bluuebunny/crossref_metadata_2025 huggingface dataset:
PERSISTENCE OF BLOOD PRESSURE PHENOTYPES ACCORDING TO OFFICE AND 24 HOUR AMBULATORY BLOOD PRESSURE IN CHILDREN
Authors: Martinez Fernando , Alvarez Julio , Ponce Francisco , Redon Josep , Lurbe Empar
Published: June 2022

Objective:

To assess the persistence of BP phenotypes according to office and 24-h ABPM in youth over time.

Design and method:

Retrospective study including 582 children who underwent measurement of both office BP (OBP) and ABPM on the same day. The second office BP and ABPM was performed within 1 year apart. OBP was measured using an oscillometric device validated in children. ABPM was performed using oscillometric SpaceLabs 90207 monitors. OBP and ABPM were classified according to the criteria of the ESH (Lurbe et al J Hypertens 2016). Four phenotypes based on OBP and ABPM were defined: true normotensives, sustained hypertensives, white-coat hypertensives, and masked hypertensives. Persistence and Kappa statistic were used to evaluate the concordance of BP phenotypes. Factors related with persistence on BP phenotypes were evaluated using logistic regression models.

Results:

At the initial assessment, the majority of children fell within the category of true normotension (77%), followed by masked hypertension (13%), sustained hypertension (5%) and white coat hypertension (5%). The prevalence of true normotensive increased significantly in the follow-up. The flow through phenotypes is shown in the Figure.

Only 38 initial true normotensive patients changed to other categories, mainly masked (12); 63 of initial masked hypertension changed, mainly to normotensive (58); 24 of white coat changed predominantly to normotension (16); finally, 25 of sustained changed, largely to normotension (14), but 9 children migrated to masked. The overall agreement was 74.2% (kappa 0.20). The grade of agreement was slightly higher for boys than for girls. In the multivariable model, higher age showed to be a protective factor, whereas increased office SBP and waist circumference were significant risk factors. The masked hypertensive phenotype carried the highest risk for lack of persistence.

Conclusions:

Children with hypertensive BP phenotypes should be re-evaluated because a large percentage of them will become normotensive. High BP levels and high BMI z-score or waist circumference were significant risk predictors for the lack of persistence on BP phenotypes.
COVID-19 ASSOCIATED REDUCTION IN HYPERTENSION-RELATED DIAGNOSTIC AND THERAPEUTIC PROCEDURES IN EXCELLENCE CENTERS OF THE EUROPEAN SOCIETY OF HYPERTENSION
Authors: Weber Thomas , Kreutz Reinhold , Januszewicz Andrzej , Mayer Christopher , Tsioufis Konstantinos , Abraham György , Amar Jaques , Barna Istvan , Barroso Weimer Kunz Sebba , De Backer Tine , van der Giet Marcus
Published: June 2022

Objective:

The Covid-19 pandemic necessitated a decrease in non-Covid-19 related diagnostic and therapeutic procedures in many countries. We explored the impact on hypertension care in the Excellence Center (EC) network of the European Society of Hypertension.

Design and method:

We conducted an electronic survey regarding 6 key procedures in hypertension care among our ECs.

Results:

Overall, 54 ECs from 18 European and 3 non-European countries participated. From 2019 to 2020, there was a significant decrease in the median number per center of ambulatory blood pressure monitorings (ABPMs; 544 vs 289), duplex ultrasound investigations of renal arteries (DUS RA; 88.5 vs 55), computed tomographic investigations of renal arteries (CT RA; 66 vs 19.5), percutaneous renal artery angioplasties (PTA RA; 5 vs 1), laboratory tests for catecholamines (2019: 116 vs 67.5) and for ennin/aldosterone (146 vs 83.5). All comparisons were statistically significant with p < 0.001, respectively (Figure). While the reduction in all diagnostic and therapeutic procedures was observed in all 3-months period comparisons between 2019 and 2020, the most profound decrease occurred from April to June 2020, which was the period of the first wave and the first lockdown in most countries. In this period, as compared to 2019, the median reduction in 2020 was 50.7% (ABPM), 47.1% (DUS RA), 50% (CT RA), 57.1% (PTA RA), 46.9% (catecholamines) and 41% (ennin/aldosterone), respectively. Based on Friedman test, overall differences in reduction between 3 months time intervals were statistically highly significant.

Conclusions:

Diagnostic and therapeutic procedures related to hypertension were dramatically reduced during the first year of the Covid-19 pandemic, with the largest reduction during the first lockdown. The long-term consequences regarding blood pressure control and, ultimately, cardiovascular events remain to be investigated.
COVID-19 AND NEW ONSET HYPERTENSION
Authors: Shalaeva Evgeniya , Shamsutdinova Maksuda , Shadmanov Alisher , Boymuradov Shukhrat , Azizova Feruza , Allaberganov Dilshod , Saner Hugo , Messerli Franz
Published: June 2022

Objective:

COVID-19 has been identified as a possible risk factor for hypertension. It may be associated with new onset hypertension or aggravate pre-existing hypertension. The objective of the study was to evaluate systolic (SBP) and diastolic blood pressure (DBP) pattern in COVID-19 patients discharged from the hospital and followed for over 3 months.

Design and method:

This is a prospective single-center observational cohort study of 1442 hospitalized COVID-19 patients including 259 ICU patients followed over 3-months (52.4 ± 12.3 years, 49.8% male) in Uzbekistan January-June 2021. Patients were subclassified according to JNC 8 hypertension stages. For patients who died, the last confirmed BP was used.

Results:

In the whole cohort, all-cause mortality was 137 (9.5%). At 3-months in ospitalisat patients (no ICU treatment), mean SBP was raised on 7.4 mmHg, DBP 5.7 mmHg compared to the 1st day of admission due to COVID-19, in ICU patients SBP increased by 12.5 mmHg and DBP 7.2 9 mmHg (Table 1). The prevalence of hypertension in the whole cohort subclassified according to JNC8 criteria is presented in Table 2. In the whole cohort at the baseline, according to JNC8, hypertension was detected in 713 (49.4) patients, and by 3-months follow-up new incidence of hypertension was observed in 254 (17.6%) patients. 483 (65%) patients with diagnosed hypertension at the baseline were required to increase the doses of antihypertensive medications after discharge during 3-months follow-up.

Conclusions:

COVID-19 necessitating ospitalisation is a powerful risk factor for new onset hypertension or for aggravating pre-existing hypertension.
CUMULATIVE EXPOSURE TO JOB STRAIN AND PREDIABETES AMONG MALE AND FEMALE WHITE-COLLAR WORKERS
Authors: Riopel Camille , Brisson Chantal
Published: June 2022

Objective:

Previous literature suggests an association between psychosocial stressors at work (PSWs) and the risk of type 2 diabetes mellitus (T2DM). According to the demand-control model, the combination of high psychological demands at work and low levels of control is called job strain, which increases the risk of T2DM. Prediabetes greatly increases the risk of developing T2DM and is also independently associated with an increased mortality risk. However, the evidence regarding the association between PSWs and prediabetes is scarce. The objective of this study is to clarify the relationship between cumulative exposure to PSWs, defined according to the demandcontrol

model, and both prediabetes prevalence in a longitudinal cohort.

Design and method:

Over 9000 white-collar workers (48.5% female) were recruited in 1991–1993 and were followed up 8 and 24 years later. Workers exposed to job strain at baseline and at the 8- year follow-up were considered exposed to chronic job strain. Glycated hemoglobin (HbA1c) was measured at the 24-year follow-up in 1461 workers and was used to measure prediabetes prevalence. Odds ratios (ORs) were computed using multiple logistic regressions which were adjusted for potential confounding factors.

Results:

In female workers, chronic job strain was associated more than twice the odds of prediabetes (OR = 2.21, 95% CI 1.05–4.67) compared to unexposed workers, even after adjusting for sociodemographic factors and lifestyle habits. There was no association between job strain and prediabetes in male workers.

Conclusion: Our results suggest that PSWs, when they are measured with the demand-control model, are associated with an increased prediabetes prevalence. Given the increasing burden of disease of prediabetes and T2DM in Canada and in other developed countries, addressing these frequent and modifiable occupational factors could improve the health of Canadian workers, especially female workers. Therefore, workplace interventions that aim to decrease adverse PSWs should be considered to reduce glucose metabolism imbalances at the population level.
EFFECT OF A WEB-BASED MANAGEMENT PLATFORM ON HYPERTENSION CONTROL IN COMMUNITY: A RANDOMIZED CLINICAL TRIAL
Authors: Zhou Haoqi , Wang Xin , Chen Zuo , Zhang Linfeng , Zheng Congyi , Chen Lu , Cai Jiayin , Cao Xue , Wang Zengwu
Published: June 2022

Objective:

To assess the effect of multi-component intervention delivered by a web-based platform on improving blood pressure control rate.

Design and method:

A cluster andomised clinical trial of a hypertension management program was conducted from January 1 to December 31, 2018 in 66 communities. Communities were andomised to either the intervention group (usual care combined with multi-component intervention delivered by a web-based platform) or control group (usual care only). The intervention included health education, lifestyle modification, self-monitoring and treatment. In order to support the implementation of intervention program, a web based-platform was established. Automated classification and personalized follow-up schedule would be generated by prespecified algorithm according to the patients’ information. The primary outcome was the change in blood pressure control rate from baseline to 12 months among hypertension patients in the intervention and control group. The secondary outcomes were the changes in blood pressure and lifestyle factors.

Results:

A total of 3,872 participants (2,994 in the intervention group and 878 in control group) were included in the analysis. Blood pressure control rate at baseline was 31.4% in the intervention group and 30.2% in the control group. After 12 months of the intervention, the blood pressure control rate for the intervention group compared with the control group was significantly higher (65.9% vs 42.0%; odds ratio, 1.25; 95%CI,1.19–1.32; P < 0.001). The intervention effect on systolic blood pressure was -8.0 mmHg (95%CI, -9.8 to -6.2 mmHg; P < 0.001) and on diastolic blood pressure was -1.7 mmHg (95%CI, -2.8 to -0.6 mmHg, P = 0.003). The blood pressure control rate showed a gradual increment throughout the whole intervention duration. What's more, greater improvement was observed in the proportion of regular exercise (17.8%; 95%CI, 15.3%-20.3%; P < 0.001).

Conclusions:

This trial found that a multi-component intervention delivered by a web-based platform appeared to be more effective than usual care, leading to measurable benefits such as lower blood pressure, improved hypertension control, and adoption of healthy lifestyle habits. Telemedicine may be a better way to manage hypertension patients in community.
PROFILING CIRCULATING EXTRACELLULAR VESICLE SURFACE ANTIGENS IN PRIMARY ALDOSTERONISM
Authors: Burrello Jacopo , Tetti Martina , Forestiero Vittorio , Biemmi Vanessa , Bolis Sara , Pomatto Margherita , Amongero Martina , Di Silvestre Dario , Mauri Pierluigi , Vassalli Giuseppe , Camussi Giovanni , Williams Tracy Ann , Mulatero Paolo , Barile Lucio , Monticone Silvia
Published: June 2022

Objective:

Primary aldosteronism (PA) is characterized by an inappropriate secretion of aldosterone. Chronic aldosterone excess exerts detrimental effects on cardiovascular system, including endothelial dysfunction and vascular inflammation. Circulating extracellular vesicles (EVs) are central players in the crosstalk between endothelium and inflammatory cells, and they may be involved in the development of organ damage in patients with PA. The aim of the present study was to assess the potential role of EVs in aldosterone-related vascular injury by evaluating a panel of 37 EV surface antigens through an innovative flow cytometry multiplex bead-based platform.

Design and method:

Serum EVs were isolated by immuno-capture from 32 patients with PA, 29 patients with essential hypertension (EH) and from 22 normotensive (NT) controls. EVs were characterized by nanoparticle tracking analysis, transmission electron microscopy, western blotting, and flow cytometry.

Results:

EV concentration was higher and diameter lower in patients with PA compared to patients with EH and NT controls and the number of particles decreased after unilateral adrenalectomy. Nineteen EV surface antigens were differentially expressed in patients with PA compared to patients with EH or NT controls, including markers from activated platelets, endothelial and immune/inflammatory cells. Supervised learning was used to combine the expression levels of EV surface markers in a specific molecular signature which discriminated patients with PA from controls (EH and NT), whereas after specific treatment the profile became similar to EH. Stimulation of human endothelial cells with PA patient-derived EVs, but not with EVs from EH, resulted in the overexpression of 5 selected genes (AKT1, CALR, CSNK2A1, FN1, and PIK3R1), previously identified by bioinformatics analysis as potential targets of differentially expressed EV antigens. Notably, the effect was specifically dependent on EV surface antigens, since it was abolished by removal of EV membrane associated proteins. The overexpression of CALR and FN1 was confirmed also at protein level.

Conclusions:

Our data suggest that EVs represent biomarkers of vascular inflammation and endothelial dysfunction in patients with PA, and also potential biovectors contributing to endothelial dysfunction, vascular inflammation, and accelerated organ damage by multiple signalling processes.
NOX5 EXPRESSION IN A VASCULAR SMOOTH MUSCLE CELL-SPECIFIC MANNER INDUCES FIBROBLAST PHENOTYPIC SWITCH AND PRO-FIBROTIC EFFECTS
Authors: Montezano Augusto , Rios Francisco , Blaikie Zachariel , Saad Tomador , Camargo Livia , Palacios-Ramirez Roberto , Tarjus Antoine , Sagan Agnieszka , Beattie Wendy , Guzik Tomasz , Jaisser Frederic , Graham Delyth , Touyz Rhian M.
Published: June 2022

Objective:

Mice expressing human Nox5 (hNox5) in vascular smooth muscle cells (VSMC) exhibit redox-sensitive vascular dysfunction and cardio-renal fibrosis. Mechanisms underlying pro-fibrotic effects are unclear. Here we assessed whether hNox5 in VSMCs promotes fibroblast phenotypic changes leading to myofibroblast differentiation and pro-fibrotic/inflammatory responses.

Design and method:

Fibroblasts were cultured from wildtype (WT) and mice expressing hNOX5 in VSMC (Nox5+SM22+). Mice (20 weeks old) were infused with Ang II (600 ng/Kg/day) for 28 days and renal fibrosis/inflammation studied. Markers of myofibroblasts, pro-fibrotic and inflammatory phenotypes were assessed by qPCR and immunoblotting. Inflammatory infiltrate was assessed by FACS.

Results:

Fibroblasts isolated from Nox5+SM22+ mice exhibited increased mRNA expression of pro-fibrotic markers, such as Col1A1 (2-ddCt: 1.74 ± 0.16 vs. WT 0.67 ± 0.11), Col3A1 (2-ddCt: 1.74 ± 0.18 vs. WT 0.96 ± 0.24) and TIMP3 (2-ddCt: 2.65 ± 0.25 vs. WT 0.38 ± 0.07), p < 0.05. Myofibroblast phenotype (SMC) markers mRNA, aSMA (2-ddCt: 1.54 ± 0.05 vs. WT 0.78 ± 0.17) and Myocd (2-ddCt: 1.36 ± 0.17 vs. WT 0.39 ± 0.22) were also increased in fibroblasts from Nox5 mice, p < 0.05. In terms of inflammatory phenotype, we observed that mRNA expression of CD36 (2-ddCt: 1.37 ± 0.07 vs. WT 86 ± 0.24), TNFa (2-ddCt: 1.32 ± 0.2 vs. WT 0.71 ± 0.17) and TNFR1 (2-ddCt: 1.26 ± 0.04 vs. WT 1.02 ± 0.10) were increased, while CD68 expression was decreased (2-ddCt: 0.82 ± 0.11 vs. WT 1.36 ± 0.18) in fibroblasts from Nox5+SM22+ mice (p < 0.05). In Nox5 mice fibroblasts, key regulators of fibrosis such as ROS production and TGFb protein expression (AU: 1.8 ± 0.05 vs. WT 1.4 ± 0.06), as well as TGFbR2 gene expression (2-ddCt: 2.04 ± 0.17 vs. WT 0.57 ± 0.12), were increased (p < 0.05). Kidneys from Ang II-infused Nox5+SM22+ mice exhibited significant perivascular fibrosis and inflammatory cell infiltration compared to WT. Kidney expression of vimentin (AU: 1.01 ± 0.05 vs WT 0.85 ± 0.03) and aSMA (AU: 0.44 ± 0.03 vs WT 0.33 ± 0.01), markers of myofibroblast differentiation, were increased in Nox5 mice (p < 0.05). In kidneys from Nox5+SM22+ mice, increased frequencies of macrophage F4/80 + (%: 24 ± 2 vs WT 18 ± 1, p < 0.05).

Conclusions:

Our findings suggest that Nox5 in VSMCs influences fibroblast phenotypic switching to myofibroblasts that likely influences cardiovascular and renal fibrosis in hypertension.
THERAPEUTIC EFFECTS OF NEBULIZATION- BASED DELIVERY OF ANTI-MIR-146A IN EXPERIMENTAL PULMONARY ARTERIAL HYPERTENSION
Authors: Gomes Joana , Ferreira Pedro , Adão Rui , Rocha Carolina , Vasconcelos Inês , Rego Beatriz , Salvador Pedro , Moreira Adelino , Silva Carmén
Published: June 2022

Objective:

Pulmonary arterial hypertension (PAH), is a chronic disorder characterized by excessive pulmonary vascular remodelling, resulting in elevated pulmonary vascular resistance and right ventricle (RV) overload and failure. PAH remains incurable, and new therapeutic approaches are required. The microRNA-146a (miR-146a) promotes vascular smooth muscle cell proliferation and vascular neointimal hyperplasia, both important hallmarks of PAH.

This study aimed to investigate the role of miR-146a in the pathophysiology of PAH and in the progression to RV hypertrophy and failure.

Design and method:

Sprague Dawley rats received a subcutaneous injection of monocrotaline (MCT group) or vehicle (CTRL group) and, after fourteen days they were treated, by intratracheal nebulization, with an anti-miR-146a, forming four distinct groups: CTRL-treated; CTRL-untreated, MCT-treated, and MCT-untreated. Twenty-seven days after MCT injection, echocardiographic and invasive hemodynamic evaluations were performed in all animal groups. Also, wild-type (WT) and miR-146a knock-out (KO) (miR-146a-/-) mice were submitted to either 3 weeks of chronic hypoxia-induced PAH with weekly Sugen 5416 administration (SuHx).

Results:

Compared to MCT-untreated rats, the MCT-treated rats showed decreased RV hypertrophy, (as measured by the Fulton index), decreased RV end-diastolic diameter/left ventricle end-diastolic diameter (RVEDD/LVEDD) ratio, and decreased in RV diastolic pressures. KO-SuHx group, when compared to WT-SuHx group, showed decreased RV hypertrophy (as measured by the Fulton index), and decreased RV systolic pressures and dilation, as well as lower RV end end-diastolic diameter (RVEDDi) and right atria area (RAAi).

Conclusions:

Our findings show that miR-146a pharmacological or genetic inhibition reduces RV remodelling and improves cardiac function. Thus, miR-146a represents a promising therapeutic target in PAH.
AORTIC CALCIFICATION INCREASES CENTRAL BLOOD PRESSURE RELATIVE TO BRACHIAL BLOOD PRESSURE IN CKD PATIENTS – A STUDY IN PATIENTS UNDERGOING ELECTIVE CORONARY ANGIOGRAPHY
Authors: Nyvad Jakob , Christensen Kent Lodberg , Andersen Gratien , Reinhard Mark , Nielsen Sebastian , Thomsen Martin , Jensen Jesper M⊘ller , N⊘rgaard Bjarne Linde , Buus Niels Henrik
Published: June 2022

Objective:

Chronic kidney disease (CKD) and arterial stiffness are associated with increased central (aortic) systolic blood pressure (cSBP) relative to brachial systolic blood pressure (bSBP). This study examined the impact of aortic calcification on cSBP relative to bSBP in patients with CKD.

Design and method:

Patients with or without CKD undergoing elective coronary angiography (CAG) at Aarhus University Hospital were considered for inclusion in this cross-sectional study. During CAG, cSBP was measured in the ascending aorta with a fluid-filled catheter while bSBP was measured simultaneously with an oscillometric device using a cuff. Furthermore, patients underwent a non-contrast computed tomography (CT) scan of the entire aorta with subsequent blinded Agatston-scoring of the aorta from (but excluding) the aortic valve to the aortic bifurcation. Carotid-femoral pulse wave velocity was measured in duplicate using a Sphygmocor device. Data are presented as mean ± standard deviation unless stated otherwise. Statistical comparisons were made using Wilcoxon rank sum test for differences between 2 groups and Bonferroni-adjusted Kruskal-Wallis test when testing for differences between > 2 groups.

Results:

149 patients were included in the study. Of these, 134 patients had a CT-scan of sufficient quality to allow analysis. Patient characteristics and measurements of BP and pulse wave velocity are presented in Table 1. Agatston-score was higher in CKD patients as compared to patients with normal kidney function (table 1, P < 0.001). bSBP was 6.5 ± 13.1 mmHg higher than cSBP in patients categorized into the first tertile of Agatston-scores. This difference was reduced to 3.3 ± 11.0 mmHg in the second tertile (p = 0.31, compared to first tertile) and -2.6 ± 16.8 mmHg in the third tertile (p < 0.01, compared to first tertile).

Conclusions:

Patients with CKD have a higher degree of aortic calcification. Furthermore, patients with a high degree of aortic calcification have a higher invasively measured cSBP as compared to the bSBP measured with an ordinary oscillometric BP device.
KIDNEY SUBCLINICAL LESIONS IN HYPERTENSION PHENOTYPES DEFINED BY HOME BLOOD PRESSURE MONITORING AMONG YOUNG ADULTS ENROLLED IN A FAMILY HEALTH STRATEGY UNIT
Authors: Pecly Inah Maria Drummond , Fernandes Ana Cristina Tenorio C. , Bica Rafael Barbosa Da S. , Flumingnan Vitoria Santa Marinha , Marinho Beatriz Deberaldini , Da Silva Luisa Leite Vaz , Boghossian Rodney Barberá , Falcão Michelle Felipe , Neto Valter Correa Branco , Bandeira Heito De O. M. Rego , Moura Carlos Augusto Parente M. , Ushijima Nathalia Rossilho , Muxfeldt Elizabeth Silaid
Published: June 2022

Objective:

To assess kidney subclinical lesions among different hypertension (HTN) phenotypes identified by Home Blood Pressure Monitoring (HBPM) in an adult population enrolled in a Family Health Strategy unit

Design and method:

Cross-sectional, populational study with adults between 20–50 years old enrolled in a Family Health Strategy unit in a metropolis. Sociodemographic, anthropometric and CV risk factors were registered. Office blood pressure (BP) was the average of two consecutive measurements, and HBPM followed a 7-day protocol. HBPM < 135x85 mmHg and office BP < 140x90mmHg were considered normal, identifying four phenotypes: normotension (controlled office BP and HBPM); white-coat hypertension (uncontrolled office BP and controlled HBPM); masked hypertension (controlled office BP and uncontrolled HBPM) and sustained hypertension (uncontrolled office BP and HBPM). Albuminuria was dosed in an isolated urine sample whereas glomerular filtration rate was calculated by CKD Epi formula using serum creatinine.

Results:

A total of 483 individuals were evaluated (39% male; mean age: 37.6 ± 8.8 years). More often, individuals with white-coat hypertension (9.3%) are male, with greater neck circumference and higher prevalence of metabolic syndrome. Individuals with masked hypertension (10%) are more obese, with increased neck and waist circumferences whereas those who present sustained hypertension are predominantly male, more obese, with increased neck and waist circumferences and higher prevalence of diabetes and metabolic syndrome. Analyzing four phenotypes, a progressive albuminuria increase was observed among normotensive patients: white-coat hypertension 4.0 ± 2.2; masked hypertension 5.3 ± 3.4 and sustained hypertension 7.1 ± 1.4 mg/g creatinine. We also observed an increased serum creatinine and decreased GFR: white-coat hypertension 0.74 ± 0.16/132 ± 34; masked hypertension 0.79 ± 0.17/123 ± 28; sustained hypertension 0.81 ± 0.32/120 ± 59, respectively, although without statistical significance.

Conclusions:

The performance of HBPM refined HTN diagnosis and was able to early identify a progressive worsening of kidney function parameters in the different phenotypes.
IMPAIRED SKIN MICROCIRCULATION DYNAMICS IN PATIENTS WITH RHEUMATOID ARTHRITIS: ASSOCIATION WITH ARTERIAL STIFFNESS AND CORONARY MICROVASCULAR PERFUSION
Authors: Anyfanti Panagiota , Gavriilaki Eleni , Nikolaidou Barbara , Triantafyllou Areti , Dolgyras Panagiotis , Zarifis Hippokrates , Lazaridis Antonios , Koletsos Nikolaos , Douma Stella , Gkaliagkousi Eugenia
Published: June 2022

Objective:

Rheumatoid arthritis (RA) is characterized by excess cardiovascular risk. Laser Speckle Contrast Imaging (LSCI) is a novel and highly reproducible technique for the real-time evaluation of skin microcirculation. However, relevant data using non-invasive laser techniques remain far too limited in RA, especially in patients free from cardiovascular risk factors with relatively suppressed inflammatory load.

Design and method:

We assessed skin microvascular function in a well-characterized sample of RA patients free from hypertension and cardiovascular diseases with low levels of systemic inflammation, compared to non-RA individuals. Microvascular function was dynamically evaluated using LSCI coupled with a post-occlusive reactive hyperaemia protocol. Applanation tonometry with the Sphygmocor device was applied to assess a) subendocardial viability ratio (SEVR) or Buckberg index as a functional marker of microvascular myocardial perfusion, b) carotid-femoral pulse wave velocity (PWV) as a marker of macrovascular dysfunction.

Results:

We studied 35 patients with RA at remission or low disease activity, and 35 controls matched for cardiovascular risk factors. Skin microvascular responses were impaired in RA patients compared to controls, specifically baseline flux [46.8(18.9) vs 36.4(13.9) LSPUs, p < 0.001], occlusion flux [12.4(13.5) vs 7.0(3.6) LSPUs, p = 0.001], time-to-peak [7.0(0.4) vs 11.0(8) sec, p < 0.001], peak magnitude [113.1(25.4) vs 99.1(32.5) LSPUs, p = 0.017], peak-to-baseline magnitude [136.5(75.2) vs 172.1(65.9) %, p = 0.014], baseline cutaneous vascular conductance (CVC) (0.54 ± 0.15 vs 0.44 ± 0.14 LSPUs/mmHg, p = 0.006), and percentage increase in CVC [139.5(75.3) vs 172.1(67.3) %, p = 0.011]. Moreover, SEVR was lower in RA patients compared to controls (140.6 ± 21.8 vs 157.2 ± 25.2%, p = 0.046), whereas PWV did not significantly differ. SEVR strongly and significantly correlated with nearly all LSCI indices (baseline and occlusion flux, peak magnitude, peak-to-baseline magnitude, baseline CVC, and percentage CVC increase). PWV significantly correlated only with baseline flux, occlusion flux, and time-to-peak.

Conclusions:

Microcirculation dynamics appear impaired even in RA patients with relatively low inflammatory load, regardless of cardiovascular risk factors. Importantly, we showed for the first time an association between impaired skin microvascular dynamics assessed with LSCI and microvascular myocardial perfusion using SEVR. Further studies need to evaluate the prognostic potential of LSCI in terms of cardiovascular risk in RA.
TIME DOSING OF ANTIHYPERTENSIVE TREATMENT AND PROGNOSIS
Authors: de la Sierra Alejandro , Ruilope Luis , Martinez-Camblor Pablo , Vinyoles Ernest , Gorostidi Manuel , Segura Julian , Williams Bryan
Published: June 2022

Objective:

Night BP is the most powerful estimate of cardiovascular prognosis. It has been suggested that bedtime administration of antihypertensive therapy may favour night BP reduction and prognosis. We aimed to evaluate the risk of total and cardiovascular mortality in a large cohort of treated hypertensives, depending on the schedule of treatment administration (entirely in the morning, entirely at bedtime, or combined morning and evening) at the time ABPM was performed.

Design and method:

Vital status and death due to cardiovascular causes were obtained from death certificates in 26751 treated hypertensives (mean age 62, 60% males), enrolled in the Spanish ABPM Registry between 2004 and 2014, and having a valid 24-h ABPM at entry. Cox-models adjusted for clinical confounders and 24-hour systolic BP were used for HR calculation in groups depending on treatment administration.

Results:

Among the 26751 evaluable patients, most (76.7%) received their medication exclusively in the morning; 13% exclusively in the evening, and 10.3% in a multiple schedule both in the morning and in the evening. Mortality incidence in these 3 groups were 13.7, 17.8 and 21.8 per 1000 patients/year, respectively. Compared to patients receiving their antihypertensive medication entirely in the morning (reference group), those receiving their medication entirely in the evening did not show a significant increase in the HR for total mortality (1.06; 95%CI: 0.93–1.21) or in cardiovascular mortality (1.15; 0.93–1.41) after adjustment for clinical confounders and 24-hour systolic BP. Patients receiving their antihypertensive medication both in the morning and at bedtime had an increased risk for mortality (1.29; 1.14–1.48) and for cardiovascular mortality (1.46; 1.18–1.80). Additional analyses using double-robust propensity score yielded similar results.

Conclusions:

Morning or bedtime dosing of the antihypertensive medication has no effect on prognosis. We have found that patients receiving their medication in a multiple schedule, including morning and evening dosing have an increased risk of mortality and cardiovascular mortality, even after adjustment for confounders. However, we cannot exclude other aspects, such as a poorer treatment adherence, being the responsible of this worse prognosis.
INITIATION OF EMPAGLIFLOZIN THERAPY IS ASSOCIATED WITH A CLINICALLY RELEVANT DECREASE IN BLOOD PRESSURE IN PATIENTS WITH TYPE 2 DIABETES MELLITUS AND UNCONTROLLED HYPERTENSION
Authors: Kuzior Agnieszka , Hernandez-Lazaro Alba , De Leon-Durango Ricardo , Rios-Gomez Carlos , Arnas-Leon Claudia , Acosta-Calero Carmen , Fernandeztrujillo-Comenge Paula Maria , Santana-Suarez Ana Delia , Gonzalez-Diaz Paula , Martin Francisco Javier Martinez
Published: June 2022

Objective:

In published clinical trials, initiation of empagliflozin is associated with modest BP reductions (around 2–3 mmHg vs. placebo, with doubtful clinical relevance). However, the patients who enter andomised clinical trials are receiving standard-of-care therapy with intensive antihypertensive medication when needed, and their baseline BP values are near-normal (typically around 135/75 mmHg). On the other hand, real-life patients who start empagliflozin therapy are often living with uncontrolled hypertension. Empagliflozin has well-known natriuretic and diuretic effects which might conceivably lower BP more powerfully in those subjects with a higher baseline BP.

Design and method:

Retrospective analysis of the BP data in patients with type 2 diabetes and office BP > 140/90 mmHg. Data were obtained from the patient's clinical records, and consent for their anonymous analysis and reporting was obtained from included subjects. Patients who changed their antihypertensive medication simultaneously with empagliflozin initiation were excluded.

Results:

We obtained SBP, height and body weight data from 158 patients (59.5% female, age 64 ± 9 years) in the visit in which empagliflozin was started and the following one (3–4 months afterwards typically). Dosages were 5, 10, 12.5 and 25 mg/day in 8, 126, 10 and 14 patients, respectively. Baseline BMI was 31.5 ± 8.4 Kg/m2. Baseline SBP was 164 ± 18 mmHg, with 141–160 mmHg in 52 patients (Grade 1), 161–180 mmHg in 75 (Grade 2), and > 180 mmHg in 31 (Grade 3). The reduction in SBP was 7.1 ± 5.8 mmHg, clinically and statistically significant (p = 0.014, paired t-test). In Grade 1 patients it was 4.9 ± 3.2 mmHg; 7.5 ± 5.1 mmHg in Grade 2, and 9.7 ± 6.8 mmHg in Grade 3. SBP reduction was strongly correlated with baseline SBP (Pearson's r = 0.39, p < 0.001) and weakly with body weight loss (Pearson's r = 0.318, p = 0.032) but not with gender, age, empagliflozin dosage and baseline BMI.

Conclusions:

In patients with type 2 diabetes and uncontrolled hypertension, empagliflozin initiation is associated with a reduction in SBP pressure which is both statistically and clinically significant, nearing the effect of classic antihypertensive drugs.
CARDIOVASCULAR EVENTS ACCORDING TO FOLLOW-UP INTERVAL IN HYPERTENSIVE PATIENTS
Authors: Lee Hae-Young , Cho Myeong-Chan
Published: June 2022

Objective:

Hypertension is a chronic disease that requires long-term follow-up in many patients. Although the European hypertension guideline recommended that once the BP target is reached, a visit interval of a few months is reasonable, and there might be no difference in BP control between 3-month and 6-month intervals, there was limited evidence regarding shorter intervals of follow-up.

This study sought to evaluate the incidences of cardiovascular events and death according to the visit intervals.

Design and method:

This Korean Hypertension Cohort (KHC) enrolled 11,043 hypertensive patients and followed up for more than ten years. We evaluated the incidences of cardiovascular events and death according to the visit intervals after stabilization.

Results:

In this cohort, 28% of patients visited the clinic with intervals of 3 months, followed by visits with intervals of 4 months (23%), 4–6 months (20%), 2 months (18%), more than 6 months (9%), and less than 1 week (2%). Male, lower SBP and low risk patients had larger visit intervals than female, higher SBP, and high-risk patients. Surprisingly, shorter visit intervals of 34–66 days (about 2 months) showed a relatively larger visit-to-visit variation of 13.6 days, suggesting that shorter visit intervals do not always accompany better treatment adherence. The large visit-to-visit variation reaching 89 days of standard deviation in patients with visit interval of more than 6 months also support the decrease in treatment adherence. In the Cox proportional hazards model for cardiovascular events or death according to visit intervals, with adjustment of age, gender, and cardiovascular risk, showed that hypertensive patients with visit intervals of 3–4 months had fewer cardiovascular events than those either with more extended or shorter visit intervals.

Conclusions:

Hypertensive patients with visit intervals of 3–4 months had fewer cardiovascular events than those with longer or shorter visit intervals. Although we did not present a possible explanation for this, the increased standard deviation in the more extended interval group suggests that reduced treatment adherence may play a role.
FACTORS ASSOCIATED TO POOR ADHERENCE TO TREATMENT IN THE TUNISIAN ELDERLY
Authors: Mzoughi Khadija , Bergaoui Zeineb , Soltani Chayma , Belkahla Noufeil , Bouzidi Hela , Zairi Ihsen , Kamoun Sofien , Labbene Sonia , Mrad Imtinene Ben , Kraiem Sondos
Published: June 2022

Objective:

Management of hypertension requires a good adherence to treatment for a successful antihypertensive long-term therapy.

Purpose:

The aim of our study was to identify the factors associated with poor adherence to treatment in the elderly.

Design and method:

We conducted a descriptive study including 101 Tunisian hypertensive treated subjects, aged 65 years and over, followed on outpatient basis between November and December 2019. Adherence to treatment was evaluated using EvalOBs, a visual scale of adherence to antihypertensive treatment.

Results:

Median age was 73 and sex ratio 0.57. Our patients were completely dependent in 4% of cases and among those aged 80 and over, 68.2% were frail. Adherence to treatment was satisfactory in 75.2% of cases. Patients forgot to take their antihypertensive treatment the day of the consultation in 51% of cases and 33% had a medication breakdown since the last consultation. Seventeen per cent of the patients have been away from their treatment because of memory disorder and 7%missed their treatment because some days they feel that the treatment is doing more harm than good.

In multivariate analysis, the factors associated with poor adherence to treatment were: male (OR = 11,774; p = 0.013), patient smoker (OR = 0,167; p = 0,02), medication break-down (OR = 0253; p = 0,006) and forgetting the treatment the day of the consultation (OR = 0,159; p = 0,047).

Conclusions:

Detection of the risk of non-adherence and therapeutic education are necessary to improve the adherence to antihypertensive treatment. The education must be focused on male and smokers and a better medication supply is needed.
ACHIEVED BLOOD PRESSURE LEVELS, COMORBIDITIES AND ONE YEAR PROGNOSIS OF ANTICOAGULATED PATIENTS WITH ATRIAL FIBRILLATION
Authors: Postadzhiyan Arman , Velichkova Anna , Markova Simona , Tochev Sotir , Andreeva Lora , Raev Dimitar
Published: June 2022

Objective:

The aim of the study was to analyze clinical characteristics of the consecutive sample of patients with atrial fibrillation admitted to Saint Anna University Hospital, ESH Excellence center of hypertension.

Design and method:

Consecutive sample of 215 patients with AFib (112 M, 103 F; age 70.5) was enrolled 2017–2019. Data were collected during hospitalization and the patients were followed for one year for the occurrence of death/ischemic events and bleeding. BP was measured in a sitting position using an automatic validated device. In the present analysis we report the associations of mean achieved BP during the year (an average 6,8 BP measurements) with the key ischemic outcomes.

Results:

Mean CHADSVASC was 3,77 ± 1.8 and HASBLEED 2,91 ± 1,3 with 191 (88.8%) and 127 (59.1%) of patients having CHADSVASC= > 2 and HASBLEED= > 3. Arterial hypertension was the most frequent risk factor in 88.4% (average duration of 17.7 ± 9 years). Previous history of myocardial infarction or stroke, obesity, heart failure and chronic kidney disease were established in 27,9%, 23.3%, 52.6%, 79,5% and 55.8%. OAC therapy was changed in approximately 23% during the year. Average BP values were 136/84.7 mmHg at admission and mean achieved BP during the follow-up were 129.7/81.9 mmHg. The annual event rates for death/ischemic events were 19.1%, for cardiovascular death 7% and for all cause bleeding 20%. Factors, associated with subsequent ischemic events includes higher CHADSVASC (4.2 vs 3.6) and HASBLEED (3.6 vs 2.7), presence of CKD (eGFR Epi < 60 ml/min) and worsening of CKD during the year (-6.7 ml/min vs – 1 ml/min). On treatment SBP> 130 mmHg and < 110 mmHg was associated with death/ischemic events compared with SBP 120–130 mmHg, HR 2.42 (0.9–5.4) and 2.76 (1–7.6) respectively. Similar patterns were observed for DBP with an increased risk at < 70 mmHg HR 1,52 (0.9–2.56) and > 90 mmHg HR 2,31 (1,1–8.1). Factors associated with unfavorable outcomes at low achieved BP < 120/80 were the presence of ischemic heart disease, CKD or heart failure.

Conclusions:

The presence of comorbidities mediate the effect of blood pressure on prognosis for ischemic complications especially at low achieved levels of BP.
ATRIAL FIBRILLATION INCIDENCE IN SARS-COV-2 INFECTED PATIENTS: PREDICTORS AND RELATIONSHIP WITH IN-HOSPITAL MORTALITY
Authors: Maloberti Alessandro , Giannattasio Cristina , Rebora Paola , Occhino Giuseppe , Ughi Nicola , Rizzo Jacopo , Fabbri Saverio , Leidi Filippo , Cartella Iside , Algeri Michela , Scarpellini Sara , Rossetti Claudio , Epis Oscar , Molon Giulio , Bonfanti Paolo , Valsecchi Maria Grazia , Genovesi Simonetta
Published: June 2022

Objective:

Among the different CardioVascular (CV) manifestation of the COronaVIrus-related Disease (COVID) particular attention has been paid to arrhythmia and particularly to Atrial fibrillation (AF). The aim of our study was to assess the incidence of AF episodes in patients ospitalisat for COVID and to evaluate its predictors and its relationship with in-hospital all-cause mortality.

Design and method:

We enrolled 3435 cases of SARS-CoV2 infection admitted in four hospitals in Northern Italy. We collected data on clinical history, vital signs, Intensive Care Unit (ICU) admission, laboratory tests and pharmacological treatment. AF incident and all-cause in-hospital mortality were considered as outcomes.

Results:

145 (4.2%) patients develop AF during ospitalisation, with a median time of 3 days (IQR: 0, 11.5) from admission. Incident AF patients were older and had lower eGFR, lower platelet and lymphocytes count and higher C-Reactive Protein (CRP), were admitted more frequently to ICU and more frequently died compared to subjects that didn’t present AF. At the Cox regression model significant determinants of incident AF were older age (HR 1.070; 95% CI: 1.048, 1.092), history of AF (HR 2.800; 95% CI: 1.465, 5.351), ischemic heart disease (HR 0.324; 95% CI: 0.130, 0.811) and ICU admission (HR 8.030; 95% CI: 4.511, 14.292). Incident AF was a predictor of all-cause mortality (HR 1.679; 95% CI: 1.170, 2.410), together with age (HR 1.053; 95% CI: 1.042, 1.065), dementia (HR 1.553; 95% CI 1.151, 2.095), platelet count (HR 0.997; 95% CI: 0.996, 0.999) higher CRP (HR 1.004; 95% CI: 1.003, 1.005) and eGFR (HR: 0.991; 95% CI: 0.986, 0.996)

Conclusions:

AF present as the main arrhythmia in COVID-19 patients and its development during the ospitalisation strongly relates with in-hospital mortality.
A PROSPECTIVE STUDY ON THE ASSOCIATION BETWEEN ATRIAL FIBRILLATION AND BLOOD PRESSURE IN AN ELDERLY CHINESE POPULATION
Authors: Chen Yi , Zhang Wei , Sheng Chang-Sheng , Huang Qi-Fang , Cheng Yi-Bang , Guo Qian-Hui , Zhang Dong-Yan , Li Yan , Freedman Ben , Wang Ji-Guang
Published: June 2022

Objective:

In the present prospective study, we investigated the association between atrial fibrillation (AF) and blood pressure (BP) in an elderly Chinese population.

Design and method:

Elderly (aged 65 years and over) residents were recruited from 6 communities in Shanghai from 2006 to 2020. 9019 participants who did not have AF at baseline had at least one ECG recording during follow-up. BP status at baseline was defined according to the European hypertension guidelines as optimal, normal, or high-normal BP, and stage 1, 2 or 3 hypertension.

Results:

During a median of 3.5 years follow-up, the overall incidence rate of AF was 5.6 per 1000 person-years (n = 178, men vs. women: 7.0 vs. 4.5 per 1000 person-years, P = 0.008). The AF incidence increased with both higher systolic and diastolic BP. Statistical significance was achieved for age- and sex-adjusted hazard ratio (HR) relative to optimal BP in stage 2 or 3 systolic hypertension (1.78, 95% confidence interval [CI] 1.04–3.05, P = 0.03) and in stage 1 (1.67, 95% CI 1.01–2.77, P = 0.04) and stage 2 or 3 systolic and diastolic hypertension (1.93, 95% CI 1.11–3.33, P = 0.02) and for fully adjusted HR relative to optimal BP in stage 2 or 3 systolic and diastolic hypertension (1.76, 95% CI 1.00–3.08, P = 0.05). The association between AF incidence and BP status tended to be stronger in participants with no than those with a history of cardiovascular disease at baseline (P for interaction = 0.06). Indeed, in participants with no history of cardiovascular disease at baseline, multivariate-adjusted HRs of AF relative to their counterparts with optimal BP were statistically significant in stage 1 (1.76, 95% CI 1.00–3.11 P = 0.05) and stage 2 or 3 systolic hypertension (2.08, 95% CI 1.12–3.85, P = 0.02) and stage 1 (1.93, 95% CI 1.06–3.50, P = 0.03) and stage 2 or 3 systolic and diastolic hypertension (2.34, 95% CI 1.24–4.44, P = 0.01).

Conclusions:

In the Chinese people aged 65 years and over, AF incidence is higher with high BP, especially systolic hypertension and in the absence of cardiovascular disease.
INFLUENCE OF MEAN OFFICE BLOOD PRESSURE(BP) LEVELS ON MORTALITY IN ELDERLY PATIENTS WITH CHRONIC HEART FAILURE WITH PRESERVED EJECTION FRACTION (HFPEF)
Authors: Chen Jiwei , Sánchez Marcos , Viñas Esther , Costafreda Miriam , Torres Manuel , Martínez Rosa , Benítez Cristina , Sierra Cristina , Coca Antonio , Camafort Miguel
Published: June 2022

Objective:

Heart failure (HF) is a major public health problem and one of the leading causes of ospitalisations and death. HFpEF is related to hypertension (HT) either in the pathogenesis and outcome, particularly in the elderly, and is becoming an increasingly worrisome health issue due to higher life expectancies in Western Countries. This study aimed to evaluate the influence of BP and its control in elderly patients with HFpEF.

Design and method:

Retrospective study in outpatients older than 80 years with stable HFpEF, seen in a University Hospital. Data were obtained from electronic medical records with prior authorization from the Ethics Committee. For the analysis, the first measured Office BP levels were used.

Results:

106 patients were included. For Systolic BP (SBP) analysis, we use three cut-off points of SBP (measured in the office at the first visit): <░90░mmHg, between 90–139░mmHg and >░140░mm Hg. For Diastolic BP (DBP) we used two cut-off points: <░70 and >░70░mm Hg. As for the characteristics, the only differences were that those with Low SBP had significantly lowered LVEF compared to those with normal or high SBP (54% vs 59 p 0.035). As for DBP, those with low DBP had significantly lowered heart rate than those with high DBP (72░bpm vs 79░bpm, p 0.039). There were no mortality differences between those with low SBP, normal SBP and high SBP fx8, neither among patients with low DBP nor normal/high DBP. Kaplan Meier curve showed a non-significant trend to higher mortality on those with lower values of BP

Conclusions:

In our study, we did not observe differences in mortality between patients with low normal or high SBP, neither on those with high, normal nor low DBP. Although there may be a selection bias and this is a retrospective study, more studies are needed to assess the influence of BP control on the evolution of HFpEF in octogenarian patients with stable disease.
COMPARATIVE EFFICACY OF ANTIARRHYTHMIC MEDICATIONS FOR SINUS RHYTHM MAINTENANCE AFTER ELECTRICAL CARDIOVERSION FOR ATRIAL FIBRILLATION
Authors: Sokolova Emma , Rudzitis Ainars , Kalejs Oskars
Published: June 2022

Objective:

Sinusa rhythm maintenance while using IC class medications is not practically studied. IC class medications aethacizinum is widely used, but has no large studies proving safety and efficacy.

The aim of this study was to compare the efficacy of class IC antiarrhythmic medications, for sinus rhythm maintenance, after ECV (electrical cardioversion), in patients with atrial fibrillation (AF).

Design and method:

It is an open-label, one-center prospective study that held in the Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital from September 2019 to June 2020. Before hospitalisation patients have not received any antiarrhythmic drugs except of amiodarone and beta blockers. Patients with persistent form of AF received beta blockers (bisoprolol 5 mg daily), amiodarone (200 mg daily), propaphenone (300 mg daily) or aethacizinum (100 mg daily) for 6 months after conversion to sinus rhytm by ECV. Rest ECG, Holter monitoring, echocardiography, ergometer stress test, blood tests were performed.

Results:

The total number of patients finished study per protocol – n = 52. On echocardiographical study no significant changes in AFR (AF paroxysm group) and MSR (maintained sinus rhythm) groups were found. No safety parameters were significantly changed in this group. All patients were followed up for 6-month period. Reccurance rate of AF in aethacizinum group showed a statistically significant superiority compared to propafenone (55,6% vs 72,5%) (p = 0,05). Patients with higher atrial strain and strain rate appear to have a greater likelihood of staying in sinus rhythm. In our research, duration of AF was not predictive value of maintenance of SR at follow-up after 6 months from ECV.

Conclusions:

Antiarrhythmic medications of Ic class may be safe in patients with persistent form of atrial fibrillation and have no negative impact on inotropic function of myocardium. The most commonly used drug from Ic class ir etacizin. The observed efficacy provides the rationale for a larger, double-blind controlled study with different antiarrhythmic medications in different daily dosage.