bluuebunny/crossref_metadata_2025 huggingface dataset:
EPIDEMIOLOGICAL PREVALENCE ESTIMATES OF HYPERTENSION OF 856,878 ADULTS IN GLASGOW
Authors: Lip Stefanie , Mccallum Linsay , Strachan Kylie , Mckinstry Brian , Webb David , Padmanabhan Sandosh
Published: April 2021

Objective:

Systematic reviews estimate the prevalence of hypertension in high income countries to be 28.5%, with 55.6% of hypertensives on treatment and 28.4% of those on treatment having controlled hypertension. We used these estimates to determine the proportion of untreated hypertensives in the Greater Glasgow and Clyde population and to evaluate if the estimated proportion of untreated hypertension translated into increased CV mortality.

Design and method:

Dispensed prescription and mortality data were obtained on 856,878 adults who attended either primary care or secondary care in the NHS Greater Glasgow and Clyde area between 2010 and 2016. Age-specific hypertension prevalence were obtained from the Scottish Public Health Observatory (2018) and for high income countries from Mills et al (Circulation 2016). Individuals were considered to be on hypertension treatment if they had at least 6 months of 2011 covered by their antihypertensive prescriptions. Cardiovascular deaths from 2012–2016 were obtained from mortality records through record linkage. Generalised estimating equations (GEE) were used to assess the relationship between proportion of untreated hypertension and CV mortality.

Results:

The estimated number of hypertensives was 308,208 (35.9%) and the numbers treated and untreated were 181,662 (58.9%) and 126,546 (41.1%) respectively. Age-stratified analyses showed the highest proportion of untreated hypertensives was in the 30–40-year (72%) and 40–50 year (58%) age groups while the lowest proportion was the 70–80 year group (28%).

Stratification by SIMD showed SIMD 1 (least deprived group) had the lowest proportion of untreated hypertensives (34%) while the most deprived groups 4 and 5 had 49% and 43% respectively. Cardiovascular mortality rates increased with each decade of life -0.95/1000 among 30–40 years old group and rising to 233/1000 in the 80+ age group. These results were maintained even after adjusting for age and SIMD using GEE.

Conclusions:

Estimating prevalence of untreated hypertension in the Greater Glasgow and Clyde region do not show correlation with five-year cardiovascular mortality. This discrepancy indicates more accurate estimation of hypertension prevalence and treatment using home BP is required for formulating effective health policies on hypertension.
CLINICAL CHARACTERISTICS IN THE PATIENTS WITH MASKED UNCONTROLLED NOCTURNAL HYPERTENSION MEASURED BY NIGHTTIME HOME BLOOD PRESSURE MONITORING: THE J-HOP NOCTURNAL BLOOD PRESSURE ST
Authors: Narita Keisuke , Hoshide Satoshi , Kario Kazuomi
Published: April 2021

Objective:

Various international guidelines on the management of hypertension recommend nighttime blood pressure (BP) measurements in specific conditions such as sleep apnea, secondary hypertension, etc. However, we physicians sometimes miss nocturnal hypertension in patients with controlled daytime (morning and evening) home BP (HBP), i.e. “masked uncontrolled nocturnal hypertension”. Risk factors of masked uncontrolled nocturnal hypertension remain unclear in clinical practice and we thus assessed that using a dataset of the Japan Morning Home-Surge BP (J-HOP) Nocturnal BP study.

Design and method:

This is a cross-sectional, post-hoc analysis using the dataset of the J-HOP Nocturnal BP study, which recruited patients with risk factors of CVD. Participants underwent consecutive 14-day HBP measurements (morning and evening) and nighttime HBP measurements (a.m. 2, 3, and 4). In the present study, masked uncontrolled nocturnal hypertension was defined as controlled daytime HBP (mean of morning and evening home systolic BP [SBP] < 135 mmHg and diastolic BP [DBP] < 85 mmHg) and uncontrolled nighttime HBP (mean nighttime home SBP > = 120 or DBP > = 70 mmHg). To detect the risk factors of masked uncontrolled nocturnal hypertension, we used traditional host factors, using each type of antihypertensive medications, and markers of target organ damage (urine-albumin creatinine ratio [UACR] and b-type Natriuretic peptide) as covariant in stepwise logistic regression models.

Results:

Among 1490 participants with controlled daytime HBP levels (age, 62.5 ± 9.7yrs; 49% of male; antihypertensive medication use, 82.2%), male, diabetes, elevated office BP, and log-UACR were significant risk factors for masked uncontrolled nocturnal hypertension in multivariate logistic regression models (OR [95%CI]: male, 1.42 [1.11–1.82]; diabetes, 1.41 [1.09–1.83]; elevated office BP, 1.72 [1.38–2.14]; log-UACR, 1.35 [1.06–1.71]) (Table). Whereas, combination therapy of more than three antihypertensives including diuretics showed a lower odds ratio (0.56 [0.40–0.78]).

Conclusions:

In the present study, we revealed that male, diabetes, elevated office BP, and highly log-UACR were suggested to be risks for masked uncontrolled nocturnal hypertension. A nighttime HBP monitoring might be recommended for patients who have these risks even if they are controlled daytime HBP levels.
THE RELATIONSHIP BETWEEN CIRCADIAN RHYTHM OF BLOOD PRESSURE AND LEFT ATRIAL PHASIC FUNCTION IN HYPERTENSION
Authors: Liu Yan , Zhao Yixiao , Sun Qiaobing , Lu Yan , Zhang Ying , Song Wei , Cheng Yunpeng , Cong Tao , Jiang Yinong
Published: April 2021

Objective:

Objective: We used two dimensional speckle tracking echocardiography (2DSTE)-based strain and strain rate imaging to evaluate left atrial (LA) mechanics and investigated its correlation with circadian rhythm of blood pressure in essential hypertension (HT).

Design and method:

Design and Methods: We enrolled 249 HT patients. All subjects were evaluated by ambulatory 24-hour blood pressure monitoring and 2D-STE. According to blood pressure (BP) patterns, these patients were divided into three groups. Group I (dipper, n = 91), patients with a 10%-20% reduction in BP at nighttime; Group II (non-dipper, n = 129), patients with a < 10% reduction in BP at nighttime; Group III (reverse dipper, n = 29), patients with higher BP at nighttime compared with daytime. The strain and strain rate images were studied, and the following parameters were measured: LA reservoir strain and strain rate (LAS-S, LASR-S), LA conduit strain and strain rate (LAS-E and LASR-E), LA booster strain and strain rate (LAS-A and LASR-A). LA stiffness index (LASI) was defined as the ratio of E/e‘ to LAS-S. In the present study, we also explored the correlation between LASI and cardiovascular risk factors as well as ambulatory blood pressure indexes. The factors related to LASI were evaluated by multivariate regression analysis to find the independent factors.

Results:

Results: LASI was significantly higher in Group III than Group I (p < 0.05). LAS-E and LASR-E were significantly lower in Group III than Group I and II (p < 0.05 for both). However, there were no significant differences between the Group I and II (p > 0.05). Otherwise, LAS-S, LASR-S, LAS-A and LASR-A were not significantly different among these three groups. We also found LASI was correlated with ages, diabetes, courses of HT, 24-hour mean systolic blood pressure (24h-mSBP), 24-hour mean diastolic blood pressure (24h-mDBP), daytime mean SBP (d-SBP), nighttime mean SBP (n-SBP) and nighttime mean DBP (n-DBP). Multivariate regression analysis revealed that age, n-SBP and n-DBP were independent factors related to LASI.

Conclusions:

Conclusions: Left atrial function is associated with circadian rhythm of blood pressure. Nocturnal blood pressure may have more influence on left atrial stiffness and conduit function.
INVESTIGATING THE ADHERENCE TO THE 5-MINUTE RESTING INSTRUCTION BEFORE SELF-MEASURING HOME BLOOD PRESSURE USING ACCELEROMETER-BASED PHYSICAL ACTIVITY DATA
Authors: de Heus Rianne , Maasakkers Carlijn , Claassen Jurgen
Published: April 2021

Objective:

Accuracy of blood pressure (BP) readings is crucial, especially in populations at risk for improper treatment decisions such as older persons. International guidelines recommend 5-minutes rest before taking an office BP measurement and have adopted similar recommendations for home BP measurements (HBPM). However, there is no data underlying this recommendation. Also, it is unknown if patients adhere to this instruction and how non-adherence affects BP. This study addresses these questions in an older population.

Design and method:

We included 45 patients referred to our geriatric outpatient clinic. HBPM was performed with the memory-equipped Microlife WatchBP home according to guidelines (one week, twice in the morning and twice in the evening), resulting in a max. of 28 measurements per patient. Patients received oral and written instruction to rest at least 5-minutes before taking their BP. During the same week, all patients wore the ActivPAL monitor for 24-hours/day. This is a validated thigh-worn accelerometer able to distinguish between sitting, standing and stepping. Information on physical activity in the 15-minute window before each BP measurement was extracted. In this preliminary analysis we present results from the first 14 patients.

Results:

These first 14 patients (out of 45) had a mean age of 74.9 ± 10.6 (range: 51–91 years), a mean home BP 146/81 ± 16/12 mmHg and 4 were female. On average, patients adhered to the 5-minute resting instruction in only 22 ± 14% of the measurements (range: 0–50%). Mean resting time was 2.3 ± 2.4 minutes (range: 0–12 minutes). Adherence to the 5-minute resting instruction resulted in significantly lower systolic BP value's compared to non-adherence (143.9 ± 15.4 versus 138.1 ± 14.2 mmHg, p = 0.04) using paired samples t-test. For diastolic BP, the same trend was observed (79.5 ± 7.6 versus 77.6 ± 7.4 mmHg, p = 0.22).

Conclusions:

These preliminary findings indicate that the instruction to wait 5-minutes before measuring BP at home is often not followed in practice and affects BP value's. Analyses of the full study population will be available at the conference. Since out-of-office BP measurements are becoming more common, these results will provide relevant information on the interpretation of home BP readings.
IS POSTOPERATIVE SUBSTITUTION WITH HYDROCORTISONE NECESSARY AFTER ADRENALECTOMY FOR PRIMARY ALDOSTERONISM?
Authors: Zelinka Tomas , Petrak Ondrej , Michalsky David , Novak Kvetoslav , Widimsky Jiri
Published: April 2021

Objective:

Concomitant cortisol secretion in primary aldosteronism (PA) has repeatedly been described. Recently, clinically significant adrenal insufficiency after adrenalectomy in subjects with PA has been described. In this study, we retrospectively searched for possible adrenal insufficiency in subjects who underwent adrenalectomy for PA and have measured cortisol in the early postoperative course.

Design and Methods:

We included subjects with confirmed diagnosis of PA who underwent either posture testing (blood draw at approximately 06:00 and 08:00) and/or adrenal venous sampling (AVS) (blood draw between 08:00 and 09:00) and have also measured cortisol after surgery (cortisol measured approximately at 07:00). Cortisol was measured by immunoassay.

Design and method:

We identified 110 subjects (age 49.5 ± 10.1 years) with available cortisol values in the early postoperative course (median [25th percentile, 75th percentile]) 6 [5, 6] days. Postoperative cortisol values (529 [431, 620] nmol/L) were significantly higher compared to preoperative standing cortisol values (388 [292, 482] nmol/L; (P < 0.005) and AVS cortisol values (472.5 [339, 615] nmol/L; P = 0.04), and did not significantly differ from preoperative supine cortisol values. The lowest cortisol value post-surgery was 292 nmol/L. Postsurgical cortisol values were not different among subjects with or without abnormal dexamethasone suppression test or elevated urinary free cortisol pre-surgery.

Conclusion:

Postoperative cortisol values did not indicate any suspicion of possible adrenal insufficiency. These values were significantly higher compared to preoperative standing or AVS cortisol values obtained approximately 1 hour later, which reflects postoperative stress on one hand and normal diurnal cortisol rhythmicity on the other hand.
BOTH MEDICAL AND SURGICAL TREATMENT FOR UNILATERAL PRIMARY ALDOSTERONISM LEAD TO BLOOD PRESSURE IMPROVEMENTS
Authors: Puar Troy , Kek Peng , Ming Lih , Loh Wann , Lim Dawn , Tin Pei , Zhang Meifen , Lee Lynette , Swee Du , Tay Donovan , Tan Saran , Khoo Joan , Foo Roger
Published: April 2021

Objective:

All patients with primary aldosteronism (PA) can be treated with medications but those with unilateral PA can be offered surgery (adrenalectomy). Since most patients confirmed to have unilateral PA by adrenal vein sampling undergo surgery, there is a paucity of data comparing the effects of medical versus surgical treatment in patients with unilateral PA. We applied a clinical prediction score to include patients with likely unilateral PA and assessed post-treatment blood pressure (BP) outcomes.

Design and method:

214 patients diagnosed with PA managed in two major tertiary centres in Singapore from 2000 – 2019 were identified for this retrospective analysis. Patients with confirmed unilateral PA by adrenal vein sampling were included. Patients with indeterminate subtype were categorised using our previously validated clinical prediction score, Aldosterone-potassium ratio (APR), and patients with APR > 10 (highly predictive of unilateral disease) were included.

Results:

Of 214 patients, 38 patients had confirmed unilateral PA on adrenal vein sampling, and another 78 patients had likely unilateral PA using APR score. Hence, 116 patients were included for analysis, median age 53 (46 – 60) yrs, 47 females (40.5%). 56 patients (48.3%) underwent adrenalectomy, and 60 patients (51.7%) were treated with medications (spironolactone, eplerenone or amiloride). In the surgical group, there was improvement in systolic and diastolic BP from 150 to 131 mmHg, P < 0.001 and 87 to 76 mmHg, P < 0.001 respectively, over a follow-up duration of 6.5 (3 – 9.25) yr. In the medical group, there was significant improvement in systolic and diastolic BP from 148 to 134 mmHg, P < 0.001 and 85 to 76 mmHg, P < 0.001 respectively, over a follow-up duration of 5 (2 – 11) yrs. In addition, post-surgery, there was a decrease in WHO-daily defined dose of antihypertensive medications from 1.8 to 0.8, P < 0.001, whereas it did not change in the medical group, from 2.2 to 2.0 medications, P = 0.337.

Conclusions:

Both medical and surgical treatment for unilateral primary aldosteronism led to significant blood pressure improvements. However, surgical treatment reduces the pill burden of hypertension medications, and offers the possibility of complete cure of hypertension.
THE EFFECT OF RAMIPRIL ON THE ALDOSTERONE/RENIN RATIO AND THE ALDOSTERONE/ANGIOTENSIN II RATIO IN PATIENTS WITH PRIMARY ALDOSTERONISM
Authors: Guo Zeng , Poglitsch Marko , Cowley Diane , Mcwhinney Brett , Ungerer Jacobus , Wolley Martin , Stowasser Michael
Published: April 2021

Objective:

The aldosterone/renin ratio (ARR) is recommended for case detection of PA. However, many anti-hypertensive medications [such as angiotensin-converting enzyme (ACE) inhibitors] and physiological factors have been reported to affect renin and aldosterone, thereby causing false-negative ARR screening results. We sought to investigate the diagnostic performance of the ARR and aldosterone/AngII ratio (AA2R) among PA patients receiving ramipril treatment.

Design and method:

Blood samples from 60 PA and 40 non-PA patients were collected, aiming to predict optimal PA screening cut-offs for the ARR and AA2R (using ROC analysis). Another 26 PA patients were recruited and were administered ramipril (5 mg tablet, once daily) for 2 weeks. Blood was collected in the morning of day 0 (basal), day 14 (2 h after taking ramipril) and day 15 (26 h after last dose ramipril). Plasma aldosterone (PAC), equilibrium AngI and AngII (eqAngI and eqAngII) were measured by LC-MS/MS, while renin concentration (DRC) and activity (PRA) were measured by immunoassays.

Results:

When PAC was measured by LC-MS/MS, the predicted PA screening cut-offs for the ARR_DRC, ARR_PRA and AA2R were 53.9 (pmol/mU), 495.9 (pmol/L)/(ng/ml/h) and 8.3 (pmol/pmol), respectively. Compared to the basal levels, eqAngII and ACE activity (ACE-S, eqAngII/eqAngI) both decreased (P < 0.01) after ramipril treatment, whereas DRC, PRA and eqAngI all increased (P < 0.01 or P < 0.05). Although median PAC tended to fall from 504.9 (day 0) to 458.3 (day 14) and to 488.0 (day 15) pmol/L, the changes were not statistically significant. On day 14, five patients displayed false-negative results in both ARR_DRC and ARR_PRA, whereas no false-negative AA2R result was observed. On day 15, three patients still demonstrated false-negative screening results, including one with both false-negative ARR_DRC and ARR_PRA, one with both false-negative ARR_DRC and AA2R, and one with false-negative ARR_PRA only.

Conclusions:

Although PAC did not change significantly, the changes of renin, eqAngI, eqAngII and ACE-S were consistent with ramipril's effect on ACE. Unlike the ARR which can be affected by ACE inhibitors causing false-negative screening results, the AA2R seems to be superior in PA screening among subjects who are receiving ACE inhibitors.
MUTUAL COMPLEMENTALLY RELATIONSHIP OF AT2 AND MAS RECEPTORS IN PROTECTIVE EFFECT AGAINST SKELETAL MUSCLE AGEING IN MICE
Authors: Takeshita Hikari , Yamamoto Koichi , Mogi Masaki , Rakugi Hiromi
Published: April 2021

Objective:

Increasing evidence suggests that the renin-angiotensin system (RAS) is a candidate for control aging-associated phenotypes. RAS have two distinct axes, which counter-regulate each other. One is canonical RAS axis composed of angiotensin II and AT1 receptor, another is non-canonical RAS axis, it's main components are angiotensin 1–7 and AT2 and Mas receptors. To elucidate whether non-canonical axis have protective effect against age-associated muscle weakness, we first tested with Mas KO mice. But we didn’t any significant difference in aging phenotype in Mas KO mice compared with wild-type (WT) mice (Clinical Science, 2019.). In this study, we focused on AT2 receptor, we tested skeletal muscle function of AT2 KO mice and AT2 / Mas double KO (DKO) mice.

Design and method:

AT2 KO mice, DKO mice and WT mice were used (n = 5–8). To assess serial change in motor function, we performed grip strength test in 6, 12, 18, 24 months old. At 24 months old, mice were sacrificed and extracted six kinds of skeletal muscles. Using skeletal muscles, wet weight, cross sectional area of myofiber, expression of RAS-associated, inflammatory-associated and senescence-associated genes were assessed. All of data are statically analyzed by using Dunnett's test.

Results:

DKO mice showed significant weaker grip strength than WT mice from the age of 18 months. Wet weights of soleus and Vastus muscle were lower in DKO than WT mice. Classical RAS associated genes (Renin, ACE, AT1), inflammatory-associated genes (MCP-1, IL-6, TGF beta-1) and senescence-associated genes (p16, p19) is highly expressed in vastus of DKO. Grip strength, wet weight of skeletal muscles, and gene expression levels in AT2KO mice are equivalent to WT mice. Cross sectional area of vastus myofiber is significantly lower in AT2KO and DKO than in WT.

Conclusions:

In summary, we observed exaggerated ageing phenotypes of skeletal muscles in DKO mice, while hardly any ageing phenotypes were observed neither in AT2KO mice nor Mas KO mice. Our data suggests AT2 and Mas receptors are mutual complementally relationship in protective roll against age-associated skeletal muscle weakness via blockade of canonical RAS axis.
SUPERNOVA PHENOMENA IN SURVIVORS OF THE LENINGRAD SIEGE
Authors: Moguchaia Ekaterina , Rotar Oxana , Boyarinova Maria , Kolesova Ekaterina , Erina Anastasia , Solntsev Vladislav , Konradi Aleksandra
Published: April 2021

Objective:

The concept of supernormal vascular aging (SUPERNOVA) is now widely discussed. SUPERNOVA can be detected in subjects with exceptionally low arterial stiffness for their age and sex. The aim of our study is to determine whether SUPERNOVA phenomena takes place in a unique population - survivors of the Leningrad Siege.

Design and method:

232 survivors of Leningrad Siege (59 males and 173 females) were examined. Informed consent was obtained from all participants. Blood pressure (BP) was measured on right arm in the sitting position after 5 minute of rest. Anthropometry (weight, height, waist circumference) were performed according to standard procedures. Fasting serum lipids and plasma glucose were measured on Hitachi-902. The arterial stiffness was assessed by SphygmoCor device (carotid-femoral pulse wave velocity (PWV)). According to The Reference Values for Arterial Stiffness’ Collaboration (2010) for siege survivors group (over 70 years old) the median value (10–90 percentile) of the PWV is 8.0–14.6 m/s. SUPERNOVA phenomena was determined in case of PWV < = 8.0 m/s.

Results:

35 (11,3%) participants had SUPERNOVA phenomena. There were no significant differences in the level of glucose, total cholesterol, HDL, LDL and body mass index detected. Significant differences between the groups are presented in table.

Conclusions:

Despite old age and starvation in the early period of life 11% of Leningrad siege survivors had supernormal vascular aging. SUPERNOVA phenomena was associated with lower blood pressure, anthropometric indexes and triglycerides level which can be reflection of more favorable diet pattern.
SURVIVAL AMONG SEVERELY DISABLED NURSING HOME RESIDENTS IN TERMS OF CARDIOVASCULAR DISEASES
Authors: Kantoch Anna , Gryglewska Barbara , Wojkowska-Mach Jadwiga , Wizner Barbara , Heczko Piotr , Grodzicki Tomasz
Published: April 2021

Objective:

An expert opinion of the European Society of Hypertension-European Union Geriatric Medicine Society Working Group (2016) suggested that treating hypertension in old, frail subjects should be individualized. The impact of antihypertensive treatment on mortality in this population is unknown.

The aim of the study was to estimate factors affecting survival among severely disabled nursing home residents in terms of cardiovascular diseases.

Design and method:

A retrospective cohort substudy with a 3-year follow-up was performed among nursing home residents with Barthel Index not greater than 40 points. The preliminary assessment included the implementation of scales: Mini Nutritional Assessment Short-Form (MNA-SF), Abbreviated Mental Test Score (AMTS) and clinical measurements: blood pressure (BP) and body mass index (BMI). Comorbidities, used drugs and mortality were extracted from medical records. Based on the median time of follow-up, the analyzed cohort was divided into 2 groups: deceased- residents who died within 3 years and those who survived >3 years of observation. Data are presented as means ± standard deviation or median [quartiles:1;3].

Results:

In the comparative analysis, deceased (n = 48) and survivors (n = 40) did not differ significantly in terms of age (79.9 ± 8.2 vs. 79.2 ± 7.9), systolic BP (121 ± 12.7 vs. 121 ± 15.6 mmHg), diastolic BP (69 ± 10.1 vs. 69 ± 11.8 mmHg), Barthel Index: 12.5[0; 35] vs. 30[5; 40], comorbidities: 4[3; 5] vs. 4[3; 5], used drugs in general: 7[4; 10] vs. 7[4; 9] and antihypertensive drugs: 1[0.5; 2] vs. 2[1; 3]. Moreover, survivors were more frequently treated with aspirin (54% vs. 46%, p = 0.043), ACE inhibitors (58% vs. 42%, p = 0.017) and statins (83% vs. 17%, p = 0.054) than deceased. Hypertension was diagnosed more often among survivors (57% vs. 43%, p = 0.032, respectively). However, deceased had significantly lower scores in MNA-SF, BMI and AMTS.

Logistic regression analysis showed that only MNA-SF (OR = 2.30 [95% CI; 1.15–4.58], p = 0.019) was a factor affecting survival after adjusting: age, comorbidities, AMTS and Barthel Index.

Conclusions:

Our results revealed that the presence of hypertension might be the protective factor for short-term mortality among older residents. However, survival was mainly related to better nutritional status among the institutionalized geriatric population.
EFFECTS OF CALCIUM CHANNEL BLOCKERS ON SYMPATHETIC NERVE FUNCTION IN THE ELDERLY WERE EVALUATED WITH PUPILLARY FUNCTION
Authors: Hano Takuzo , Koike Yumi
Published: April 2021

Objective:

Pupillary function test is used to evaluate the sympathetic and parasympathetic activity in diabetic and autonomic dysfunction patients. Mydriatic velocity is used as a marker of sympathetic activity. Pupillary function test and power spectrum analysis were performed during handgrip test in hypertensive patients taking calcium antagonist, amlodipine (M) and azelnidipine (Z) to clarify the effects of calcium antagonists on sympathetic nerves between the group under 70 years (young group) and the group above 70 years (elderly group).

Design and method:

Young Z group (n = 11, 65.2 ± 9.3 y.o., mean ± SD) and elderly Z group (n = 14, 74.6 ± 4.2 y.o.), young M group (n = 10, 58.1 ± 9.3 y.o.) and elderly M group (n = 10, 77.4 ± 3.9 y.o.) are enrolled in this study. Hand grip test were performed for 1 minute at 70% of grip strength and changes of blood pressure, pulse rate, mydriatic velocity and LF/HF by power spectrum analysis were measured before and after handgrip test.

Results:

Changes in blood pressure (young: 137.0 ± 8.6 to142.4 ± 16.8mmHg, elderly; 137.3 ± 8.6 to143.9 ± 14.6mmHg) pulse rate (young: 67.1 ± 9.4 to 69.0 ± 8.4/min., elderly; 66.4 ± 7.3 to 67.6 ± 10.5/min.), mydriatic velocity (young: 1.8 ± 0.4to1.9 ± 0.3ms, elderly; 1.4 ± 0.3 to 1.6 ± 0.6ms), and LF / HF (young: 3.5 ± 2.2 to 2.7 ± 2.3, elderly; 3.4 ± 3.2 to 2.9 ± 2.3) due to hand grip load showed no significant change in young and elderly Z group. In young M group, blood pressure increased significantly (132.4 ± 11.4mmHg to144.94 ± 12.3mmHg), but pulse rate (68.3 ± 10.7 to 72.5 ± 11.5/min.), mydriatic velocity (1.8 ± 0.6 to 2.18 ± 0.6ms) and LF / HF (2.8 ± 1.9 to 4.1 ± 3.3) did not change significantly. On the other hand, blood pressure (134.2 ± 11.5 to 144.2 ± 14.1mmHg) and pulse rate (66.9 ± 8.5 to 72.8 ± 8.7/min.) were not changed, but mydriatic velocity (1.8 ± 0.6ms to 2.18 ± 0.6ms, p < 0.01) and LF / HF (1.7 ± 1.9 to 5.8 ± 5.2, p < 0.05) increased significantly in the elderly M group.

Conclusions:

Pupillary function during static exercise can be used to evaluate the sympathetic activity in hypertension. Azelnidipine suppress sympathetic activity compared with amlodipine. Elderly patient shows hyper-sympathetic response by handgrip test. Azelnidipine is safe to use even in elderly patients under static exercise.
THE ASSOCIATION BETWEEN BLOOD PRESSURE AND FRAILTY IN VERY ELDERLY PATIENTS (>90 YEARS)
Authors: Demirevska Liliya , Daskalov Ivaylo , Valova Tatyana , Chobanov Aleksander , Stoychev Deyan , Nedkova Mariya , Pashunov Mario
Published: April 2021

Objective:

Frailty is a common geriatric syndrome characterized by increased risk of hospitalization and mortality. The aim of this study was to assess the association between hypertension (HTN) and frailty, and mortality in very elderly patients (>90 years).

Design and method:

This prospective study included 107 patients aged >90 years (mean age 94.3, 37% male) hospitalized at the Cardiology department, Military Medical Academy, Sofia between January 2016 and December 2018. Study protocol included demographics, blood pressure measurement, body mass index, frailty screening, number of comorbidities, medications, physical activity, and cognitive status. Patients were classified as nonfrail, prefrail, or frail based on the internationally validated FRAIL (fatigue, resistance, ambulation, illnesses, and loss of weight) scale, PRISMA 7 questionnaire, Mini-Mental State Examination, gait speed, timed-up-and-go test. Participants were followed for 18 ± 6 months. Outcomes of interest were pharmacological treatment of HTN and one-year mortality. We used the Cox regression model to examine the association between frailty, mean systolic blood pressure (SBP) and outcomes of interest. Ordinal logistic regression was used to evaluate factors associated with frailty.

Results:

Prevalence of HTN and frailty was 77.2% and 44.8%, respectively. HTN was more prevalent in prefrail (22.5%) and frail (43%) groups than in the nonfrail one (11.7%) (p = 0.005). When compared to nonfrails, the frail patients had lower SBP ((104.3 ± 15.2) vs. (131.5 ± 23.6) mmHg, p = 0.002) and higher one-year mortality (19.2% vs. 39.1%, p < 0.001). Low SBP was associated with increased all-cause mortality and accelerated cognitive decline in all patients regardless of frailty, but the effect was more pronounced among those on antihypertensive therapy. (HR 1.39 per 10 mmHg decrease in SBP, 95% CI 1.25–1.46, p < 0.001). Mortality rates increased with frailty level with the highest values for SBP <110 mmHg.

Conclusions:

Frail very elderly patients have a substantially lower SBP compared to nonfrail ones. Lower SBP may be associated with higher frailty rates and all-cause mortality among patients hospitalized for cardiac problems.
EXTERNAL VALIDATION STUDY OF THE EARLY VASCULAR AGING AMBULATORY SCORE (EVAAS)
Authors: Antza Christina , Doundoulakis Ioannis , Akribos Evangelos , Stabouli Stella , Kotsis Vasilios
Published: April 2021

Objective:

The Early Vascular Aging Ambulatory score (EVVAs) identify hypertensive patients with Early Vascular Aging using ambulatory blood pressure monitoring values and classic cardiovascular risk factors. Our aim was to validate the EVAAs externally in a new population-based cohort study.

Design and method:

This cohort study included all consecutive patients (N = 789, 45.87 ± 23.27, 45.4% men), who referred to the Hypertension-24hour Ambulatory Blood Pressure Monitoring Center of Excellence, at the 3rd Internal Medicine Department of Aristotle University for elevated BP and consented to participate to the study. Carotid-femoral pulse wave velocity (c-f PWV) was measured in all patients. EVA was defined as c-f PWV values higher than the expected for age average values according to European population data. We evaluated the predictive power of the original EVVAs.

Results:

The calculated sensitivity and specificity for EVAAS was 98% and 75% respectively. The EVVAs has a high positive predictive value (PPV) of 95%. The negative predictive value (NPV) was slightly lower at 92%. Receiver operating characteristic curve, including the area under the curve, was 0.951 which indicates a very high accuracy.

Conclusions:

The external validation of the EVVAs yields high sensitivity and PPV in an independent population.

The EVAAs should now be evaluated for its predictive value regarding cardiovascular mortality and morbidity. Finally, the prediction of EVA, assessed by EVAAs, could be used to guide early lifestyle or pharmaceutical interventions in order to prevent future CV events.
ARTERIAL STIFFNESS PREDICTS ATRIAL FIBRILLATION INCIDENCE IN HYPERTENSIVE SUBJECTS
Authors: Andrikou I. , Tsioufis K. , Dimitriadis K. , Konstantinidis D. , Papakonstantinou P. , Tatakis F. , Anastasiou A. , Andrikou E. , Dimitriadou M. , Tousoulis D.
Published: April 2021

Objective:

Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice, while hypertension is one of the main factors that influence the development of AF. On the other hand, arterial stiffness is associated with increased blood pressure. The possible relationship between arterial stiffness and AF is not fully elucidated and warrants further investigation. In this setting, we examined the main factors influencing AF development in hypertensive subjects over time.

Design and method:

950 hypertensive subjects, without history of AF (mean age 55.7 ± 11years), 53.3% males, with baseline office blood pressure (BP) 145/92mmHg were followed for a mean period of 6.4 ± 3.3 years. At baseline and last follow-up visit all patients underwent office BP and laboratory evaluation. Electrocardiogram test was performed as well as echocardiographical examination, including determination of left ventricular mass index (LVMI) and left atrial volume index (LAVI). At baseline arterial stiffness was estimated by pulse wave velocity (PWV) measurement. Main outcome variable was new onset AF.

Results:

5.1% of study population (48 subjects) presented new onset AF during follow-up period. Cox-regression analysis, after adjustment for clinical, biochemical and echocardiographic parameters revealed that baseline age >65years (HR = 2.42, 95% CI 1.11–5.25, p = 0.03), baseline PWV (HR = 1.21 95% CI 1.02–1.44, p = 0.01) and baseline LAVI (HR = 1.08, 95% CI 1.03–1.13, p = 0.006) were independent predictors of new-onset AF during follow-up.

Conclusions:

In conclusion, beyond increased left atrial volume, pulse wave velocity is a significant determinant of the development of AF in hypertensive subjects. It seems that arterial stiffness evaluation may help in the prediction of AF episodes in hypertensive patients.
GLP-1 ANALOG LIRAGLUTIDE INDUCED CARDIAC DYSFUNCTION DUE TO ENERGETIC STARVATION IN HEART FAILURE WITH NON-DIABETIC DILATED CARDIOMYOPATHY IN HAMSTERS
Authors: Shiraki Aya , Oyama Jun-Ichi , Node Koichi
Published: April 2021

Objective:

Glucagon-like peptide-1 analog and DPP4 inhibitors are reported to have cardio-protective properties against atherosclerosis and cardiac function in vitro and in vivo, however, concerns that incretin -related drug can increase the risk of heart failure also have been arisen. Therefore, the purpose of this study was to elucidate the effects and the mechanisms of incretin-related drugs on failing heart in vivo.

Design and method:

We used J2N-k hamsters which develop dilated cardiomyopathy and heart failure. Hamsters were randomized to receive PBS or GLP-1 analog (liraglutide) for 6 weeks using Alzet osmotic pumps. In the complementary experiments, J2N-k hamsters were treated 10% glucose as drinking solution.

Results:

In GLP-1 analog group, energy starvation and increased apoptosis in cardiac tissue were detected by up-regulated LC3 2/1 and cleaved caspase-3. Indirect calorimetry showed increased RQ value in failing heart and this dependency on carbohydrate augmented by administration of GLP-1 analog. In the complementary experiment, glucose was additionally supplied to GLP-1 analog-treated group. As a result, heart failure induced by GLP-1 analog were dramatically ameliorated by adequate glucose supply, exerting improved cardiac function and mortality, and marked the highest RQ value, suggesting heart muscle treated with incretin-related drug need much more carbohydrate as energy substrate to maintain cardiac function.

Conclusions:

Extra higher glucose-demand arose and cardiac function was exacerbated by treatment with incretin-related drug in failing heart, which was caused as the result that energy, especially glucose, could not meet the augmented carbohydrate demand by GLP-1 analog.

Incretin-related treatment with an appropriate glycemic balance as energy regulation should be required when applying GLP-1 analogue to the patients with heart failure.
DIFFERENCES IN BIOMARKERS AMONG HEART FAILURE PATIENTS WITH OR WITHOUT HYPERTENSION
Authors: Imprialos Konstantinos , Koutsampasopoulos Konstantinos , Stavropoulos Konstantinos , Patoulias Dimitrios , Katsimardou Alexandra , Toumpourleka Maria , Bakogiannis Konstantinos , Mitas Christos , Bakaloudi Dimitra , Ziakas Antonios , Papadopoulos Christodoulos , Vassilikos Vassilios , Karagiannis Asterios , Doumas Michael
Published: April 2021

Objective:

Although hypertension is a well-established risk factor for the development of heart failure (HF) and several biomarkers have a major role in risk stratification of HF patients, it is largely unknown if biomarkers differ among hypertensive and non-hypertensive patients with HF.

Design and method:

HF patients were evaluated in a cross sectional study. Office systolic and diastolic blood pressure (SBP, DBP) were measured, and previous history of hypertension or uncontrolled hypertension were recorded as well. Hemoglobin, serum creatinine, urea, glucose, electrolytes (K+, Na+), NT-proBNP, troponin, SGOT, SGPT, clearance of creatinine (Cockcroft-Gault Equation) and Estimated Glomerular Filtration Rate (eGFR) using MDRD and EPI equations were used.

Results:

306 consecutive patients with HF (men and women) were recruited. Of them, 239 (78.1%) had a history of hypertension and 207 (90.8%) reported adequate blood pressure (BP) control. No statistically significant differences were noticed regarding previous history of hypertension and NT-proBNP, troponin, SGOT, and SGPT levels. Non-hypertensive patients had lower levels of Hb and Hct (p = 0.002 and p = 0.005, respectively), but serum urea and creatinine were higher in hypertensive patients (p = 0.001 and p = 0.005, respectively), and clearance of Creatinine and eGFR values were higher in patients with hypertension as well (p < 0.0001 and p < 0.0001, respectively).

Conclusions:

Our study provides some new insights about the relationship between HF and biomarkers in hypertensive patients. The results might have important implications, regarding the prognostic role of biomarkers in hypertensive patients with HF.
LEFT VENTRICULAR MASS AND SEXUAL FUNCTION IN HYPERTENSIVE PATIENTS WITH HEART FAILURE: SO FAR SO GOOD?
Authors: Imprialos Konstantinos , Koutsampasopoulos Konstantinos , Katsimardou Alexandra , Stavropoulos Konstantinos , Alataki Sofia , Toumpourleka Maria , Bakogiannis Konstantinos , Kerpiniotis Georgios , Lales Georgios , Ziakas Antonios , Papadopoulos Christodoulos , Vassilikos Vassilios , Karagiannis Asterios , Doumas Michael
Published: April 2021

Objective:

The relation between hypertension and erectile dysfunction (ED) is well established. Moreover, sexual dysfunction, both erectile and female sexual dysfunction (FSD), is highly prevalent in heart failure (HF) patients. On the other hand, hypertension and HF are associated with left ventricular hypertrophy; however the relation between left ventricular mass and sexual function in hypertensive patients with HF has never been investigated sufficiently.

Design and method:

Patients with HF were evaluated in a cross sectional study. ED was evaluated by the International Index of Erectile Function (IIEF) and FSD by the Female Sexual Functioning Index (FSFI). Left ventricular mass (LV mass), relative wall thickness (RWT), interventricular septum (IVS), posterior wall (PW) thickness and LV mass were evaluated by transthoracic echocardiography as well.

Results:

A total of 239 consecutive hypertensive patients (147 men and 92 women) with HF participated in the study. The majority of patients had a normal pattern (39.4%) of LV mass, 15.0% had a concentric remodeling pattern, 13.1% concentric left ventricular hypertrophy (LVH), and 32.4 % eccentric LVH. FSFI had a negative correlation with IVS (r = -0.234, p = 0.032), and IIEF a near to significant negative correlation with PW (r = -0.170, p = 0.053). Patients with or without ED and FSD did not have differences in LV mass.

Conclusions:

Both sexual dysfunction and LV hypertrophy are considered to be hypertension-mediated organ damage. Echocardiographic LV mass is a potent predictor of mortality in hypertensive patients and regression of echocardiographic LVH might lead to a better sexual function and an improved prognosis, although the evidence is limited in HF patients.
CHANGES IN EPICARDIAL FAT THICKNESS IN PATIENTS WITH HYPERTENSION AND PAROXYSMAL FORM OF ATRIAL FIBRILLATION
Authors: Podzolkov Valery , Tarzimanova Aida , Bragina Anna , Osadchiy Konstantin , Gataulin Radik , Oganesyan Karine , Japharova Zarema
Published: April 2021

Objective:

To evaluate the changes of the epicardial fat thickness in hypertensive patients with paroxysmal form of atrial fibrillation (AF).

Design and method:

The study involved 80 obese patients with hypertension aged from 38 to 77 years. Patients were divided into 2 groups: 40 hypertensive patients with paroxysmal form of AF in sinus rhythm and obesity (Group I) and 40 obese patients with hypertension (Group II). There were no significant differences in body mass index between studied groups. All patients had echocardiography to evaluate the epicardial fat thickness (EFT) around the left atrium. Waist circumference, abdominal sagittal diameter, waist-to-hip and waist-to-height ratios were assessed to evaluate the visceral adiposity.

Results:

There was a significant increase of anthropometric indicators of visceral adiposity in the group of hypertensive patients with paroxysmal form of AF: the waist-to-hip ratio in I group was 1.37 ± 0.09 and 0.84 ± 0.06 in II group (p = 0.04); the waist-to-height ratio in I group and in II group was 0.8 ± 0.02 and 0.69 ± 0.01 respectively (p = 0.0012); abdominal sagittal diameter in I group and in II group was 37.98 ± 1.26 and 31.85 ± 0.85 respectively (p = 0.03). There was a strong positive correlation between EFT and waist-to-hip ratio in group of patients with hypertension and paroxysmal form of AF (r = 0.583, p = 0.002). Also, there was a positive correlation between EFT and waist-to-height ratio (r = 0.328, p = 0.035) and between abdominal sagittal diameter and EFT (r = 0.673, p = 0.001) in I group.

Conclusions:

Positive correlations between increased EFT and anthropometric indicators confirms the role of visceral obesity in the development of AF.
RELATIONSHIP BETWEEN ATRIAL FIBRILLATION, RHO KINASE ACTIVITY AND CONNEXIN40. STUDY IN END-STAGE RENAL DISEASE PATIENTS ON HAEMODIALYSIS
Authors: Calò Lorenzo , Bertoldi Giovanni , Pagnin Elisa , Rossi Barbara , Fragasso Antonio , Gobbi Laura , Rigato Matteo
Published: April 2021

Objective:

Evidence on cellular/molecular mechanisms leading to atrial fibrillation (AF) are scanty. Recently, it has been proposed a role for Rho Kinase (ROCK) pathway in terms of increased expression of ROCK, and myosin-phosphatase-target-subunit-1 (MYPT-1), downstream target of ROCK pathway, which correlated with the increased expression of Connexin40 (Cx40), an integral membrane protein of heart gap junctions, fundamental for the rapid cell-cell transfer of action potential. AF is the most frequent arrhythmia in CKD and dialysis patients in which we observed increased MYPT-1 phosphorylation which correlated with their LV mass. Given the ROCK established role in cardiovascular-renal remodelling, induction of impairment of cell-to-cell coupling/potential conduction leading to AF, we evaluated in dialysis patients with AF, the phosphorylation state of MYPT-1, expression of Cx40 and their relationship to support their involvement in AF.

Design and method:

11 AF-dialysis patients (DPAF) under chronic bicarbonate dialysis 3-times/week (8 males, 3 females, 49–91yo), 11 sinus rhythm-dialysis patients (DP) (7 males, 4 females, 53–91yo) and 11 healthy subjects (C) (7 males, 4 females, 26–38yo) were enrolled. Mononuclear cells MYPT-1 phosphorylation state, Cx40 expression and ROCK inhibitor fasudil's effect were determined by Western blot. LV mass and left atrial systolic volume were measured by M-mode echocardiography.

Results:

DPAF's phospho-MYPT-1 was increased vs DP and C (1.57 ± 0.17 du vs 0.69 ± 0.04 vs 0.51 ± 0.05, p < 0.0001). MYPT-1 phosphorylation in DP was also higher vs C, p = 0.009. Cx40 was higher in DPAF (1.23 ± 0.12 vs 0.74 ± 0.03 vs 0.69 ± 0.03, p < 0.0001). DPAF's phospho-MYPT-1 correlated with Cx40 (r = 0.84, p = 0.0014), with cardiac left atrial systolic volume (r = 0.72, p = 0.013) and with LV mass (p = 0.014). Cardiac left atrial systolic volume was increased in DPAF compared with DP (44.45 ± 1,38 vs 35.09 ± 2,62, p = 0.005) and also significantly correlated with LV mass (r = 0.60, p = 0.049). In DPAF Fasudil reduced MYPT-1 phosphorylation (p < 0.01) and Cx40 expression (p = 0.03).

Conclusions:

These data confirm at mechanistic level a significant role of ROCK pathway, MYPT-1 and Cx40 in the mechanisms leading to AF in dialysis patients. The clarification on a mechanistic basis of this relationship/association should contribute to provide mechanistic explanations for AF generation and identify potential pharmacological targets for translations into treatment to AF.
PARTICULARITIES AND CO-MORBIDITIES IN VERY ELDERLY PATIENTS WITH HYPERTENSION AND ATRIAL FIBRILLATION
Authors: Balaceanu Alice , Stirban Raluca Elena , Draganescu Cristiana , Voiculet Cornelia , Zara Octavian Dumitru , Pirvu Diana Maria , Balaceanu Beatrice , Gurau Dorin Cristian , Dina Ion
Published: April 2021

Objective:

The aim of the study was to assess the particularities of very elderly patients with high blood pressure and atrial fibrillation, which associate other comorbidities.

Design and method:

We performed a retrospective study on a group of 97 very elderly patients over 90 years with hypertension, admitted to an emergency hospital in the last 5 years.

Results:

The average age was 92 years. 67% of the patients were female and 33% male. 40.21% of these patients also had atrial fibrillation. In the subgroup of patients with hypertension and atrial fibrillation, the gender distribution was: 64.10% Female and 35.90% Male. The minimum age was 90 years, the maximum age 98 years. 5.13% Of them came from an old foster care and 41% were immobile. 17.95% Had bed sores. The mean systolic blood pressure that was detected at admission was 135 mmhg and the mean diastolic blood pressure was 75 mmhg. 84.62% of patients were diagnosed with chronic heart failure (33.34% Nyha class ii, 36.36% Nyha class iii and 30.3% Nyha class iv). An echocardiography was performed in 30.77% Of cases and 25% of patients had a preserved ejection fraction. Changes in the electrocardiogram encountered were: right branch block in 12.82% of patients, left branch block in 10.26%, Premature ventricular contractions in 5.13%, And atrial fibrillation with rapid ventricular response in 28.21%. Other co-morbidities: 51.28% Presented with respiratory failure, 15.38% Had copd, 20.51% Required noninvasive ventilation and at the same number of patients an oxygen concentrator was recommended at discharge. 17.95% Of patients had type 2 diabetes mellitus, 20.51% Had a history of stroke and 94.87% Had an altered estimated glomerular filtration rate (based on mdrd formula).

Conclusions:

The management of very elderly patients is a challenge for the clinician. It is necessary to pay greater attention to the interactions between drugs and the type of administration. They are very fragile patients, with many comorbidities that can lead to complications.