bluuebunny/crossref_metadata_2025 huggingface dataset:
MICROVASCULAR ENDOTHELIUM FUNCTION RESPONSE TO N-3 POLYUNSATURATED FATTY ACIDS, VITAMIN E, SELENIUM AND LUTEIN ENRICHED FUNCTIONAL FOOD IN PATIENTS WITH CHRONIC CORONARY SYNDROME
Authors: Stupin Ana , Curic Zeljka Breskic , Masle Ana Marija , Susnjara Petar , Kolobaric Nikolina , Mihaljevic Zrinka , Jukic Ivana , Kibel Aleksandar , Selthofer-Relatic Kristina , Juranic Brankica , Drenjancevic Ines
Published: June 2023

Objective:

Ischemic heart disease is the leading cause of death at a global level. A healthy lifestyle, and especially a healthy diet, can have the effect of reducing the risk of subsequent cardiovascular events and mortality. The aim of this study was to examine the effect of hen eggs enriched with n-3 polyunsaturated fatty acids (n-3 PUFAs), vitamin E, selenium and lutein consumption on oxidative stress level and microvascular endothelium function in patients with existing chronic coronary syndrome (CCS).

Design and method:

A total of 30 patients (9 women and 21 men) with existing CCS participated in this study. The participants were divided in two groups; Control group (N = 15) who ate three regular hen eggs per day (n-3 PUFAs 146 mg, vitamin E 0.595 mg, selenium 0.0183 mg, lutein 0.11mg/per egg), and Nutri4 group (N = 15) who ate three enriched hen eggs per day (n-3 PUFAs 432 mg, vitamin E 1.098 mg, selenium 0.0191 mg, lutein 0.616 mg/per egg) for three weeks. Peripheral microvascular reactivity in response to vascular occlusion (PORH), and iontophoresis of acetylcholine (AChID) and sodium nitroprusside (SNPID), as well as serum lipid and fatty acids profile, pro- and anti-inflammatory cytokines level, as well as biomarkers of oxidative stress and antioxidant capacity were measured before and after the respective diet protocol.

Results:

Consumption of Nutri4 eggs significantly decreased serum triglycerides levels and n6/n3 PUFAs ratio, decreased levels of cytokines IL-17A and TGF-1beta, and improved endothelium-dependent microvascular PORH and AChID, but not endothelium-independent response in patients with CCS. Consumption of both Nutri4 and regular hen eggs did not affect biomarkers of oxidative stress and antioxidant capacity in CCS patients.

Conclusions:

Consumption of hen eggs enriched with n-3 PUFAs, vitamin E, selenium and lutein for three weeks induced an anti-inflammatory response, a favorable effect on lipid and fatty acids profile, especially on triglycerides levels and n6/n3 PUFAs ratio, as well as an improved endothelium-dependent peripheral microvascular reactivity in patients with CCS.
SOCIAL DEPRIVATION AND PRE-ECLAMPSIA RECURRENCE: THE NATIONWIDE CONCEPTION STUDY
Authors: Lailler Gregory , Grave Clémence , Gabet Amélie , Regnault Nolwenn , Deneux-Tharaux Catherine , Kretz Sandrine , Tsatsaris Vassilis , Plu-Bureau Geneviève , Blacher Jacques , Olié Valérie
Published: June 2023

Objective:

The recurrence rate of pre-eclampsia in a subsequent pregnancy ranges between 10 and 20% in the literature. We aimed to study the association between social deprivation and the prevention and recurrence of preeclampsia.

Design and method:

All women of the nationwide Conception study (elaborated from French National Health Insurance Information System) who gave birth for the first time in France in 2010-2018, and who subsequently gave birth in the same period were included. Pre-eclampsia was identified through hospital diagnoses. Aspirin deliveries during the second pregnancy were collected to assess the rate and timing of initiation, and the treatment adherence. All medical consultations in the year before the beginning of their second pregnancy and until 20 weeks of gestation were identified. Women who benefitted from Universal Medical Coverage providing free access to health care for people with an annual income less than 60% of the poverty threshold were defined as living in social deprivation. The adjusted incidence rate ratios (aIRR) of preeclampsia during the second pregnancy were estimated using Poisson models adjusted for confounding

Results:

Of the 2,829,274 women included, 31,956 (1.9%) were diagnosed with a pre-eclampsia during their first pregnancy. From those, 4,697 (14.7%) had recurrent pre-eclampsia during the second pregnancy. Women living in social deprivation had more cardiovascular risk factors, were less likely to consult a physician in the year before and until 20 weeks of gestation (90.3% vs 97.5%), to receive prescribed aspirin at least once during their second pregnancy (33.7 vs 45.7%), to begin the treatment before 16 week of gestation (81.4 vs 90.7% among those receiving at least one delivery of aspirin during pregnancy), and to be adherent to therapy throughout the pregnancy (44.6 vs 55.9%). In multivariate analyses, women living in social deprivation were less likely to initiate aspirin during the second pregnancy (aIRR = 0.74 [0.70-0.78] and had a higher risk of pre-eclampsia recurrence (aIRR = 1.31 [1.28-1.33]).

Conclusions:

Greater efforts should be made to improve the medical monitoring and prevention strategies of socially deprived women with pre-eclampsia because of their high risk of recurrence.
HYPERTENSION AND SOCIAL STATUS
Authors: Oliveira Monica Amorim De , Rey Helena Cramer Veiga
Published: June 2023

Objective:

To describe socioeconomic data in patients treated at a basic health unit in developing countries and their relationship with arterial hypertension

Design and method:

Prospective cohort of 1000 patients over 18 years selected in 21 primary care units in the city of Rio de Janeiro. At the initial consultation, the clinical form was filled out, in which medical history, socioeconomic variables, data on life habits and functional assessment were documented. Weight and height were measured at the initial visit, and, from these data, the Body Mass Index (BMI) was calculated in Kg/m2. The definition of hypertension was based on data from medical records.

Results:

The higher the level of education, the lower the proportion of SAH. Most patients had, as shown in table attached, primary education (53.83%). It was more frequent to find non-literate individuals among hypertensives (3.9%) than non-hypertensives (2.6%), with statistical significance. A higher proportion, also with a statistically significant difference, of patients with secondary education (40.44%) and higher education (15.1%) was found among non-hypertensive patients than among hypertensive patients (31.1% and 6.1% respectively). .

The vast majority of the sample receives even less than two minimum wages. This can be seen in table attached. It was found that the higher the family income, the lower the proportion of hypertensive individuals.

Conclusions:

It was verified in the current project that about 60% of the hypertensive population had an income of up to two minimum wages and also an inverse relationship between the level of education and the prevalence of SAH. Low educational level and low economic power, mainly in middle and low-income countries, are even associated with a higher risk of cardiovascular disease.
PRACTICES OF HOME BLOOD PRESSURE MEASUREMENT AND E-HEALTH: REAL-LIFE DATA GENERATED BY THE HY-RESULT APP
Authors: Postel-Vinay Nicolas , Gebara Nicole , Freminville Jean Baptiste , Bobrie Guillaume , Lorthioir Aurelien , Amar Laurence
Published: June 2023

Objective:

To evaluate quality of Home Blood Pressure Measurement (HPBM) data generated in real-life circumstances by Hy-Result software, a validated App designed to help patients to: perform HBPM according to a standardized protocol; understand their results; share their readings in a PDF format report.

Design and method:

We analyzed 19,176 HBPM reports collected in real-life. Each report was generated by patients who self-measured BP (3 morning, 3 evening) for 1 to 7 consecutive days. Reports totaled over 51,000 BP (SBP)/Diastolic (DBP) readings. Data was generated through App used in-home, by patients following a self-management protocol. Reports are grouped according to two criteria: i) whether generated by “PRIMARY care users” (who find the app on internet or following the recommendation of their practitioner) and “TERTIARY patients” using the app per recommendation of ESH hypertension center; ii) whether patients were receiving antihypertensive drugs or not. The patient reported outcomes are saved in a secured database.

Results:

Mean age of users was 62 years (62.1 (+/- 13.1), and 63 % of reports (12,117) declared receiving hypertension drugs (Tab 1). PRIMARY were younger, less severely hypertensive, were receiving less treatment and suffered from fewer comorbidities (diabetes, stroke, kidney disease) than TERTIARY (Tab 2).

HBPM schedule: Tab. 3, show compliance with monitoring schedule. Reports are considered adequate for medical analysis if patients proceed to a minimum of 15 consecutive measurements for at least 3 days.

HBPM oscillometric devices: Upper arm cuff devices are declared by 81 % of PRIMARY reports and 93 % of ESH CENTER. Treated patients used more frequently the recommended monitor than untreated. Furthermore, Therapeutic education in the ESH Center promoted better compliance with the measurement schedule and greater use of humeral devices.

Conclusions:

Through generating 90% of HBPM reports of sufficient quality for medical interpretation in real-life conditions, the Hy-Result app has significant potential for triage in the care pathway of hypertensive patients in primary care settings or in ESH center for hypertension. Out of 19,000 reports, 43% presented PAS and/or PAD > 135/85 and the users were automatically prompted to seek medical advice by the software.
VASCULAR COMPLICATIONS IN LYMPHOCYTIC THYROIDITIS – SONOGRAPHIC FINDINGS
Authors: João Isabel , Almeida Paula , Mateus Sónia , Pós-De-Mina Vanda , Mendes Irene
Published: June 2023

Objective:

Alert to the ultrasonographic findings of cervical vascular involvement in the context of lymphocytic thyroiditis, since it is a rare situation.

Design and method:

CASE DESCRIPTION: Male patient, 87 years old, caucasian, diagnosed with lymphocytic thyroiditis since 2004, euthyroid, stable until 2019, presenting an enlarged thyroid volume on that date. He has a history of ischemic stroke in 2003. In 2019, he underwent a thyroid ultrasound where the hypothesis of intraluminal thrombus of the right internal carotid artery was raised. The evaluation with cervical vascular ultrasonography revealed an iso-hypoechogenic, heterogeneous image, lining the arterial wall, in the proximal segment of the internal carotid arteries, without hemodynamic repercussions, compatible with a probable inflammatory/fibrous infiltrate, in the context of lymphocytic thyroiditis. Computed Tomography scan of the thyroid and soft tissue confirmed the progression of the adjacent soft tissue infiltrate.

Results:

DISCUSSION: Taking into account the size of the inflammatory changes and the fact that the patient remains euthyroid, it is important to question about a the possibility of an evolution/adjustment of the disease previously diagnosed in 2004 to a new one: Riedel's thyroiditis, also known as an invasive fibrous or sclerosing thyroiditis. Riedel's thyroiditis is a pathological condition with an unknown etiology that causes a fibro-inflammatory infiltrative stated in the 2019 examination. Considering the low prevalence of the pathology, it is important to alert sonographers to the possible vascular complications observed in a supposed Riedel's thyroiditis, in order to make a reliable evaluation and diagnosis of the cervical vascular ultrasonographic findings.

Conclusions:

Regarding the monitoring of lymphocytic thyroiditis, it is just as important to do a periodic evaluation of the dimensions, characteristics of the gland and analytical evaluation of the thyroid function, as it is to monitor the infiltrate of adjacent tissues, namely vascular, to prevent possible serious complications.
DIETARY HABITS OF POPULATION IN THE CROATIAN RURAL AREA DAMAGED BY AN EARTHQUAKE. “THE SILENT KILLER HUNT”- CROATIAN SOCIETY OF HYPERTENSION PROJECT
Authors: Bosnic Klara , Brcic Alojzija , Bozic Katarina , Bogdanic Jakov Emanuel , Jurkovic Ana Marija , Vuksan-Cusa Zrinka , Jelakovic Bojan
Published: June 2023

Objective:

A healthy diet is a crucial modifying factor for a healthy life. The World Health Organization (WHO) recommends taking at least 400 g or 5 portions of fruits and vegetables daily. Unsaturated fats found in fish are preferred to saturated fats found in fatty meat. Salt intake should be limited to 5 g daily and people should be careful with hidden salt that is found in bread, smoked meat, and spices. It is recommended that daily sugar intake is less than 10% of total daily energy intake.

We aimed to investigate the dietary habits of the adult population living in a rural area damaged by the earthquake.

Design and method:

The survey was performed using a modified food consumption questionnaire. In this analysis, we included 214 participants older than 18 years of age (opportunistic screening).

Results:

The study revealed unhealthy dietary patterns in terms of low consumption of fish, rare fruit and vegetable intake and high incidence of red and smoked meat consumption. A total of 60.7% of participants consume less than 3 portions of fruits and vegetables per day and only 7.5% take the recommended 5 or more portions per day. Very few subjects do eat fish (8.4%) or eat it a few times a month (53.3%). A total of 44.4% of subjects eat red meat up to 2 times a week and 21.5% of them eat it every day. A total of 37.4% of people consume smoked processed meat on a weekly basis, while 16.8% eat it every day. Almost one-third of survey respondents (31.3%) reported eating sweets and cakes on a daily basis.

Conclusions:

Major consumption of red and smoked meat, high intake of sugar and low intake of fruits, vegetables and fish indicates that further education of the population of rural areas and promotion of a healthy diet is needed in order to ameliorate their dietary behaviors.
NOCTURNAL HYPERTENSION IS ASSOCIATED WITH HEART FAILURE RE-HOSPITALIZATION IN PATIENTS WITH HEART FAILURE AND PRESERVED EJECTION FRACTION
Authors: Huang Gang , Xu Jun Bo , Zhang Zhen , Wu Jin
Published: June 2023

Objective:

Nocturnal hypertension is reported as a risk factor for cardiovascular disease. This study was to explore the potential association between nocturnal hypertension and heart failure (HF) rehospitalization in patients with HF and preserved ejection fraction(HFpEF).

Design and method:

Totally, 538 patients with HFpEF were consequently recruited in this study and followed up until they were readmitted for HF or the end of this study. Cox regression analysis was used to reveal the potential association between nighttime blood pressure (BP) levels, nocturnal hypertension and nocturnal BP patterns and HF rehospitalization. Kaplan-Meier curve was used to assess the cumulative events free rate between groups.

Results:

The mean age of the study population was 77.14±8.68 years, and 41.2% was men. After a median follow up duration of 10.93 (4.19, 21.13) months, 176 (32.7%) patients with HFpEF were readmitted for HF. Cox analyse had revealed that nighttime systolic blood pressure (BP) level (Hazards ratio(HR):1.018, 95% confidence interval(CI): 1.008-1.028, p = 0.001), nightime diastolic BP level (HR:1.024, 95%CI:1.007-1.042, p = 0.007), nocturnal hypertension (HR:1.688, 95%CI:1.229-2.317, p = 0.001) were associated with HF rehospitalizaiton. Kaplan-Meier analysis had demonstrated that patients with nocturnal hypertension had significantly lower events free rate (Log rank test, p<0.001). Furthermore, patients with a riser pattern had a higher risk of HF rehospitalization (HR:1.828, 95%CI:1.055-3.166, p = 0.031) and lower events free rate (Log rank test, p = 0.003) than those with a dipper pattern.

Conclusions:

Nighttime BP levels, nocturnal hypertension and a riser pattern are independently associated with HF rehospitalization in patients with HFpEF. Well controlled nighttime BP levels should be emphasized and considered in patients with HFpEF.
IMPACT OF PROLONGED NOCTURNAL HYPOXEMIA ON LONG-TERM CLINICAL OUTCOMES IN PATIENTS WITH PRE-CAPILLARY PULMONARY HYPERTENSION
Authors: Huang Zhihua , Liu Zhihong , Luo Qin , Zhao Zhihui , Zhao Qing , Zhang Yi , Li Xin , Duan Anqi , Hu Meixi
Published: June 2023

Objective:

Obstructive sleep apnea (OSA) and/or nocturnal hypoxemia is prevalent in patients with pulmonary hypertension (PH). However, the pathophysiological determinants of adverse outcomes remain ambiguous. We aimed to investigate the prognostic significance of various sleep parameters for long-term prognosis in patients with pre-capillary PH.

Design and method:

Consecutive patients diagnosed with precapillary pulmonary hypertension (PH) by right heart catheterization who underwent overnight cardiorespiratory polygraphy for the assessment of OSA were enrolled. Time-to-event analysis was performed investigating cardiorespiratory indices (apnea-hypopnea index [AHI] and percentage total recording time <90% [T90]) and clinical worsening using the log-rank test and multivariable Cox proportional hazard models adjusted for multiple confounders.

Results:

Of 440 eligible Chinese patients with PH, 134 (30.5%) had OSA and 147 (33.4%) had nocturnal hypoxemia (T90 greater than 10%). Over a median follow-up of 12.1 months, 72 (16.4%) patients experienced clinical worsening. AHI did not predict a higher risk of incident CW (hazard ratio [HR]: 0.98, 95% confidence interval [CI]: 0.932-1.001, P = 0.225), whereas T90 was associated with an increased risk of CW (HR: 1.01, 95% CI 1.00-1.01, P = 0.018). The likelihood of CW increased by 8% per 10-unit increase in T90 (HR: 1.08, 95% CI 1.020-1.14, P = 0.018). Patients with nocturnal hypoxemia carried an HR of 1.89 for CW events (HR: 1.89, 95% CI 1.19-3.00, P = 0.007) and these associations persisted after covariates adjustments. Clinical worsening-free survival probability over two-year follow-up periods for patients with nocturnal normoxemia and hypoxemia were 87% and 76.9%, respectively (Log-rank P = 0.006), while the trend towards a non-statistical significance of patients with and without OSA. The association of nocturnal hypoxemia reflected by T90 and CW remained robust across different subgroups and did not potentially interact with potential effect modifiers including age, gender, BMI, and pulmonary hemodynamic parameters (P for interaction >0.05).

Conclusions:

In patients with precapillary PH, nocturnal hypoxemia defined by T90 was a robust risk predictor of long-term clinical worsening. Investigation of nocturnal hypoxemic burden in PH may aid in the early risk-stratification in patients with precapillary PH.
ARTERIAL HYPERTENSION IN PREGNANCY - PULSE WAVE VELOCITY EVALUATION AS A PROGNOSTIC MARKER
Authors: Carvalho Simão Almeida , Costa Carlos , Martins Maria João , Martins Nancy , Cruz Andreia , Ribau Verónica , Jaria Elisabete , Brás Susana , Leitão Cátia , Neves Ana Briosa , Bastos José Mesquita
Published: June 2023

Objective:

In the general population, arterial stiffness is associated with a higher incidence of cardiovascular complications. Little is known whether this same trend is observed in pregnant women with hypertension. The authors presented in 2020, a series of 234 pregnant women complicated by arterial hypertension submitted to 24-hour ambulatory monitoring (ABPM). They concluded that the absence of nocturnal pressure drop, especially diastolic pressure, was associated with a worse maternal-fetal outcome. The aim of this work is to present preliminary results of PWV in pregnant women with hypertension, and its relationship with an aggravated maternal-fetal outcome, as well as its relationship with the findings previously obtained with ABPM.

Design and method:

Observational study of 22 pregnant women who underwent VOP (Complior Analyze) and ABPM (Spacelabs 90207), between July 2015 and July 2022. Event was defined by: maternal death, fetal or neonatal death, preeclampsia or eclampsia, gestational diabetes, prematurity, fetal growth retardation, or dystocia due to uncontrolled hypertension.

Results:

The mean age and BMI were 31.0 ± 6.0 years and 27.2 ± 4.3 kg/m2. PWV showed mean values of 6.2 ± 0.9 m/s, and ABPM values for the studied population, SBP 24h 117.8 ± 8.6mmHg; DBP 24h 73.3 ± 8.8 mmHg; daytime SBP 123.8 ± 8.5 mmHg; daytime DBP 78.4 ± 7.9 mmHg; nocturnal SBP 106.9 ± 9.7mmHg; Night DBP 63.4 ± 9.2 mmHg. Pearson's correlation coefficient was calculated to measure the linear correlation between the variables and a hypothesis test was performed to conclude on the hypothesis of correlation between the variables.

Analysis with Pearson's correlation showed a negative correlation between PWV values and nocturnal DBP and SBP decreases in percentage, which infers that nocturnal decrease values decrease when PWV values increase. In the case of the correlation between PWV and nocturnal SBP decrease, the correlation coefficient was -0.495 (p = 0.016). In the case of the correlation between PWV and nocturnal fall in DBP, the correlation coefficient was -0.425 (p = 0.043).

Conclusions:

In line with what was previously demonstrated, the results suggest that a higher PWV, pathophysiological related to alterations in vessel elasticity, pro-inflammatory status
HYPERTENSION AND ANTIHYPERTENSIVE THERAPY IMPAIR RESPIRATORY FUNCTION
Authors: Dzhuryak Valentyna , Sydorchuk Larysa , Voroniuk Kseniia , Sydorchuk Ruslan , Petrynych Oksana , Kazantseva Tetyana , Sokolenko Alina , Yarynych Yulia , Kushnir Oksana
Published: June 2023

Objective:

Tight relationship between respiratory and vascular system appear obvious and several studies showed an association between lung function and hypertension. Furthermore, antihypertensive treatment itself might have an effect on lung function. Thus, the aim of this study was to determine association of hypertension and its treatment with respiratory function.

Design and method:

In order to evaluate the respiratory system functional state in hypertensive patients we studied 107 patients (mean 49,5±2,7 years old) with mild (1st group), moderate (2nd group) essential hypertension (EH) and neurocirculatory hypertensive asthenia (3d group), for control we observed 30 healthy subjects (4th group). Furthermore, stratification of treatment non-compliant and compliant patients was made to observe the possible impact of antihypertensive treatment. All patients had no chronic respiratory disease in anamnesis and were randomized dependently from the blood pressure levels. Parameters of the respiratory system function were examined by computer spirography.

Results:

Such predictive and active parameters of computer spirography as Maximum Voluntary Ventilation (MVV), Forced Vital Capacity (FVC), Forced Expiratory Volume after 1s (FEV1), FEV1 as % of Inspiratory Vital Capacity (FEV1%VCIN), FEV1 as % of FVC (FEV1E), and Peak Inspiratory Flow (PIF) did not significantly differ between 1st, 3d and 4th observed groups. But in the 1st and a little bit less in the 3d groups data of active parameters mentioned above were insignificantly lower (p>0.05) compared to healthy individuals. In the 2nd group patients MVV, FEV1%VCIN, FEV1E were uncertainly lower (p>0.05) than in the 1st and 3d groups, but were still border-normal with tendency to forming combined respiratory and heart failure. Antihypertensive treatment was associated with a deterioration in FEV1 by -150.3±12.78 ml (p = 0.01) and in FVC by -190.2±20.05 ml (p<0.01). With both high blood pressure and antihypertensive medication as individual variables in one regression model, only medication decreased FEV1 and FVC statistically significantly (p<0.01).

Conclusions:

Thus, a tendency for aggravation of the active parameters of respiratory function in patients with arterial hypertension is dependent on the blood pressure levels and use of antihypertensive medications.
EARLY INDICES OF SUBCLINICAL CARDIOVASCULAR DAMAGE IN PATIENTS WITH ESSENTIAL HYPERTENSION AND PRIMARY ALDOSTERONISM. A PRELIMINARY OBSERVATIONAL STUDY
Authors: Burrei Giulia , Sabba’ Giulia Elena , Rosin Elena , Franzin Angelica , Biasotto Andrea , Giontella Alice , Cattazzo Filippo , Bonafini Sara , Marcon Denise , Romano Simone , Bortolotti Stefano , Fava Cristiano , Minuz Pietro
Published: June 2023

Objective:

In hypertensive patients, the activation of the renin-angiotensin-aldosterone system is associated with an increase of subclinical vascular and cardiac damage. Our study aimed to compare some early markers of cardiovascular organ damage between patients with essential hypertension and patients with secondary hypertension, in particular primary aldosteronism.

Design and method:

Fifty-seven hypertensive patients (mean age: 44,4±13,6 years, 60.7% males) were included, 47

with essential hypertension and 10 with primary hyperaldosteronism. Peripheral blood pressure (pBP), central blood pressure (cBP) and pulse wave velocity (PWV) were assessed by the SphygmoCorXCEL. The carotid Intima-Media Thickness (cIMT) and the carotid Distensibility Coefficient (cCD) were measured by a scanner connected with an image acquisition and analysis system (CardiovascularSuite). Left ventricular mass index (LVMI) and relative wall thickness (RWT) were evaluated by transthoracic echocardiography.

Results:

Patients with primary aldosteronism have higher cIMT and PWV values compared to patients with essential hypertension (0.7±0.1mm vs. 0.6±0.1 mm, p = 0.02 and 8.6±2.5 m/s vs. 7.2±1.5 m/s, p = 0.02; respectively). By linear regression, age was the only variable independently associated with cIMT.

On the other hand, various factors such as age, the diagnosis of primary aldosteronism, pSBP and cSBP were independently associated with PWV.

Although not statistically significant, LVMI and RWT tended to be higher in the group with primary aldosteronism in comparison to patients with essential hypertension (14.3% vs. 0% exhibited concentric hypertrophy and 42.8% vs. 28.1% showed findings consistent with concentric cardiac remodelling). No differences were found in cDC values between the two groups.

Conclusions:

The results of this study confirm a possible deleterious impact of aldosteronism on cardiovascular damage in hypertensive patients, more evident for PWV than for cIMT or DC. This fact could suggest a possible different effect of the abnormal hormone secretion at different vascular districts.
CARDIOVASCULAR RISK PROFILE OF REFRACTORY HYPERTENSION DIAGNOSED BY ABPM AND HBPM IN A COHORT OF RESISTANT HYPERTENSION
Authors: Santos Taissa Lorena dos , Margallo Victor da Silva , Pimenta Carlos Filipe dos Santos , Cavalcanti Aline de Hollanda , Nemer Camila Bello , Fortes Carolina de Carvalho , Sousa Vitória Miriam da Silva de , Chedier Bernardo , Muxfeldt Elizabeth Silaid
Published: June 2023

Objective:

Refractory hypertension (RefHT) is considered an extreme phenotype of resistant hypertension (RHT) and has recently been defined as uncontrolled blood pressure (BP) despite the use of 5 or more antihypertensives including a long-acting thiazide diuretic and a mineralocorticoid receptor antagonist. The objective of this study is to evaluate the clinical profile and characterize the cardiovascular (CV) risk involved through the analysis of hypertension-mediated organ damage (HMOD) and established cardiovascular disease.

Design and method:

This is a cross-sectional study of a historical cohort of patients with RHT who underwent a standardized protocol consisting of: a questionnaire to record cardiovascular risk factors (physical inactivity, smoking, obesity, dyslipidemia, and diabetes), hypertension-mediated organ damage (albuminuria, chronic kidney diseases (CKD) stage 3, left ventricular hypertrophy (LVH) diagnosed by transthoracic echodopplercardiogram, and arterial stiffness measured by pulse wave velocity) and established CV diseases (coronary diseases, stroke, heart failure, peripheral arterial disease, and CKD stage 4 or 5). All of them were submitted to 24-hour ABPM and 5-day HBPM (triplicate morning and evening measurements).

Results:

A total of 354 patients (23.9% male; mean age 60.4 ± 11.1 years old) was included in the study. The prevalence of RefHT was 20.3% (72 patients) by ABPM and 18.9% by HBPM (67 patients).

In both groups, refractories were younger with higher levels of albuminuria. Refractory patients diagnosed by the ABPM had a higher prevalence of stroke (18.1% vs 9.6%) and established CV diseases (45.8% vs 33.7%) than resistant patients. We did not observe differences regarding LVH (75.0% vs 71.8%), arterial stiffness (13.1% vs 16.4%) and CKD stage 3 (22.2% vs 27.0%).

In turn, refractory patients diagnosed by HBPM had a higher prevalence of heart failure (7.5% vs 2.8%), also showing similar prevalence of LVH (76.1% vs 71.6%), arterial stiffness (12.7% vs 16.4%), and CKD stage 3 (22.4% vs 26.8%).

Conclusions:

Refractory hypertensives presented a cardiovascular risk profile similar to resistant hypertensives, despite the lack of blood pressure control. Possibly the pharmacological treatment with spironolactone acting on the neurohumoral axis of hypertension may have an impact on the clinical course and survival of these patients.
IMPACT OF ROUTINE BRAIN IMAGING ON THE PROGNOSIS OF PATIENTS WITH LEFT-SIDED VALVE INFECTIVE ENDOCARDITIS WITHOUT NEUROLOGICAL MANIFESTATIONS
Authors: Oh Jin Kyung , Jung Jongtak , Lee Seung-Ah , Lee Sahmin , Chang Euijin , Kang Chang Kyoung , Choe Pyoeng Gyun , Kim Yong-Jin , Kim Nam Joong , Song Jong-Min , Kang Duk-Hyun , Song Jae-Kwan , Oh Myoung-Don , Park Wan Beom , Kim Dae-Hee
Published: June 2023

Objective:

There are limited data on the impact of routine use of brain magnetic resonance imaging (MRI) on the prognosis of neurologically asymptomatic patients with left-sided infective endocarditis (IE).

Design and method:

Among patients diagnosed with possible or definite IE in two tertiary referral centers, we identified 527 left-sided IE patients without neurological symptoms or signs at the time of diagnosis. Patients who underwent brain MRI within 1 week after the IE diagnosis were classified as the routine brain imaging group (n = 216), and the rest were categorized as the control group (n = 311). All endpoints were compared after adjustment using inverse probability of treatment weighting (IPTW).

Results:

During a median follow-up of 57 months, the routine brain imaging group had a similar risk of 3-month all-cause mortality to the control group in the multivariate analysis (hazard ratio [HR], 0.53; 95% confidence interval [CI], 0.24–1.14) and IPTW-adjusted cohort (HR, 0.59; 95% CI, 0.25–1.42). The risks of attributable mortality (defined as death directly related to IE) and fatal neurological events were also similar between the two groups in the multivariable analysis and IPTW-adjusted cohort. In the subgroup analysis, the routine brain imaging group showed more favorable outcomes in cases of large vegetation (> 10 mm) or acute-onset microorganisms.

Conclusions:

Routine use of brain MRI in left-sided IE patients without neurological manifestations is not associated with improved clinical outcomes. However, routine brain imaging in appropriate clinical settings, such as in cases of large vegetation or acute-onset microorganisms, could improve clinical outcomes.
VASODILATION IS THE PREDOMINANT FACTOR OF BLOOD PRESSURE LOWERING DURING DEVICE-GUIDED SLOW BREATHING– ANALYSIS BY WAVE SHAPE PARAMETERS OF PULSE WAVE ANALYSIS
Authors: Mengden Thomas , Bachler Martin , Marschal Philip , Sehnert Walther , Wassertheurer Siegfried
Published: June 2023

Objective:

There is evidence that device-guided slow breathing with direct biofeedback of pulse arrival time (PAT) leads to favorable changes (increase) in PAT and blood pressure (decrease). Slow breathing modulates peripheral blood flow and may decrease blood pressure by vasodilation.

The objectives of the study presented here was to identify hemodynamic mechanisms of the blood pressure lowering effect of device-guided breathing observed in a previously published study (Mengden Blood Pressure Monitoring 2023).

Design and method:

Patients with a systolic BP 130-160 mmHg or treated essential hypertension (21 females / 23 males) were trained to perform repeated and unattended device guided slow breathing exercises for 10 minutes and 5 minutes cool down over 5 days.

Furthermore, they were skilled to perform a self-measurement of blood pressure before and after the breathing exercise using a validated upper-arm device.

A simple device was used to measure pulse arrival time by electrocardiography and photoplethysmography connected with a smartphone or tablet to provide biofeedback. Using pulse wave analysis, time to systolic peak (tsys) and time to dicrotic notch (tnotch) were measured and normalized to RR interval, i.e., as tsys / tT and tnotch / tT.

Results:

Oscillometric self measured blood pressure showed a reproducible decrease in systolic blood pressure of 5 mmHg (p<0.01, SD 8 mmHg).

Absolute tsys increased by 13ms (p<0.001, SD 36 ms) and relative tsys / tT increased by 0.013 (p<0.001, SD 0.033) by the end of the exercise compared to baseline after cooling down (15 min). Similarly absolute tnotch increased by 11ms (p<0.001, SD 31 ms) as well as relative tnotch / tT in total by 0.011 (p<0.001, SD 0.036) compared to baseline.

Conclusions:

The delayed arrival of the first pulse wave maximum and the prolonged ejection time after adjustment for heart rate can be assumed here as a surrogate of a decreasing afterload. It is thus evident from this perspective that vasodilation is an important factor of blood pressure lowering during device-guided breathing.
DIETARY SODIUM RESTRICTION REDUCES NOCTURNAL BLOOD PRESSURE IN PATIENTS WITH TREATMENT RESISTANT HYPERTENSION
Authors: Hornstrup Bodil , Hoffmann-Petersen Nikolai , Lauridsen Thomas Guldager , Bech Jesper Nørgaard
Published: June 2023

Objective:

Patients with treatment resistant hypertension (TRH) are characterised by lack of blood pressure (BP) control despite antihypertensive treatment. They are at particular risk of cardiovascular disease and more likely to experience BP increase as a response to sodium loading than other individuals.

In this study, we aimed to analyse if self-performed dietary sodium restriction could be implemented in patients with TRH. Moreover, we aimed to analyse the effect of this on nocturnal and 24h BP, and how BP changes were correlated to changes in plasma levels of BNP, nitric oxide and body water content.

Design and method:

The study was conducted as an interventional cross-over study including patients with TRH from 20-70 years. Patients were screened with 24h ambulatory BP monitoring initiated after observed intake of usual antihypertensive medication. They were included if 24h systolic BP>130/80 mmHg. Study participation included two periods of 14 days; a standard period with usual diet and an interventional period with instructed dietary sodium restriction and handed-out sodium-free bread. At the end of each period, patients were examined with 24h BP monitoring, 24h urine collection (sodium excretion), blood samples (nitric oxide, BNP), and bioimpedance measurement (body water content).

Results:

Participation was completed by 15 patients with mean age 59 years and mean 24h BP 144/82 mmHg. Mean baseline urinary sodium excretion was 192(86) mmol/24h (11.2 grams of salt).

As seen in Table 1, sodium excretion was reduced to 91 mmol/24h equalling 5.3 grams of salt. BP levels were reduced significantly. Plasma levels of nitric oxide increased significantly, and this was correlated to the change in 24h BP. Total body water content and plasma levels of BNP was reduced significantly. The changes in BP were not correlated to changes in sodium excretion, body water or BNP.

Conclusions:

Self-performed dietary sodium restriction could be implemented resulting in a significant reduction in BP levels. BP change was not related to changes in body water or sodium excretion. Increased levels of nitric oxide may be evidence of improved endothelial function and may be one of the involved mechanisms in BP decrease following sodium restriction
GASTROINTESTINAL ANGIONEUROTIC EDEMA AS A CONSEQUENCE OF ANGIOTENSIN – CONVERTING ENZYME INHIBITOR TREATMENT
Authors: Wojciechowska Ewa , Gryglas Piotr , Dul Pawel
Published: June 2023

Objective:

To report a case of unusual severe adverse reaction to an angiotensin-converting enzyme inhibitor (ACEI).

Design and method:

A 33-year-old male with a history of hypertension for 10 years, asthma, and atopy was admitted to a local emergency department due to diffuse abdominal pain with vomiting and diarrhea for about 3 days. A few days earlier, the patient had blood pressure (BP) lowering treatment modified due to suboptimal BP control, with introduction of perindopril. The first ACEI dose was followed by lower abdominal pain, urge to have bowel movement, and difficulty passing stool. 24 hours later, the next dose was followed by severe, gradually increasing, diffuse abdominal pain, nausea, vomiting, and diar-rhea. With signs of peritonitis present on admission, a surgeon suspected an acute abdomen and or-dered abdominal computed tomography (CT) due to unclear etiology. CT showed diffuse infiltrates within the small intestine and its mesentery, with free abdominal fluid but no perforation. The patient was not operated and seen by an internist who suspected gastrointestinal angioneurotic edema related to ACEI. On admission to the medical unit, the patient was moderately unwell, conscious, with BP 185/110 mmHg, HR 128 bpm, SaO2 99% on room air, and no fever. Abdomen examination showed reduced bowel sounds, abdominal guarding, tenderness on palpation, especially in the mid-abdomen, and rebound tenderness. Laboratory tests showed elevated WBC (16,800/mm3) and CRP (19 mg/L).

Results:

Perindopril was withdrawn, the patient received antihistamines, analgesics, and intravenous fluids, with improvement of the patient's condition and reduction of pain and inflammation markers. Follow-up abdominal CT after 5 days showed resolution of small intestinal edematous lesions. The patient was discharged home in good condition, without abdominal pain, and with good BP control. The final diag-nosis was gastrointestinal angioneurotic edema associated with ACEI treatment.

Conclusions:

One condition may mimic another and thus unclear clinical presentations require cautious diagnostic and therapeutic decisions. In the presented case, angioneurotic edema following introduction of perin-dopril was unusually located in the gastrointestinal tract and its manifestations imitated an acute abdo-men.
CLINICAL INERTIA AND ADHERENCE IN THE CROATIAN RURAL AREA DAMAGED BY AN EARTHQUAKE. “THE SILENT KILLER HUNT”-CROATIAN SOCIETY OF HYPERTENSION PROJECT
Authors: Sovic Ariana , Abramovic Inga , Lonic Jakov , Mestrovic Dora , Petrinovic Martina , Strabic Adrijana , Jelakovic Bojan
Published: June 2023

Objective:

Adherence to medical advice is a major factor in treating hypertension. Motivation to implement lifestyle changes is as important as taking medications. To gain a better understanding of patient compliance our aim was to find out patients’ adherence to physicians’ medical advice.

Design and method:

A survey was conducted on a sample of 214 subjects as a part of a project ’The Silent Killer Hunt’, which targets populations at risk for developing hypertension (opportunistic screening). The participants were given a questionnaire containing two types of questions, the first one being about the recommendation they were or were not given by their general practitioner, and the second one about their subsequent change of behavior. Jamovi was used for statistical analysis.

Results:

A total of 94.7% have received a recommendation to use medication for hypertension and 106 (49.5%) people have confirmed that they take their medication regularly. On the other hand, only 46.5% of the surveyed participants have been advised to decrease their body weight. Increasement in physical activity was suggested to 55.3% and a total of 30.2% and 28.6%, have not been successful in reducing their body weight and increasing their physical activity, respectively. More than half of the subjects (63.2%) were educated about lowering their salt intake.

Conclusions:

Clinical inertia and poor adherence were found in this rural area. Education of physicians and nurses is equally important as the education of patients and according to our results, it is even more important in this remote and poor part of Croatia.
Surgical Ergonomics and Preventing Work-Related Musculoskeletal Disorders
Authors: Yurteri-Kaplan Ladin A. , Park Amy J.
Published: June 2023

(Abstracted from Obstet Gynecol 2023;141(3):455–462

A busy surgical career requires many intense years of training, practice, and education. The authors of this article postulate an urgent need for a significant paradigm shift to viewing surgeons as high-performance athletes, with a need for a new concept for their work environment to ensure mental acuity, and ergonomic changes to preserve physical dexterity and longevity.
A Phase III Study of Pafolacianine Injection (OTL38) for Intraoperative Imaging of Folate Receptor–Positive Ovarian Cancer (Study 006)
Authors: Tanyi Janos L. , Randall Leslie M. , Chambers Setsuko K. , Butler Kristina A. , Winer Ira S. , Langstraat Carrie L. , Han Ernest S. , Vahrmeijer Alexander L. , Chon Hye Sook , Morgan Mark A. , Powell Matthew A. , Tseng Jill H. , Lopez Alexis S. , Wenham Robert M.
Published: June 2023

(Abstracted from J Clin Oncol 2022;41:276–284

Complete resection of macroscopic disease remains a key focus of cytoreductive surgery for the treatment of ovarian cancer. Barriers to achieving complete resection include small-sized lesions, obscuring tissue damage from prior chemotherapy, and incomplete exploration.
Referred sensations in the orofacial region are associated with a decreased descending pain inhibition and modulated by remote noxious stimuli and local anesthesia
Authors: Sago Teppei , Costa Yuri M. , Ferreira Dyna M. , Svensson Peter , Exposto Fernando G.
Published: June 2023

Referred sensation (RS) as a specific clinical phenomenon has been known for a long time, although the underlying mechanisms remain unclear. The aims of this study were to assess if (1) healthy individuals who experienced RS had a less active endogenous pain system when compared with those who did not; (2) activation of descending pain inhibition mechanisms can modulate RS parameters; and finally, (3) a transient decrease in peripheral afferent input because of a local anesthetic (LA) block in the masseter muscle can modulate RS parameters. To assess these, 50 healthy participants were assessed in 3 different sessions. In the first session, conditioned pain modulation (CPM) as well as mechanical sensitivity and RS at the masseter muscle were assessed. In the same session, participants who experienced RS had their mechanical sensitivity and RS assessed again while undergoing a CPM protocol. In the second and third sessions, participants had their mechanical sensitivity and RS assessed before and after receiving an injection of 2 mL of LA and isotonic saline into the masseter muscle. The main findings of this study were (1) participants who experienced RS during standardized palpation exhibited increased mechanical sensitivity (P < 0.05, Tukey post hoc test) and decreased CPM (P < 0.05, Tukey post hoc test) when compared with those who did not; RS incidence (P < 0.05, Cochran Q test), frequency (P < 0.05; Friedman test), intensity (P < 0.05, Tukey post hoc test), and area (P < 0.05, Tukey post hoc test) were all significantly reduced when assessed (2) during a painful conditioning stimulus and (3) after LA block. These novel findings highlight that RS in the orofacial region are strongly modified by both peripheral and central nervous system factors.
Application of metagenomic sequencing of drainage fluid in rapid and accurate diagnosis of postoperative intra-abdominal infection: a diagnostic study
Authors: Zhu Ruizhe , Hong Xiafei , Zhang Dong , Xiao Yi , Xu Qiang , Wu Bin , Guo Junchao , Han Xianlin , Yang Qiwen , Zhao Yupei , Wu Wenming
Published: June 2023

Background:

Postoperative intra-abdominal infection (PIAI) is one of the most serious complications of abdominal surgery, increasing the risk of postoperative morbidity and mortality and prolonging hospital stay. Rapid diagnosis of PIAI is of great clinical value. Unfortunately, the current diagnostic methods of PIAI are not fast and accurate enough.

Methods:

We performed an exploratory study to establish a rapid and accurate diagnostic method of PIAI. We explored the turnaround time and accuracy of metagenomic next-generation sequencing (mNGS) in diagnosing PIAI. Patients who underwent elective abdominal surgery and routine abdominal drainage with suspected PIAI were enrolled in the study. The fresh midstream abdominal drainage fluid was collected for mNGS and culturing.

Results:

We found that the median sample-to-answer turnaround time of mNGS was dramatically decreased than that of culture-based methods (less than 24 h vs. 59.5 to 111 h). The detection coverage of mNGS was much broader than culture-based methods. We found 26 species from 15 genera could only be detected by mNGS. The accuracy of mNGS was not inferior to culture-based methods in the 8 most common pathogens detected from abdominal drainage fluid (sensitivity ranged from 75% to 100%, specificity ranged from 83.3% to 100%, and kappa values were higher than 0.5). Moreover, the composition of the microbial spectrum established by mNGS varied between upper and lower gastrointestinal surgery, enhancing the understanding of PIAI pathogenesis.

Conclusion:

This study preliminarily revealed the clinical value of mNGS in the rapid diagnosis of PIAI and provided a rationale for further research.
Group vs Traditional Prenatal Care for Improving Racial Equity in Preterm Birth and Low Birthweight: The Centering and Racial Disparities Randomized Clinical Trial Study
Authors: Crockett Amy H. , Chen Liwei , Heberlein Emily C. , Britt Jessica L. , Covington-Kolb Sarah , Witrick Brian , Doherty Emily , Zhang Lu , Borders Ann , Keenan-Devlin Lauren , Smart Britney , Heo Moonseong
Published: June 2023

(Abstracted from Am J Obstet Gynecol 2022;227:893.e1–893.e15

Preterm birth (PTB) is far too common in the United States and disproportionately affects Black individuals. To address these differences, a group care model was proposed that would provide health care with family and peer support and provider-led patient-centered health education.