bluuebunny/crossref_metadata_2025 huggingface dataset:
SEVERE-1 STUDY PROTOCOL: SECONDARY PREVENTION AND EXTREME CARDIOVASCULAR RISK EVALUATION, FOCUS ON PREVALENCE AND ASSOCIATED RISK FACTORS
Authors: Maloberti Alessandro , Intravaia Rita , Mancusi Costantino , Luca Nicola De , Golia Enrica , Cesaro Arturo , Chiara Benedetta Carla De , Bernasconi Davide , Algeri Michela , Grasso Alice , Giannattasio Cristina
Published: June 2023

Objective:

Despite significant improvement in secondary CV prevention strategies, some Acute and Chronic Coronary Sindrome (ACS and CCS) patients will suffer recurrent CV events (also called “extreme CV risk”). Recently new biochemical markers, such as Uric Acid (UA), Lipoprotein A (LpA) and several markers of inflammation, have been described to be associated with CV events recurrence.

We proposed a study (SEVERE-1) for the accurate characterization of extreme CV risk patients enrolled in Cardiac Rehabilitation (CR) programs. Our aims are to describe the prevalence of extreme CV risk and its association with newly described CV risk factors.

Design and method:

We will evaluate 730 ACS patients enrolled in a CR program. Extreme CV risk will be defined as the presence of a previous (within 2 years) CV events in the patients clinical hystory. UA, LpA and inflammatory markers (interleukin-6 and -18, tumor necrosys factor alpha, C-reactive protein, calprotectin and osteoprotegerin) will be assessed in ACS/CCS patients with extreme CV risk and compared with ACS/CCS patients without extreme CV risk and two control groups: 1180 hypertensives and 765 healthy subjects.

Results:

Then we will assess the association between newly described CV risk factors and extreme CV risk with multivariable model and, for biomarkers selected as relevant, we will create two score system for the identification of extreme CV risk patients. The first one will use only clinical variables while the second one will introduce biochemical markers on top. The AUC values will be used to compare the diagnostic accuracy. Finally, by exome sequencing we ill both evaluate polygenic risk score ability to predict recurrent events and we will do mendellian randomization analysis on CV biomarkers

Conclusions:

Our study proposal was granted by the PNRR M6/C2 call. With this study we will give definitive data on extreme CV risk prevalence (probably higher than what actually believed) rising attention on this condition and leading cardiologist to better diagnose this condition and to carry out a more intensive treatment optimization that will leads to a reduction of future ACS recurrence.
FECAL ZONULIN IS ASSOCIATED WITH CARDIOVASCULAR RISK MARKERS AND INCREASED ARTERIAL STIFFNESS IN A POPULATION-BASED SAMPLE
Authors: Kolesova Ekaterina , Rotar Oxana , Moguchaya Ekaterina , Boyarinova Maria , Erina Anastasia , Tolkunova Kristina , Kibkalo Sofia , Gurina Marina , Vasilieva Elena , Usoltsev Dmitrii , Artomov Mykyta , Mazing Aleksandra , Maslyanskiy Aleksey , Konradi Aleksandra
Published: June 2023

Objective:

To identify associations of fecal zonulin with cardiovascular risk factors including vascular damage in population-based sample.

Design and method:

77 patients without cardiovascular disease from a population-based sample were randomly invited and signed informed consent. All patients underwent a questionnaire (eating habits, physical activity, smoking, alcohol consumption, stress, anxiety, and depression, quality of life, EFPQ), anthropometry, blood pressure and pulse measurement, laboratory examination (biochemical blood test, lipids, fecal zonulin), vascular examination (carotid arteries ultrasound, applanation tonometry by SphygmoCor, volume sphygmomanometry by Vasera).

Results:

The analysis included 77 patients - 33 (42.8%) male with mean age 52 [43;59] years, and 44 (57.2%) female with mean age 60.5 [47.75;66] years. The results of the linear regression analysis adjusted for sex and age of the level of zonulin are presented in Table 1.

Conclusions:

Fecal zonulin has been associated with dietary patterns, heart and kidney markers, vitamin D), behavioral habits such as a tendency to depression and increased alcohol consumption, as well as signs of increased arterial stiffness. For the first time, we used an integrated approach using a surrogate marker of increased intestinal permeability and revealed its relationship with dietary characteristics and markers of vascular stiffness.
ELECTROLYTES AND VITAMINS IN HYPERTENSION. UPDATE 2023
Authors: Kisters Klaus , Gröber Uwe , Kisters Sophia
Published: June 2023

Objective:

Essential hypertension is the most common internal disease in Germany. This disease can result in a variety of cardiovascular diseases like myocardial infarction, heart insufficiency, or stroke.

In this context, electrolytes and vitamins are of growing interest. Especially an existing deficiency in electrolytes or vitamins has to be avoided. Due to malnutrition or medical treatment, a loss in electrolytes and vitamins can occur. Therefore the elderly hypertensive is at a special risk.

Design and method:

45 elderly (beyond 65 years) hypertensives (23 male, 22 female) patients were studied. None of the patients was renal insufficient, diabetic or under diuretics or supplemented with biofactors for at least 6 weeks before study.

Electrolytes (sodium, potassium, calcium and magnesium in serum, in addition ionized magnesium in blood) and vitamin D and interleukin 6 were measured.

Ionized magnesium was measured by a NOVA Prime plus apparatus, NOVA BIOMEDICAL, Andover, USA.

Data are means +/- SD. ANOVA was used for statisdtical analysis.

Results:

Sodium, potassium and calcium values were measured normal in each patient. Serum creatinine was below 1.2 mg/dl in all patients.

In seerum magnesium concentrations, only 1 subject had values below 1,5 mg/dl, all other elderly hypertensives had a normal serum magnesium concentration.

In contrast, ionized magnesium concentrations were significantly decreased in 15 of 45 patients, showing values below 0.5 mmol/l (py< 0.01), that is 30%.

Vitamin D levels were also significantly decreased, 17.6 +/- 6.1 ng/ml as compared to the normal values (> 20 ng/ml)(p< 0.01).

Interleukin 6 levels were significantly increased (5.52 +/- 3.38 pg/ml)(normal range below 2 pg/ml)(p< 0.01).

Conclusions:

In elderly hypertensives electrolyte disorder has to be corrected. A magnesium deficiency is observed in elderly hypertensives in about 30%, due to recent literature. In our study we can confirm these findings concerning ionized magnesium, too.

Interleukin 6 levels were found significantly increased, depending on a sufficient magnesium content.

Vitamins A, C, E and K can reduce oxidative stress, B vitamins are protective for vessels and neurons.

Vitamin D (in our study reduced)(in combination with magnesium) can reduce blood pressure, too.
THE ROLE OF IONIZED MAGNESIUM IN HYPERTENSION - INTERLEUKINS
Authors: Kisters Klaus , Cziborra Markus , Kisters Sophia
Published: June 2023

Objective:

Magnesium is involved in about 600 enzymatic and metabolic reactions. In patients at risk, e.g. hypertensives, a magnesium deficiency has to be taken into account. This can result in a varity of diseases, e.g. cardiovascular disorder, inflammation, arteriosclerosis and hypertension.

In addition, a magnesium loss can result in inreased interleukins 6 values, an important marker for inflammation.

Design and method:

Diagnosis of a magnesium deficiency can be usually performed either by laboratory measurements of serum magnesium routinely, anamnesis, or clinical symptoms.

The determination of ionized magnesium in blood is a new diagnostic tool to detect a magnesium deficiency very early (Phox plus apparatus, Nova Biomedical, Andover, USA). The analytical specification for imprecision CV% is about 3.0. In a variety of newer studies no correlation between serum and ionozed magnesium existed.

Interleukins were measured addionally in our patients, as a marker for inflammation in hypertension.

24 Patient with primary hypertension and metabolic syndrome were studied. All patients had a normal renal function, and no diuretics or magnesium supplements.

Results:

Ionized magnesium was measured 0.61 +/- 0.11 mmol/l. Normal range: 0.55-0.75 mmol/l.

Interleukin 6 values were statistically significantly inreased in hypertensives with metabolic syndrome, 5.43 +/- 3.9 pg/ml as compared to the normal range (p< 0.05, means +/- SD, normally < 2 pg/ml).

Conclusions:

Ionized magnesium was found in the lower normal range in hypertensive patients with metabolic syndrome.

In all patients Interleukins 6 were significantly increased (p<0.05).

Newer data show that patients with hypertension and metabolic syndrome can benefit from a magnesium therapy showing also a positive effect on interleukins and inflammation or artriosclerosis.

In this context an intact magnesium handling is of special importance in avoiding organ damage.

A supplementation of about 300 mg magnesium daily in these patients can be beneficial.
POLYGENIC RISK SCORES AND THEIR PHENOTYPIC ADJUSTMENT: NOVEL BIOMARKERS IN CARDIOVASCULAR DISEASE PREVENTION
Authors: Panagiotou Nikolaos , Bersimis Fragkiskos , Fotis Athanasios , Sagonas Alexis , Ntoumou Eleni , Salata Efi , Psychogios Apostolos , Kallistratos Manolis
Published: June 2023

Objective:

This study aimed to develop a novel genetic tool, the Polygenic Risk Score (PRS), to non-invasively and routinely estimate predisposition to cardiovascular diseases (CVDs), comprising coronary artery disease, dilated cardiomyopathy, hypertrophic cardiomyopathy, atrial fibrillation, ischemic stroke, and heart failure. The study also aimed to improve risk estimation by incorporating chronological age, physiological characteristics, and behavioral parameters to calculate an adjusted PRS.

Design and method:

Three algorithms were designed to i) search literature databases for GWAS on CVD predisposition, ii) derive Single Nucleotide Polymorphisms (SNPs) by assessing p-values, beta coefficients, odds ratios, and linkage disequilibrium metrics, and then iii) calculate the PRS for each CVD. Manual scientific evaluation was also employed. Thus, a novel genetic panel (termed iDNA Cardio Health) was developed to assess polygenic risk for the six above mentioned CVDs, following buccal swab sampling. Finally, we employed the American Heart Association's (AHA) Life's Simple 7 (LS7) lifestyle and phenotypic characteristics scoring system to assess current cardiovascular health status and then use this information, as well as chronological age, to dynamically calculate an adjusted PRS.

Results:

After testing the iDNA Cardio Health on a Greek population sample, we were capable to examine CVD risk stratification. Additionally, we could identify individuals with high polygenic risk, who could significantly benefit from lifestyle and/or clinical modifications. Furthermore, employing the LS7 categorization, we were capable to fine-tune risk prediction based on the adjusted PRS.

Conclusions:

It is evident that current clinical tools for CVD risk estimation may underestimate the risk, while the PRS can be employed to optimally reclassify individuals with marginal intermediate risk to a high-risk category. Our novel methodology, which at its core encompasses polygenic risk, can be combined with LS7 traditional clinical risk prediction metrics and chronological age to revolutionize CVD prevention though screening, monitoring, and clinical management, thus enabling the implementation of PRS and adjusted PRS in clinical care to empower personalized medicine.
THE INFLUENCE OF AMBULATORY BLOOD PRESSURE ON THE ASSOCIATIONS OF SEX WITH CARDIOVASCULAR EVENTS AND MORTALITY IN PATIENTS UNDERGOING HEMODIALYSIS: A PROSPECTIVE COHORT STUDY
Authors: Sarafidis Pantelis , Theodorakopoulou Marieta , Iatridi Fotini , Georgiou Areti , Karagiannidis Artemios , Karkamani Eleni , Tsitouridis Alexandros , Faitatzidou Danai , Papagianni Aikaterini
Published: June 2023

Objective:

Male patients with pre-dialysis CKD have worse ambulatory BP control than females and this is associated with higher mortality risk. Male hemodialysis patients have higher ambulatory BP levels compared to females. The aim of this study was to investigate the influence of ambulatory BP on the associations of sex with cardiovascular events and mortality in hemodialysis individuals.

Design and method:

129 male and 91 female hemodialysis patients with valid 48-hour ABPM were followed prospectively for 53.4±31.1 months. The primary endpoint was cardiovascular mortality; the secondary endpoint was a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, resuscitation after cardiac arrest, hospitalization for heart failure, coronary or peripheral revascularization procedure.

Results:

Cumulative-freedom from the primary endpoint was significantly lower for women (logrank-p = 0.032), while cumulative-freedom from the secondary endpoint did not differ significantly between the two groups (logrank-p = 0.644). The crude risk for cardiovascular mortality was significantly higher for women (HR = 1.613, 95% CI [1.037, 2.509]). The crude risk for the combined cardiovascular endpoint was not different between the two genders (HR = 0.918, 95% CI [0.638, 1.320]). After adjusting for other risk factors (age, diabetes, dialysis vintage, coronary disease) no significant differences in the risk for both the primary and the secondary endpoint were observed between women and men (primary: HR = 1.464 (95% CI [0.929, 2.307]), secondary: 0.866 (95% CI [0.596, 1.260])). After additional adjustment for 44-hour ambulatory BP the above relationships did not alter (primary: HR = 1.498, 95% CI [0.947, 2.368]), secondary: (HR = 0.911, 95%CI [0.625, 1.327])).

Conclusions:

In contrast to patients with pre-dialysis CKD, ambulatory BP does not appear to significantly influence the relationship between gender and adverse cardiovascular outcomes in hemodialysis patients.
RELATIONSHIP OF ARTERIAL STIFFNESS AND BASELINE CEREBRAL SMALL VESSEL DISEASE SCORE, WITH THE OCCURRENCE OF NEW LESIONS AFTER 2 YEARS OF FOLLOW-UP, INDEPENDENTLY OF BP CONTROL
Authors: Armario Pedro , Garcia-Sanzhez Sonia M , Font Maria Angels , Mengual Juan Jose , Avellaneda Carla , Montull Caterina , Castrillo Laura , Castellanos Pere , Blanch Pedro , Lleixa Merce , Martin-Baranera Montserrat , Gomez-Choco Manuel
Published: June 2023

Objective:

Hypertension is a prominent determinant of cerebral small vessel disease (cSVD). The aim of this study was to assess in subjects with a recent lacunar stroke, the factors associated with the occurrence of new lesions of cSVD after 2 years of follow-up.

Design and method:

Patients with a recent small subcortical infarct according to STRIVE criteria were consecutively included in this prospective study. Clinical BP was measured after 5 min of rest in a sitting position using a validated semiautomatic device (OMRON Digital Automatic Blood Pressure Monitor Model HEM-907XL, Kyoto, Japan). Three measurements of BP were averaged to determine values of clinical BP at baseline and at 3, 6, 12 and 24 months of follow-up. 24h-Ambulatory blood pressure monitoring (ABPM) was performed after hospital discharge within 30 days after stroke onset and after 2-years follow-up. The aortic pulse wave velocity (aPWV), the augmentation index (AIx) and 24h brachial and central BP (24h-ABPM) were measured by means of a Mobil-O-Graph PWV (IEM, Stolberg, Germany) device. The AIx was normalized for heart rate of 75 bpm (AIX75). Brain MRI was performed using a Phillips Achieva 1.5 T MRI at admission and at 2-years follow-up.

Results:

A total of 103 patients, aged 67.04 (10.9) years, 30.4% female, were included. Follow-up MRI was acquired in 92 patients. Backwards stepwise logistic regression analysis showed that 24h-PWV (OR 1.44 CI 95% 1.01-2,06 p = 0.044) and cSVD score (OR 2.3 CI 95% 1.41-3.77, p = 0.001) were associated with the presence of new lesions. Significance for 24h-PWV was lost after introducing age in de model, and only cSVD score remained significant (OR 2.33 CI95% 1.34-3.98, p = 0.002). The presence of new lesions was not significantly different between patients with or without BP control defined by BP < 130/80 mm Hg during the 24h-ABPM.

Conclusions:

In subjects with a lacunar stroke, 24h-PWV and cSVD score were associated significantly with the presence of new lesions after 2 year of follow-up, independently of BP control
COGNITIVE COMPLAINT IN HYPERTENSIVE PATIENTS
Authors: Rivero María Noel , Más Valentina , Spósito Paola , Cuba Ximena , Llorens Mario
Published: June 2023

Objective:

To describe the prevalence of CC in hypertensive patients and its link to an increased cardiovascular risk (CVR) profile.

Design and method:

Observational, descriptive, analytical and cross-sectional study. Inclusion criteria: hypertensive patients over 18 years old presenting Montreal Cognitive Assessment (MoCA). Exclusion criteria: motor or sensory difficulties, psychiatric disease, illiteracy.

Qualitative variables are presented as absolute and relative frequencies. Chi-square test was used for association analysis. Differences were studied through Student's t-test for independent samples. A significance level of alpha = 0.05 was set. The statistical software used was STATA v.17.0.

Results:

This study included 111 patients, with a 1:4 women:men rate and an average of 60 years old. Cognitive complaint was present in 45.9% of patients. Of all patients, 81% presented grade 3 arterial hypertension according to 2018 ESC guidelines, 31.5% having been diagnosed at least 20 years prior. 35.1% showed a non-dipper pattern and 45.9% nocturnal hypertension. Around 52.3% of patients had less than 8 years of studies and 33.3% had a MoCA score higher than 23. Dyslipidemia was present in 34.2% of patients, 72.1% were overweight/obese and 36% were smokers. 40.5% of patients had established heart disease (HD). The cognitive complaint patient group was associated with those with non-dipper pattern (p = 0.034), coronary artery disease and ischemic cardiopathy, with p-values of 0.019 and 0.045 respectively. This study observed a link between CC and transient ischemic cerebrovascular stroke (p = 0.027). Out of all patients suffering CC (51), 58.8% (30) presented unaltered MoCA, while association to an altered MoCA was significant (p = 0.039).

Conclusions:

Cognitive Complaint is related to a cardiovascular risk profile in hypertensive patients. Association with an altered MoCA in patients suffering CC highlights the risk of evolution towards Mild Cognitive Decline and dementia.
MICRONUTRIENT INTAKE AND HYPERTENSION AMONG ADOLESCENTS, NHANES 2007-2018
Authors: Baker-Smith Carissa , Kernizan Daphney , Falkner Bonita , Akins Robert
Published: June 2023

Objective:

To examine the relationship between nutrient intake and hypertension (HTN) diagnosis in adolescents.

Design and method:

This cross-sectional study analyzed representative nutrient and sociodemographic factors from six 2-year cycles (2007 to 2008 through 2017 to 2018) of the National Health and Nutrition Examination Survey. The sample included adolescent survey participants,13 to 18 years of age. Nutrient intake estimates were derived from total dietary recall and daily supplement recall data. Systolic and diastolic HTN were defined based upon the average of 2-3 measured blood pressures. An average systolic blood pressure at or above 130mmHg was used to identify adolescents with systolic HTN, while an average diastolic blood pressure at or above 80mmHg was used to identify youth with diastolic HTN.

Using descriptive statistics, inclusive of chi-square analysis for categorical data and Wilcoxon rank sum test for continuous data, we assessed the relationship between a variety of sociodemographic variables, nutrient variables and systolic HTN (or diastolic HTN). Logistic regression was performed to determine factors associated with a greater odd of HTN. Goodness of Fit of the logistic regression model was assessed.

Results:

Among 5866 US adolescents, the sodium to potassium ratio was higher and the folate level lower among youth with systolic HTN. Other factors associated with systolic HTN included older age, male sex, and obesity. According to the logistic regression model, factors associated with a greater odd of systolic HTN included age, sex (male), and obesity. Higher folate levels were associated with a lower odd of systolic HTN. Among youth with diastolic HTN, only age and obesity were associated.

Conclusions:

Hypertension (HTN) is the most common preventable cause of cardiovascular disease (CVD) in the US and globally. It is prevalent in 2-4% of youth.1, 2 Nutrient intake and HTN in adolescents has major public health implications. Like previously published findings in adults, 3 we found that folate > 5000mcg is associated with lower blood pressure. In this study, sodium intake, potassium intake, magnesium and lycopene levels were not associated with HTN in adolescents.
FROM A SYNCOPE TO MYOCARDITIS - AN UNUSUAL MANIFESTATION OF MYOCARDITIS IN OBESE PATIENT WITH HYPERTENSION AND PARANOIDAL SCHIZOPHRENIA
Authors: Zbroch Edyta , Wawiernia Julia , Zbroch Aleksandra , Zalewska Aleksandra , Baranowska Magdalena , Sielatycki Piotr
Published: June 2023

Objective:

The case report presents a 30-year-old obese patient with a history of paranoidal schizophrenia, sinus tachycardia and hypertension which was admitted to the Department of Internal Medicine and Hypertension after fainting the day before. In the admission the patient suffers from a chest pain, dizziness, and abdominal pain. The physical examination revealed: BP 161/104mmHg, HR 120/min, SatO2 94%, overdeveloped fatty tissue and pain in the left chest and abdominal area after a collapse. Laboratory tests showed increased inflammation and cardiac parameters as well as extremely high concentration of TCAs (Tricyclic antidepressants). The ECG and ECHO were carried out, the former showed ST elevations in ECG leads II, III, aVF, V4-V6, the latter reveled dilation of the right ventricle, left ventricular hypertrophy and lower ejection fraction, EF = 48%. Hypotensive treatment was implemented resulting lowering blood pressure. However, the patient's condition did not get better. Stabbing and burning chest pain persisted. Considering a clinical picture, contrast-MRI was performed showing LGE (late gadolinium enhancement) on the lateral-inferior part of the left ventricle wall characteristic for myocarditis (MC).

The objective of this case report is to highlight a possibility of myocarditis when there are symptoms responding to other heart diseases, atypical for MC and the role of detailed diagnostic process and holistic perspective.

Design and method:

Case report presentation of the patient admitted to the hospital due to the collapse episode the day before. Symptoms and additional test analysis and making the final diagnosis.

Results:

Initial diagnostic tests were negative or inconclusive until heart contrast-MRI was performed revealing - LGE foci in the left ventricle wall corresponding to the area of inflammatory lesion of the lateral-inferior part of the left ventricle wall.

Conclusions:

Although, myocarditis is a rare finding, more frequent in younger population, it is associated with significant complications and mortality thus early diagnosis can prevent critical condition. In presented case, the difficulty in making a final diagnosis of myocarditis was affected by predominant cardiac attack symptoms. Moreover, MC could be caused by TCA which high concentration was found in the patient's blood.
HYPERTENSION-RELATED IMPAIRMENT OF MESENTERIC ENDOTHELIAL FUNCTION CONTRIBUTES INTO GUT-LIVER AXIS VIA INTESTINAL DYSBIOSIS AND HEPATIC STEATOSIS, AND ASSOCIATES WITH GENETIC DYSRE
Authors: Dzhuryak Valentyna , Sydorchuk Larysa , Voroniuk Kseniia , Sydorchuk Ruslan , Sokolenko Alina , Repchuk Yulia , Semianiv Marianna , Yarynych Yulia , Iftoda Oksana
Published: June 2023

Objective:

Metabolic violations, obesity and other related comorbidities are obvious in arterial hypertension. It is known that Hepatic Steatosis (HS) and Arterial hypertension (AH) has to some extend common pathogenesis realized through metabolic and immune mechanisms involving vascular and digestive system injury, and forming Gut-Liver axis, which remain mostly untouched in recent studies. We aimed on evaluating the endothelial function and mesenteric vessels remodeling depending on I/D polymorphism of angiotensin-converting enzyme (ACE) gene and A1166C polymorphism of angiotensin II type 1 receptor (AGTR1) gene in hypertensive patients with HS.

Design and method:

Study included 104 AH patients with HS (50 females, 54 males, age 53.2±8.7). Intimae-media thickness (IMT) of abdominal aorta (AO) and other flow mediated parameters of mesenteric vessels state evaluated by sonography. NO (nitrite/nitrate) plasma concentration, vascular adhesive molecule (sVCAM-1) level were defined by IEA. ACE (I/D) and AGTR1 (A1166C) genes polymorphisms assessed with PCR.

Results:

High risk of endothelial dysfunction (ED) is: D-allele of ACE gene (p<.001); C-allele of AGTR1 gene (p = .02). In DD-genotype were higher flow-mediated parameters of mesenteric vessels. IMT of AO was thicker in CC-genotype of AGTR1 gene (p = .039-.01) and independent on I/D genotypes of ACE gene. sVCAM-1 level was higher (p<.01) in D-allele of ACE gene, than in II-genotype and not depending on A1166C polymorphism of AGTR1 gene. NO plasma level doesn’t depend on ACE (I/D) and AGTR1 (A1166C) genes polymorphisms. Vascular remodeling in HS patients (AO IMT enlargement for more than 0.9 mm) is associated with dysbiosis III-IV grades’ and sVCAM-1 plasma level growth by 1,3-1,6 times (p<.05-.001). AO IMT correlates with dysbiosis severity, presence of HS and sVCAM-1 level and is independent from AH severity.

Conclusions:

Risk contingents for endothelial dysfunction and mesenteric vessels remodeling in HS patients are: by sVCAM-1 plasma level and diameter of mesenteric vessels increasing – DD-genotype carriers of ACE gene; by IMT of abdominal aorta enlargement – CC-genotype carriers of AGTR1 gene (p<0.02-0.001).
DIURETIC THERAPY – STILL NUMBER 1 REASON FOR HYPONATREMIA
Authors: Sima Diana-Stefania , Nicolae Lorena-Daiana , Weiss Emma , Munteanu Diana Mihaela , Barboi Teodora-Maria , Diaconu Camelia Cristina , Balahura Ana-Maria
Published: June 2023

Objective:

Hyponatremia is the most common electrolyte imbalance in hospitalized patients. Up to 35% of patients develop hyponatremia during hospitalization. Hypertension is also common in hospitalized patients with prevalence rates up to 72%. We aimed to study the main causes of hyponatremia in hospitalized patients and to investigate the association between hyponatremia and hypertension in this population.

Design and method:

We included consecutive patients admitted to our hospital between March 2019 and August 2021, with the diagnosis of hyponatremia. We retrospectively analyzed the electronic health records and we collected demographic data, clinical and paraclinical data, hyponatremia etiology and associated comorbidities. We conducted comparative analysis between group without hypertension (Group 1) versus group with hypertension (Group 2).

Results:

The study population included 397 patients (mean age 71 ± 12 years old, 50,9 % women) with hyponatremia (4,9% of total admissions to our department in the specified period of time) -40,6% mild and 59,4% moderate-severe hyponatremia. The main causes of hyponatremia were diuretic use (37,7%), SARS-COV2 infection (17,1%), NYHA class IV heart failure (12,5%), SARS-COV2 infection associated with diuretic use (10,3%). 21,9% of patients had chronic treatment with psychotropic medication (antidepressants or antipsychotics), 8,6% of patients had chronic treatment with antiepileptic drugs The majority of patients in the study population had hypertension (68,3%). Patients in the hypertensive group were older (72 ± 11 vs 67 ± 15 years old, p<0,001). Mean sodium at hospital admission was lower in group 2 (125,9 vs 127,8 p = 0,01). Hyponatremic encephalopathy was more common in group 2 (15,9% vs 4,0%, p = 0,001). Diuretic use was also more prevalent in hypertensive group (56,3% vs 31,0%, p<0,001). Loop diuretic use was similar between groups (38,5%-Group 1 vs 32,5% - Group 2, p = 0,47), but thiazide-like diuretic use was more common in Group 2 (46,8% vs 20,5%, p = 0,003).

Conclusions:

The most common etiology of hyponatremia in the internal medicine department of an emergency hospital was diuretic use. Hypertension was associated with older age, lower sodium at hospital admission, hyponatremic encephalopathy and thiazide-like diuretic use in this population.
PROGNOSTIC VALUE OF ISOLATED HIGH SERUM CYSTATIN C LEVELS WITHOUT GLOMERULAR FILTRATION RATE REDUCTION
Authors: Villa Juan , Cancho Barbara , Valladares Julian , Lopez Alvaro Alvarez , Sabillon Jorge Alberto Rodriguez , Gomez Juan Lopez , Robles Nicolas Roberto
Published: June 2023

Objective:

Cystatin C is increasingly used as a marker of renal function as a complement or alternative to serum creatinine and GFR calculated from it. However, cystatin C is also a marker of inflammation. We have assessed its efficacy as a predictor of mortality in a group of patients with elevated cystatin C and GFR > 60 ml/min.

Design and method:

We included 608 patients seen at our hospital, 65.9% of whom were male and 34.6% had diabetes mellitus. The mean age was 58.5±14.5 years and a mean GFR of 64.1±33.5 ml/min. Patients were divided into 3 groups: CONTROL (normal cystatin C and GFR > 60 ml/min, age 53.3±12.8 years, GFR 96.6±22.4 ml/min, n = 193), ELEVATED CYSTATIN (elevated cystatin C and GFR >60 ml/min, age 58.9±13, 1 years, GFR 72.2± 10.4 ml/min, n = 40 ) and CKD (chronic kidney disease, elevated cystatin C and GFR <60 ml/min, age 61.4±14.8 years, GFR 36.0±12.7 ml/min, n = 160). The relationship with overall mortality was analyzed using the survival curve by Kaplan-Meier method.

Results:

Mean cystatin C was 0.75±0.13 mg/l, versus 1.79±0.54 in the CKD group and 1.14±0.14 mg/l, p<0.001 ANOVA). In the CONTROL group survival was 93.9% at five years, compared to 78.8% in the ERC group and 82.3% in the CYSTATIN ELEVATED group (p < 0.001 Log Rank). Five-year survival before renal replacement therapy was also different for the ERC group (73%, p < 0.001 Log Rank) but not between the other two groups (CONTROL 99.0%, HIGH CYSTATIN 94.3% p = 0.08 Log Rank).

Conclusions:

The presence of elevated cystatin C in patients with GFR > 60 ml/min was a predictor of increased mortality but not of progression to end-stage renal failure. These results confirm the interest of routinely measuring cystatin C in our patients.
SECONDARY HYPERTENSION IN THE INTERNAL MEDICINE OUTPATIENT DEPARTMENT OF A PORTUGUESE HOSPITAL
Authors: Féria Rita Palma , Martins Joao Dinis , Moules Pedro , Pina Henrique , Oliveira Joana , Guerra Silvia , Valadas Cristina , Gonçalves Fernando Martos , Araújo José Lomelino
Published: June 2023

Objective:

Secondary hypertension is an uncommon form of hypertension and universal screening is not beneficial or cost-effective. Consequently, investigation is reserved for selected cases, according to clinical suspicion, and is often referred to a specialist.

The aim of this study was to characterize the evaluation of secondary hypertension in the Internal Medicine Outpatient Department of a portuguese hospital.

Design and method:

This longitudinal retrospective study analysed patients referred to our Internal Medicine Outpatient Department for hypertension evaluation in 2021. Patient records and results were analysed, focusing on indication for evaluation, testing performed and identified causes of secondary hypertension.

Results:

A total of 147 patients were referred for hypertension evaluation, 7 (4,76%) of which were explicitly referred for secondary hypertension screening. Testing was conducted in 105 patients (71,43%), with basic evaluation (CBC, renal function, thyroid function) in 71 patients (48,30%) and additional testing (such as endocrine, renovascular, obstructive sleep apnoea screening) performed in 34 patients (23,13%).

Considering age criteria, resistant hypertension, and other clinical clues, 60 patients (40,82%) had a documented indication for additional testing for secondary hypertension.

Additional testing was requested in 5 patients (3,40%) not meeting these criteria, most of whom needed testing to follow-up investigations ordered in primary care without clear indication.

Conversely, a small proportion (6,12%) met criteria for additional testing that wasn’t requested: 22% already had a previous screening ordered in primary care negative for secondary hypertension; 44% were evaluated for hypertension-mediated organ damage without further screening.

Patients in which specific evaluation was complete at the time of this study, a secondary cause was identified in 9 patients (6.12%), all with a previous diagnosis of Obstructive Sleep Apnea.

Conclusions:

The prevalence of secondary forms identified didn’t significantly differ from the described 5-10% overall prevalence of secondary hypertension and reiterated the identification of OSA as an exceedingly common recognized cause of hypertension.

This study emphasised that extensive testing was mostly non-diagnostic and was associated with inconclusive results leading to further investigations, raising costs and risks. This suggests that careful selection of patients and method of screening by a specialist is beneficial.
ARTERIAL WALL CONDITION IN WOMEN WITH HYPERTENSION AND POSTMENOPAUSAL OSTEOPOROSIS
Authors: Kniazkova Iryna , Bilovol Alexander , Tsygankov Alexander , Frolova Tetyana , Zhadan Andriy , Bogun Maryna
Published: June 2023

Objective:

The aim of the study was to investigate the indices of arterial stiffness and central aortic pressure in women with hypertension in combination with osteoporosis.

Design and method:

The study included 68 females (mean age 62.7±3.8 years) with hypertension, grade 2 in postmenopause including 35 females with osteoporosis (group 1) and 33 females without signs of osteoporosis (group 2) according to osteodensitometry investigation. The control group consisted of 20 healthy females (mean age 61.3±3.5 years). Before the study, the patients did not receive regular antihypertensive drugs and hormone replacement therapy. In addition to conventional studies the levels of calcium, phosphorus, alkaline phosphatase, deoxypyridinoline, parathyroid hormone, 25(OH) vitamin D, osteocalcin, C-terminal telopeptide of type I collagen in blood were determined. Fracture risk assessment (FRAX), daily blood pressure monitoring, applanation tonometry and dual-energy X-ray absorptiometry were performed.

Results:

It was found that in group 1 the levels of office systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 3.7% and 4.9% (p<0.05) higher than in group 2. According to the data of daily BP monitoring a more pronounced increase of mean daily SBP and DBP by 4.1% and 6.6% (p<0.05) was observed in group 1 in comparison to group 2. Indicators of pressure load according to the time index of hypertension by SBP and DBP were significantly higher by 21.7% and 25.4% during the day and 22% and 18.2% at night (all p<0.05). In patients of group 1 an increase in the aortic augmentation index of wave reflection (Aix) and the augmentation index of wave reflection, adjusted for heart rate (AIx @ HR 75) by 26.6% and 29.8% compared to patients of group 2 respectively, was revealed. It was found that in group 1, compared with the control group and group 2, an increase in pulse wave velocity by 37.2% and 26.4% respectively was detected.

Conclusions:

It was found that in patients with hypertension in combination with postmenopausal osteoporosis, according to office, daily monitoring and applanation tonometry, blood pressure levels and arterial stiffness parameters were significantly higher than in patients with hypertension without osteoporosis.
ARTERYAL HIPERTENSION AND VERY ELDERLY PATIENTS. THE EXPERIENCE OF AN INTERNAL MEDICINE DEPARTMENT
Authors: Grigore Cristiana , Balaceanu Beatrice , Gurau Cristian Dorin , Giuglea Carmen , Dina Ion , Balaceanu Alice
Published: June 2023

Objective:

The purpose of this study is to highlight the clinical and paraclinical characteristics of fragile hypertensive patients, over 85 years old, admitted to a mixed internal medicine department (Covid and non-Covid) between January 2022 and October 2022.

Design and method:

Between January 2022 and October 2022, 80 patients with a primary or secondary diagnosis of arterial hypertension were admitted, of which only 23 (28.75%) were over 85 years old. Of the 23 patients, 13 (56.52%) were hospitalized with a diagnosis of Sars Cov 2 infection. Regarding the gender distribution, 12 are women (52.17%) and 11 are men (47.82%). Patients comorbidities: 14 patients (60.86%) with different degrees of heart failure, atrial fibrillation (39.13%) - 8 patients and one patient was diagnosed with atrial fibrillation during hospitalization, cognitive disorders and dementia in a proportion of 47.82 % (11 patients) and a significant number of patients were admitted with moderate-severe anemia (13 patients, 56.52%). Of the 9 patients with atrial fibrillation, 5 are male (55%) and 4 (45%) female, cardiac enzymes (troponin and CK MB) are within normal limits in 8 patients. During the medical tests, 3 patients (13.04%) were diagnosed withdifferent of neoplasia. Only 2 patients (8.69%) presented slight dyselectrolytemia (hyponatremia and hypokalemia).

Results:

Pathologies are treated with: angiotensin converting enzyme inhibitors (17.39% - 4 patients), calcium channel blockers (39.13% - 9), anticoagulants (39.13% - 9 patients), diuretics (26.08 %-6 patients) and beta blockers (11 pac-47.82%).

13 patients (56.52%) died and 43.47% were discharged with an improved condition. 9 patients died as a result of Covid multiple organ system failure, 1 death was of cardiovascular cause and 3 non-Covid pulmonary failure deaths.

Conclusions:

Frail patients, older than 85 years, with multiple comorbidities, require detailed investigations and adjustments of medication doses according to their status in order to maintain the discreet balance in which they are.
STUDIES OF THE CORRELATION OF THE TAFI GENE WITH ARTERIAL HYPERTENSION IN PATIENTS WITH CORONARY HEART DISEASE
Authors: Zokirova Muborakhon
Published: June 2023

Objective:

The purpose of our work was to study the associative relationship and role of the thrombin-activated fibrinolysis inhibitor (TAFI) with hypertension and the severity of coronary heart disease.

Design and method:

The object of the study was 2 groups of patients, 1 group of 35 people with Stable angina and 2 group of 33 people with Unstable angina who voluntarily signed the information consent. The study was conducted by a prospective method in the TMA clinic. in group 1, grade 2 hypertension (40%) and grade 1 hypertension (31.4%), grade 3 hypertension (14.3%) prevail. smoking – 37.1%, inactivity – 48.5%, as well as severe Anxiety-depressive syndrome – 34.3%. In group 2, hypertension 2 (13.6%), hypertension 1 (27.1%) and hypertension 3 degrees (12.1%). smoking and sedentary lifestyle – 45.5% each; overweight – 30.3%. All patients underwent a genetic blood test for TAFI gene polymorphism. In group 2 of patients with NS, the indicators of hypertension of 1 and 2 degrees became reliable, which means that the contribution of arterial hypertension to the development of complications of coronary heart disease is unambiguous. According to EchoCG data, no significant differences in EDV and ESV of LV, as well as LV EF parameters were revealed in the studied groups.

Results:

According to the results of our study, in both groups of respondents from groups 1 and 2, the picture of correlation dependence turned out to be as follows: a strong correlation was found between hypertension, hereditary burden, smoking, inactivity, hypercholesterolemia, as well as malnutrition and patients with diabetes in both groups. The average correlation is determined with hypercholesterolemia in the blood and Anxiety depressive syndrome.

Conclusions:

Together with the factors of coagulation hemostasis and hereditary predisposition to them, the doctor should pay attention to the prevention of Arterial hypertension and smoking in patients with Stable angina pectoris and Unstable angina pectoris.
4-OCTYL ITACONATE ATTENUATES ISOPROTERENOL INDUCED MYOCARDIAL DAMAGE VIA NLRP3 INFLAMMASOME PATHWAY, NRF-2/HO-1 AND MAPK PATHWAY IN AN EXPERIMENTAL MODEL
Authors: Sharma Jatin , Bhargava Poorva , Arya Ds , Bhatia Jagriti
Published: June 2023

Objective:

Myocardial infarction (MI) is the major cause of morbidity and mortality worldwide. According to the World Health Organisation, more than 9 million deaths occurred due to ischemic heart disease worldwide in 2016. 4-octyl itaconate (4-OI) is a cell permeable derivative of itaconate with potent anti-oxidative, anti-inflammatory and anti-fibrotic properties. Studies have shown that 4-OI inhibits pro-inflammatory cytokines (IL6, IL1beta, TNF alpha) and activates the anti-oxidant Nrf-2/HO-1 pathway. The aim of the study was to investigate the cardio-protective effect of 4-OI in experimental model of Isoproterenol induced myocardial damage.

Design and method:

Adult male albino wistar rats were used in the study. They were randomly divided to five groups i.e., normal control group, isoproterenol control group, 4-OI group (2.5, 5 or 10 mg/kg) for 14 days and 4-OI perse group. On the 15th day, rats were anaesthetized and right coronary artery was cannulated to record hemodynamic parameters. Following this, blood was withdrawn using cardiac puncture, heart was excised and preserved for analysis of biochemical, histopathological and molecular pathway studies.

Results:

Isoproterenol administration to rats resulted in induction of Myocardial damage as shown by impairment in hemodynamic parameters, left ventricular dysfunction and raised cardiac injury markers. Treatment with 4-OI significantly improved hemodynamic and cardiac injury markers (CKMB, LDH). Further, 4OI significantly reduced oxidative stress (enhanced levels of SOD, GSH, decreased MDA levels) and inflammation (reduced levels of TNF alpha, IL-6, IL-1beta and NLRP3). Further it activated the Nrf-2-HO-1 pathway while inhibits the inflammatory NFKB pathway. Apart from this, it also ameliorated apoptosis by decreasing the expression of Bax, caspase-3 and increasing the expression of anti-apoptotic Bcl-2. It also inhibited inflammatory MAPK proteins (JNK, phospho JNK, P38, phospho P38) while enhancing the expression of pro-survival kinases ERK1/2, and Phospho ERK1/ 2.

Conclusions:

Oral administration of 4-OI at a dose of 10 mg/kg ameliorated the severity of isoprotorenol-induced cardio-toxicity in rats via NLRP-3 inflammasome pathway, MAPK and Nrf-2/HO1 pathway and by maintaining morphological structure of heart tissue and oxidative stress profile along with reduced inflammation and apoptosis.
MARKERS OF ENDOTHELIAL DYSFUNCTION IN CORONARY HEART DISEASE PATIENTS DEPENDING ON ARTERIAL HYPERTENSION PRESENCE
Authors: Romanova Valentyna , Kuzminova Nataliia , Romanova Lidiia , Ivankova Anastasiia
Published: June 2023

Objective:

To evaluate the role of arterial hypertension (AH) on endothelial functional state in the coronary heart disease (CHD) patients.

Design and method:

173 CHD patients were examined (the average age was 57.24±5.12 years): 92 patients with stable angina (45 with II functional class (FC) (23 without and 22 with AH) and 47 with III FC (26 without and 21 with AH) and 81 patients with acute coronary syndromes (ACS)(43–with unstable angina (UA) (22 without and 21 with AH) and 38–with acute myocardial infarction (MI) (20 without and 18 with AH)).

Endothelial dysfunction was assessed by the levels of vasoconstrictor endothelin-1 (ET-1) and the concentration of soluble vascular adhesion molecule (sVCAM), which were determined by ELISA.

Results:

Both markers of endothelial dysfunction increased with an increase in disease severity. The most severe changes were in patients with ACS, although differences between patients with UA and MI were not significant (p>0.05). Levels of ET-1 were significantly higher (p<0.05) in all clinical variants of CHD in patients with AH regarding patients without it. The same tendance (difference with p<0.01 ) was observed with sVCAM levels, but only in stable CHD patients. sVCAM levels raised significantly in ACS patients not only according to the control group, but also patients with stable CHD (p<0.05), but without difference depending on AH presence in both groups with UA and MI (p>0.05).

There were no significant associations between levels of endothelial dysfunction markers and troponin I and T (p>0.05).

The significant relationships between levels of sVCAM and ET-1 on one hand and C-reactive protein on other were noted in both groups with stable CHD and with ACS, regardless of the presence of hypertension.

Conclusions:

Elevated levels of ET-1 and sVCAM in blood of CHD patients are the indicator of atherosclerotic plaque instability and the possibility of ACS development, especially with AH comorbidity.
DEMOGRAPHIC AND CLINICAL CHARACTERISTICS AND IN-HOSPITAL OUTCOME OF HYPERTENSIVE PATIENTS WITH ST SEGMENT ELEVATION MYOCARDIAL INFARCTION
Authors: Kalimuddin Md , Malik Fazilatun-Nesa , Ahmed Nazir , Badiuzzaman Mohammad , Ahmed Mir Nesaruddin , Dutta Ashok , Banik Dhiman , Kanungo Smita , Laila Nazmun , Ara Esmat
Published: June 2023

Objective:

There is little information on the incidence and prognostic significance of hypertension in ST segment elevation myocardial infarction (STEMI) patients, especially in Bangladeshi population. The study aimed to compare the demographic & clinical characteristics and in-hospital outcome of hypertensive versus non-hypertensive patients with STEMI.

Design and method:

This prospective observational study was conducted from January 2015 to December 2022 at National Heart Foundation Hospital & Research Institute. Patients were divided into two groups: hypertensive and non-hypertensive groups.

Results:

A total of 10378 patients were enrolled in this study. Of them 65.6% (6813) patients were hypertensive, and 34.4% (3565) patients were non-hypertensive. Mean age of the hypertensive group was 55.89 ± 11.18 years and the non-hypertensive group was 53.49 ± 12.25 years (p = 0.001). In hypertensive group, 84.1% patients were male and 15.9% were female & in non-hypertensive group, 90.4% patients were male and 9.6% were female (p = 0.001). Compared to non-hypertensive patients, hypertensive patients were predominantly non-smoker (49.1% vs 39.9%; p = 0.001), diabetic (68.3% vs 32.1%; p = 0.001), dyslipidemic (80.7% vs 77.3%; p = 0.001), obese (37.8% vs 32%; p = 0.001), have positive family history of ischemic heart disease (IHD) (29% vs 22.4%; p = 0.001), prior history of percutaneous coronary angioplasty (3.7% vs 2.1%; p = 0.001), prior history of myocardial infarction (5.8% vs 4.6%; p = 0.007), and chronic kidney disease (48.2% vs 40.2%; p = 0.001). Hypertensive patients had more multi-vessel disease (49.3% vs 42.6%; p = 0.001), higher in-hospital complications (acute left ventricular failure-24.4% vs 21.9%; p = 0.005) and in-hospital death (4.8% vs 4%; 0.04).

Conclusions:

Hypertensive patients with STEMI were predominantly non-smoker, diabetic, dyslipidemic, obese, have positive family history of IHD, chronic kidney disease and had higher in-hospital complications & in-hospital death.