bluuebunny/crossref_metadata_2025 huggingface dataset:
META-ANALYSIS EVALUATING THE EFFICACY OF SODIUM-GLUCOSE CO-TRANSPORTER-2 INHIBITORS IN SUBJECTS WITH HEART FAILURE WITH PRESERVED LEFT VENTRICULAR EJECTION FRACTION
Authors: Patoulias Dimitrios , Katsimardou Alexandra , Toumpourleka Maria , Zografou Ioanna , Petidis Konstantinos , Imprialos Konstantinos , Kassimis George , Boulmpou Aristi , Papadopoulos Christodoulos , Doumas Michael
Published: June 2022

Objective:

Heart failure (HF) is a chronic, disabling and deadly disease. Subjects with HF feature an increased risk for death and recurrent ospitalisation for HF decompensation. Sodium-glucose co-transporter-2 (SGLT-2) inhibitors are a novel class of drugs primarily developed for patients with diabetes mellitus. SGLT-2 inhibitors have proven cardiovascular efficacy in HFrEF; however, their efficacy in subjects with HFpEF has not be elucidated. Therefore, we sought to determine the effect of SGLT-2 inhibitors on surrogate cardiovascular outcomes in HFpEF, utilizing both data from ospitalis controlled trials and real-world studies.

Design and method:

We searched PubMed and the Cochrane Library for RCTs and observational studies enrolling adult subjects with HFpEF regardless of concomitant type 2 diabetes mellitus (T2DM), assigned to a SGLT-2 inhibitor versus placebo or active comparator. We set as primary efficacy outcome the composite of cardiovascular death or ospitalisation for HF decompensation. We set as secondary efficacy outcome that of all-cause death.

Results:

We pooled data from four RCTs and one observational study for a total of 7,920 subjects with HFpEF. We demonstrated that treatment with SGLT-2 inhibitors versus placebo or active comparator produced a significant decrease in the risk for the primary composite outcome by 30% (RR = 0.70, 95% CI; 0.52 – 0.93, I2 = 48%, p = 0.01). As far as all-cause death is concerned, we showed that SGLT-2 inhibitors compared to control did not produce a significant effect on the corresponding risk (RR = 0.65, 95% CI; 0.34 – 1.26, I2 = 67%, p = 0.21). Overall risk of bias was evaluated as low across the selected studies.

Conclusions:

Current evidence suggests that SGLT-2 inhibitors are also efficacious in HFpEF. Although total mortality was not significantly reduced, the trend towards beneficial effects along with the demonstrated morbidity benefits point towards the use of SGLT-2 inhibitors in this patient population.
HYPERTENSION AND QUALITY OF LIFE OF PATIENTS WITH HEART FAILURE
Authors: Mzoughi Khadija , Zairi Ihsen , Marwa Chouaieb , Belkahla Noufeil , Bouzidi Hela , Kammoun Sofien , Ben Mrad Imtinene , Kraiem Sondos
Published: June 2022

Objective:

The increasing prevalence and poor prognosis associated with chronic heart failure (CHF) have made the improvement of quality of life (QoL) one of the main goals in the treatment of CHF patients. The aim of the study was to assess if hypertension was associated with QoL in a sample of patients ospitalised with HF.

Design and method:

In this prospective study, we evaluated patients with CHF attending the cardiology department of Habib Thameur University Hospital in a four-month period. Echocardiography was performed and patients with left ventricular ejection fraction (LVEF) of 45% or less were selected. QoL assessment was performed with a disease-specific instrument: the Minnesota Living with Heart Failure Questionnaire (MLHFQ) in a sample of 100 selected patients.

Results:

In the total sample (n = 100), mean age was 62.7 years. The majority were male (77%), married (76%), with a mean of 2.5 comorbidities, and in a New York Heart Association (NYHA) functional class III to IV (61%). Mean LVEF was 36%. Half of the patients had poor QoL on the total MLHFQ scale (median = 41,5) as well as on its physical (median = 17,5) and emotional (median = 11,25) domains. In univariate analysis, a history of hypertension was a factor of poor quality of life with a calculated odds ratio of 2.263, its presence alters the total score by approximately 14 points (p = 0.045), the physical score by approximately 11 points (p = 0.009) and the emotional by seven points (p = 0.005).

In multivariate analysis, hypertension was not associated with poor Qol.

Conclusions:

This study has found that hypertension was a factor of poor quality of life among patients with heart failure in univariate analysis.
DYNAMICS OF VENOUS CONGESTION (VEXUS) AND LIVER STIFFNESS BY TRANSIENT ELASTOGRAPHY IN PATIENTS WITH ARTERIAL HYPERTENSION AND DECOMPENSATED HEART FAILURE
Authors: Aslanova Rena , Lapshin Artem , Andriamanohery Robinson , Abdulloev Dzhakhongir , Efimova Viktoriia , Safarova Ayten , Sarlykov Bekbolot , Kobalava Zhanna
Published: June 2022

Objective:

comprehensive assessment of venous congestion (VC) is relevant in patients with arterial hypertension (AH) and decompensated heart failure (DHF).

Design and method:

to assess the incidence and severity of VC according to the VExUS protocol (assessment of the IVC diameter, the shape of the portohepatic and renal veins blood flow) and to assess the relationship of VC to the liver stiffness (LS), estimated by transient elastography (TE), in patients with AH and DHF on admission and their dynamic changes during ospitalisation. The METAVIR scale was used to interpret the stages of fibrosis.

Routine clinical assessment, VExUS, TE was performed in 52 patients with AH and DHF (men 48%, age 70 ± 11 years (M ± SD), atrial fibrillation 60%, diabetes 40%, chronic anemia 27%, left ventricle ejection fraction (EF LV) 50 [40; 57] %, EF < 40% - 29%,NTproBNP 1421 [754; 2024] pg/ml (Me; IQR)). Exclusion criteria: primary chronic liver disease or acute hepatitis, severe tricuspid regurgitation

Results:

on admission mild, moderate and severe venous congestion were detected in 31%, 13%, 17% of patients, respectively. 79% of patients had increased liver stiffness - 22% had F1 / F2, 17% had F3 and 40% had F4.

At discharge, venous congestion was observed in 38% of patients. Mild, moderate and severe venous congestion was detected in 20%, 12%, 6% of cases respectively. An increase in liver stiffness at discharge was detected in 54%. 29% of patients had F1 / F2, 13% had F3, and 12% had F4.

The dynamics of clinical signs of congestion on admission and at discharge is presented in Diagram 1.

A significant correlation between severity of VC and degree of increase in LS was observed (r = 0.43, p = 0.001). There is a positive correlation between the LS and VC with NT-proBNP (r = 0.47, p = 0.04 and r = 0.30, p = 0.03, respectively), a significant negative correlation between the severity of VC and LVEF (r = -0.49; p = 0.000), and between the degree of LS with LVEF (r = -0.33; p = 0.018).

Conclusions:

Correlations were revealed between venous congestion, by VEXUS protocol, and LS in TE with LVEF in patients with AH and DHF
A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS OF PDE5 INHIBITOR SILDENAFIL IN THE TREATMENT OF HEART FAILURE WITH PRESERVED EJECTION FRACTION
Authors: Sun Runmin , Wang Qiongying , Yu Jing
Published: June 2022

Objective:

he results of clinical trials of phosphodiesterase (PDE) 5 inhibitors for the treatment of HFpEF patients are inconsistent. Thus, we undertook a meta-analysis to evaluate the clinical value of sildenafil for HF with preserved EF (HFpEF) patients.

Design and method:

Relevant studies were searched and identified in the PubMed, Cochrane Library and EMBASE databases. We searched andomised controlled trials (RCTs) that compared PDE5i with placebo in HFpEF and extracted relevant clinical data.

Results:

Six RCTs enrolling 471 HFpEF patients were included in the meta-analysis.Compared with placebo, sildenafil was not significantly associated in death (OR = 1.12, 95%CI: 0.06 to 19.40), adverse events (OR = 2.55, 95%CI:0.67 to 9.62). Also, sildenafil therapy had no impact on the patient’s six-minute walk test, PASP, E/e’, peak VO2, NT-proBNP but improved at PVR(SMD = -1.04, 95% CI = -1.96 to -0.13) significantly compared to placebo in HFpEF patients. Whereas, if only the RCT study with HFpEF combined with pulmonary hypertension is included, sildenafil therapy was associated with a marked improvement in E/e’ (SMD = -0.745, 95% CI = -1.24 to -0.25) in HFpEF patients combined with pulmonary hypertension.

Conclusions:

Compared with placebo, sildenafil therapy was associated with the improvement of diastolic function in HFpEF patients combined with pulmonary hypertension, while sildenafil treatment of HFpEF patients does not increase death or rehospitalization.
AI FOR AF IN ASIANS-WHERE ARE WE AND WHERE RE WE GOING?
Authors: Syun Hu Wei
Published: June 2022

Objective:

We aimed to construct a random forest model to predict atrial fibrillation (AF) in Chinese population.

Design and method:

This study was comprised of 682 237 subjects with or without AF. Each subject had 19 features that included the subjects’ age, gender, underlying diseases, CHA2DS2-VASc score, and follow-up period. The data were split into train and test sets at an approximate 9:1 ratio: 614 013 data points were placed into the train set and 68 224 data points were placed into the test set. In this study, weighted average F1, precision, and recall values were used to measure prediction model performance. The F1, precision, and recall values were calculated across the train set, the test set, and all data.

Results:

The area under receiving operating characteristic (ROC) curve was also used to evaluate the performance of the prediction model. The prediction model achieved a k-fold cross-validation accuracy of 0.979 (k = 10). In the test set, the prediction model achieved an F1 value of 0.968, precision value of 0.958, and recall value of 0.979. The area under ROC curve of the model was 0.948 (95% confidence interval 0.947–0.949). This model was validated with a separate dataset.

Conclusions:

This study showed a novel AF risk prediction scheme for Chinese individuals with random forest model methodology.
IMPACT OF ATRIAL FIBRILLATION ON RENAL FUNCTION IN HEART FAILURE PATIENTS USING REAL WORLD DATA
Authors: Diaz Jvier , Calderon Jose Miguel , Martinez Fernando , Sauri Inmaculada , Fernandez Antonio , Trillo Jose Luis , Uso Ruth , Redon Josep
Published: June 2022

Objective:

The objective of the present study is to assess the nalysedional interaction between heart failure (HF) and atrial fibrillation (AF) in the renal function using Real World Data.

Design and method:

From an Electronic Health Recording with a population of 3,799,885 adult subjects, those with prevalent or incident HF were selected and followed throughout a study period of 5 years. Prevalence and incidence of AF, and their impact in worsening renal function (decrease eGFR> 20%), were identified. When both eGFR and albuminuria data was available, the patients were classified on the Kidney Disease Global Outcomes (KDIGO) risk scale. Two different sets of data were nalysed in two groups of HF patients: S1) included all patients with prevalent or incident HF, 128086 patients; S2) included subjects with a new diagnosis of HF during the study period in the absence of previous AF, 57354 patients.

Results:

In S1, the impact of AF on a reduction of eGFR by > 20% was observed in 18,513 patients, incidence 66.2/103 patients/year, Figure panel A with an increment of risk (HR 1.13, P95th CI 1.09–1.18, p < 0.001) higher than the present due to diabetes, hypertension, dyslipidemia or coronary heart disease. The increment of risk was also demonstrated in S2, Figure panel B. The number of subjects with decreased eGFR values was 7,067, incidence 94.0/103 patients/year with AF increasing the risk (HR 1.22, P95th CI 1.14–1.31, p < 0.001) independent of the other potential factors. In the subgroup of patients with KDIGO risk classification, 10,425 (27.8%) and 3,297 (23.2%) respectively in S1 and S2 cohorts increased by at least one category in S1 and S2, respectively.

Conclusions:

AF largely increases the risk of decline renal function contributing to the deterioration in the condition of these patients.
PREDICTING THE RISK OF FALLS IN PATIENTS WITH AN INDICATION FOR ANTIHYPERTENSIVE TREATMENT: DEVELOPMENT AND VALIDATION OF THE STRATIFY-FALLS PREDICTION MODEL
Authors: Archer Lucinda , Koshiaris Constantinos , Snell Ie Kym , Riley Richard D. , Stevens Richard , Hobbs Fd. Richard , McManus Richard J. , Sheppard James P.
Published: June 2022

Objective:

Falls are one of the most common side effects associated with antihypertensive medication. In patients at high risk of falls, the additional risk of harm from medication may outweigh the potential benefits in terms of cardiovascular risk reduction. However, it is currently unclear which patients are at high risk of falls. This study aimed to develop and validate a clinical prediction model for risk of hospitalisation or death from falls in adults eligible for antihypertensive treatment.

Design and method:

Eligible patients were aged 40 and above, with at least one blood pressure measurement between 130–179 mm Hg. The outcome was a fall resulting in hospitalisation or death within 10 years of entering the study. Model development was conducted in data from CPRD GOLD using a Fine-Gray approach, accounting for the competing risk of death from other causes, with subsequent recalibration at specific time-points using pseudo-values. External validation was conducted using data from CPRD Aurum, with performance assessed through calibration curves, the Observed/Expected (O/E) ratio, C-statistic, and D-statistic, each pooled across GP practices.

Results:

Analysis included 1,773,224 patients (62,691 events) for model development, and 3,805,322 (206,956 events) for external validation. Conditional on other variables, increasing age, being female, of white ethnicity, being a heavy drinker and living in an area of high social deprivation were associated with an increased risk of falls. Upon external validation, the re-calibrated model showed good discrimination, with pooled C-statistics of 0.843 (95%CI: 0.841 to 0.844) and 0.833 (95%CI: 0.831 to 0.835) at 5 and 10 years respectively. Original model calibration was poor on visual inspection and whilst this improved with re-calibration, under-prediction of risk remained (Observed/Expected ratio 1.839 at 10 years, 95%CI: 1.811 to 1.865) (Figure 1)

Conclusions:

STRATIFY-Falls uses commonly recorded clinical characteristics and shows good discrimination on external validation, accurately distinguishing between patients at high and low risk of falls in the next 5–10 years. This model may be used in routine clinical practice to help identify those at high risk of falls, for whom the benefits of antihypertensive medication may be outweighed by the harms.
STRESSED HEART MORPHOLOGY AND NEUROLOGIC STRESS SCORE EFFECT BEYOND HEMODYNAMIC STRESS ON FOCAL GEOMETRY
Authors: Yalcin Fatih , Melek Ismet , Mutlu Turay
Published: June 2022

Objective:

Recent work have emphasized the importance of adaptive cardiac emodelling (Plos One, IJCCRP, Am J Cardiovasc Dis., 2021). In addition to hemodynamic stress in hypertension, novel cardiac imaging have shown that stressed heart morphology (SHM: basal septal hypertrophy, the early imaging biomarker in hypertension, J Applied Physiol 2019) could be affected by emotional stress and aortic stenosis (B Press Monitor 2020, ATCS 2021).

Design and method:

The aim of the study was to explore the potential effect of chronic emotional and mental overdrive in addition to chronic hemodynamic stress due to chronic hypertension. Therefore, we planned to determine imaging data as well as neurologic stress scores in SHM and compare them in terms of geometric details and severity of stress scores.

Results:

SHM was diagnosed in 50 chronic patients with systemic hypertension using the universal criteria (thicker than 1.4 cm septal base on the parasternal long axis). Then, we decided to detect quantitative scores of neurologic stress for all patients of the study group. The patients with SHM with irregular septal basal emodelling with septal bulging were associated with high neurologic stress score, while the other SHM patients with regular emodelling had lower score (p < 0.05).

Conclusions:

SHM seems like a quite complex phenomenon which possibly affected by emotional and mental overdrive beyond pure hemodynamic stress due to hypertension. Complex imaging findings also are consistent with adaptive phase SHM (J Clinic Med 2022, J of Hypertension 2022) showing irregular nature of human SHM which is likely to depend on cognitive function compared to regular emodelling in animals.
STRESSED HEART MORPHOLOGY: A SPECIFIC LOCATION FOR VARIETY OF STRESS STIMULI
Authors: Yalcin Fatih , Yalcin Hulya , Abraham M. Rosell , Abraham Theodore P.
Published: June 2022

Objective:

Myocardial on-specifi is a response to increased stress in acute or chronic situations. Stressed heart morphology (SHM) is a very interesting description representing basal septal hypertrophy (The early Imaging Biomarker in Hypertension, J Aplied Physiol 2019) caused by both acute emotional stress, functional due to increased afterload in hypertension and mechanic in aortic stenosis.

Design and method:

Echocardiography and coronary angiography were used to evaluate underlying mechanism of the symptoms of the particular patient who applied for health care.

Results:

In this case, we detected ampulla shape geometry with chronic stress and hypertension. 72 years old lady with 25 years of hypertension history was examined for exercise intolerance and dyspnea Echocardiography showed a left ventricular dysfunction with 40 % ejection fraction and basal septal hypertrophy. Coronary anjiography was planned and no coronary stenosis detected. The patient gave a typical history for chronic emotional disturbance and was on longstanding antidepressive medication.

Conclusions:

While SHM is associated with acute stress cardiomyopathy, hypertension and aortic stenosis (Blood Press Monitor 2020, Am J Cardiovasc Dis 2021, ATCS 2021), it also could be seen in those with chronic hypertension and emotional disturbance. This support the notion that SHM could be a specific location for variety of on-specific stress stimuli.
EVALUATION OF PLASMA HOMOCYSTEINE LEVELS AND ERYTHROCYTE ANTIOXIDANT ENZYMATIC ACTIVITIES IN TYPE 2 DIABETICS WITH ARTERIAL HYPERTENSION
Authors: Bendiab Nabila Taleb , Bouanane Samira , Baba Ahmed Fatema Zohra
Published: June 2022

Objective:

Diabetes associated with high blood pressure and hyperhomocysteinemia are both the cause early and rapidly evolving vascular lesions. There are multiple mechanisms behind these lesions and still imperfectly known, but diabetes and hyperhomocysteinemia have many in common deleterious effects affecting hemostasis, and lipid peroxidation, suggesting that there may be a synergistic effect of these two pathologies. Currently, oxidative stress is recognized as an important factor involved in the degenerative complications of diabetes. The objective of our study is to assess the plasma homocysteine level and the activity erythrocyte antioxidant enzymes in hypertensive women with type 2 diabetes.

Design and method:

Blood samples are from hypertensive women with type 2 diabetes (n = 36), and healthy female volunteers (n = 36). A blood sample is taken for the assay of plasma biochemical parameters (glycemia, glycated hemoglobin, plasma assay homocysteine, urea and creatinine) and markers of plasma oxidative stress. Enzyme activity antioxidant erythrocytes (dismutase, glutathione peroxidase and reductase) is also determined.

Results:

Our results show that type 2 diabetes linked to hypertension causes complications metabolic resulting in hyperglycemia and glycated hemoglobin. However, the average of homocysteinemia is very high associated with hypercreatinemia and hyperuremia in diabetic women this can be explained by the marked presence of a hypertension. The activities of antioxidant enzymes: catalase, superoxide dismutase, glutathione peroxidase and reductase are significantly reduced in diabetic patients compared to control values.

Conclusions:

Diabetes mellitus is associated with alterations in the antioxidant defense system which can worsen the complications of diabetes. A diet rich in vitamins (vitamins B - vitamins B6, B12 and B9 or folic acid) and management of the diabetic’s antioxidant status is necessary for avourable assessment of this pathology.
MODULATION OF BIOMARKERS ASSOCIATED WITH LYMPHANGIOGENESIS AND CARDIOVASCULAR RISK BY POLYMORPHIC GENETIC VARIANTS OF AQUAPORINS AND HEPARANASE IN PSORIASIS
Authors: Santos Ana Carolina , Gil Ângela , Da Silva Inês Vieira , Ferreira Joana , Soveral Graça , Bicho Maria Clara , Filipe Paulo , Bicho Manuel
Published: June 2022

Objective:

Psoriasis is a chronic inflammatory disease associated with cardiovascular risk factors. Aquaporins(AQP) are a family of channels, which can transport: water, urea, hydrogen peroxide and/or glycerol, essential for redox signalling and metabolic skin homeostasis.

Heparanase(HPSE) is an endo--glucuronidase that cleaves heparan sulfate chains of proteoglycans from the extracellular matrix(ECM), an essential step in the neovascularization and cell growth process.

Vascular endothelial growth factor-C(VEGF-C) is an important growth factor regulating lymphatic neovascularization and pathological processes associated with sodium accumulation in ECM in the skin. The VEGF soluble receptors(s-flt1) are decoy receptors present in endothelial cells, hematopoietic stem cells, monocytes, macrophages, and platelets.

This study aims to evaluate the impact of AQP3, AQP7 and HPSE genetic polymorphisms in biomarkers related to cardiovascular risk in patients with psoriasis and their clinical severity determined by Psoriasis Area and Severity Index(PASI).

Design and method:

Sixty-three psoriasis patients with a mean age of 52.50 ± 12.81years. Sociodemographic, hemodynamic and routine blood laboratory data were collected. Biochemical parameters were determined in serum according to standardized methods. Genetic polymorphisms were determined by endpoint analysis and s-flt1 and VEGF-C by ELISA. Patients were stratified based on PASI:< 5(G1) and > or equal to 5(G2). For statistical analysis, SPSS program was used with a p-value < 0.05.

Results:

Comparing the genotypic and allelic frequencies of the studied polymorphisms, no differences were found between G1 and G2.

In general, patients with genotype AA of AQP3 had higher levels of s-flt1(p = 0.005) and VEGF-C(p = 0.048). For AQP7, genotype TT was associated with higher levels of mean platelet volume(p = 0.049) and lower levels of creatinine(Cr)(p = 0.023).

Elevated levels of neutrophils(N)(p = 0.017) and potassium(p = 0.001) was observed in genotype AA of HPSE.

For G1 was observed an increased level of: s-flt1(p = 0.022) and VEGF-C(p = 0.044) associated with genotype AA of AQP3; Cr in allele C of AQP7(p = 0.018), N in genotype CC of AQP7(p = 0.017). For G2 was observed: higher levels of leucocytes in allele C of AQP3(p = 0.016) and angiotensin-converting enzyme activity(ACE1) in allele T of AQP7(p = 0.033).

Conclusions:

AQP3, AQP7 and HPSE polymorphisms appear to modulate some biochemical parameters relevant to lymphangiogenesis associated with cardiovascular risk in a sample of patients with psoriasis.
COMBINED EXOSOMAL AND PLASMA NON-CODING RNA SIGNATURE ASSOCIATED WITH URINARY ALBUMIN EXCRETION IN HYPERTENSION
Authors: Ortega Ana , Martinez-Arroyo Olga , Riffo-Campos Angela Leticia , Perez-Hernandez Javier , Flores-Chova Ana , Redon Josep , Cortes Raquel
Published: June 2022

Objective:

Non-coding RNA (ncRNA), released into circulation or packaged into exosomes, play important roles in many biological processes in the kidney. The purpose of the present study is to identify a common ncRNA signature associated with early renal damage and its related molecular pathways by constructing a RNA-based transcriptional network.

Design and method:

This is an observational case-control study which included 43 hypertensives, twenty-one patients with essential hypertension and twenty-two without persistent elevated urinary albuminuria (UAE) (higher or equal to 30 mg/g urinary creatinine). Three individual libraries (plasma and urinary exosomes and total plasma) were prepared from each hypertensive patient for ncRNA sequencing analysis. Next, a RNA-based transcriptional regulatory network was constructed.

Results:

The three RNA biotypes with the greatest number of differentially expressed transcripts were long-ncRNA (lncRNA), microRNA (miRNA) and piwi-interacting RNA (piRNA). We identified a common 24 ncRNA molecular signature related to hypertension-associated albuminuria, of which lncRNA was the most representative. In addition, the transcriptional regulatory network analysis showed five lncRNA (LINC02614, BAALC-AS1, FAM230B, LOC100505824 and LINC01484), and the miR-301a-3p to play a significant role in network organization and to target critical pathways regulating filtration barrier integrity, tubule reabsorption and systemic endothelial dysfunction.

Conclusions:

Our study found a combined ncRNA signature associated with albuminuria, independently of biofluid origin (urine or plasma, circulating or in exosomes) that identifies a handful of potential targets involved in filtration barrier, tubule reabsorption and endothelial function that may be utilized to treating hypertension-associated albuminuria and cardiovascular damage progression.
ANALYSIS OF RAAS BIOMARKERS TO CLASSIFY ANTI-HYPERTENSIVE DRUG TREATMENTS IN THE GENERAL POPULATION: THE CHRIS STUDY
Authors: Arisido Maeregu Woldeyes , Foco Luisa , Gögele Martin , Melotti Roberto , Pramstaller Peter , Poglitsch Marko , Pattaro Cristian
Published: June 2022

Objective:

Hypertension is a leading cause of death worldwide. Large-scale population-based epidemiological studies are an opportunity to assess the effectiveness of anti-hypertensive drug (AHD) treatment. However, these studies often lack treatment documentation, especially in situations where linkage to electronic health records is not established, with consequent recall and classification biases. When relevant biomarkers are measured, it should however be possible to attribute individuals to the most likely AHD treatment, limiting information loss.

We investigate whether unsupervised cluster analysis applied to measured RAAS biomarkers may help to classify different AHD treatments in a general population sample.

Design and method:

In the Cooperative Health Research in South Tyrol (CHRIS) study, automated drug barcode scans allowed classification of AHD specific treatment among participants. We measured angiotensin I, angiotensin II and aldosterone levels on 800 participants using liquid chromatography combined with tandem mass spectrometry (LC-MS/MS) analysis, as implemented in the RAAS Triple-A assay. Age and sex matched participants (age: 43–90 years; 54% females) were split into 8 balanced groups: normotensive (n = 101); untreated hypertensive (n = 100); non-AHD (n = 100); ACEi (n = 99); ARB (n = 98); ACEi+diuretic (n = 100); ARB+diuretic (n = 102); and beta-blockers (n = 100).

We performed unsupervised cluster analysis based on the three biomarkers ignoring the known AHD treatment. We evaluated the extent of agreement between the automated drug recognition system and RAAS based classification.

Results:

We identified three clinically heterogeneous clusters. Cluster 1 (n = 444) was characterized by participants not receiving any AHD and having high systolic blood pressure. Cluster 2 (n = 235) identified the use of ARB with or without diuretics. These individuals were more likely to present diabetes. Cluster 3 (n = 121) identified ACEi with or without diuretics and included older and overweight participants. The inter-classification agreement between the automated recognition system and RAAS clusters was highest for ACEi and ARB.

Conclusions:

In the absence of specific information, unsupervised cluster analysis applied to RAAS biomarkers can reliably identify individuals under ACEi and ARB treatment.
ROLE OF SERUM URIC ACID LEVELS AND CRP IN THE EXISTENCE OF ATRIAL FIBRILLATION IN HYPERTENSIVE PATIENTS
Authors: Papavasileiou M.V. , Karamanou A. , Aravantinos D. , Moustakas G. , Patsianis S. , Pittaras A.
Published: June 2022

Objective:

The inflammatory effect of the serum uric acid and C-reactive protein (CRP) is evident, as well as the role and significance, of inflammation in the presence of atrial fibrillation.

The aim of this study was to investigate a possible association between the serum uric acid levels with the existence of atrial fibrillation in hypertensive patients and the possible role of CRP in this status.

Design and method:

We studied 1196 hypertensive patients (45,1% female), treated or newly diagnosed untreated, of mean age: 63,1 ± 13,3 years, without any known cardiovascular disease and with mean office systolic/diastolic arterial blood pressure (S/DBPo): 142,1 ± 19.3/86.5 ± 12,6 mmHg, mean office heart rate (HRo): 73,7 ± 10,7 bpm, average body mass index (BMI): 28.5 ± 5,8 kg/m2and average waist circumference (WC) 96.1 ± 12.9 cm

The levels of serum uric acid (SUA), C-reactive protein (CRP), urea, creatinine,were recorded. eGFR was calculated according Cockcroft-Gault Equation and the atrial fibrillation (AF) status was recorded. The study population was separated in two groups, according the existence or not of any evidence for AF

Group A: with PAF or PEAF

Group B: without AF

By using the ANOVA statistic method we registered the SUA and CRP values in both groups.

Using Pearson correlation method we correlated SUA with CRP serum levels.

Results:

Table 1: Differences of serum uric acid and CRP levels between group A and group B 

Table 2: Correlation between serum uric acid levels with C-reactive protein levels 

SUA: serum uric acid

CRP: C-reactive protein

Conclusions:

In hypertensive patients treated or not, the presence of PAF or PEAF was associated with significantly higher serum uric acid levels and CRP levels, while a significant positive correlation exists between SUA and CRP levels in this population. possibly indicating their importance in the inflammatory status of hypertensive patients with atrial fibrillation.
PROGNOSTIC SIGNIFICANCE OF RISK FACTORS AND BIOMARKERS IN PATIENTS HOSPITALIZED FOR CARDIORENAL SYNDROMES
Authors: Vordoni Aikaterini , Theofilis Panagiotis , Nakas Nikos , Kotsakis Athanasios , Kranidis Athanasios , Makryniotou Ioanna , Kalaitzidis Rigas
Published: June 2022

Objective:

Cardiorenal syndromes (CRS), involving the heart-kidney cross-talk and the activation of neurohumoral and inflammatory pathways, is an entity characterized by high morbidity and mortality. Our study aimed to evaluate the prognostic role of risk factors and biomarkers in patients ospitalised for CRS.

Design and method:

In this observational cohort study, 100 consecutive patients ospitalised for CRS were enrolled. Socio-demographic characteristics, personal medical history, and prior medication use were recorded upon admission, and echocardiography was performed. Moreover, an array of blood markers was measured. The endpoint of interest was a composite of death or dialysis dependence at discharge.

Results:

Patients were classified into two groups; Group 1 (N = 52): discharged being dialysis-independent, Group 2 (N = 48): death/dialysis dependence at discharge. No significant differences were detected in baseline characteristics between the two groups. Group 2 patients used ospit-angiotensin-aldosterone system blockers (RAASb) less often (Group 1: 71.2% vs. Group 2: 41.7%, p = .003) and more frequently presented with oliguria/anuria (Group 1: 28.8% vs. Group 2: 66.7%, p < .001). Group 2 patients had significantly lower hemoglobin, serum albumin, and 25-hydroxy-vitamin D [25(OH)D] (Figure). At the same time, serum phosphate, potassium, N-terminal-pro hormone brain natriuretic peptide, and parathyroid hormone (PTH) were significantly higher in Group 2 patients (Figure). In a multivariate regression analysis, lack of prior RAASb (Odds ratio: 22.0, 95% confidence interval: 2.7–179.5, p = .004) and lower 25(OH)D levels (Odds ratio: 0.90, 95% confidence interval: 0.82–0.99, p = .03) were independently associated with an increased risk of death or dialysis dependence at discharge. 25(OH)D/PTH ratio was the most accurate predictor of the composite endpoint (area under receiver operating characteristics curve: 0.81), with a cutoff of equal or less than 97.9 having a sensitivity and specificity of 79.4% and 70.4%, respectively.

Conclusions:

Lack of prior RAASb use, high PTH, low 25(OH)D levels, and low 25(OH)D/PTH ratio are associated with a poor prognosis in patients ospitalised for CRS.
AMBULATORY BLOOD PRESSURE MONITORING IN HEART FAILURE WITH PRESERVED EJECTION FRACTION PATIENTS
Authors: Yarosh Vitalina , Yepanchinceva Olga , Babenko Vasyl , Yena Larysa
Published: June 2022

Objective:

120 hypertensive patients (pts) aged 67,8 ± 1,2 years. 30 pts with essential hypertension (EH), 90 pts with EH complicated by heart failure with preserved ejection fraction (HFpEF), NYHA class II.

Design and method:

Doppler echocardiography, office BP measuring and ambulatory BP monitoring, 6 -minute walk test.

Results:

The increased values of office systolic BP (SBP) were determined in both groups (154,3 ± 1,4 mm Hg in HFpEF pts and 145,5 ± 2,3 mm Hg in EH pts, p < 0,01). But mean 24-h (141,0 ± 1,5 mm Hg vs 131,6 ± 1,9 mm Hg, p < 0,001), daytime (144,6 ± 1,5 mm Hg vs 136,7 ± 2,0 mm Hg, p < 0,01) and nighttime (134,0 ± 1,8 mm Hg vs 121,5 ± 3,2 mm Hg, p < 0,05) BP values were significantly higher in HFpEF patients. There is no limiting impact of high blood pressure (in the range up to 154,3 ± 1,4 mm Hg) on physical activity in patients with initial stages of HFpEF.

Office DBP values were comparable in two groups and did not exceed the recommended range. Mean 24-h DBP values slightly exceeded the upper limits in both groups. 24-h pulse BP in HFpEF pts was 63,2 ± 0,9 mm Hg compared to 54,9 ± 1,4 mm Hg in EH pts, (p < 0,05).

54 HFpEF pts (60,0%) demonstrated abnormal pattern of day/night SBP dynamics and 37 pts (41,1%) - abnormal pattern of DBP, in case of EH - 43,3 % and 20,0 %, respectively.

The normal BP circadian rhythm was recorded in 12 (40,0 %) EH pts compared to 16 (17,8 %) HFpEF pts (x2 = 6,21; p < 0,05).

Conclusions:

HFpEF patients demonstrated insufficient control of office and 24-h BP. 82,2% of HFpEF patients were characterized by pathological types of BP circadian rhythm with dominating non-dipper type confirming the increased risk of cardiovascular events in HFpEF patients. Inadequate control of blood pressure is an important factor in the development of chronic heart failure with preserved ejection fraction. Mean ambulatory systolic BP level, unlike the office systolic BP, is independently associated with the development of HFpEF.
PARAMETERS INDICATING DEVELOPMENT OF HYPERTENSION IN THREE-YEAR FOLLOW-UP STUDY OF SUBJECTS WITH HIGH NORMAL BLOOD PRESSURE
Authors: Kalos Theodoros , Dimitriadis Kyriakos , Konstantinidis Dimitrios , Siafi Eirini , Kariori Maria , Kakouri Niki , Manta Eleni , Tatakis Fotis , Polyzos Dimitrios , Drogkaris Sotiris , Zammanis Ioannis , Fragoulis Christos , Andrikou Ioannis , Tsioufis Konstantinos
Published: June 2022

Objective:

Assess the relation of hypertensive response to exercise (HRE) in subjects with high normal blood pressure (BP) while sympathetic overactivity assessed by muscle sympathetic nerve activity (MSNA) and arterial stiffening are linked with development of hypertension (HTN).

Design and method:

100 consecutive subjects with high normal BP [systolic BP = 130–139mmHg and/or diastolic BP = 85–89mmHg], underwent a negative for ischemia treadmill exercise test (Bruce protocol). Arterial stiffness was evaluated using carotid-femoral pulse wave velocity (PWV). Sympathetic drive was assessed by MSNA. Follow-up was scheduled every 6 months for 3 consecutive years, where BP measurements were assessed in office and with ambulatory BP monitoring (ABPM). All participants offered lifestyle advice. Endpoint was development of HTN either with OffBP or ABPM. We divided into Group I those who developed HTN and Group II without HTN.

Results:

From 100 subjects (54 ± 8 years, 42 males, baseline OffBP: 132/82 mmHg, 24-hour BP: 122/76 mmHg) 40 developed HTN (Group I) and 50 developed HRE (BP> or = 210mmHg in men and > or = 190mmHg in women). Group I vs II had higher HRE (75%vs13%, p = 0.026) with intermediate stage intervals of 3 min (160vs147mmHg, p = 0.068) and 6 min (181vs164mmHg, p = 0.035). The SBP/MET-slope [(peakSBP—restingSBP)/(peakMET-1)] in Group I was increased in all stages till peak exercise (stage1: 6.25vs4.25, stage2: 7.6vs5.3, peak: 7.22vs5.1, p = 0.035). Their exercise capacity was reduced (10vs11.5METs) as their maximum exercise heart rate (154vs164, p = 0.001). They demonstrated higher levels of PWV (8.35vs7.5m/sec, p = 0.043) and MSNA levels (37vs31 bursts, p = 0.04), while did not differ regarding their metabolic profile at the follow-up. Echocardiographicly LVMI did not differ, but LVEDD (47vs45 mm, p = 0.02), E/A ratio of mitral valve inflow (0.92vs1.05, p = 0.034) and left atrium diameter (3.8vs3.6 mm p < 0.1) were statistically significant. At their initial ECG had shorter P-wave duration (101.3vs93.2, p = 0.013) and QRS duration (93.4vs85.7, p = 0.006). In ABPM they demonstrated higher night systolic BP (116vs112mmHg, p < 0.04).

Conclusions:

In subjects with high normal BP, MSNA identifies a state of increased sympathetic overdrive, PWV demonstrates arterial stiffening and exercise testing proves its prognostic value as a hypertension predictor screening tool acknowledging a state of increased systemic vascular resistance.
THE SIZE OF BLOOD PRESSURE MEASUREMENT REDUCTION IN THE UNATTENDED AUTOMATED BLOOD PRESSURE MEASUREMENTS IS CORRELATED WITH THE LEVEL OF ANXIETY
Authors: Stopa Marek , Zieba Katarzyna , Tofilska Anna , Korpala Barbara Betkowska , Rajzer Marek , Olszanecka Agnieszka
Published: June 2022

Objective:

Accurate and precise measurement of blood pressure [BP] is critical for both diagnostics and guiding clinical decisions in arterial hypertension. Unattended automated blood pressure measurement [UABPM] can simplify the measurement process, reducing human error and minimizing the white coat effect. The purpose of this study was to analyze the differences in BP between office attended [oABPM] and UABPM and examine their relation with the level of anxiety.

Design and method:

We conducted a prospective study in the group of 124 hypertensive outpatients (56 % female, mean age 55,3 ± 12,3 years). Each patient had been asked to fill out a health questionnaire and perform the State-Trait Anxiety Inventory, a standardized psychological questionnaire measuring level of anxiety. Afterward, BP was measured using two methods with random order:

oABPM – after 5 minutes of rest 3 measurements in 1-minute intervals were taken by a doctor

UABPM – after programming the device by a doctor, patient was left alone, after 5 minutes the device performed 3 measurements in 1-minute intervals.

Differences in BP were compared using paired sample t-test. Correlation between differences and level of anxiety was nalysed using Pearson correlation coefficient.

Results:

In UABPM both systolic and diastolic BP values were significantly lower than in oABPM (4,19 ± 6,48 mmHg, p < 0,001 and 2,04 ± 3,34 mmHg, p < 0,001, respectively). These differences t were more pronounced in the group that had attended measurements taken first (5,98 ± 6,57 mmHg, p < 0,001 for systolic and 3,11 ± 3,52 mmHg, p < 0,001 for diastolic). In this group, significant correlation between systolic BP and level of anxiety was found (r = 0,27, p = 0,047). In multiple regression female sex (B = -4,62, p < 0,001 for systolic and -1,19, p = 0,042 for diastolic) and order of measurements (B = 3,63, p < 0,001 for systolic and 2,06, p < 0,001) for diastolic) were most significantly influencing BP differences between compared methods.

Conclusions:

Routine clinic measurements can overestimate BP values and the difference in oABPM and UABPM partly depends on the level of anxiety. Accurate BP measurement has important implications for treatment decisions like dose and/or drug escalation.
TENSIOBOT: A CHATBOT ASSISTANT FOR SELF-MANAGED IN-HOUSE BLOOD PRESSURE CHECKING
Authors: Ramón Saracho , Echeazarra Leyre , Pereira Juan Antonio
Published: June 2022

Objective:

Patients with HBP are often asked to have their BP checked at home. The traditional at-home procedure has some drawbacks, such as forgetting to check or write down the values, errors in transcribing the numbers, or the impossibility of immediately notifying medical staff of out-of-range BP values. To facilitate self-measurements by patients at home we devised TensioBot, a Telegram based chatbot. The bot sends patients reminders to check their BP, advice on good monitoring practices, measurement tracking, medical alerts and allows healthcare professionals to access up-to-date measurement information. The aim of our study was to compare the use of Tensiobot against usual method of home BP checking.

Design and method:

In an Clinical Hypertension Unit, we tested TensioBot for two years in a andomised controlled trial with 112 patients, 55 using the bot and 57 in the control group, (using paper annotations). Patients of both groups underwent an ABMP study at the same time. An specific questionnaire about knowledge and skills on BP checking was administered face to face by an specialized nurse of the unit.

Results:

We found that, although the bot group showed similar results in terms of adherence to the BP checking schedule, bot users scored better in terms of knowledge and skills on BP checking best practices. Patients of bot group shown a lesser mean difference between ABPM mean diurnal SBP and SBP registered by Tensiobot, -0.34 mmHg vs -2.5 mmHg, although such difference was not significant. The standard deviation of differences in SBP was higher in the control group.

Conclusions:

Participants rated the bot very positively, perceived it as useful and easy to use, and continued to use it after the intervention. Moreover, all data being equal, we describe some other benefits of using a chatbot for self-managed in-house BP control, both for patients and healthcare professionals and systems. There was a trend to closer values to diurnal ABPM in SPB using the bot.
COMPARISON OF OFFICE, HOME AND AMBULATORY BLOOD PRESSURE MEASUREMENT IN HYPERTENSIVE PARTICIPANTS IN THE POPULATION-BASED SWISS LONGITUDINAL COHORT STUDY (SWICOS)
Authors: Radovanovic Dragana , Schoenenberger-Berzins Renate , Muggli Franco , Gallino Augusto , Parati Gianfranco , Suter Paolo , Bianchetti Mario , Erne Paul , Schoenenberger Andreas
Published: June 2022

Objective:

The 2021 guideline of the ESH states that a reliable hypertension diagnosis should not be based on office BP measurement solely, but should be confirmed with the use of home BP measurement (HBPM) or 24 h ambulatory BP measurement (ABPM). The aim of our study was to compare BP measurements obtained in the office (OBPM), at home (HBPM) and ambulatory (ABPM) in individuals with elevated OBP participating in the Swiss Longitudinal Cohort Study (SWICOS).

Design and method:

Participants with OBP = > 140/90mmHg were invited to assess their BP using HBPM and ABPM. The cut-off for hypertension was = > 135/85 mmHg for HBPM and = > 130/80 mmHg for ABPM. White-coat hypertension (WCH) was defined as normal HPBM or ABPM in the subgroup of participants who had OBP = > 140/90mmHg. Undertreatment was defined as hypertension in HBPM or ABPM despite antihypertensive treatment.

Results:

Of 72 hypertensive participating subjects with office BP = > 140/90mmHg and valid measurements of HBPM and ABPM, 39 were males (aged 62.8 ± 11.8y) and 33 were females (aged 57.4 ± 14.2y). Systolic BP measured in the office (151.7 ± 15.5 mmHg) was significantly higher than values measured using HPBM (130.0 ± 13.5 mmHg) (p < 0.001) or during ABPM (131.8 ± 14.7 mmHg) (p < 0.001). Diastolic BP was also highest in the office (89.3 ± 8.0 mmHg) and significantly different from HBPM (81.6 ± 6.6 mmHg) or ABPM (80.8 ± 11.2 mmHg) (both p < 0.001). Hypertension was confirmed with HBPM in only 21 participants (29%), and with ABPM in 41 participants (57%). Participants who had hypertension according to ABPM but not to HBPM were significantly younger (p < 0.001) and more frequently working (p < 0.001). The prevalence of WCH was 44% using HBPM and 26% using ABPM. Undertreatment was found in 13 participants (18%) using HBPM and 21 (29%) using ABPM.

Conclusions:

This study found highest BP for OBPM; HBPM and ABPM were significantly lower. Hypertension prevalence was lower using HBPM than using ABPM in young working participants. Potentially, HBPM might lead to underdiagnosis and undertreatment. Nevertheless, the findings of this study support the ESH recommendations of complementing office BP using HBPM or ABPM given the high prevalence of WCH and undertreatment.
AMBULATORY BLOOD PRESSURE MEASURMENT INTEREST IN GENERAL PRACTICE
Authors: De La Rue Du Can Arthur , Rey Jean-Marie , Ormezzano Olivier
Published: June 2022

Objective:

International societies recommend out of office blood pressure (BP) measurement to confirm and follow hypertension (HT). In France Ambulatory blood pressure monitoring (ABPM) is usually used only by cardiologists or hypertensive specialists. However a majority of hypertensive patients are seen by general practitioners GP’s. The objective of our study was to evaluate ABPM interest in GP’s daily practice.

Design and method:

This is a retrospective, monocentric, observational study including all consecutive patients undergoing ABPM in a GP’s surgery in Grenoble.

The study groups were divided in three depending on ABPM indications:

- Screening of normal clinical blood pressure patients with high cardiovascular risk factors (SNBPP)

- Diagnosis in unknown hypertensive patients with elevated clinical BP (DHBPP)

Follow up of known treated hypertensive patients (HPP).

Results:

422 subjects ABPM were analysed. ABPM changed 43% patient BP status.

- Among SNBPP (35 subjects) 49% presented masked HT.

- Among DHBPP (158 subjects) 41% presented white coat HT. Systolic and diastolic office BP were significantly higher in confirmed hypertensive patients (p = 0.01 and < 10–4 respectively).

- Among HPP (229 subjects) 16% presented controlled BP, 33% presented white coat HTN, 11% masked HTN, 40% uncontrolled HT. Number and type of medications were not statistically correlated with BP control.

Dipping profil: 40.4% of patients were dippers, 40.2% were non dippers, 9.9% were reverse dippers, and 9.4% extreme dippers. Dipping variations were statistically different over the 3 groups (p < 10–4).

Conclusions:

ABPM is a great tool for GP’s to characterise accurately BP profil, and improve follow up and monitoring of patients.