bluuebunny/crossref_metadata_2025 huggingface dataset:
ASSOCIATION OF SHORT-TERM AND MID-TERM BLOOD PRESSURE VARIABILITY INDICES WITH LEFT VENTICULAR MASS INDEX IN CHRONIC KIDNEY DISEASE PATIENTS
Authors: Manousopoulos Konstantinos , Tsoutsoura Nefeli , Koromboki Eleni , Mitsikosta Efthalia , Spiliopoulou Sotiria , Malakou Anna , Zakopoulos Nikolaos , Manios Efstathios
Published: April 2021

Objective:

Several studies have demonstrated that increased blood pressure (BP) variability is associated with target-organ damage development in hypertensive patients. However, the impact of BP variability (BPV) indices on target-organ damage in chronic kidney disease patients (CKD) is unclear. Aim of the study was to evaluate the association between short-term and mid-term BPV indices with left ventricular mass index (LVMI) in chronic kidney disease patients.

Design and method:

A total of 131 CKD patients, referred for evaluation at the Hypertension Unit of our department, underwent 24-h ambulatory BP monitoring, home BP monitoring and echocardiographic measurements. Short-term BPV was expressed by standard deviation (SD), time rate (TR) of BP variation and coefficient of variation (CV) of systolic and diastolic BP for both 24-h, daytime and nighttime intervals. Mid-term BPV was expressed by SD and CV of systolic and diastolic BP for morning and evening BP measurements. Statistical analysis was performed by means of bivariate correlations, simple and multiple linear regression analysis.

Results:

All home BPV indices did not correlated significantly with LVMI. Regarding short-term BPV, only 24-h systolic TR (r = 0.320, p < 0.001) and daytime systolic TR of BP variation (r = 0.310, p < 0.001) significantly correlated with LVMI. The multivariate analysis revealed that 24-h systolic TR of BP variation was the only variable that was significantly and independently associated with LVMI (B = 12.016 95%CI 4.981–19.052, p < 0.001). The association remained significant after adjustment for baseline characteristics and risk factors.

Conclusions:

Short-term BPV indices such as 24-h and daytime systolic TR of BP variation were significantly associated with LVMI in CKD patients. In contrast, no significant association was observed between mid-term BPV indices and LVMI.
CONTINUOUS BEAT TO BEAT AMBULATORY BLOOD PRESSURE MONITORING: INITIAL EXPERIENCE IN SUSTAINED UNCONTROLLED HYPERTENSIVES (SUCH)
Authors: Kotliar Carol , Obregon Sebastian
Published: April 2021

Objective:

We aim to BP values obtained at interval periods versus beat to beat in sustained uncontrolled hypertensives (SUCH) by analysing the role of BP variability, sympathetic-vagal balance, relation of nocturnal-diurnal pattern,and oxygen desaturation index.

Design and method:

30 consecutively patients (66% male; 59,2+-11 years) with uncontrolled hypertension at office and ABPM were included. For 24 hours ABPM we used a beat to beat, cuff less monitor (Somnotouch NIBP Germany). We analysed: a) continuous BP records and also averages at conventional interval period (15–30 minutes’ day/night), b) BP variability, c) RR interval and sympathovagal balance (SVB) through evaluation of frequency domain by spectral analysis, d) oxygen saturation.

Results:

We obtained an average of 54.978 BP values per patient. Office versus 24 hs BP: 158 +-9.1/96.7 +-11.0 versus 144,9+-8,2/90,1+-5,1 mm Hg. Beat to beat continuous monitoring was well tolerated with no disturbances on daily activity. Interval data was associated with significant higher values of SBP (24 hrs. 145,9+-9.4 vs 144,9+-8,2; wake 147,8+-8,4 vs 147+-7,8; sleep 135,4+-7 vs 134,5+-5,8) (p.04) and DBP (24 hrs. 91.2+-5.6 vs 90,1+5,1, wake 93,5+-5 vs 92,6+-4,5, sleep 88+-6.2 vs 87,1+-5) (p.01). We classified SUCH patients in tertiles according to their increasingly 24 hrs. systolic average record and their data are shown in table 1. A positive direct association was found as expected with SBP and BMI, PP and MAP. When sympato-vagal balance was evaluated an increased sympathetic tone or decreased vagal tone was observed with a reverse or an absence of the expected reduction of SVB during sleep. (table 1). SUCH patients received a median of 2.8 antihypertensive drugs was observed but no differences in BP nocturnal behaviour was observed among different drugs.

Conclusions:

BP values obtained at interval periods were higher than those obtained continuously beat by beat. In our sample of patients, SUCH was associated with nocturnal hypertension and nocturnal lack of the expected sympato-vagal balance.

We need further studies including normotensives, white uncontrolled hypertensives and controlled hypertensives for a better understanding of populations behaviour and different epigenetic influences.
MORNING SURGE IN BLOOD PRESSURE AS A PREDICTOR OF WORSENING HEART FAILURE IN HEART FAILURE WITH REDUCED EJECTION FRACTION
Authors: Komori Takahiro , Hoshide Satoshi , Kario Kazuomi
Published: April 2021

Objective:

Abnormal circadian blood pressure (BP) rhythm is observed in heart failure (HF) patients. Rising BP in the morning known as the morning surge (MS) is one of the abnormal circadian BP rhythm, and a cardiovascular risk factor in hypertensives. However, the significance of MS is not established in patients with HF.

Design and method:

We performed a prospective, observational cohort study of hospitalized HF patients who underwent ambulatory BP monitoring (ABPM). Four hundred fifty seven hospitalized HF patients (age, 68 ± 13 yrs; 63.9% males [n = 292] and 36.1% females [n = 165]) were followed up for 20.0 (median) months.

Results:

HF with reduced ejection fraction (HFrEF) was 197 (43.1%), HF with mid-range ejection fraction (HFmrEF) was 101 (22.1%), and HF with preserved ejection fraction (HFpEF) was 159 (34.8%). The composite outcome consisting of all-cause mortality and worsening HF was observed in 143 patients. In a Kaplan-Meier analysis, the MS group had a significantly higher incidence of the composite outcome than the non-MS group in HFrEF and HFmrEF patients.(figure) However, in multivariate Cox regression analysis, MS was a significant predictor for adverse outcomes only in HFrEF patients (HR 2.63, 95%CI 1.11–6.25, p = 0.03).

Conclusions:

The MS was found to be a novel predictor of worsening HF in patients with HFrEF.
NON-DIPPING BLOOD PRESSURE VARIATIONS IN JUVENILE KAZAKHS MIGHT BE DERIVED FROM INCREASED SYMPATHETIC ACTIVITY AND DECREASED PARASYMPATHETIC ACTIVITY AND DAYTIME PHYSICAL ACTIVITY
Authors: Kawamura Hiroshi , Ozawa Yukio , Izumi Yooichi , Kasamaki Yuji , Nakayama Tomohiro , Mitsubayashi Hiromi , Ichimaru Yuhei
Published: April 2021

Objective:

A large number of adult and elderly Kazakhs were reported to exhibit hypertension and non-dipping blood pressure variations (BPV). However, no study has been performed to see whether non-dipping BPV still exist in juvenile Kazakhs. The purpose of this study was to investigate whether non-dipping BPV still exist in juvenile Kazakhs.

Design and method:

We performed ambulatory blood pressure (BP) monitoring and studied autonomic nerve activity by performing a frequency domain analysis of the subjects’ heart rate variability (HRV). We also assessed the subjects’ physical activity with accelerometry. The power spectral density (PSD) of the subjects’ HRV was calculated using fast Fourier transformation. We analyzed systolic BP (SBP) variations with the maximum entropy method (MEM).

Results:

MEM analysis of juvenile Kazakhs revealed that the SBP variations of the non-dippers exhibited a 24-hour periodicity with a very weak PSD. Among juvenile Kazakhs, the non-dippers displayed higher low-frequency (LF)/high-frequency (HF)(LF/HF) ratios and lower HF/(LF+HF) ratios than the dippers over 24 hours (dippers vs. non-dippers: 0.43 (0.37, 0.57) vs. 0.51 (0.44, 0.61)(median, Q1, Q3), P = 0.0001). The non-dippers’ HF/(LF+HF) ratios were lower than those of the dippers (dippers vs. non-dippers: 1.87 (1.11, 2.34) vs. 1.30 (0.92, 1.75)(median, Q1, Q3), P = 0.0001). Furthermore, the daytime physical activity scores of the non-dippers were lower than those of the dippers (dippers vs. non-dippers: 1.27 (1.06, 1.38) vs. 1.00 (0.80, 1.20)(median, Q1, Q3), P = 0.0733).

Conclusions:

Non-dipping BPV still exist in juvenile Kazakhs. The differences in cardiac autonomic function and physical activity seen in non-dipping juvenile Kazakhs might contribute to the generation of weak circadian variations in SBP, leading to non-dipping SBP variations.
THE EFFECTS OF SYSTOLIC ARTERIAL PRESSURE ON LOCOMOTOR ACTIVITY IN CONGENIC RATS DERIVED FROM STROKE PRONE SPONTANEOUSLY HYPERTENSIVE RATS AND WISTAR KYOTO RATS
Authors: Kawamura Hiroshi , Mitsubayashi Hiromi , Ikeda Katsumi , Kawakami Kohhei , Nabika Toru
Published: April 2021

Objective:

The systolic arterial pressure (SAP) levels of congenic rats were reported to be intermediate between those of stroke-prone spontaneously hypertensive (SHRSP) rats and Wistar Kyoto (WKY) rats, and the congenic rats were reported to exhibit higher locomotor activity than SHRSP and WKY rats. Locomotor activity in the early morning was higher in the congenic rats than in the other two strains. However, no study on the relationship between SAP and locomotor activity in congenic rats has been performed. Therefore, we aimed to examine this topic.

Design and method:

We used 10 mature male congenic rats and age- and gender-matched SHRSP and WKY rats (n = 10 each) as the controls. We measured the SAP and locomotor activity of the rats telemetrically. We estimated best-fit curves of locomotor activity using the maximal entropy method.

Results:

The congenic rats exhibited the highest locomotor activity counts (congenic rats vs. SHRSP rats vs. WKY rats: 58 (23, 89) vs. 18 (4, 40) vs. 4 (1, 8) counts/10 seconds (median, Q1, Q3), P = 0.0010). The congenic rats also exhibited SAP levels that were intermediate between those of the SHRSP and WKY rats (congenic rats vs. SHRSP rats vs. WKY rats: 194 ± 7 vs. 229 ± 7 vs. 117 ± 4 mmHg (mean ± SD, P = 0.0098). The strongest correlation between locomotor activity and SAP was seen in the congenic rats (Y = -1851.3 + 9.87X, rS = 0.592, P = 0.00001). The ratio of the increase in locomotor activity to the increase in SAP was highest in the congenic rats (congenic rats vs. SHRSP rats vs. WKY rats: 7.05 (4.92, 10.20) vs. 0.04 (0.87, 0.88) vs. 0.11 (3.46, 3.55)(median, Q1, Q3); SHRSP rats vs. congenic rats: P < 0.01; SHRSP rats vs. WKY rats: n.s.; congenic rats vs. WKY rats: P < 0.05).

Conclusions:

Among these three rat strains, the response of locomotor activity to increases in SAP was strongest in the congenic rats.
ANALYSIS OF FACTORS RELATING TO DAY-TO-DAY HOME BLOOD PRESSURE VARIATION IN HYPERTENSIVE PATIENTS
Authors: Ishimitsu Toshihiko , Furuichi Masahito , Sato Yuka , Wakabayashi Haruna , Satonaka Hiroshi , Iwashima Yoshio , Honda Takeaki , Tojo Akihiro
Published: April 2021

Objective:

In order to prevent cardiovascular events and organ injuries in hypertensive patients, strict blood pressure (BP) control over 24 hours is of primary importance. In addition to the BP level, it has been indicated that the variabilities of blood pressure during a day or between visits also influence the risk of cardiovascular disorders. This study aimed to delineate the factors relating to the variations of office and home BPs throughout a year in hypertensive outpatients under antihypertensive therapy.

Design and method:

The subjects enrolled in this study were 83 hypertensive out-patients who recorded home blood pressure measurements. Office BP and the home BP records within 7 days before each visit were collected for the analyses calculating the coefficient of variation (CV). In addition to the physical findings such as blood pressure and body mass index, laboratory data of blood and urine samples were collected.

Results:

The office BP value (131/77mmHg) was comparable to the morning home BP (130/76) and higher than the evening home BP (126/73), however, the CV values were comparable between the office and the morning and evening home BPs. Correlations of BP and CV were stronger between the morning and the evening home BPs than between the office and the home BPs. The CV of systolic office BP was greater in patients with diabetes mellitus than patients without diabetes (7.8 vs 6.1%). In patients with chronic kidney disease, the CVs of diastolic office BP and diastolic evening home BP were greater than patients without chronic kidney disease (8.0 vs 6.2% and 8.1 vs 6.7%, respectively). In addition, The CVs of diastolic morning and evening home BP were positively correlated with serum creatinine and negatively correlated with estimated glomerular filtration rate. Patients with cardiovascular diseases such as stroke and coronary artery disease showed greater CV of diastolic morning home BP than patients without cardiovascular diseases (8.2 vs 6.6%).

Conclusions:

These results suggest that the home BP exhibits different variability from the office BP and the BP variability is increased in high-risk hypertensive patients with diabetes mellitus, chronic kidney disease and cardiovascular diseases.
BLOOD PRESSURE VARIATION IS DEPENDENT ON THE BALANCE OF SYMPATHETIC AND PARASYMPATHETIC ACTIVITY
Authors: Hano Takuzo , Koike Yumi
Published: April 2021

Objective:

Blood pressure variability is an independent risk factor for cardiovascular complications in hypertension. There were reports that sympathetic nervous system was involved in the regulation of blood pressure, whereas beta-blocker was not involved in blood pressure variability. Therefore, the relationship between autonomic nervous system and blood pressure variability is unclear. We reported the usefulness of the pupillary function test as an index of sympathetic and parasympathetic nerves. In the present study, we clarify how the autonomic nervous system is related to blood pressure variability using the pupillary function test.

Design and method:

For 23 patients undergoing outpatient visits, blood pressure and heart rate variability factors were measured at 14 consecutive outpatient visits. The coefficient of variation of systolic blood pressure, diastolic blood pressure, and heart rate was calculated. In the pupillary function test, mydriatic velocity was used as an index of sympathetic nerve function, and miotic speed was used as an index of para-sympathetic function.

Results:

The average age is 66 ± 6 years old. The coefficient of variation for systolic blood pressure, diastolic blood pressure, and heart rate was 5.57 ± 2.13, 6.78 ± 2.96 and 6.73 ± 2.79, respectively. Mydriatic velocity and contraction velocity were 3.29 ± 0.79 ms and 1.69 ± 0.58 ms. Variation coefficient of systolic blood pressure, diastolic blood pressure and heart rate were not significantly correlated with mydriatic and miotic velocity. On the other hand, there was a significant negative correlation between coefficient of variation of systolic blood pressure, diastolic blood pressure and heart rate and ratio of mydriatic and miotic velocity.

Conclusions:

Visit-to-visit variability of systolic pressure, diastolic pressure and the heart rate was not related to sympathetic or parasympathetic activity alone but balance between both are involved in these variabilities.
THE EFFECT OF METFORMIN ADMINISTRATION ON BLOOD PRESSURE VARIABILITY IN HYPERTENSIVE SUBJECTS WITH PREDIABETES RECEIVING LISINOPRIL
Authors: Hakim Abdul , Hersunarti Nani , Soerarso Rarsasi , Siwanto Bambang Budi , Kuncoro Ario S. , Atmadikoesoemah Celly , Indriani Suci , Adiarto Suko , Sukmawan Renan
Published: April 2021

Objective:

To determine the effect of adding metformin to lisinopril as well as an oral antidiabetic drug that has antihypertensive effects and influence on blood pressure variability in the hypertensive population and prediabetes.

Design and method:

Method: This study was a randomized clinical trial conducted at National Cardiac Center Harapan Kita Hospital (NCCHK) in hypertensive employees with prediabetes. Divided into 2 groups that received Lisinopril 5 mg (open) and Metformin 2x500 mg (disguised) or placebo for 8 weeks. Examination of Home Blood Pressure Monitoring (HBPM) is carried out before and after therapy is given.

Results:

Results: A total of 64 patients completed the study (31 placebo groups, 33 metformin groups). After 8 weeks of follow-up, the blood pressure variability of the metformin group had lower blood pressure variability (3.8 ± 2.2 mmHg, p = 0.03) than in the placebo group. The mean change in mean systolic and diastolic blood pressure in the metformin group decreased significantly (p < 0.05)

Conclusions:

Conclusion: Addition of metformin to hypertensive subjects with prediabetes who received lisinopril decreased morning blood pressure variability and morning mean blood pressure which was statistically significant.
AUGMENTED BLOOD PRESSURE VARIABILITY FOLLOWING CONTINUOUS INFUSION OF NORADRENALINE IN RATS
Authors: Jiang Danfeng , Kawagoe Yukiko , Asada Yujiro , Kitamura Kazuo , Kato Johji
Published: April 2021

Objective:

Augmented blood pressure (BP) variability has been shown to be an independent cardiovascular risk factor. Activity of the sympathetic nervous system is an important determinant factor of the 24-h profile of BP variability, although it is unknown whether persistent adrenergic activation causes augmented BP variability or not. Here we report that continuous infusion of noradrenalin augments 24-h BP variability in rats, and our efforts were also made to explore the mechanism of action through which noradrenalin exerted this effect.

Design and method:

Nine-week-old male Wistar rats maintained under a 12-h light and 12-h dark cycle were continuously infused with subcutaneous 30 mg/h noradrenalin, 150 mg/h of the a1-adrenergic agonist phenylephrine, or 30 mg/h of the non-selective b-agonist isoproterenol, for 14 days. Noradrenalin-infused rats were also administered either oral 5 mg/day prazosin, an a1-blocker, or 50 mg/day atenolol, a b1-blocker, during the infusion period. BP variability was evaluated before and after 7 and 14 days of the infusion, using a coefficient of variation (CV) of BP recorded every 15 min under an unrestrained condition via an abdominal aortic catheter by a radiotelemetry system.

Results:

Continuous infusion of noradrenalin significantly increased BP variability at 7 and 14 days, slightly elevating BP levels, and this increase was observed similarly in the light and dark cycles. Noradrenalin-induced augmentation of BP variability was partially attenuated by oral administration of prazosin, but not by atenolol. This action of noradrenalin was mimicked by continuous infusion of phenylephrine, while isoproterenol failed to affect the BP variability.

Conclusions:

Continuous infusion of noradrenalin increased BP variability in rats through an a1-adrenergic receptor-mediated mechanism, suggesting that the noradrenalin-infused rat is an animal model of augmented BP variability induced by persistent adrenergic activation. This model could be useful in pharmacological screening of the suppressive action of candidate drugs on augmented BP variability in vivo.
HOME BLOOD PRESSURE MONITORING (HBPM) IN CLINICAL PRACTICE: A SYSTEMATIC REVIEW AND EXPERIENCE REPORT OF ONLINE TOLL FOR RESULTS REPORT IN BRAZIL
Authors: De Melo Kamilla Correia , Nascimento Loreanne G. , Vieira Pedro H. S. , De Brito Jaques Lais A. , Do Nascimento Emerson B. , Maciel De Figueirêdo Anne G. , Lins Lais Pinheiro , Magno Isabella Maria Figueiredo , De Andrade Lucas G. , Neto Inácio De Barros Melo , De Oliveira Thárcia Kiara Beserra , Veiga Da Silva Joelmir L. , Torres Rodrigo De L. , Silva Jose Sergio N.
Published: April 2021

Objective:

Perform a systematic review of systemic arterial hypertension (SAH) diagnosis and follow-up using home blood pressure monitoring (HBPM) and report the experience of using an online tool (TeleMRPAÔ) for results report in Brazil.

Design and method:

The MedlineÔ, EmbaseÔ, and Cochrane LibraryÔ databases were searched for randomized studies on the effectiveness of the monitoring and diagnosis of SAH with HBPM from 2014 to 2018. The keywords used were hypertension, blood pressure, home blood pressure monitoring. A full review of 132 articles was performed and 36 studies were considered potentially eligible. Out of the 36 potentially eligible studies, 25 studies were published from 2014 to 2018, conducted in North America and Europe and included a wide variety of hypertension assessment methods. Only 10 studies aimed to analyze HBPM as a tool for the diagnosis and / or follow-up of SAH. TeleMRPAâ is an online tool (www.telemrpa.com) developed in Brazil to facilitate HBPM results reporting by cardiologists. Through this tool, it is possible to standardize the report and, from the data entered online, it is possible to generate a final report that gives greater feasibility, reproducibility of the method, minimizing errors.

Results:

The regular use of HBPM decreases the rates of cardiovascular events and SAH related mortality, as well as lower health care costs when compared to the monitoring of SAH only with office measurements. There was a consonance of the studies indicating a low sensitivity of the blood pressure measurement in the office to detect the optimal control of SAH when compared to the addition of HBPM. Thus, TeleMRPAâ made it possible for HBPM to be extended to more cardiologists and their patients.

Conclusions:

The use of HBPM showed to be effective. The HBPM should be included in the diagnosis and follow-up of SAH more routinely. Still, HBPM encourages the increase of patient participation in their self-care, as it reinforces patient-centered care, improving SAH control. In addition, in Brazil, the TeleMRPAâ has made SAH monitoring more comprehensive.
CIRCADIAN VARIABILITY AND CIRCADIAN HYPER AMPLITUDE TENSION AS A EARLY PREDICTIVE MARKER OF CHEMOTHERAPHY INDUCED CARDIOTOXICITY
Authors: Bhardwaj Shipra , Verma Narsingh , Bhatt M L B , Rastogi Madhup
Published: April 2021

Objective:

Chemotherapeutic Medicines like Anthracycline antibiotics are effectively being used for breast cancer treatment in India. Despite of close clinical monitoring, the use of serological markers, such as troponins and BNP, and finally by using standard and novel imaging techniques like, nuclear imaging, echocardiograms etc some patients still develop severe left ventricular dysfunction. Also there are certain limitations of these techniques as these techniques can predict CV damages only after Cardiac function deterioration has become irreversible.

Design and method:

Therefore in this study Seven day continuous ambulatory blood pressure monitoring and CHAT (circadian hyper amplitude tension) have been evaluated to find out the variability in blood pressure and heart rate as a marker for cardiac function. Subjects who were fulfilling the inclusion criteria were enrolled for study. 24 hour /7days Ambulatory blood pressure monitoring, Left ventricular Ejection Fraction ratio (LVEF), Heart rate variability (HRV) and Cardiotoxicity Biomarkers viz Brain Natruitic peptide (BNP) and C- Reactive Protein (Hs CRP) and Troponin T were analyzed before receiving first Cycle of Antracycline Chemotherapy. All the parameters were repeated after first and Second Cycle of Chemotherapy.

Results:

Results shows significant increase in MESOR and Double Amplitude and Hyperbaric indexes of SBP, DBP and HR after Chemotherapy. Number of subjects diagonosed with CHAT (Circadian Hyper Amplitude Tension) increased after Chemotherapy while No Significant Changes were noted in LVEF (Left Ventricular ejection fraction) and serum biomarkers (i.e Troponin T, Hs CRP, and BNP). These data suggest that Anthracyclines Chemotheraphy treatment in Breast Cancer Subjects produces variations in 7 day circadian pattern of blood pressure and heart rate which can result into disturbed vascular events and thus are at greater risk of cardiovascular morbidity.

Conclusions:

long term monitoring of circadian pattern of blood pressure and heart rate in cancer patients will be an effective measure to prevent chemotherapy induced cardiotoxicity. Chronobiological screening parameters will be a novel approach in the context of chemotherapy induced cardiotoxity in order to identify or stratify risk in cancer patients that would potentially benefit from early cardio protective or other precautionary measures.
A COMPARATIVE STUDY OF AMBULATORY BLOOD PRESSURE LEVELS, TRAJECTORIES AND SHORT-TERM BLOOD PRESSURE VARIABILITY IN DIABETIC AND NON-DIABETIC PATIENTS WITH CKD STAGE 2, 3A, 3B AND 4
Authors: Loutradis Charalampos , Schoina Maria , Minopoulou Ioanna , Theodorakopoulou Marieta , Pyrgidis Nikolaos , Tzanis George , Papadopoulos Rafael , Intzevidou Eleni , Papagianni Aikaterini , Sarafidis Pantelis
Published: April 2021

Objective:

Diabetic kidney disease is the leading cause of end-stage renal disease worldwide. Whether diabetes mellitus (DM) is an additional factor leading to elevated blood pressure (BP) levels and BP variability (BPV) in patients with chronic kidney disease (CKD) is unknown. This study aimed to compare ambulatory BP levels, BP trends and BPV in diabetic and non-diabetic patients with CKD.

Design and method:

This study included 48 diabetic and 48 non-diabetic adult patients (>18 years) with CKD (eGFR: < 90 and >15 mL/min/1.73m2), matched in a 1:1 ratio for age, sex and eGFR within each CKD stage (2, 3a, 3b and 4). All patients underwent 24-hour ambulatory BP measurement with the Mobil-O-Graph device. To evaluate the effect of diabetes and time on the trajectories of 24-hour BP levels, we performed two-way mixed ANOVA analysis for repeated measurements using hourly means. BPV was calculated using standard deviation (SD), weighted SD (wSD), coefficient of variation (CV) and average real variability (ARV) of BP during the 24-hour, day- and night-time periods.

Results:

In total, patients with DM had significantly higher 24-hour systolic BP (SBP) (132.13 ± 10.71 vs 124.16 ± 11.45 mmHg, p = 0.001) and similar 24-hour diastolic BP (DBP) (75.00 ± 8.43 vs 74.62 ± 6.86 mmHg, p = 0.809) compared to patients without DM. A similar trend was evident across all CKD stages. The effect of DM on BP trajectories during the recording period was significant for SBP [F = 18.766, p < 0.001, partial h2 = 0.261] and marginally significant for DBP [F = 3.782, p = 0.057, partial h2 = 0.067]. 24hour SBP SD, wSD and ARV (10.94 ± 2.75 vs 9.46 ± 2.10, p = 0.004), as well as 24hour DBP SD, wSD, CV and ARV (8.23 ± 2.10 vs 7.10 ± 1.32, p = 0.002) were significantly higher in diabetic compared to non-diabetic CKD patients.

Conclusions:

Ambulatory SBP levels are higher and SBP-profile is different in patients with diabetic compared to those with non-diabetic CKD. Systolic and diastolic BPV are also higher in diabetic subjects. These findings may signify a higher cardiovascular risk of diabetic CKD patients.
THE RELATIONSHIP BETWEEN BP-CONTROL, BP -VARIABILITY AND ANTIHYPERTENSIVE TREATMENT WITH THE LONG-TERM RISK OF CARDIOVASCULAR EVENT: LESSONS FROM THE ASCOT-LEGACY 20 YEAR FOLLOW-UP
Authors: Gupta Ajay , Whiteley William , Godec Thomas , Rostamian Somayeh , Mackay Judith , Whitehouse Andrew , Sever Peter
Published: April 2021

Objective:

The long-term cardiovascular (CV) impact of a period of blood pressure (BP)-control and -variability (BPV) achieved on different BP-lowering treatments is unclear. The findings will inform the debate on BP-control targets, and explore the reason of legacy effects.

Design and method:

In the ASCOT-Legacy Study, 7092 hypertensive patients (assigned to either amlodipine- or atenolol-based treatment [3588 and 3504, respectively] and survived for the first 5.5 years [landmark period]), were evaluated using > 100,000 BP records to estimate 5-year mean SBP and standard deviation [SD] of all reported SBPs (denoting 5-year BPV). Patients were subsequently followed using electronic health records for up to16-years [IQR: 9.1–19.3 years] for the first occurrence of fatal/non-fatal heart failure, non-fatal myocardial infarction/fatal-coronary heart disease, total coronary events (TCE) and total CV events. Cox proportional hazards from the end of the landmark period were used to estimate the hazard ratio [HR] associated with mean BP-control, BPV, and assigned treatment after adjustments (see Table)

Results:

During the landmark period, those on amlodipine-based (vs. atenolol-based) treatment had lower mean SBP (-1.71 mm Hg, p < 0.001) and BPV (SD, -1.99, p < 0.001). Table 1 shows that increase in mean SBP and BPV was associated with a significantly increased risk of all 4 outcomes, with the magnitude of risk higher for each SD rise in the BPV vs. SD rise of mean SBP. Adjustment of mean BP for BPV and vice versa attenuated the magnitude of mean SBP but not that associated with BPV. Those on amlodipine-based (vs atenolol-based) treatment showed long-term beneficial legacy effect with a 7% significant reduction of CV events. However, this long-term treatment benefit (legacy effect) becomes insignificant after adjusting for BPV.

Those who have mean SBP > = 140 (vs SBP < 130) and BPV > = 15 mm Hg (vs < 10) continue to have a significant excess risk of TCE (45% [95%CI 1.28–1.63] and 62% [1.44–1.82], respectively) regardless of BP-treatment.

Conclusions:

Legacy effect of BP-lowering amlodipine-based treatment is primarily mediated by the reduction in BPV. Those with high mean SBP (>140) and/or high BPV (>15) and should be targeted to mitigate long-term CV risk.
PROGNOSTIC IMPORTANCE OF LOW VISIT-TO-VISIT SYSTOLIC BLOOD PRESSURE VARIABILITY IN HIGH-RISK HYPERTENSION
Authors: Del Pinto Rita , Pietropaoli Davide , Dobre Mirela , Ferri Claudio
Published: April 2021

Objective:

Besides high blood pressure variability (BPV), low BPV was associated with adverse cardiovascular (CV) prognosis in selected high-risk patients. We explored this issue among high-risk, nondiabetic, nonstroke hypertensive adults from the Systolic Blood Pressure Intervention Trial (SPRINT).

Design and method:

Long-term SBPV (coefficient of variation, CoV %) was calculated on quarterly visits

from randomization until an outcome, excluding titration period and patients with missing visits. The primary outcome was any fatal/nonfatal CV event (myocardial infarction [MI]; acute coronary syndrome not resulting in MI; stroke, acute decompensated heart failure [HF], death from CV diseases [CVD]); secondary outcomes were all-cause mortality and the composite of CV events and mortality.

Multivariate (treatment arm, pulse pressure, age > = 75 years, gender, race, CVD, chronic kidney disease [CKD], smoke, n.BP medications) Cox proportional hazard models with penalized smoothing splines were used to explore the potential nonlinear relationship between the continuum of CoV and the HR (95%CI) for outcomes. Sensitivity analysis based on 1:1 propensity score matching (PSM) was performed.

Results:

The association of SBPV with CV events was J-shaped (lowest risk for CoV 5–10%), while that with all-cause mortality and with the composite outcome was linear. After multivariate adjustment, only low SBPV (CoV < 5%) was associated with CV events (HR 1.85, 95%CI 1.24–2.75), especially MI (HR 2.76, p < 0.001). High SBPV (CoV>10%) was associated with the risk of the composite outcome (HR 1.35, p = 0.037). PSM, matching 566 non-smoker, non-CVD/CKD participants having SBPV 5–10% with an equal number of patients having different SBPV, confirmed the inverse association of low SBPV with CV events (HR 3.33, p = 0.035).

Conclusions:

Nonlinear modeling indicates that low visit-to-visit SBPV has prognostic relevance in high-risk hypertensives from SPRINT. Unmeasured factors, like inflammatory and metabolic changes, might contribute to the observed results. We treated SBPV as a continuous variable calculated on 16 visits and included 60% of the SPRINT cohort, which might explain the limited analogy with earlier findings. Dedicated trials are needed to test these results and related implications.
HYPERTENSION MANAGEMENT DURING RAMADAN: RESULTS FROM THE NATIONAL TUNISIAN REGISTRY OF HYPERTENSION (NATURE HTN)
Authors: Chamtouri Ikram , Mejdoub Yousra , Hammami Rania , Amdouni Nesrine , Hamda Khaldoun Ben , Abdessalem Salem Ben , Zakhama Lilia , Maatouk Faouzi , Abid Leila
Published: April 2021

Objective:

Ramadan fasting is a religious obligation practiced by Muslim population. No clear consensus and a paucity of evidence are published to guide patients and clinicians in management of hypertension during fasting Ramadan as well as fasting effects are not well studied. This study was performed to assess the impact of Ramadan fasting on hypertensive patients.

Design and method:

We performed a prospective multi centric Tunisian study from April, 15th to Mai, 15th 2019. We compared hypertensive patients who fasted Ramadan to those who did not fast. Life style, adherence to treatment and impact of fasting Ramadan were compared between two groups.

Results:

We analyzed 25609 patients with hypertension. Mean age was 64.4 ± 12.5 years old. More than 48% of patients were aged more than 65 years old. Female gender represented 54.7%. Prevalence of diabetes, obesity and coronary artery diseases were 39.5%, 27% and 18.5% respectively. Mean of systolic blood pressure (SBP) was 138.87 ± 19.62 mmHg. Prevalence of stroke, atrial fibrillation and hypertensive nephropathy were 6.6%, 7.4% and 33% respectively. Sixty four percent of patients fasted during Ramadan. In comparison to patients who did not fast during Ramadan, eating salty food was significantly lower in patients who fasted during Ramadan (42.1%vs. 60.1%; p < 0.001). There was an obvious change in the lifestyle activities and a significant increase of sport practice in patients who fasted Ramadan (19% vs. 7.5% p < 0.001). Anti-hypertensive drug adherence was significantly higher in patients who fasted Ramadan. A significant difference in blood pressure target was reported in hypertensive patients who fasted Ramadan (32.4% vs. 17.4%; p < 0.001).

Conclusions:

Ramadan Fasting could be beneficial in hypertensive patients to reach target blood pressure level provided that they should be carefully monitored during fasting and adhere to treatment and diet. Physician should adopt an educational program and avoid therapeutic inertia to prevent complications during fasting Ramadan.
EFFECT OF NIFEDIPINE GITS VERSUS RAMIPRIL ON HOME BLOOD PRESSURE VARIABILITY: PRELIMINARY RESULTS OF REVERENT RANDOMIZED TRIAL
Authors: Bilo Grzegorz , Kyriakoulis Konstantinos , Liu Chang -Yuan , Soranna Davide , Ceravolo Isabella , Cassago Silvia , Zhang Wei , Kollias Anastasios , Pengo Martino , Zambon Antonella , Wang Jiguang , Stergiou George S. , Parati Gianfranco
Published: April 2021

Objective:

Blood pressure (BP) variability (BPV) was shown to independently predict adverse outcomes, making it a potential target for treatment. Preliminary data indicated a possible larger reduction of BPV with dihydropyridine calcium channel blockers (CCB). However, it is not clear whether different antihypertensive drug classes can differently affect BPV. Aim of REVERENT (Reducing blood pressure Variability in Essential hypertension with Ramipril vErsus Nifedipine GITS) Trial was to compare BPV changes after a period of treatment with a CCB (nifedipine GITS) or an ACEI (ramipril).

Design and method:

Patients with essential hypertension either treatment naïve or after washout from previous treatment were included. Participants were randomized according to a PROBE design to nifedipine GITS 30 mg or ramipril 10 mg in a single morning dose. We report preliminary data on day-to-day BPV (expressed as standard deviation; SD of all readings) estimated from home measurements (7 days; duplicate morning and evening measurements per day; AND UA-651BLE) at baseline and after 10 weeks of treatment.

Results:

153 patients successfully completed the study (table). Patient characteristics, home BP and BPV values at baseline and after 10-week treatment in all participants and separately in naïve (N = 121) and previously treated patients (N = 32) are reported (table). We observed no significant differences between treatment groups in the change (baseline to 10-week) of home BPV except for treatment naïve hypertensive patients in whom a small but significant difference in systolic BPV change was observed.

Conclusions:

These data, overall, did not show clear differences between nifedipine GITS and ramipril in reducing home BPV, except for treatment-naïve individuals in whom a small but significant difference in favour of the CCB was observed. The relevance of treatment induced BPV changes requires documentation in outcome studies.
THE EFFECT OF THYROID HORMONE NORMALIZATION ON AMBULATORY BLOOD PRESSURE MONITORING IN HYPOTHYROID PATIENTS
Authors: Colapietro Nina , Xodo Carlotta , Rovina Matteo , Grillo Andrea , Darin Anna , Giudici Fabiola , Carretta Renzo , Fabris Bruno , Bernardi Stella
Published: April 2021

Objective:

It is well known that thyroid hormones regulate cardiovascular function. Thyroid disease is extremely common with a prevalence of 9–15% in the general population. The aim of our study was to assess the effects of thyroid hormones on the changes of blood pressure and pulse wave in a cohort of hypothyroid patients.

Design and method:

a total of 24 patients with severe hypothyroidism were enrolled in this study. Follow-up data are available for 11 patients, after normalization of their thyroid hormone profile. At baseline and after normalization of thyroid hormone profile, patients underwent an ABPM and an arterial tonometry. Data were analyzed with the statistical software R (version 3.0.3). In particular, patients were compared by Wilcoxon test for paired data, as they didn’t have normal gaussian distributions.

Results:

hypothyroid patients presented with overt thyroid disease (TSH 58,66 ± 47,50). Our preliminary data show that after euthyroidism restoration (TSH 2,21 ± 1,21), there weren’t any variations in global systolic and diastolic blood pressure, meanwhile their variability was reduced. In particular, this was observed for global sistolic variability (p value 0.05) and there was a decrease with borderline significance of global diastolic variability (p value 0.06). We did not observe any difference in terms of mean arterial pressure, PWV, and the other pulse wave analysis parameters

Conclusions:

our preliminary data suggest that euthyroidism restoration with levothyroxine can significantly reduce blood pressure variability in hypothyroid patients. This confirms the importance of thyroid hormones for blood pressure control.
EFFECTS OF GLYCOSYLATED HEMOGLOBIN LEVEL ON BLOOD PRESSURE VARIABILITY IN HYPERTENSIVE PATIENTS
Authors: Li Yuan , Guo Yuxuan , Hu Tao , Xia Ke
Published: April 2021

Objective:

To investigate the effect of glycosylated hemoglobin (HbA1c) levels on blood pressure variability in hypertensive patients.

Design and method:

From September 2018 to April 2019, in the Xiangya Hospital of Central South University, 429 case of hypertensive patients with complete basic information, medical records, HbA1c measures and other biochemical indicators, as well as the 24-hour ambulatory blood pressure result were enroll in and divided into two groups (119 in the high HbA1c group with HbA1c more than 6.1 mg/dl and 310 in the normal HbA1c group with HbA1c less than 6.1 mg/dl). The blood variability, night drop rate, and fluctuations were compared between the two groups. Multivariate logistic regression analysis and Pearson correlation analysis were used to explore the relationship between HbA1c level and blood pressure variability.

Results:

In hypertensive patients, the level of systolic and diastolic pressure during 24-hour, daytime, nighttime and the proportion of non-dipping blood pressure in the high HbA1c group was higher than that in the normal HbA1c group (p < 0.05); There was no significant difference between the two groups in blood pressure load, variability, and nocturnal blood pressure drop rate (p > 0.05).Multivariate logistic regression analysis showed that nocturnal mean systolic blood pressure was a risk factor for increased HbA1c levels, with OR (95% CI) of 1.031 (1.017 to 1.045). Pearson correlation analysis implied that the level of HbA1c was positively correlated with the maximum, the minimum and the average value of 24-hour systolic pressure and mean systolic pressure of daytime and nighttime (r = 0.131, 0.129, 0.155, 0.151, 0.164; p < 0.05). Further analysis of grade 3 hypertensive patients, the high HbA1c group of had the higher value of night systolic pressure load and non-dipping blood pressure ratio. Multivariate logistic regression analysis showed that the mean nocturnal systolic pressure was a risk factor for elevated HbA1c levels, with OR (95% CI) being 3.774 (1.086 to 13.117).

Conclusions:

HbA1c is closely related to hypertension (especially systolic blood pressure). In the grade 3 hypertensive patients, the elevated HbA1c might increase the value of the nocturnal systolic blood pressure load.
METHOD OF PREVENTING CARDIOTOXIC EFFECT OF ANTITUMOR TREATMENT FOR BREAST CANCER
Authors: Natallia Natallia Kananchuk , Mitkovskaya Natalya Pavlovna Natalya , Mikulich Dmitriy Mikulich Dmitriy , Smirnov Sergey Smirnov Sergey , Gutkovskaya Ekaterinagutkov Ekaterina
Published: April 2021

Objective:

In the Republic of Belarus cancer and cardiovascular disease are the leading causes of disability and mortality. Anthracyclines and radiation therapy have a high efficacy for the treatment of breast cancer. However, these treatments can also induce progressive cardiac remodelling as a late consequence of earlier myocyte damage, resulting in late cardiomyopathy.

Design and method:

97 women with breast cancer were included in the study. The patients received surgery, anthracycline chemotherapy and 47 women radiation therapy.

The patients were randomized into 3 groups: group 1- with antitumor treatment alone (54 cases), group 2 –patients with antitumor treatment who received carvedilol combined with valsartan and had no hypertension (24 cases); group 3- patients with antitumor treatment who received carvedilol combined with valsartan and had hypertension (19 cases).

Results:

After a full course of antitumor treatment left ventricular ejection fraction significantly decreased in group 1 (p < 0,05), which indicates deterioration of left ventricular systolic function. Group 1 also showed a significant increase in the sphericity index systole and diastole (p < 0,05), indicating the left ventricle remodeling during chemotherapy. This study revealed significant decrease of the ratio transmitral flows, which indicates deterioration of left ventricular diastolic function in group 1 (p < 0,05).

These changes were not revealed in groups 2 and 3.

Conclusions:

Chemotherapy with anthracyclines and radiation therapy cause left ventricle remodeling, deterioration of left ventricular systolic and diastolic functions.

The use of valsartan in combination with carvedilol can reduce acute and chronic cardiotoxicity of breast cancer chemotherapy.
MULTIPLE MYELOMA PATIENTS UNDERGOING CARFILZOMIB: VALIDATION OF A MANAGEMENT PROTOCOL FOR CARDIOVASCULAR RISK ASSESSMENT AND A NEW SCORE FOR EVENTS PREDICTION
Authors: Astarita Anna , Mingrone Giulia , Airale Lorenzo , Cesareo Marco , Vallelonga Fabrizio , Bruno Giulia , Leone Dario , Giordana Carlo , Rabbia Franco , Salvini Marco , Gay Francesca , Bringhen Sara , Veglio Franco , Milan Alberto
Published: April 2021

Objective:

Cardiovascular adverse events (CVAEs) are closely related to Carfilzomib (CFZ) therapy in multiple myeloma (MM), however no validated management protocols are available. This perspective study investigated the effectiveness of the European Myeloma Network protocol (EMN) in cardiovascular risk assessment. A risk score to predict CVAEs was developed and the type and incidence of CVAEs were assessed.

Design and method:

116 MM patients scheduled for CFZ underwent a baseline evaluation including office and out-of-office blood pressure measurements, ECG, echocardiography (included GLS) and arterial stiffness estimation. The repeated evaluations every 3–6 months allow CVAEs detection.

Results:

During a median of 10.8 months of follow-up, 62 patients (53.4%) experienced one or more CVAEs: 17 (14.7%) had major CVEAs (41.2% arrhythmias, 23.5% acute ischemic cardiopathy as most frequent) and 45 (38.7%) had hypertensive CVAEs. 51.9% of CVAEs occurred within the first 3 months, with 30.9% grade 3 or greater in severity. At baseline the prevalence of uncontrolled blood pressure values (51.7%) and of subclinical organ damage, were substantial. Five baseline parameters have proved to be independent predictors for CVAEs: higher office systolic blood pressure (p = 0.003), higher 24-hours blood pressure variability (p = 0.004), left ventricular hypertrophy (p = 0.021), higher pulse wave velocity value (p = 0.002) and global longitudinal strain impairment (p = 0.033). The resulting CVAEs risk score allows to define a low- and high-risk group, obtaining a sensibility of 94% in detecting CVAEs in the high-risk (AUC 0.76).

Conclusions:

CFZ therapy is closely linked to CVAEs developing in MM patients. The application of the EMN protocol and the use of the CVAEs risk score might be useful to correctly estimate the cardiovascular risk profile and to identify the higher risk patients, enabling risk mitigation strategies.
APATINIB-INDUCED HYPERTENSION ASSOCIATED WITH BETTER PROGNOSIS IN PATIENT WITH SOLID TUMOR
Authors: Li Caie , Ma Liping , Wang Qiongying , Zhao Xu , Ma Ruixin , Li Ningyin , Yu Jing
Published: April 2021

Objective:

To investigate the incidence of apatinib-induced hypertension (HTN) in the treatment of patients with solid tumor in real world and to determine whether apatinib-induced HTN is associated with its anti-tumor efficacy.

Design and method:

We retrospectively collected the medical records of patients with solid tumor treated with apatinib in Lanzhou University Second Hospital and Gansu Provincial Cancer Hospital, from Oct 1st 2014 to Jun 30st 2019. The patients were then prospectively followed to determine the disease state, time of disease progression and death, as well as whether or not have newly initiated HTN. The mean follow-up was 16.5month, with the longest follow-up of 48 months. The apatinib-induced HTN was defined as either newly initiated HTN in patients with normal blood pressure or increases of antihypertensive intensity in patients with pre-existed HTN. The prognosis of patients was estimated with progression-free survival (PFS) and overall survival (OS).

Results:

A total of 400 patients were enrolled, of whom 136 (34%) were diagnosed with HTN induced by apatinib. The primary tumor in 40% of the patients were gastrointestinal cancer, followed by hepatobiliary cancer (14.5%) and lung cancer (13.3%). Patients in HTN group were older (p = 0.03), more frequently with proteinuria (p = 0.035) and higher dosage of apatinib (p = 0.024). The survival analysis showed that apatinib-induced HTN was associated with significantly longer PFS, as well as OS (both p < 0.01), the differences existed both in univariate and multivariate analyses. The subgroup analyses were performed in patients with gastrointestinal cancer, hepatobiliary cancer, and lung cancer, all showed consistent results.

Conclusions:

HTN is one of the most common side effects of apatinib in the treatment of solid tumors, with an incidence of as high as 34% in real world. Apatinib-induced HTN is significantly associated with better anti-tumor efficacy in patients with solid tumors. Given that there is still no effective predictive biomarker for apatinib, drug-induced HTN may be used as an surrogate one. The development of new antihypertensive drugs with better antihypertensive effects while no influences on antitumor activity, is in urgent need.