bluuebunny/crossref_metadata_2025 huggingface dataset:
ASSOCIATION OF LEFT VENTRICULAR MASS WITH STANDARD, UNATTENDED AUTOMATED, AND AMBULATORY BLOOD PRESSURE DURING HOUSEHOLD-BASED SCREENING IN LESOTHO
Authors: Firima Emmanuel , Gonzalez Lucia , Retselisitsoe Lefokotsane , Leisa Ikhetheleng , Manthabiseng Molulela , Sematle Mamorontsane , Bane Matumaole , Khomolishoele Makhebe , Gupta Ravi , Lee Tristan , Chammartin Frèdèrique , Kaufmann Beat , Weisser Maja , Amstutz Alain , Labhardt Niklaus Daniel , Burkard Thilo
Published: May 2024

Objective:

Left ventricular (LV) geometry and mass index (LVMi) including concentric remodeling (CR) and LV hypertrophy are important determinants of outcome in hypertension. Data concerning the association between standard blood pressure measurement (SBPM) and LVMi in sub-Saharan Africa populations are scarce, and data analysing this association with different BPM methods are even less. Aim of the study was to evaluate the association of LVMi with SBPM, unattended automated BPM (uABPM) and 24hr-ambulatory BPM (24h-ABPM) during a household-based screening program in Lesotho.

Design and method:

6108 individuals with measurement of SBP were included into the screening program. For this nested study 639 received focused echocardiography for analysing LV geometry over different SBPM hypertension grades, and 209 additional uABP and 24h-ABPM to compare BPM methods. Pearson's correlation coefficient was used to determine linear correlations of LVMi with SBPM, uABP and 24h-ABPM. Logistic regression models with CR as dependent variable, and the three BPM approaches as primary independent variables were developed. C statistics were calculated for each logistic model as area under the receiver operating characteristic curve, and compared for the capacity of each BP measurement approach to discriminate the odds of CR.

Results:

Among the 639 participants (mean age 55+/-18 years), 59.6% were females and 53.4% had elevated SBPM values. Mean LVMi was 59.4+/-15.4 g/m2. For SBPM, mean LVMi increased across BP grades, starting at high normal (p<0.0001 compared to optimal/normal) (figure1a). CR, present among 56% of all participants, was evident among 34% participants with optimal BP and increased across BP grades (figure1b). Among participants with all three BPM, correlation between systolic BP and LVMi was highest for 24h-ABPM, followed by uABPM (figure1c). AUROC for prediction of CR was 0.66, 0.70 and 0.70 for SBPM, uABP, and 24h-ABPM respectively.

Conclusions:

LVMi increased at high normal BP compared to normal and optimal BP. CR was unexpectedly common with 1/3 participants with optimal and half of participants with normal BP values. 24h-ABPM showed higher correlation with LVMi than uABP and SBPM, with a numerically higher AUROC to predict CR than SBPM.
GENOME-WIDE ASSOCIATION STUDY OF APPARENT TREATMENT-RESISTANT HYPERTENSION
Authors: Niiranen Teemu , Kauko Anni , Vaura Felix , Ebinger Joe , Gordin Daniel , Cheng Susan
Published: May 2024

Objective:

Apparent treatment-resistant hypertension (aTRH) is associated with adverse outcomes compared with mild hypertension. However, the etiopathogenesis of aTRH is still poorly elucidated and only a handful of genetic discovery efforts in aTRH with small sample sizes and largely null results have been described.

Design and method:

We conducted a genome-wide association analysis in 55733 hypertensive individuals with a register-based diagnosis of hypertension from the FinnGen study. Cases included 39737 individuals with aTRH (use of four or more antihypertensives over life course) and controls included 15996 individuals with mild hypertension (maximum use of one antihypertensive over life course). Top variants associated with aTRH at p<5.0e-8 were tested for replication in up to 36461 hypertensive participants of UK Biobank. aTRH-risk loci were characterised using pathway enrichment, a transcriptome-wide association study (TWAS), and mendelian randomization (MR).

Results:

The analysis found six genome-wide significant associations that also replicated in UK Biobank, all of which have been previously associated with BP. These loci were identified in the proximity of genes involved in mineralocorticoid receptor activity (WNT2B [odds ratio 1.21; p=6.9e-25], CASZ1 [odds ratio 1.14; p=2.7e-48]), endothelial function (LSP1 [odds ratio 1.13; p=2.0e-18], HOTTIP [odds ratio 1.28; p=2.4e-25]), and ion transport (KCNK3 [odds ratio 0.88; p=7.9e-19], SLC4A7 [odds ratio 0.89; p=1.1e-17]). VEGAS2 pathway analysis revealed significant enrichment of aTRH-risk loci in pathways involved in vitamin B12 metabolism and negative regulation of catabolic processes. In transcriptome-wide association studies using TWAS-Fusion and eQTL based on RNA-sequencing analyses in different tissues, we identified 37 genes of which the genetically regulated expression is associated with aTRH at the transcriptome-wide level and colocalized in at least one tissue (22 genes in arteries and heart; 13 genes in subcutaneous or visceral adipose tissue; 11 genes in adrenal gland). Of these genes, two overlapped with the six genome-wide significant aTRH-risk loci. Using two-sample MR, we found evidence for a possible causal association for four vascular risk traits (CRP, triglycerides, waist circumference, and BMI) with aTRH.

Conclusions:

Our results provide critical insights to inform future biological research on aTRH pathogenesis and highlight potential drug targets for intervention.
INTRINSIC GENETIC FACTORS WERE INCONSISTENTLY REPORTED FOR HYPERTENSION: A SYSTEMATIC REVIEW OF GENOME-WIDE ASSOCIATION STUDIES
Authors: Hao Ziyu , Jia Pingping , Chen Yize , Tran Joshua Ys , Yiu Karen Kl , Tsoi Kelvin Kf
Published: May 2024

Objective:

Genome-wide association studies (GWAS) played a pivotal role in exploring the intrinsic genetic factors of hypertension. Hundreds of studies using various datasets demonstrated the causal relationship between single nucleotide polymorphisms (SNPs) and phenotypes for hypertension, but the SNPs were inconsistently found over the years. This study aims to review all SNPs and make a conclusive direction of using SNPs to predict the risk of hypertension.

Design and method:

A literature search was conducted in May 2023. Original GWAS that examined the phenotype BP, BPV, or hypertension-related SNPs or Locus, with significant level at P <10-4, were included in this review. Name of the dataset, ethnicity of participants, marker SNPs, loci, Allele(A1), minor allele frequency (MAF), beta or Odds Ratio (OR), Standard Error (SE), and P-value were extracted as the outcomes. SNPs that lack loci were matched with corresponding loci on FUMA GWAS, and the specific diseases related to the target locus were extracted from the NIH National Library of Medicine. Data visualization was conducted by Python.

Results:

A total of 8,451 studies were identified and 63 original studies reported significant hypertension-related SNPs or Locus were included in this analysis. A total of 2,637 SNPs from 572 loci were identified with a causal relationship to BP or hypertension. Eight SNPs from 7 loci were identified with a causal relationship to BPV. Rs381858 from chromosome 14 was the most popular SNP identified by eight original studies, and rs8096897 within C18orf1 from chromosome 18 had the largest OR of 12.87 for phenotype systolic BP. The figure plotted the top 100 SNPs arranged in descending order of effect size, after grouping SNPs with the same loci (Figure 1.)

Conclusions:

Only a small number of SNPs showed a significant impact on the phenotype of BP or hypertension. For those in the same loci, some SNPs exhibited a contradicting direction of interpretation. As hypertension is an early situation for different types of disease, such as cardiovascular or neurodegenerative diseases, inconclusive findings demonstrate that genome-wide association studies may not be suitable for the symptoms of chronic diseases, including hypertension.
ASSOCIATIONS OF LEFT VENTRICLE HYPERTROPHIC GEOMETRIC MODELS WITH METABOLIC CHANGES IN HYPERTENSIVE PATIENTS
Authors: Sydorchuk Andrii , Voronyuk Ksenia , Sydorchuk Larysa , Yarynych Yulia , Dzhuryak Valentyna , Sydorchuk Ruslan
Published: May 2024

Objective:

Left ventricle hypertrophy (LVH) is one of the most frequent manifestations of hypertensive-mediated myocardial damage (HMOD) due to essential arterial hypertension (EAH), the so-called hypertensive heart disease [ESH 2023]: its prevalence is 58-77% in high-risk patients. It is worth noting that LVH is present in 15-20% of the general population regardless of blood pressure (BP) level. Therefore, the aim of the study is to analyze the association of LVH models with metabolic changes in EAH patients.

Design and method:

The case-control study involved 100 EAH patients with HMOD (LVH), 1-3 degrees of blood pressure (BP), high and very high cardiovascular risk. Among the patients there were 21% men, 79% women, the mean age 59.86±6.22y.o. The control group consisted of 60 practically healthy individuals, relevant by age (49.13±6.28 y.o.) and gender distribution (63% – women, 37% – men). The lipid panel parameters, such as total cholesterol (TC), triglycerides (TG), low- and high-density lipoprotein cholesterol (LDL-C, HDL-C) were stiduied in plasma. Atherogenic index (AI) was calculated by equation. LVH models (concentric – CLVH, excentric – ELVH) were assessed by EchoCG.

Results:

ELVH in EAH patients is associated with hyperglycemia more often than CLVH by 35.98% (χ2=7.0; p=0.008). Hyperglycemia increases the risk of ELHV 4.5 times (OR 95%CI: 1.29-15.81; p=0.008). The ELVH is associated with a higher TC and AI value more than 2.5 times (p<0,05). TG, LDL-C, HDL-C did not differ significantly between groups with different hypertrophic models of the LV. Systolic and diastolic BP in EAH patients with ELVH exceeded those in patients with CLVH by 5% and 4% (p=0.04; p=0.05) as well. Similarly, anthropometric parameters such as BMI and waist circumference (WC) – by 8% and 7.5% (p=0.051; p=0.048), respectively, but only in women. WC in men with CLVH was 20% greater than in women (p<0.001).

Conclusions:

It is found that TG, LDL-C, HDL-C concentration do not determine the development of any LVH model. ELVH is associated with hyperglycemia and higher TC and AI value.
HYPERTENSION CONTROL, STILL A CAUSE OF CONCERN IN THE ELDERLY POPULATION WITH DIABETES & DYSLIPIDEMIA — A MULTICENTRE STUDY ACROSS INDIA
Authors: Saxena Ashish , Maheshwari Anuj , Meenakshisundaram L , Singh N K , Chandra K P , Gupta Mukulesh , Patil Aashna , Kumar Dinesh , Sheohare Raka , Ansari Sajid
Published: May 2024

Objective:

Diabetes patients have a relative risk of cardiovascular disease development that is more than twice as high as non-diabetics. In individuals with type II diabetes, optimal blood pressure management & within-range lipid profiles (lower levels of LDL-C) offer cardiovascular benefits. Diabetes with coexisting hypertension, dyslipidemia, pro-inflammatory, & prothrombic states is an example of a metabolic syndrome that can lead to complicated pathological diseases involving several pathways. This EHR-based real-world study aimed to understand hypertension control in patients with diabetes and dyslipidemia in the Indian population.

Design and method:

The trial was open to patients with a history of type 2 diabetes mellitus (T2DM) lasting at least 6 months who were presenting for regular treatment in 14 nationwide centers. Data on the patient's medical history, comorbidities, complications from diabetes, medicines, & laboratory results were gathered using an EMR (MEDEVA) integrated research format. The data extracted for analysis spanned from March to August 2022.

Results:

Of the total 821 elderly Type 2 Diabetes Mellitus patients, 45.3% had hypertension, and 16% patients had dyslipidemia. It is seen that dyslipidemia (81.7%) is higher in patients with hypertension when compared to the group without hypertension (18.3%).

Conclusions:

There is a significant relationship between hypertension control and dyslipidemia, & it was found that dyslipidemia is seen more among hypertensive patients than non-hypertensive patients.
ANALYSIS OF THE FREQUENCY AND STRUCTURE OF HOSPITALIZATION OF YOUNG PATIENTS IN A CARDIOLOGY HOSPITAL IN ALMATY
Authors: Nurkina Dinara , Zhussupbekova Lazzat , Baimuratova Mairash , Smagulov Zhasken
Published: May 2024

Objective:

To study the frequency and structure of hospitalizations of young patients (up to 44 years old, WHO) at the Almaty City Cardiology Center for the period 2018–2022.

Design and method:

In the course of an observational, descriptive, cross-sectional study, we studied the frequency and structure of reasons for hospitalization in young patients over a five-year period.

Results:

During the study, it was found that during the designated period, a total of 1827 young patients were hospitalized (average age 36.7 ± 4.4 years), which amounted to 4.8% of the total number of hospitalized patients (n = 38054). Detailing by year, it should be noted that the peak of hospitalizations occurred in 2019 - 8.5%, with a significant decrease in 2020 - 4%, (which may have been due to the COVID-SARS-2 pandemic), while the minimum was recorded in 2018 - 3%. The most common cause of hospitalization (more than 30%) were acute forms of coronary heart disease, while the frequency of hospitalization with unstable angina (23.5%) prevailed over the myocardial infarction (12.2%). The third position was occupied by arterial hypertension - 9.9%. In descending order, the following nosologies followed: cardiomyopathies - 8.1% and acute myocarditis - 5.6%. The top ten most common reasons for hospitalization also included supraventricular tachycardia, atrial fibrillation/flutter, WPW syndrome. Analysis of the frequency of hospitalizations of patients with acute forms of coronary heart disease over the years demonstrated an upward trend. Among all hospitalizations of young patients with myocardial infarction, the most common was, according to the ICD-11 code (I21.0) -42.8%, then in descending order - (I21.1) -25.7%, (I21.4) -12.2%, (I22.1) -7.2%, (I22.0) -6.8% (I22.8) -2.3%.

Conclusions:

Thus, among all reasons for hospitalization, unstable angina, myocardial infarction and arterial hypertension occupied the three leading positions. Dynamics of the frequency of hospitalization of young patients with acute forms of coronary heart disease had an upward trend. The most common type of myocardial infarction in young people was acute transmural myocardial infarction of the left ventricle, which probably determines the severity of myocardial damage and the unfavorable prognosis in this population.
PREDICTIVE VALUE OF VARIOUS BLOOD PRESSURE INDICES FOR ADVERSE EVENTS IN PATIENTS WITH NON-VALVULAR ATRIAL FIBRILLATION: THE J-RHYTHM REGISTRY
Authors: Kodani Eitaro , Inoue Hiroshi , Atarashi Hirotsugu , Otsuka Toshiaki , Okumura Ken , Yamashita Takeshi , Origasa Hideki
Published: May 2024

Objective:

Various blood pressure (BP) indices are reportedly associated with the incidence of adverse events in patients with hypertension and other cardiovascular diseases. This study aimed to explore predictive value for adverse events among several BP indices, including the indices of single BP measurement (systolic BP [SBP] at baseline and at the time closest to an event or at the last visit of follow-up [SBP-end]), indices of visit-to-visit BP variability (SBP standard deviation [SBP-SD] and coefficient of variation [SBP-CV]), and indices of BP consistency (SBP time in target range [SBP-TTR] and frequency in range [SBP-FIR]), in patients with non-valvular atrial fibrillation (NVAF), using data from the J-RHYTHM Registry.

Design and method:

Of 7406 outpatients with NVAF, 7226 (age, 69.7±9.9 years; men, 70.7%), in whom BP was measured 4 times or more (14.6±5.0 times) during the 2-year follow-up period or until occurrence of an event, were included. The SBP-TTR was calculated by the Rosendaal method and target SBP range was set between 110 and 130 mmHg. Predictive value of each index for adverse events was evaluated by the area under receiver-operating-characteristic curve (AUC) and compared by the DeLong's test.

Results:

AUCs of these indices for thromboembolism, major hemorrhage, and all-cause death were 0.51, 0.55, and 0.57 for baseline SBP; 0.67, 0.55, and 0.70 for SBP-end; 0.62, 0.64, and 0.63 for SBP-SD; 0.61, 0.63, and 0.68 for SBP-CV; 0.56, 0.55, and 0.56 for SBP-TTR; and 0.55, 0.56, and 0.58 for SBP-FIR; respectively. AUCs of SBP-SD were significantly larger than those of baseline SBP for thromboembolism (P=0.006) and major hemorrhage (P=0.017), SBP-end for major hemorrhage (P=0.012), SBP-TTR for major hemorrhage (P=0.010) and all-cause death (P=0.015), and SBP-FIR for major hemorrhage (P=0.017). AUCs of SBP-CV showed almost same results as of SBP-SD.

Conclusions:

Among various BP indices, the visit-to-visit BP variability indices such as SBP-SD and SBP-CV had more powerful predictive value for all adverse events than baseline BP and BP consistency indices in patients with NVAF. BP-end had also strong predictive value for thromboembolism and all-cause death, despite an index of single BP measurement.
RELATIONSHIP BETWEEN MITRAL ANNULAR CALCIFICATION AND CORONARY ARTERY CALCIFICATION IN ASYMPTOMATIC INDIVIDUALS
Authors: Kim Kyung An , Jung Hae -OK , Lee So -YOUNG , Ahn Yuran , Jung Mi -HYANG , Chung Woo -BEAK , Lee Dong -HYEON , Youn Ho -JOONG
Published: May 2024

Objective:

Despite the common atherosclerotic origins of mitral annular calcification (MAC) and coronary artery calcification (CAC), the relationship between MAC and CAC is not fully understood. We aimed to identify the factors associated with prevalent MAC and CAC, and also with their progression.

Design and method:

Using data from the KOrea Initiatives on Coronary Artery (KOICA) registry, 722 asymptomatic individuals who underwent health screening with serial cardiac computed tomography (CT) were selected for analysis. MAC and CAC were identified on CT, and the severity quantified using Agatston units (AU). The associations between the prevalence, severity, and the annualized progression rate of MAC and CAC were identified using multivariable regression models.

Results:

On initial CT, 47 (6.5%) participants had prevalent MAC and 334 (46.3%) had prevalent CAC.

Increasing CAC severity was associated with a significantly higher probability of prevalent MAC (OR per 100 AU increase 1.06, 95% CI 1.05-1.07, p<0.001) even after correction for baseline characteristics. Similar results were true when CAC severity was assessed as a graded variable. Other factors associated with MAC were older age, female sex, higher body-mass index, diabetes, higher systolic blood pressure, and left atrial volume index. In those with prevalent MAC and CAC, the factors associated with a higher MAC progression rate were initial MAC severity (p<0.001), female sex (p=0.01), and higher serum phosphorus (p<0.001), while the factors associated with a higher CAC progression rate were initial CAC severity (p<0.001) and higher low-density lipoprotein cholesterol (p=0.02).

Conclusions:

We observed a close correlation between MAC and CAC, which is in accord with their common atherosclerotic origin. However, the differences in risk factors associated with the progression rate of MAC and CAC suggest the importance of site-specific mechanisms in the progression of calcification.
CONTROL RATE OF THE OFFICE BLOOD PRESSURE AND ECHOCARDIOGRAPHIC DATA FOR TARGET ORGAN DAMAGE IN ONE AMBULATORY CARDIOLOGICAL PRACTICE IN BULGARIA
Authors: Gruev Ivan , Tsanova Veska
Published: May 2024

Objective:

After the COVID 19 pandemic, the regular examinations of the patients with arterial hypertension were restarted in the ambulatory cardiological practice. 297 visits were done in one such outpatient clinic in the city center of Sofia, Bulgaria during the first 9 month of 2023.

The aim of or study was to estimate the control rate of the office blood pressure and the hypertension mediated target organ damage, evaluated with echocardiography.

Design and method:

The patients were with mean age 62 years/18-87/.193 were women and 106 men. They were examined by cardiologist, an ECG was performed, and their office blood pressure was measured according to the ESH recommendations.Only 25 patients underwent 24 hours ABPM.

According to the regulations of the National Health Care Fund, the patients with arterial hypertension should be referred for echocardiography every 2 years, so we analyzed the results, entered in their medical records.

Results:

52% of the subjects were with good control of the office blood pressure/below 140/90 mm Hg/ and this percentage is comparable with the results from the recent real world data trails in Bulgaria.

71% of them fulfill the criteria for grade 1 diastolic dysfunction with E/A less than 1. 64% of the patients were with left ventricular hypertrophy, defined as left ventricular wall thickness greater than 11 mm. And 64% of them had LA diameter greater than 40 mm.

Conclusions:

Despite of the decent control of the office blood pressure almost 2/3 of the patients had data for hypertension mediated target organ damage from their routine echocardiography. This may be a result of the delay of the initiation of the therapy or more probably of the insufficient time under control

That is why we must strongly encourage wider implementation of ABPM and home BP monitoring in ambulatory cardiology practice in Bulgaria.
MOLECULAR UNDERSTANDING TOWARDS ANTI-INFLAMMATORY ROLE OF MORIN IN ISOPROTERENOL INDUCED MYOCARDIAL NECROSIS IN MURINE MODEL
Authors: Dinesh Drishya , Verma Vipin Kumar , Bhatia Jagriti , Arya D S
Published: May 2024

Objective:

Present study was aimed to investigate the cardioprotective effects of Morin, a bioflavonoid against isoproterenol-induced myocardial necrosis in male albino Wistar rat model via modulation of inflammatory pathway.

Design and method:

Acclimatized rats were divided into 5 groups (n=8) i.e., Normal control, ISO-control, Morin20+ISO, Morin40+ISO, and Morin80+ISO. Morin was administered for 28 days as pretreatment at doses of 20, 40, and 80 mg/kg respectively. On the 26th and 27th day, isoproterenol was injected at 85 mg/kg s.c. at 24 h intervals to induce myocardial necrosis in ISO-control and morin pre-treated groups. On day 28 animals were anesthetized, tracheostomy was done and the carotid artery was ligated and connected to the pressure transducers to measure hemodynamic parameters. After measuring left ventricular pressures, the rats were sacrificed using overdose of anesthesia, and blood was withdrawn. Levels of cardiac injury markers, pro-inflammatory cytokines, hemodynamic and anti-oxidant parameters were determined.

Results:

Oral administration of morin significantly prevented the isoproterenol-induced inflammation that led to myocardial necrosis. There was a marked reduction in the levels of pro-inflammatory cytokines (TNF-alpha and IL-6), Bax, Caspase-3, p-JNK, p-38, NF-kappa B, and increased expression of Bcl-2 and p-ERK1/2 in treatment groups compared to ISO-Control. Besides, immunoblot analysis of MAPK pathway proteins illustrated the mechanism behind the anti-apoptotic and anti-inflammatory action of morin.

Conclusions:

The cardioprotective effect of morin can be ascribable to the modulation of MAPK pathway in isoproterenol-induced myocardial inflammation.
ECHOCARDIOGRAPHIC AND ELECTROCARDIOGRAPHIC PREDICTORS OF NEW ATRIAL FIBRILLATION IN END-STAGE RENAL DISEASE PATIENTS WITH PRESERVED LEFT VENTRICULAR SYSTOLIC FUNCTION
Authors: Chung Hyemoon
Published: May 2024

Objective:

We investigated the echocardiographic and electrocardiographic predictors for future development of AF in patients with ESRD and preserved LV EF who had never diagnosed AF.

Design and method:

Atrial fibrillation (AF) is a common cause which leads to adverse cardiovascular outcome in patients with end-stage renal disease (ESRD). AF is common arrhythmia in patients with reduced left ventricular (LV) ejection fraction (EF). It is unclear the predictor of new AF in patients with preserved LV EF. We enrolled 226 patients with ESRD who has performed transthoracic echocardiography. We excluded the 1) 16 patients who has been received a diagnosis of AF, and 2) 19 patients with LV EF < 50%, and 191 patients (121 males, mean 62 ± 14 years)

Results:

During a mean follow-up period of 885 ± 720 days, AF occurred in 20 (10.5%) patients. The patients with AF development was older (69 ± 12 vs. 61 ± 14 years, p=0.023). There were no differences in history of hypertension, diabetes, stroke and coronary artery disease between two groups. In univariate Cox regression analysis, left atrial volume index (LAVI), right ventricular systolic pressure, age and QRS duration were associated with future AF events. After multivariate Cox regression analysis, age (HR: 1.015, 95% CI: 1.008-1.105, p value: 0.022) and QRS duration (HR: 1.025, 95% CI: 1.001-1.049, p value: 0.043) significantly predicted the future development of AF.

Conclusions:

QRS duration is well known predictor of cardiovascular outcome in patients with reduced LV EF. In this study, we demonstrated QRS duration predicted new AF events in ESRD patients with preserved LV EF.
DIAGNOSING WHITE COAT HYPERTENSION AMONG SOLDIERS AT STRESSFUL DUTIES – IS THERE AN ALTERNATIVE TO 24 HOUR ABPM?
Authors: Rapoport Vladimir , Lenkovsky Ori , Nidam Naomi Nakash , Angel-korman Avital , Leiba Adi
Published: May 2024

Objective:

White Coat Hypertension (WCH) is defined as elevated office blood pressure (BP) readings with a normal blood pressure during ambulatory blood pressure monitoring (ABPM). We recently established a dedicated “fast track” clinic for diagnosis of hypertension among soldiers.

We assumed that WCH might be highly prevalent among these examinees, whose blood pressure is measured in a stressful, non-standardized, military setting.

Since home BP for diagnosing of WCH is not feasible among most military personnel, we aimed at comparing possible alternatives: standardized hospital clinic BP, aortic (central) BP measurement or 24-hour ABPM.

Design and method:

We estabished a dedicated hypertension clinic, in which soldiers who are off duty for a long weekend (Thursday-Sunday) undergo full hypertension workup during 2 consecutive work days. The workup consists of standardized clinic BP, measured by an experienced medical technician, central BP measurement and 24-hour ABPM as well as echocardiography, renal ultrasound, renal artery doppler, fundoscopic exam, blood and urine tests.

Results:

During 2023, 56 examinees were seen in our clinic.

Thirty-five of those (68.6% men, median age 20) were referred due to repeated elevated BP in a military setting (BP>=140/90mmHg), but no clear diagnosis of hypertension.

Sixteen of these patients (45.7%) were diagnosed as WCH by 24-hour ABPM. Standardized office BP measurements done by a medical technician unmasked the white coat effect (WCE) in 5 patients (31.2% of WCH). Central (aortic) BP measurements followed the standardized BP measurements and were within normal limits in patients with normal standardized brachial BP measurements. Similarly, central BP was elevated in those with elevated standardized brachial BP measurements.

Conclusions:

WCH is more common among women, elderly and obese and occurs in up to 30% of subjects with elevated blood pressure. We found a prevalence of 45.7% among young examinees, most of whom were men.

Standardized clinic BP measurements unmasked 31.2% of WCH cases, possibly, as they were performed by a technician and not a physician. However, 24 hour ABPM is mandatory in order to diagnose WCH. Central BP measurement adds no value as compared to brachial BP.
ANALYSIS OF DETECTION RATE OF EARLY EVENING ELEVATED BLOOD PRESSURE IN HYPERTENSIVE PATIENTS BY AMBULATORY BLOOD PRESSURE MONITORING
Authors: Ma Zhiyi , Zhang Yuqing , Xu Yang
Published: May 2024

Objective:

The aim of the study is to investigate the detection rate of early evening elevated blood pressure (EEE) in treated and untreated hypertensive patients by ambulatory blood pressure monitoring.

Design and method:

From February 1, 2020 to February 28, 2023, the total of 1413 hypertensive patients underwent ambulatory blood pressure monitoring in 13 medical institutions through the National 13th Five Year Plan Major Cooperation Group for Chronic Disease Prevention and Control (Research on the Application of Lifestyle and Nutritional Intervention Techniques and Strategies for Obesity and Hypertension, No. 2016YFC1300100). Among them, 1026 patients had taken antihypertensive drugs and 387 patients had not taken antihypertensive drugs. EEE is defined as average systolic blood pressure is higher or equal to 135mmHg or average diastolic blood pressure is higher or equal to 85mmHg from 6PM to 10PM.

Results:

1. The detection rate of EEE in treated hypertensive patients was 60.4% (620 patients), while the detection rate of EEE in untreated hypertensive patients was 70.5% (273 patients); 2. The detection rate of daytime hypertension in treated hypertensive patients was 55.8% (573 patients), while the detection rate of daytime hypertension in untreated hypertensive patients was 71.6% (277 patients); 3. The detection rate of nighttime hypertension in treated hypertensive patients was 81.2% (833 patients), while the detection rate of nighttime hypertension in untreated hypertensive patients was 87.6% (339 patients); 4. The detection rate of whole-day hypertension in treated hypertensive patients was 69.3% (711 patients), while the detection rate of whole-day hypertension in untreated hypertensive patients was 80.9% (313 patients); 5. The detection rate of morning hypertension in treated hypertensive patients was 61.1% (627 patients), while the detection rate of morning hypertension in untreated hypertensive patients was 72.9% (282 patients).

Conclusions:

In this study, the detection rate of EEE in treated hypertensive patients did not significantly decrease compared to those untreated patients, while the detection rate of EEE was similar to that of morning hypertension. It is necessary to conduct further research to reveal the correlation between EEE and cardiovascular diseases.
PERIPHERAL TH1 AND TH17 CELLS AND IL17-A IN PERITONEAL DIALYSIS PATIENTS ACCORDING TO DIPPING PROFILE – A CROSS-SECTIONAL STUDY
Authors: Grilo João , Coutinho Joana , Barreto Inês , Chorão Raquel , Filipe Rui Alves , Fonseca Mafalda , Santos Catarina Reis
Published: May 2024

Objective:

Despite technical advances, hypertension (HT) in peritoneal dialysis (PD) patients remains highly prevalent, with 24-hour ambulatory blood pressure monitoring (ABPM) allowing for a better understanding of the blood pressure profile. Recent studies suggest a close relationship between T helper (Th)1 and Th17 cells and non-dipping HT. In this setting, we aimed to evaluate the relationship between dipping profile and peripheral Th1 and Th17 cells and IL-17A levels in chronic PD patients.

Design and method:

Cross-sectional study of 26 PD patients with history of HT and 10 healthy controls. Peripheral blood frequencies of TCD4+, TCD8+, Th1 and Th17 cells were quantified by flow cytometry and IL-17A concentrations measured by enzyme-linked immunosorbent assay. All patients were examined by ABPM on the same day as the blood collection.

Results:

Table 1 summarizes patient characteristics. The frequency of Th1 cells in PD patients was lower than in healthy controls (p=0.001). A lower percentage of Th17 cells was also observed, although not statistically significant (p=0.061). According to ABPM, 10 PD patients were classified as dippers and the remaining as non-dippers. There were no significant differences in age, PD duration, office systolic and diastolic pressures, body mass index, lipid profile and hemoglobin A1c between dippers and non-dippers. All patients with diabetic nephropathy (n=7) were non-dippers. The average number of prescribed anti-hypertensive medication classes in dipper patients was 2.20 ± 1.14 and in non-dippers was 2.81 ± 0.91. Non-dippers presented lower frequencies of Th17 cells than dippers (p=0.018), and frequencies were also lower than the observed in healthy controls (p=0.008). These differences were not accompanied by a significant difference in IL-17A levels across the three groups. Both dipper and non-dippers had lower frequencies of Th1 cells when compared to the controls.

Conclusions:

Non-dipping is a frequent characteristic in PD patients, although higher frequencies of Th1 and Th17 cells, as well as IL-17A levels were not documented in these patients. Whether these cells may be the link between immunity and poorer blood pressure control in PD patients should be further evaluated in larger cohorts.
WHITE-COAT AND MASKED HYPERTENSION IN HEMODIALYSIS PATIENTS
Authors: Leonidou K , Georgianos P , Kollias A , Vaios V , Divanis D , Roumeliotis S , Varouktsi G , Tsinari A , Stergiou G , Zebekakis P , Liakopoulos V
Published: May 2024

Objective:

Unlike the general population or patients with earlier stages of chronic kidney disease, there are no clear diagnostic criteria for white-coat and masked hypertension in the hemodialysis population. In the present study, we aimed to estimate the prevalence of these 2 BP phenotypes using routine predialysis BP recordings in combination with 44-hour ambulatory BP monitoring (ABPM).

Design and method:

In a cohort of 70 hemodialysis patients, hypertension was assessed with 2 methods: (i) the average of routine predialysis BP recordings over 6 consecuitive dialysis sessions; (ii) ABPM over an entire 44-hour interdialytic period (BP measurements at 20-minute intervals; Microlife WatchBP O3 device). The thresholds of 140/90 mmHg and 130/80 mmHg were used to define abnormal predialysis and ambulatory BP, respectively.

Results:

Study participants (45 males and 25 females) had a mean age of 65.3±13.3 years and a median dialysis vintage of 15 months. The prevalence of hypertension was 88.6% by predialysis BP recordings and 90% by ABPM. In all, 61 patients were being treated with an average of 1.5±0.6 antihypertensive medications daily. In all, 51.4% of patients had either normotension or adequately controlled hypertension confirmed by the 2 different BP monitoring techniques, whereas 18.6% of patients had uncontrolled hypertension confirmed by both techniques. The prevalence of white-coat hypertension was 24.3% and the prevalence of masked hypertension was 5.7%. A 2-week averaged routine predialysis BP at the threshold of 140/90 mmHg provided 77.8% sensitivity and 30.8% specificity for the diagnosis of an average 44-hour ambulatory BPequal or higher than 130/80 mmHg. The agreement between these 2 techniques for the identification of patients with adequately controlled hypertension was poor (k-statistic: 0.378, P<0.001).

Conclusions:

This study shows that in approximately 30% of hemodialysis patients, there is lack of concordance between routine predialysis BP recordings and ABPM for the determination of BP control status. Routine predialysis BP recordings, even when averaged over 6 consecutive dialysis sessions, are inaccurate estimates of the actual BP load, as assessed by ABPM.
TRV027 REDUCES BLOOD PRESSURE IN SHR AND RESTORES VENTRICULAR HYPERTROPHY BY AFFECTING CONNEXIN 43 PATHWAY
Authors: Fan Xin , Yu Jing
Published: May 2024

Objective:

Hypertension is one of the common causes of cardiovascular diseases. Angiotensin II (AngII) plays a crucial role in hypertension and hypertension-induced cardiac hypertrophy. Whether TRV027, an AngII type 1 receptor biased agonist, could lower blood pressure and treat hypertensive cardiac hypertrophy is unknown.

Design and method:

Spontaneously hypertensive rats and Wistar-Kyoto rats were selected as the study subjects. Some SHRs were giving TRV027. H9c2 cells were selected as the in vitro study subjects to explore the mechanism of action of TRV027.

Results:

When compared to the WKY group, the SHR group displayed a pronounced increase in blood pressure. However, after giving subcutaneous pump of TRV027, blood pressure exhibited a marked reduction. Based on the Doppler ultrasound data, prior to the intervention, the SHR group had higher values for LVAWs, LVAWd, LVPWs, and LVPWd when contrasted with the WKY group. Moreover, the left ventricular mass in the SHR group also increased significantly (P<0.05). After the intervention with TRV027 in the SHR group, all the above-mentioned cardiac Doppler parameters were lower than those in the SHR group. HE staining of cardiac sections revealed a slight disarray in myocardial arrangement and significant myocardial hypertrophy in the SHR group. Compared with the WKY group, the level of Cx43 in the heart tissue of the SHR group was decreased, and the phosphorylation of MAPK and ERK2 was increased. After administration of TRV027, the expression levels of these proteins were restored. In the cell intervention, the expression level of Cx43 was significantly decreased, the phosphorylation levels of MAPK and ERK2 were increased, and the levels of MHC and ANP were increased in the AngII intervention group. After the intervention of TRV027 the expressions of Cx43 and MAPK/ERK pathways and MHC and ANP were restored. When Cx43 inhibitor was given to H9C2 cells,along with the decrease of Cx43 expression, the phosphorylation levels of MAPK and ERK2 were increased, while the levels of MHC and ANP were significantly increased.

Conclusions:

TRV027 lower blood pressure in SHR and ameliorate cardiac hypertrophy induced by hypertension. This effect is likely achieved through the Cx43 pathway.
BLOOD PRESSURE CLASSIFICATION USING BRACHIAL VERSUS CENTRAL HYPERTENSION PHENOTYPES AND ASSOCIATION WITH LEFT VENTRICULAR MASS – FINDINGS FROM THE I24ABC CONSORTIUM
Authors: Danninger Kathrin , Weber Thomas , Wassertheurer Siegfried , Protogerou Athanase , Sharman James E. , Sala Enrique Rodilla , Ortner Stefan , Athanasopoulou Elpida , Hametner Bernhard , Mayer Christopher , Li Yan , Pascual Jose Maria , Karachalias Fotis , Stergiou George , Bahous Sola Aoun , Zhang Yi , De La Sierra Alejandro
Published: May 2024

Objective:

Brachial and central systolic blood pressure (BP) is different, which may have implications for BP classification and cardiovascular risk stratification. We investigated the association between BP phenotypes, based on brachial versus central SBP, and left ventricular mass, an important intermediate endpoint in hypertension.

Design and method:

In all centers, 24-hour blood pressure (24hBP) was measured with the same validated oscillometric upper arm device (Mobil-O-Graph, I.E.M., Germany), using a transfer function and ARCSolver algorithms for determination of central pressures (using mean/diastolic BP calibration). Hypertension phenotypes were defined according to average 24h brachial BP as normotension (NTN), isolated systolic (ISH) and diastolic (IDH) hypertension, and systolic/diastolic hypertension (SDH), using brachial 130 and 80 mm Hg as systolic and diastolic threshold, respectively. Brachial BP phenotypes were further subdivided based on central 24h SBP (threshold for central hypertension was 135 mmHg). Left ventricular mass was determined by echocardiography, and indexed to body surface area (LVMi).

Results:

Overall, 2378 participants from 21 centers worldwide, connected in an academic research consortium, were included. Based on 24h brachial BP, 43.9%, 7.0%, 22.0% and 27.1% were classified as NTN, ISH, IDH, and SDH, respectively. The fraction of discordantly elevated central SBP in brachial NTN and IDH was 10.4% and 5.2%, respectively, and the fraction of discordantly normal central SBP in brachial ISH and SDH was 15.1% and 28.1%, respectively. Sex-differences were most striking in brachial NTN with elevated central SBP (male predominance), and brachial SDH with normal central SBP (female predominance). LVMi was higher in all brachial BP phenotypes, if central SBP was elevated (as compared to normal; see Table).

Conclusions:

Discordant BP classification based on central systolic BP is not uncommon and to some degree sex-specific. Measurement of central SBP likely adds to risk stratification in all brachial-BP based phenotypes, due to the stronger relationship with LVMi.
HYPERTENSION PHENOTYPES BASED ON BRACHIAL AND AORTIC 24HR SYSTOLIC PRESSURE AND THEIR ASSOCIATION WITH HYPERTENSION PHENOTYPES BASED ON BOTH BRACHIAL AND AORTIC 24HR SYSTOLIC PRESSURE AND THEIR ASSOCIATION WITH LEFT VENTRICULAR HYPERTROPHY: FINDINGS FROM THE I24ABC CONSORTIUM
Authors: Athanasopoulou Elpida , Weber Thomas , Wassertheurer Siegfried , Sharman James E. , Argyris Antonios , Sala Enrique Rodilla , Jankowski Piotr , Muiesan Maria Lorenza , Giannattasio Cristina , Wilkinson Ian , Hametner Bernhard , Orter Stefan , Mayer Christopher , Li Yan , Pascual Jose Maria , Danninger Kathrin , Karachalias Fotis , McEniery Carmel , Pucci Giacomo , Blacher Jaques , Stergiou George , Gomes Marco Antonia Mota , McDonnell Barry , de la Sierra Alejandro , Piskorz Daniel , Agharazii Mohsen , Bahous Sola Aoun , Perl Sabine , Zhang Yi , Nemcsik Janos , Gkaliagkousi Eugenia , Protogerou Athanase ,   the international24 hour Aortic Blood pressure Consortium (i24ABC)
Published: May 2024

Objective:

To describe the prevalence of systolic hypertension phenotypes based on simultaneous 24hr ambulatory blood pressure monitoring (ABPM) of the brachial (br) and aortic (ao) systolic pressure, as well as their association with left ventricular hypertrophy (LVH), using data from the international 24hr aortic blood pressure consortium (i24ABC).

Design and method:

Participants with 24hr br & ao ABPM (Mobil-O-Graph, IEM Germany) and echocardiography data from 21 centers worldwide were analyzed and categorized into the following 4 phenotypes: sustained [br & ao] systolic normotension (SSN), isolated br systolic hypertension (IbrSH), isolated ao systolic hypertension (IaoSH), and sustained [br & ao] systolic hypertension (SSH). These phenotypes were generated using 2 different calibration (C) methods and various proposed 24hr ao systolic pressure cut-off values (mmHg) (C1: systolic /diastolic pressure [120 and 114]; C2: mean/diastolic [135 and 132]).

Results:

We analysed 2367 individuals (49.5 ± 16.1 years, 54.5% men, 55.8% hypertensives). Depending on both cut-off values as well as on calibration method the phenotypes prevalence ranged: IaoSH 5.8% - 24.2%; IbrSH: 0.2% - 8.7%; SSN: 41.9% - 60.3%; SSH: 29.2% - 33.9%. In comparison to the SSN and after adjustment for age, sex and diastolic blood pressure: the SSH phenotype had 2.4 to 3.2 times more often LVH (statistically significant irrespectively of calibration and cut-off); the IaoSH had 1.7 to 2.4 times more often LVH (statistically significant with both C1 and C2); the IbrSH had 2.1 times more often LVH only with C1 and 120 mmHg cut-off.

Conclusions:

Individuals with the novel herein defined phenotype of 24hr IaoSH constitute a non-neglectable percentage of the population that cannot be identified by brachial arm ABPM, possibly carrying high cardiovascular risk as suggested by the more frequent LVH. Outcome studies are needed to verify these results.
24 HOUR ISOLATED AORTIC SYSTOLIC HYPERTENSION AND HYPERTENSION MEDIATED ORGAN DAMAGE: DATA FROM THE SAFAR STUDY
Authors: Athanasopoulou Elpida , Karachalias Fotios , Yofoglou Lazaros , Kanatas Panagiotis , Weber Thomas , Danninger Kathrin , Blacher Jacques , Manios Efstathios , Protogerou Athanase , Argyris Antonios
Published: May 2024

Objective:

To describe the prevalence of systolic hypertension phenotypes according to simultaneous 24hr brachial systolic pressure (br) and aortic (ao) ambulatory blood pressure monitoring (ABPM) and their association with carotid and left ventricular damage, using data from the NoninvaSive Aortic ambulatory blood pressure monitoring for the detection of tARrget organ damage (SAFAR) study.

Design and method:

Participants with 24hr br & ao ABPM (Mobil-O-Graph, IEM Germany), carotid ultrasound and echocardiography data were analyzed and categorized into 4 systolic hypertension phenotypes: sustained systolic br & ao normotension (SSN), isolated br systolic hypertension (IbrSH), isolated ao systolic hypertension (IaoSH) and sustained br & ao systolic hypertension (SSH); using 2 different calibration peripheral waveform methods and different 24hr ao systolic proposed cut-off values (i.e., 120mmHg or 114mmHg for type 1 calibration; 135mmHg or 132mmHg for type 2 calibration [mean/ diastolic pressure]). We examined the prevalence of these phenotypes and their associations with carotid and cardiac damage.

Results:

Out of 1024 participants (55.0 ± 13.1 years, 58.1% males, 60.4% hypertensives) with ABPM, 684 (53.5 ± 12.4 years, 57.7% males, 61.0% hypertensives) had carotid and 423 (55.4 ± 14.3 years, 57.4% males, 60.3% hypertensives) had echocardiography data. IaSH ranged from 3.7% to 23.0% of the population depending on the calibration and the applied cut-off; (SSN: 37.0% – 56.3%, IbrSH: 0.6% – 9.5%, SSH: 30.5% – 39.4%). In comparison to SSN and IbrSH, IaoSH phenotype (only by calibration 2 - but independently of the applied cut-off) had significantly higher common carotid intimal-medial thickness, cross-sectional area and left ventricular mass. Irrespectively of the type of calibration and applied cut-off, SSH had consistently the highest carotid and cardiac damage.

Conclusions:

Individuals with 24hr IaoSH constitute a non-neglectable percentage (3.7% to 23.0%) of the population with otherwise normal 24hr br pressure, possibly carrying high cardiovascular risk. Further mortality outcome studies are needed to verify these results.
COMBINED EFFECTS OF CHILD AND ADULT ELEVATED BLOOD PRESSURE ON ADULT SUBCLINICAL KIDNEY DAMAGE AND ALBUMINURIA: A 36-YEAR PROSPECTIVE COHORT STUDY
Authors: Wang Yang , Jia Hao , Du Ming -Fei , Sun Yue , Wang Dan , Hu Gui -Lin , Man Zi -Yue , Chu Chao , Desir Gary , Safirstein Robert , Zheng Xiao -Wei , Mu Jian -Jun
Published: May 2024

Objective:

Elevated blood pressure (BP) is associated with increased risk of chronic kidney disease. However, it is uncertain whether this risk is attenuated in individuals who acquire normal BP by adulthood. The present study examined the effect of child and adult BP levels on subclinical kidney damage (SKD) and albuminuria in adulthood.

Design and method:

Using data from the longitudinal cohort of Hanzhong Adolescent Hypertension Study, 1897 participants aged 6 to 18 years were enrolled and followed up for 36 years. Childhood elevated BP was defined according to the tables from the National Health Commission of the People's Republic of China. In adulthood, BP was classified as elevated if systolic BP greater than or equal to 140 mmHg, diastolic BP greater than or equal to 90 mmHg, or self-reported use of antihypertensive medications. Presence of SKD was defined as estimated glomerular filtration rate between 30 and 60 mL/min per 1.73 m2 or elevated urinary albumin-to creatinine ratio at least 30 mg/g. Albuminuria was defined as urinary albumin-to creatinine ratio greater than or equal to 30 mg/g.

Results:

Individuals with persistently elevated BP and individuals with normal childhood BP, but elevated adult BP had increased risk of SKD [odds ratios (ORs) 95% confidence interval (CI) were 2.46(1.68-3.60) and 3.28(1.85-5.82), respectively] in comparison with individuals with normal child and adult BP. In contrast, individuals with elevated BP as children but not as adults did not have significantly increased risk [OR 95% CI, 0.93(0.58-1.50)]. In addition, these individuals had a lower risk of increased SKD [OR 95% CI, 0.28(0.14-0.57)] in compared with those with persistently elevated BP. Consistent findings were observed in the risk of albuminuria.

Conclusions:

Individuals with persistently elevated BP from childhood to adulthood had increased risks of SKD and albuminuria. These risks were reduced if elevated BP during childhood resolved by adulthood.