bluuebunny/crossref_metadata_2025 huggingface dataset:
LIPOPROTEIN(A) AND CARDIOVASCULAR RISK IN HYPERTENSION: A RETROSPECTIVE STUDY
Authors: Vythoulkas-Biotis Nikolaos , Kyvelou Stela -Maria , Lytra Thekla , Anastasiou Theocharis , Karpanou Evanggelia , Vyssoulis Gregory
Published: June 2023

Objective:

Lipoprotein(a) [Lp(a)] has been shown to be a significant risk factor for cardiovascular disease (CVD) in the general population. However, its association with CVD risk in patients with hypertension remains unclear. This study aimed to compare the cardiovascular risk profiles of hypertensive patients with Lp(a) levels above and below 30 mg/dL.

Design and method:

This retrospective study included 34,280 consecutive hypertensive patients from a single center. Patients were divided into two groups based on their Lp(a) levels: Group 1 had 25,719 patients with Lp(a) < 30 mg/dL, and Group 2 had 8,561 patients with Lp(a) > 30 mg/dL. Stroke, cerebrovascular accident (CVA), transient ischemic attack (TIA), acute myocardial infarction (AMI), coronary artery bypass graft (CABG) and percutaneous transluminal coronary angioplasty were compared between the two groups. Furthermore, risks such as Stroke risk, HeartScore, InterHeart, 5-year risk, 10-year risk, and deep vein thrombosis (DVT) risk were also compared.

Results:

In the univariate analysis Group 2 (Lp(a) > 30 mg/dL) had significantly higher stroke rate (OR = 0.52, 95% CI [0.49, 0.63], p < 0.001), CVA (OR = 0.49, 95% CI [0.43, 0.55], p < 0.001), TIA (OR = 0.58, 95% CI [0.54, 0.63], p < 0.001), AMI (OR = 0.56, 95% CI [0.51, 0.63], p < 0.001), CABG (OR = 0.43, 95% CI [0.37, 0.52], p < 0.001) and PTCA (OR = 0.46, 95% CI [0.38, 0.55], p < 0.001) compared to Group 1 (Lp(a) < 30 mg/dL). Risk scores (Stroke risk, Heartscore, InterHeart, 5-year risk, 10-year risk and DVT risk) were also included in the univariate analysis where the difference is considered to be extremely statistically significant (p < 0.01). In the multivariate regression analysis the Lp(a) was the dependent variable and age, gender, glucose levels and total cholesterol levels were the independent variables. The correlation between the variables remained significant (p < 0.001).

Conclusions:

Our findings suggest that Lp(a) levels above 30 mg/dL is associated with a higher risk of CVD in hypertensive patients. These results may have implications for the management and treatment of hypertensive patients with elevated Lp(a) levels.
USEFULNESS OF BPN LEVELS IN IDENTIFYING DIABETIC HYPERTENSIVES WITH SYSTOLIC-DIASTOLIC LEFT VENTRICULAR DYSFUNCTION. ABILITY OF THE ANGIOTENSIN II INHIBITOR TO CONVERT IT BACK
Authors: Rosa Maria Leonarda De , Perrotti Maria , Corbia Luca , Ferrara Nicola
Published: June 2023

Objective:

We tested the hypothesis that the renin-angiotensin system could convert left ventricular diastolic dysfunction in patients with type 2 diabetes.

Design and method:

Fifty asymptomatic patients with type 2 diabetes were recruited in this double-blind cross-over trial. Baseline left ventricular diastolic function was assessed with Doppler echocardiography; using velocity ratios of peak flow through the mitral orifice (E/A) and the integral velocity of before end diastolic transmitral flow (VTIE/VTIA). In addition, plasma brain natriuretic peptide (BNP) levels were measured.

Patients randomly received either zofenopril (15mg/day), or Olmesartan (10mg/day) or their combination for 3 months and each time after a 2-week washout period. Measurements were repeated at the end of each treatment period.

Results:

Both E/A and VTIE/VTIA ratios increased (29 and 20% with zofenopril, 25 and 23% with olmesartan, and 36 and 28% with combination treatment, respectively, p < 0.001), while levels plasma BNP levels were significantly reduced with all 3 regimens (9% with zofenopril, 25% with olmesartan, and 36% with combination, p < 0.001).

Conclusions:

Both olmesartan and zofenopril improve left ventricular diastolic echocardiographic indices and reduce plasma BNP levels in diabetic patients, their combination produces an even better therapeutic effect.
PERFORMANCE OF STANDARD, IMMEDIATE AND DELAYED UNATTENDED AUTOMATED BLOOD PRESSURE MEASUREMENTS DURING HOUSEHOLD-BASED SCREENING IN RURAL AFRICA: A DIAGNOSTIC ACCURACY STUDY
Authors: Firima Emmanuel , Retselisitsoe Lefokosane , Ikhetheleng Leisa , Manthabiseng Molulela , Mamorontssane Sematle , Matumaole Bane , Khomolishoele Makhebe , Gonzalez Lucia , Gupta Ravi , Lee Tristan , Chammartin Frédérique Frédérique , Leigh Bailah , Weisser Maja , Amstutz Alain , Burkard Thilo , Labhardt Niklaus
Published: June 2023

Objective:

The World Health Organization's STEPwise approach to surveillance (STEPS) recommends three standard blood pressure measurements over five minutes (SBPM) to monitor trends of hypertension in low-income countries. The objective of this study was to assess the diagnostic accuracy of SBPM, same-day and next-day unattended automated measurement (uABP), with 24hr ambulatory measurement (24h-ABPM) as reference during a population-based prevalence survey in Lesotho.

Design and method:

Participants with elevated SBPM (> = 140/90 mmHg) and age- and sex-matched participants with normal SBPM during a household-based survey were recruited. For SBPM and uABP, participants sat and rested for 5 minutes before three measurements were taken each 2 min apart. For both, the mean of second and third measurements was taken as final blood pressure. 1st uABP readings were obtained on survey day. Afterwards participants received a 24h-ABPM device. 2nd uABP readings were taken 24h later after retrieval of the 24h-ABPM. Discrimination was determined for all screening measurements (SBPM, 1st, 2nd uABP) using area under the receiver operating characteristic curve (AUROC), and 24h-ABPM as reference.

Results:

We enrolled 275 participants [mean age 58 years, 163 (59%) female], 183 with elevated and 92 with normal SBPM. Mean difference between systolic daytime 24h-ABPM and screening measurements was highest for SBPM (mean difference: -12 mmHg; 95%CI: -14 to -9). Mean difference between diastolic daytime ABPM and diastolic SBPM was -2 mmHg (95%CI: -3 to -0.7), whereas no difference was found for mean diastolic 1st uABP (mean difference: -0.6 mmHg; 95%CI: -1.9 to 0.6); and mean diastolic 2nd uABP (mean difference: 1.0 mmHg; 95%CI: -0.4 to 2.4). Misclassification as having hypertension (Figure 1) was highest with SBPM (55 [20%]), followed by 1st uABP (27 [9.8%]) and 2nd uABP (18 [6.5%]). Using systolic daytime 24h-ABPM as reference, the uABPs had higher AUROC (1st uABP: 87% [95%CI: 83-91]; 2nd uABP: 88% [95%CI: 84-92]); SBPM: (79% [95%CI: 74-85]). This difference was significant between 1st uABP and SBPM (p = 0.002), and between 2nd uABP and SBPM (p<0.001).

Conclusions:

uABP measurements had better diagnostic performance compared to SBPM. Integration of uABP into the STEPS protocol should be considered.
KNOWLEDGE, PERCEPTION, AND PRACTICE OF QUEBEC HEALTH PROFESSIONALS REGARDING AMBULATORY AND CLINIC BLOOD PRESSURE MEASUREMENT METHODS
Authors: Todkar Shweta , Padwal Raj , Cloutier Lyne
Published: June 2023

Objective:

Hypertension Canada Guidelines recommend using standardized methods of blood pressure measurement (BPM), namely home (HBPM), ambulatory (ABPM), office (OBPM), and automated (AOBP) for hypertension management. Health professionals (HP), namely nurses, physicians, and pharmacists, routinely perform BPM, but their knowledge, perception, and practice concerning all methods is understudied, including in Canada, and results show critical gaps with the guidelines. This descriptive study is the first to establish a portrait primary care HP's in Quebec concerning the four BPM methods.

Design and method:

All licensed primary care HP's in Quebec were targeted. A validated and pretested investigator-initiated BPM questionnaire in English and French was used for data collection. In December 2019, physicians and pharmacists were recruited through their associations’ monthly newsletter, while nurses received a personalized email invitation with a link to a secured platform. UQTR issued the certificate of ethics.

Results:

A total of 453 nurses, 45 physicians, and 30 pharmacists participated in the study. The median age was 40 ± 11 years for nurses, 50 ± 13 years for physicians, and 42 ± 12 for pharmacists. The overall knowledge and perception scores for BPM methods are presented in Table 1. In practice, physicians frequently use HBPM for diagnostic purposes (73%), treatment (91%), and follow-up (86%), while HBPM was recommended by 47% of nurses and 53% of pharmacists. Overall, ABPM was used less frequently (<50% of the time) by all HP's. In the clinic, the auscultatory method is still used by a significant percentage of nurses (11%), physicians (32%) and pharmacists (7%), while only 25% nurses, 13% physicians and 30% pharmacists use the AOBP method.

Conclusions:

Overall, knowledge was suboptimal for nurses and somewhat optimal for physicians and pharmacists. Practice was unsatisfactory for all HPs. Training and continuing education should be encouraged and should be renewed with the newest education methods along with practice assessment.
CORRELATION BETWEEN BLOOD PRESSURE RESPONSE TO SUB MAXIMAL EXERCISE AND LEFT VENTRICULAR HYPERTROPHY
Authors: Gaprindashvili Tamar , Agladze Rusudan , Botchorishvili Inga , Khajalia Sergo , Pagava Zurab
Published: June 2023

Objective:

Currently, there is no common consent on what constitutes a normal increase in blood pressure (BP) during physical activity and, consequently, what constitutes an exaggerated increase in BP response to exercise. At this stage, the processes, and clinical consequences of hypertensive response to exercise (HRE) remain unknown. Even in those who do not have hypertension or other cardiovascular disorders, a hypertensive response to exercise (HRE) is common.

An increased blood pressure response to exercise is a legitimate risk marker for future hypertension, as previous research has demonstrated. HRE has among its contributors the endothelial dysfunction and an increase in afterload. in terms of neurohormonal aspects Excess sympathetic nervous system activation and an increase in angiotensin II appear to be crucial mechanisms in HRE, according to studies.

Design and method:

Of the 84 eligible participants, men (n 46) women (n 38) with I and II degree hypertension (n 32) and pre hypertension (n 22). The study analysis included the subjects with an age range of 18-64 years (mean age 42.1±12.7 years) With or without left ventricular hypertrophy (LVH) described as normal, Concentric hypertrophy, Eccentric hypertrophy, concentric remodeling.

Results:

For most of the subjects on the initial evaluation, we discovered echocardiographic evidence of concentric hypertrophy. Among the resting and exercise BP indices, submaximal SBP was the strongest correlate of LV mass (r = 0.40, P<0.04). In multivariate analysis, maximal SBP was independently associated with LV mass and concentric LV hypertrophy, after adjustment for lean body mass and gender. Submaximal exercise SBP is a modest but still independent predictor of LV remodeling (grade and type of LV geometry) in population with prehypertension, I and II grade hypertension.

Conclusions:

More frequent clinical control of resting BP, an echocardiogram, a 24-hour BP ambulatory monitoring as a more dynamic test, and at least annual repetition of the exercise test, to follow up the same abnormal response, as more studies are needed and a consensus regarding the abnormal response of the BP during exercise. Our study can be of clinical importance to prevent future adverse events linked to hypertension induced organ damage.
INTENSIVE BLOOD PRESSURE CONTROL MAY INCREASE THE RISK OF MORTALITY AMONG PATIENTS WITH PERITONEAL DIALYSIS AND HYPERTENSION
Authors: Liu Yifan , Chi Chen , Xu Yawei
Published: June 2023

Objective:

Several clinical trials showed that intensive blood pressure (BP) control reduced the risk of mortality among hypertensive patients. We aimed to verify whether patients with peritoneal dialysis (PD) and hypertension could benefit from intensive BP control.

Design and method:

This is a retrospective single-center cohort study. 146 long-term PD hypertensive patients (81 male, mean age 60.2±11.7 years) with official sitting SBP 100 to <160mmHg at baseline were included in the present analysis. Patients were divided into the intensive group (100 to <130 mmHg) and the non-intensive group (130 to <160 mmHg). Kaplan-Meier curves and log-rank tests were performed to compare the survival rates of the two groups. Cox proportional regression was used to calculate the adjusted hazard ratios (HRs) and 95% CIs of all-cause and cardiovascular mortality of the intensive group compared to the non-intensive group.

Results:

41 patients were in the intensive group and 105 patients were in the non-intensive group. The median follow-up time was 28 (quartiles 19-56) months. 65 all-cause deaths and 28 cardiovascular deaths were identified in total. Kaplan-Meier curves showed that compared with the non-intensive group, patients in the intensive group were at higher risk of all-cause mortality (HR, 1.91 [95% CI, 1.10-3.31], P = 0.02) and cardiovascular mortality (HR, 2.56 [1.12-5.88], P = 0.03). Cox regressions showed that after adjustment for potential confounders including age, gender, BMI, LDL-C, diabetes, and creatinine clearance rate, intensive BP control was also associated with the increased risk of all-cause mortality (HR, 2.14 [1.18-3.86], P = 0.01) and cardiovascular mortality (HR, 3.35 [1.37-8,17], P = 0.01).

Conclusions:

Lower systolic BP (<130mmHg) in patients with PD and hypertension was associated with a higher risk of all-cause and cardiovascular mortality. Our results suggested that intensive blood control should be cautious in hypertensive PD patients, and more clinical studies especially random controlled trials focusing on the blood pressure target of PD patients are warranted in the future.
MEDICATION ADHERENCE IN PATIENTS WITH UNCONTROLLED HYPERTENSION AND HYPERTENSIVE CRISIS PRESENTING TO AN HOSPITAL SETTING IN KARACHI, PAKISTAN
Authors: Yousuf Fatimah Sireen , Khan Muhammad Arbaz Arshad , Bibi Raheela , Arif Aiman , Arshad Ainan , Almas Aysha
Published: June 2023

Objective:

Hypertension is an established risk factor for cardiovascular disease. Non-adherence to antihypertensive medications contributes to poorly controlled hypertension while also increasing the risk of hypertensive crisis. The aim of our study was thus to estimate the frequency of adherence to antihypertensive medications and also see if an association exists between adherence and the development of hypertensive crisis.

Design and method:

This cross-sectional study was undertaken on patients admitted to Aga Khan University Hospital between July 2020 and March 2022. All patients with uncontrolled hypertension with systolic blood pressure (BP) > 140 and diastolic BP > 90 were included. Hypertensive crisis was defined as a systolic BP over 180mm Hg or diastolic BP over 120mm Hg, with or without end organ damage. Adherence to medications was assessed using the 4 item Morisky Green Levine scale. A cumulative score of more than and equal to 3 signified adherence while a score of 0, 1 or 2 was classified as non-adherence.

Results:

We found that 64% of the cohort were adherent to their medications while 93(36%) were non-adherent. Depression was seen in 133(51.2%) while 147(56.5%) had anxiety. Similar rates were seen amongst males (49.1%) and females (50.9%) when stratified by adherence. The highest level of adherence was seen in the 61-75 years age group (34.9%). We also found statistically significant association of adherence to antihypertensive medications with anxiety (p value = 0.048). Moreover, in the hypertensive crisis group, 40.7% of the patients were adherent to their antihypertensive medications while 54.8% were found to be non-adherent, with p value reaching statistical significance (p = 0.028).

Conclusions:

We found a higher rate of adherence (64%) in this inpatient hypertensive population as compared to previous studies in our population. We also found that non adherence is a risk factor for the development of hypertensive crisis. Therefore, at clinic visits, physicians should assess their patient's adherence to antihypertensive medications to prevent the development of a hypertensive crisis, which is a potentially life threatening complication of uncontrolled hypertension.
PREDICTION OF ATHEROSCLEROSIS DEVELOPMENT AND MODIFICATION OF ITS RISK FACTORS IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS
Authors: Iaremenko Oleg , Koliadenko Daria , Stepanova Natalia , Matiyashchuk Iryna
Published: June 2023

Objective:

Early-onset atherosclerosis with cardiovascular (CV) sequelae is the major cause of death in systemic lupus erythematosus (SLE); that cannot be explained only by traditional Framingham risk factors as SLE-related factors may also have an impact. The present study aimed to analyze the determinants of atherosclerosis development and risk factors modification by statin therapy in SLE patients.

Design and method:

This prospective randomized study included 100 SLE patients aged 40.9±1.4 years (90 females, 10 males) and 32 age-, sex-matched healthy controls. Brachial artery flow-mediated dilation (FMD), ultrasound of extracranial and peripheral arteries, and cardiac calcium scoring were used for the identification of atherosclerosis. 52 SLE patients with dyslipidemia were randomized to receive simvastatin 40 mg/day (n = 27) or placebo (n = 25). Lipid panel, FMD, and inflammatory markers were assessed at baseline and after 6 months.

Results:

The mean duration of SLE was 9.9±0.88 years. The disease activity index (SLEDAI) and SLE damage score (SLICC) were 11.8±0.6 and 1.85±0.13 points, respectively. In 66% of SLE patients, atherosclerosis was present in at least one vascular area which was 3.5 times more frequently compared with controls. Atherosclerosis of carotid arteries was detected in 41% of SLE patients, lower limb arteries, and coronary arteries in 58% and 39% of patients, respectively. FMD was significantly decreased in SLE patients compared to controls (7.95±0.49% vs 11.6±0.3%, p<0.001). In multiple linear regression, age (p<0.001), nephritis (p = 0.001), polyarthritis (p = 0.019), and Raynaud's syndrome (p = 0.045) were associated with low FMD. In binary logistic regression, independent determinants of the atherosclerosis development in SLE were age (p<0.001), body mass index (BMI) (p = 0.001), anti-dsDNA (p = 0.023), FMD (p = 0.017) and malar rash (p = 0.02). After simvastatin treatment, the level of LDL-Cholesterol reduced by 42%, erythrocyte sedimentation rate, C-reactive protein, and interleukin-6 decreased by 34.7%, 51.1%, and 47.7% respectively, while FMD increased by 26.0% (p<0.05); in the placebo group, there were no significant changes.

Conclusions:

The independent determinants of atherosclerosis in SLE patients were both traditional CV risk factors (age, BMI) and SLE-specific factors (anti-dsDNA, malar rash, FMD). In SLE patients with dyslipidemia, simvastatin may have not only lipid-lowering but also potentially anti-inflammatory benefits.
EFFECT OF YOGA ON RISK FACTORS IN POST MYOCARDIAL INFARCTION CASES
Authors: Prasad Avneesh , Dwivedi Shridhar , Sharma Vinod
Published: June 2023

Objective:

To study the effect of yoga on risk factors and Beck's Depression Inventory score after myocardial infarction

Design and method:

Our study that comprised of 300 patients were randomized into test group (n = 150) who were subjected to conventional treatment and yoga and control group (n = 150) subjected to conventional treatment only.

The study included patients diagnosed as myocardial infarction above 18 years with their consent to participate. Patients with hemodynamic instability, heart failure, pregnancy, prior yoga practice, arrhythmia, cardiac pacemaker, autonomic neuropathy and musculoskeletal disease were excluded.

Initially, assessment of clinical & biochemical parameters and routine investigations were performed. Beck's depression score was calculated. Yoga was started on 4th day after MI (test group) and there were sessions of 10 minutes of pranayam, 15 minutes of shavasan and 15 minutes of transcendental meditation. The patients were followed after 24 weeks for assessment of clinical & biochemical parameters. Carotid doppler & depression score was evaluated.

Results:

After 24 weeks of intervention, a significant improvement was noted among yoga group in comparison to control group for BMI (p = 0.04), heart rate (p = 0.01), systolic & diastolic blood pressure (p<0.05), fasting & post prandial blood sugar (p<0.05), HbA1c (p = 0.03), Beck's depression score (p = 0.001) and lipid profile (p<0.05). In contrast, no improvement was seen for carotid intima media thickness.

Conclusions:

On the basis of the study, it was concluded that conventional therapy with yoga has a positive impact on risk factors of MI and psychosocial stress including blood pressure. Therefore, yoga can be recommended to reduce morbidity and mortality after MI. Large trials with more number of cases and long term follow up are needed so that yoga as an intervention, can be added for secondary prevention and rehabilitation in myocardial infarction cases.
LEUKOCYTE INDICES IN NON-DIABETIC HYPERTENSIVES CAMEROONIANS MODESTLY PREDICT CARDIOVASCULAR RISK. PRELIMINARY RESULTS OF THE HYRICCA PROJECT
Authors: Liliane Kuate Mfeukeu , Nkeck Jan Rene , Ndedi Claudine Jessca Yondo , Moor Vicky Ama , Menanga Alain , Kingue Samuel
Published: June 2023

Objective:

study the contribution of leukocyte parameters in cardiovascular risk assessment of non-diabetic hypertensive adults

Design and method:

we carried out a cross sectional study including non-diabetic hypertensive patients followed up at the cardiology unit of the Yaoundé Central Hospital from November to June 2022. The collected data included cardiovascular risk factors, biomarkers of risk (Hs CRP and atherogenic indices) and cardiovascular risk scores (Framingham 2008, European SCORE 2003, WHO CVD risk laboratory-based charts 2019, ASCVD 2013 and Reynolds score).

Results:

we included 165 participants (102 females) with a mean age of 57.6 ± 10.4 years. The median duration of hypertension since diagnosis was 7 years and only 27% of participants on treatment had a controlled blood pressure. There was a significantly weak and positive correlation between neutrophil to lymphocyte ratio and systolic blood pressure (rho = 0.24, p = 0.02). Participants with dyslipidaemia had significantly raised levels of granulocyte count, eosinophil count and their corresponding leukocyte ratios (p < 0.05). Highly sensitive CRP and the atherogenic index of plasma were significantly correlated respectively with the eosinophil to lymphocyte ratio (rho = 0.28, p = 0.01) and granulocyte to lymphocyte ratio (rho = 0.18, p = 0.03). There were also weak positive correlations between leukocyte parameters, Reynolds and ASCVD 2013 scores.

Conclusions:

leukocyte indices could be useful in cardiovascular risk assessment of hypertensive patients.
EFFECT OF COENZYME Q10 ON MUSCULAR STRENGTH IN ELDERLY PATIENTS WITH STATIN-ASSOCIATED ASTHENIA: A DOUBLE-BLIND, RANDOMIZED, PLACEBO-CONTROLLED CLINICAL TRIAL
Authors: Cicero Arrigo , Fogacci Federica , Giovannini Marina , Tocci Giuliano , Borghi Claudio
Published: June 2023

Objective:

Statin treatment has been associated with decreased serum level of coenzyme Q10 (CoQ10). This double-blind, randomized, placebo-controlled clinical study aimed to investigate the effect of chronic dietary supplementation with CoQ10 phytosome on muscular strength in elderly patients with statin-associated asthenia.

Design and method:

Participants were randomized to receive daily either 2 indistinguishable pills of placebo or 150 mg CoQ10 phytosome (i.e. 300 mg CoQ10 phytosome per day, equivalent to 60 mg CoQ10; Ubiqsome®). Asthenia and handgrip strength (HGs), 1-minute sit-to-stand (STS) repetitions and 2-minute steps (2MST) were performed at baseline and at 8-week follow-up.

Results:

All enrolled patients successfully completed the trial. After the first 4 weeks of dietary supplementation, CoQ10 phytosome supplementation correlates with more significant improvement in asthenia compared placebo (p< 0.05). At 8-week follow-up, patients undergoing CoQ10 dietary supplementation experienced significant improvements in asthenia (-30.0±20.0%), HGs (+29.8±3.6%), 1-min STS repetitions (+36.4±3.9%), and 2MST (11.1±1.8%) (p <0.05 versus baseline and versus placebo).

Conclusions:

According to the present observations, chronic dietary supplementation with CoQ10 phytosome is able to effectively improve muscular strength in elderly patients with statin-associated asthenia.
SUBCLINICAL TARGET ORGAN DAMAGE IN PATIENTS WITH RESTLESS LEGS SYNDROME. A PRELIMINARY OBSERVATIONAL STUDY
Authors: Biasotto Andrea , Franzin Angelica , Rosin Elena , Burrei Giulia , Sabba’ Giulia Elena , Bonafini Sara , Giontella Alice , Cattazzo Filippo , Minuz Pietro , Antelmi Elena , Fava Cristiano
Published: June 2023

Objective:

Restless legs syndrome (RLLS) is a frequent and often underdiagnosed type of insomnia. Since other types of insomnia present a strict association with cardiovascular disease, our study aimed to evaluate the possible association of RLLS with some early markers of cardiovascular organ damage.

Design and method:

Patients with other types of insomnia and those with central nervous system diseases were excluded. Twenty-eight patients (mean age: 63,1±13,9 years; 28.6% males) participated in the study. Fourteen subjects with diagnosis of RLLS according to International diagnostic criteria (Allen RP et al. 2014 Sleep Medicine) (disease mean duration 9.6±9.2 years; International Restless Legs Scale score 22.9±5.2) were matched for sex, age and major cardiovascular risk factors with 14 controls. In both groups, peripheral Blood Pressure (pBP), central Blood Pressure (cBP) and Pulse Wave Velocity (PWV) were assessed by the SphygmoCorXCEL. Carotid Intima-Media Thickness (cIMT) and the carotid Distensibility Coefficient (cCD) were assessed by ultrasound connected with an image acquisition and analysis system (CardiovascularSuite).

Results:

We did not find any significant difference between the two groups in the indices of subclinical vascular damage. In the RLS group, blood pressure measurements significantly correlated with all the markers of subclinical vascular damage, particularly pSBP was associated with PWV (r = 0.53, p = 0.009), Pulse Pressure correlated with cIMT (r = 0.58, p = 0.01) and cDBP was inversely related to cDC (r = -0.53; p = 0.03).

Conclusions:

Our data did not show significant differences in markers of early vascular damage between patients with RLS and matched controls. As expected, the markers of vascular damage were associated with BP. The present is only a pilot study; further studies with a larger sample size are required to confirm our findings.
ASSOCIATION OF TRANSITION IN METABOLIC HEALTH AND OBESITY WITH AGE AT ONSET FOR INCIDENT CARDIOVASCULAR DISEASES
Authors: Zhao Maoxiang , Hao Xue , Wu Shouling
Published: June 2023

Objective:

The cardiometabolic risk associated with metabolically healthy obesity (MHO) remains the subject of debate. It is unclear whether changes in MHO status affect premature cardiovascular disease (CVD) risk. In this study, we aimed to investigate the association of MHO and its transition over time with incident CVD by age at onset.

Design and method:

In a community-based prospective cohort study, 54441 adults who were free of CVD in or before 2010 were followed up for incident CVD until 2020. Four age groups were examined (<55, 55-65, 65-75, and > = 75 years) for CVD onset. In each age group, participants were cross-classified by BMI categories and metabolic health. The Cox proportional hazards model with age as the underlying time scale was used to examine the associations of metabolic health status and its transition with CVD across BMI categories.

Results:

During a median follow-up of 9.59 years, 3038 participants developed CVD. Individuals with metabolic unhealthy obesity (MUO) had the highest hazard ratio (HR) for CVD onset at any age, ranging from 2.68 (95% CI, 2.02-3.55) for CVD onset in those younger than 55 years to 1.55 (95% CI, 1.09-2.10) for CVD onset in those older than 75 years. Individuals who were MHO at baseline or even remained metabolically healthy were still at increased risk of premature CVD, and the association attenuated with increasing onset age.

Conclusions:

In this cohort study, the association between metabolically healthy and obesity status and incident CVD appeared to differ by age at CVD onset and the associations were more evident for premature onset of CVD.
ASSESSMENT OF SST2 BEHAVIORS TO EVALUATE SEVERITY/CLINICAL IMPACT OF ACUTE PULMONARY EMBOLISM
Authors: Petramala Luigi , Concistrè Antonio , Sarlo Francesca , Baroni Silvia , Suppa Marianna , Servello Adriana , Circosta Francesco , Galardo Gioacchino , Gandini Orietta , Marino Luca , Cavallaro Giuseppe , Iannucci Gino , Letizia Claudio
Published: June 2023

Objective:

Pulmonary embolism (PE) is a potentially life-threatening disorder. Beyond its usefulness in the prognostic stratification of heart failure, sST2 can represent a biomarker with high utility in several acute conditions. Our study was aimed to investigate whether sST2 can be used as a clinical marker of severity and prognostic outcome in acute PE.

Design and method:

We enrolled 72 patients with documented PE and 38 healthy subjects; we measured the plasma concentrations of sST2 to evaluate the prognostic and severity performance of different levels of sST2 according to its association with the pulmonary embolism severity index (PESI) score and several parameters of respiratory function.

Results:

PE patients had significantly higher levels of sST2 compared with healthy subjects (87.74 ± 17.1 vs. 17.1 ± 0.4 ng/mL, p < 0.001); we found higher PESI scores and serum lactate values in the group of patients with sST2 > 35 ng/mL compared with patients with sST2 < 35 ng/mL (138.7 ± 14.9 vs. 103.7 ± 15.1 and 2.43 ± 0.69 vs. 1.025 ± 0.05 mmol/L, respectively; p < 0.05). Patients with sST2 > 35 ng/mL showed higher radiological severity of PE compared with patients with sST2 < 35 ng/mL. Moreover, sST2 was the strongest parameter with a discriminative capacity for the development of acute respiratory failure and a PESI score >106 with respect to C reactive protein (CRP), creatinine, d-dimer, and serum lactate.

Conclusions:

We clearly demonstrated that sST2 significantly increased in PE and that its elevation was associated with disease severity. Therefore, sST2 may be used as a clinical marker in the evaluation of PE severity. However, further studies with larger patient populations are required to confirm these findings.
SCREENING FOR ARTERIOPATHY OBLITERANTS OF THE LOWER LIMBS BY MEASUREMENT OF THE SYSTOLIC PRESSURE INDEX IN PATIENTS LIVING WITH HIV ON ANTIRETROVIRALS
Authors: Alassane Ngaide Aliou , Diaba Gaye Ngone , Salvador Mingou Joseph , Tening Diouf Marguerite , Houda Haimed , Rassoul Diop Khadim , Youssou Diouf , Karim Diop , Bara Diop El Hadji , Abdoul Kane
Published: June 2023

Objective:

The objectives of this study were to evaluate the frequency of obliterating arteriopathy of the lower limbs in HIV-positive patients on antiretrovirals by measuring the systolic pressure index, to describe the epidemiological and diagnostic aspects and to see the links between the field of HIV, the administration of antiretrovirals and the associated cardiovascular risk factors.

Design and method:

This was a descriptive and analytical cross-sectional study with prospective data collection which took place from May 1, 2022 to June 30, 2022. Included were HIV-positive patients on antiretrovirals, followed on an outpatient basis at the Regional Research Center and Training of the FANN Hospital Center, after having signed a free and informed consent. The data was collected on a pre-established survey sheet and included cardiovascular risk factors and especially those of the measurement of the systolic pressure index in a systematic and bilateral. Data analysis was performed with SPSS version 18 software. Any difference less than 0.05 was considered statistically significant.

Results:

Our study was conducted on 150 patients. The predominance was female with a sex ration of 0.58. The average age was 46.78 years. The main cardiovascular risk factors found were dyslipidemia (51.6%), hypertension (19.5%), smoking (6.9%) and diabetes (3.4%).

Fifty-five percent (55%) had PAD (systolic pressure index < 0.9). Among them, 72.4% had a well-compensated PAD and 37.6% a poorly compensated PAD. The right lower limb was most often affected with a proportion of 37.9% and mainly concerned the anterior tibial artery (40.5%). The left lower limb was affected in 25.3% of cases with a predominance of involvement of the anterior tibial artery (35.5%). PAD was more frequent in women with a proportion of 68.5%, either. a sex ratio F/M of 2.17 and in patients under 50 (50.8%). All patients were on triple therapy with Tenofovir, Lamivudine and Dolutegravir.

There was a correlation between smoking (p = 0.029), dyslipidemia (p = 0.02) and duration of HIV infection between 6-10 years (p = 0.039).

Conclusions:

Our study has highlighted the interest of systolic pressure index in the detection of PAD in patients living with HIV.
CHARACTERISTICS OF THE HIGH BLOOD PRESSURE IN A TYPE 2 DIABETIC POPULATION IN THE AREA OF BLIDA (ALGERIA)
Authors: Cherif Abdelghani Bachir , Bennouar Salam
Published: June 2023

Objective:

The association diabetes-high blood pressure (BP) is frequent. It increases the cardiovascular risk and accelerates the onset of degenerative complications of diabetes. The aim of the present study was to test the effect of the hypertension-diabetes association on the degenerative complications of diabetes and to determine the proportion and the factors associated with uncontrolled hypertension.

Design and method:

This was a cross-sectional study conducted among 2129 type 2 diabetic hypertensive patients aged 40 years or over, followed in the internal medicine department of hospital of Blida (Algeria), between February 2020 to November 2022.

Results:

The average age was 46 ± 6.6 years, with a female predominance (73.5%). Hypertension was present in 60.4% of normal weight patients, in 55.1% of overweight patients and 62.8% of obese patients with a significant difference (p = 0.03). Macroangiopathy was observed in 57% of patients with mainly ischemic heart disease (44%). It was significantly more frequent in patients with LDL-c greater than 1.3 g/l and hypoHDLemia less than 0.35 g/l. The proportion of uncontrolled hypertension (BP > 140/90) was 55% including 13% of cases of severe hypertension (BP > 180/110). Resistant hypertension was found in 21% of cases. This poor blood pressure control was correlated with insulin treatment (p = 0.05), insufficient physical activity (p = 0.03), treatment duration greater than 10 years (p = 0.01) and a number of tablets greater than 2 (p = 0.031). We did not find a significant difference between the level of BP control and the seniority of diabetes, the body mass index, the presence of degenerative complications, the intellectual and socioeconomic level. The analytical study showed no positive association between the onset of hypertension and the following factors: the HbA1c level and the duration of diabetes progression. We found a strong correlation between the degenerative complications of diabetes and the presence of hypertension: retinopathy (p = 0.05), neuropathy (p = 0.02), nephropathy (p = 0.001), coronary artery disease (p = 0.001), cerebrovascular accidents (p = 0.01).

Conclusions:

Our study highlights the positive effect of hypertension on the degenerative complications of diabetes. Optimal control of blood pressure figures is imperative to limit the development of these complications and improve life expectancy.
CHANGES IN BLOOD COUNT INDUCED BY DOXAZOSIN TREATMENT IN SUBJECTS WITH PHEOCHROMOCYTOMA
Authors: Zelinka Tomas , Petrak Ondrej , Waldauf Pavel , Michalsky David , Novak Kvetoslav , Widimsky Jiri
Published: June 2023

Objective:

Not only pre-treatment with with alfa-receptor antagonists and high-sodium diet, but also intravenous fluid administration immediately before surgery are recommended to minimalize per- and postoperative complications in subjects with pheochromocytoma or paraganglioma (PPGL). Aim of this study was to search for changes in blood count induced by doxazosin.

Design and method:

We studied PPGL subjects treated with doxazosin before operation and approximately one year after tumor removal. We measured count of blood elements – leukocytes, erythrocytes, thrombocytes, and hemoglobin level before initiation of treatment with doxazosin, during the treatment, and after tumor removal. Diagnosis of PPGL was based on elevated levels of plasma metanephrines preoperatively and was confirmed by histopathology.

Results:

In this retrospective study, we included 40 subjects with PPGL (15 males and 25 females, 51.8±14 years). Average doxazosin dose was 3.4±1.6 mg and median of duration of doxazosin treatment was 41 (25; 55) days. Leukocyte count decreased from 8.5±2.8 G/L to 7±2 G/L (P<0.001) after doxazosin treatment and to 6.5±1.6 G/L/l (P<0.001 vs. preoperatively) after surgery. Erythrocyte count decreased from 4.7±0.5 T/L to 4.3±0.5 T/L after doxazosin treatment (P = 0.01) and returned back after surgery: 4.6±0.3 T/L (P = 0.04 vs. after doxazosin). Similar results were found for hemoglobin levels: decrease from 140±15 g/L to 130±16 g/L (P<0.001) after doxazosin and increase after surgery to 140±14 g/L (P<0.001 vs. after doxazosin), and for hematocrit values: decrease from 0.42±0.04 to 0.39±0.04 (P<0.001) after doxazosin and increase after surgery to 0.41±0.05 (P<0.001). Platelets decreased significantly from 296±75 G/L to 263±78 G/L (P<0.001) after doxazosin and to 239±63 G/L after tumor removal (P = 0.02 vs. after doxazosin).

Conclusions:

These data show that doxazosin pretreatment before surgery was accompanied with a significant decrease in red blood cell count, and hemoglobin level and hematocrit compared to values before initiation of doxazosin treatment and after surgery (the highest decrease of hemoglobin value after doxazosin was almost 30 g/l). We conclude that routine fluid administration before PPGL surgery is not supported by presented data.
WHEN HYPERTENSION IS RESISTANT WE THINK IT OVER!
Authors: Torin Gioia , Cuppini Stefano , Zattoni Luca , Ricciardi Costantino , Camerotto Alessandro , Shafiei Vennus , Mazza Alberto
Published: June 2023

Objective:

Hypertension is defined as resistant when the treatment strategy fails to lower office SBP and DBP values to <140 mmHg and/or <90 mmHg, respectively, and the inadequate control of blood pressure is confirmed by ABPM or HBPM in patients whose adherent to therapy. We report a case of resistant hypertension of a 64-year-old woman who referred to our Center in August 2021 for uncontrolled BP (160/94 mmHg) despite anti-hypertensive treatment with ramipril/hydrochlorothiazide 5/25 mg, atenolol 50 mg, ramipril 5 mg and lacidipine 4 mg daily and mild hypokalaemia (3.3 mmol/L).

Design and method:

Clinical history revealed dyslipidemia in treatment with simvastatin 20 mg/daily, osteoporosis in treatment with calcium and vitamin D supplements, parathyroid nodules in follow-up,family history of CAD.

Laboratory tests confirmed hypokalaemia (3.1 mmol/L). Blood glucose, creatinine,lipids thyroid function were normal; no proteinuria was observed. The echocardiogram showed left ventricular hypertrophy with EF 60% and grade-1 diastolic dysfunction.

Results:

After wash-out of anti-hypertensive drugs, the screening tests revealed high aldosterone plasma levels (1166 pg/mL) and low renin level (1.6 microu/mL) with an ARR of 729. Other adrenal hormone levels were within normal limits. The saline infusion test confirmed the hyper-aldosteronism and an abdominal CT scan revealed a left adrenal neoformation of 17 x 15 mm in seize (Figure 1A).

The patient underwent adrenal venous sampling which did not show lateralization and patients refuse to repeat the procedure. Anti-hypertensive therapy with spironolactone, eplerenone, canrenone and amiloride was stopped due to diarrhoea and rectal tenesmus (colonscopy excluded microscopic colitis). A 131I-norcholesterol adrenal scintigraphy with dexamethasone suppression documented early uptake only in the left adrenal gland (Figure 1B).

After surgical evaluation, the patient underwent a video-laparoscopic left adrenalectomy and the histological examination revealed an adrenal cortical adenoma. The post-operative course was complicated by a syncopal episode due to hypotension (80/50 mmHg) with head injury for which antihypertensive therapy was revised and at the discharged she takes valsartan 80 mg, verapamil 40 mg twice.

Conclusions:

Primary aldosteronism intolerant to potassium-sparing diuretics and aldosterone antagonists is a rare condition and the establishment of a multidisciplinary team can improve its management.
A 120-MINUTE SALINE INFUSION TEST FOR THE CONFIRMATION OF PRIMARY ALDOSTERONISM
Authors: Golani Tiran , Bleier Jonathan , Kaplan Alon , Hod Tamar , Sharabi Yehonatan , Leibowitz Avshalom , Grossman Ehud , Shlomai Gadi
Published: June 2023

Objective:

Saline infusion test (SIT) for confirmation of primary aldosteronism (PA) traditionally requires two liters of normal saline and is 240 minutes long. Previous studies have raised concerns regarding increased blood pressure (BP) and worsening hypokalemia during and after SIT. Therefore, we aim to evaluate the diagnostic applicability of a shorter, one liter 120-minute-long SIT.

Design and method:

A cross-sectional study, including all consecutive patients with suspected PA who underwent SIT from 1st January 2015 to 31st December 2022 in a large, tertiary medical center in Israel. Blood samples were drawn for renin and aldosterone at baseline (t = 0), after 2 hours (t = 120 min), and after 4 hours (t = 240 min) of saline infusion. Receiver-operator curve (ROC) analysis was used to evaluate the sensitivity and specificity of various aldosterone cutoff values at t = 120 for the confirmation of PA. Logistic regression was performed to analyze the association of baseline variables and aldosterone levels after 120 minutes and after 240 minutes.

Results:

The final analysis included 55 patients. ROC analysis with an area under the curve (AUC) of 0.97 (95% CI [0.93, 1.00], P < 0.001) demonstrated 90% specificity and 92% sensitivity for an aldosterone cutoff value of 342 pmol/L at t = 120 to confirm PA. 45% (25/55) of patients did not suppress aldosterone levels after 240 minutes, of them 92% (23/25) did not suppress aldosterone at t = 120 according to the 342 pmol/L cutoff. Univariate analysis showed that male sex, hypokalemia, and elevated systolic BP were all associated with failure to suppress aldosterone levels below the traditional threshold for PA confirmation at t = 240 (i.e. <276 pmol/L), as well as below 342 pmol/L at t = 120. Mean systolic BP (SBP) at t = 0 was 139.9±21.2 mm/Hg and increased to 146.2±14.1 mm/Hg (p = 0.016) during the SIT.

Conclusions:

We present data showing that an aldosterone cutoff of 342 pmol/l at t = 120 has both high sensitivity and specificity for PA diagnosis confirmation.
HYPERTENSION AND HYPERALDOSTERONISM
Authors: Oliveira Monica Amorim de , Amaral Antonio , Tamiozzo Joao Felipe , Cleto Bernardo , Pedroso Ana Carolina , Figueiredo Caio , Pedro Flavia Moises , Buchsbaum Diana , Garcia Thaisa , Godomiczer Alessandra , Vieira Claudio , Marcondes Andre , Lamback Elisa , Ferraz Cristiane , Haddad Andrea
Published: June 2023

Objective:

describe the importance of investigating secondary hypertension in cases of hypertension that is difficult to control through clinical signs

Design and method:

Case Report: Patient R.A., female, 47 years old, hypertensive for seventeen years appears in the emergency department with a report of a hypertensive peak in a periodic consultation. At the time she was asymptomatic with a blood pressure of 260 x 120 mmHg. The electrocardiogram showed sinus rhythm with reduced T wave amplitude, increased U wave amplitude, and increased QT interval. The laboratory test showed hypokalemia associated with metabolic alkalosis, and slight elevation of renal slag.

Results:

The investigation of arterial hypertension secondary to primary hyperaldosteronism was initiated with plasma aldosterone dosage and plasma renin activity, showing an AP/ARP ratio > 100 ng/mL/h. Computed tomography of the abdomen and pelvis showed adenoma in the right adrenal, which was resected laparoscopically.

One month after hospital discharge, the patient returns to the emergency room with nausea, vomiting and general malaise. Laboratory with hyperkalemia and worsening of renal function. At this moment, the patient was using a potassium-sparing diuretic, considered as a possible cause of the disorder, since other tests performed did not show any alteration. The diuretic was discontinued, with clinical and laboratory evolutionary improvement. The patient is discharged from hospital, with adequate blood pressure control and stable renal function.

Conclusions:

Primary hyperaldosteronism is a clinical condition determined by excessive production of aldosterone, caused by bilateral adrenal hyperplasia or unilateral adenoma.

Hyperaldosteronism is suspected when we observe hypertension associated with difficult control, hypokalemia, adrenal incidentaloma. The investigation continues through serum levels of aldosterone and renin activity, as well as imaging tests, such as computed tomography.

Laparoscopic surgery is indicated, with a success rate between 30-60%. It is important to emphasize that regular follow-up after the surgical procedure is essential to control blood pressure, with the aim of preventing the progression of renal hypertensive disease.
DELAYED DIAGNOSIS OF PRIMARY ALDOSTERONISM IN PATIENTS WITH HYPOKALEMIA: CLINICAL COURSE AND ASSOCIATED FACTORS
Authors: Gupta Gaytri , Teo Ada , Loh Lih Ming , Seyed Ehsan Saffari , Kek Peng Chin , Puar Troy
Published: June 2023

Objective:

PA is a common and curable cause of hypertension. However, diagnosis is often delayed, leading to poorer clinical outcomes. Presence of hypokalemia, with hypertension, is characteristic of PA, and is an indication for screening. We evaluated if patients with PA had prolonged hypokalaemia before PA screening, the subsequent clinical course, and factors associated with delayed diagnosis.

Design and method:

Our retrospective study included all PA patients with hypokalemia diagnosed between 2001 to 2022. Delayed diagnosis was defined as duration of hypokalemia of >1 year from first occurrence, to first evaluation by a PA specialist. Patients who underwent unilateral adrenalectomy were assessed using the Primary Aldosteronism Surgery Outcomes criteria. We performed multivariable analysis to assess for factors associated with delayed diagnosis.

Results:

Of 240 newly diagnosed PA patients with hypokalemia, 122 (51%) patients had prolonged hypokalemia, with a median duration 4.5 (2.3 – 7.5) years. Patients with delayed diagnosis were older, had longer duration of hypertension, poorer renal function and more frequent cardiovascular disease. A lower proportion of patients with delayed diagnosis underwent adrenal vein sampling (58% vs 73%), P<0.05, adrenalectomy (32% vs 51%), P<0.05, and eventually achieved partial/complete clinical success post-adrenalectomy (21% vs 37%), P<0.05, compared to those with early diagnosis. Factors associated with delayed diagnosis included older age, presence of hyperlipidemia, and less severe hypokalemia (serum potassium >3mmol/L).

Conclusions:

Despite manifestation of hypokalaemia, many patients with PA fail to be promptly screened. Greater emphasis in hypertension guidelines, and efforts to improve awareness amongst primary care physicians are urgently needed.