bluuebunny/crossref_metadata_2025 huggingface dataset:
HYPERTENSIVE HEART DISEASE, WHAT ARE THE FACTORS PRECIPITATING ITS EARLY ONSET?
Authors: Bendiab Nabila Taleb , Henaoui Latifa , Benkhedda Salim
Published: June 2022

Objective:

Hypertension is a well-established risk factor for cardiovascular disease. It causes left ventricular pressure overload, and changes in cardiac geometry and LV hypertrophy.

This study is intended to assess the clinical and echocardiographic factors associated with and predictive for early impairment of left ventricular function as assessed using global longitudinal strain evaluation in hypertensive patients.

Design and method:

Cross-sectional descriptive study, with a total number of 130 hypertensive and with the objective of evaluating the study of longitudinal function by 2D strain in patients with systemic hypertension with preserved LVEF and the determination of predictors the decrease GLS in this population. This work is to make a complete study echo cardiographic, including LVEF biplane Simpson method, calculation of left ventricular mass indexed and relative parietal thickness, analysis diastolic function and the study of longitudinal strain of the LV by the speckle tracking technique (calculation of GLS)

Results:

The prevalence of left ventricular hypertrophy (LVH) was found in (66%). half of the patients (49%) presented a concentric hypertrophy, It was clearly noted that 73%of the patients had a relative wall thickness (RWT)> 0.42. Alterations in diastolic function were detected in 89% of the group, 18% had severe diastolic dysfunction with elevation in filling pressure. Analysis of the longitudinal systolic function of the left ventricle took the average GLS as a reference value. The mean GLS was found to be -16.9 ± 3.2%, within a range between -25% and-11.6%.

Low GLS values (>-17%) were found in 45.5%. In particular, 34.4% of the patients had no left ventricular hypertrophy (LVH) and 50.7% of them presented LVH.

The average systolic and diastolic blood pressures, taken at the time of echocardiographic analysis, were found higher in the subgroup of hypertensive patients with low GLS.

Statistical analysis revealed significant correlation between the decrease in GLS and diabetes the values of blood pressure and elevated filling pressures.

Conclusions:

The evaluation of longitudinal systolic function by 2D strain provides new insight of myocardial function in hypertension that could improve the pathophysiological understanding and identify high-risk heart failure patients eligible for preventive strategies.
SEMI-AUTOMATIC MEASUREMENT OF INTIMA-MEDIA THICKNESS OF BRACHIAL ARTERY IN PATIENTS WITH CONGESTIVE HEART FAILURE
Authors: Kannenkeril Dennis , Kolwelter Julie , Pietschner Robert , Striepe Kristina , Bosch Agnes , Achenbach Stephan , Schmieder Roland E.
Published: June 2022

Objective:

Cardiovascular diseases are associated with an increase in intima-media thickness (IMT). However, the techniques used to measure IMT have limitations. A semi-automatic device called UNEX has been developed, which overcomes the limitation of classic systems (in particular the investigator-dependency of conventional, “hand-held’’ measurements). The purpose of this study was to measure the intima-media thickness of the brachial artery (bIMT) with the UNEX device in patients with and without congestive heart failure.

Design and method:

The UNEX device is comprised of a 7.5-MHz, H-shaped linear array transducer and a novel stereotactic probe-holding device (UNEX EF 18G; UNEX Co., Nagoya, Japan). Another advantage of this device is the continuous recording of B-mode images and A-mode waves of the brachial artery. Measurement of bIMT was automatically performed on A-mode images of the far wall of the brachial artery. The analysis system automatically detects the measurement point where an image was clearly obtained. The average of mean measurement values obtained from 10 cardiac cycles was defined as bIMT. In a first set of clinical studies, we measured bIMT in patients with reduced left ventricular ejection fraction (HFrEF) and in patients without heart failure.

Results:

Patients with HFrEF (n = 85, ejection fraction: 38.3 ± 8.4 %, NT-pro-BNP: 713 ± 714.7 pg/ml) compared to patients without heart failure (n = 63) were older (66.4 ± 9.2 vs. 53.8 ± 12.6 years, p < 0.001), with more male subjects (67 vs. 40, p = 0.039). bIMT was higher in patients with HFrEF compared to the other group (0.295 ± 0.083 vs. 0.249 ± 0.083 mm, p < 0.001). After adjustment for age, gender and other cardiovascular risk factors, the result remained significant (p = 0.032).

Conclusions:

Our study demonstrate that IMT of large muscular arteries can be automatically (investigator independently) measured. Our data indicate an increased vascular remodeling in patients with HFrEF independent of other confounders.
INFLAMMATORY MARKERS AND HYPERTENSION-MEDIATED ORGAN DAMAGE IN COMMUNITY-DWELLING ELDERLY INDIVIDUALS: THE NORTHERN SHANGHAI STUDY
Authors: Zhao Song , Yu Shikai , Tang Jiamin , Maimaitiaili Rusitanmujiang , Teliewubai Jiadela , Li Jiaxin , Chi Chen , Xu Yawei , Zhang Yi
Published: June 2022

Objective:

Inflammation plays a role in pathogenesis of atherosclerosis. Many inflammatory makers have proven to can predict cardiovascular events. This study is investigating the association between inflammatory makers and hypertension-mediated organ damage.

Design and method:

2451 participants who had available blood routine examination from the Northern Shanghai Study were included in this analysis. Inflammatory makers include white blood cell (WBC), neutrophile, monocyte and monocyte to high-density lipoprotein cholesterol ratio (MHR). Hypertension-mediated organ damage (HMOD), including left ventricular hypertrophy (LVH), arterial stiffness (AS), lower extremity atherosclerotic (LEA), carotid hypertrophy (CH), micro-albuminuria (MAU) and chronic kidney disease (CKD), were measured by standard methods. Logistic regression model was used to explore the relationship between the quartiles of inflammatory makers and HOMD.

Results:

In multivariable logistic regression analysis, set quartile 1 (Q1) as reference, quartile 4 (Q4) of WBC (odds ratio (OR) = 1.72, 95% confidence interval (CI): 1.31–2.24, Pfor trend < 0.001), neutrophile (OR = 1.48, 95%CI:1.14–1.94, Pfor trend = 0.005), monocyte (OR = 1.37, 95%CI:1.05–1.77, Pfor trend = 0.026) and MHR (OR = 1.41, 95%CI:1.05–1.88, Pfor trend = 0.036) were associated with AS; Q4 of WBC (OR = 1.78, 95%CI:1.24–2.58, Pfor trend = 0.001), neutrophile (OR = 2.06, 95%CI:1.40–3.02, Pfor trend < 0.001), monocyte (OR = 1.64, 95%CI:1.11–2.38, Pfor trend = 0.013) and MHR (OR = 2.23, 95%CI:1.49–3.35, Pfor trend < 0.001) were associated with LEA; Q4 of WBC (OR = 1.60, 95%CI:1.13–2.27, Pfor trend = 0.012), neutrophile (OR = 1.74, 95%CI:1.21–2.51, Pfor trend = 0.002), monocyte (OR = 1.71, 95%CI:1.18–2.46, Pfor trend = 0.013) and MHR (OR = 2.46, 95%CI:1.60–3.77, Pfor trend < 0.001) were associated with CKD; Q4 of monocyte (OR = 0.69, 95%CI:0.54–0.87, Pfor trend < 0.001) and MHR (OR = 0.61, 95%CI:0.47–0.79, Pfor trend < 0.001) were inversely associated with MAU; but no inflammatory markers associated with LVH or CH.

Conclusions:

In Chinese community-dwelling elderly individuals, WBC, neutrophile, monocyte and MHR are significantly and independently associated with an increased risk of AS, LEA and CKD; monocyte and MHR inversely associated an increased risk of MAU.
7-DAYS HIGH SALT DIET AFFECTS THE PRODUCTION OF PRO- AND ANTI-INFLAMMATORY CYTOKINES IN YOUNG HEALTHY INDIVIDUALS
Authors: Knezovic Ana , Kolobaric Nikolina , Drenjancevic Ines , Mihaljevic Zrinka , Susnjara Petar , Jukic Ivana , Mihalj Martina , Stupin Ana
Published: June 2022

Objective:

This study aimed to investigate the earliest immunomodulatory effects of NaCl during pre-hypertensive phase of acute salt loading in humans. Thus we have investigated serum levels of systemic pro- and anti-inflammatory cytokines in relation to peripheral Th17 and regulatory T cell abundance following 7-day high-salt (HS) loading in young salt-resistant healthy individuals.

Design and method:

30 young healthy individuals adhered to a 7-day low-salt (LS) diet (3.5 g salt/day) followed by a 7-day high-salt (HS) diet (~14.7 g salt/day) protocol. Serum pro- and anti-inflammatory cytokines (INF-gamma, TNF-alpha, IL-6, IL-9, IL-17A, IL-23, IL-10, IL-21, IL-22, TGF-beta1), complement component C3a, as well as frequencies of peripheral blood Th17 and regulatory T cells (Treg), Th17/Treg ratio and the level of enzymes involved in their activation and differentiation (SGK1 and p38/MAP kinase) were measured before and after 7-day HS diet protocol.

Results:

Short-term HS diet significantly increased serum level of pro-inflammatory cytokines INF-gamma, TNF-alpha, IL-9 and IL-17A level, but also serum concentration of anti-inflammatory cytokines IL-10 and TGF-beta1. In addition, serum INF-gamma and IL-9 levels positively correlated to 24-h urine natriuresis. Relative amount of total and phosphorylated p38/MA kinase remained unchanged, while relative amount of total SGK1 significantly increased following 7-day HS diet compared to LS values.

Conclusions:

Result of the present study provided evidence of acute salt-loading induced changes in the immune status of young healthy individuals. The increase in relative amount of total SGK1 in peripheral mononuclear cells suggests lymphocyte (re)activation in response to hyperosmotic stress resulting in enhanced production of proinflammatory (IL-17, INF-gamma), but also anti-inflammatory cytokines (IL-10 and TGF-beta1). Still, which effect is prevailing remains elusive and warrants further studies.
INFLAMMATION MARKERS IN SUBJECTS WITH DIPPER AND NON-DIPPER BLOOD PRESSURE PATTERNS
Authors: Isayeva Anna , Matiashova Lolita
Published: June 2022

Objective:

Elevated inflammation markers play important role in vessels damage and remodeling in patients with hypertension. However, the data are limited concerning the association between blood pressure circadian rhythm and inflammation status, especially in early changes of a pattern of blood pressure circadian rhythm in normotensive subjects.

The aim of the work was to study the connection between dipper and non-dipper patterns of blood pressure circadian variation and inflammatory markers in normotensive and hypertensive subjects.

Design and method:

The cross-sectional study included 125 hypertensive patients (54 men) with an age median of 56,5 [45.0 ÷ 63.7] years old and 41 normotensive subjects 52,1 [41.5 ÷ 61.2] years old. All hypertensive patients had been on stable antihypertensive therapy during the last three months and had target blood pressure at the moment of inclusion to the study. Ambulatory blood pressure monitoring was done to all patients with Heaco ABPM50 monitoring. Fasting glucose, blood lipids, creatinine, uric acid, high sensitive C-reactive protein (hCRP), and interleukin 1 beta (IL-1B) were measured. Physical activity was assessed using the International Physical Activity Questionnaire. Data were analyzed with SPSS IBM 19.0.

Results:

Parameters of ambulatory blood pressure monitoring are presented in the table1 1. Normotensive subjects had lower BMI than hypertensive patients (26,1 [23,5–28,4] vs 35,3 [31,0–37,9]), p = 0.03, Mann-Whitney). It was found out that hCRP was significantly higher in a non-dipper subgroup of hypertensive patients (7.43[3.26–11.45] vs 9.50[7.70–15.87], p = 0.01, Mann-Whitney) as well as in the non-dipper subgroup of normotensive patients (2.37[0.97–4.75] vs 2.87[1.84–523], p = 0,03, Mann-Whitney). There was no significant difference in interleukin-1b level in dipper and non-dipper normotensive patients (2.10 [1.63–2.65] vs 1.8 [1.55–2.10], p = 4.13, Mann-Whitney). However, in hypertensive patients with non-dipper patterns, interleukin-1b was significantly higher, than in dipper patients (2.21 [1.62–2.77] vs 2.26 [2.0–3.11], p = 0.03, Mann-Whitney).

Conclusions:

Non-dipper pattern of blood pressure circadian rhythm is associated with increased inflammatory markers in hypertensive patients as well as in normotensive subjects.
CORRELATION BETWEEN VASCULAR INFLAMMATION MARKERS, DIASTOLIC DYSFUNCTION AND CARDIOVASCULAR RISK IN PATIENTS WITH TAKAYASU ARTERITIS
Authors: Cicco Sebastiano , Desantis Vanessa , Vacca Antonio , Cazzato Gerardo , Solimando Antonio G. , Susca Cecilia , Brosolo Gabriele , Caterna Cristiana , Lamanuzzi Aurelia , Saltarella Ilaria , Frassanito Maria Antonia , Ingravallo Giuseppe , Resta Leonardo , Ranieri Giuseppe , Montagnani Monica , Ria Roberto
Published: June 2022

Objective:

Takayasu arteritis (TAK) increases vascular stiffness and arterial resistance. Abnormal immune response is a crucial factor in the pathogenesis of TAK. Here, we investigated I) vascular and cardiac ultrasonography parameters as increased cardiovascular risk in TAK patients, compared to atherosclerotic patients; ii) Treg and Th17 cells frequencyin TAK-refractory patients treated with infliximab

Design and method:

Clinical, instrumental and biochemical data in patients with active TAK were compared in a case control study were compared to age- and sex-matched atherosclerotic patients. In a subpopulation of TAK patients, Treg/Th17 cells percentage was measured before (T0) and after 18 months (T18) of infliximab treatment. Echocardiogram, supraaortic Doppler ultrasound, and lymphocytogram were carried out in all patients. Histological and immunohistochemical analysis were performed to correlate vessel wall patho-morphology and clinical/laboratory results

Results:

TAK patients displayed increased aortic valve dysfunction and diastolic dysfunction compared to atherosclerosis. Moderate-to-severe aortic regurgitation correlates with the highest serum levels of uric acid in TAK patients. A significant increase in aortic stiffness was associated with peripheral T lymphocyte levels. Increase in CD3+CD4+ and CD8+ infiltration and High-mobility group box 1 (HMGB1) was significantly higher in TAK group. CD15+ neutrophils were significantly higher in TAK, suggesting an association with inflammation-related vascular damage. Flow cytometric Tregs percentage was significantly reduced in TAK patients. Interestingly, in patients treated with infliximab, this value significantly increased at T18 compared to T0. Concomitantly, the frequency of CD3+CD4+IL-17+ cells behaved in the opposite way: the higher number of Th17 cells observed in TAK patients at T0 compared to controls significantly decreased at T18 compared to T0.

Supporting the specific pathogenetic mechanisms of vessel damage in TAK, we found an increased risk of cardiovascular disease that correlates directly with the degree of inflammatory cell infiltration in the vessel wall.

Conclusions:

These observations strengthen the clinical efficacy of infliximab in TAK patients, supporting the idea that biologic therapy may achieve a better control of TAK progression and help to stabilize the Treg/Th17 score toward values similar to those found in atherosclerotic patients
ANTIPLATELET AND ANTICOAGULANT THERAPY DURING ANGIOPLASTY PROCEDURES FOR ATHEROMATOUS OR FIBROMUSCULAR DYSPLASIA RENAL ARTERY STENOSIS: A SURVEY OF PRACTICES IN EUROPEAN SOCIETY OF HYPERTENSION EXCELLENCE CENTRES (ESH-EC) IN FRANCE
Authors: Bouhanick Beatrice , Amar Jacques , Amar Laurence , Courand Pierre Yves , Delsart Pascal , Denolle Thierry , Doublet Julien , Fauvel Jean Pierre , Fesler Pierre , Girerd Xavier , Jeune Sylvain Le , Pelletier Caroline , Rossignol Patrick , Rodière Mathieu , Silhol François , Lopez-Sublet Marilucy
Published: June 2022

Objective:

Recommendations framing antiplatelet therapy (APT) and/or anticoagulation (AC) therapy during renal artery angioplasty procedures remain succinct or absent¹.

The aim was to describe the practice of using APT and AC in the 17 French ESH-EC during renal artery angioplasties for atheromatous stenoses (AS) or fibromuscular dysplasia stenoses (FMD).

Design and method:

Sending of a questionnaire via the French Society of Hypertension mailing to collect data with a reminder 1 month later.

Results:

Are summarized in the table. 12 centres responded partially or completely for AS and 10 for FMD. 2 centres considered that they did not recruit enough; 3 did not respond.

Conclusions:

In AS, single APT before angioplasty is the rule, while double APT is routine after angioplasty for 1 month, followed by single APT over the long term. In FMD, in most cases (90% of cases) there is no double APT before or after angioplasty (except in the case of dissection), while a single APT is continued in 60% of cases over the long term. Anticoagulants are reserved for bolus injection in operating room (with some exceptions) for both AS and FMD.

For AS, the handling of APT (duration, dose) differs, due to the lack of recommendations. In contrast, the use of AC/APT seems to be homogeneous in FMD before and during angioplasty, in accordance with the recommendations ¹.

¹Gornik HL et al. J Hypertens. 2019 Feb;37(2):229-252
URINARY ALBUMIN EXCRETION CHANGES AFTER ADRENALECTOMY IN PATIENTS WITH PRIMARY ALDOSTERONISM
Authors: Herrera Isabel Galceran , Closa Andres Ribas , González Susana Vázquez , Barrio Marta Crespo , Serrano Anna Oliveras
Published: June 2022

Objective:

We aimed to evaluate changes in urinary albumin excretion (UAE) in patients with primary aldosteronism (PA) after adrenalectomy compared with those who remained with non-surgical treatment.

Design and method:

We evaluated 28 patients with PA diagnosed by adrenal venous sampling (AVS), attended by hypertension specialists or endocrinologists in Hospital del Mar, Barcelona. Office blood pressure (BP), body weight and laboratory parameters (estimated glomerular filtration rate by CKD-EPI equation (eGFR), plasma potassium (K) and UAE) were analyzed before and at 6 months after adrenalectomy (Adx group) or before and 6 months after AVS (non-Adx group).

Results:

Most patients (66.7%) were male and the mean age was 55.8 ± 9.6 years. Twelve patients (42.8%) underwent adrenalectomy and 16 (57.1%) remained on pharmacological treatment alone. Spironolactone was the principal antihypertensive treatment in the non-Adx group (84.6% of patients). The proportion of diabetes mellitus was similar in both groups (12.5% in Adx group vs 16.2% in non-Adx group, p = 0.6).

The decrease in BP was statistically significant in both groups (table 1). Adx group patients showed a statistically significant reduction in the UAE (-7.7 [-33.2 to -4.0] mg/g, p = 0.002) compared to patients in non-Adx group (+0.1 [-6.5 to + 24.9], p = 0.8).

After six months, the mean reduction in UAE (log-transformed) was significantly superior in the Adx group than in the non-Adx group. After adjusting by variation of systolic-BP and variation of body weight, a mean difference between the two groups of -0.966 mmHg (95% CI -1.746 to -1.182); p = 0.018 was observed.

Conclusions:

Patients with PA who underwent adrenalectomy presented a higher reduction in UAE than patients who remained on pharmacological treatment alone.
THE EFFECT OF RENAL DENERVATION ON THE CIRCADIAN BLOOD PRESSURE PATTERN IN PATIENTS WITH RESISTANT HYPERTENSION
Authors: Anna Moiseeva , Alexandru Caraus , Marcel Abras , Nicolae Ciobanu , Vitalie Moscalu , Artiom Surev , Maria Cociu , Mihaela Caraus , Alla Falkovskaya
Published: June 2022

Objective:

Loss of the normal circadian rhythm of blood pressure is associated with adverse cardiovascular outcomes, the activity of the sympathetic nervous system in this context having an important pathophysiological mechanism. So, the objective of the study was to evaluate the impact of sympathetic renal denervation on circadian blood pressure pattern in patients with resistant hypertension.

Design and method:

The study included 75 patients with resistant hypertension, without comorbidities and mean age of 49.59 ± 0.52 years. After a 3 week standardized treatment with Losartan, Amlodipine and Indapamide patients were randomly assigned into three equal groups, depending on medication supplemented to the previously administered: I M group (n = 25) – Moxonidine, II B group (n = 25) - Bisoprolol and III D group (n = 25) – renal artery denervation. AMBP was done at baseline and 6 months follow-up. Renal denervation was performed using Medtronic Spyral catheters.

Results:

At baseline, most patients presented a non-dipper pathological profile for both systolic and diastolic blood pressure (Table 1).

At 6 months of evaluation, the improvement of the diurnal profile was recorded in all three observational groups, renal denervation demonstrating a net superior effect compared to the SNS-blockers. In this way, towards the end of the study the dipper profile for SBP was recorded in 5 (20%), 4 (16%) and 10 (40%) patients, non-dipper – in 19 (76%), 21 (84%) and 15 (60%) patients from I M, II B and III D groups, respectively; night-picker pattern was noted in 1 (4%) patient from I M group, over-dipper profile not being registered (p > 0.05, x2 = 6.28). Circadian DBP pattern noted the disappearance of pathological profiles night-picker and over-dipper, non-dipper being registered in 19 (76%), 18 (72%) and 16 (64%) patients, the physiological dipper profile was recovered by 6 (24%), 7 (28%) and 9 (36%) patients from I M, II B and III D groups, respectively (p > 0.05, x2 = 0.90).

Conclusions:

Renal denervation has shown efficacy in improving the circadian diurnal profile, thus reducing the risk of cardiovascular events in patients with resistant hypertension.
CENTRAL AND BRACHIAL PULSE PRESSURE PREDICTS CARDIOVASCULAR AND RENAL EVENTS IN TREATED HYPERTENSIVE PATIENTS
Authors: Takenaka Tsuneo
Published: June 2022

Objective:

Central blood pressure is a stronger predictor of cardiovascular prognosis rather than brachial blood pressure. Reflection wave reaches abdominal aorta sooner than ascending aorta. Thus, the contribution of central pulse pressure (cPP) to renal events may differ from that to cardiovascular events.

Design and method:

The subanalysis of ABC-J II study (Hypertens Res. 2018;41:947–956) was performed. Subjects were 3434 treatedhypertensive patients with mean follow-up of 4.7 years. The contribution of brachial pulse pressure (bPP) and cPP to cardiovascular and renal events were analyzed.

Results:

Cox proportional-hazard analysis revealed that sex (p < 0.001), height (p < 0.05), history of cardiovascular diseases (p < 0.001), numbers of antihypertensive drugs (p < 0.05) and cPP (p < 0.05) contributed to cardiovascular events. However, baseline serum creatinine (p < 0.001) and bPP (p < 0.05) were selected as significant predictors of renal events.

Conclusions:

The present findings indicate that cPP and bPP independently contribute to cardiovascular and renal events, and suggest that the diverse results may be attributable to the anatomy that abdominal aorta feeds renal arteries, but thoracic aorta does cerebral and coronary arteries.
ALDOSTERONE SYNTHASE CYP11B2 (-344C/T) GENE POLYMORPHISM INFLUENCES RISK OF CHRONIC KIDNEY DISEASE IN PATIENTS WITH ARTERIAL HYPERTENSION
Authors: Dzhuryak Valentyna , Sydorchuk Andrii , Voroniuk Ksenia , Sydorchuk Larysa , Repchuk Yulia , Semianiv Marianna , Sydorchuk Ruslan , Sydorchuk Iryna , Iftoda Oksana
Published: June 2022

Objective:

Renin-angiotensin aldosterone system plays a major role in blood pressure regulation. Aldosterone, synthesized in the adrenal cortex by aldosterone synthase is encoded by the cytochrome 11B2 aldosterone synthase gene (CYP11B2). The aim of the study was to analyze the association of aldosterone synthase gene (CYP11B2) biallelic polymorphism (-344C/T) with Chronic Kidney Disease (CKD) in patients with essential arterial hypertension (EAH) in West-Ukrainian population.

Design and method:

One-hundred subjects with EAH and target-organ damaging (2nd stage), moderate, high or very high cardiovascular risk were involved in the case-control study. Among them 79.0% (79) females and 21.0% (21) males, mean age 59.87 ± 8.02 yo; disease duration from 6 to 25 years. CKD was determined by the National Kidney Foundation recommendations (Kidney Disease: Improving Global Outcomes (KDIGO), 2012) after glomerular filtration rate (GFR) decline < 60 ml/min/1.73sq.m for over 3 months (by Cockroft-Gault formula and CKD-EPI for Cystatin-C and Creatinine serum levels depending on gender). CKD was diagnosed in 29 persons. All enrolled / screened patients signed the Informed Consent to participate in the research. Control group included 48 practically healthy persons of relevant age. Gene polymorphism of aldosterone synthase gene CYP11B2 (-344C/T) was examined by polymerase chain reaction (PCR).

Results:

The probability of EAH in observed population increased 1.49 times in T-allele carriers of CYP11B2 gene, but only in females [OR = 1.90; 95%CI:1.02–3.54; p = 0.029], with contrary decreasing in C-allele women (p = 0.041). No relevant dependences were observed in hypertensive males. Also T-allele increased probability of CKD (GFR< 60 ml/min/1,73m2) in hypertensive population 1.48 times [OR = 1.86; 95%CI:1.01–3.58; p = 0.049], especially in T-allele females 1.53 times [OR = 6.51; 95%CI:1.39–30.60; p = 0.007] with low CKD risk in T-allele males [OR = 0.15; 95%CI:0.03–0.72; p = 0.009], respectively. Some predictors like DM2, the 2nd and 3rd grades of Obesity, and the 3rd grade level of Blood Pressure elevation escalated the risk of CKD 2.4, 2.08–2.32 and 2.91 times, accordingly (p< 0.05).

Conclusions:

Aldosterone synthase gene CYP11B2 (-344C/T) is associated with EAH. T-allele increased risk of CKD in hypertensive population, especially in females.
HIGH INCIDENCE OF CHRONIC KIDNEY DISEASE IN THE BELARUSIAN POPULATION PARTICULARLY IN PATIENTS WITH ARTERIAL HYPERTENSION
Authors: Schastlivenko Andrei , Vykhrystenka Ludmila
Published: June 2022

Objective:

To study the true incidence of chronic kidney disease in Vitebsk urban unorganized population (Belarus).

Design and method:

During research the representative group consisting of 315 persons from Vitebsk urban unorganized population was formed. The survey included standard questionnaires (WHO) for detection of cardiovascular risk factors, measurements of blood pressure, electrocardiography, kidney ultrasound and serum creatinine values. Chronic kidney disease is defined as abnormalities of kidney structure or function, present for 3 months, with implications for health (KDIGO, 2012).

For diagnosis of arterial hypertension have been used according to guidelines on blood pressure management in chronic kidney disease (2021).

Results:

The average age of the population in the representative sample was 47.3 + -0.7 years. The prevalence of chronic kidney disease in the representative sample was 22.9%. The frequency of incidence of arterial hypertension in the representative sample was 33.3%. The prevalence of chronic kidney disease among patients with arterial hypertension was 42.9%. Thus, a higher incidence of chronic kidney disease was found in patients with arterial hypertension (42.9%) compared to the unorganized population (22.9%) (df = 1; x2 = 6.4; p < 0.01).

Conclusions:

High prevalence of chronic kidney disease is becoming a health problem in people of Belarus particularly in patients with arterial hypertension.
EFFECT OF CHRONIC KIDNEY DISEASE ON PROGNOSIS OF PATIENTS WITH ACUTE CORONARY SYNDROME
Authors: Gkini Konstantia-Paras , Terentes-Printzios Dimitrios , Aznaouridis Konstantinos , Georgakopoulos Christos , Gardikioti Vasiliki , Kallikazaros Ioannis , Tsioufis Konstantinos , Vlachopoulos Charalambos
Published: June 2022

Objective:

Chronic kidney disease (CKD) is associated with worse prognosis in acute coronary syndromes (ACS).

We sought to investigate the prognostic effect of conservative management of ACS in CKD patients in a tertiary University Hospital.

Design and method:

Two hundred and one patients (mean age 66.5 ± 13.6 years, 150 males) admitted to our Hospital with ACS from 2016–2017 were included in the study. CKD was defined by an estimated glomerular filtration rate (eGFR) < 60 ml/min/m2, as assessed by the Modification of Diet in Renal Disease (MDRD) equation. We grouped patients into four groups according to their CKD status and whether they underwent coronary angiography or not. Patients were followed for a median of 2 years post the index event. The primary outcome was all-cause death and secondary outcomes were cardiovascular and non-cardiovascular death.

Results:

The majority of patients (n = 120, 60%) presented with non-ST elevation ACS (NSTE-ACS), whereas 81 patients as ST-elevation myocardial infarction (STEMI) (40%). 135 patients (68%) had history of hypertension. Fifty-four patients (27%) were identified as CKD patients. Overall, 29 patients (14.4%) did not undergo coronary angiography. Patients at a higher age and with CKD were more likely to not undergo angiography. Thirty-seven (18.4%) died during follow-up (25 non-cardiovascular deaths and 12 cardiovascular deaths). Patients with conservative treatment and CKD had the worse prognosis (Hazard ratio [HR] = 11.00, 95% Confidence intervals [CI] 4.00 to 30.24, p < 0.001) followed by non-CKD patients with conservative treatment (HR = 4.37, 95% CI 1.20 to 15.90, p = 0.025) compared to non-CKD patients treated invasively (reference group) after adjusting for age, gender, STEMI/NSTE-ACS diagnosis. Results were similar for non-cardiovascular death, whereas regarding cardiovascular death only the group with CKD and conservative treatment had a lower survival compared to the reference group (HR = 26.5, 95% CI 2.9 to 241.7, p = 0.004)

Conclusions:

Patients with ACS and CKD have higher mortality from both cardiovascular and non-cardiovascular causes than patients without CKD. Regardless of CKD status, conservative management of ACS was associated with higher long-term mortality versus invasive management in all patients.
IMPACT OF THE CARDIOVASCULAR POLYPILL (TRINOMIA) ON CHRONIC KIDNEY DISEASE. PROSPECTIVE REAL-LIFE DATA
Authors: Cuadrado-Payán Elena , Rodríguez-Espinosa Diana , Casals-Urquiza Joaquim , Risco-Zevallos Jimena Del , Hermida Evelyn , López-Romero Luis Carlos , Rodas Lida , Broseta Jose Jesús
Published: June 2022

Objective:

Cardiovascular diseases are the leading cause of mortality and morbidity worldwide. Moreover, chronic kidney disease (CKD) patients exhibit significantly higher incidence and prevalence of cardiovascular events. In this population, used to a high burden of pills, the importance of a polypill-based treatment strategy increases to simplify treatment and ensure adherence.

The cardiovascular polypill composition includes a lipid-lowering drug, antihypertensive agent, and antiplatelet therapy and is marketed in Spain since 2015 with the name of Trinomia.

This report aims to obtain real-life data to evaluate ifTrinomia improves the standard of care.

Design and method:

Prospective, single-center, observational study of a cohort of CKD patients under the standard of care starting any combination of Trinomia in secondary prevention. Patient demographics, clinical history, blood pressure, and analysis of blood lipids, albumin-to-creatinineratio, and estimated glomerular filtration rate were measured at baseline and 6 and 12 months after starting treatment

Results:

A total of 49 patients (35 males) were included, with a mean age of 78,83 years (range 51–95). 91,83% had hypertension, 63,26% with type 2 diabetes and 2,04% with type 1 diabetes. Regarding the cause of secondary prevention, 75,4% had cardiovascular disease, 16,4% had a stroke, and 8.16% had both. All laboratory results are displayed in table 1.

Conclusions:

Although most of the variables studied, probably because it was a small group of patients with adequate baseline control, did not reach statistical significance, some results are worth noting. eGFR is 3 points higher at one year, with a reduction in UACR, which does not reach statistical significance but translates into a lower hyperfiltration without worsening renal function or an increase in serum potassium. In addition, there was a 5-point decrease in systolic blood pressure and a 3-point in diastolic (n.s.), and a better lipid profile is achieved, with a 10-point reduction in LDL and a 24-point reduction in triglycerides.
COMPARISON OF AMBULATORY CENTRAL HEMODYNAMICS AND ARTERIAL STIFFNESS IN HEMODIALYSIS PATIENTS WITH AND WITHOUT INTRADIALYTIC HYPERTENSION
Authors: Theodorakopoulou Marieta , Alexandrou Maria-Eleni , Iatridi Fotini , Faitatzidou Danai , Karpetas Antonios , Bikos Athanasios , Papagianni Aikaterini , Sarafidis Pantelis
Published: June 2022

Objective:

Increased arterial stiffness is suggested to be involved in the pathogenesis of intradialytic hypertension (IDH). Ambulatory pulse wave velocity (PWV) is an independent predictor for all-cause-mortality in hemodialysis patients and its prognostic power is better than office PWV. This is the first study comparing ambulatory central blood pressure (BP) and arterial stiffness parameters between patients with and without IDH.

Design and method:

This study examined 45 patients with IDH (defined as: SBP rise greater than or equal to 10 mmHg from pre- to post-dialysis and post-dialysis SBP greater than or equal to 150 mmHg) in comparison 197 without IDH. All participants underwent 48-h ABPM with the Mobil-O-Graph-NG device; parameters of central hemodynamics [central systolic (cSBP) and diastolic BP (cDBP), pulse pressure (PP)], wave reflection [augmentation index (AIx), and pressure (AP)] and PWV were estimated.

Results:

Age, dialysis vintage, interdialytic weight gain and prevalence of major comorbidities did not differ between the two study groups. Patients with IDH had higher 44-h cSBP (131.6 ± 16.7 vs. 119.3 ± 15.6, p < 0.001), 44-h cDBP (86.4 ± 12.8 vs. 79.3 ± 11.7, p < 0.001) and 44-h cPP (45.7 ± 10.7 vs. 40.3 ± 10.3, p = 0.002) levels compared to patients without IDH. Similarly, during day- and nighttime periods, cSBP/cDBP and cPP levels were higher in IDH patients compared to non-IDH. 44-h augmentation pressure and index, but not AIx(75) were higher in patients with IDH than those without IDH. 44-h PWV (10.0 ± 2.0 vs. 9.2 ± 2.1 m/s, p = 0.020) was significantly higher in patients with IDH.

Conclusions:

Patients with IDH have higher ambulatory central BP and increased arterial stiffness, as indicated by higher ambulatory cPP and PWV. Increased arterial stiffness could be a prominent factor associated with the high burden of cardiovascular disease in this population.
AORTIC STIFFNESS ASSESSED BY HIGH-RESOLUTION PHOTOPLETHYSMOGRAPHY AND SINGLE-LEAD ECG
Authors: Hellqvist Henrik , Karlsson Mikael , Kahan Thomas , Spaak Jonas
Published: June 2022

Objective:

Aortic stiffness is an independent predictor of cardiovascular risk and plays an important role for the development of cardiovascular disease. However, it is rarely measured in clinical practice as it requires complicated methodology and expensive equipment. We assessed whether high-resolution photoplethysmography (PPG) and single-lead ECG, two methods available in current consumer devices, could be used to measure aortic stiffness.

Design and method:

Simultaneous recordings of infrared PPG (earlobe and index finger), single lead ECG (PowerLab, ADInstruments) and continuous blood pressure (BP) by the volume-clamp method (Ohmeda 2300, Finapres) at 1000 Hz were made in 33 subjects and repeated after 1–3 wks. Carotid-femoral pulse wave velocity (cfPWV, SphygmoCor, AtCor Medical) and aortic pulse wave velocity (aoPWV, Arteriograph, Tensiomed) were measured as reference.

PPG fiducial point identification was refined using pulse wave shapes and the blood pressure signal. Pulse wave analysis extracted 23 features previously associated with arterial stiffness, which were ranked according to univariate strength of correlations with cfPWV and aoPWV. The feature with highest rank was used in a multiple linear regression model with heart rate, body height, mean arterial BP and PAT (ECG R-peak to PPG foot) as covariates.

Results:

Mean age was 44 (range 21–66) ys, 19 were men, and 5 had hypertension; office BP was 119 ± 12/72 ± 9 mm Hg. PWV was similar at visit 1 and 2 (cfPWV 6.74 ± 1.17 vs 6.80 ± 1.18; aoPWV 7.66 ± 1.80 vs 7.55 ± 1.52).

Finger-PPG showed stronger relations with PWV than earlobe-PPG, and 17 of the 23 extracted features showed correlations (P < 0.05) with cfPWV and aoPWV.

The ratio of acceleration features (b-c-d-e)/a showed highest correlations with cfPWV and aoPWV (r2 = 0.58 and 0.64, respectively), that improved in multiple regression (r2 = 0.72 and 0.71, respectively; both P < 0.001).

Conclusions:

High-resolution finger-PPG combined with advanced feature extraction can be used to assess aortic stiffness. Adding body height, BP and single-lead ECG improve the strength of the correlation. Easily available PPG based aortic stiffness may facilitate cardiovascular risk prevention, evaluation, and improve treatment.
ON THE PRESENCE OF EVA SYNDROME IN YOUNG PEOPLE WITHOUT ELEVATED BLOOD PRESSURE
Authors: Evsevyeva Maria , Sergeeva Oksana , Kudryavtseva Victoria , Gachkova Irina , Penzova Violetta , Ovchinnikova Olga
Published: June 2022

Objective:

The problem of early vascular aging or EVA syndrome is intensively studied. While it remains unclear what is primary - an increase in blood pressure (BP) or an increase in vascular stiffness (VS) due to the primary pathology of the arterial wall? The Objective is to assess the possibility of the presence of cases of isolated EVA syndrome against the background of normotension among young people (YP).

Design and method:

275 YP (95 boys and 180 girls) aged from 18 to 25 years were examined on basis of the StSMU Health Center as part of the National Preventive Project University - Health Territory. Angiological screening was performed using the VaSera VS-1500 device (Fukuda Denshi, Japan), which allows us to evaluate such an VS indicator as cardio-ankle vascular index (CAVI). The examined patients were divided into terciles according to this indicator, taking into account gender, which made it possible to distinguish carriers of elevated (upper CAVI-tercile), normal (middle CAVI-tercile) and favorable (lower CAVI-tercile) VS. The upper tercile is correlated with EVA syndrome. 4 groups were formed: 1gr. - increased VS; 2gr. - increased VS and arterial hypertension -prehypertension (AH-PH); 3gr. - AH-PH; 4gr. - favorable VS and normotension. Carriers of hereditary connective tissue disorders were excluded from the study for a reason an increase in their VS due to genetically determined angiopathy with an imbalance of elastin and collagen fibers in arterial wall.

Results:

It was found that 14.7% (14) fell into the first group among boys, and 20.6% (37) of their total number among girls (P = 0.098). In the second and third groups there were 11.6% (11) and 47.4% (45) boys, and 5.0% (9) and 16.1% (29) girls with P = 0.041 and P = 0.028. Cases with favorable VS in combination with normotension (control) were revealed among boys and girls 11.8% (10) and 21.1% (38), respectively (P = 0.037).

Conclusions:

Our data indicate possibility of the development of isolated EVA syndrome in YP without presence of elevated office BP. Such results are useful to use when conducting screening activities among YP to perform more individualized preventive interventions among them.
HIGHER PREVALENCE OF MASKED UNCONTROLLED HYPERTENSION WITH NEW EUROPEAN BLOOD PRESSURE TARGETS IN AN ELDERLY PRIMARY CARE POPULATION
Authors: Berglund John , Wijkman Magnus O. , Nilsson Staffan
Published: June 2022

Objective:

The aim of this study was to examine the distribution and clinical characteristics of hypertension phenotypes among patients aged 65 years or older, in a primary care setting, applying the new lower blood pressure targets, of 140/80 mmHg for office blood pressure measurement and 130/75 for ambulatory measurement, proposed by the European Society of Hypertension in 2018.

Design and method:

This is a cross-sectional analysis of 77 subjects previously diagnosed with hypertension who used at least one antihypertensive drug in a primary care setting in south-east Sweden. Data was collected between May 2012 and May 2016. All subjects were examined regarding general clinical characteristics, office blood pressure and ambulatory blood pressure (Spacelabs ABP monitor 90217). The participants were grouped based on office blood pressure target achievement. Furthermore, subjects were categorized in four groups based on hypertension phenotype. These groups were defined based on office- and ambulatory blood pressure target achievement; Sustained controlled hypertension i.e. concordant goal achievement, Sustained uncontrolled hypertension i.e. non-achievement, Masked uncontrolled hypertension i.e. controlled office blood pressure with uncontrolled ambulatory blood pressure and White coat uncontrolled hypertension i.e. uncontrolled office blood pressure with controlled ambulatory blood pressure. Lastly, shifts in the distribution of hypertension phenotypes using current and previous blood pressure targets respectively were examined.

Results:

Obesity related parameters (i.e. BMI and waist circumference) were significantly lower in the group with controlled hypertension based solely on current office blood pressure targets, with BMI (kg/m2) of 25.5 ± 3.9 vs. 28.8 ± 4.9 (p < 0.01) and waist circumference (cm) of 91.0 ± 12.1 vs. 100.3 ± 12.7 (p < 0.01).

Among subjects with controlled office blood pressure, the prevalence of masked uncontrolled hypertension was higher (14/29 or 48%) when new office- and ambulatory blood pressure targets were applied than when older targets were applied (14/43 or 33%).

Conclusions:

The main finding of this observational study was that the prevalence of masked uncontrolled hypertension among subjects with controlled office blood pressure was higher applying new instead of old blood pressure targets. We believe that regular ambulatory blood pressure monitoring can facilitate optimized antihypertensive treatment.
Evaluation of the Processes and Outcomes of a Physician Leadership Program: The Continuous Feedback Loop Design
Authors: Gascon Gregg M. , Chen Huey T. , Morosanu Liliana , Chen Victor H. , Cass Phil , Falcone Robert
Published: June 2022

Introduction:

Physicians assume leadership roles in their health care organizations and practices often without support or training. The Physicians Leadership Academy provides integrated leadership seminars, mindfulness training, and executive coaching in a 10-month curriculum to physicians across area organizations.

Methods:

Program evaluators responded to stakeholders' need for continuous program improvement by developing a continuous feedback loop evaluation design incorporating a program monitoring system and a theory-driven program evaluation. Given the size of the 2019 to 20 cohort (n = 19), a one-group pretest/posttest design was used to assess the mechanisms of the program (mindfulness and wellbeing) along with knowledge development, emotional intelligence, and personal and professional growth. The assessments used a combination of published and administrator-developed assessments to address the unique aspects of the program. Doing such ensured continuous improvement and sustainability for the program.

Results:

The cohort of physicians demonstrated significant engagement and learning across the curriculum, improved mindfulness, and improved capacity of the providers to affect their health care system and communities.

Conclusions:

The utility of the program was demonstrated through quantitative and qualitative analyses. Implications of the methodology for future evaluations of program developments are discussed.
Consensus-Based Development of an Assessment Tool: A Methodology for Patient Engagement in Primary Care and CPD Research
Authors: Lin Ethan , Gobraeil Jeanne , Johnston Sharon , Venables Maddie J. , Archibald Douglas
Published: June 2022

With cardiovascular disease (CVD) posing a significant disease burden in Canada and more broadly, preventative efforts which incorporate best evidence, patient preference, and physician expertise must continue to take place. Primary care providers play a pivotal role in this effort, and a greater understanding of patient perspectives is needed to guide management and inform training. We used a validated consensus method, the nominal group technique (NGT), to identify patient-reported experience measures (PREM) related to CVD prevention deemed most important by both patients and providers. The NGT was used by using structured discussions between patients and providers to bring ideas about PREM CVD outcomes to a consensus. Four patient partners and four primary care providers were selected to participate in an NGT session. Each participant wrote down items/questions they believed important in CVD preventative care. After discussions, all items underwent anonymous ranking on a 5-point scale. Items were included/excluded based on 75% agreement a priori. The panel produced 10 items from a total of 26 after 2 rounds of ranking. The top two items were as follows: “Is your treatment plan tailored to you” and “Was your physician good at giving information about your risk factors?” These results are significantly different compared with existing quality measures because they highlight aspects of patient experience and therapeutic relationship. A questionnaire consisting of prioritized PREM items is valuable in quality improvement and continuous professional development (CPD).
First Episodes of Norovirus and Sapovirus Gastroenteritis Protect Against Subsequent Episodes in a Nicaraguan Birth Cohort
Authors: Vielot Nadja A. , Reyes Yaoska , Blette Bryan , González Fredman , Toval-Ruiz Christian , Gutiérrez Lester , Vilchez Samuel , Diez-Valcarce Marta , Vinjé Jan , Becker-Dreps Sylvia , Bucardo Filemón
Published: June 2022

Background:

Norovirus and sapovirus cause a large burden of acute gastroenteritis (AGE) in young children. We assessed protection conferred by norovirus and sapovirus AGE episodes against future episodes.

Methods:

Between June 2017 and July 2018, we recruited 444 newborns in León, Nicaragua. Weekly household surveys identified AGE episodes over 36 months, and AGE stools were tested by reverse transcriptase-quantitative polymerase chain reaction (RT-qPCR) for norovirus genogroup (G)I/GII and sapovirus. We used recurrent-event Cox models and negative control methods to estimate protection conferred by first episodes, controlling for observed and unobserved risk factors, respectively.

Results:

Sapovirus episodes conferred a 69% reduced hazard of subsequent episodes using the negative control method. Norovirus GI (hazard ratio [HR] = 0.67; 95% confidence interval [CI] = 0.31, 1.3) and GII (HR = 0.20; 95% CI = 0.04, 0.44) episodes also appeared highly protective. Protection against norovirus GII was enhanced following two episodes.

Conclusions:

Evidence of natural immunity in early childhood provides optimism for the future success of pediatric norovirus and sapovirus vaccines.
Pregnancy Exposure to Phenols and Anthropometric Measures in Gestation and at Birth
Authors: Jedynak Paulina , Rolland Matthieu , Pin Isabelle , Thomsen Cathrine , Sakhi Amrit K. , Sabaredzovic Azemira , Philippat Claire , Slama Rémy ,   the SEPAGES Study Group
Published: June 2022

Background:

Some synthetic phenols alter pathways involved in fetal development. Despite their high within-subject temporal variability, earlier studies relied on spot urine samples to assess pregnancy exposure. In this study, we examined associations between prenatal phenol exposure and fetal growth.

Methods:

We measured concentrations of two bisphenols, four parabens, benzophenone-3, and triclosan in 478 pregnant women in two weekly pools of 21 samples each, collected at 18 and 34 gestational weeks. We used adjusted linear regressions to study associations between phenol concentrations and growth outcomes assessed twice during pregnancy and at birth.

Results:

Benzophenone-3 was positively associated with all ultrasound growth parameters in at least one time point, in males but not females. In females, butylparaben was negatively associated with third-trimester abdominal circumference and weight at birth. We observed isolated associations for triclosan (negative) and for methylparaben and bisphenol S (positive) and late pregnancy fetal growth.

Conclusions:

Our results suggest associations between prenatal exposure to phenols and fetal growth. Benzophenone-3 was the exposure most consistently (positively) associated across all growth parameters.