bluuebunny/crossref_metadata_2025 huggingface dataset:
TEMPORAL TRENDS IN LIFESTYLE MODIFICATION OF PATIENTS WITH HYPERTENSION IN KOREA, 2007-2021
Authors: Won Hoyoun , Cho Jun Hwan , Park Kyung -TAEK , Kim Hyue Mee , Lee Sang Yeub , Jeong Young -HOON , Kim Sang -WOOK
Published: May 2024

Objective:

Lifestyle modification is crucial in managing hypertension, independent of medical treatment. This study aimed to evaluate the implementation of lifestyle modifications and analyze the trends in lifestyle modification among patients with hypertension in Korea from 2007 to 2021.

Design and method:

Data from the Korea National Health and Nutrition Examination Survey conducted between 2007 and 2021 was analyzed. The study included patients with hypertension and aged >19 years. Factors such as regular physical activity, smoking and alcohol abstinence, weight and stress management, and adherence to a healthy diet were analyzed.

Results:

In 2021, a double-fold increase was observed in the proportion of patients with hypertension who adhered to sodium restriction compared to 2007. However, 70% of patients with hypertension consume more sodium than recommended. Moreover, potassium intake has steadily decreased since 2014, with only 23.8% of patients with hypertension meeting the recommended intake. (Figure) The body mass index and waist circumference of patients with hypertension have gradually increased, with fewer patients maintaining an appropriate weight. The neglect of diet and weight control among young patients with hypertension who experience high stress levels poses challenges in modifying their lifestyles.

Conclusions:

Patients with hypertension in Korea still consume high amounts of sodium, whereas potassium intake is gradually decreasing. Additionally, obesity rates have been increasing, especially among young patients with hypertension. Considering the increasing number of young patients with hypertension and the low control rate, the importance of lifestyle modifications should be further emphasized.
AN ALTERNATIVE PROTOCOL TO IMPROVE ACCESSIBILITY TO ISOMETRIC EXERCISE TRAINING TO TREAT UNCOMPLICATED HYPERTENSION
Authors: Wiles Jonathan , Rees-roberts Melanie , Santer Ellie , Lea John , O’Driscoll Jamie , Macinnes Douglas , Pellatt-higgins Tracey , Mills Ashley , Gousia Katerina , West Alan , Darby John , Borthwick Rachel , Doulton Tim , Swift Pauline , Farmer Chris
Published: May 2024

Objective:

Isometric exercise training (IET) is consistently shown to reduce blood pressure (BP). We recently investigated the feasibility of delivering a personalised isometric wall-squat protocol to patients with Stage-1 hypertension within a free-to-access healthcare setting. Whist healthcare professionals (HCP) and patients thought the intervention was feasible, any exercise prescription requiring HCP input and specific resource allocation was not deemed viable. This study aimed to examine the effect of a low resource IET prescription using rating of perceived exertion (RPE) versus HCP prescription and control group upon BP.

Design and method:

30 participants with normal to high-normal BP were randomised into either a (heart rate) HR-Exercise (HR-EX), RPE-Exercise (RPE-EX) or control (CON) group. IET groups undertook a 4-week home-based wall-squat programme with intensity prescribed either directly by a HCP using our established HR method (HR-EX), or self-prescribed using a RPE selection protocol (RPE-EX). The CON group maintained their normal lifestyle. Clinic BP was measured at baseline and post-IET.

Results:

Clinic systolic (SBP) and diastolic (DBP) were significantly reduced (p < 0.001) in both intervention groups following IET compared to baseline. Group mean reductions for the HR-EX (SBP: -14 ± 6, DBP: -6 ± 4 mmHg) and RPE-EX (SBP: -9 ± 6, DBP: -6 ± 4 mmHg) were greater (p < 0.001) than CON (no differences) group. There were no differences between intervention groups in the magnitude of the BP reductions; however, at baseline HR-EX had greater SBP (p < 0.001) results compared to RPE-EX, but following the IET there were no significant differences between these groups.

Conclusions:

RPE prescribed wall-squat IET provides an efficacious method for reducing BP at home, delivering reductions comparable to the HR-based prescription method. This new RPE-based method, developed because of difficulties in delivering IET prescription in a general healthcare setting, demonstrates great potential as an effective lifestyle intervention to lower BP mainly due to improved access. It requires minimal resource to deliver and implement in any environment and could be provided entirely online.
PROMOTING CARDIOVASCULAR HEALTH IN THE WORKPLACE: RESULTS OF A LIFESTYLE INTERVENTION ON BLOOD PRESSURE AND CARDIOVASCULAR RISK FACTORS
Authors: Gonçalves Lurdes Costa , Lau Beatriz , Costa Carlos , Amaro António , Ribeiro Fernando
Published: May 2024

Objective:

The workplace is a pivotal setting for implementing lifestyle interventions aimed at improving blood pressure management and cardiovascular health. This study aims to evaluate the impact of a comprehensive lifestyle intervention on blood pressure and other cardiovascular risk factors among employees of a kitchen appliances manufacturing company.

Design and method:

A total of 266 adults (39.2±10.6 years; 75.9% women) employed in the company were divided into three groups: Lifestyle intervention (n= 86), Health Education (n= 85), and Active Breaks (n = 95). All groups received guidance on healthy lifestyle behaviors. Moreover, the lifestyle group participated in a weekly session of resistance exercises tailored to their workstations and a daily 10-minute active break comprising stretching, coordination, and range of motion exercises. The active breaks group engaged in the daily active break, while the education group solely received guidance on healthy lifestyles. Resting blood pressure, body weight, body mass index, waist circumference, total cholesterol, and physical activity were evaluated at baseline and after the 7-month intervention.

Results:

At baseline, participant characteristics (e.g., age, body mass index, resting blood pressure, total cholesterol) were similar across the three groups. Systolic blood pressure (mean difference: 117.8 ± 15.8 to 118.1 ± 14.8 mmHg, p<.05) did not change from baseline to the end of the intervention in either group. However, diastolic blood pressure significantly decreased in all groups from baseline to the end of the intervention (mean difference: 1.9 ± 6.2 mmHg, 95% CI: 1.2 – 2.7 mmHg), without a group X time interaction. Waist circumference and total cholesterol also decreased in all the groups by 0.7 cm (95% CI: 0.2 – 1.0 cm) and 5.5 mg/dL (95% CI: 3.8 – 9.3 mg/dL), respectively, without a group X time interaction. Moderate intensity physical activity levels increased from 330.5±543.4 to 390.5±562.3 MET-min/wk, with a significant group X time interaction; only the Active Breaks group demonstrated a significant increase in moderate-intensity physical activity.

Conclusions:

Among middle-aged adults, a workplace lifestyle intervention, irrespective of its intensity, led to significant improvements in diastolic blood pressure, total cholesterol, waist circumference, and moderate physical activity.
ASSOCIATION OF HEALTHY LIFESTYLE INDEX AND ANTIHYPERTENSIVE MEDICATION USE WITH BLOOD PRESSURE CONTROL AMONG EMPLOYEES WITH HYPERTENSION IN CHINA
Authors: Zhen Huzhen , Xin Xin Wang , Congyi Congyi Zheng , Xue Xue Cao , Yixin Yixin Tian , Runqin Runqing Gu , Jiayin Jiayin Cai , Ye Ye Tian , Zengwu Zengwu Wang
Published: May 2024

Objective:

We examined the association of antihypertensive medication use and HLI with BP control among employees with hypertension in China based on a workplace-based multicomponent intervention program.

Design and method:

A cluster randomized clinical trial of a workplace-based multicomponent intervention program was conducted in 60 workplaces across 20 urban areas in China. Workplaces were randomly divided into intervention (n = 40) and control (n = 20) groups. Basic information on employees at each workplace was collected by trained professionals, including sociodemographic characteristics, medical history, family history, lifestyle behaviors, medication status and physical measurements. After baseline, the intervention group received a 2-year intervention to achieve BP control, which included:(1) a workplace wellness program for all employees; (2) a guidelines-oriented hypertension management protocol. HLI including nonsmoking, nondrinking, adequate physical activity, weight within reference range and balanced diet, were coded on a 5-point scale (range, 0-5, with higher score indicating a healthier lifestyle). Antihypertensive medication use was defined as taking drug within the last 2 weeks. Changes in HLI, antihypertensive medication use and BP control from baseline to 24 months were measured after the intervention.

Results:

After 24 months of the intervention, there was a significant improvement in lifestyle [smoking (0.65, 95% CI, 0.43∼0.99; P=0.045), drinking (OR=0.52, 95% CI, 0.40∼0.68; P<0.001), regular exercise (OR=3.10, 95% CI, 2.53∼3.78; P<0.001), excessive intake of fatty food (OR=0.17, 95% CI, 0.06∼0.52; P=0.002), restrictive use of salt (OR=0.26, 95% CI, 0.12∼0.56; P=0.001)]. Compare to employees with a deteriorating lifestyle after the intervention, those with an improved lifestyle had a higher BP control. In the intervention group, compared with employees not using antihypertensive medication, those who consistent used (OR, 2.34; 95% CI, 1.16∼4.72; P=0.017) or changed from not using to using antihypertensive medication (OR, 2.24; 95% CI, 1.08∼4.62; P=0.030) had higher BP control. Those who used antihypertensive medication and had a high HLI had the highest BP control (OR, 1.88; 95% CI, 1.32∼2.67, P<0.001).

Conclusions:

These findings suggest that adherence to antihypertensive medication treatment and healthy lifestyle were associated with a significant improvement in BP control among employees with hypertension.
MAGNESIUM SUPPLEMENTATION REDUCES INERLEUKIN-6 AND BLOOD PRESSURE IN METABOLIC SYNDROME
Authors: Kisters Klaus , Werner Tanja , Tokmak Faruk , Predel Hans -GEORG , Reuter Hannes , Kisters Sophia
Published: May 2024

Objective:

Due to a metabolic syndrome cardiovascular morbidity and mortality is increased. Recent data show that a magnesium supplementation can decrease inflammation and atherogenic vessel damage via calcium magnesium antagonism and reducing elevated interleukin-6 levels, hereby improving metabolic parameters. The blood pressure lowering effect of magnesium has been described in several studies before, both in systolic and diastolic values.

Design and method:

In this context we conducted a double-blinded, controlled, prospective study on magnesium, blood pressure and interleukin-6 levels in 27 patients (13 male/14 female, age: 60.2+/-12.5 years) with a metabolic syndrome. The study was performed in accordance with the declaration of Helsinki and approved by the ethic committee of the University of Münster, Germany (2015-493-f-S9). Registration in clinicaltrials.gov (NCT03002545). All patients, with normal renal function, were supplemented with orally given 400 mg magnesium citrate daily. Interleukin-6 concentrations were measured before and after 6 and 12 weeks of treatment. 27 metabolic patients served as controls without an additional magnesium therapy (10 male/17 female, age: 64.6+/-13.2 years).

Results:

In the magnesium treated group interleukin-6 values decreased significantly from 4.94+/-3.30 to 4.53+/-6.89 after 6 weeks to 3.01+/-1.32 pg/mL after 12 weeks (means+/-s.d.)(p< 0.01).

In the control group interleukin-6 was 3.73+/-4.36 before start of supplementation, 4.87+/-4.35 after 6 weeks, 4.41+/-3.15 pg/mL after 12 weeks (means+/-s.d.)(n.s.).

In the magnesium treated group there was a significant decrease in both systolic and diastolic blood pressure values after 12 weeks (systolic 134.6+/-6.8 to 126.3+/-5.6 mmHg, diastolic: 84.1+/-3.9 to 79.4+/-1.6 mmHg)(means+/-s.d.)(p< 0.01). In the control group blood pressure values did not change and were similar to the supplemented group at beginning.

Mann-Whitney-U-Test was used for statistics analysis.

Conclusions:

In metabolic syndrome magnesium supplementation significantly improved systolic and diastolic blood pressure values and interleukin-6 levels. Magnesium acts anti-inflammatory and anti-arteriosclerotic, hereby a benefit for metabolic patients at high risk for vascular damage inclusive stroke is given. A magnesium deficiency has to be corrected in every metabolic patient. A long-lasting magnesium supplementatio (12 weeks) has to be preferred. The daily amount of oral magnesium sujpplementation should be 300 to 500 mg.
PREVALENCE OF ABDOMINAL OBESITY AND ITS ASSOCIATED COMORBID CONDITION IN ADULT YEMENI PEOPLE OF SANA’A CITY
Authors: Bamashmos Mohammed
Published: May 2024

Objective:

Abdominal obesity is a metabolic problem that has become increasingly common worldwide over the past several decades. Its prevalence is increased in both advanced and developing countries including Yemen. The aim of this cross sectional study was to investigate the prevalence of Abdominal obesity in a sample of Yemeni adult individuals and its association with other comorbid conditions namely, hypertension, diabetes, dyslipidemia (high triglyceride, low high density lipoprotein) and metabolic syndrome (MS).

Design and method:

A sample of 1118 adult Yemeni people equal to or over 18 years was randomly chosen to represent the population living in Sana’a City during a period of two years from April 2016 to April 2018. All the study group underwent full clinical history and examination which included measurement of BP and waist circumference and the following laboratory investigations (FBS, serum TG, HDL, and LDL).

Results:

The prevalence of abdominal obesity in this study was 24.5% (7.9% male and 44.2% female). Central obesity in this study was significantly correlated with age and sex. The highest prevalent comorbidity in patients with abdominal obesity was high BP (41.3%), followed by high serum TG (40%), higher prevalence of MS (40%), low serum HDL (37.8%) high LDL (20.1%) raised fasting blood glucose (22.1%) than those without abdominal obesity (5.5%, 31.3%, 16.6%, 8.5%, 12.5% and increased FBS 10% respectively).

Conclusions:

Hypertension, diabetes, dyslipidemia and MS are strongly correlated with abdominal obesity.
SYSTEMIC INFLAMMATION RESPONSE INDEX AS A PREDICTOR OF STROKE RISK IN ELDERLY PATIENTS WITH HYPERTENSION: A COHORT STUDY
Authors: Song Shuaiwei , Cai Xintian , Hu Junli , Li Nanfang
Published: May 2024

Objective:

Little research has investigated the relationship between the systemic inflammation response index (SIRI) and stroke, especially in elderly hypertensive patients. This study aimed to evaluate the relationship between the SIRI and the risk of stroke and its subtypes in elderly patients with hypertension and to explore its predictive superiority and any potential effect modifiers.

Design and method:

The study included 4749 participants with no history of stroke at baseline. Cox regression was used to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CIs). Interaction tests and subgroup analyses were conducted. The predictive performance of various inflammatory indicators for stroke was compared using the area under the curve (AUC), continuous net reclassification improvement (NRI), and integrated discrimination improvement (IDI).

Results:

During a median follow-up period of 3.2 years, 640 strokes were recorded, of which 526 were ischemic and the remainder hemorrhagic. After adjustment for confounders, compared to the reference group, the HRs (95% CI) of stroke were 1.29 (95% CI, 1.01–1.65) and 1.48 (95% CI, 1.15–1.90) for participants in the second and third tertiles, respectively. We observed interactions between SIRI and homocysteine levels (< 15 vs > = 15 umol/L) (P for interaction = 0.014) on ischemic stroke risk. Furthermore, the AUC, NRI, and IDI analyses demonstrated that SIRI exhibited better predictive value for stroke risk when compared to other indicators. Similar results were observed for both ischemic and hemorrhagic strokes.

Conclusions:

Elevated SIRI levels were significantly associated with the risk of stroke and its subtypes in elderly patients with hypertension, suggesting their potential as a promising indicator for stroke risk in this population. However, larger prospective studies are needed to confirm these findings.
BLOOD PRESSURE VARIABILITY AS PREDICTOR OF CANCER THERAPY-RELATED CARDIOVASCULAR TOXICITY IN PATIENTS WITH MULTIPLE MYELOMA
Authors: Fanelli Elvira , Picca Giulia , Airale Lorenzo , Astarita Anna , Mingrone Giulia , Catarinella Cinzia , Votta Simona , Colomba Anna , Cesareo Marco , Leone Dario , Paladino Arianna , Rabbia Franco , Bringhen Sara , Gay Francesca , Veglio Franco , Milan Alberto , Vallelonga Fabrizio
Published: May 2024

Objective:

Blood pressure variability (BPV) is an independent predictor of cardiovascular (CV) events and overall mortality. The potential role of BPV in defining CV risk of patients undergoing anticancer therapy with a potential cancer therapy-related cardiovascular toxicity (CTR-CVT) is currently unknown.

The aims of this study were: (i) to assess the predictive value of BPV indexes for CTR-CVT development and defining the corresponding cut-off values; (ii) to identify subgroups of subjects based on BPV, through clustering analysis.

Design and method:

Patients with Multiple Myeloma, who were eligible to anticancer therapy with Carfilzomib, were consecutively enrolled and underwent a baseline evaluation, including office blood pressure (BP) measurement, 24h-Ambulatory Blood pressure Monitoring (ABPM), PWV, and Echocardiography.

Short-term BPV was assessed through standard deviation (SD), weighted standard deviation (wSD), coefficient of variation (CoV), average real variability (ARV), and variability independent of the mean (VIM), evaluated on ABPM measurements.

Results:

The study population included 124 patients (50% female). During follow-up, CTR-CVT occurred in 70 subjects (56.5% of the total population), including both BP and CV events. Night-time BPV was associated to CTR-CVT, independently by BP, age, smoking, and comorbidities as diabetes and renal dysfunction (night-time systolic CoV: adjusted OR 1.11 [1.01-1.22]; night-time systolic VIM adjusted OR 1.17 [1.03-1.35]; night-time diastolic VIM adjusted OR 1.18 [1.01-1.40]). Cut-off for these BPV parameters were identified as predictor of CTR-CVT occurrence: 10.5 for night-time systolic CoV (sensibility 73%, specificity 47%); 7.8 and 6.4 for systolic and diastolic night-time VIM (sensibility 85% for both; specificity 35% and 39%, respectively).

Clustering analysis identified a subgroup of subjects characterized by the highest BPV, who had a greater prevalence of events during follow-up, but no differences in other conventional CV risk factors, as BP, dyslipidaemia, diabetes, renal function, and smoking habit, as well as left ventricular mass and global longitudinal strain.

Conclusions:

Short-term BPV is an independent predictor of CTR-CVT in patients with Multiple Myeloma undergoing therapy with Carfilzomib. The inclusion of these indexes improves CV risk prediction in these subjects and higher BPV is a distinctive feature predicting adverse events, on top of conventional CV risk factors.
EARLY IMPACT OF AN OUTPATIENT HYPERTENSION CLINIC IN A DISTRICT HOSPITAL
Authors: Matos Maria , Madeira Daniela , Monteiro Miguel , Costa Mariana , Negrão Catarina , Nunes Filipa , Orfão Ana , Sukhoviy Anna , Santos João , Brandão Rodrigo , Silva Maria , Tomás Ana Rita , Dutschmann Rita , Branco Teresa
Published: May 2024

Objective:

Arterial hypertension (HTN) is a major preventable cause of cardiovascular morbidity and mortality. To address this issue, we implemented an outpatient HTN clinic at our hospital, mainly focused on patients with suspected secondary and complex HTN (including HTN associated with oncology treatments, dysautonomy or autoimmune disease). We aim to characterize the patients followed at our clinic and to analyze the effectiveness of this consultation in relation to HTN etiological classification, blood pressure (BP) control and emergency department episodes.

Design and method:

We designed a retrospective cohort study, concerning all patients who were evaluated in our clinic from June 2022 until December 2023. We excluded patients who abandoned the follow-up after the first evaluation.

Results:

We evaluated 238 patients with a mean age of 48.3±15.1 years. Although the majority of patients were caucasian (56.8%, n=138), our population is characterized by a significant proportion of patients of african ancestry (36%, n=85). We observed a slightly higher prevalence of resistant HTN in these patients, when compared to other groups (21.8% vs 18.8%). Of the patients who have concluded the etiologic study, a secondary cause of HTN was found in 64.5% (n=80). When evaluating the effectiveness in BP control, we observed that there was a significant reduction in both systolic (mean variation of -14.1±25.4mmHg, p<0.001) and diastolic BP (mean variation of -7.7±16.4mmHg, p<0.001) between the first and last patient evaluations. The proportion of patients with controlled BP improved significantly from 26.9% to 55.6% (p<0.001). Additionally, the emergency department episodes due to hypertension crisis were also significantly reduced after initiating follow-up at the outpatient clinic (mean 0.5±0.6 vs. 0.1±0.4 episodes/patient, before and after follow-up respectively, p<0.001).

Conclusions:

Monitoring selected patients with HTN in a hospital outpatient setting is an effective way to improve their BP control and to investigate any underlying causes that may require targeted treatment. This approach not only benefits individual health but may also reduce the number of hypertensive crisis admissions in the emergency department, thereby reducing the burden on the health system.
AT1R/ROS/ENOS/AT2R AXIS IN ANGIOTENSIN II UPREGULATION OF NEURONAL NITRIC OXIDE SYNTHASE IN CARDIOMYOCYTES
Authors: Zhang Yin Hua
Published: May 2024

Objective:

Angiotensin II (Ang II) is a potent precursor of hypertrophy and heart failure. However, neuronal nitric oxide synthase (nNOS or NOS1) is upregulated by Ang II, suggesting pro-protective mechanisms of Ang II signaling in the heart. Until recently, the mechanisms mediating Ang II-inducing nNOS remained unclear. The main purpose was to identify cellular mechanisms of Ang II type I and type II receptors and the subsequent signaling cascades mediating nNOS upregulation in cardiomyocytes.

Design and method:

nNOS expression was detected in left ventricular (LV) myocytes from SD rats (8-10 weeks, male) pre-treated with Ang II with and without antagonists of AT1R or AT2R (losartan, PD123319) and ROS scavengers (apocynin, tiron or PEG-catalase). Surface biotinylation and immunocytochemistry experiments were conducted to examine AT1R expression in plasma membrane. eNOS inhibitors and LV myocytes from eNOS gene deletion mice were used to test the effects of eNOS in the signaling pathway. Site-specific mutagenesis analysis was used to specify s-nitrosylation cysteine residue of AT2R for its membrane translocation.

Results:

Our results showed that Ang II increased nNOS protein expression but losartan, PD123319 and apocynin, tiron or PEG-catalase blocked Ang II-upregulation of nNOS. AT1R expression was progressively internalization with Ang II treatment accompanied by membrane trafficking of AT2R. Inhibition of AT1R or ROS scavengers prevented Ang II-induced translocation of AT2R to plasma membrane. Furthermore, eNOS-Ser1177 was increased by Ang II but eNOS-Thr495 was decreased, and ROS scavengers prevented Ang II-activation of eNOS. L-NG-Nitroarginine Methyl Ester (L-NAME) or eNOS gene deletion abolished Ang II-induced membrane trafficking of AT2R, nNOS protein expression and activity. Mechanistically, NO induces S-nitrosation of AT2R and site-specific mutagenesis analysis reveals that C-terminal cysteine 349 in AT2R is essential in AT2R translocation to plasma membrane.

Conclusions:

Here, we demonstrate that Ang II upregulates nNOS protein expression and activity via AT1R/ROS/eNOS-dependent S-nitrosation and membrane translocation of AT2R. Crosstalk between

AT1R and AT2R in regulating nNOS via eNOS is important in cardiac protection under pathogenic stimuli.
TESTOSTERONE COULD INDUCE CARDIAC HYPERTROPHY IN OVARIECTOMIZED SHR THROUGH THE ACTIVATION OF THE MTORC2/ATG9A
Authors: Wang Wenting , Zhu Lulu , Chen Jianshu , Wang Qiongying , Yu Jing
Published: May 2024

Objective:

The estrogen level of postmenopausal women decreased sharply, while the androgen level did not decrease significantly, which was characterized by the inversion of estrogen / androgen ratio. Therefore, it could be observed that relative excess androgen in the circulation of postmenopausal women, which may be one of the reasons for the increase of cardiovascular disease in postmenopausal women. In this study, the model of postmenopausal hypertension was established by bilateral ovariectomy in spontaneously hypertensive rats (SHR), and the specific mechanism of testosterone-induced myocardial hypertrophy in ovariectomized SHR was explored.

Design and method:

24 SHR were randomly divided into four groups: WKY group (n=6), sham operation group (Sham group, n=6), bilateral ovariectomized group (OVX group, n=6) and testosterone propionate intervention group (OVX+T group, 6mg/kg/Weekly, im for 4 weeks, n=6). Western Blot was used to detect the protein expression of B-MHC, ANP, Androgen receptor, Akt, p-Akt, mTORC2 and its subunits Rictor. Moreover, the expression of autophagy-related proteins LC3 was observed.

Results:

1. Testosterone-induced cardiac hypertrophy in ovariectomized SHR: the expression of B-MHC and ANP was significantly increased in both the OVX and OVX+T groups when compared to the WKY and Sham groups. Additionally, the expression of androgen receptors was markedly upregulated in both the OVX and OVX+T groups. These findings strongly suggest that testosterone primarily induces myocardial hypertrophy in SHR after ovariectomy through androgen receptors.

2. Testosterone activation of mTORC2 expression in myocardial tissue: Testosterone exhibited a notable capacity to activate mTORC2 expression and the p-Rictor subunit in the OVX+T group.

3. Testosterone inhibit cardiomyocyte autophagy: A conspicuous reduction in the expression of LC3II was observed in the OVX+T group when compared to the OVX groups. This reduction indicates that testosterone may effectively inhibit cardiomyocyte autophagy under the experimental conditions.

Conclusions:

In bilateral ovariectomized SHR, testosterone could inhibit cardiac autophagy by activating the expression of mTORC2, which, in turn, leads to cardiac hypertrophy.
BLOOD PRESSURE, RENAL ARTERIAL FUNCTION AND OXIDATIVE-NITRATIVE STRESS IN A RAT MODEL OF POLYCYSTIC OVARY SYNDROME
Authors: Várbíró Szabolcs , Benko Rita , Junhyung Kim , Yoojin Ham , Bányai Bálint , Kiss Stella Tímea , Szekeres Mária , Horvath Eszter Mária
Published: May 2024

Objective:

Polycystic ovary syndrome (PCOS), a prevalent endocrine disorder in women, is associated with elevated cardiovascular risk and vitamin D deficiency. This study evaluates blood pressure, renal arterial function and oxidative stress in a rat PCOS model, also exploring the impact of vitamin D supplementation. Assessing mean arterial blood pressure under anesthesia, renal arterial function and oxidative stress in a hyperandrogenic rat model, and the effectiveness of vitamin D substitution.

Design and method:

Thirty-two adolescent female Wistar rats were randomly assigned into four groups. Eight rats received no treatment (controls, C), eight received weekly Vitamin D per os (140 IU/100 g body weight, group D), eight received cutaneous testosterone daily (3.3 mg/100 g, T), and eight received Vitamin D and testosterone together (T+D). In the eighth week of the treatment, rats were anaesthetized with urethane, and blood pressure (MABP) was measured. The isolated renal arterial rings were cut into 3-4 mm long segments for wire myography. Other segments were formaldehyde-fixed and paraffin-embedded for histological evaluations. By immunohistochemical methods, we assessed the oxidative stress marker 4-hydroxynoneal (HNE) and poly(ADP-ribose) polymerase activation shown by nuclear poly(ADP-ribose) polymer (PAR).

Results:

MABP was lower in hyperandrogenic rats, which was not altered by Vitamin D supplementation. Phenylephrine-induced contraction (Phe) in 10-9-10-7 M concentrations was identical in all groups; however, 10-6 M Phe caused a lower contraction in D and T rats (54.4± 21% and 41.9±20% vs. C: 72.78±8% and T+D: 69.68±21%. p<0.05) compared to controls and double treated animals. Endothelium-mediated relaxation did not differ between groups.

PAR staining was also identical, but HNE staining showed a tendency for increment in group T (p=0.12) but not in T+D.

Conclusions:

The decreased mean arterial pressure is likely the result of the compromised sensitivity to alpha1-adrenergic stimulus. The reduced reactivity of the renal artery may influence the activity of the renin-angiotensin-aldosterone system (RAAS). By normalizing the phenylephrine-induced contraction, Vitamin D supplementation might restore RAAS, thus blood pressure regulation.
ACUTE EXERCISE-INDUCED INFLAMMATORY AND THROMBOTIC RESPONSE IN HYPERTENSIVE PATIENTS
Authors: Liakos Charalampos , Aggeli Constantina , Toutouzas Konstantinos , Markou Maria , Vyssoulis Gregory , Tsioufis Constantinos
Published: May 2024

Objective:

Vigorous physical activity may acutely trigger the onset of an acute coronary syndrome especially in sedentary persons with established cardiovascular risk factors such as arterial hypertension. The rupture of an inflamed coronary plaque and the activation of the coagulation cascade are the main underlying mechanisms. The present study aimed to determine the effect of acute exercise on the inflammatory and thrombotic response in patients with arterial hypertension as compared to normotensive peers.

Design and method:

After excluding patients with any inflammatory or/and coronary artery disease, a total of 60 non-treated hypertensive patients and 65 normotensive individuals underwent a maximal treadmill exercise testing. Blood samples were drawn at rest and immediately after peak exercise. High-sensitivity C-reactive protein (hsCRP), serum amyloid A (SAA), white blood cell (WBC), interleukin-6 (IL-6), and total fibrinogen (TF) levels, as well as plasminogen activator inhibitor-1 (PAI-1) activity were measured.

Results:

All biomarkers increased with exercise, except PAI-1, which decreased (P<0.05 for the change between resting and peak exercise for all biomarkers). The normotensive group had less marked (P<0.05) exercise-induced changes than the hypertensive group in hsCRP (7.7 vs. 8.6%), SAA (5.6 vs. 11.9%), WBC (45.0 vs. 51.7%), and PAI-1 (-17.3 vs. -20.1%) and a similar (P=NS) change in IL-6 (23.8 vs. 23.0%) and TF (8.5 vs. 8.5%).

Conclusions:

In conclusion, the acute exercise-induced inflammatory and thrombotic response seems to be more pronounced in non-treated hypertensive patients than in normotensive controls. The effect of blood-pressure lowering treatment on the exercise-induced acute phase response remains to be elucidated.
DIURETICS, CCB, RAAS INHIBITORS AND MRAS- WHO IS NEXT IN THE MANAGEMENT OF REFRACTORY HYPERTENSION?
Authors: Leiba Adi , Hadad Orpaz , Lencovsky Ori , Niddam Naomi Nakash , Rappoport Vladimir , Korman Avital Angel , Azran Carmil
Published: May 2024

Objective:

We analyzed refractory hypertensive (refHTN) patients, i.e. patients whose blood pressure is above goal despite being on 5-7 different antihypertensive drug classes. Our goal was to delineate prescription habits of the 5th-7th antihypertensive medications, adherence rates, and BP control.

Design and method:

In this real-life observational study we utilized the Maccabi Healthcare Services (MHS) database during 2023. MHS is a nationwide Health Maintenance Organization (HMO), providing health services to about one quarter of the Israeli population.

In order to describe adherence rates we compared refractory hypertensive patients who were fully adherent (at least six prescriptions and purchases of each medication during 2023) to partially adherent patients (at least one purchase of each medication).

Blood pressure control was strictly defined as 80% or more BP measurements during 2023 at goal, meaning 130mmHg systolic BP or less and 80mmHg diastolic BP or less.

Results:

Out of 1,821,685 adult members of Maccabi HMO during 2023, 361,721 patients were defined as hypertensive (20%). Only 0.5% (1750) of the hypertensive population were at some stage during 2023 on at least 5 anti-hypertensive medications (i.e., apparent refHTN). Of these only 264 patients (15%) were adherent to their medications during the whole year. There was no significant difference between adherence to the different drug classes: 15% were fully adherent to alpha blockers and central alpha 2 agonists, 16% to beta blockers and 17% to direct vasodilators.

Practically all (99%) prescriptions given to fully adherent patients were of medications acting on the sympathetic nervous system, correlating with our understanding of refHTN (figure 1).

Of the fully adherent patients’ group, only 58 patients (22%) were well controlled during 2023 on a stable 5-7 drug regimen, with 1 patient adherent to 8 drugs. The remaining 78% (205 patients) of the fully adherent group were not optimally controlled and were therefore defined as true refHTN.

There was a non-significant trend towards better control of blood pressure with beta blockers vs. alpha blockers (26% vs. 23% of patients, respectively).

Conclusions:

Novel antihypertensive medications are needed in order to manage this most challenging subgroup of hypertensive patients.
IMPROVEMENT OF COGNITIVE FUNCTION IN HEART FAILURE PATIENTS BY SGLT2 INHIBITORS—CLINICAL ADVANCES, MECHANISMS, AND FUTURE PERSPECTIVES
Authors: Di Xiaofan , Zhang Fangjing , Zhang Yong , Zhang Kefan , Bai Feng , Yu Jing , Wang Qiongying
Published: May 2024

Objective:

SGLT2 inhibitors belong to a new category of oral antidiabetic medications that decrease blood glucose by obstructing glucose reabsorption in the proximal tubule (PCT), resulting in elevated urinary levels of sodium and glucose. The 2023 ESC guidelines for acute and chronic heart failure encourage the usage of SGLT2 inhibitors in patients with HFmrEF and HFpEF to lower the danger of hospitalization or cardiovascular mortality in heart failure patients. Cognitive decline is a significant issue for heart failure patients. This narrative review's objective is to examine the impact of SGLT2i on cognitive dysfunction associated with heart failure and foster further research, predominantly in the form of large-scale clinical trials.

Design and method:

An exhaustive literature search was executed on PubMed to analyze the fundamental mechanisms of SHLT2 inhibitors on cognitive impairment in heart failure patients, related clinical evaluations, the consequences of cardiac dysfunction on cognitive function, and possible underlying mechanisms.

Results:

The published literature substantiates the argument that cognitive impairment is provoked by cardiac dysfunction. Current research suggests that cognitive dysfunction in patients with heart failure results from inadequate cerebral perfusion, the Locus coeruleus noradrenergic system, chronic inflammation, mitochondrial dysfunction, and microRNA-1. Furthermore, numerous randomized controlled trials have confirmed that SGLT2 inhibitors, with or without diabetes mellitus, enhance cardio-renal outcomes in patients. SGLT2 proteins are present in the central nervous system (CNS). SGLT2 inhibitors reduce oxidative stress, inflammation, and endothelial cell proliferation, as well as improve brain mitochondrial function, synaptic plasticity, acetylcholinesterase activity, amyloid plaques, and modulation of the mTOR pathway. They also attenuate brain injury and cognitive decline. There are additional clinical studies that demonstrate the reduction in the risk of cerebrovascular events and dementia through SGLT2i treatment.

Conclusions:

To summarize, all existing studies establish the direct and indirect neuroprotective effects of SGLT2i. Nevertheless, there is limited clinical research on using SGLT2i for the treatment of cognitive dysfunction related to heart failure. Further clinical experiments are required to determine the effectiveness of SGLT2i treatment in improving cognitive dysfunction associated with heart failure.
EFFECTIVENESS & TOLERABILITY OF METOPROLOL ER, TELMISARTAN & CHLORTHALIDONE IN ESSENTIAL HYPERTENSION PATIENTS WITH STABLE CAD: INDIAN REAL-WORLD STUDY STRATIFIED BY COMORBIDITIES
Authors: Markandeywar Neeraj , M Vijaykumar , Pande Arindam , Kumari Rama , Dutta Soumya , Reddy Susheel , Chile Vijay , Mane Amey , Ahire Prachi , Kudrigikar Vinay , Dharmadhikari Shruti , Khandhedia Chintan , Mehta Suyog , Joglekar Sadhna
Published: May 2024

Objective:

We conducted a real-world study to assess effectiveness (on blood pressure [BP; mmHg]) and tolerability of fixed dose combination (FDC) of 25/50 mg Metoprolol + 40 mg Telmisartan + 12.5 mg Chlorthalidone in treating hypertension and stable coronary artery disease (CAD). Considering comorbidities as risk factors for hypertension and CAD, this subgroup analysis was conducted in patients with common comorbidities.

Design and method:

A retrospective, multicenter study retrieved data over 15 months from electronic medical records of 1,810 adult patients with essential hypertension [systolic BP (SBP) greater than or equal to 140 and/or diastolic BP (DBP) greater than or equal to 90] and stable CAD. Of 1,784 patients who received this FDC for 24 ± 2 weeks; 1,224 had comorbidities (obesity: 1,062; diabetes mellitus: 494; dyslipidaemia: 270; hypothyroidism: 121).

Results:

Mean change in SBP / DBP (obese: -31.1 / -12.2; diabetes mellitus: -29.8 / -11.4; dyslipidaemia: -28.6 / -10.7; hypothyroidism: -26.4 / -8.5) from baseline to 24 ± 2 weeks was significant (p<0.001, Fig 1). Proportions of patients achieving target BP (SBP < 140 and DBP < 90) was >90% in diabetes mellitus and hypothyroidism and >82% in obese and dyslipidaemia patients. Of 14 patients with adverse events (hypotension being most common), 10 had comorbidities.

Conclusions:

This real-world study demonstrated that the FDC of Metoprolol + Telmisartan + Chlorthalidone was effective in reducing blood pressure and well tolerated in treating patients with hypertension and CAD who had common comorbidities.
EFFECTIVENESS & TOLERABILITY OF METOPROLOL ER, TELMISARTAN & CHLORTHALIDONE IN PATIENTS OF ESSENTIAL HYPERTENSION WITH STABLE CAD: INDIAN REAL-WORLD STUDY STRATIFIED BY BMI
Authors: Ahire Prachi , M Vijaykumar , Pande Arindam , Kumari Rama , Dutta Soumya , Reddy Susheel , Chile Vijay , Mane Amey , Markandeywar Neeraj , Kudrigikar Vinay , Dharmadhikari Shruti , Khandhedia Chintan , Mehta Suyog , Joglekar Sadhna
Published: May 2024

Objective:

We conducted real world study to assess effectiveness (on blood pressure [BP; mmHg]) and tolerability of fixed dose combination (FDC) of 25/50 mg Metoprolol + 40 mg Telmisartan + 12.5 mg Chlorthalidone in treating hypertension and stable coronary artery disease (CAD). Body mass index (BMI) is one of the factors that affects hypertension and CAD. Hence, we performed this subgroup analysis to assess effectiveness of the FDC based on patients’ BMI.

Design and method:

A retrospective, multicenter study retrieved data over 15 months from electronic medical records of 1,810 adult patients with systolic BP greater or equal to 140 and/or diastolic BP greater or equal to 90 and stable CAD; 1,784 were treated with FDC for 24 ± 2 weeks. Mean change in BP from baseline, proportion of patients achieving target BP (systolic BP < 140 and diastolic BP < 90) and incidence of adverse events were analyzed in patients with BMI < 18.5 kg/m2 (underweight n= 9); 18.5-22.9 kg/m2 (normal n= 249), 23.0-24.9 kg/m2 (overweight n= 464) and greater or equal to 25 kg/m2 (obese n=1,062).

Results:

Mean changes in systolic (underweight, -33.6; normal, -29.9; overweight, -27.7; obese, -31) and diastolic BP (underweight, -12.2; normal, -11.5; overweight, -12; obese, -12.2) from baseline to 24 ± 2 weeks were significant (p<0.001), Fig 1. Proportion of patients achieving target BP at 24 ± 2 weeks in all except underweight category was >84%. Fourteen patients had adverse events; hypotension being most common.

Conclusions:

In a real-world setting, the FDC of Metoprolol + Telmisartan + Chlorthalidone was effective in reducing blood pressure and was well-tolerated in treating hypertension with CAD across all BMI categories. The study demonstrated significant reductions in both systolic and diastolic BP for patients with different BMI levels, highlights the potential benefits of FDC in managing hypertension in various body weight groups.
EFFICACY OF ULTRASOUND RENAL DENERVATION BASED UPON CHANGES IN DETECTED ANTIHYPERTENSIVE MEDICATIONS WITHIN THE RADIANCE HTN-TRIO STUDY
Authors: Zeijen Victor J. M. , Azizi Michel , Kirtane Ajay J. , Kably Benjamin , Daemen Joost
Published: May 2024

Objective:

The randomized RADIANCE-HTN TRIO trial assessed the safety and efficacy of ultrasound renal denervation (uRDN) among patients with resistant hypertension (HTN), demonstrating a difference in daytime ambulatory systolic BP (DASBP) of -4.5 mmHg in favor of uRDN over a sham procedure at 2 months. Blood pressure results may be confounded by changes in anti-hypertensive medications (AHM). In this analysis, we assessed the BP-lowering efficacy of uRDN adjusted for detected AHM metabolites at baseline and 2 months.

Design and method:

Following standardization on a single triple combination antihypertensive pill, patients with daytime ambulatory blood pressure (DABP) 135/85 mmHg or greater were randomized 1:1 to uRDN or sham. Chemical adherence testing was used to detect AHM or their metabolites in spot urine samples under blinding to treatment assignment at baseline and 2 months. Analysis of covariance (ANCOVA) was utilized to assess the 2-month change in DASBP between groups, adjusting for DASBP at baseline and AHM detected at baseline and 2 months.

Results:

Both DABP and AHM urine metabolite data at baseline and 2 months were available in 100 patients (uRDN n=47; sham n=53). Mean age was 52.6±8.8 years, 23% were female, and 71% were white. At baseline, DASBP was 149±11 mmHg and 2.7±1.2 AHM metabolites were detected. No changes in number of detected drugs between baseline and 2 months were found in 72% of the patients. Between baseline and 2 months, the change in DASBP was -10.9 [95% CI: -15.5, -6.3] mmHg in the uRDN group and -4.0 [-8.0, 0.0] mmHg in the sham group (baseline-adjusted between-group difference: -6.9 [-12.8, -1.1] mmHg; p=0.007). Following additional adjustment for the number of detected AHM at baseline and 2M, the mean between-group difference in DASBP was -9.3 [-14.9, -3.7] mmHg (p=0.0003) in favor of uRDN.

Conclusions:

The blood pressure-lowering efficacy of uRDN in patients with resistant HTN was maintained and numerically more pronounced when adjusting for changes in detected AHM metabolites.
ASSOCIATION OF RESTING HEART RATE AND BLOOD PRESSURE WITH CLINICAL OUTCOMES IN PATIENTS WITH DIABETES MELLITUS: DATA FROM THE KAILUAN COHORT STUDY
Authors: Yin Zifang , Wang Chi , Zheng Mengyi , Tian Lu , Feng Zekun , Li Yanjie , Lan Lihua , Chen Shuohua , Wu Shouling , Xue Hao
Published: May 2024

Objective:

The present study aimed to evaluate the association of resting heart rate (RHR) and blood pressure (BP) with clinical outcomes in patients with diabetes mellitus in the Kailuan cohort study.

Design and method:

A total of 22,963 diabetes mellitus patients without prior cardiovascular disease were included. RHR and BP were analyzed according to values as high RHR (H-RHR) >=74 bpm versus low RHR (L-RHR) <74 bpm (the cutoff value was determined using the receiver operator characteristics curve analysis), and high BP (H-BP) >=130/80 mmHg versus low BP (L-BP) <130/80 mmHg. The endpoint was a composite of cardiovascular disease (including myocardial infarction, ischemic stroke, and hemorrhagic stroke) and all-cause mortality. We used Cox proportional hazard model to calculate the hazard ratio (HR) and 95% confidence interval (CI) for outcomes according to each of the following four phenotypes: H-RHR/H-BP (reference group), L-RHR/H-BP, H-RHR/L-BP, and L-RHR/L-BP. In addition, given RHR and BP could change over time, we entered RHR/BP groups as a time-dependent explanatory variable in a time-dependent Cox regression analysis. We also investigate the association of RHR/BP groups in the long term, where the long-term RHR/BP groups was determined using updated mean of RHR and BP, with the risk of outcomes.

Results:

After a median 8.19-year follow-up, the endpoint was documented in 4,420 patients (including 2,175 cases of cardiovascular disease and 2,709 cases of all-cause mortality). Compared with the H-RHR/H-BP group, L-RHR and L-BP were individually associated with lower risk of outcomes, whereas L-RHR/L-BP group was associated with the lowest risk of the endpoint (adjusted HR [95% CI] was 0.61 [0.52-0.71] for the composite outcome [P <0.01], 0.49 [0.39-0.63] for cardiovascular disease [P <0.01], and 0.69 [0.58-0.83] for all-cause mortality [P <0.01]) (Table 1). Similar findings were observed in time-dependent Cox regression analysis and time-updated Cox regression analysis (Table 1).

Conclusions:

In patients with diabetes mellitus, lower RHR and lower BP are associated with reduced risk of clinical outcomes. Combined management of RHR and BP may help improve the prognosis of patients with diabetes mellitus.
ANKLE-BRACHIAL INDEX AS SHORT TERM AND LONG-TERM PREDICTOR OF CARDIOVASCULAR EVENTS AFTER MYOCARDIAL INFARCTION: A 3-YEAR FOLLOW-UP STUDY
Authors: Koumelli Areti , Konstantinou Konstantinos , Mantzouranis Emmanouil , Sakalidis Athanasios , Leontsinis Ioannis , Andrikou Ioannis , Manta Eleni , Kakouri Niki , Fragoulis Christos , Kariori Maria , Liatakis Ioannis , Kasiakogias Alexandros , Dimitriadis Kyriakos , Tsioufis Costas
Published: May 2024

Objective:

The ankle-brachial index (ABI) is a non-invasive index originally proposed for the diagnosis of lower-extremity peripheral artery disease. It is also a marker of atherosclerosis in other vascular sites and may serve as a prognostic marker for cardiovascular events even in the absence of PAD symptoms. However, data on the prognostic value of this index in the setting of acute myocardial infarction (MI) are scarce.

Design and method:

We prospectively evaluated 441 patients [79.4% male; average age 62 years, 67.6% hypertensive, 29.7% diabetes mellitus (DM); 54.9% STEMI] hospitalized for acute MI. Basic demographic, echocardiographic, peri- and postoperative details were recorded and analyzed. The ABI threshold used to define abnormal levels was less than or equal to 0.90 and recorded according to established guidelines using a certified automated device (ABPI MD, MESI®). The primary endpoint was a composite of all-cause and cardiovascular death, as well as major cardiovascular events including decompensated heart failure, new ACS, cerebrovascular event, malignant arrhythmia, PAD event and new onset renal dysfunction. All events were assessed both in-hospital and within 3 years of follow-up.

Results:

The mean ABI of our study population was estimated to be 1.1 (IQR: 1.00 to 1.18). In reduced multivariate regression models ABI was a prognostic indicator for the in-hospital composite endpoint. Particularly, patients with abnormal ABI showed a threefold risk of in-hospital events [HR 2.93, 95% CI: 1.48-5.81, p=0.002]. Regarding all-cause mortality, after multivariate analysis, ABI [HR 2.88, 95% CI: 1.53 – 5.42, p=0.001] maintained its predictive power regardless of hypertension, DM, LDL levels and smoking status of the study population in 3 years follow-up.

Conclusions:

In the setting of an acute MI, lower ABI values expose these patients to a higher risk of in-hospital events and are independently associated with long-term all-cause mortality. Consequently, ABI monitoring in patients with MI may identify patients with a higher risk profile and contribute to early clinical decision making.