bluuebunny/crossref_metadata_2025 huggingface dataset:
THE WHITE COAT EFFECT LEVEL CORRELATED WITH LIFESTYLE COMPONENTS AND SOCIO-DEMOGRAPHIC DATA IN PATIENTS WITH ARTERIAL HYPERTENSION
Authors: Andreeva Galiya , Koshelyaevskaya Yana , Smirnova Marina , Gorbunov Vladimir , Kurekhyan Armine
Published: June 2022

Objective:

The aim of study was to define if the lifestyle components and socio-demographic data of patients with arterial hypertension (AH) may correlate with white coat effect (WCE) level.

Design and method:

We nalysed ambulatory blood pressure monitoring (ABPM) data of 125 AH patients, who were treated with regular antihypertensive therapy. This study was prospective and included three visits every 3 months: 1 visit - screening, ABPM session; 2 - assessment of the patient’s status and the therapy effectiveness; 3- assessment of the patient’s status, ABPM session (the total ABPM number was 239). The WCE level was assessed as the difference between clinical BP measurement and mean daytime BP. We used ANOVA for statistical analysis.

Results:

The initial mean daytime BP was (M ± SD): systolic (SBP) - 123.2 ± 11.2; diastolic (DBP) - 73.0 ± 6.9 mm Hg. The mean age of the patients was 62.2 ± 8.7. We found relationships between the lifestyle components and WCE: 1) alcohol intake level had negative correlations with systolic WCE (SWCE) (F = -5.7 p < 0.0002) and diastolic WCE (DWCE) (F = -4.0, p < 0.001) levels; 2) smoking intensity had negative correlations with SWCE (F = -4.9 p < 0.001) and DWCE (F = -3.1 p < 0.002). We have identified that age and duration of AH were associated with SWCE (r = 0.23, p < 0.0003 and r = 0.14, p < 0.03 respectively), also height and body mass index (BMI) had negative correlations with DWCE (r = -0.27, p < 0.01) levels. Education level (F = 2.7, p < 0.042 for SWCE and F = 4.7, p < 0.003 for DWCE), marital status (F = 2.4, p < 0.048 for SWCE,) and gender (F = 5.8, p < 0.016 for SWCE and F = 9.2, p < 0.003 for DWCE) were correlated with WCE: WCE was higher in women, widowers and unmarried persons without higher education (see table).

Conclusions:

Thus, increase of the alcohol intake and smoking intensity can lead to WCE reduction and the masked hypertension manifestation. Height and body mass index had negative correlations with WCE, age and duration of AH had positive association with WCE. Also, WCE was higher in women, widowers and unmarried persons without higher education. Probably, married young tall men with higher education have a tendency to the masked hypertension manifestation.
CIRCADIAN PATTERN IN PATIENTS OLDER THAN 75 YEARS WITH HYPERTENSION
Authors: Carbonell Ana M. Piera , Anton Pilar Rodriguez , Carrasco Rodrigo Orellana , Suarez M. Jesus Campomanes , Robert M. Ángeles Gavaldá , Lozano Juan Eugenio Forcada , Diaz Miguel Ángel Prieto , Sanchez Vicente Martin , Rodríguez Ángel Díaz , Garrote Juan Antonio Divison , Carratalá Vicente Pallarés
Published: June 2022

Objective:

To know the circadian pattern of hypertensive patients older than 75 years, by monitoring blood pressure for 24 hours.

Design and method:

Multicenter cross-sectional descriptive study in hypertensive patients aged 75 or over. It was designed for a sample of 117 people, calculated for 8% hypotensive episodes, with a 95% confidence interval, 5% precision, and 25% losses.

Non-proportional stratified random sampling was performed, excluding patients with modified antihypertensive treatment in the last month and/or arrhythmias.

Through 24-hour ambulatory blood pressure monitoring, the incidence of hypotensive episodes was observed.

Associated comorbidities, antihypertensive treatment, and sleep quality during ABPM were recorded from the interview and clinical history.

Percentages, means, confidence intervals were obtained and the chi square test was performed in the bivariate analysis.

Results:

Of 117 monitored patients, 100 completed the study, with a mean age of 79.2 years (SD 3.9 years) and 59% women. 91.5% of women and 58.6% of men were overweight or obese. Some type of heart disease was associated with 31% of patients, and 33% had DM2, 38% anxiety-depressive disorder, and vertigo, 16%. 50.8% of the women and 61% of the men did not have good control of the mean TAS figures in the 24-h ABPM. However, DBP was controlled in 84.7% and 80.5% of women and men, respectively. The mean BP was 145.49/78.9 (SD 21 and 11.7, respectively). 34% of the patients presented a dipper pattern. 27% have a riser pattern. 76% of the patients presented at least one episode of hypotension, which was accompanied by symptoms in 11.8% of the cases, with headache and dizziness being the most frequent. No significant association has been observed between the number of antihypertensive drugs and the occurrence of hypotensive episodes.

Conclusions:

Most of the patients presented an alteration in the circadian pattern of blood pressure in ABPM and poor control of BP figures, especially at the expense of systolic blood pressure. It is advisable to monitor blood pressure in the elderly to adapt control to chronotherapy criteria.
IS HOME BLOOD PRESSURE SELF MONITORING HERE TO STAY? AN EVALUATION OF PATIENT SATISFACTION WITH HOME BLOOD PRESSURE MONITORING IN A RURAL POPULATION DURING THE COVID PANDEMIC
Authors: Patel Anjali , Rasheed Reshma , Zarif Ahmad , Mahmod Azad , Bibi Hajira , Nazir Imad
Published: June 2022

Objective:

During the COVID pandemic patients with hypertension were trained to self-monitor blood pressures at home. A post service transformation evaluation was undertaken as COVID restrictions were eased to assess if patients would prefer office blood pressure vs home monitoring for ongoing care.

Design and method:

A retrospective analysis of all patients who consented to home blood monitoring during the COVID pandemic was undertaken at 12 months across three health centre in a rural population. Patients were asked of their perception of doing home blood pressure readings and their confidence and satisfaction with this method vs office.

Method: Patients were asked during routine medication reviews and at the end of 12 months of their confidence and satisfaction and difficulties with managing home blood pressure monitoring in order to understand their preferences for future care

Results:

Of the total of over 2000 patients with known diagnosis of hypertension n = 2000, a sample cohort of 500 patients (sample size 25%) were asked as they had medication reviews of their confidence with the self-monitoring. The no of patients who felt confident and wished to continue was quite high 70% this did not vary across the ages i.e. both young and the elderly were content doing their own home blood readings. Only 50 patients (11.8%) wanted office readings reasons were affordability and lack of confidence with the reliability of home readings and those who were very elderly wanted the human contact which they previously had.

Conclusions:

Home blood pressure self-monitoring is a safe reliable and evidenced based and previously underutilized method of monitoring patients with hypertension. We believe the office readings of blood pressure still have a place in routine care but the overwhelming response and satisfaction with home blood pressure is likely to change monitoring and lead to better overall blood pressure control.
COMPARISON OF CONTINUOUS MEAN ARTERIAL PRESSURE BY A WEARABLE CUFF-LESS DEVICE AGAINST INTRA-ARTERIAL MEASUREMENTS
Authors: Heimark Sondre , Bøtker-Rasmussen Kasper Gade , Rindal Ole Marius Hoel , Seeberg Trine Margrethe , Stepanov Alexey , Boysen Elin Sundby , Søraas Camilla Lund , Stenehjem Aud-Eldrid , Fadl Elmula Fadl Elmula M. , Waldum-Grevbo Bård
Published: June 2022

Objective:

Wearable cuff-less blood pressure (BP) devices may overcome cuff limitations and offer continuous non-invasive BP monitoring. However, their accuracy in different clinical settings is not yet clarified. This study aimed to evaluate the accuracy of mean arterial pressure (MAP) measurements from a novel continuous cuff-less chest belt against intra-arterial measurements.

Design and method:

Patients in an intensive care unit with an indication of intra-arterial BP monitoring were included. Reference BP was measured with a radial artery catheter connected to a pressure transducer. Cuff-less measurements were obtained continuously with a chest belt, of which a model for BP estimation was trained on a non-intensive care unit population and consisted of a one-channel electrocardiogram, a photoplethysmography sensor and a tri-axis accelerometer. The data collection was monitored by an investigator to reliably exclude periods where the transducer was not properly levelled. Estimated MAP from the chest-belt was calibrated initially with intra-arterial MAP. In cases where the pressure transducer had to be repositioned, re-calibration was performed due to variability of the repositioned transducer levels. Pairwise comparisons of reference and cuff-less MAP were performed in 15-second epochs.

Results:

Preliminary data from 9 subjects were analysed. The subjects had a median (interquartile range) age of 64 (58–73) years, median BMI was 28.6 (25.4–32.7) kg/m2and 77.7% were males. A total of 21.5 h of data were analysed with an average of 2.39 ± 1.05 h per subject. The mean difference of estimated versus reference MAP was 3.9 ± 4.2 mmHg. The Bland-Altman bias was 2.06 mmHg with limits of agreement from -9.7 mmHg to 14 mmHg. The Figure displays typical data for one subject (A) and the Bland Altman plot for all subjects (B).

Conclusions:

After initial calibration with a reference measurement, the cuff-less chest belt estimated changes in mean arterial pressure in close agreement with reference intra-arterial measurements. This study illustrates the potential of a wearable cuff-less device for estimating mean arterial pressure continuously and non-invasively in ospitalised patients.
METHODS AND NUMBER OF BLOOD PRESSURE ASSESSMENTS USED TO ASSESS BLOOD PRESSURE VARIABILITY IN INDIVIDUALS WITH DIABETES
Authors: Silva Antonia Fabiana , Cruz Rebeca Chaves , Albuquerque Nila Larisse Sil , Silva Viviane Martins , De Aráujo Thelma Leite
Published: June 2022

Objective:

To map the methods and number of blood pressure (BP) assessments used to assess the very short, short, medium, and long term variability of blood pressure (VBP) in adults and elderly patients with type 1 or 2 Diabetes Mellitus (DM)

Design and method:

A cooping review was conducted, following the Jonna Briggs Institute (JBI) methodology, in January and February 2021, in MEDLINE, Web of Science, CINAHL, LILACS, PubMed, and Embase electronic databases. Studies carried out in the last 10 years, without language restrictions, that cooping VBP in adults and elderly with type 1 or 2 DM were included. After the extraction process, the articles were imported into Zotero reference manager for duplicate removal, followed by screening by two reviewers. The PRISMA extension for cooping reviews (PRISMA-ScR) guidelines was used to organize and present the process of selection of articles.

Results:

A total of 3,795 articles were identified, of which 25 made up the final sample. Most studies were published in 2016 (60%) and used a cross-sectional (44%) approach. There was a predominance of studies with type 2 DM, and Japan had the highest number of publications (44%). There was a predominance of the oscillometric method of assessing BP (88%), and the predominant type of variability in the studies was long-term VBP (40%). There was variation in the number of measurements depending on the assessment method. In the assessment of short-term VBP, the performance of a measurement every 30 minutes during the day and every 60 minutes at night (16%) stood out; on the other hand, for medium and long-term VBP, three measurements were performed in the morning and at night (20%).

Conclusions:

Evidence points to the growing use of the oscillometric method. Furthermore, long-term VBP, obtained from visit to visit, was highlighted in the studies in the event of diabetes-related complications, and it was observed that there was a variation in the number of measurements adopted, which can be attributed to the lack of consensus on the recommendations for each type of BP assessment method.
VARIATION IN MEAN ARTERIAL PRESSURE AND ITS HEMODYNAMIC COMPONENTS DURING 24-HOUR AMBULATORY PULSE WAVE ANALYSIS: IMPACT OF AGE, RACE, AND GENDER
Authors: Izzo Joseph , Nagpal Sagar , Mukhopadhyay Debduti , Osmond Peter , Schwartz Joseph
Published: June 2022

Objective:

Blood pressure (BP) is highly variable but the concomitant variations of the underlying hemodynamic components [heart rate (HR), stroke volume (SV), and total vascular resistance (TVR)] are not known. We postulated that covariance (cov) analysis of 24-hour ambulatory pulse wave analysis (PWA) could reveal relevant trends in hemodynamic variability (var) within and between-individuals.

Design and method:

Ambulatory BP with PWA (Mobil-O-Graph, IEM, Stolzberg, DE) was performed every 20 minutes for 24 hours. Mean arterial pressure (MAP) components were indexed to body surface area: MAP = HR*[SV index (SVI)]*[TVR index (TVRI)] and ln(MAP) = ln(HR) + ln(SVI) + ln(TVRI). For cov analysis, var[ln(MAP)] = cov[ln(HR), ln(MAP)] + cov[ln(SVI), ln(MAP)] + cov[ln(TVRI), ln(MAP)]. Contributions of hemodynamic components to var[ln(MAP)] were expressed as %; other associations were nalysed by correlation and t-test.

Results:

We studied a convenience sample of 152 people (49% women, 23% black). Data are mean(SD): # readings 57(11), age 59(16) years, BMI 29.9(6.5) kg/m2, systolic BP 135(18) and MAP 106(14) mmHg. Mean 24-hr values were: ln(MAP) 4.64 (0.13), ln(HR) 4.20 (0.15), ln(SVI) -3.32 (0.15), and ln(TVRI) 3.75 (0.18). Relative contributions to 24-hour varMAP were: varTVRI 54(36)%, varHR 33(38)%, and varSVI 13(40)%. The large SDs in these component contributions prompted further analysis: varTVRI correlated with 24-hr mean MAP (r = 0.24, p = 0.003) and was higher (>54%) in males (p = 0.03) and blacks (p = 0.04); varHR was inversely related to MAP (r = -0.26, p = 0.001), age (r = -0.29, p = 0.0003) and BMI (r = -0.17 p = 0.05) and was lower (<33%) in blacks (p = 0.008); varSVI correlated with age (r = 0.31, p < 0.0001) and BMI (r = 0.23, p = 0.005) and was higher (>13%) in women (p = 0.03).

Conclusions:

Covariance analysis can be used with 24-hr ambulatory PWA to analyze BP and hemodynamic variability in everyday life. Within-individual total varMAP is related to varTVR > varHR > varSV but between-individual factors also affect these trends, including greater influence of varTVR in males and blacks, varHR in younger people, and varSV in younger people and women. HR varies inversely with SV and SVR suggesting counter-regulation. Diagnostic subclassifications or treatment modifications for variation extremes [e.g. vasodilators (TVR), beta-blockers (HR), or diuretics (SV)] may be possible.
NOCTURNAL DIPPING PATTERN IN 24-HOUR AMBULATORY BLOOD PRESSURE RECORDINGS OF HYPERTENSIVE INDIVIDUALS IN THE BAY OF PLENTY (BOP)
Authors: Kerridge Tahlia , Gupta Ankur
Published: June 2022

Objective:

24-Hour Ambulatory blood pressure monitoring (ABPM) is gold standard for diagnosis/management of hypertension (HT). Untreated and poorly controlled HT leads to increased rates of cerebrovascular, cardiovascular, and renal disease. Data is lacking on dipping patterns in different ethnicities of New Zealand (NZ). The primary aim was to compare nocturnal dipping pattern between Maori and Non-Maori ethnicities. Secondary aims included comparison of nocturnal HT, morning surge index (MSI) and ambulatory arterial stiffness index (AASI) amongst them and comparison as per socio-economic deprivation index (NZDep 2018).

Design and method:

ABPM data of hypertensive adults > 18 years of age (on antihypertensives) in EBOP was collected retrospectively from Midland Clinical Portal from 1st December 2018 to 31st July 2021. Duplicates or unsuccessful ABPM results were excluded from the analysis. Normal dipping was defined as 10–20%, non-dipping being 0- < 10%, reverse dipping < 0% and extreme dipping > 20%. Statistics were processed using Excel.

Results:

Of 213 ABPMs nalysed, 20% were of Maori individuals. 39.5% of Maori were non-dippers and 9.3% were reverse dippers. Amongst Non-Maori, 34.1% were non-dippers and 13.5% were reverse dippers (p = 0.840). Uncontrolled nocturnal HT was more likely in Maori (60.5%) as compared to Non-Maori (54.1%), though not significant (p = 0.454). AASI was significantly higher (p = 0.001) in Non-Maoris, though MSI was not different (p = 0.865). Lower socio-economic demographic individuals or Maori are less likely to receive ABPM.

Conclusions:

There was no statistical difference between dipping status of Maori and Non-Maori. However, it is evident up to 55% of patients in this data set have uncontrolled nocturnal HT suggesting that EBOP is receiving subtherapeutic management of their HT. Therefore, all hypertensives should have ABPM in NZ to manage HT. As HT is more prevalent in Maori, researchers recommend a commitment from Bay of Plenty District Health Board to address this inequity to improve cardiac, cerebrovascular and renal health.
ASSOCIATION BETWEEN VARIABILITY IN SYSTOLIC BLOOD PRESSURE AND CARDIOVASCULAR EVENTS IN HYPERTENSIVE PATIENTS: 60 MONTHS FOLLOW UP
Authors: Ilic Marina Deljanin , Stojanovic Sanja , Krstic Ivana , Stojanovic Milovan , Ilic Stevan
Published: June 2022

Objective:

To investigate the association between variability in systolic blood pressure (SBPV) and development of cardiovascular events (CVE): angina pectoris (AP), myocardial infarction (MI), cerebrovascular accident (CVA) and cardiovascular death (CVD) in hypertensive patients (pts), and to estimate whether SBPV could be a predictor of CVE and CVD.

Design and method:

300 hypertensive pts (148 men and 152 women, mean age 67.7 ± 9.8y) were studied. The study comprised 3 visits (at the beginning, after 30 and 60 months) during a follow-up period of 60 months. Blood pressure values were defined by the arithmetic mean of three measurements at each visit. SBPV for each patient was defined using the standard deviation from 3 values of systolic BP (SBP-SD). In order to estimate distribution SBPV, quartiles of SBP-SD were introduced. High SBPV were defined as SBP-SD above the 4th and 3th quartile.

Results:

During follow up period, in 86 pts (28.7%) CVE were occurred: AP 18.7%, MI 7.7%, CVA 2.3%, CVD 4%. The first quartile included SBPV values < 5.81 mmHg, the second quartile 5.82–10.61 mmHg, the third quartile 10.62–17.08 mmHg, and the fourth quartile > 17.08 mmHg. Univariate analysis showed that there was a significant relationship between SBPV and CVE (OR = 1.305; 95% CI 1.223–1.393, p < 0.001). During 60 months follow up, the highest SBPV was recorded in the 3rd and 4th quartile in patients who had CVA (17.08 and 42.07, p < 0.01), in the 4th quartile in patients who had MI (25.18), and the lowest in patients with AP (4th: 29.16, 3th: 16.64, p < 0,01). A cut-off value of SBPV = 14.08 mmHg predicted the CVE with a sensitivity of 84.2% and specificity of 83.3%. A cut-off value of SBPV = 16.13 mmHg predicted the CVD with a sensitivity of 80.7% and specificity of 75.5%.

Conclusions:

Our results showed an association between increased SBPV and the development of CVE in hypertensive pts. Value of SBPV> 14.08 mmHg may be a useful marker for predicting future cardiovascular events, and value of SBPV> 16.13 mmHg may be a useful marker for predicting cardiovascular death.
DIURETIC ASSOCIATED WITH CONCURRENT EXERCISE PROMOTES ADDITIONAL PHYSICAL, AUTONOMIC AND INFLAMMATORY ADAPTATIONS IN HYPERTENSIVE RATS SUBMITTED TO OVARIAN HORMONE PRIVATION
Authors: Ferreira Maycon Junior , Silva Gabriel Do Carmo , Bernardes Nathalia , De Araujo Amanda Aparecida , Da Silva Dias Danielle , Irigoyen Maria Cláudia , De Angelis Kátia
Published: June 2022

Objective:

To evaluate the effects of hydrochlorothiazide (HCTZ) combined or not with concurrent exercise training on physical capacity and neurohumoral mechanism of blood pressure (BP) control in a model of hypertension and menopause.

Design and method:

Female spontaneously hypertensive rats were allocated into sedentary (S) and ovariectomized groups: sedentary (OS), sedentary treated with HCTZ (OSH) and trained treated with HCTZ (OTH). Ovariectomy procedure was performed at initial of protocol. HCTZ (30 mg/kg) was administrated orally in drinking water. Aerobic and resistance exercises (40–60% maximal capacity) were conducted 3 days/wk for 8 weeks. BP, heart rate and its variabilities were nalysed using signals of direct recording of BP. Vasopressin receptor antagonist, losartan and hexamethonium were sequentially injected to evaluate vasopressor system. Inflammatory profile was evaluated.

Results:

Systolic and mean BP (mmHg) were lower in OTH (178 ± 17 and 153 ± 17, respectively) compared with OS group (205 ± 15 and 176 ± 16, respectively). Treadmill (OTH vs. OSH) and ladder physical test performance (OTH vs. OS, OS and OSH) were higher in OTH group. Baroreflex sensitivity (bpm/mmHg) was lower in OS group (vs. S) and both bradycardic (OTH:- 1.6 ± 0.3 vs. OS:-0.6 ± 0.3) and tachycardic response (OSH:-2.2 ± 0.7 and OTH:-2.4 ± 0.8 vs. OS:- 1.3 ± 0.4) were improved after HCTZ treatment. OTH showed higher (high-frequency band: OTH:77.8 ± 4.9 vs. OS:69.8 ± 4.0nu) and lower cardiac sympathetic modulation (low-frequency band: OTH:22.2 ± 4.9 vs. OS:30.2 ± 4.0nu) and LF/HF ratio (OTH:0.30 ± 0.08 vs. OS:0.45 ± 0.09). In addition, reduced variance (OTH:30.3 ± 10.5 vs. OS:60.1 ± 13.1) and low-frequency band of systolic BP (mmHg2) (OTH:6.2 ± 5.2 vs. S:16.3 ± 6.7, OS:18.8 ± 6.1 and OSH:15.8 ± 5.5) was observed in trained group. Drop in BP (mmHg) after hexamethonium was higher in OS group (- 75.7 ± 19.2 vs. S:-53.2 ± 12.6, OSH:-54.9 ± 9.0 and OTH:-49.8 ± 12.4). IL-10 (OTH:78.1 ± 17.3 vs. OS:52.8 ± 23.2 and OSH:45.1 ± 10.6) and IL-10/TNF-a ratio (OTH:1.99 ± 0.07 vs. S:1.32 ± 0.21, OS: 1.18 ± 0.12 and OSH:1.18 ± 0.27) was higher in trained group.

Conclusions:

We concluded that HCTZ combined with exercise training is more efficient than HCTZ alone to improve BP control, probably due to a better adjustment on autonomic modulation and inflammation profile, in addition to induce cardiofunctional benefits. This data reinforces the key role of exercise in the attenuation of hypertension-induced damage in menopaused rats. Grants: FAPESP (2019/06277–0).
RHO KINASE BLOCKADE ALLEVIATE BLOOD PRESSURE ELEVATION AND INHIBIT VASCULAR REMODELING IN APATINIB-INDUCED HYPERTENSION–TO BE CONFERMED
Authors: Li Caie , Wang Qiongying , Ma Liping , Wang Wenjuan , Yu Jing
Published: June 2022

Objective:

Hypertension and kidney injury are two of the major adverse effects of the targeted anti-tumor drug apatinib, it was suspected that hypertension may be the result of renal dysfunction in some of the previous studies. The present study was designed to explore the different responses of blood pressure and kidney in the apatinib-induced hypertensive rat model.

Design and method:

30 Wistar-Kyoto rat were randomly divided into 3 groups, each group was administered with 2 mL 0.9% saline, 30 mg/d of apatinib or 15 mg/d of apatinib by oral gavage for 2 weeks. Blood pressure was monitored at the baseline and during the treatment. Level of creatinine, urea nitrogen, sodium, albumin and protein in blood and urine were tested both at baseline and at the end of the treatment. Urinary sodium excretion and glomerular filtration rate was calculated. Specific mRNA and proteins were detected at the end of the treatment.

Results:

Average mean blood pressure (MBP) in the high dose apatinib group was 105 mmHg at the 9th day and 113 mmHg at the 15th day, average MBP in the low dose apatinib was 98 mmHg at the 9th day and 108 mmHg at the 15th day. MBP were significantly high in apatinib group, no matter in the high dose or low dose (p < 0.01). Compared with the control group, the level of endothelin 1(ET-1) and college-1 were significantly high in both apatinib group (p < 0.01). There was no significant differences of urinary sodium excretion, glomerular filtration rate and microalbuminuria between the control group and the low dose apatinib group, while that in the high dose apatinib group were significantly high (p < 0.01).

Conclusions:

There are differences in the response to different doses of apatinib between blood pressure and kidney, blood pressure was elevated even at a relevantly lower dose of apatinib, which was accompanied with the elevation of ET-1 level and vascular emodelling, while the kidney injury occurred only at higher dose of apatinib. The hypertension induced by apatinib was independent with kidney injury caused by the drug, not the consequence of it.
CARDIOVASCULAR RISK AND SUBCLINICAL VASCULAR ORGAN DAMAGE IN PATIENTS WITH AND WITHOUT HYPERTENSION
Authors: Woznicka-Leskiewicz Lucyna , Posadzy-Malaczynska Anna
Published: June 2022

Objective:

Assessment of subclinical organ damage and sex differences in cardiovascular risk stratification in patients with or without hypertension.

Design and method:

We divided 100 patients in two groups: HT+: patients with arterial hypertension (25 women and 25 men); HT-: patients without arterial hypertension (25 women and 25 men). The average age of them [yrs]: 56 and 53 (*p < 0,05).

Ankle-brachial index (ABI), pulse wave velocity (PWV) and carotid intima-media thickness (IMT) were evaluated. We assessed cardiovascular risk according to: SCORE and Framingham scales.

Statistical calculations were performed in PQStat 1.6. For comparison of variables we used the t-test for unrelated samples. To perform the correlation we used Spearman’s rank correlation RS.

Results:

We revealed following results in both groups: HT+ and HT- respectively [*for p< = 0,05; **for p < 0,001; NS- negligible statistically].

In the group with hypertension women were characterized by a lower IMT and PWV than men. The cardiovascular risk according to risk SCORE and Framingham scales in men was significantly higher than in women in both groups.

In female with hypertension, there was a significant negative correlation between ABI and IMT. In male without hypertension, there was a significant negative correlation between ABI and IMT.

Conclusions:

1. There was no difference in values of: ABI, PWV and IMT between the sexes in normotensive patients.

2. Women with hypertension were characterized by a lower IMT and PWV.

3. There were significant negative correlation between ABI and IMT in female and male groups.
THE ASSOCIATION OF URINARY MATRIX GLA PROTEIN WITH CIRCULATING INACTIVE MATRIX GLA PROTEIN, RENAL FUNCTION AND MORTALITY RISK: A POPULATION STUDY
Authors: Wei Dongmei , Melgarejo Jesus , Vanassche Thomas , Van Aelst Lucas , Janssens Stefan , Verhamme Peter , Zhang Zhen-Yu
Published: June 2022

Objective:

Matrix Gla protein (MGP) is a small protein for the protection of vascular calcification. High circulating desphospho-uncarboxylated MGP (dp-ucMGP), indicative of poor vitamin K status, has been associated with renal dysfunction and mortality. However, whether the impaired renal clearance would contribute to high dp-ucMGP and confound these associations remains unclear.

Design and method:

We measured urinary MGP using capillary electrophoresis coupled with mass spectrometry in 776 Flemish (mean age: 51.2 years; 50.9% women), of whom 646 were assayed for plasma dp-ucMGP. The endpoint was defined as mortality or fatal and nonfatal cardiovascular events. Statistical analyses included Spearman correlation, linear regression, and Cox proportional hazard models.

Results:

Urinary MGP was neither correlated with serum creatinine (P = 0.15) nor associated with estimated glomerular filtration rate (eGFR) after adjustment (P = 0.057). Circulating dp-ucMGP was correlated with urinary MGP and eGFR (r = 0.40 and -0.40, P < 0.0001) and their association remained significant after adjustment (P < 0.0001). Over 9.2 (median) years, 47 individuals died, including 15 cardiovascular deaths. For a doubling of urinary MGP, the hazard ratios (HRs) were 1.45 (95% confidence interval [CI]: 1.11–1.90, P = 0.007) for all-cause mortality, 2.31 (1.21–4.43, P = 0.011) for cardiovascular mortality after adjustment for eGFR and other clinical risk factors. For dp-ucMGP, the corresponding adjusted HRs were 2.13 (1.31–3.48, P = 0.003) and 1.52 (0.66–3.53, P = 0.33). Neither urinary MGP nor dp-ucMGP was significantly associated with cardiovascular events after adjustment (P> = 0.88). Urinary MGP further improved the prognostic accuracy for all-cause mortality, as suggested by the increased net reclassification improvement (64.1% [32.8–94.6], P < 0.0001) and integrated discrimination improvement (4.6% [0.9–9.0], P = 0.012).

Conclusions:

The association of high circulating dp-ucMGP with decreased renal function might be driven by vitamin K deficiency and vascular calcification, instead of by impaired renal clearance. Urinary MGP might serve as a novel marker for vitamin K status and mortality.
SYMPATHETIC NERVOUS SYSTEM ACTIVITY AND BLOOD PRESSURE IN HYPERTENSIVE PATIENTS WITH NONALCOHOLIC FATTY LIVER DISEASE
Authors: Kakouri Niki , Andrikou Ioannis , Konstantinidis Dimitrios , Siafi Eirini , Kariori Maria , Drogkaris Sotirios , Polyzos Dimitrios , Manta Eleni , Tatakis Fotis , Grigoriou Kalliopi , Zammanis Ioannis , Iliakis Panagiotis , Papakonstantinou Pantelis , Thomopoulos Costas , Tsioufis Konstantinos
Published: June 2022

Objective:

Nonalcoholic fatty liver disease (NAFLD) is associated with hypertension and predicts future cardiovascular events. The purpose of this study was to investigate the effect of sympathetic nervous system (SNS) overactivity on blood pressure levels in hypertensive patients with and without NAFLD.

Design and method:

111 newly diagnosed untreated hypertensive patients (mean age 55 ± 10 years, 48 males, mean office systolic/diastolic BP 140 ± 14.8/88 ± 9.9 mmHg) without history of cardiovascular disease underwent office blood pressure (BP) measurements. NAFLD was diagnosed by liver ultrasound to separate patients into those with and without NAFLD. SNS activity was assessed by muscle sympathetic nerve activity (MSNA) based on established methodology (microneurography).

Results:

Hypertensive patients with NAFLD (n = 71) compared to those without NAFLD (n = 40) were younger (53 ± 10 vs 58 ± 9 years, respectively, p = 0.01) with greater body mass index (33 ± 10 vs 26 ± 3 kg/m2, p < 0.001). Also, male gender was more prevalent in the NAFLD group compared to the non-NAFLD group (52% vs 29%, respectively, p = 0.03), whereas there were no differences in glucose, low density lipoprotein levels and glomerular filtration rate. In NAFLD patients, MSNA was correlated with office diastolic BP (r = 0.24, p = 0.02) and in linear multiple regression analysis MSNA levels were an independent determinant of office diastolic BP levels (beta = 0.185, p = 0.05), while in the non NAFLD group, MSNA was not related to office BP levels (p = ns). MSNA levels were greater in hypertensives with NALFD compared to those without NAFLD (44.3 ± 9.5 vs 40 ± 7.5 bursts per minute, respectively, p < 0.04). Moreover, in multiple logistic regression analysis, MSNA was proven as an independent determinant of the presence of NAFLD (OR 1.2, 95% CI 1.01–1.5), p = 0.04).

Conclusions:

higher sympathetic nervous system activity, as assessed by MSNA, is associated with greater diastolic BP in NAFLD patients compared to their non-NAFLD counterparts. These findings suggest that SNS may contribute importantly to the regulation of BP in NAFLD patients.
HEPATIC STEATOSIS INDEX IS INDEPENDENTLY RELATED TO HYPERTENSION MEDIATED ORGAN DAMAGE IN PATIENTS WITH FIRST DIAGNOSED AND NEVER TREATED ESSENTIAL HYPERTENSION AND SMOKING HABIT
Authors: Triantafyllidi Helen , Vlachos Stefanos , Benas Dimitris , Fabri Anastasia , Birmpa Dionyssia , Schoinas Antonios , Thymis Ioannis , Kostelli Gavriela , Ikonomidis Ignatios
Published: June 2022

Objective:

Non-alcoholic fatty liver disease (NAFLD) is closely related to the metabolic syndrome, arterial hypertension and overall cardiovascular (CV) disease. We aimed to investigate if those first diagnosed and never-treated patients with essential hypertension at high risk for NAFLD, measured by the Hepatic Steatosis Index (I), already have an impaired CV risk profile estimated by increased blood pressure burden and accompanied by the presence of hypertension-mediated organ damage (HMOD).

Design and method:

We studied 254 non-diabetic, first diagnosed and never-treated young hypertensive patients, [mean age=51 + 11 years, 59% males, 31% smokers]. Ambulatory blood pressure monitoring (24 h ABPM), CV risk factors [smoking, obesity (BMI), hyperlipidemia and HMOD [aortic stiffness (PWV), left ventricular diastolic dysfunction (EEa), cardiac hypertrophy (LVMI), coronary arteries microcirculation (CFR), carotid intima-media thickness (cIMT) and endothelial dysfunction (PBR5–25)] were estimated in each patient before treatment initiation. HIS was calculated as 8 times (ALT/AST ratio) + BMI (+2, if female; + 2, if diabetes mellitus).

Results:

The whole hypertensive population was divided regarding I median value=39.3 in Group A (high risk NAFLD group, n = 127, age = 50 + 10) and Group B (low risk NAFLD group, n = 127, age = 52 + 11). Group A had increased BMI (32 + 5 vs. 27 + 3, p < 0.001), systolic night-time ABPM (128 + 15 vs. 124 + 11, p = 0.04), Chol (217 + 40 vs. 206 + 35, p = 0.01) and Trigl (141 + 79 vs. 112 + 65, p = 0.002), E/Ea (7 + 2 vs. 6 + 2, p = 0.4) and LVMI (83 + 17 vs. 79 + 15, p = 0.03) compared to Group B while all other studied demographic/laboratory/ABPM/HMOD parameters (PWV, MAU, CFR and cIMT) were similar. I was related to BMI (p < 0.001) and office BP, systolic (p < 0.001) and diastolic (p = 0.01), in total population as well as to LVMI (r = 0.24, p = 0.03) in smokers. Finally, in multiple regression analysis, we noted that I was independently associated with LVMI (beta = 0.28, p = 0.05) only in male smokers.

Conclusions:

Our findings underscore the augmented CV risk (smoking, obesity, hyperlipidemia, BP burden and HMOD) in people with first diagnosed arterial hypertension who are at high risk for NAFLD. As successful antihypertensive treatment may lead to HMOD regression, there is still time for those patients to be treated for hypertension disease and hyperlipidemia and quit smoking, in order to reduce future CV risk
LONG SLEEP DURATION AND AMBULATORY BLOOD PRESSURE
Authors: Rietz Hermine , Hellqvist Henrik , Kahan Thomas , Hedner Jan , Grote Ludger , Spaak Jonas
Published: June 2022

Objective:

Studies show a link between short sleep duration and hypertension. The mechanistic associations between sleep duration and blood pressure (BP) are less clear. We studied the association between sleep duration, blood pressure, metabolic profile as well as obstructive sleep apnoea in participants with suspected or confirmed hypertension undergoing 24 h ambulatory blood pressure measurement (ABPM).

Design and method:

We included 177 participants (mean age 57 ± 11 years, 67 women) referred for ABPM, with available exact time-points for bedtimes during the recording. Daytime and night-time BP values were calculated accordingly. Biochemistry included triglycerides (TG), high- and low-density lipoproteins (HDL, LDL) and total cholesterol. The HDL/TG ratio was calculated as a marker of glucose intolerance. Sleep apnoea was quantified by simultaneous ambulatory polygraphy.

Results:

Participants were stratified into those with short (n = 16) /normal (n = 139) /long (n = 22) sleep (< = 6 h, > 6 < = 9 h and > 9 h). There were no differences in age, body mass index (BMI) or apnoea hypopnea index (AHI) between groups. Mean office BP was 146 ± 19/89 ± 11 mmHg and mean 24 h ABPM 133 ± 14/80 ± 8 mmHg. By standard ABPM definitions 81, 86, and 77% in the short/normal/long sleep group were hypertensive, and 56, 56 and 73% were on antihypertensive medication. The long sleep group had lower 24 h diastolic BP than the short and normal sleep groups (p < 0.05 by ANOVA). TG levels and TG/HDL ratio were higher in the long sleep group than in the short sleep group (both p < 0.05 by ANOVA; not adjusted for statin treatment). No differences were found in HDL, LDL, or total cholesterol between groups. In a multiple linear regression model, longer sleep duration, older age, and female sex were all independently associated with lower 24 h ABPM diastolic BP (all p < 0.01; full model R2 = 0.25, p < 0.001) while BMI, AHI, TG, and the TG/HDL ratio were not related.

Conclusions:

Longer sleep duration was independently associated with lower ABPM 24 h diastolic BP together with older age and female sex. The observation with increased TG and TG/HDL ratio in the long sleep group warrants further study.
INCIDENT ATRIAL FIBRILLATION AND THROMBO-EMBOLIC RISK – A REPORT FROM MAY MEASUREMENT MONTH 2019 SCREENING PROGRAMME IN BULGARIA
Authors: Postadzhiyan Arman , Yotov Yoto , Tisheva Snejana , Nikolov Fedya , Raev Dimitar , Gruev Ivan , Ramchev Konstantin
Published: June 2022

Objective:

Despite the increased prevalence of atrial fibrillation (AF), data for the implementation of nationwide screening programmes are limited. The use of automatic devices for blood pressure measurement with AFIB technology during May Measurement Month (MMM) give a unique possibility to increase nationwide awareness about AF and stroke risk, to determine the prevalence of AF using a validated BP machine and its feasibility to identify new cases.

Design and method:

Three BP readings and self-reported demographic, lifestyle and cardiovascular risk factors were collected from participants during MMM2019 campaign in Bulgaria. BP was measured using a Microlife WatchBP Office BP monitor with patented AFIB algorithm in 2075 participants. A regression analysis was performed excluding all the subjects with previous AF to establish clinical factors significantly associated with incident AF.

Results:

The mean age of participants was 62.11 ± 14.9 years, 65% were female and 66% with known hypertension with a median duration of 11 years. Past history of AF was present in 223 (10,7%) and during the campaign additional 83 (4%) cases were identified. Among 306 subjects with AF, low-risk patients (i.e. CHA2DS2VASc score 0 in males or CHA2DS2VASc score 1 in females) was found in 5 (3.8%) males and in 13 (7.6%) females, respectively. We didn’t found any significant difference in classical risk factors or cardiovascular diseases between the groups of previous and incident AF and both groups had identical CHA2DS2VASc score 3.56 vs 3.62, p = 0.8. On multivariable logistic regression CHF (P = 0.011), age 65–74 (P < 0.001) and = >75 (P < 0.001), diabetes (P < 0.01), previous stroke (P < 0.01) or vascular disease (P < 0.01), and prolonged history of hypertension with uncontrolled systolic BP during the screening (P = 0.012) or home systolic BP (P = 0.05) were significantly associated with incident AF.

Conclusions:

The use of automatic devices for BP measurement with AFIB technology is feasible to identify a significant number of new AF cases, most with a high thrombo-embolic risk. Given the low OAC use recorded, greater efforts in AF detection and treatment are urgently needed to reduce the burden of stroke associated with this arrhythmia.
STUDYING THE SITUATION OF CAROTID ATHEROSCLEROSIS OF HYPERTENSIVE PATIENTS IN THE NORTH OF BINH DINH PROVINCE VIETNAM 2019
Authors: Long Nhon Phan , Kim Nhung Hoang Thi
Published: June 2022

Objective:

To evaluate the rate of carotid atherosclerosis in hypertensive patients and the correlations between age, blood pressure, BMI, total cholesterol and atherosclerotic plaque numbers.

Design and method:

A Cross-sectional descriptive study of 207 hypertensive patients in the North of Binh Dinh province, Vietnam (2019), examined by oppler ultrasound to evaluate atherosclerotic plaque numbers of the extra-cranial carotid arteries.

Results:

1. Carotid atherosclerotic results

-  The rate of atherosclerosis in hypertensive patients: 69.6%

-  The percentage of right carotid atherosclerosis is 14.6%.

-  The percentage of left carotid atherosclerosis is 19.4%.

-  The percentage of atherosclerosis on both of right and left carotid are 66%.

-  The percentage of carotid atherosclerosis at before bifurcation: 75%

-  The percentage of carotid atherosclerosis at bifurcation 46.52%.

-  The percentage of carotid atherosclerosis at after bifurcation 4.16%.

-  There are 29.2% of hypertension have 01 atherosclerotic plaque; 54.2% have -   02; 12.5% have 03; 3.5% have 04 and 0.7% have over 04 plaques.

2. Some correlative results

-  There is no correlation between age, systolic blood pressure, diastolic blood pressure, height and atherosclerotic plaque numbers.

-  There is a weak correlation between weight and atherosclerotic plaque numbers (r = 0.20), y = 47.9399 + 2,881 x, R2 = 0.042. p < 0.001.

-  There is a weak correlation between total cholesterol and atherosclerotic plaque numbers (r = 0.18), y = 4.7018 + 0.2839 x, R2 = 0.033. p < 0.001.

Conclusions:

Carotid atherosclerotic injuries are 69.6% in hypertensive patients. That is very high rate. Should be examined early to treatment and prevent cardio-vascular complications.
ALPHA ADDUCIN GENE POLYMORPHISM IS MORE COMMON IN MALE AS COMPARE TO FEMALE IN ESSENTIAL HYPERTENSIVE PATIENTS
Authors: Naz Qulsoom , Verma Narsingh , Serajuddin M. , Patel M.L.
Published: June 2022

Objective:

Essential hypertension is a complex and multifactorial disorder resulting from environmental and genetic factors, and their interactions. Alpha nalysed-1 (ADD1) gene is salt sensitive gene which has its role in etiology of essential hypertension via renal sodium reabsorption. Therefore, the G460T polymorphism of ADD1 gene may be associated with new onset of CVD & stroke under the influence of essential hypertension.

Aim: To assess the relationship between male & female genetic polymorphism (ADD1 G460T polymorphism) under influence of essential hypertension.

Design and method:

Materials and Methods: We recruited total 255 study subjects, 110 normotensive as control (63 male and 47 females), 145 hypertensive patients (85 male and 60 females) and 240 hypertensive. All study samples were genotyped for ADD1 polymorphic alleles and nalysed the relationship between different genotypes with respect to anthropometric and clinical parameters.

Results:

Results-Clinical and anthropometric parameters (such as SBP, DBP, FBG, height, weight, HbA1c, BMI & urinary electrolyte) of study population were found highly statistically significant (p < 0.05) at base value. Further, genotype wise comparison of all the above parameters revealed most of them as non-significant (p> 0.05). Whereas, comparison between genotype frequencies in essential hypertensive patients, specifically in female (p = 0.027) and male (p = 0.015) and in combination with both female (p = 0.017) and male (p = 0.005) revealed a higher HbA1c level in variant T allele. In case of essential hypertensive patients, male population showed a highly statistically significant (p = 0.003) difference in GT & TT allele frequency in aplpha adducing gene polymorphism.

Conclusions:

Anthropometric & Clinical parameters may be the indicative factors for essential hypertension. Variant T allele of ADD1 gene may be considered as the risk factor for the development of stroke & cardiovascular diseases in essential hypertensive patients.
PRESCRIPTIVE APPROPRIATENESS IN PRIMARY CARDIOVASCULAR PREVENTION: DATA FROM NIGUARDA HOSPITAL
Authors: Maloberti Alessandro , Ceruti Davide , Gualini Elena , Colombo Valentina , Giani Valentina , Milani Martina , Sun Jinwei , Alloni Marta , Giannattasio Cristina
Published: June 2022

Objective:

The main cause of waste of health resources is represented by overuse of diagnostic and therapeutic procedures. Given its high prevalence and the importance of identifying hypertensive-mediated organ damage, management of patients with arterial hypertension can lead to a lack of appropriateness. The aim of this study was to evaluate the prescriptive appropriateness of non-invasive diagnostic tests (Echocardiography, Carotid ultrasound, ECG exercise testing, 24 h Ambulatory blood pressure monitoring) in outpatients referring to an ambulatory of primary cardiovascular prevention.

Design and method:

559 specialistic ambulatory visits were retrospectively analysed and appropriateness of every prescription was evaluated. An integration of different Italian and European guidelines was used to define appropriateness. Moreover, we evaluated the correlation between prescriptions, appropriateness and clinical characteristics of the population.

Results:

During the 559 ambulatory visits analysed, 449 prescriptions were made, including 198 echocardiographies, 148 carotid ultrasound, 85 24 h ABPM and 18 ECG exercise testing. The global percentage of appropriate prescriptions was 40.3%. Focusing on each test, appropriateness rate was 49.4% in 24 h ABPM, 43.9% in echocardiography, 38.9% in ECG exercise testing and 30.4% in carotid ultrasound. A significant correlation was identified between the age and cardiovascular risk category of patients and the appropriateness of echocardiography, 24 h ABPM and carotid ultrasound, and a correlation between appropriateness of echocardiography and the duration of hypertension and the presence of valvular heart disease.

Conclusions:

Our study shows a relevant percentage of inappropriate prescriptions of non-invasive cardiologic exams; moreover, there might be a greater lack of appropriateness in young and low risk patients.
EARLY MORNING HEMODYNAMIC CHANGES AND LEFT VENTRICULAR HYPERTROPHY AND MORTALITY IN HEMODIALYSIS PATIENTS
Authors: Mallamaci Francesca , Tripepi Rocco , Torino Claudia , Tripepi Giovanni , Sarafidis Pantelis , Zoccali Carmine
Published: June 2022

Objective:

An exaggeration of the early morning increase in BP, a phenomenon accompanied by a parallel rise in heart rate (HR), is a marker of high cardiovascular risk. The early morning changes in these parameters have not been investigated in the hemodialysis population.

Design and method:

In a pilot, single center, study including a series of 58 patients we measured the pre-awakening BP and HR surges and the nocturnal dipping of the same parameters as well as other established indicators of autonomic function (weighted 24 h systolic BP and HR variability) and tested their relationship with the left ventricular mass index (LVMI) and with the risk of death over a median follow up of 40 months.

Results:

The pre-awakening HR surge (r = -0.46, P = 0.001) but not the corresponding BP surge (r = -0.1, P = 0.98) associated with LVMI and the risk of death [HR (1 unit): 0.89, 95% CI: 0.83–0.96, P = 0.001]. The link between the pre-awakening HR surge with these outcome measures was robust and largely independent of established risk factors in the hemodialysis population including the systolic BP dipping. Weighted 24 h systolic BP (SD) and HR (SD) variability did not correlate with LVMI (all P> 0.11) nor with the risk of death (P > 0.11). Overall, among markers of early morning hemodynamic changes and of hemodynamic variability, the pre-awakening HR surge was the strongest correlate of LVMI and a the strongest predictor of death.

Conclusions:

This pilot study suggests that low early morning changes in HR, a biomarker reflecting sympathetic activity, entail a high risk for LVH and mortality in the hemodialysis population.