bluuebunny/crossref_metadata_2025 huggingface dataset:
ARTERIAL STIFNESS AND SYMPATHETIC OVERDRIVE IN HYPERTENSIVE PATIENTS WITH ANGINA AND NON-OBSTRUCTIVE CORONARY ARTERY DISEASE
Authors: Sakalidis Athanasios , Dimitriadis Kyriakos , Dri Eirini , Soulaidopoulos Stergios , Manta Eleni , Leontsinis Ioannis , Mantzouranis Emmanouil , Fragoulis Christos , Konstantinidis Dimitrios , Tsioufis Konstantinos
Published: June 2022

Objective:

Existing data support that hypertension is related to sympathetic overdrive and arterial stiffness. Non-obstructive coronary artery disease (CAD) is frequent among hypertensive patients with angina. Nowadays, there are scarce evidence on the role of sympathetic nervous system (SNS) in the above population. The aim of this preliminary analysis of our study was to assess whether hypertensive patients with angina and non-obstructive CAD, hypertensives without angina and normotensive controls are characterized by different level of SNS activation and arterial stifness.

Design and method:

We studied 13 hypertensive patients with angina and non-obstructive CAD in coronary angiography [9 females, mean age: 61.2 ± 9.9 years, office blood pressure (BP): 159/96 ± 14/10 mmHg], 16 treated hypertensive patients without angina (9 females, mean age: 59.5 ± 7.5 years, office BP:142/88 mmHg) and 11 normotensive controls (8 females, mean age: 51.8 ± 11 years, BP:125/87 mmHg). In all participants, sympathetic drive was assessed by muscle sympathetic nerve activity (MSNA) estimated by microneurography and arterial stiffness, measured with heart rate-corrected aortic augmentation index (Aix@75), calculated by analyzing the ambulatory blood pressure monitoring (ABPM) waveforms.

Results:

Hypertensives with angina and non-obstructive CAD (n = 13) compared to hypertensive patients without angina (n = 16) and normotensive individuals (n = 11) exhibited higher levels of MSNA (59.6 ± 6.6 vs 43 ± 8.4 vs 45 ± 9.5 bursts per minute, respectively; p < 0.01 for all) and 24-h BP (146/85 ± 18/11 vs 141/83 ± 7/10 vs 125/81 ± 7/6 mmHg, respectively; p < 0.001 for all). Hypertensives with and without angina did not differ regarding renal function based on eGFR (p = NS). Moreover, there were no differences in left ventricular mass index, total cholesterol and low-density lipoprotein between hypertensive patients with and without angina and no gender related effects on MSNA and Aix@75 (p = NS). Furthermore, patients with angina and non-obstructive CAD patients compared to hypertensives without angina were characterized by increased levels of Aix@75 (36.13 ± 7.4 vs 22.5 ± 11.7, p < 0.05).

Conclusions:

Patients with hypertension and non-obstructive CAD are characterized by higher MSNA and increased Aix levels compared to hypertensives without angina and normotensive controls. These preliminary results suggest that therapies targeting sympathetic overdrive and vascular stiffening could provide additional clinical benefit in this special category of hypertensive patients.
SMOKING PARADOX IN HYPERTENSIVE ST SEGMENT ELEVATION MYOCARDIAL INFARCTION PATIENTS: 25-YEAR POPULATION-BASED STUDY
Authors: Ghrab Aiman , Chamtouri Ikram , Louati Molka , Abdallah Wajih , Jomaa Walid , Hamda Khaldoun Ben , Faouzi Maatouk
Published: June 2022

Objective:

The main objective of our paper is to study the effect of smoking status on the outcomes of hypertensive patients presenting with ST-segment elevation myocardial infraction.

Design and method:

Patients with STEMI who were hospitalised in our coronary care unit during a 25-year period (since 1994) were included in a specific registry. Their in-hospital and follow-up data have been regularly updated.

We selected only patients with known or newly diagnosed hypertension in our study. Then, we divided the population into two groups according to their smoking status. The primary endpoints were death, rehospitalization, non-fatal myocardial infarction. The secondary endpoints were in-hospital mortality, left ventricular dysfunction, life-threatening arrythmias, prolonged hospital stay and bleeding complications.

Results:

A total of 1609 patients were included during the study period. Among 489 patients having hypertension, 45.5% were smokers with male sex predominance (sex ratio 11/1). Baseline characteristics are detailed in table 1. Among the primary endpoint: One-year mortality was significantly more important in the non-smokers group (p = 0.012): there was no significant difference in non-fatal MI (p = 0,142) and in all cause rehospitalization (p = 0.093). As for the secondary endpoints, there was no significant difference between the two groups except for the in-hospital death (p < 0.01). The results of the endpoints are detailed in table 1.

Conclusions:

Smoking seems to have a beneficial effect on the outcomes of STEMI of hypertensive patients.
COVID-19 AND CARDIOVASCULAR SYSTEM: NOT ONLY HEART BUT ALSO VASCULAR. THE EFFECTS OF THE INFECTION ON ARTERIAL STIFFNESS
Authors: Maloberti Alessandro , Gualini Elena , Scarpellini Sara , Algeri Michela , Biolcati Marco , Grasso Enzo , Tognola Chiara , Moreo Antonella , Fabbri Saverio , Giannattasio Cristina
Published: June 2022

Objective:

SARS-CoV-2 determines a framework of multi-organ dysfunction that can involve the cardiovascular system creating damages of different nature. Among these, endothelial damage could play a key role in increasing arterial stiffness and thus the cardiovascular risk of infected patients. The aim of this study is to evaluate the Pulse Wave Velocity (PWV) of a population of patients after recovery from infection and to compare them with those of a group affected by arterial hypertension.

Design and method:

This prospective observational monocentric study involved 143 patients with previous diagnosis of Covid-19 who undergone PWV measurement during the follow-up at a median time of 3.8 months after the infection. These patients were compared to a population of 143 patients with hypertension matched by age, sex, Systolic Blood Pressure values and Body Mass Index.

Results:

PWV values were higher in Covid-19 group comparing to hypertension group (10.5 ± 3.0 m/s VS 8.9 ± 2.5 m/s). Furthermore, there is a correlation between higher PWV values and lower values of SpO2% at time of admission at the Emergency Department. (R = -0.302; p < 0.001).

Conclusions:

SARS-CoV-2 infection seems related to increased PWV values. Moreover, higher arterial stiffness seems correlated to a worse oxygen saturation in Emergency Department. More studies with longer follow-up time are necessary to establish whether the vascular damage is reversible and whether it correlates with an increase of long-term cardiovascular risk.
CONTINUOUS REMOTE PATIENT MONITORING SHOWS EARLY CARDIOVASCULAR CHANGES IN COVID-19 PATIENTS
Authors: Eisenkraft Arik
Published: June 2022

Objective:

COVID-19 exerts deleterious cardiopulmonary effects, leading to a worse prognosis in the most affected. This study aimed to analyze the trajectories of key vitals amongst hospitalized COVID-19 patients using a chest-patch wearable medical-grade monitor providing continuous remote patient monitoring of numerous vital signs.

Design and method:

This retrospective multicenter observational cohort study was conducted in five COVID-19 isolation units. 492 COVID-19 patients were included in the final analysis. Physiological parameters were measured every 15 minutes.

Results:

More than 3 million measurements were collected including heart rate, systolic and diastolic blood pressure, cardiac output, cardiac index, systemic vascular resistance, respiratory rate, blood oxygen saturation, and body temperature. Cardiovascular deterioration appeared early after admission and in parallel with changes in the respiratory parameters, showing a significant difference in trajectories within sub-populations at high risk.

Conclusions:

Early detection of cardiovascular deterioration of COVID-19 patients is achievable when using frequent remote patient monitoring.
AORTIC STIFFNESS AND INDEXES OF DISEASE SEVERITY IN SUBJECTS WITH PREVIOUS COVID-19 PNEUMONIA: A FOLLOW-UP STUDY
Authors: Baiano Valeria , Catena Cristiana , Bulfone Luca , Scandolin Laura , Vacca Antonio , Brosolo Gabriele , Da Porto Andrea , Cavarape Alessandro , Colussi Gianluca , Bertin Nicole , Vivarelli Cinzia , Sechi Leonardo
Published: June 2022

Objective:

Up to date the possibility of a vascular damage due to COVID-19 pneumonia is a not clarified. We searched for relationships between the carotid-femoral pulse wave velocity (cfPWV) and clinical and biochemical markers of severity of the infectious disease, after hospital discharge, in a group of patients who had been admitted in care units.

Design and method:

In 69 subjects (age 58 ± 13 years, 36 males), previously admitted in hospital because of COVID-19 pneumonia, we evaluated at the time of hospital admission anthropometric parameters, blood pressure, history of arterial hypertension or other diseases, drugs, smoking and alcohol habit, physical activity level, and indexes of infectious disease severity, such as the SIMEU score, need for invasive oxygen delivery, PaO2, PaCo2, inflammatory markers such as white blood cells count, levels of proadrenomedulline (proADM), reactive C protein, procalcitonin, IL- 6, glomerular filtration rate (GFR), troponin, mioglobin, B natriuretic peptide. After an average 2 months follow-up the cfPWV was measured.

Results:

At univariate analysis the cfPWV was significantly and positively related to age (r = 0.454, P < 0.001), body mass index (r = 0.436, P = 0.016), waist circumference (r = 0.345, P = 0.004), levels of plasma glucose (r = 0.430, P = 0.001), proADM (r = 0.456, P = 0.006), IL-6 (r = 0.280, P = 0.037), mioglobin (r = 0.443, P = 0.001) and inversely related to GFR (r = -0.289, P = 0.023). The cfPWV was higher in diabetics subjects than in non-diabetics (P = 0.011), and in patients who had needed invasive oxygen support (P = 0.044). There was no difference in cfPWV in patients with or without history of arterial hypertension or with different blood pressure levels at admission. At multivariate analysis the cfPWV was independently associated with invasive oxygen support (B = 0.168, P = 0.012), body mass index (B = 0.180, P = 0.001), waist circumference (B = 0.162, P = 0.002), GFR (B = 0.078, P = 0.008), and proADM levels (B = 0.161, P = 0.003).

Conclusions:

In patients who recovered from COVID-19 pneumonia the aortic stiffness is associated with severity of disease and levels of proADM, but not with history of hypertension. Patients with more higher proADM levels in acute phase of the infectious disease could need a longer follow-up evaluation of the CFPWV after the recovering from disease to search for long time vascular damage.
RISK FACTORS FOR POST-COVID-19 SYNDROME DEVELOPMENT IN PATIENTS WITH ARTERIAL HYPERTENSION
Authors: Makeeva Tatiana , Zbyshevskaya Elizaveta , Bitakova Fatima , Butaev Tamerlan , Saiganov Sergey , Talibov Faiz , Mayer Mark
Published: June 2022

Objective:

To determine risk factors for post-COVID-19 syndrome development in patients with arterial hypertension (AH).

Design and method:

A total of 81 patients with AH were examined 3–6 months after COVID-19. 48 people (group 1: 27 women, 21 men) suffered from SARS-CoV-2 pneumonia with lungs lesion from 15% to 74%. The patients’ age was 18–87 years old (65 years old on average). In 38 patients chronic ischemic heart disease (IHD) was diagnosed; in 18 – myocardial infarction (MI); in 10 – permanent atrial fibrillation (AF); in 12 – AF paroxysms. 33 people (group 2: 18 women, 15 men) suffered from COVID-19 in the form of an acute respiratory illness without pneumonia. These patients were aged from 41 to 74 (56.9 years old on average). 25 patients had coronary artery disease; 2 – MI; 2 – permanent AF; 4 – AF paroxysms.

Results:

Comparing to group 2, in group 1 the patients had higher blood pressure; higher left atrial volume index (LAVI) (35.1 ± 3.3 ml/m2 vs. 29.6 ± 3.2 ml/m2; p < 0.05); higher left ventricular (LV) end-diastolic volume index (EDVI) (76.1 ± 8.8 ml/m2 vs. 62.6 ± 10.3 ml/m2; p < 0.05); lower LV ejection fraction (EF) (56.1 ± 8.1% vs. 63.2 ± 3.9%; p < 0.05). In 7 group 1 patients, an increase in the frequency of AF attacks was detected. In group 1 symptoms of inflammation persisted for a long time: higher levels of C-reactive protein (15 ± 4.9 mg/l vs. 5.5 ± 3.8 mg/l), of blood ferritin (275 ± 106.3 mcg/l vs. 155.6 ± 85.8 mcg/l; p < 0.05), of D-dimer (919.3 ± 77.1 ng/ml vs. 609 ± 87.4 ng/ml; p < 0.05) as well as of total cholesterol (5.8 ± 1.2 mmol/l vs. 4.9 ± 1.1 mmol/l; p < 0.05) and of LDL (4.1 ± 1.1 mmol/l vs. 3.2 ± 1.3 mmol/l; p < 0.05).

Conclusions:

The revealed risk factors were high blood pressure, an increase in LAVI and LV EDVI, a decrease in LVEF, an increase in LDL, previous MI, and an increase in the frequency of AF paroxysms.
PARTICULARITIES OF HYPERTENSIVE PATIENTS WITH METABOLIC SYNDROME, ADMITTED FOR SARS-COV-2 INFECTION TO A CLINICAL EMERGENCY HOSPITAL
Authors: Stirban Raluca , Grigore Cristiana , Dragoi Doina , Balaceanu Beatrice , Gurau Cristian-Dorin , Voiculet Cornelia , Zaharia Magda , Dediu Giorgiana , Zara Octavian , Giuglea Carmen , Calin Camelia , Dina Ion , Balaceanu Alice
Published: June 2022

Objective:

The aim of the study was to assess the clinical particularities and the lab tests in hypertensive patients with metabolic syndrome, admitted for SARS-COV2 infection.

Design and method:

We performed a retrospective study on 217 patients admitted to a Clinical Emergency Hospital between January 2021 and October 2021.

Results:

We had 217 patients admitted in internal medicine clinic for infection with SARS-COV2 virus, most of them with moderate and severe form of disease. From them, 148 patients (68.20%) had hypertension on admission and 114 patients (52.53%) had metabolic syndrome. Patients were aged between 23 and 99 (average age of 65 years). In comparison, the patients in the hypertensive subgroup were aged between 37 and 97 (average age of 70).

The gender distribution was similar in the large group and hypertensive subgroup: 52.07% male, 47.92% female in the large group, and 52.03% male, 47.97% female in the hypertensive subgroup.

At admission, the stages of SARS-COV2 infection in patients with metabolic syndrome, according CT examination, were severe in 54.41% of cases, moderate in 27.94%, and mild in 17.64%.

According the IDF definition of the metabolic syndrome, 8.33% of the patients had 5 criteria, 35.29% patients had 4 criteria, and 58.82% patients had 3 criteria of disease. Hypertension was encountered in 80.95% of patients with metabolic syndrome, obesity in 56.75% and diabetes mellitus in 52.70% of cases.

As comorbidities: cancer in 5.88% of patients, chronic heart failure in 26.47% of cases (72.22% NYHA II class and 27.78% NYHA III class), atherosclerosis in 55.88%, COPD in 7.35%, depression in 7.35% and dementia in 5.88% of cases.

High levels of the inflammatory markers or specific lab tests were encountered: CRP in 98.53% of cases, pro-calcitonin in 86.76%, ferritin 80.88%, IL-6 in 83.33%, D-dimers in 85.29%, NT-proBNP 71.92%, troponin 70.59%, LDH in 91.17%, uric acid in 11.76%.

Conclusions:

The most reliable comorbidity factor who predict evolution/prognosis of SARS-COV2 infection in patients with metabolic syndrome was diabetes mellitus (the levels of glycaemia and the need of high units of insulin), despite the fact that hypertension and obesity were more prevalent.
ASSOCIATION OF IN-PATIENT OUTCOMES AND RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM INHIBITOR USE AMONG HYPERTENSIVE PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19)
Authors: Lozada Ma. Cecilia , Medina Henry , Sucaldito Ma Sergia Fatima , Santos Lourdes Ella , David-Ona Deborah Ignacia , Oliva Raymond
Published: June 2022

Objective:

RAAS inhibitors were speculated to increase expression of ACE2 receptors in the respiratory tract which was feared to lead to poorer outcomes among hypertensive patients infected with COVID-19. Current evidence has not confirmed Renin-Angiotensin-Aldosterone System inhibitors exposure as harmful in patients with COVID-19 infection. This study aims to determine the association between use of RAAS inhibitors and in-patient outcomes of adult hypertensive patients admitted for COVID-19.

Design and method:

A cross-sectional analytical study using case records was done on adult hypertensive patients admitted for COVID19 starting from March 2020 to March 2021 in a tertiary government hospital. The association of RAAS inhibitor use and in-patient outcomes was determined using Fisher’s chi-square test.

Results:

A total of 2,264 charts were reviewed for all COVID 19 patients admitted from March 2020 to March 2021, and 671 patients were determined to be hypertensive. Majority of hypertensive COVID-19 patients were male (52%), elderly (58%) and with moderate disease severity (51%). The most common comorbidities were community acquired pneumonia (59%), type 2 diabetes mellitus (44%) and chronic kidney disease (22%). A total of 66% (n = 442) of the hypertensive patients admitted for COVID were on RAAS inhibitors with losartan (40%) as the most commonly used agent. RAAS inhibitor use was not found to be associated with mortality (OR 0.74, 95% CI 0.57–1.10) and development of acute kidney injury (OR 1.12, 95% CI 1.12–1.69) among hypertensive COVID19 patients. However, RAAS inhibitor use was associated with decreased mortality among hypertensive patients classified with COVID-19 moderate disease (OR 0.42, 0.19–0.92, p-value 0.02).

Conclusions:

RAAS inhibitor use was not associated with increased mortality and development of acute kidney injury.
THE EFFECT OF DAPAGLIFLOZIN ON THE LEVEL OF SYSTOLIC BLOOD PRESSURE AND GLYCEMIC CONTROL IN PATIENTS WITH ARTERIAL HYPERTENSION AND TYPE 2 DIABETES
Authors: Zhuravlyova Larysa , Rogachova Tetyana , Sokolnikova Nelya , Filonenko Maryna
Published: June 2022

Objective:

to determine the influence of dapagliflozin (D) on the level of blood pressure (BP) in patients with arterial hypertension (AH) and type 2 diabetes mellitus (T2DM).

Design and method:

A total of 57 patients with AH, stage II and concomitant non-severe T2DM were examined (fasting plasma glucose < 9 mmol/L, glycosylated hemoglobin (HbA1c) - 7.45 ± 1.3%, mean age 52.4 ± 2.8, mean BP 162/102 ± 3.5/2.3 mm Hg, BMI 28.3 ± 2.7 kg/m2, disease duration 6.6 ± 1.7 years,). Patients were divided into 2 groups: the comparison group included 23 patients who received metformin 850 mg 2/day, lisinopril 10 mg 1/day and amlodipine 10 mg 1/day. Patients of the main group (D-group, n = 34), received dapagliflozin 10 mg in addition to standard therapy.

Results:

6 months after beginning of therapy, the following results were obtained: HbA1C in the D-group was 6.28 ± 0.6%, in the comparison group – 6.56 ± 0.48% (p < 0.05). A slight decrease of BMI was observed in both groups (26.3 ± 1.2 kg/m2 and 27.4 ± 1.3 kg/m2, respectively), however, the changes were insignificant. Systolic blood pressure (SBP) in the D-group was 132 ± 7.24 mm Hg., and in the comparison group - 145.5 ± 9.17 mm Hg., (p < 0.05). The diastolic blood pressure (DBP) was 83.5 ± 3.8 mm Hg and 89,6 ± 4.2 mm Hg, respectively.

Conclusions:

the obtained data demonstrate that adding of dapagliflozin to a standard therapy of hypertension and concomitant type 2 diabetes leads both to significant decrease of SBP and improvement of glycemic control. The outcomes of our research suggest that dapagliflozin has a potential to reduce cardiovascular risk in hypertensive patients with type 2 diabetes.
THE SPECIFICS OF HEMODIALYSIS IN DIABETICS. EASTERN ALGERIAN EXPERIENCE
Authors: Zemmouchi Souheila
Published: June 2022

Objective:

The management of diabetics on hemodialysis is particularly difficult due to frequent hypoglycaemia and significant inter and perdialytic glycemic variability that is difficult to predict. The aim of our study is to describe the clinical-biological profile and to assess the cardiovascular risk of diabetics undergoing chronic hemodialysis and to compare them to non-diabetic hemodialysis patients.

Design and method:

This cross-sectional, descriptive and analytical study was carried out between January 01 and December 31, 2018, involving 309 hemodialysis patients spread over 4 centers The data were collected prospectively then compiled and analyzed by the SPSS Version 10 software The FRAMINGHAM RISK SCORE has been used to assess cardiovascular risk in all hemodialysis patients

Results:

The survey involved 309 hemodialysis patients, including 83 diabetics, for a prevalence of 27% The average age 53 ± 10.2 years. The sex ratio is 1.5. 50% of diabetic hemodialysis patients retained residual diuresis against 32% in non-diabetics. In the group of diabetics, we noted more hypertension (70% versus 38% non-diabetics P 0.004), more intradialytic hypoglycemia (15% versus 3% non-diabetics P 0.007), initially vascular exhaustion was found. in 4 diabetics versus 2 non-diabetics. 70% of diabetics with anuria had postdialytic hyperglycemia. The study found a statistically significant difference between the different levels of cardiovascular risk according to the diabetic status.

Conclusions:

There are many challenges in the management of diabetics on hemodialysis, both to optimize glycemic control according to an individualized target, and to coordinate comprehensive and effective care.
CARDIOVASCULAR OUTCOMES WITH FINERENONE ACCORDING TO STATUS OF GLYCEMIA AT BASELINE AND PRIOR TREATMENT WITH NEWER ANTIDIABETICS AMONG PATIENTS WITH TYPE 2 DIABETES MELLITUS
Authors: Patoulias Dimitrios , Katsimardou Alexandra , Stavropoulos Konstantinos , Imprialos Konstantinos , Koutsampasopoulos Konstantinos , Boulmpou Aristi , Toumpourleka Maria , Siskos Fotios , Papadopoulos Christodoulos , Doumas Michael
Published: June 2022

Objective:

Type 2 diabetes mellitus (T2DM) and cardiovascular disease are closely interconnected. We sought to determine the cardio-protective action of finerenone according to prior treatment with newer antidiabetics and level of glycemic status.

Design and method:

We searched PubMed and Cochrane Library from inception to 1st October 2021 for randomized controlled trials (RCTs) assessing the effect of finerenone on major adverse cardiovascular outcomes in patients with T2DM. We set as primary endpoint the composite of major adverse cardiovascular event, defined as the composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure (MACE).

Results:

We finally included 2 RCTs in our quantitative synthesis. Finerenone compared to placebo induced a 23% risk reduction for the composite cardiovascular endpoint, regardless of prior glycemia. We also showed that finerenone provided significant cardiovascular benefit for obese patients with T2DM, compared to placebo, which was diminished for subjects with a body mass index (BMI) lower than 30 kg/m2. Finally, combination of finerenone with SGLT-2 inhibitors or GLP-1RAs did not produce a significant risk reduction for MACE.

Conclusions:

Finerenone provides significant cardiovascular benefit for patients with T2DM, especially for those being obese, while the level of glycemia or treatment with newer antidiabetics at baseline does not seem to affect the observed cardio-protective action.
EFFECT OF SODIUM-GLUCOSE CO-TRANSPORTER-2 INHIBITORS ON ARTERIAL STIFFNESS UNDER STATIC OR AMBULATORY CONDITIONS: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS
Authors: Patoulias Dimitrios , Katsimardou Alexandra , Imprialos Konstantinos , Stavropoulos Konstantinos , Koutsampasopoulos Konstantinos , Siskos Fotios , Boulmpou Aristi , Toumpourleka Maria , Papadopoulos Christodoulos , Doumas Michael
Published: June 2022

Objective:

Arterial stiffness represents an emerging cardiovascular risk factor with independent prognostic implications. Sodium-glucose co-transporter-2 (SGLT-2) inhibitors are a novel drug class with significant cardio-protective effects, but largely unknown mechanism underlying this effect. Herein we sought to determine the effect of SGLT-2 inhibitors on pulse wave velocity (PWV), the “gold-standard’’ measure of arterial stiffness.

Design and method:

We searched PubMed, Cochrane Library and grey literature from inception to 10th October 2021 for parallel group randomized controlled trials (RCTs) enrolling adult subjects with or without type 2 diabetes mellitus (T2DM), assigned to a SGLT-2 inhibitor versus placebo or active comparator and addressing their effect on PWV under static or ambulatory conditions. We set as primary efficacy outcome the change in PWV with SGLT-2 inhibitors versus placebo or control.

Results:

We pooled data from 4 trials for a total of 301 enrolled participants assigned either to SGLT-2 inhibitor or control. Treatment with a SGLT-2 inhibitor compared to placebo or active control led to a significant decrease in PWV by 0.25 m/s (mean difference = -0.25, 95% CI; -0.49 to -0.01, I2 = 24%, p = 0.04). Certainty of evidence was graded as low.

Conclusions:

SGLT-2 inhibitors produce a slight, however statistically significant decrease in PWV in patients with established cardiovascular disease or cardiovascular risk factors, such as hypertension and T2DM.
THE SYSTOLIC RISE TIME MEASURED WIH PPG TO SCREENING PERIPHERAL ARTERY DISEASE: APPLICATION TO THE POPMETRE
Authors: Obeid Hasan , Amrani Samantha , Eveilleau Kornelia , Abi-Nasr Imad , Hallab Magid , Leftheriotis Georges
Published: June 2022

Objective:

Screening for Peripheral Artery Disease (PAD) remains a challenge in the prevention and care of patients with arteriosclerosis. The Ankle Brachial Index (ABI) is currently the gold standard. However, ABI is time consuming and requires some expertise to perform which is a limiting factor for global screening. The measurement of the Systolic Rise Time (SRT) of the pulse wave of the lower limb may provide an easier alternative to detect PAD. In a retrospective pilot study, we analyzed the possibility of detecting PAD using the SRT of the toe waveform using the Photo-PlethysmoGraphic signal (PPG).

Design and method:

We measured 79 subjects (41 patients diagnosed with different stages of PAD and 38 healthy volunteers without known PAD). In each subject, at least one lower limb was assessed with classical ABI. All subjects underwent a PPG assessment on the finger and the toe simultaneously using popmètreâ (Axelife – France). In-house software (JAVA) was used to calculate the SRT of all recorded signals.

Results:

146 lower limbs were analyzed including 72 healthy and 74 subjects with PAD. The mean age of the population was 69 ± 12 years with 75% men, 28% diabetics, 47% hypertensive, 49% without clinical PAD defined as stage 0 in this study; 16% in stage 1; 32% in stage 2; 2% in stage 3 and 1% in stage 4 according to the Leriche classification. The SRT cut-off value of 160 ms identifies PAD according to Leriche starting at stage 1 with a sensitivity of 78% vs 73% for ABI < 0.9 and a specificity of 86% vs 87%; a positive predictive value (PPV) of 85% vs 86% and a negative predictive value (NPV) of 79% vs 75%. In addition, the ratio between toe-SRT and finger-SRT cut-off value of 1 identifies PAD with a sensitivity of 76% and a specificity of 74%.

Conclusions:

SRT measured using a PPG pulse signal of the toe is promising as a facile non-invasive method to diagnose PAD (duration < 14 seconds) and determine PAD stages 1 to 4 with similar specificity and sensitivity as the reference method.
STUDY OF EARLY RETINAL CHANGES IN PATIENTS WITH NEWLY DIAGNOSED TYPE 2 DIABETES MELLITUS
Authors: Nikolaidou Barbara , Triantafyllou Areti , Anyfanti Panagiota , Gavriilaki Eleni , Lazaridis Antonios , Stoimeni Anastasia , Dolgyras Panagiotis , Douma Stella , Gkaliagkousi Eugenia
Published: June 2022

Objective:

Retina and endothelium constitute fields in which the hyperglycemia’s pathological effects of type 2 diabetes mellitus (T2DM) can be detected. However, the precise time of these lesions’ appearance and factors contributing to it are still under investigation. Thus, we studied the early retinal lesions and endothelial function in patients with a recent diagnosis of T2DM (<6 months) and their association with adverse prognostic factors.

Design and method:

Patients with a recent diagnosis of T2DM receiving no other diabetic medication except from Metformin, and volunteers matched for age and blood pressure (BP) participated in the study. Somatometric data, BP measurements (ambulatory and office) and hematological parameters (lipids, renal function, fasting glucose, glycosylated hemoglobin) were recorded. Endothelial function was assessed by Asymmetric Dimethylarginine (ADMA). Retinal vessel diameters (central retinal arteriolar equivalent-CRAE / central retinal venular equivalent-CRVE) and their ratio (arteriovenous ratio-AVR) were assessed with a non-mydriatic fundus camera using special software.

Results:

We studied 165 participants, 81 T2DM patients and 84 non-T2DM volunteers. No differences were found between the 2 groups in retinopathy and ADMA measurements. ADMA was associated with female sex (p = 0.037), Body Mass Index (p = 0.033) and AVR (p = 0.047). AVR was significantly associated with age, male sex, ADMA, estimated Glomerular Filtration Rate (eGFR), smoking, office, day and nighttime diastolic, 24-hour, and nighttime systolic BP. Linear regression analysis showed the independent correlation of AVR with nighttime systolic blood pressure (p = 0.002) and age (p = 0.019) taking into consideration gender, smoking, eGFR, ADMA and T2DM.

Conclusions:

In patients with a very recent diagnosis of Type 2 Diabetes Mellitus, the retinal vessels diameters do not differ compared with individuals of similar age and blood pressure. However, the AVR index correlates with age and nighttime BP, highlighting the important contribution of the latter in early target organ damage in this population.
LEVEL OF ADHERENCE TO THE PHARMACOLOGICAL AND NON-PHARMACOLOGICAL TREATMENT OF PATIENTS WITH DIABETES MELLITUS
Authors: Rodero Eulalia Maria Amador , Esmeral Leslie Piedad Montealegre , Contrera Marco Eulalio , Charris Martha Arteta , de Oro Aguado Carlos , Rebolledo Roberto , Pulido Tammy
Published: June 2022

Objective:

To identify the level of adherence to pharmacological and non-pharmacological treatments according to age, sex and time of evolution in patients with diabetes mellitu

Design and method:

Cross-sectional observational analytical descriptive study, population 739 patients, with a sample of 272, which were randomly selected. Bonilla questionnaire validated with a Crombach alpha of 0.86 was applied. Tests were made for the variables age, sex and time of evolution to compare it with the variable level of adherence, with the corresponding descriptive statistics. Additionally, bivariate analysis to determine the association of the level of adherence with the variables age, sex and time of evolution.

Results:

63% were female, 37% were male. The average age was 54.93 +/- 12.44 years and the evolution time was 7.6 +/- 3.7 years. Regarding the level of adherence, the 272 participants had an average score of 70.53 +/- 11.38, which indicates that they are at risk of non-adherence to treatments

Conclusions:

Non-adherent behavior in patients with diabetes continues to be a concern, which is why governments continue to invest in educational programs for patients and their families to control diabetes and prevent its complications.
A COMPARISON OF ATRIAL FIBRILLATION INCIDENCE AMONG INTENSIVIST AND THE GENERAL POPULATION: UNRAVEL THE HEALTH MYTHS FOR PHYSICIANS
Authors: Syun Hu Wei
Published: June 2022

Objective:

Purpose: To explore the association of atrial fibrillation (AF) among physician specialist.

Design and method:

We used Cox proportional hazards models to estimate the incidence rate and the adjusted hazard ratios (aHR) with 95% confidence intervals (CIs) to determine the risk of atrial fibrillation in the physician study cohort relative to the comparison cohort, and further analyzed stratified by age and comorbidities.

Results:

The Cox proportional hazard regression model revealed that male physician was significantly associated with an increased risk of AF than non-physician after adjusting for potential confounders (adjusted HR, 1.05; 95% CI: 1.00– 1.11). In age-specific analysis, male physician age less than 35 years old showed the strongest association with AF (adjusted HR, 3.70; 95% CI: 3.01– 4.55). When stratified by comorbidity, the male physician cohort exhibited a significantly higher risk of AF than controls (adjusted HR, 1.45; 95% CI: 1.34– 1.57).

Conclusions:

Association of AF among physicians was shown.
LATVIA’S DOCTORS EXPERIENCE ON PROVIDING REMOTE CONSULTATIONS DURING COVID-19 PANDEMICS
Authors: Jeniceka Aleksandra , Homka Dzintra , Bikava Ieva , Sen Sevinç Elif , Sokolova Emma
Published: June 2022

Objective:

Major challenge for health care service became a situation of a pandemic caused by COVID-19 infection, when doctors continued to provide care switching to remote consultations when possible. This provided better accessibility to receive consultation form doctor, and those consultations where sometimes the only way to be consulted for the patient.

Aims of the study: To explore and analyze Latvia’s doctors experience on providing remote consultations during COVID-19 pandemics.

Objective:

1) To detect the volume and type of work physicians are able to manage remotely. 2) To find out what technical, GDPR-associated and other difficulties face doctors during the process. 3) To define the general attractiveness of remote consulting.

Design and method:

Two groups of doctors filled in the questionnaires in year 2021.

Results:

In one group, which consisted of 200 general practitioners, most respondents consider they could provide remote medical consultation about healthy lifestyle - 89,0% (n = 178); regarding check-ups, screening results - 86,5% (n = 173); to manage recommendations of other healthcare specialists - 66% (n = 132). Difficulties faced: 54,0% (n = 108) were not satisfied with payment, 22,5% (n = 45) admitted lack of specific skills, 45,5% (n = 91) found it problematic to make e-referrals. 61,0% (n = 122) like the idea of implementing services in practice on a regular basis. Another group, which consisted of 62 doctors of different specialties working in Clinical University Hospital. All doctors (62) were consulting by phone, 18 doctors only by phone, however 44 were consulting via e-mails, social network on video-conference platforms as well.

Research revealed that the process of patient identification, search of patient’s data and sensitive data transfer is complicated, time consuming and requires different approaches to manage.

Conclusions:

Latvian doctors have experience in remote consulting. When consulting remotely Latvian doctors were facing technical, legal, social and other difficulties. Some Latvian doctors are interested in introducing remote consulting services in their practice, if the restrictive moments for their provision would be eliminated. As well as there is need for amendments in normative regulation for providing remote consultations, and challenges relates to payment system implementations especially for state paid services.
HYPERTENSION OUTCOMES OF ADRENALECTOMY FOR UNILATERAL PRIMARY ALDOSTERONISM
Authors: Václavík Jan , Hartmann Igor , Hruska Frantisek , Kocianová Eva , Frysak Zdenek , Nesvadbova Marika , Tudos Zbynek , Ctvrtlik Filip , Benesova Klara
Published: June 2022

Objective:

To evaluate laboratory and clinical results after unilateral adrenalectomy in patients with primary aldosteronism (PHA).

Design and method:

A cross-sectional analysis was performed using data from patients who underwent transperitoneal laparoscopic adrenalectomy for PHA, between January 2008 and December 2019. Surgical indications were based on adrenal venous sampling without ACTH stimulation. Analyses included patient demographics; preoperative clinical, pharmacological, laboratory, and radiological data; and postoperative results assessed after a median of 4 months. Antihypertensive drug use was quantified by estimating the daily defined dose (DDD) of antihypertensive medication, thus enabling standardized comparison of dosage between the drug classes. Statistical assessments included univariable and multivariable logistic regression analysis.

Results:

This study enrolled 87 patients. The patients were taking 5.4 DDD of antihypertensive medication before surgery, and 3.0 DDD after surgery. Complete biochemical success of surgery was reached 67 patients (77%), 19 patients (22%) had partial biochemical success. Complete clinical success with normalization of blood pressure and withdrawal of all antihypertensive drugs was achieved in 19 patients (22%). 57 patients (65%) exhibited a reduction of DDD after surgery and/or improvement of blood pressure - partial clinical success. Thus, in 76 (87%) of all enrolled patients, surgery had an overall positive effect on hypertension control. Multivariable logistic regression showed that complete clinical success was independently associated with female gender and baseline sum of antihypertensive drugs DDD < 4.

Conclusions:

A majority of patients undergoing unilateral adrenalectomy for PHA achieved markedly improved hypertension control, despite almost halving their antihypertensive medication. Almost a quarter of patients were cured and able to cease using all antihypertensive drugs.
AMBULATORY BLOOD PRESSURE IN POSTMENOPAUSAL WOMEN ON ESTROGEN, ANDROGEN OR PROGESTERONE THERAPY
Authors: Stojanovic Milos , Vujovic Svetlana , Ivovic Miomira , Gajic Milina Tancic , Marina Ljilja , Miletic Marija , Nedeljkovic Biljana Beleslin , Stojkovic Mirjana , Ciric Jasmina , Zarkovic Milos
Published: June 2022

Objective:

Objective of this study was to evaluate different hormone replacement therapy (HRT) combinations on ambulatory blood pressure (ABPM) and body mass index (BMI) in postmenopausal women.

Design and method:

One hundred and fifty women 47–62 y’s of age were first on estrogen/androgen therapy, then they were without HRT therapy for three months and later on estradiol and drospirenone combined therapy. Validated, Meditech ABPM 05 was used to obtain 24-h blood pressure (BP) after each regime. All women did not change antihypertensive treatment during the study. Wilcoxon Signed Rank Test was used to examine whether there was a statistically significant difference in blood pressure and body mass index values at different hormone therapy regimens.

Results:

There were no significant differences in BP parameters and BMI between different therapy regimes but lowest BP and BMI values were recorded while women were on estradiol and drospirenone combined therapy. The affinity of progesterone for the mineralocorticoid receptor is about five times that of aldosterone and may well antagonize the salt-retaining effect of estrogens, and thus lowering of blood pressure. 

Conclusions:

We may conclude that estradiol and drospirenone combined therapy lowers blood pressure and maintains a stable body weight in postmenopausal women.
IMPROVEMENT OF LEFT VENTRICULAR SYSTOLIC DYSFUNCTION AFTER TREATMENT FOR PRIMARY ALDOSTERONISM CORRELATES WITH REVERSAL OF RENIN SUPPRESSION
Authors: Puar Troy , Cheong Chin Kai , Foo Roger , Saffari Ehsan , Tu Tianming , Lee Sheldon , Chai Siang Chew
Published: June 2022

Objective:

Primary aldosteronism (PA) leads to hypertension, left ventricular hypertrophy and systolic dysfunction. While treatment can lead to regression of left ventricular mass, improvement of left ventricular function has not been demonstrated, using the conventional left ventricular ejection fraction for assessment. We used speckle-tracking echocardiography to assess if treatment of PA can improve left ventricular subclinical systolic dysfunction.

Design and method:

We prospectively recruited 57 patients with PA. All patients underwent 24–hours ambulatory blood pressure (BP) measurements and 2D echocardiography, including global longitudinal strain (GLS), at baseline and 12 months after surgical or medical therapy.

Results:

Forty–eight of 57 patients underwent adrenal vein sampling, and all procedures were successful. Twenty–five patients underwent unilateral adrenalectomy, and 32 patients were treated with medications. Patients treated with surgery had improved daytime systolic and diastolic BP, with reduced antihypertensive medications, while patients on medications had improved daytime systolic BP, with increased medications. While left ventricular ejection fraction did not change in either group post-treatment, GLS improved post–adrenalectomy by –2.3, 95%CI: –3.9 to –0.6, P = 0.0095, and post–medications by –1.3, 95%CI: –2.6 to 0.03, P = 0.089. On multivariate analysis, baseline GLS was associated with baseline diastolic BP (P = 0.019). Post–adrenalectomy, there were also improvements in left ventricular mass index by –10, 95% CI: –18.0 to –2.4, P = 0.012 left atrial volume index by –5.0, 95%CI: –9.1 to –2.2, P = 0.0016 and mitral E/e’ –1.9, 95%CI: –4.1 to –0.5, P = 0.0064, which were not significant in patients treated medically. Improvement in GLS was independently correlated with baseline GLS (P = 0.0001), and increase in plasma renin activity (P = 0.0068).

Conclusions:

Treatment of hyperaldosteronism can effectively reverse left ventricular systolic dysfunction, with greater benefit seen with surgery compared to medications. Greater improvement of systolic function is associated with increase in renin levels. This underlies the importance of adequate treatment to reverse the sodium overload state, that is the hallmark of PA.
SIMULTANEOUS ADRENAL VEIN SAMPLING WITH SUBSEQUENT SEQUENTIAL SECOND LEFT SAMPLING: A NEW PERSPECTIVE IN PRIMARY ALDOSTERONISM
Authors: Gebara Nicole , Eid Roland , Pagny Jean-Yves , Cornu Erika , Baron Stephanie , Riancho Julien , Martiano Mikael , Pariente Benjamin , Laffy Pierre-Yves , Carreres Thierry , Ahmar Marc Al , Azizi Michel , Amar Laurence
Published: June 2022

Objective:

Adrenal venous sampling (AVS) is a technically challenging procedure that has its limitations because of a potentially unestimated risk of tube inversion between right (RAVS) and left (LAVS) adrenal venous sampling, which can lead to operating the wrong side in patients with lateralized PA.

The aim of this study is to evaluate whether a subsequent sequential second left adrenal venous sampling (LAVS2) can ensure a higher success rate of the procedure and limit the risk of tube inversion in patients who underwent a simultaneous AVS.

Design and method:

This an observational retrospective study conducted at the Hypertension Unit at Georges-Pompidou European Hospital in Paris, France, that analyzes patients who underwent an AVS between first June 2015 and end of May 2021. The difference between all three AVS was tested using Mann-Whitney test.

A random sampling of 100 patients was distributed to 6 physicians, 2 times in a 5-day interval, to test whether they can identify LAVS1 and RAVS based on LAVS2 and to compare between categories: lateralized versus non-lateralized PA, experts versus not experts physicians, at day 1 and day 5.

Results:

Among the 408 patients, the median age was 46 years. Lateralized PA was found in 216 patients (52.9%). (LAVS2-LAVS1) was inferior to (LAVS2-RAVS) in 90.4% of the cases and significant in all groups (table). In lateralized PA, all expert physicians gave the correct answer in 100% of the cases at day 1. The clinical expertise and PA lateralization were significantly associated with answers. In the correct answers’ category, there was no effect of time on the correct answer but statistically significant effects of clinical expertise and PA lateralization (p < 0.001).

Conclusions:

The use of a LAVS2 limits the risk on misinterpretation of AVS due to error in the labeling of the sample. As this procedure is easy and cost effective, it could be used in all the centers who do perform AVS. Therefore, based on the HEGP experience, we describe a roadmap for an AVS protocol to ensure a successful procedure
MTOR INHIBITOR IMPROVES TESTOSTERONE-INDUCED MYOCARDIAL HYPERTROPHY IN HYPERTENSIVE RATS
Authors: Chen Jianshu , Yu Jing
Published: June 2022

Objective:

Compelling evidence have described the incidence of hypertension and left ventricular hypertrophy (LVH) in postmenopausal women is significantly increased worldwide. Our team’s previous research identified that androgen was an underlying factor contributing to increased blood pressure and LVH in postmenopausal women. However, little is known about how androgens affect LVH in postmenopausal hypertensive women. The purpose of this study was to evaluate the role of mTOR signaling pathway in myocardial hypertrophy in androgen-induced postmenopausal hypertension and whether mTOR inhibitors can protect the myocardium from androgen-induced interference to prevent and treat cardiac hypertrophy.

Design and method:

For that, ovariectomized (OVX) spontaneously hypertensive rats (SHR) aged 12 weeks were used to study the effects of testosterone (T 2.85 mg/kg/weekly im) on blood pressure and myocardial tissue. On the basis of antihypertensive therapy (chlorthalidone 8 mg/kg/day ig), the improvement of blood pressure and myocardial hypertrophy in rats treated with different dose gradients of rapamycin (0.8 mg/kg/day Vs 1.5 mg/kg/day Vs 2 mg/kg/day ip) in OVX+ estrogens (E 9.6 mg/Kg/day, ig)+T group was further evaluated.

Results:

After T intervention, the OVX female rats exhibited significant increments in the heart weight / tibial length (TL), cross-sectional area of cardiomyocytes and the mRNA expressions of atrial natriuretic peptide, B- myosin heavy chain and matrix metalloproteinase 9 accompanied by a significant reduction in the uterine weight/TL and issue inhibitor of metalloproteinase 1. Mammalian rapamycin receptor (mTOR), ribosomal protein S6 kinase (S6K1), 4E-bindiong protein 1(4EBP1) and eukaryotic translation initiation factor 4E in myocardial tissue of OVX+E+T group were expressed at higher levels than those of the other four groups. On the other hand, rapamycin abolished the effects of T-induced cardiac hypertrophy, decreased the systolic and diastolic blood pressure of SHR, and inhibited the activation of mTOR/ S6K1/4EBP1 signaling pathway in a concentration-dependent manner.

Conclusions:

Collectively, these data suggest that the mTOR/S6K1/4EBP1 pathway is an important therapeutic target for the prevention of LVH in postmenopausal hypertensive women with high T levels. Our findings also support the standpoint that the mTOR inhibitor, rapamycin, can eliminate T-induced cardiomyocyte hypertrophy.