bluuebunny/crossref_metadata_2025 huggingface dataset:
PRESCRIPTIONS OF ANTIHYPERTENSIVE DRUGS ARE INFLUENCED BY THE CHARACTERISTICS OF GENERAL PRACTITIONERS AND THEIR PATIENTS: A CROSS-SECTIONAL STUDY IN NORMANDY (FRANCE)
Authors: Humbert Xavier , Rabiaza Andry
Published: June 2022

Objective:

Hypertension is associated with significant cardio-vascular morbi-mortality. However, hypertension control is low, especially in France. The reasons influencing general practitioners’(GP) prescription of antihypertensive drugs (AD) remains unclear. This study aimed at assessing the influence of GP and patient characteristics on AD prescriptions.

Design and method:

A cross-sectional study based on a sample of 2,165 GPs working with French national health insurance was realized in Normandy (region of France) in 2019. Only GPs meeting the criteria for full-time GP practice were included. The ration of AD prescription to overall prescription volume, a relative measure of AD prescription level, was calculated for each GP and permited the “low-high AD prescriber’’ definition. Associations of this AD prescription ratio with GP’s age, gender, practice location, number of years of practice, number of home visits and consultations, number and age of registered patients, man patient income and number of patient with a chronic condition were assessed using univariate and multivariate analysis.

Results:

The low prescribers GPs were 51.3 ± 11.2 year-old and were mainly women (56%) and practiced in urban context (53%). They prescribed less antihypertensives drugs (4% vs 8%, p < 0.001) and had more low-income patients (6% vs 4%, p < 0.001). In the multivariate analysis, low prescribers were associated to urban practice (OR: 1.47, 95%CI: 1.14;1.88), GP’s younger age (OR: 1.87, 95%CI: 1.42;2.44), patients younger age (OR: 3.39, 95%CI: 2.77;4.15), more patients consultations (OR: 1.33, 95%CI: 1.11;1.61), more low-income patients (OR: 1.44, 95%CI: 1.17;1.76) and less diabetes mellitus patients (OR: 0.72, 95%CI: 0.59;0.88).

Conclusions:

Our study described a profile of the typical lower AD prescriber GP. In future work, a more detailed assessment of all components of the consultation (in particular home blood pressure monitoring use) is necessary to explain AD prescription in general practice.
ASSOCIATION OF BASELINE ALDOSTERONE/RENIN WITH MAGNITUDE OF BLOOD PRESSURE REDUCTION FROM FIRST-LINE TREATMENT IN TREATMENT-NAÏVE HYPERTENSIVE PATIENTS
Authors: Vischer Annina , Socrates Thenral , Glinz Delphine , Mayr Michael , Haschke Manuel , Burkard Thilo
Published: June 2022

Objective:

Aldosterone and renin play an important role in the regulation of blood pressure. While it is well known that treatment causes distinct alterations in the concentrations of aldosterone/renin, less is understood regarding baseline hormone concentrations and its association with response to treatment.

Design and method:

Patients with newly diagnosed arterial hypertension according to 24h-BP measurements (ABPM) were randomized into four arms in a 1:1:1:1 fashion to either 5 mg perindopril (ACE), 20 mg olmesartan (ARB), 5 mg amlodipine (CCB), or 25 mg hydrochlorothiazide (HCT). Aldosterone, renin and its ratio (ARR) were measured before treatment initiation and after 4 weeks of treatment at 8 a.m. and 12 a.m. at both visits. All values were analyzed separately. ABPM was repeated after 4 weeks of treatment. Super-response was defined as a BP-reduction > = 10 mmHg of the 24 h mean ABPM values.

Results:

80 patients were randomized: 20 (25.0%) to ACE, 20 (25.0%) to ARB, 21 (26.3%) to CCB, and 19 (23.8%) to HCT. Mean age was 48 (±14) years, mean BMI 26.5 (±3.7) kg/m2. Systolic/diastolic super-responders was detected in the various groups: ACE-arm 14/6 patients (70%/30%), ARB-arm 12/6 patients (60%/30 %), CCB-arm12/1 patients (57%/5%), and HCT-arm 8/3 patients (42%/16%). ACE and HCT increased renin and reduced the ARR, ARB reduced aldosterone, increased renin and reduced the ARR; CCB did not uniformly alter the hormones (Figure, panel A). While there were no significant differences for systolic super-responders with any drug, diastolic super-responders with ACE had significantly higher aldosterone and renin values at 8 and 12 a.m. at baseline (p-value 0.015/0.051 and 0.033/0.072 for aldosterone and renin), whereas super-responders with ARB had significantly higher renin and lower ARR (p-value 0.105/0.029 and 0.089/0.015) compared to non-super-responders. There was no significant differences for patients treated with CCB or HCT (Figure, panels B - D).

Conclusions:

For ACE and ARB, there is an association of the baseline aldosterone, renin and ARR values with the magnitude of BP response to the drug after 4 weeks of treatment.
EXTREMELY HIGH DIRECT PLASMA RENIN IN A YOUNG WOMAN WITH NEGATIVE IMAGING FOR RENOVASCULAR HYPERTENSION
Authors: Kuzior Agnieszka , Hernandez-Lazaro Alba , De Leon-Durango Ricardo , Rios-Gomez Carlos , Arnas-Leon Claudia , Calero Carmen Acosta , Fernandeztrujillo-Comeng Paula Maria , Santana-Suarez Ana Delia , Gonzalez-Diaz Paula , Tocino-Hernandez Alba Lucia , Perdomo-Herrera Esperanza , Martin-Perez Marta , Del Pino Perez-Garcia Maria , Garcia-Alamo Debora , Martinez-Martin Francisco Javier
Published: June 2022

Objective:

Direct plasma renin (DPR) has a much broader distribution than plasma renin activity (PRA). The finding in one patient of extremely high DPR values without apparent cause led us to the diagnosis and successful treatment of renovascular hypertension which had been initially ruled out by magnetic resonance angiography.

Design and method:

Review of the patient’s clinical records and the relevant literature.

Results:

A 39-year-old woman, long-term user of oral contraceptives was referred to our Hypertension Clinic. For the last two years she had presented severe hypertension, with BP often > 200/120 mmHg, poorly responding to antihypertensive drugs including ACEI or ARB plus calcium antagonists, diuretics, spironolactone, doxazosin and bisoprolol. She reported frequent holocranial non-pulsatile headaches without pallor, tachycardia, nausea or other vegetative symptoms. Laboratory testing was normal except for albuminuria (378 mg/g Cr) with normal plasma creatinine,eGFR, potassium, TSH and ACTH. Blood pressure remained high after contraceptive withdrawal. Physical examination showed only grade I overweight. ABPM showed diurnal 198/96 mmHg and nocturnal 186/89 mmHg, non-dipper without marked highs or lows. Echocardiography showed moderate LVH but ruled out heart failure. All drugs except diltiazem and doxazosin were withdrawn for a month, plasma metanephrines and cortisol suppression were normal, and plasma aldosterone was in the upper normal range (29.6 ng/dL) while DPR was extremely high (2196 mU/L, normal upper limit 39 mU/L). Renovascular hypertension (or reninoma) was suspected, but magnetic resonance renal angiography was informed as normal. However, the left kidney was significantly smaller and hypoperfused. A standard renal angiogram showed fibromuscular dysplasia with severe left stenosis. Angioplasty was performed, and after 3 months the patient’s blood pressure is well controlled with 120 mg slow-release diltiazem daily, and her plasma angiotensin and renin are normal.

Conclusions:

DPR can be raised by low-salt diet, hypovolemia, drugs such as diuretics, ACEIs and ARBs, hyperthyroidism, pheochromocytoma/paraganglioma and edematous states (heart or liver failure, nephrotic syndrome). However these conditions are unlikely to cause extremely high renin. Renovascular hypertension or reninoma should be suspected, even when the initial imaging seems negative. Fibromuscular dysplasia is likelier than atherosclerotic stenosis or reninoma in contraceptive users.
PRIMARY ALDOSTERONISM: INITIAL EXPERIENCE FROM A NEWLY ESTABLISHED ESH HYPERTENSION CENTER OF EXCELLENCE - WORK IN PROGRESS
Authors: Tabbalat Ramzi , Al-Hayek Tahani , Al Ani Hashim , Barghouthi Hiba
Published: June 2022

Objective:

Primary aldosteronism is a common, yet underdiagnosed, cause of hypertension and resistant hypertension. It is estimated to be responsible for 6% of all cases of hypertension and 23% of all cases of resistant hypertension and is associated with disproportionately high rates of cardiovascular events and renal damage relative to the degree of hypertension. We sought to determine the prevalence of primary aldosteronism in patients referred to our center with the diagnosis of hypertension or resistant hypertension

Design and method:

From 08/03/2021 to 04/01/2022, 46 Patients (18 Females, 39.1%) were evaluated for primary aldosteronism. Thirty two patients (69.6%) were diagnosed with hypertension, of which 22 patients were newly diagnosed and were not on antihypertensive therapy. Fourteen patients (30.4%) were diagnosed with resistant hypertension and were on an average of 4 antihypertensive medications (range, 3 to 7). All were screened with Serum aldosterone (Ald) (pg/ml) and Plasma Renin activity (PRA) (mU/L) levels and ratio. To confirm the diagnosis, a seated saline suppression test (SSST) was performed when the Ald/PRA ratio was above 300. Adrenal computed tomography (CT) and adrenal vein sampling (AVS) were recommended or performed whenever the SSST was positive.

Results:

Of the 32 Patients with hypertension, 7 had an abnormal Ald/PRA ratio, 2 of which had a SSST which was positive in 1. Of the 14 patients with resistant hypertension, 7 (50%) had an abnormal Ald/PRA ratio, 4 of which underwent a SSST which was positive in all 4. Adrenal CT and AVS were done in 3 patients with resistant hypertension and positive SSST. AVS confirmed unilaterality in 2, both with adrenal adenomas. Adrenalectomy was recommended for the 2 patients and was performed in one with significant improvement in blood pressure control.

Conclusions:

Although this is a small number of evaluated patients, the data suggests that primary aldosteronism is not rare in hypertensive patients and is a common cause of resistant hypertension. All efforts should be made to improve physicians and patients’ awareness about its prevalence.
MRI POTENTIAL FOR PREDICTION OF THE ANTIHYPERTENSIVE EFFECT OF RFA IN PATIENTS WITH TREATMENT-RESISTANT HYPERTENSION
Authors: Sukhareva Anna , Falkovskaya Alla , Baev Andrey E. , Mochula Olga V. , Maksimova Alexandra S. , Ryumshina Nadezhda I. , Shelkovnikova Tatyana A. , Zyubanova Irina V. , Tsoi Ekaterina I. , Manukyan Musheg A. , Mordovin Viktor F. , Ussov Vladimir Yu
Published: June 2022

Objective:

50% of the RFA procedures in patients with treatment-resistant hypertension (TRH) are ineffective or have ambiguous results. The most significant challenge is to find differential diagnostic predictors of the RFA efficacy in these patients.

Our purpose was to assess the MRI potential for efficacy prediction and real-world prospective control of the brain as a target organ in patients with RH during a course of treatment.

Design and method:

We studied 176 patients with RH (124 men and 51 women, aged 55.65 ± 8.99 years). All of them underwent an MRI brain scan before RFA, six months and one year after the procedure. The patients were divided into 2 groups: patients who had the average daytime BP drop by > 10 mmHg (Group 1) and patients whose BP decreased by < 10 mmHg or increased (Group 2). Using brain MRI, the CSF system measurements, including the linear measurements of the cerebral lateral ventricles and the external subarachnoid spaces in 6 regions (in the right and left frontal, parietal, and occipital lobes), sizes of the third and fourth ventricles, dimensions of intracerebral cisterns (quadrigeminal, prepontine, and chiasmatic), the presence of periventricular leukoaraiosis and focal changes in the brain were evaluated.

Results:

The methodology was based on a logistic regression model. fx180 If the p-value is< 0.5, the prognosis for the patient is “no effect’’; if the p-value is > 0.5, the prognosis is “a positive effect’’. The operating characteristics of the test on the training set amounted to 80.6% sensitivity, 85.4% specificity, and 83.3% diagnostic accuracy. The most significant brain MRI measures in hypertensive patients have been identified, which affect the RFA efficacy: the transverse dimensions of the quadrigeminal and prepontine cisterns and the fourth ventricle, the third ventricle width, the presence of lacunar infarcts, the presence of lacunae in II region—the area of the basal ganglia (thalamus, internal capsule), as well as age, DBP, and SBP.

Conclusions:

Quantitative indices are suitable for dynamic prospective assessment of the RFA efficacy in patients with TRH. Changes in MRI tomographic indices have prognostic significance.
DIFFERING EFFECTS OF RENAL DENERVATION ON BLOOD PRESSURE AND SYMPATHETIC NERVE TRAFFIC: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Seravalle Gino , Biffi Annalisa , Vanoli Jennifer , Quarti-Trevano Fosca , Dell’oro Raffaella , Corrao Giovanni , Mncia Giuseppe , Grassi Guido
Published: June 2022

Objective:

Whether and to what extent the reported BP lowering effects of renal denervation (RD) are mediated by a sympathetic deactivation induced by the procedure is still largely undefined. We examined this issue by performing a meta-analysis of the microneurographic studies published so far based on the evaluation of the blood pressure (BP) and muscle sympathetic nerve traffic (MSNA) responses to RD.

Design and method:

The meta-analysis was based on 12 studies including a total of 394 patients with resistant hypertension underwent RD and followed up to 12 months. Evaluation was extended to the relationships of MSNA with heart rate (HR) and clinic or ambulatory blood pressure (BP) values (expressed such as mean and 95% confidence interval).

Results:

Baseline MSNA values amounted to 48.25 (43.86–52.64) bursts/minute, clinic HR to 66.35 (65.02–67.67) beats/minute and systo/diastolic clinic BP to 167.3 (157.6–177.01) and 90.54 (84.81–96.27) mmHg. RD caused a significant BP reduction at 3/6/12 months following the procedure amounting to 12.6 mmHg for systolic (range 20.9 to 4.39 mmhg, p = 0.003) and to 6.4 mmHg for diastolic BP (range -11.9 t0 0.9 mmHg, p = 0.02) respectively. No significant change in MSNA (-2.65, range -6.7 to 1.4 bursts/minute, P = NS) and HR (-0.58, range -3.98 to 2.81 b/min, P = NS) were concomitantly observed. No relationship was found between the number of renal ablations and the magnitude of the blood pressure or MSNA changes, this being the case also for HR.

Conclusions:

This meta-analysis, the first ever done on the MSNA responses to RD, shows that in a consistent number of patients underwent RD, the BP lowering effects of the procedure are not accompanied by any significant change in 2 adrenergic markers, i.e. MSNA and HR, and thus appear not to be mediated by any sympathetic deactivation.
PROGNOSTIC OF PATIENTS WITH REFRACTORY HYPERTENSION IN A COHORT OF RESISTANT HYPERTENSIVES
Authors: Chedier Bernardo , Souza Fabio de , Viegas Bianca , Carlos Fernanda Oliveira C. , Santos Taissa Lorena dos , Alves Hugo Farah Affonso , de Sá Kimura Lucca Hiroshi , de Carvalho Fortes Carolina , da Silva Marcus Vinicius Serejo Borges V. , Nemer Camila Bello , Lobo Sofia Luz Botelho , de Mello Barreto Bianca Zattar , de Melo Nolasco Vitor , da Silva João Gabriell Bezerra , Vallaperde João Gabriel Rega do N. , Muxfeldt Elizabeth Silaid
Published: June 2022

Objective:

To determine prognostic value of true refractory hypertension diagnosis in a large cohort of resistant hypertensives

Design and method:

Prospective cohort study enrolled 835 patients of a large historical cohort of RHTN. After at least 6 months of follow-up, 147 (17.6%) patients remained refractory to treatment in ABPM despite the use of 5 or more drugs, including a thiazide-like diuretic and spironolactone. All of them were submitted to a standard protocol including laboratory tests, ABPM, echocardiography, and pulse wave velocity (PWV). Primary outcomes were total mortality, cardiovascular mortality, and fatal and non-fatal cardiovascular events. Secondary outcomes were major cardiovascular events separately (coronary artery disease, cerebrovascular disease, chronic kidney disease with substitutive therapy, peripheral arterial disease). Person-time rates for interest outcomes were calculated to find correlations of Kaplan-Meier survival curves using Cox regression multivariate models, after adjustments for several risk factors. Follow-up remained until December 2021

Results:

The median follow-up was 162 months [IQR 115–196]. When compared to resistant hypertensives, patients with RfHTN were younger and more obese. Regarding subclinical lesions, refractories presented less aortic stiffness (13 vs 21%, p = 0.02) and stage 3 chronic kidney diseases (26 vs 34%, p = 0.03) with albuminuria and LVMI similar to those of resistant hypertension despite uncontrolled ambulatory blood pressure. There were 232 all causes deaths (21.1 vs 29.2%), of which 122 from CV causes (12.9% vs 15%), and 253 total CV events (44.1% vs 49%). The diagnosis of RfHTN was associated with a significantly lower risk of all-cause mortality when adjusted by sex and age. It also presented a tendency to be a protective factor of cardiovascular death, chronic kidney disease with substitutive therapy and peripheral arterial disease, although without statistical significance. Risk ratio ranged from 0.62 to 0,94 for every analysis/adjustment, except incidence of stroke (IC95%:1.22(0.70–2.17) after every adjustment in RfHTN.

Conclusions:

Despite uncontrolled ABPM, refractory hypertensive patients presented lower overall and cardiovascular morbimortality at long-term when compared to non-refractory ones, except stroke, which seems to be at least partially influenced by spironolactone use.
A CLINICAL CASE OF SECONDARY HYPERTENSION IN A 20-YEAR-OLD FEMALE WITH COARCTATION OF THE AORTA
Authors: Manukyan Musheg , Falkovskaya Alla , Mordovin Victor , Zyubanova Irina , Tsoy Ekaterina , Saushkin Victor , Ryabova Tamara
Published: June 2022

Objective:

Coarctation of the aorta (CoA) is a curable cause of secondary hypertension. Patients with CoA and associated heart disease typically are diagnosed in childhood, while isolated CoA may not be recognized until adulthood.

Design and method:

We report a case of diagnosis and treatment of CoA in a young female, previously observed with a diagnosis of essential hypertension.

Results:

A 20 years old female, diagnosed with hypertension at the age of 18, with difficult control of blood pressure (BP) values under treatment with angiotensin-converting enzyme inhibitors, beta-blockers and diuretics. The patient was referred to our clinic for evaluation. The clinical examination showed normal body development. BP on the left arm was 203/115 mm Hg, on the right arm - 206/115 mm Hg, normal heart sounds, 76 bpm. A systolic murmur was audible at the parasternal left area. BP on both legs was 140/90 mm Hg. There were no clinically significant abnormalities in other organs and systems. At transthoracic echocardiography we found the signs of a CoA, with a gradient of 80/32 mm Hg, and post-stenotic blood flow in the abdominal aorta. According to the computed tomography angiography signs of CoA in a typical place were confirmed as well as collateral blood flow through the dilated intercostal and mammary arteries. A week after admission to the hospital an operation of resecting the CoA, prosthetics of the arch and descending aorta, and transection of the aortopulmonary ligament was performed. The postoperative period was uneventful, the patient was discharged 10 days after the intervention with the recommendations of continuous administration of metoprolol 100 mg, torasemide 5 mg. At the 3–month follow–up visit the BP was stabilized at 130/80 mm Hg.

Conclusions:

This clinical case presented a rare isolated type of CoA and demonstrates the importance of qualitative examination of young patients with hypertension, including BP measurement on the lower extremities and transthoracic echocardiography with a compulsory examination of the aorta.
RADIOFREQUENCY RENAL SYMPATHETIC DENERVATION WITH MULTIELECTRODE CATHETERS IN PATIENTS WITH RESISTANT HYPERTENSION: EARLY PROCEDURAL RESULTS
Authors: Ionov Mikhail , Emelyanov Igor , Vakhrushev Aleksander , Alieva Asiyat , Avdonina Natalia , Yudina Yulia , Lebedev Dmitry , Mikhaylov Evgeny , Konradi Aleksandra
Published: June 2022

Objective:

Renal sympathetic denervation (RD) is the most promising invasive options to treat resistant hypertension (HTN). In Russian practice radiofrequency (RF) is the only feasible option. Emergence of the new RF RD multielectrode catheter systems in Russian HTN Excellence Centers provide a way to test this method.

The aim of the study was to investigate the baseline characteristics of patients with resistant HTN undergoing RF RD and to determine immediate postprocedural clinical effects.

Design and method:

During 2018–2019, two series of RF RD procedures were performed in patients with truly resistant HTN using balloon-type (bipolar ablation) or spiral-type (unipolar ablation) multielectorde catheters. A comparative analysis of two groups of patients was carried out according to the type of catheter used. Dynamics of office systolic blood pressure (SBP) were assessed as delta between the two timepoints: at screening and at hospital discharge. The safety assessment of RF RD was performed. We applied multiple linear regression method to determine the factors associated with the delta of office SBP after RF RD.

Results:

A total of 48 patients taking 4 (4;6) antihypertensive drugs were included. Radiofrequency RD was performed with a balloon-type catheter in 27 patients (mean age 56 ± 12 y.o.; 12 males) and with a spiral-type catheter in 21 patients (50 ± 14 y.o.; 8 males). The duration of RF RD was significantly longer in the spiral catheter group (110 vs 60 min, p < 0.001), but twice as much RF ablations (24 vs 12, p = 0.002). None had acute kidney injury after RD (delta creatinine -0.6 micromol/L; 95% CI [-3.97; 2.78]). At discharge there was a pronounced decrease in office SBP (adjusted for baseline covariates) of -26 mm Hg (95% CI [-29; -23]). The main factors associated with the delta of office SBP were: smoking status (beta = -7.95; positive if “yes’’), baseline office SBP (beta = -0.48; positive), and blood glucose (beta = 5.28; negative).

Conclusions:

Radiofrequency renal denervation using multielectode catheters is characterized by pronounced and favorable short-term hemodynamic effects. We have found new potential predictors of these effects. Further research will focus on testing initial hypotheses in the long term run.
ARTERIAL STIFFNESS ASSESSMENT IN DIABETIC PATIENTS IN A CARDIOLOGY CLINIC
Authors: Paffer Matheus Toscano , Paffer Pedro Toscano , Paffer Tatiana , Castro Camila De , Caminha Natália , Terra Vitória , Didier Kamille , Paffer Silvio
Published: June 2022

Objective:

Arterial stiffness is a complex phenomenon characterized by decreased compliance of the great arteries. In diabetes, the arterial wall undergoes a series of biomechanical changes, which can result in arterial stiffness. The mechanisms of these structural and functional arterial alterations in diabetes include insulin resistance, collagen accumulation due to inadequate enzymatic glycation, endothelial and autonomic nervous system dysfunction. Increased arterial stiffness is a marker of cardiovascular risk in diabetic patients.

We aimed to evaluate the arterial stiffness of diabetic pateients in a private cardiology clinic

Design and method:

We evaluated 46 patients in cardiology service, who underwent central pressure assessment with the Mobil O’Graph device. All additional information about the patients conditions were taken from their medical records.

Results:

A total of 46 patients underwent the examination, being 26 of them women (56%), with a mean age of 58.93 years (+-35). Of these patients, 22 (47.8%) were diabetic, reported by their medical records. The mean central systolic pressure of diabetic patients was 142.9mmHg (+-35.1) and the central diastolic pressure was 86.9mmHg (+-19.9). The mean pulse wave velocity was 9.68 (+-5.31), with 11 (50%) above the normal value, according to the Brazilian Guideline of Hypertension 2020.

Conclusions:

As seen in the analyzed patients, diabetic patients are at high risk for an increase in arterial stiffness. This is possibly because the mechanisms that cause changes in endothelial collagen loss, such as advanced glycation end products and the inhibitor of formation of these products, aminoguanidine, are exacerbated in diabetic patients.

The importance of assessing arterial stiffness, through pulse wave velocity, in diabetic patients is evident.
IMPACT OF LONG-TERM USE OF CPAP TREATMENT ON BLOOD PRESSURE AMONG REFRACTORY HYPERTENSIVE PATIENTS WITH OBSTRUCTIVE SLEEP APNEA
Authors: Nemer Camila Bello , Chedier Bernardo , de Hollanda Cavalcanti Aline , Nejm Roderjan Christian , Viegas Bianca , dos Santos Taissa Lorena , de Azevedo João Carlos Moreno , Alves Hugo Farah Affonso , de Sá Kimura Lucca Hiroshi , de Carvalho Fortes Carolina , da Silva Marcus Vinicius Serejo Borges V. , Lobo Sofia Luz Coutinho Botelho , de Souza Fabio , Muxfeldt Elizabeth Silaid
Published: June 2022

Objective:

To assess blood pressure response to long-term continuous positive airway pressure (CPAP) treatment among patients with refractory hypertension (RfHTN) with moderate and severe obstructive sleep apnea (OSA).

Design and method:

An observational prospective study was performed in 26 patients (35.7% male, average age 59.3 ± 7.9 years) with diagnostic of RfHTN and moderate and severe OSA who were divided in 2 groups to use CPAP (CPAP group, n = 13) or not (control group, n = 15). All of them were submitted to clinical follow-up and their anti-hypertensive medication was adjusted according to the assistant physician. 24-hour ABPM was performed both at the beginning and at the end of the study. Primary outcomes were changes in office and ambulatory blood pressure (BP) and BP control. The comparison between groups of BP changes were calculated by a general linear model with group allocation as a fixed factor and adjusted by its respective BP basal values in addition to gender and age.

Results:

The median follow-up time was 68 months (IQR: 49–81 months). CPAP and control groups were similar in their baseline demographic, anthropometric, laboratory characteristics, and office and ambulatory BP. They had mean systolic and diastolic 24-hour BP of 142 (15) and 83 (14), respectively. At the end of follow-up, refractory patients using CPAP had a reduction of 8.5 and 5.0 mmHg of office systolic and diastolic BP with an intergroup difference (CPAP and control) of 13.5 (-15.2 – 42.3) mmHg and 10.1 (-7.5 – 5.4) mmHg, respectively. The most important difference between groups was noticed at nighttime with an intergroup difference of 10.0 (-8.6 – 28.7) mmHg of systolic BP and 6.7 (-3.9 – 17.3) mmHg of nighttime diastolic BP. Out of 28 initial refractory patients, 12 are not refractory anymore, being 3 (20%) in control group and 9 (69.2%) in CPAP group with a significant difference between the groups (p = 0.02)

Conclusions:

Long-term use of CPAP among refractory hypertensive patients with moderate/severe OSA seems to be effective to reduce and control blood pressure measured both in the office BP and 24-hour ABPM, especially lowering nighttime blood pressure.
ADHERENCE TO PHYSICAL ACTIVITY IN OLDER ADULTS WITH HYPERTENSION: LESSONS FROM THE HOLDAGE RANDOMIZED CONTROLLED TRIAL
Authors: Pinto Diogo , Rato Nuno D. , Garcia Catarina , Teixeira Manuel , Marques Maria J. , Amaral Teresa , Amaral Leonor , Ruivo Pedro , Abreu Ricardo , Oliveira Ana P. , Carneiro Cristiana , Figueiredo Daniela , Polónia Jorge , Mesquita-Bastos José , Viana João L. , Pescatello Linda S. , Ribeiro Fernando , Alves Alberto J.
Published: June 2022

Objective:

Isometric exercise training (IHT) may be a practical, inexpensive and time efficient modality to reduce blood pressure (BP). We report preliminary exercise adherence data from HoldAge (NCT04275037) among older adults with high-normal BP to stage I hypertension.

Design and method:

Participants performed a total of 24 sessions of IHT or aerobic exercise training (AET), 3 times/week, for 8 wks. IHT was 4x45 min contractions, alternatively with both hands, at an intensity of 50% of the maximum voluntary contraction, with 1 min rest between sets. AET was walking 20–30 min at an intensity of 50–70% of the estimated peak maximal oxygen consumption (VO2peak) assessed with a submaximal step test. The attention control (AC) group received standardized optimal medical care including lifestyle advice. The adherence to IHT was a mean quality score recorded in the digital dynamometer, representing the % time participants performed the exercise sessions at the prescribed intensity. The adherence to AET was the time spent exercising at the prescribed intensity, recorded with a heart rate monitor.

Results:

95 eligible people were contacted to participate and 72 agreed to participate (76%). Of these, 49 participants have finished the study (IHT:19; AET:18; AC:12) with 4 dropouts (AET:1; AC:3). Three participants changed their antihypertensive medication and were excluded (AET:1; AC:2). IHT had a self-reported exercise adherence of 96.7 ± 9.3%, while data downloaded from the exercise devices showed an adherence of 88.6 ± 13.9% of the sessions, with 2.3 ± 3.3% incomplete sessions. IHT registered a mean quality score of 91.8 ± 11.2% for the right hand (mean strength: 22.6 ± 7.7 kg), 91.7 ± 13.5% for the left-hand (mean strength: 20.9 ± 8.6 kg), and 91.6 ± 12.2% for both hands. AET had a self-reported exercise adherence of 83.8 ± 33.6%, consistent with the data downloaded from the heart rate monitors. AET participants spent a total of 578.1 ± 263.6 min exercising, of which 153.3 ± 152.4 min (22.6 ± 23.2%) was spent walking at the prescribed intensity, 286.3 ± 210.5 min (45.4 ± 35.2%) was below and 137.8 ± 154.7 minutes (19.4 ± 21.7%) was above.

Conclusions:

Exercise adherence in HoldAge is high in both IHT and AET, but the time spent at the prescribed intensity appears to be higher in IHT than AET.
INFLUENCE OF TRIATHLON ON AORTIC STIFFNESS: THE ATLAS STUDY
Authors: Piscitello Tessy Cuffaro , Dupont Anne Charlotte , Labat Carlos , Salvi Paolo , Joly Laure
Published: June 2022

Objective:

Arterial stiffness is a strong predictor of future cardiovascular events and all-cause mortality. Endurance exercise is efficacious in reducing arterial stiffness. Triathlon, i.e., swimming, cycling and running over long to ultra-long distances in a row, is one of the most demanding endurance sports disciplines inducing major cardiovascular adaptations. However, acute and long-term effects of triathlon on arterial stiffness are still unknown. Therefore, we investigated arterial stiffness modification during a triathlon season.

Design and method:

The ATLAS study is a prospective interventional controlled and age matched study. We included thirty-four 19–39-years-old male long-distance triathletes (Tri) and twenty-nine healthy sex- and age-matched volunteers who were insufficiently active (Ctrl) according to World Health Organization recommendations. All participants attended three visits (V1, V2, V3) each separated by five months intervals, spread over the course of the race season. Each visit included an aortic stiffness evaluation by applanation tonometry.

Results:

After a race season, aortic pulse wave velocity (aoPWV) was significantly lower in the triathletes group (aoPWV tri = 6,11 ± 0,95 versus aoPWV ctrl = 7,17 ± 1,24 m/s with p = 0,0009). Triathletes had central systolic blood pressure (cSBP) and central pulse pressure (cPP) significantly higher than in control group (respectively, cSBP tri = 122,60 ± 11,43 versus cSBP ctrl = 116,64 ± 6,88 mmHg with p = 0,01, and cPP tri = 54,18 ± 10,04 versus cPP ctrl = 45, 44 ± 7,55 mmHg with p = 0,0002). Triathlon was correlated with a statistically significant positive impact on subendocardial viability ratio (SEVR) (SEVR tri = 162,89 ± 26,55 versus SEVR ctrl = 133,22 ± 26,99 with p = 0,00009). No statistically significant longitudinal variation of aoPWV was observed in triathletes during the race season.

Conclusions:

These results suggest that triathlon has persistent beneficial effects on arterial stiffness, and even on myocardial perfusion. This improvement cardiovascular health for triathletes seems to reach its peak at the end of the sportive season.
EPLERENONE VS IRBESARTAN AS FIRST LINE THERAPY IN OBESE HYPERTENSIVE PATIENTS: PRELIMINARY RESULTS FROM HEBRO STUDY
Authors: Kouremeti Maria , Iliakis Panagiotis , Konstantinidis Dimitrios , Polyzos Dimitrios , Andrikou Ioannis , Drogkaris Sotirios , Tatakis Fotis , Manta Eleni , Leontsinis Ioannis , Zamanis Ioannis , Siafi Eirini , Dimitriad Kyriakos , Thomopoulos Costas , Tsioufis Konstantinos
Published: June 2022

Objective:

Obesity is significantly associated with adverse cardiovascular outcomes. The relationship between obesity and hypertension is well described with obese patients having two times the incidence of developing increased blood pressure (BP). However, little is known about the impact of aldosterone blockade using eplerenone on hypertensive obese patients as first line therapy. The aim of this study was to compare the efficacy between eplerenone and irbesartan in obese hypertensive subjects.

Design and method:

A prospective, randomized, open-labeled, multicenter trial enrolled 54 hypertensive patients aged 30 to 75 years old, with obesity [body mass index BMI > or = 30 kg/m2)], evaluated by home BP, office BP and ambulatory BP measurements. Subjects randomly received 25 mg eplerenone twice daily or 150 mg irbesartan every morning. The primary endpoint were systolic and diastolic BP after 2 months of follow up.

Results:

In 54 hypertensive obese patients [53.7% women, mean age 55.8 ± 10.9 years, BMI 34.6 ± 3.1 kg/m2, mean office BP 146.4 ± 9.7/91.8 ± 9.8 mmHg and mean ABP 140.9 ± 7.9/84.6 ± 8.2 mmHg] there was no significant difference in the reduction of systolic ABP between irbesartan and eplerenone (11 ± 14.8 vs. 7 ± 14.7, p = 0.11), nor in the reduction of diastolic ABP (5 ± 8.3 vs. 3.8 ± 9.7, p = 0.13). Moreover, there was no difference in the reduction of OBP in irbesartan group (12 ± 11.3 vs. 9.4 ± 12.7, p = 0.14) in comparison with eplerenone group (7.1 ± 8.7 vs. 2.8 ± 8.7, p = 0.11). Also, there was no statistical significant change in renal function parameters and electrolytes levels in both groups

Conclusions:

this study suggests that eplerenone does not differ in efficacy and safety compared to irbesartan, an established angiotensin receptor antagonist, as first line therapy in obese hypertensive patients.
GENDER AS A RISK FACTOR FOR CARDIOVASCULAR EVENTS IN PATIENTS WITH HYPERTENSIVE CRISES AFTER 12-MONTH FOLLOW-UP: A GREEK REGISTRY
Authors: Fragoulis Christos , Polyzos Dimitrios , Konstantinidis Dimitrios , Mavroudis Andreas , Dimitriadis Kyriakos , Karior Maria , Leontsinis Ioannis , Manta Eleni , Drogkaris Sotirios , Tatakis Fotis , Zammanis Ioannis , Siafi Eirini , Papakonstantinou Pantelis , Mantzouranis Emmanouil , Thomopoulos Costas , Tsioufis Konstantinos
Published: June 2022

Objective:

Currently, epidemiological data on prognosis of patients with hypertensive crises (HC) are limited. The purpose of our study was to register the prevalence and clinical characteristics of patients with hypertensive urgencies (HU) and emergencies (HE) admitting to the emergency department (ED) and during hospitalization and a 12-month follow-up to record new end points in a Greek tertiary hospital.

Design and method:

The study population included patients reporting to the ED with acute rise in blood pressure (BP) (systolic BP> or = 180mmHg and/or diastolic BP> or = 120mmHg), categorizing as HE and HU depending on the presence or absence of acute hypertension-mediated target organ damage, respectively. In all patients the demographic and clinical information were registered for 12 consecutive months. In addition, there was a 12-month follow-up for new events.

Results:

Out of 38,589 patients assessed in the ED during a period of 12 months, 353(0.91%) had HC, out of whom 256(72.5%) had HU and 97(27.5%) had HE. The mean age of the HE patients was 73 ± 12years, 51.5% were males and 86.4% had a history of hypertension. During the study period 3 HE patients did not complete the follow-up. After stratification of HE population by gender, we created two subgroups, males and females, and analyzed the composite end point involving deaths or hospitalizations by cardiovascular causality. Men reported more composite events than women (21 vs 11 events, p = 0.042, HR for males 2.2, 95% CI 1.03–4.6). Cox regression models were adjusted for age, gender, cardiovascular disease, chronic kidney disease and diabetes mellitus.

Conclusions:

The results indicate male gender as an independent risk factor for deaths or hospitalizations caused by cardiovascular disease in patients with HE. Our registry highlights the commitment for a more intensive follow-up of HE patients, especially for men, and underlines the need for further research in this pathological entity.
OBSERVATIONAL PROSPECTIVE STUDY OF AZILSARTAN MEDOXOMIL/ CHLORTALIDONE COMPARED WITH IRBESARTAN/ HYDROCHLOROTHIAZIDE COMBINATION THERAPY IN OBESE HYPERTENSIVES (PUZZLE)
Authors: Shupenina Elena , Vasyuk Yury , Namazova Gulnar
Published: June 2022

Objective:

Attainment of blood pressure (BP) control is important to successful management of arterial hypertension (AH). It is more difficult to reach recommended BP goals in obese hypertensives. Combination of ARB and thiazide diuretics is recommended. Azilsartan medoxomil/chlorthalidone (AZL-C) is potent and currently the only fixed combination of ARB and thiazide-like diuretic used for AH. The objective of this study was to evaluate influence of AZL-C on office, 24-hour brachial, central blood pressure and aortic stiffness parameters compared with irbesartan/hydrochlorothiazide (IRB-H).

Design and method:

We included 94 patients 35–55 years old with I-II grade AH and obesity at high cardiovascular risk. Patients with symptomatic organ damage, intolerance of ARB, thiazide diuretics, secondary AH were exluded. All patients underwent phisical exam, office, ambulatory BP measurement with arterial stiffness analysis on inclusion, during 1, 3 and 6 months visit. After inclusion 47 patients received AZL-C dose 40/12.5 or 40/25 mg, 47 patients received IRB-H dose 150/12.5 or 300/25 mg. The study was approved by local ethic committee and registered on clinicaltrials.gov (NCT03006796).

Results:

On 1 month visit 37(79%) patients reached office BP goals in AZL-C group vs 32(68%) in IRB-H, finally the proportion was 45(96%) vs 41(87%). After 3 months significantly more patients received higher doses of IRB-H: 18(38%) vs 9(19%) in AZL-C group. The mean office systolic/diastolic BP on the final visit was 126,4/84,5 in AZL-C vs 132,7/89,9 mmHg in IRB-H group. The mean ambulatory SBP/DBP was 124,6/77,6 in AZL-C vs 127,4/81,7 mmHg in IRB-H group. After 6 months the mean ambulatory central SBP and aortic augmentation index reduced in both groups, more significantly in AZL-C patients: from 129,4 to 115,3 vs. from 129,5 to 117,6 mmHg in IRB-H group; from 26% to 17% vs. from 28% to 21% in IRB-H. There were no changes in ambulatory PWV in both groups, which may be due to the variability of this parameter during the day.

Conclusions:

Both fixed combinations of ARB and diuretic are safe and effective treatment of AH in obese patients, but long-term treatment with AZL-C allows to achieve more stable peripheral and central BP decrease.
THE OPEN-LABEL MULTICENTRAL STUDY OF ANTIHYPERTENSIVE FIXED-DOSE COMBINATION EFFECTIVENESS IN UKRAINE
Authors: Radchenko Ganna , Sirenko Yuriy , Torbas Olena
Published: June 2022

Objective:

The aim of this study was to evaluate the effectiveness of new 2- or 3-component fixed-dose combinations (FDC) with Olmesartan in comparison with general clinical practice antihypertensive treatment.

Design and method:

72 physicians were involved in the multicenter open-label study. They included patients with uncontrolled systolic (SBP)/diastolic(DBP) blood pressure in spite of at least one-month therapy and without exclusion criteria. The one group(n = 604) was treated by Olmesartan/HTC or Olmesatan/HTC/Amlodipin (with up-titration). The other group(n = 311) was treated according to general clinical practice. The physicians were asked to use the FDC more frequently. The follow-up period was 3 months.

Results:

There were included 1055 patients (59.9 ± 0.5 yr), but only 915 (SBP/DBP–164.9 ± 4.2/93.3 ± 0.3mmHg) were examined at 3 month, the others were lost of follow up. 62.5% at baseline and 94% at the end were on FDC therapy. Baseline 56.7% missed the pills vs 9% at the end of study (P < 0.001). The main reasons were forgetfulness, consideration of not need taking due to BP normalization, not convenient regime, unwilling - 35.5, 30.9, 10.7 and 12.4% at baseline vs 8.1, 0.3,1.4 and 1.4% at the end of study (P < 0.001). 48.6% at baseline vs 9.5% at the end considered the missing of one or more pills could not influence on treatment results and 35.4 vs 3.4% receptively considered they take a lot of pills. Baseline in the group of non-FDC treatment the not-compliant, partly compliant, compliant patients consist 68.1, 11.3 and 20.8% vs 63.4, 18.5 and 18.1% (NS) in the group of FDC therapy. At the end of study there were 59.7, 6,5 and 33.9 vs 17.7, 25.9 and 58 % respectively (P < 0.05).  SBP/DBP was -48/23, 44/21 and 28/14 mmHg (P < 0.001/0.039) in Olmesartan 2-, 3-component FDC and in other therapy groups. The target BP (<140/90mmHg) was achieved in 83.5% of Olmesartan FDC group vs 71.2% (P < 0.05) in other therapy group.

Conclusions:

Only 62.5% of hypertensive patients are on FDC therapy in Ukraine. More frequently use of FDC was associated with improving patient compliance. The 2- or 3-component Olmesartan based FDCs were more effective in BP decreasing than routine antihypertensive therapy.
PRESCRIBED ANTIHYPERTENSIVE AGENTS IN PATIENTS WITH AND WITHOUT ITS “ESCAPE’’ PHENOMENON
Authors: Mikhailova Oksana , Elfimova Evgenia , Khachatryan Narine , Litvin Alexander , Chazova Irina
Published: June 2022

Objective:

To identify the percentage of antihypertensive therapy (AHT) groups prescription in patients with and without delayed inefficiency of AHT (“escape’’phenomenon).

Design and method:

The study included 102 hypertensive patients (52 male, age 54.2 ± 9.8 years), whom were assigned 2–3 agents from various AHT group.In 2–3 weeks after therapy initiation (with the single correction if needed), all participants achieved the target blood pressure (BP). The latter was confirmed by office BP measurement (office BP) (<140/90mmHg, oscillometric method, OMRON, Japan), and by 24-hour ambulatory BP monitoring (ABPM) (mean 24-hour BP < 130/80mmHg, oscillometric method, BPLab, Russia). In 1 and 3 months after inclusion, the efficacy of AHT was reassessed by both measurement methods. The “escape’’ phenomenon was verified when BP became higher target by any method in any reassessment time. Adherence was calculated as the ratio of the number of correct medication intake days to the number of follow-up days multiplied by 100%.

Results:

34 patients (33.3%) demonstrated the ‘escape’ phenomenon (Group 1), while BP level in 68 (66.7%) patients remained target (Group 2). There weren’t differences in the cardiovascular (CV) risk factors between groups (Table 1). Both groups received primarily fixed combinations of AHT, which resulted in 1.9 ± 0.7 tablets intake per day. There was comparably high adherence to treatment in groups (89.2 ± 3.8% in group 1, 90.2 ± 5.0% in group 2,p = 0.28). When comparing the percentage of different AHT groups, there was no difference revealed between groups, with the exception of more frequent ARA-II prescription in Group 1 (Table 2). Nevertheless, although in both groups the target BP levels were achieved, the BP in the Group 1 was higher already at the stage of inclusion (Table 2). Moreover, baseline systolic BP was found to be an ‘escape’ phenomenon predictor in univariate logistic regression model (for office BP: systolic BP> 128mmHg (OR 3.43 (95%CI 1.39–8.47,p < 0.00), for ABPM: 24-systolic BP> 124mmHg (OR 25.81 (95%CI 5.61–119.11,p < 0.00).

Further studies on ‘escape’ phenomenon issue in patients with ARA-II intake are required. A higher frequency of ARA-II usage in the ‘escape’ group is likely due to overestimation of the continuing BP decline in 2–3 weeks after ARA-II prescription.
TELMISARTAN/AMLODIPINE SINGLE-PILL COMBINATION THERAPY TO ACHIEVE BLOOD PRESSURE GOAL VALUES IN HYPERTENSIVE PATIENTS IN GPS’ PRACTICE – AN OBSERVATIONAL STUDY
Authors: Járai Zoltán , Ámon Tamás , Baracsi-Botos Viktória , Mészáros Ágota
Published: June 2022

Objective:

Current ESC/ESH Guidelines suggests a simple therapeutic strategy to increase treatment effectiveness: the application of single pill combination (SPC) of a RAS inhibitor with a calcium channel antagonist or a diuretic as a first step. Our primary goal was to assess the percentage of patients reaching optimal BP goal (130/80 mmHg) after 12 weeks of SPC therapy with telmisartan/amlodipine according to office BP measurements in hypertensive patients treated by general practitioners (GPs) in regular clinical practice. We also examined the percentage of patients achieving primary target BP (<140/90 mmHg).

Design and method:

After given informed consent, 729 patients with primary hypertension from 120 GP’s offices participated in this multicentre, observational, non-interventional, prospective study.

Results:

The average age of the patients was 62 ± 12 years, 357 patients (49.8%) of the population was male. The average office BP at baseline was 150 ± 17/88 ± 10 mmHg, and decreased to 130 ± 8.1/78 ± 6.1 mmHg at 12 week (p < 0.05). Pulse rate has decreased as well (from 80 ± 9.8/min to 75 ± 6.3/min). At baseline, 10.1 % of the patients were at optimal systolic BP goal (<130 mmHg), 15.8% at optimal diastolic BP goal (<80 mmHg) and only 5.5% simultaneously at systolic and diastolic BP goal (<130/80 mmHg). By the end of the observational period the percentage of patients reaching these optimal BP goal values increased to 51.6%, 54.1% and 33.0%, respectively. At baseline 19.2% of patients had BP less than 140/90 mmHg, which increased to 87.1% by the end of the study. Dose adjustments during the study were made in only 3 % of patients (n = 22). Patients tolerated SPC telmisartan/amlodipine well, 95% of the patients continued medication after study conclusion.

Conclusions:

The introduction of a SPC therapy of telmisartan/amlodipine increases the success rate of treatment during a relative short period. High proportion of patients were able to lower within 3 months their BP levels under 140/90 mmHg, however, only one third of the patients reached optimal target BP. Main possible reasons for this was the low rate of dose adjustment during the study.

The study was sponsored by KRKA Hungary Ltd.