bluuebunny/crossref_metadata_2025 huggingface dataset:
PRECISE PREDICTION OF BLOOD PRESSURE LEVELS AFTER CONTROLLING FOR SEASONAL TEMPERATURE: A THREE-YEAR PROSPECTIVE COHORT OF ELDERLY POPULATION IN HONG KONG
Authors: Tsoi Kelvin Kf , Li Jinhui , Xue Jiashu , Yiu Karen Kl , Lee Eric Kp , Wong Samuel Ys
Published: April 2021

Objective:

Cardiovascular disease risk has been linked to the environmental temperature changes, but few studies have evaluated the long-term temperature impacts on the blood pressure (BP) projection.

Design and method:

Regular blood pressure records were uploaded to the data servers from elderly community centres in Hong Kong since 2016. Meteorological data were obtained from the Hong Kong observatory. The Vector Autoregressions, the most common deep learning method was adopted for systolic BP (SBP) projection. Temperature and diastolic BP (DBP) were controlled in the model. The predictions of SBP were compared with the real BP records in the last 6-month and 12-month. The mean absolute percentage error (MAPE) and the mean absolute deviation in terms of mmHg were used to describe the accuracy of prediction. Subgroup analyses were also conducted based on age, gender, social-economic status (SES), drug intake level, and medical diseases (diabetes & hypertension).

Results:

A total of 733 participants regularly measured BP over three years since 2016. Most of them (67.7%) were aged over 75 years and the majority are female (73.8%). The MAPE of the projection models were 1.8% for 6-month and 1.9% for 12-month BP projections. The mean absolute SBP value in the 6-month projection model was 1.66mmHg with the 95%CI range of 2.3319mmHg. between the projection model and real SBP records. Moreover, the temperature increment of one unit in degree Celsius was associated with a 0.597 mmHg increased in SBP. The temperature effect on BP was more prominent for the participants with hypertension. Subpopulation analysis showed that the impact of gender (p = 0.005) and hypertension status (p = 0.0416) had more significant impacts on the blood pressure projection among the elderly participants.

Conclusions:

Seasonal temperature showed as a critical factor for the evaluation of hypertension. Understanding the blood pressure readings after removal of seasonal temperatures will help for a better diagnosis.
EFFECT OF L- AND N-TYPE CALCIUM CHANNEL BLOCKER CILNIDIPINE ON SERUM SOLUBLE (PRO)RENIN RECEPTOR CONCENTRATION
Authors: Watanabe Daisuke , Morimot Satoshi , Ichihara Atsuhiro
Published: April 2021

Objective:

Cilnidipine (Cil) is an L- and N-type calcium channel blocker that inhibits the release of norepinephrine (NE) from the sympathetic nerve endings. It has inhibitory effects on SNA and the renin-angiotensin-aldosterone system (RAAS), as well as its strong renal and vascular protective effects. (Pro)renin receptor [(P)RR] activates the tissue RAAS and contributes to the pathogenesis of organ damages. The soluble form of (P)RR [s(P)RR] is produced via cleavage of (P)RR, and its blood concentration is a biomarker of organ damage. The present study investigated the effects of Cil on serum s(P)RR concentration, as well as the relationships between the serum s(P)RR concentration and changes in NE and aldosterone (ALDO) levels.

Design and method:

Patients with essential hypertension were randomly assigned to 2 groups: the Cil treatment (C) group (n = 19) and the amlodipine treatment (A) group (18). Changes in various parameters (urinary, biochemistry, and endocrine data and cardio-ankle vascular index (CAVI), an index of arterial stiffness, during the 6 months-treatment period were compared.

Results:

In both groups, there was a significant decrease in blood pressure by the treatments, while there was no difference in changes in blood pressure between the two groups. In the C group, urinary albumin excretion and CAVI decreased significantly. There were no changes in s(P)RR levels in both groups. Serum NE levels (rate of decline: 13.6 ± 33.3%) and ALDO levels (18.4 ± 33.6%) significantly decreased in the C group. In the C group, while the decline rate of NE was significantly greater in the low s(P)RR group (24.6 ± 31.4%, n = 9) than in the high s(P)RR group (1.2 ± 33.0%, n = 10), changes in ALDO was not significantly different between the groups.

Conclusions:

The present study reconfirmed that Cil reduces NE and ALDO levels, and has renal and vascular protective effects. Although changes in serum s(P)RR concentration by Cil were not demonstrated, there was an association between the serum s(P)RR levels and the rate of decline of NE, suggesting involvement of (P)RR expression in the regulation of SNA. Future studies are needed to determine the underlying mechanism of this involvement.
CLINICAL AND BIOCHEMICAL OUTCOMES AFTER RADIOFREQUENCY ABLATION FOR ALDOSTERONE-PRODUCING ADENOMA AT KEIO UNIVERSITY HOSPITAL - 2020 ANNUAL REPORT
Authors: Kozuma Takahide , Kurihara Isao , Kobayashi Sakiko , Yokota Kenichi , Miyashita Kazutoshi , Kohata Nao , Takase Kei , Nakatsuka Seishi , Itoh Hiroshi
Published: April 2021

Objective:

Total adrenalectomy of affected adrenal is the standard therapy for aldosterone-producing adenoma (APA), which is a curable subtype of primary aldosteronism (PA). However, there are cases in which total adrenalectomy could not be performed because of bilateral adenomas or incapability of operation under general anesthesia. For these cases radiofrequency ablation (RFA), which is minimally invasive and enables cortical-sparing treatment, could be a choice of treatment. A multicenter clinical trial of RFA for APA was performed in Japan from 2015 to 2016. The long-term efficacy of this treatment remains to be established, so we have assessed its effectiveness and safety annually and reported it at ISH 2018. The evaluation of clinical and biochemical outcomes has been extended. This time we report these outcomes 4 years after treatment.

Design and method:

The long-term efficacy of RFA for APA was monitored and analyzed.

Results:

10 cases of APA were treated with RFA between June 2015 and March 2016. 7 cases were in valid follow-up at the end of November 2019. Aldosterone-renin ratio (ARR) returned to normal in all 7 cases. Hypertension was not cured in 2 cases (29%) though ARR were normal. Urinary albumin levels were improved in all cases. Follow-up CT images showed that the tumor vanished in 1 case (14%), shrank in 3 cases (43%) and unchanged in 3 cases (43%). There were no cases indicating adrenal insufficiency after RFA.

Conclusions:

In average 4-year follow-up after RFA, there were no cases suggesting recurrence. RFA for APA appears to be effective and safe.
THE CHARACTERISTICS OF PATIENTS SENSITIVE TO MINERALOCORTICOID RECEPTOR ANTAGONISTS
Authors: Kidoguchi Satoshi , Sugano Naoki , Takahashi Daisuke , Yokoo Takashi
Published: April 2021

Objective:

Primary aldosteronism (PA) is related to various cardiovascular events, thus the treatment of this disease is exceedingly important. From the current guidelines, physicians are encouraged to administrate mineralocorticoid receptor antagonists (MRA) to the patients with bilateral type of this disease, so-called idiopathic hyperaldosteronism (IHA). However, it is recently demonstrated that the benefit of this medicine is only exerted in the patients with enough PRA elevation after MRA treatment. We retrospectively evaluated the predictors for the patients who exceed plasma renin activity (PRA) > 1.0 ng/ml/h at arbitrary chance after MRA administration from baseline characteristics and the result of confirmatory tests.

Design and method:

Our study protocol was approved by the Ethics Committee of The Jikei University School of Medicine (No. 31-271). 67 patients who received eplerenone for PA are included. We included the patients exceed plasma renin activity (PRA) > 1.0 ng/ml/h at arbitrary chance within a year after MRA administration in Group A, and the patients who did not were included in Group B.

Results:

The eplerenone dose was comparable in two groups (Group A: 47.7 ± 13.1 v.s. Group B: 46.7 ± 14.4 P = 0.78). The patients in Group A were younger, and baseline PRA was lower in Group A. PRA after furosemide upright test, plasma aldosterone concentration (PAC) after saline infusion test, and PAC and PAC/F (Cortisol) after rapid adrenocorticotropic hormone (ACTH) stimulation test were higher in the Group A. Above all, it is revealed with Receiver operating characteristic curve analyses that PAC/F after rapid ACTH stimulation test at the cut-off value of 12.4 was proved to have the highest Area Under Curve (AUC) among all the indices (AUC 0.770).

Conclusions:

In conclusion, rapid ACTH stimulation test might be useful for discriminating the patients sensitive to MRA treatment.
A DIRE WOLF IN WOLF'S CLOTHING
Authors: Farhi Hannane El , Giudiceandrea F. , Jeewooth A. , Koffi M. , Lahjouji J.
Published: April 2021

Objective:

Takotsubo cardiomyopathy is often attributed to women over 60 years of age as a result of an emotional event stress.

Pheochromocytoma is a rare etiology that can mimic Takotsubo cardiomyopathy through hypersecretion of catecholamines.

This case is that of a patient presenting with atypical Takotsubo cardiomyopathy fortuitously discovered in a context of intense paroxysmal migraine.

Design and method:

A 38 year old female patient with a medical history of migraine, depression, anorexia, and an active smoking attends the emergency for frontal-orbital migraine headache, bilateral otalgia and myodesopsia. arterial blood pressure at 175/95 mmHg,The patient received analgesic treatment and a cerebral CT scan was performed with a normal outcome. Her ECG showS incidental findings of ST depression in V1-V2 and negative T waves in upper lateral leads(DI, AVL). HS troponin levels are elevated. The patient received a triple antithrombotic therapy transferred to our hospital for emergency coronary angiogram. Upon arrival, the patient is asymptomatic, BP 145/75 mmHg, and received emergency coronary angiogram revealing a healthy coronary artery up and the ventriculography detected a ballooning of the left ventricle. TTE findings are an altered LVEF estimated at 40%, apical akinesia and hypokinesia of the adjacent segments, an apical ballooning. The rest of the TEE is normal. Takotsubo is evoked. hospitalization is marked by a normalization of the patient's ECG. 2 days after the coronography, the patient presents with intense recurrence of migraines, ST depression on leads V1-V2 and a severe hypertensive crisis at 220/160mmHg. After initiating an IV antihypertensive treatment, there is a regression of the symptomatology and electrocardiographic changes.

Results:

Atypical Takotsubo associated with HTN crisis resulted in the panel of secondary HTN.

CT scan findings show an adrenal mass. The normetanephrine values and total metanephrine values are elevated. These elements are in favor of a pheochromocytoma.

Conclusions:

The patient presented an atypical picture of ACS. The initial diagnosis associated with paroxysmal hypertensive flare-ups are the result of an underlying pheochromocytoma.

It is important not to settle for a diagnosis of exclusion without mentioning all possible etiologies and thus reduce the morbidity and mortality of this pathology.
SCREENING OF PRIMARY ALDOSTERONISM WITH A NOVEL RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM TRIPLE-A ANALYSIS
Authors: Burrello Jacopo , Buffolo Fabrizio , Domenig Oliver , Tetti Martina , Pecori Alessio , Monticone Silvia , Poglitsch Marko , Mulatero Paolo
Published: April 2021

Objective:

Primary aldosteronism (PA) is the most frequent cause of endocrine hypertension and its screening is expected to become a routine evaluation in hypertensive patients. The interference of antihypertensive medications with the Aldosterone-to-Renin-Ratio (ARR) is a major confounder during screening testing. Renin-angiotensin-aldosterone system (RAAS) triple-A analysis is a novel liquid chromatography/tandem mass spectrometry diagnostic assay that allows simultaneous quantification of aldosterone, equilibrium angiotensin I (eqAngI) and equilibrium angiotensin II (eqAngII) from a single serum sample. The aim of the present study was to assess the reliability of RAAS triple-A analysis for the screening of PA.

Design and method:

We performed a comparative evaluation of the diagnostic performance of the Aldosterone-to-AngII-Ratio (AA2R) and five renin based diagnostic ratios, differing in methods to determine aldosterone levels and renin activity, either based on chemiluminescence or radioimmunoassay.

Results:

We prospectively enrolled a cohort of 110 patients with hypertension and suspected PA referred to a single hypertension unit (33 patients with confirmed PA and 77 with essential hypertension). All ratios showed comparable areas under the curves ranging between 0.924 and 0.970 without significant differences between each other. The evaluation of the AngII-to-AngI ratio revealed persistent ACE inhibitor intake in some patients as cause for suppressed renin-based diagnostic ratios, while AA2R remained unaffected, allowing a AA2-R-based PA screening in presence of ACE inhibitor and providing major advantage over currently available tests.

The Youden-Index optimal cut-off value for the AA2R was 6.6 [(pmol/L)/(pmol/L)] with a sensitivity of 90% and a specificity of 93%, non-inferior compared with the ARR while pointing to the potential for an interference free application in patients under ACE-inhibitor therapy.

Conclusions:

This study shows for the first time the accuracy and reliability of RAAS triple-A analysis for the screening of PA, even in the presence of theraphy with ACE inhibitors. Combining informations on drug efficacy and compliance monitoring with PA screening, this method might have a significant impact on the overall performance of PA screening procedures.
LEFT VENTRICULAR HYPERTROPHY IN WOMEN AND MEN WITH PRIMARY ALDOSTERONISM
Authors: Aune Arleen , Kokorina Marina , Saeed Sahrai , Grytaas Marianne , Løvås Kristian , Gerdts Eva
Published: April 2021

Objective:

Primary aldosteronism (PA) is the leading cause of secondary hypertension and has been associated with higher prevalence of left ventricular hypertrophy (LVH) compared to essential hypertension (EH). In EH, women have higher prevalence of LVH than men. Whether this also applies to PA patients remains unknown. We aimed to compare the prevalence and type of LVH in women and men with PA.

Design and method:

109 patients (mean age 57 ± 11 years, 32% women) recently diagnosed with PA according to current guidelines, underwent echocardiography and ambulatory blood pressure monitoring. LVH was identified using guideline recommended sex-specific values. Post saline infusion test (SIT) aldosterone level was considered an indicator of PA-severity.

Results:

Women had a shorter duration of hypertension than men (9 ± 9 vs. 16 ± 10 years, p < 0.001), lower BMI (28 ± 6 vs. 31 ± 5 kg/m2, p = 0.04) and lower prevalence of diabetes (6 vs. 23%, p = 0.034), while clinical and ambulatory blood pressure and post-SIT aldosterone level did not differ. LVH was more prevalent in men than women (63% vs. 41%, p = 0.04), eccentric hypertrophy was the most common geometric pattern in both sexes. In univariate logistic regression analyses, male sex, higher BMI, night-time blood pressure and co-presence of diabetes were all associated with prevalent LVH, while post-SIT aldosterone level was not. In multivariate analysis, the association of male sex with prevalent LVH became statistically non-significant when adjusted for confounder (Table 1).

Conclusions:

The higher prevalence of LVH in men than women with PA in our study was fully explained by differences in BMI and nocturnal hypertension, independent of PA-severity.
EFFECT OF ADRENALECTOMY ON REMISSION OF SUBCLINICAL LEFT VENTRICULAR DYSFUNCTION IN PATIENTS WITH PHEOCHROMOCYTOMA: A SPECKLE-TRACKING ECHOCARDIOGRAPHY STUDY
Authors: Kvasnicka Jan , Zelinka Tomas , Petrak Ondrej , Kratka Zuzana , Indra Tomas , Widimsky Jiri
Published: April 2021

Objective:

Pheochromocytomas (PHEO) are tumors arising from chromaffin cells from the adrenal medulla, having the ability to produce, metabolize and secrete catecholamines. The overproduction of catecholamines leads by many mechanisms to the decline of longitudinal function of the left ventricle measured by speckle tracking echocardiography. Patients with PHEO have a lower magnitude of global longitudinal strain (GLS) than the patients with essential hypertension, although the ejection fraction of left ventricle (LV EF) remains in normal range.

Design and method:

We analysed 24 patients (14 females and 10 males) with recent diagnosis of PHEO and one year after adrenalectomy. We performed an echocardiographic examination including the evaluation of GLS by speckle tracking analysis.

Results:

One year after adrenalectomy magnitude of GLS increased (-14.3 ± 1.8 to -17.7 ± 1.6 %; p < 0.001), although values of LV EF remained unchanged (0.66 ± 0.07 vs. 0.65 ± 0.05; n.s.). In addition, there was also found a decrease in the indexed mass of the left ventricle (95.3 ± 18.7 to 83.6 ± 17.8 g/m2; p < 0.05).

Conclusions:

In patients with PHEO, adrenalectomy leads to an improvement of subclinical left ventricular dysfunction represented by increasing magnitude of GLS.
NUMBER AND REPLATING CAPACITY OF ENDOTHELIAL COLONY FORMING CELLS ARE TELOMERE LENGTH DEPENDENT: IMPLICATION FOR HUMAN ATHEROGENESIS
Authors: Toupance Simon , Simoncini Stéphanie , Labat Carlos , Dumoulin Chloé , Lai Tsung-Po , Ayad Oualid , Lakomy Cécile , Aviv Abraham , Dignat-George Françoise , Sabatier Florence , Benetos Athanase
Published: April 2021

Objective:

Short leukocyte telomere length (TL) is associated with atherosclerotic cardiovascular disease. Endothelial repair plays a key role in the development of atherosclerosis. To explore a potential role of short TL in atherogenesis, we examined associations between TL and proliferative dynamics of endothelial colony forming cells (ECFCs), which behave as progenitor cells displaying endothelial repair activity.

Design and method:

To isolate ECFCs, we performed a clonogenic assay on blood samples from 116 participants (24 to 94 years old) in the TELARTA (Telomere in Arterial Aging) study. We detected no ECFC clone in 29 (Group 1), clones with no replating capacity in other 29 (Group 2), and clones with replating capacity in additional 58 (Group 3). TL was measured by Southern blotting in leukocytes (LTL) and ECFCs (ECFC-TL).

Results:

Age- and sex-adjusted LTL (mean ± SEM) was the shortest in Group 1 (6.51 ± 0.13 kb), longer in Group 2 (6.69 ± 0.13 kb) and the longest in Group 3 (6.78 ± 0.09 kb) (p < 0.05). In group 3, ECFC-TL was associated with the number of detected clones (p < 0.01). ECFC-TL (7.98 ± 0.13 kb) was longer than LTL (6.74 ± 0.012 kb) (p < 0.0001) and both parameters were strongly correlated (r = 0.82; p < 0.0001).

Conclusions:

Individuals with longer telomeres display a higher number of self-renewing ECFCs suggesting that they might have a better endothelial repair capacity. Our results also indicate that LTL, as a proxy of TL dynamics in ECFCs, could be used as a surrogate marker of endothelial repair capacity in clinical and laboratory practice due to easy accessibility of leukocytes.
ASSESSMENT OF THE REPRODUCIBILITY OF SEMI-AUTOMATED FLOW MEDIATED DILATION MEASUREMENTS PERFORMED ON SEPARATE DAYS
Authors: Dobbie Laurence , Mackin Sharon , Hogarth Katrina , Lonergan Frances , Brooksbank Katriona , Delles Christian
Published: April 2021

Objective:

Assessment of endothelial function has the potential to diagnose cardiovascular disease earlier than traditional methods. The gold standard non-invasive measure of endothelial function is brachial artery flow-mediated dilatation (FMD). However, this technique is limited by significant measurement variability and requiring extensive operator training. Semi-autonomous FMD has the potential to overcome these problems. This study assessed the reproducibility of separate-day semi-autonomous FMD measurements by investigators who received basic training on the correct use of the device.

Design and method:

Forty three healthy participants were recruited for serial FMD readings using the UNEX EF 38G device. The cohort was largely Caucasian and composed of younger normotensive adults. Two readings were taken 20 minutes apart with a further reading taken on a separate day. The device produced automatic FMD outputs which were manually analysed using edge-detection software. The reproducibility of FMD measurements performed on separate days was compared for automated and manual readings.

Results:

25% of scans were not diagnostic (final sample size = 32). Automated results correlated poorly (r = 0.106) whereas manual results demonstrated good correlation (r = 0.622). Poor reproducibility and high measurement variance were shown for automated analyses (intraclass correlation coefficient (ICCC) = 0.103, coefficient of variation (CV) = 45.71%). In contrast, manually analysed scans demonstrated good reproducibility and low measurement variance (ICCC = 0.679, CV = 12.43%). Same day measurements had improved reproducibility for both automatic (ICCC = 0.334) and manual (ICCC = 0.815) results when compared to separate day readings.

Conclusions:

Manually analysed FMD scans had good reproducibility, indicating that semi-autonomous FMD requires manual analysis before independent automatic interrogation. The lower reproducibility of separate-day measurements is most probably due to the inherent biological variability of endothelial function. The high non-diagnostic scan rate most likely reflects the investigator's basic and limited training. Thus, we strongly advocate for more extensive training before performing assessments in a research context.
EFFECTS OF 3 MONTH COMBINED THERAPY WITH PERINDOPRIL AND INDAPAMIDE ON ENDOTHELIAL FUNCTION AND ARTERIAL STIFNESS IN OBESE HYPERTENSIVE WOMEN IN PERIMENOPAUSE
Authors: Danilogorskaya Yulia , Zheleznykh Elena , Privalova Ekaterina , Belenkov Yuriy , Kozhevnikova Maria , Shchendrygina Anastasia , Shakaryants Gayane , Zektser Vita
Published: April 2021

Objective:

To evaluate effects of 3-month combined therapy with Perindopril 10 mg and Indapamide 2.5 mg on endothelial function and arterial stiffness in obese hypertensive women in perimenopause.

Design and method:

Fifty perimenopause women with EAH and Obesity were enrolled in the study (average age 48,5 (40,75;48,00) years old; average body mass index 31,6 (31,2; 32,7) kg/sqm), SBP 139,0 (137,8;146,3) mm Hg., DBP 84 (78,8;89,0) mm Hg.

Investigation of endothelial function and arterial stiffness based on the pulse wave contour analysis and reactive hyperemia test (“Angioscan-01” device used) was conducted before and after 3 month treatment with 10 mg/day perindopril A and 2,5 mg/day indapamide.

The following parameters were evaluated: SI (stifness index), PS (phase shift) which caraterise structural and functional changes in large arteries and RI (resistance index), IO (occlusion index) which caracterise structural and functional changes in arteriols.

Results:

After 3-month combined treatment with 10 mg/day perindopril A and 2.5 mg/day indapamide significant decrease of SBP and DBP were observed: SBP from 139,0 (137,8;146,3) mm Hg. to 123.0 (120,75;128,75), DBP from 84 (78,8;89,0) mm Hg. to 75,5 (70;81,5) mm Hg (p < 0.05); while SI significantly decrease from 9,4 (8,58;11,33) m/s to 8,4 (8,0;9,23) m/s (p < 0.05); as well as RI from 35,0 (31,0;48,5) to 30 (26,75; 34,25)% (p < 0.05); SF significantly increased up to 8,90 (7,4;10,02)ms from 7,45 (6,55;9,15)ms (p < 0.05), as well as IO up to 1,85 (1,7;2,1) from 1,6 (1,3;1,9)

Conclusions:

3-month therapy with perindopril A 10 mg/day and 2,5 mg/day indapamide was associated with not only significat decrease of SBP and DBP but significant improving of endothelial function and structural parameters in large muscular arteries (increase of phase shift between channels, decrease of stiffness of large arteries) as well as in arteriols (decrease of RI and increase of IO).
BODY MASS INDEX TRAJECTORIES IN EARLY LIFE IS PREDICTIVE OF CARDIOMETABOLIC RISK
Authors: Yuan Yue , Mu Jian-Jun , Chu Chao , Zheng Wen-Ling , Ma Qiong , Hu Jia-Wen , Wang Yang , Yan Yu , Liao Yue-Yuan , Chen Chen
Published: April 2021

Objective:

Few studies have clarified the association between body mass index (BMI) and cardiovascular disease (CVD), and in China, the predictive values of BMI trajectory in early life for the cardiometabolic risks remains unclear. This study aimed at exploring the effects of BMI trajectories on the adult CVD outcomes using a dataset with 30 years of follow-up.

Design and method:

A total of 2839 participants aged 6–18 years whose BMIs were measured 3–6 times during the Hanzhong Adolescent Hypertension Study were included in our analysis. Latent Mixture Modeling was used to clarify distinct BMI trajectories in longitudinal analyses.

Results:

Three groups with distinct trajectories in BMI were identified by the latent mixed models: a normal group (n = 1324, 36.64%), a moderate-increasing group (n = 1178, 16.89%) and a high-increasing group (n = 337, 39.46%). Compared with the participants in the normal group, the RRs of hypertension, Type 2 diabetes mellitus, high-risk triglycerides and high-risk high-density lipoprotein (HDL) cholesterol were more than 3.0 in the high-increasing group (all P < 0.001) after being fully adjusted. Increased risks existed in high brachial-ankle pulse wave velocity (baPWV) for the high-increasing group compared with the normal group (RR = 2.75, 95% CI: 1.94–3.91, P < 0.001). Additionally, participants in the moderate-increasing group had a 2.31-fold increased risks of left ventricular hypertrophy (LVH) (95% CI: 1.25–4.30, P = 0.008).

Conclusions:

Our study indicates that BMI trajectories from childhood to adulthood vary and that elevated BMI trajectory in early life is predictive of an increased the risk of developing CVD risks.
DIFFERENT APPROACH FOR Management OF HYPERTENSION EMERGENCY AND URGENCY AMONG EMERGENCY PHYSICIANS AND OTHER SPECIALISTS IN THE ITALIAN REAL WORLD
Authors: Saladini Francesca , Mancusi Costantino , Maloberti Alessandro , Giavarini Alessandra , Bertacchini Fabio , Spannella Francesco , Rosticci Martina , Bruno Rosa Maria , Pucci Giacomo , Pengo Martino , Grassi Davide , Muiesan Maria Lorenza
Published: April 2021

Objective:

To investigate differences for management and treatment of hypertension emergency (HE) (HU) and urgency among emergency physician and doctors working in other departments.

Design and method:

The young investigator research group of the Italian Society of Hypertension developed a 23-item questionnaire spread by E-mail invitation to the members of Italian Scientific societies in the field of Emergency Medicine and Hypertension.

Results:

665 questionnaires were collected: 59.7% from emergency departments (EDs), 22% from Emergency and Urgency Medicine wards, 8.7% from Cardiology Units, 5.7% from Internal Medicines and 3.9% from Intensive care or Stroke units. Emergency physicians more frequently defined chest pain as possible presentation of HE than other physicians (91.2 % vs 85.8% p < 0.05), while tinnitus and conjunctival hemorrhages were less frequently considered as possible presenting symptoms (35% vs 42.9%, p < 0.05 for tinnitus; 38.5% vs 45.9% p = 0.05 for conjunctival hemorrhages). We did not observe any significant differences in most of laboratory and instrumental examinations, except for lung ultrasound that was most frequently performed by emergency physicians compared the other specialists (43.8% vs 32.1% p < 0.005). They also investigated cocaine or amphetamine abuse more frequently than the others (98.5% vs 95.9% p < 0.05). The therapeutic approach for blood pressure (BP) reduction showed some differences: a larger use of urapidil (67.8% vs 54.9% p = 0.003) and captopril (59.6% vs 39.2 % p = 0.002) and lower of furosemide (54.4% vs 66.8% p < 0.05) was reported by ED physicians compared to other groups. Hospitalization was more frequently required in the presence of acute organ damage (45.3% vs 30% p < 0.05) by emergency physicians than other specialists, on the opposite side they suggested less frequently hypertension specialist evaluation (63% vs 74% hypertension specialist advice in more than 50% of cases, p < 0.05) and ambulatory BP monitoring (65% vs 79% p = 0.001) or home self BP monitoring (39.4% vs 56.1% in at least the 75% of cases, p = 0.003) than the other specialists.

Conclusions:

Management and treatment of HE and HU may be different according to doctor's specialty. Educational initiatives, should be done to standardized treatment protocols and to improve medical knowledge about this largely prevalent problem.
BP VALUES AND CONTROL RATES IN A GENERAL POPULATION: IMPACT OF THE ESC-ESH AND ACC-AHA GUIDELINES
Authors: Ruiz Adrian , Fernandez Antonio , Holgado Jose Luis , Lopez Cristina , Sauri Inmaculada , Uso Ruth , Trillo Jose Luis , Vela Sara , Bea Carlos , Martinez Fernando , Redon Josep
Published: April 2021

Objective:

The recent guidelines on the hypertension (HTN) management, ESC-ESH and ACC-AHA, establish different recommendations for BP goals. The impact in the rates of BP control differs among the countries based on the prevalence of HTN. The objective was to assess the rates of BP control in a Mediterranean population.

Design and method:

The sample was recruited from beneficiaries of the Valencian Health Agency's health care system, with a population of 3799884 people older than 25 years in 2012. The observational study was undertaken as part of routine clinical practice in data from the last 6 months of 2016. Hypertension was defined by a recorded physician diagnosis, or antihypertensive medication use.

Results:

Among the total population, 2552417 normotensives and 1247467 hypertensives were included. Among normotensives 123332 (4.8%) were diabetics and 45142 (1.7%) CKD. Among HTN, 387590 (31%) were diabetics and 272800 (21.8%) CKD. BP values was recorded in 46% of subject no diagnosed of HTN and 80% of HTN. According the ESH-ESC (<140/90 mmHg) and the ACC-AHA (<130/80 mmHg) criteria, distribution of subjects with BP higher that the recommended among the non-diagnosed of HTN (left figure) and the rate of control by the in the HTN (right figure), by decades of age and sex are below.

Conclusions:

Control rates of hypertension among subjects diagnosed varies across age and sex. Furthermore, large per cent of subjects with BP recorded were not diagnosed of hypertension neither are receiving antihypertensive treatment. The magnitude of this “diagnosed inertia” is clearly magnified, around twice, if the ACC criteria for diagnosis and goals are adopted.
ASSOCIATION OF THYROXINE WITH INSULIN RESISTANCE IN NEWLY DIAGNOSED HYPERTENSIVES WITH OR WITHOUT DIABETES MELLITUS
Authors: Olatunji Victoria , Olaoye Morolake , Arinde Olufemi , Olarinoye John , Olatunji Lawrence
Published: April 2021

Objective:

Altered thyroid function is associated with insulin resistance (IR). There are divergent reports regarding association of thyroid function with IR in hypertension and type 2 diabetes mellitus (T2DM). The present study aimed at determining the association between thyroxine (T4), thyronine (T3) or T3/T4 ratio and IR in hypertensives with or without T2DM.

Design and method:

Cross-sectional study involving newly diagnosed hypertensives with (n = 39) or without T2DM (n = 35) and healthy controls (n = 19). The groups were matched for age, sex and BMI. Fasting blood glucose, glycated hemoglobin, T3, T4, and lipid profile were determined. Homeostatic model assessment of IR (HOMA-IR) was used to determine the level of IR. T3/T4 ratio was estimated and anthropometric variables were recorded.

Results:

Plasma T3, T4 and T3/T4 ratios were comparable among the groups, however, using multiple regression (stepwise) analysis, there was a strong relationship between T4 but not T3 and IR in hypertensive with (Beta = 0.456, p < 0.001, R2 = 0.208) and without T2DM (Beta = 0.781, p < 0.0001, R2 = 0.610). On the other hand, there was no relationship between T4 and IR in the control group.

Conclusions:

The findings in the present study indicate that IR could be predicted by T4 but not T3 or T3/T4 ratio in treatment-naïve hypertensives with or without T2DM.
MEAN ANNUAL TEMPERATURE IN VARIOUS REGION IS ASSOCIATED WITH THE PREVALENCE OF MASKED MORNING HYPERTENSION: THE J-HOP STUDY
Authors: Narita Keisuke , Hoshide Satoshi , Kario Kazuomi
Published: April 2021

Objective:

Although previous studies have been reported home BP (HBP) is higher in cold region than that in warm region, regional variation in prevalence of masked hypertension remains unclear. We hypothesized that the prevalence of masked hypertension would be higher in cold region than that in warm region. Thus, we assessed the regional variation in the prevalence of masked hypertension using the dataset of the Japan Morning Home-Surge BP (J-HOP) study.

Design and method:

This is a cross-sectional, post-hoc analysis using the dataset of the J-HOP study, which recruited patients with a history of or risk factors of cardiovascular disease. Participants underwent consecutive 14-day HBP measurements (morning and evening). We divided participants into three regions, which were divided by mean annual temperature (< 13 degree [Celsius], 13–15 degree, 15 degree < ) in each participated facility. Masked morning or evening hypertension was defined as controlled office BP (systolic BP [SBP] < 140 mmHg and diastolic BP [DBP] < 90 mmHg) and uncontrolled morning or evening HBP (SBP >  = 135 or DBP > = 85 mmHg). These criteria of BP levels were based on the Japanese guidelin on the management hypertension 2014 (JSH2014).

Results:

In the present study, 4268 participants (mean age, 64.9 ± 10.9 years; 46.9% male; 91.4% hypertensives) were divided 453, 1955, and 1860 partcipants into cold, moderate, and warm region, respectively. Office SBP was higher in cold region than others and morning home SBP was also higher in cold region than others. Whereas, evening home SBP had no significant differences between three regions. Moreover, in participants with normal (well-controlled) office BP, the prevalence of masked morning hypertension was higher in cold and moderate region than in warm region. However, the prevalence of masked evening hypertension had no significant differences between three regions. These relationships were also demonstrated after adjusted for traditional host factors in multivariate logistic regression analysis (All results are shown in Table).

Conclusions:

The present study demonstrated that the prevalence of masked morning hypertension was higher in colder regions than in warmer regions.
CLINICAL OUTCOMES AND PATIENT CHARACTERISTICS ACCORDING TO THE COMBINATION OF TEN-YEAR RISK OF ATHEROSCLEROTIC CARDIOVASCULAR DISEASE AND SYSTOLIC BLOOD PRESSURE
Authors: Harris Katie , Jun Min , Oshima Megumi , Woodward Mark , Menard Joel , Chalmers John
Published: April 2021

Objective:

Improving the efficiency of hypertension management has driven treatment indications to be based on cardiovascular disease risk calculations instead of blood pressure or cholesterol management.

The aim of this study was to explore the relationship between ten-year risk of atherosclerotic cardiovascular disease (ASCVD) and systolic blood pressure (SBP) in individuals with type 2 diabetes and describe the characteristics of individuals according to their ASCVD risk and SBP cross-classification. The secondary aim was to model the association of ASCVD risk and SBP at study baseline with clinical outcomes (major macrovascular, major microvascular and death).

Design and method:

This current study used 7,426 individuals from the Action in Diabetes and Vascular Disease: PreterAx and DiamicroN Modified-Release Controlled Evaluation (ADVANCE) randomised clinical trial, that were free from macrovascular disease at baseline.

ASCVD risk and SBP were categorised into approximate thirds, reflecting clinically meaningful cut points, defined as intermediate risk: ASCVD < 20 or SBP < 130, high risk: ASCVD 20 -34 or SBP 130–149, and very high risk: ASCVD > = 35 or SBP > = 150. Individuals were cross-classified according to their ASCVD and SBP categories.

Characteristics of individuals among the categories were summarised using descriptive statistics. Cox proportional hazards models were fitted to model the association of ASCVD and SBP cross-classification with clinical outcomes.

Results:

There was a high proportion of women for ASCVD < 20 across the three sequential SBP categories (67.3%, 80.3% and 87.6%). Mean age increased through increasing ASCVD risk categories, in all risk categories the mean age was highest for SBP < 130 and lowest for SBP > = 150.

The risk of death increased as ASCVD increased; though there was no significant association of SBP within the ASCVD categories. The risk of major macrovascular events increased sequentially through the combined effect of ASCVD and SBP (see figure). The highest risk of major microvascular events was for SBP > = 150 across all ASCVD categories.

Conclusions:

The cross-classification of ASCVD and SBP yielded varying associations with death, major macrovascular and major microvascular events, thus indicating that using ASCVD and /or SBP as predictors produces a non-uniform pattern for adverse clinical outcomes.
EVALUATION OF THE CONCOMITANT PRESENCE OF HYPERTENSION AND OSTEOPOROSIS AND THE IMPORTANCE OF SCREENING IN LEBANON: A PILOT STUDY
Authors: El-Bikai Rana , Eid Kevin , Sader Georgio , Al-Masry Zeina , Skaf Rana , Abbass Nivine
Published: April 2021

Objective:

Hypertension and osteoporosis are two age-related diseases whose interlinkage are under investigated. In Lebanon, given the high morbidity and mortality rates due to cardiovascular diseases, and the low national health priority given to osteoporosis, we conducted a pilot study to investigate the relationship between the two diseases and the need to screen for them.

Design and method:

In the summer of 2019, Lebanon participated for a second year in the May Measurement Month. As part of this campaign, a cross-sectional pilot study was launched based on a convenient sampling. It included 730 participants of both genders, aged 18 and above; consent was obtained from all participants. Participants answered a questionnaire about blood pressure and bone health, and were screened for hypertension, following which lifestyle tips were distributed.

Results:

Our data showed a hypertension prevalence of 41%. When asked about the last time they checked their blood pressure, participants’ response was: 11.4% never, 19.8% more than a year ago, and 68.8% within the last 12 months. 45% of hypertensive participants were not aware of their hypertensive status. Concerning osteoporosis, 8.3% of participants claimed they had it, while 24.8% did not know whether they had it or not. Furthermore, 80.5% mentioned never screening for bone thinning in their lifetime (with 35.6% of them being 43 years and above). A significant association was observed between hypertension and osteoporosis (P = 0.0424). Osteoporosis was a significant risk factor for fractures (P = 0.0068), with an OR of 2.2 CI (1.23–3.99). Height was significantly associated with blood pressure (P < 0.0001), with a higher correlation among participants less than 43 years of age (P < 0.0001). Hypertensive status was significantly associated with bone fractures (P = 0.011).

Conclusions:

An association exists between hypertension, osteoporosis and bone fractures. This makes screening for both diseases important, given that hypertension is the leading risk factor for cardiovascular death in Lebanon and that the country lacks national comprehensive data about incidence and prevalence of hypertension and osteoporosis. This pilot study can serve as a foundation for an upcoming nationwide screening campaign, and an evidence base for future preventative measures.
FACTORS ASSOCIATED WITH ANTIHYPERTENSIVE MONOTHERAPY AMONG US ADULTS WITH TREATED AND UNCONTROLLED BLOOD PRESSURE, NHANES 2005-2016
Authors: Derington Catherine , King Jordan , Herrick Jennifer , Dixon Dave , Cohen Jordana , Shimbo Daichi , Kronish Ian , Saseen Joseph , Muntner Paul , Moran Andrew , Bress Adam
Published: April 2021

Objective:

Combining antihypertensive medication classes more efficaciously lowers blood pressure (BP) than monotherapy. We sought to determine factors associated with antihypertensive monotherapy in US adults with uncontrolled BP.

Design and method:

This serial, cross-sectional study analyzed pooled data from the 2005–2008, 2009–2012, and 2013–2016 US National Health and Nutrition Examination Survey (NHANES) cycles. We included NHANES participants age 20 years or older with hypertension taking antihypertensive medication and with uncontrolled BP, defined as systolic BP of 140 mm Hg or greater or diastolic BP of 90 mm Hg or greater (N = 2,699). Antihypertensive medication use was obtained from a medication inventory of participants’ pill bottles. We calculated prevalence ratios (PRs) and 95% confidence intervals (CIs) for antihypertensive monotherapy versus taking more than one antihypertensive medication associated with each characteristic using multivariable adjusted Poisson regression models with robust standard errors.

Results:

The proportion of US adults with hypertension and uncontrolled BP taking monotherapy was 35.7%, 36.3%, and 37.9% in 2005–2008, 2009–2012, and 2013–2016, respectively. After multivariable-adjustment, monotherapy was more common among current smokers (PR 1.26, 95%CI 1.06–1.50) compared to never/former smokers. Monotherapy was less common among participants 75 years or older (PR 0.71, 95%CI 0.53–0.95) compared to participants younger than 40 years, females (PR 0.81, 95%CI 0.71–0.92) compared to males, non-Hispanic black adults (PR 0.76, 95%CI 0.65–0.89) compared to non-Hispanic white adults, and obese (PR 0.73, 95%CI 0.63–0.86) compared to normal/underweight participants. Monotherapy was also less common among participants with versus without diabetes (PR 0.80 95%CI 0.67–0.94), coronary heart disease (PR 0.73, 95%CI 0.54–0.98), chronic kidney disease (PR 0.80, 95%CI 0.68–0.94), and heart failure (PR 0.46, 95%CI 0.29–0.73).

Conclusions:

Among US adults with hypertension and uncontrolled BP, smoking was positively associated with monotherapy use while older age, female sex, and comorbidities of diabetes, coronary heart disease, chronic kidney disease, and heart failure were associated with a lower prevalence of monotherapy use. The extent to which other factors such as clinician or patient preferences, adverse medication effects, or therapeutic inertia influence monotherapy among those with uncontrolled BP need to be investigated.
COMPARISON AND IMPLICATION OF THE CONTEMPORARY BLOOD PRESSURE GUIDELINES ON KOREAN POPULATION
Authors: Cho So Mi Jemma , Lee Hokyou , Kim Hyeon Chang
Published: April 2021

Objective:

With continued effort to provide optimal prevention and management of high blood pressure (BP), we compared the potential impact on prevalence of hypertension, recommended antihypertensive treatment, and achievement of target BP according to the 2017 American College of Cardiology/American Heart Association (ACC/AHA) and the 2018 Korean Society of Hypertension (KSH) guidelines.

Design and method:

We analyzed the 2007–2017 Korea National Health and Nutrition Examination Survey data to calculate guideline-specific hypertension prevalence and treatment implications on adults aged 20 years or older by sex, age, and atherosclerotic cardiovascular disease risk.

Results:

The prevalence of hypertension was markedly higher 46.3% (95% confidence interval (CI) 45.6–46.9) by the ACC/AHA guideline due to the lowered BP cutoff than 25.9% (95% CI 25.4–26.5) by the KSH guideline; the increase was most pronounced in young adults. Yet, when incorporating age, atherosclerotic cardiovascular risk, comorbidity/target organ damage, there was only a marginal 1.6% (95% CI 0.9–3.0) increase in the percentage of adults who are suggested pharmacological approach by the ACC/AHA guideline, notably in the eldest subgroup. In addition, 45.6% (95% CI 44.4–46.8) of Korean adults currently undergoing antihypertensive treatment would fail to satisfy BP goal according to the 2018 KSH guideline, which would extend to 61.7% (95% CI 60.5–62.9) of participants according to the 2017 ACC/AHA guideline; the underachievement was contributed primarily by the younger subgroup.

Conclusions:

Despite a considerable increase in the prevalence of hypertension, the adoption of ACC/AHA guideline, regardless of sex and age, would leave modest percentage increase in adults recommended for antihypertensive medication and similar percentage of suggestions for nonpharmacological interventions, otherwise suggested also by the KSH guideline. Yet, in adherence to the ACC/AHA guideline, over half of the treated individuals would fail to achieve target BP especially in younger adults, thereby be laden with more intensive antihypertensive treatment. Despite accumulated evidence suggesting substantial cardiovascular risk reduction benefit with rigorous pharmacological approach, BP management should consider comprehensive aspects of the intended target. Future studies should assess differences in subclinical cardiovascular incidence and the benefits of long-term primary prevention of hypertension by various BP cutoffs.
BLOOD PRESSURE PATTERN AND VARIATIONS IN A PREDOMINANTLY FARMING RURAL REGION IN SOUTH-WEST NIGERIA
Authors: Arije Ayodeji , Ajayi Ssamuel , Raji Yemi , Michael Obaro , Bello Nike , Adewole David , Abiola Busayo , Efuntoye Femi , Aminu Segun
Published: April 2021

Objective:

The prevalence of high blood pressure in rural communities has been on the rise as reported in many previous studies. A number of factors are implicated in these studies including dietary habits, smoking and alcohol use. In this cross sectional descriptive study we evaluated blood pressure pattern in a predominantly farming rural region comprising three communities, as well as intercommunity variation of blood pressure.

Design and method:

A total of 572 rural dwellers were studied. An interviewer administered questionnaire was used to obtain information from the participants on socio-demographic data. Blood pressure was measured twice after 5 minutes interval in accordance with WHO guidelines. Height and weight were recorded for BMI calculation. Data was analysed using SPSS version 2018.

Results:

Four hundred and thirty three (76%) participants were not aware whether they were hypertensive or not, while 139 (24%) were aware and using medications. Only 47 (7.2%) of participants ever had their BP checked at home. Using the WHO cut-off of 140/90mmHg for the diagnosis of hypertension, 315 (55%) had normal BP <140/90; 134 (23%) had both systolic and diastolic BP above cut-off values, 98 (17%) had only systolic elevation, while 25 (4.4%) had only diastolic BP elevation. Among those with elevated systolic pressure alone (n = 98) 28 (28.6%), and 70 (71.4%) either knew they were hypertensive and using medications, or did not know and were not on any medication respectively. Similarly among those with elevated diastolic BP alone (n = 25) only 6 (24%) knew they were hypertensive and were on medications while 19 (76%) did not know they were hypertensive and were not on any medication. BMI did not vary significantly among the various communities, and did not show any significant effect on blood pressure in all the communities.

Conclusions:

The overall crude prevalence of high blood pressure in this study was high and seemed to be in consonance with some previous rural community studies. There is need for more intensified blood pressure awareness campaign and treatment services to rural community dwellers in Nigeria.