticity (interaction test p=0.371). In the fully adjusted model in logistic regression, a one-point rise in PSS-10 correlated with having an elasticity index in the lowest quartile of C2 by 5% in the entire study population (OR=1.05, CI: 1.009- 1.093, p= 0.015). Correspondingly, one quartile higher PSS-10 was associated with a 25% elevated risk of having a cardiovascular elasticity in the lowest quartile of C2 (OR=1.25, CI: 1.03- 1.52, p= 0.021).

Conclusions:

Increased perceived stress was associated with decreased vascular elasticity in this cohort.
DOGS ARE ASSOCIATED WITH FEWER HYPERTENSION DIAGNOSES, BUT CATS ARE NOT
Authors: Schoenenberger Andreas , Radovanovic Dragana , Muggli Franco , Bianchetti Mario , Gallino Augusto , Parati Gianfranco , Suter Paolo , Schoenenberger-berzins Renate
Published: May 2024

Objective:

Previous studies on pet ownership and the risk of arterial hypertension have provided conflicting results. Most of these previous studies were not prospective, exhibited relevant selection bias, and were unable to differentiate between different pets or control for relevant contributing factors such as physical activity.

Design and method:

We report findings from the Swiss Longitudinal Cohort study (SWICOS), a prospective population-based study. Socio-demographic factors, pet ownership, physical activity, depression, and cardiovascular risk factors were assessed. Hypertension diagnosis was defined as known hypertension according to medical records and/or a prescription for antihypertensive drugs. Multivariate logistic regression was used to evaluate associations of potential influential factors and a diagnosis of hypertension.

Results:

Among 474 participants of the SWICOS cohort, 96 participants (20%) had a diagnosis of hypertension. Prevalence of hypertension was 12% among dog owners, significantly lower than the 26% among non-owners (p=0.002), whereas in cat owners prevalence was similar (39% vs. 45%, p=0.30). In the multivariate logistic model controlled for factors that showed significant associations with hypertension in univariate analysis (i.e., age, sex, body mass index, education, physical activity, and depression), dog ownership remained independently associated with fewer diagnoses of hypertension (OR 0.44, 95%CI 0.21-0.94, p=0.034), whereas walking time per week (p=0.61) or depression (p=0.18) were not.

Conclusions:

In this prospective population-based cohort, dog ownership was independently associated with a lower prevalence of hypertension, whereas cat ownership was not. The factors contributing to lower hypertension prevalence in dog owners are unclear, but presumably are not related to higher physical activity or to a better emotional stability.
PREVALENCE, AWARENESS AND TREATMENT OF RISK FACTORS AMONG DOCUMENTED AND UNDOCUMENTED CHINESE IMMIGRANTS
Authors: Pellegrino Alessio , Calabrese Maria , Vacirca Irene , Boddi Maria , Modesti Pietro Amedeo
Published: May 2024

Objective:

Cardio-metabolic diseases are highly prevalent among ethnic minority groups in Europe. However, information on health needs of undocumented immigrants, especially regarding risk factors, are lacking. The aim of this study was to examine prevalence, awareness and treatment of hypertension, diabetes mellitus, and hypercholesterolemia in a large cohort of undocumented and documented (registered with National Health Service, NHS) Chinese immigrants living in Italy.

Design and method:

Population-based, cross-sectional study. Chinese first-generation immigrants living in Prato, underwent blood pressure (BP) measurement, blood tests (fasting glucose, FG, and total cholesterol, TC), and anthropometric measurements. Hypertension was diagnosed for BP>140/90 mmHg at two visits, and/or BP-lowering medication use; type 2 diabetes for FG>126 mg/dL at two visits, and/or glucose lowering drugs use; hypercholesterolemia for TC>240 mg/dL and/or statins use. Undocumented and documented migrants were compared via logistic regression analysis adjusted for age, gender, central obesity, and educational level.

Results:

A large proportion of investigated Chinese immigrants (3435) were undocumented (1766, 51% with 1669, 49% registered with NHS). At logistic regression analysis, prevalence of hypertension was similar between the two groups, while prevalence of diabetes and hypercholesterolemia was higher among undocumented migrants, despite having a younger age and a lower prevalence of central obesity. Registration to NHS was associated with a higher awareness and prevalence of treated subjects for hypertension and diabetes. More precisely, registered migrants were 6 times more treated for type 2 diabetes than undocumented migrants. A small minority of subjects were treated with statins independently from NHS registration.

Conclusions:

Undocumented migrants seem to represent a large proportion of the Chinese migrant population living in Italy; undocumented migrants had lower levels of awareness and rate of treatment for hypertension and type 2 diabetes than migrants registered in the NHS. Acute treatment for stroke and myocardial infarction is guaranteed to all subjects regardless of NHS registration in Italy as in the majority of European countries. Health policies targeting this hard-to-reach population must be improved.