bluuebunny/crossref_metadata_2025 huggingface dataset:
ACCURACY AND BLOOD PRESSURE THRESHOLD CONTROL ANALYSIS OF UNATTENDED AUTOMATED OFFICE BLOOD PRESSURE MEASUREMENT: A CROSS-SECTIONAL STUDY BASED ON MULTICENTER POPULATIONS
Authors: Yang Shijie , Zhou Zhanyang , Miao Huanhuan , Yin Zheng , Zhang Yuqing
Published: May 2024

Objective:

The emergence of unattended automated office blood pressure (u-AOBP) measurement, facilitated by the flourishing development of electronic blood pressure monitors, has been proposed as a potential alternative or complementary approach for assessing patients’ blood pressure status within clinical settings. However, robust evidence is lacking to determine its application in diagnosing hypertension within the clinical practice in China. This study aims to compare u-AOBP values with standard office blood pressure data, assess the correlation between u-AOBP and diagnostic thresholds.

Design and method:

The study involved participants recruited from October 2023 to February 2024 in three hospitals: People's Hospital of Gongyi City in Henan Province, Nangong City Hospital in Hebei Province, and Fuwai Hospital of the Chinese Academy of Medical Sciences. Standardized validated upper arm blood pressure monitors were used to measure blood pressure. Baseline demographic data, anthropometric measurements, u-AOBP, and standard office blood pressure data were collected, along with additional examination results, including echocardiograms and 24-hour ambulatory blood pressure monitoring.

Results:

1. The difference between u-AOBP and awake dynamic average blood pressure was 1.34 mmHg (95% confidence interval: 0.88-3.55 mmHg), and the difference was not statistically significant (P = 0.236).

2. The optimal cutoff values for diagnosing elevated blood pressure using u-AOBP, determined by ROC curve analysis based on awake dynamic blood pressure measurements, were 130.75/83.75 mmHg (sensitivity 89.73%, specificity 27.27%).

3. In participants with a dipper blood pressure diurnal rhythm, there was no statistically significant difference between standard office blood pressure and u-AOBP measurements (P > 0.05). However, in the group including non-dipper rhythm participants, standard office blood pressure was higher than u-AOBP by 5.84/4.98 mmHg (P < 0.05).

Conclusions:

1. Unattended automated blood pressure measurements can reduce, but not eliminate, the white coat effect, with an optimal cutoff value for diagnosing elevated blood pressure determined as 130.75/83.75 mmHg.

2. In individuals with a normal dipper blood pressure diurnal rhythm, standardized u-AOBP values are equivalent to standard office blood pressure.
CEREBRAL SMALL VESSEL DISEASE MEDIATES THE EFFECT OF ARTERIAL STIFFNESS ON COGNITIVE DECLINE IN PATIENTS WITH HEART FAILURE WITH PRESERVED EJECTION FRACTION
Authors: Müller Patrick , Horndasch Laslo , Neumann Katja , Mattern Hendrik , Cardace Silvio , Arndt Philipp , Pfister Malte , Groscheck Thomas , Vielhaber Stefan , Meuth Sven , Dunay Ildiko , Schmeißer Alexander , Behme Daniel , Schreiber Stefanie , Braun-dullaeus Rüdiger
Published: May 2024

Objective:

Epidemiological data indicate a high prevalence of cognitive dysfunction and dementia risk in patients with heart failure with preserved ejection fraction (HFpEF). However, underlying mechanisms are yet not fully understood. Common risk factors for HFpEF and cognitive decline are hypertension and arterial stiffness, which are characterized by structural and functional vascular changes causing microvascular dysfunction and end organ damages. We hypothesize that the effect of arterial stiffness on cognition in patients with HFpEF is mediated by microvascular brain disease (cerebral small vessel disease, CSVD).

Design and method:

In this prospective cohort study we included 14 HFpEF patients (age: 66.6 ± 10.0 years) and 11 cognitively normal, healthy controls (age: 69.4 ± 9.4), who underwent comprehensive cardiovascular assessment. Arterial stiffness was assessed with pulse wave velocity measurements. The CERAD-plus neuropsychological test battery was used to estimate cognitive decline. CSVD severity (summary SVD score) was quantified in accordance with the STandards for ReportIng Vascular changes on nEuroimaging criteria (STRIVE) using 3-Tesla brain magnetic resonance imaging.

Results:

Results: Patients with HFpEF showed increased arterial stiffness [F(1,20) = 7.33, p = .014], impaired cognition [F(1,20) = 33.34, p <.001), and higher CSVD burden [F(1,23) = 32.39, p <.001] in comparison to healthy, age-matched controls, whereas arterial stiffness correlated with cognitive dysfunction (r = -.44, p = .046) and summary SVD scores (r = .71, p = .0002). Moreover, summary SVD scores fully mediated the relationship of arterial stiffness and cognition (Figure 1).

Conclusions:

We showed that CSVD mediates the effect of arterial stiffness on cognition in patients with HFpEF. Our study demonstrated the fundamental role of cardiovascular factors in the development of cognitive decline, and the urgent need for interdisciplinary heart-brain research investigating the interrelationship of heart and brain diseases.

Figure 1: Mediation Analysis. CSVD burden (summary SVD scores) fully mediated the relation between arterial stiffness (pulse wave velocity) and cognitive decline (assessed with CERAD-plus). Age was included as covariate into the model. Significant paths are marked with ∗∗/∗∗∗ for p < .01/.001.
ESTIMATING THE PREVALENCE OF CHILDHOOD HYPERTENSION AND ITS CONCOMITANT METABOLIC ABNORMALITIES IN THE NORTHEASTERN REGION OF HUNGARY USING DATA MINING METHODS
Authors: Pall Denes , Kovacs Beata , Nemeth Akos , Daroczy Balint , Karanyi Zsolt , Maroda Laszlo , Zrinyi Miklos , Dioszegi Agnes , Nadro Biborka , Szabo Tamas , Harangi Mariann
Published: May 2024

Objective:

Childhood hypertension presents a considerable public health challenge worldwide. The number of children diagnosed with hypertension has significantly grown in the past few decades. Therefore, we aim to identify the prevalence of childhood hypertension in our region and its concomitant metabolic abnormalities using data mining methods to analyze a rather large population.

Design and method:

We analyzed data from 3 to 18-year-old children who visited the University of Debrecen Clinical Center's hospital throughout a 15-year study period (from 2007 to 2021) (n = 92,198; boys/girls: 48/52%).

Results:

We identified a total of 3,687 children with hypertension (2,107 boys and 1,580 girls), with a 4% calculated prevalence of hypertension. The prevalence of hypertension was higher in boys (4.7%) compared to girls (3.2%). We found an increasing prevalence in the consecutive age groups in the whole study population (1.54; 2.64; 4.0; 5.49 and 5.56%), and in the boys (1.66; 2.6; 4.57; 6.48 and 8.22%). We found higher BMI values in hypertensive children as compared to the normotensive group in all studied patient groups (25.6; 26.7; 28.1 and 29.7 vs. 20.1; 21.4; 22.6 and 24.6 kg/m2 in the 6-9–year-old, 9-12–year-old, 12-15–year-old and 15-18–year-old groups, respectively). Significantly higher serum uric acid levels were found in children with hypertension (299.2±86.1 vs. 259.9±73.3 μmol/L, p<0.001), while glucose levels did not differ significantly. Significantly higher total cholesterol (4.27±0.95 vs. 4.17±0.88 mmol/L, p<0.001), LDL-C (2.62±0.79 vs. 2.44±0.74 mmol/L, p<0.001) and triglyceride (1.2 (0.85-1.69) vs. 0.94 (0.7-1.33) mmol/L, p<0.001) and lower HDL-C (1.2±0.3 vs. 1.42±0.39 mmol/L, p <0.001) levels were found in hypertensive children. Furthermore, we assessed the rate of significant concomitant diseases in our hypertensive population.

Conclusions:

Childhood hypertension is a chronic disease associated with metabolic complications at presentation. Although the data mining method is not widely used in epidemic studies, it is an excellent way to define prevalence in large patient cohorts. To date, this is the first study providing data on childhood hypertension in Eastern Europe to embrace the benefits of data mining methods.
CARDIOVASCULAR OUTCOMES IMPROVE IN CHILDREN WITH RENOVASCULAR HYPERTENSION FOLLOWING ENDOVASCULAR AND SURGICAL INTERVENTIONS
Authors: Paessler Alicia , Redhead Emily , Arslan Zainab , Patel Premal , Minhas Kishore , Forman Colin , Hollis Paolo , Lava Sebastiano , Ionescu Florin , Manuel Devi , Ray Samiran , Kessaris Nicos , Giardini Alessandro , Ratnamma Vineetha , Dobby Nadine , Tullus Kjell , Simmonds Jacob , Stojanovic Jelena
Published: May 2024

Objective:

Renovascular hypertension (RVH) is a common cause of hypertension in children. It is caused by renal artery stenosis reducing the blood supply to the renal parenchyma and activating the renin-angiotensin-aldosterone axis, often leading to cardiac remodelling. This is a longitudinal observational study that aims to describe the occurrence of hypertensive changes and their severity and also any improvement in cardiac remodelling after successful endovascular and/or surgical intervention in children with RVH.

Design and method:

All patients with RVH referred to our centre, who had received at least one endovascular intervention, were included. Data was collected by retrospective database review over a 22-year period. We assessed oscillometric blood pressure as well as eight echocardiographic parameters pre- and post-intervention: intraventricular septal diameter (IVSD), posterior wall diameter (PWD), left ventricular internal diastolic diameter (LVIDD), fractional shortening (FS), Relative Wall Thickness (RWT), Left Ventricular Mass (LVM) and Left Ventricular Ejection Fraction (LVEF).

Results:

152 patients met inclusion criteria and had on average two endovascular interventions. Six children presented in frank heart failure. 54.4% achieved normal blood pressure (BP) control after intervention. Average z-scores improved in IVSD, PWD and FS; LVMI and RWT also improved. PWD saw the greatest reduction in mean difference in children with an abnormal (z-score reduction of 0.25, p<0.001) and severely abnormal (z-score reduction of 0.23, p<0.001) z-scores between pre- and post-intervention echocardiograms. 45.9% of children had a reduction in prescribed antihypertensive medications.

Conclusions:

Our study reports improvement in cardiac outcomes after either endovascular or surgical intervention. This is evidenced on BP control and echocardiogram changes in which almost half achieved normalisation in systolic BP readings and reduction in the number of children with abnormal echocardiographic parameters.
ASSOCIATION BETWEEN NORMAL-WEIGHT OBESITY AND BONE MINERAL CONTENT IN CHINESE ADOLESCENTS AGED 12–18 YEARS OLD: A POPULATION-BASED CROSS-SECTIONAL STUDY
Authors: Tian Mei , Ma Xiaoyan , Liu Jianxi , Tong Lingling , Ding Wenqing
Published: May 2024

Objective:

The effects of normal-weight obesity, which is defined as having a high level of body fat despite a normal body mass index, on the health of bones in adolescents are very limited. Hence, the purpose of this investigation was to explore the relationship between normal-weight obesity and bone mineral content (BMC) among Chinese adolescents.

Design and method:

This cross-sectional study included 1,960 children and adolescents aged between 12 and 18 years who were selected from schools in Yinchuan city by stratified cluster random sampling. Subjects were divided into three groups according to body mass index (BMI) and percentage of body fat (PBF), as follows: normal-weight non-obesity(NWNO), normal-weight obesity (NWO), and obesity (OB).

Results:

The NWNO, NWO, and OB phenotypes in boys were 69.9%, 8.8%, and 21.3%, respectively, and were 35.3%, 48.6%, and 16.1% in girls, respectively. The OB phenotypes had higher BMC than the NWNO phenotype (all p < 0.05), and the NWO phenotype with BMC was significantly lower than NWNO group in boys (p < 0.05). We discovered a significant positive correlation between BMC and the NWO (OR = 1.62, 95% CI = 1.19–2.20), while negative correlation was found between BMC and OW phenotypes in neither boys nor girls.

Conclusions:

Normal-weight obesity adolescents had higher BMC, and there existed sex differences in the effect of PBF on BMC among them.
FLOW-MEDIATED DILATION OF BRACHIAL ARTERY IN CHILDREN AND ADOLESCENTS WITH ESSENTIAL ARTERIAL HYPERTENSION
Authors: Jukic Ivana , Kos Martina , Stupin Ana , Mihaljevic Zrinka , Nad Tihana , Damasek Mia , Drenjancevic Ines , Puseljic Silvija
Published: May 2024

Objective:

Flow-mediated dilation (FMD) of brachial artery represents non-invasive method that evaluates the endothelial function in macrovasculature, and some studies suggest that FMD possesses an independent prognostic value for the occurrence of future cardiovascular events. It is well accepted that hypertension is associated with impaired endothelium-dependent vascular response in adult patients and reduced vasodilation is considered an initial sign of functional alterations that precede the morphological changes. However, there is a lack of data on hypertension-related endothelial (dys)function in hypertensive children. Thus, present study aimed to evaluate macrovascular endothelium-dependent reactivity.

Design and method:

52 children and adolescents were enrolled in this observational cross-sectional study; 26 healthy normotensive (NT) and 26 with diagnosed essential arterial hypertension (HT), both sexes, 9-17 years old. In addition to anthropometric, and hemodynamic measurements, the endothelial function of brachial artery was evaluated using a method based on the assessment of flow-mediated dilation. Statistical analysis was conducted by Mann-Whitney U test (between groups) and an analysis of covariance (ANCOVA) adjusted for age, gender, BMI and lipid parameters was performed (p< 0.05 was considered statistically significant).

Results:

Although body mass index (BMI) was significantly higher in children and adolescents with essential arterial hypertension compared with normotensive, waist-to-hip (WHR) ratios were similar in both groups. Systolic (SBP), diastolic (DBP) and mean (MAP) arterial blood pressure were significantly higher in the HT compared to the NT group, while there were no difference in heart rate between groups. Endothelium-dependent vasodilation of the brachial artery assessed by ultrasound flow-mediated dilation was significantly decreased in hypertensive children compared to normotensive healthy children (FMD % of dilation NT 10.22 [7.00-17.31] vs. HT 8.68 [6.14-12.98]).

Conclusions:

Even in childhood, essential arterial hypertension has an adverse effect on vascular function and significantly reduces the endothelium-dependent response of brachial artery, independently of age, gender, BMI and lipid parameters. (Trial Registration:NCT05109013)
OFFICE BP MEASUREMENT USING CONICAL CUFFS IN OBESE CHILDREN AND ADOLESCENTS
Authors: Evripidou Kleo , Pitti Julio Alvarez , Chainoglou Athanasia , Goulas Ioannis , Herberigs Karel , Hamdani Gilad , Stabouli Stella ,   Hyperchildnet Working Group 1
Published: May 2024

Objective:

Findings from adult studies suggest that tronco-conical cuffs should be used for accurate blood pressure (BP) measurement in obese individuals with large arm circumference (AC). The aim of the present study was to examine differences in office blood pressure (BP) levels using conical cuffs compared to standard-shaped cylindrical cuffs in obese children and adolescents.

Design and method:

We performed an observational study enrolling 37 obese children and adolescents consequently recruited from the outpatient clinics of the Obesity Unit at General University Hospital Consortium of Valencia. The device used for the office BP measurements was OMRON HBP-1320 (HBP-1320-E). Middle AC was measured in all participants and the appropriate cuff size was selected among five sizes of conical and three sizes of regular cylindrical cuffs.

Results:

Mean participants’ age was 11.8±2.5 years, mean BMI was 28.8±3.4 kg/m2, BMI z-score was 2.1 ± 0.3, and mean AC was 30.0±3.6 cm. There was no statistical significance in BP levels measured by cylindrical compared to conical cuffs (mean difference cylindrical-conical cuff was -0.22±6.55 mmHg for SBP, -0.02±0.81 for SBP z-score, -0.70±4.95 mmHg for DBP, and -0.06±0.44 for DBP z-score). The analysis was repeated after excluding participants aged <9 years old, retrieving similar results. A significant positive association was found between the measurements obtained by cylindrical and conical cuffs in both mean and z-score SBP and DBP values (p <0.001). Bland-Altman analysis showed good agreement, with 94.6% of the values for all BP parameters, lying between the limits of agreement. No proportional bias was detected (p >0.05).

Conclusions:

The use of conical cuffs resulted in similar office BP levels in obese children and adolescents suggesting no advantage in enhancing tolerability and accuracy of office BP measurement in these patients. Although conical cuffs may be considered an alternative for office BP measurements in obese children, their reliability should be confirmed in larger populations and different settings.

Acknowledgments: This abstract is based on the work of the COST Action HyperChildNET (CA19115), with the support of COST (European Cooperation in Science and Technology) and the Horizon 2020 Framework Program of the European Union.
PRIMARY HYPERTENSION AND SECONDARY HYPERTENSION IN CHILDREN - A SINGLE-CENTER EXPERIENCE
Authors: Bujanowicz Adam , Skrzypczyk Piotr , Ofiara Anna , Smyk Katarzyna , Szyszka Michal , Panczyk-tomaszewska Malgorzata
Published: May 2024

Objective:

Arterial hypertension (AH) occurs in the developmental age in about 4% of patients. There is controversy regarding the prevalence of primary hypertension (PH) and secondary hypertension (SH) in children. The study aimed to characterize the hypertensive patients hospitalized in one pediatric nephrology center.

Design and method:

In 657 patients hospitalized between 2018 and 2022 with suspicion of hypertension, we diagnosed AH in 441 patients. We assessed the following: etiology of AH, age at diagnosis, current age, blood pressure (Z-score), and anthropometric and biochemical parameters.

Results:

In the study group of 441 patients, there were 282 boys and 159 girls. The age of diagnosis was 11.2±5.0, and the current age was 12.5±4.7 years. The causes of AH were: PH in 279 (63.3%), SH in 162 (36.7%): renal - 109, drug-induced - 35, renovascular - 10, hormonal - 3, aortic coarctation - 2, other - 3. Patients with PH were older (14.2±3.4 vs. 9.6±5.1 [years], p<0.001), had higher height Z-score (0.7 ±1.0 vs. 0.0±1.5, p<0.001), BMI Z-score (1.3±1.1 vs. 0.6±1.2, p<0.001) and higher uricemia (5.8±1.5 vs. 5.3±2.1 [mg/dL], p<0.001). The groups didn’t differ significantly in SBP Z-score and DBP Z-score. In children under 10 years of age, out of 120 patients with AH, 34 (28.3%) had PH; in children >=10 years of age, out of 321 patients with AH, 245 (76.3%) had PH. PH was statistically more frequent in boys than in girls (PH - 198 boys, 81 girls, SH - 84 boys, 78 girls, p=0.001). The diagnosis of PH was associated with a higher height Z-score (OR 1.49, 95CI: 1.16-1.91), higher BMI Z-score (OR 1.41, 95CI: 1.12-1.78), and older age (OR 1.33, 95CI: 1.24-1.44).

Conclusions:

1. Currently, primary hypertension may be the most common etiology of hypertension in children.

2. Higher height, higher BMI, and older age rather than blood pressure values suggest a diagnosis of primary hypertension.
COMPARATIVE EFFECTIVENESS OF FREE AND FIXED COMBINED ANTIHYPERTENSIVE THERAPY IN ACHIEVING TARGET BLOOD PRESSURE VALUES IN UNCONTROLLED ARTERIAL HYPERTENSION
Authors: Shukurova Dilafruz , Khamidullayeva Gulnoz , Abdullaeva Guzal , Yusupova Hafiza
Published: May 2024

Objective:

Aim of our study was to assess the achievement of target blood pressure in uncontrolled hypertensive patients with high and very high-risk, resistant to double AHT, depending on the treatment regimen - free and fixed combinations of three antihypertensive drugs.

Design and method:

The study included 143 patients II-III AH stage, who were on double AHT, who are not reached the target blood pressure level. The average age of patients was 55.8±9.35 years, including men n=70 (49%), women n=73 (51%). All patients underwent a physical examination with three measurements of office blood pressure using the Korotkoff method. Patients were randomized into 2 groups: group 1- triple antihypertensive therapy with a free combination of indapamide, amlodipine, and perindopril (n=71), and 2 nd group- a fixed combination therapy (n=72). Statistics were carried out between the stages before treatment and 6 months.

Results:

Research results. Against the background of triple AHT, target blood pressure levels were achieved in both groups: in group 1, initial SBP/DBP before treatment was 171.29±16.6 mmHg/99.64±9.03 mmHg, in dynamics 128.38±8.5 mmHg/80.89±6.38 mmHg. (p=0.0001); in group 2: initially SBP/DBP before treatment 170.76±17.75 mmHg/100.63±8.39 mmHg, 6 months of therapy 121.95±6.7 mmHg st./77.23±5.59 mmHg (p=0.0001). The results showed a significant decrease in SBP (p=0.0001) and DBP (p=0.0001) in group 2 compared to group 1. At the same time, the primary target level in group 1 was achieved in 83.3%, in group 2 in 94.4% of patients (χ2 = 7.471; p = 0.006). The target blood pressure level <130/80 according to SBP was achieved by 42% and 67% of patients, respectively, for groups 1 and 2 (χ2=11.61; p=0.0001); for DBP – 10% and 33.3%, respectively, for groups 1 and 2 (χ2=9.011; p=0.003).

Conclusions:

Obtained results showed the high antihypertensive effectiveness of 6-month AHT with a triple fixed combination therapy compared to free, achieving the primary target blood pressure level and the main target blood pressure level in a significantly larger number of patients with hypertension on a triple fixed combination of antihypertensive drugs.
COMPARISON OF TWO SINGLE-PILL DUAL COMBINATION ANTIHYPERTENSIVE THERAPIES IN CHINESE PATIENTS
Authors: Huang Qi -FANG , Zhang Di , Luo Yihong , Hu Kun , Wu Qiong , Qiu Hailong , Xu Fei , Wang Mei -Ling , Chen Xin , Li Yan , Wang Ji -Guang
Published: May 2024

Objective:

Current hypertension guidelines recommend combination of an angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker with a calcium-channel blocker or thiazide diuretic as initial antihypertensive therapy in patients with monotherapy uncontrolled hypertension. However, to what extent these two different combinations are comparable in blood pressure (BP) lowering efficacy and safety remains under investigation, especially in the Chinese population. We investigated the BP lowering efficacy and safety of the amlodipine/benazepril and benazepril/hydrochlorothiazide dual therapies in Chinese patients.

Design and method:

In a multi-center, randomized, actively-controlled, parallel-group trial, we enrolled patients with stage 1 or 2 hypertension from July 2018 to June 2021 in 20 hospitals and health centers across China. Of the 894 screened patients, 560 eligible patients were randomly assigned to amlodipine/benazepril 5/10 mg (n = 282) or benazepril/hydrochlorothiazide 10/12.5 mg (n = 278), with 213 and 212 patients, respectively, who completed the study and had a valid repeat ambulatory BP recording during follow-up and were included in the efficacy analysis.

Results:

In the efficacy analysis (n = 425), the primary outcome, 24-h ambulatory systolic BP reduction, was -13.8±1.2 mmHg in the amlodipine/benazepril group and -12.3±1.2 mmHg in the benazepril/hydrochlorothiazide group, with a between-group difference of -1.51 (p = 0.36) mmHg. The between-group differences for major secondary outcomes were -1.47 (p = 0.18) in 24-h diastolic BP, -2.86 (p = 0.13) and -2.74 (p = 0.03) in daytime systolic and diastolic BP and 0.45 (p = 0.82) and -0.93 (p = 0.44) in nighttime systolic and diastolic BP. In the safety analysis (n = 560), the incidence rate of dry cough was significantly lower in the amlodipine/benazepril than benazepril/hydrochlorothiazide group (5.3% vs 10.1%, p = 0.04).

Conclusions:

The amlodipine/benazepril and benazepril/hydrochlorothiazide dual therapies were comparable in ambulatory systolic BP lowering. The former combination, compared with the latter, had a greater BP lowering effect in the daytime and a lower incidence rate of dry cough.
EFFECTIVENESS OF CONSERVATIVE TREATMENTS ON CHRONIC VENOUS DISEASE SYMPTOMS AND QUALITY OF LIFE IN HYPERTENSIVE PATIENTS: A SUBGROUP ANALYSIS FROM THE VEINSTEP OBSERVATIONAL STUDY
Authors: Feodor Toni , Mezalek Zoubida Tazi , Ochoa Alejandro José González , Ulloa Jorge Hernando
Published: May 2024

Objective:

Chronic venous disease (CVeD) and arterial hypertension (HTA) are common circulatory system disorders associated with significant patient and healthcare burdens. Despite their high prevalence, patients presenting with both conditions are poorly studied resulting in a lack of evidence regarding optimal CVeD management in this specific group. This VeinStep sub-analysis evaluates the effectiveness of conservative treatments on CVeD symptoms and QoL in hypertensive patients.

Design and method:

VeinStep was an international, observational, prospective study, involving outpatients with symptomatic CVeD. Patients underwent a clinical examination to identify CVeD signs using CEAP classification. Main outcomes after 4 weeks were intensity of symptoms (VAS) and QoL using CIVIQ14. Changes over time were analyzed using a Wilcoxon test. Between-group comparisons for most prescribed venoactive drugs (VADs) used ranked ANCOVA with baseline value as covariate, adjusted on main baseline characteristics.

Results:

Among the 6084 patients analyzed in VeinStep, 1230 had HTA. They were more frequently men (28.9% vs 20.3%), older (Mean age±SD: 61.5±11.5 vs 47.9±13.0 yrs), obese (BMI>30 kg/m2: 43.9% vs 27.0%) and had more severe CEAP class (>=C4:26.6% vs 9.5%) than non-HTA patients. Most prescribed treatments involved VADs (97.2% of patients) mainly combined with compression and/or topicals: Micronized Purified Flavonoid Fraction (MPFF):77.5%, diosmin:17.7%, compression:59.1%, topicals:43.7%. VADs treatment resulted in significant decreases vs baseline in global symptoms intensity:- 2.39±1.78 (p<0.001) and in each symptom intensity (p<0.001) along with significant improvement in QoL: CIVIQ-14 score decreased by -10.49±8.21 (p<0.001). For MPFF- or diosmin-based therapy, global symptoms intensity decreased by -2.50±1.73 and -1.87±1.85, respectively (p<0.001 in favor of MPFF). MPFF-based therapy showed a higher beneficial effect on pain:-2.42±1.83 vs -1.77±1.69 (P=0.002); heaviness:-2.53±1.86 vs -1.79±1.75 (P<0.001); swelling:-2.46±1.92 vs - 1.76±2.03 (P<0.001); cramps:-2.15±1.96 vs -1.53±1.76 (P=0.002) and QoL:-10.94±8.02 vs - 9.07±8.87 (P=0.012) compared with diosmin-based therapy.

Conclusions:

This VeinStep sub-analysis offers valuable insights into the patient characteristics with both CVeD and HTA in real-life settings, guiding clinicians in selecting optimal treatments for improved outcomes. The findings suggest that VADs, particularly MPPF, significantly reduce CVeD symptoms and improve QoL in this population.
LEFT VENTRICULAR STRAIN IN PATIENTS WITH HYPERTENSIVE HEART DISEASE AND NORMAL EJECTION FRACTION ASSESSED BY SPECKLE TRACKING ECHOCARDIOGRAPHY
Authors: Drissi Hamed Bazrafshan , Khesali Hamideh , Barzegar Sara , Kaviani Raheleh , Askarinejad Amir , Ghaznavi Mohamad Ali
Published: May 2024

Objective:

Hypertension is a major risk factor for cardiovascular diseases and is associated with increased all-cause and cardiovascular mortality. Cardiac changes such as impaired left ventricular (LV) function, left ventricular hypertrophy (LVH), and heart failure are consequences of chronic exposure to elevated blood pressure. Speckle tracking echocardiography (STE) is a sensitive method for detecting early regional and global myocardial dysfunction missed in asymptomatic patients with cardiovascular disease by conventional modalities.

This study aimed to assess the ability of 2D-STE in assessing regional and global LV strain to diagnose subclinical LV dysfunction in patients with systemic hypertension and preserved ejection fraction.

Design and method:

This prospective observational study included 80 hypertensive patients and 30 healthy controls. In the hypertensive group, at least six months had passed from diagnosis of hypertension according to AHA guidelines. 2D echocardiographic LV images were acquired in apical 4, 2, and 3-chamber and parasternal short axis views. Left ventricular global longitudinal strain (LVGLS) and circumferential strain (LVGCS) were quantified in all segments using a Philips Affiniti 70 device. Differences between hypertensive patients and controls were analyzed using the independent t-test. A P-value less than 0.05 was considered statistically significant.

Results:

In comparison, LVGLS and LVGCS were significantly (P < 0.001) lower among the hypertensive group (GLS: -17.43 ± 1.71, GCS: -23.76 ± 3.35) than the control group (GLS: -20.18 ± 1.11, GCS: -27.46 ± 4.33). LVGLS was significantly (P < 0.001) lower in uncontrolled hypertension (-16.91 ± 1.70) vs. controlled hypertension (-17.96 ± 1.57). Similarly, LVGLS was significantly (P < 0.001) lower among the cases with LVH on 2D echocardiography (16.23 ± 1.69) compared to those without LVH (17.96 ± 1.6). In the hypertensive group, LVGLS was significantly lower in males (-16.84 ± 1.42) than in females (-18.02 ± 1.78; P < 0.05).

Conclusions:

This study demonstrates the potential benefits of using STE as a noninvasive imaging technique in assessing cardiac remodeling and providing a further risk assessment of hypertensive patients.
UNVEILING THE HEART'S VULNERABILITY: HOW PDE4 INHIBITION CAN INTENSIFIES MYOCARDIAL INJURY
Authors: Verma Vipin Kumar , Narayanan Susrutha P , Prajapati Vaishali , Bhatia Jagriti , Arya D S
Published: May 2024

Objective:

The dysregulation of beta-receptor signaling in heart diseases, like arrhythmias and heart failure, is a concern due to sustained elevation of cAMP levels, impacting cardiac function. Phosphodiesterase (PDEs) regulate cAMP levels, with PDE4 linked to chronotropic signaling through beta-receptors. Apremilast, a PDE4 inhibitor used in psoriasis, theoretically could heighten arrhythmia risk by prolonging catecholamine effects and increasing cardiac workload. In our study, we sought to confirm this theory, exploring PDE4 inhibition's impact on cardiomyocytes, especially in ischemic heart disease scenarios where it might exacerbate myocardial injury during acute ischemic events.

Design and method:

Male albino Wistar rats were randomly distributed into 7 groups – Normal control, ISO control, ISO+ 2.5mg/kg AP, ISO + 5mg/kg AP, ISO + 10mg/kg AP, ISO + 20mg/kg AP and 20mg/kg AP perse. Corresponding doses of Apremilast were administered to the animals for a period of 21 days. On the 20th and 21st day, isoproterenol was administered at a dose of 85 mg/kg to induce myocardial necrosis. Hemodynamic parameters, histopathological and ultrastructural appearances, levels of oxidative stress markers, inflammatory cytokines, and apoptotic markers across the groups were investigated on 22nd day from the blood and myocardium after surgery.

Results:

Pretreatment with AP before inducing myocardial necrosis using ISO led to notable hemodynamic instability and no improvement during surgery. These groups showed increased damage, evident in hemodynamic measures, oxidant-antioxidant balance, and cardiac injury markers. Inflammatory and apoptotic proteins were notably elevated after AP followed by ISO administration compared to the ISO-Control group, indicating heightened adverse effects. A subsequent pilot study focusing on AP's direct impact on cardiomyocytes revealed 21 days administration resulting in hemodynamic instability, histopathological and ultrastructural damage, increased cardiac injury markers, and elevated inflammatory and apoptotic proteins in rats, indicating detrimental effects on the heart.

Conclusions:

Apremilast may cause myocardial injury and exacerbate myocardial necrosis in rats. Hence, there are concerns of AP use in patients with concomitant ischemic heart disease.
IMPACT OF SLEEP APNEA SYNDROME ON THE EARLY OCCURRENCE OF HYPERTENSIVE HEART DISEASE
Authors: Bendiab Nabila Tale B , Ghalmi Abdallah , Khedim Nesrine , Benkhedda Salim
Published: May 2024

Objective:

Sleep apnea-hypopnea syndrome (OSAHS) is an emerging disease with a high prevalence.

OSAHS has been recognized to cause several adverse effects on the cardiovascular system, to be associated with heart failure, in this case in the hypertensive population. the early detection of this hypertensive heart disease by new myocardial deformity tools could have an impact on the establishment of a preventive therapeutic strategy including the correction of various predictive factors, in this case OSAHS.

Design and method:

This is a cross-sectional, analytical study with prospective recruitment aimed at screening for OSAHS in a population of 150 hypertensive patients using the Epworth score and polygraphy, and subsequently carrying out an assessment. Complete echocardiography in the two subgroups of hypertensive patients, in order to detect subclinical hypertensive heart disease.

Results:

We detected 45 cases of OSAHS among the 150 hypertensive patients.

We note that obesity and diabetes were significantly more prevalent in the hypertension + OSAHS arm. Likewise, the mean blood pressure figures were significantly higher.

LVH was clearly predominant in the hypertension + SAHS arm with a more substantial decrease in the index of longitudinal contraction. In hypertensive patients with OSAHS, the LVH was most often concentric (53.4%). An increase in filling pressures was found in 19 hypertensive patients with OSAHS versus only 4 hypertensive patients without OSAHS (p = 0.0001), with a good correlation with the decrease in GLS.

These results suggest that the association of OSAHS and hypertension is closely associated with an increased risk of non-control of blood pressure figures with anticipation of the onset of hypertensive heart disease, and a perfect correlation with the impairment of longitudinal systolic function and diastolic function compared to the control group.

Conclusions:

Finally, systematic screening for OSAHS in hypertensive patients, especially obese, makes it possible, on the one hand, to identify subgroups at risk, and to correct it by continuous positive pressure ventilation on the other hand.

This will have a positive impact on the delay in the onset of hypertensive heart disease and therefore a decrease in cardiovascular morbidity and mortality.
ARTERIAL STIFFNESS ASSOCIATES WITH MALNUTRITION IN HYPERTENSIVE PATIENTS WITH CONCOMITANT CHRONIC PANCREATITIS
Authors: Sirenko Oksana , Filippova Olexandra
Published: May 2024

Objective:

The association between pancreatitis and cardiovascular diseases remains incompletely understood. Malnutrition in chronic pancreatitis may be associated with an increase in arterial stiffness in hypertension.

Objective: to evaluate interaction between malnutrition markers and arterial stiffness in patients with hypertension and chronic pancreatitis.

Design and method:

Methods: 70 non-diabetic patients with 1st degree hypertension with concomitant chronic pancreatitis (median age – 52,4 [43,8;63,7] years) were included in the study. We divided all included patients into two groups: 1st group – 41 patients with malnutrition, 2nd group – 29 patients without malnutrition. Standard laboratory blood tests, haematological parameters, lipid profile, glucose, renal and liver function tests, pancreatic fecal elastase-1, total protein, serum albumin, serum iron, vitamin 25(OH)D, serum zinc and magnesium detection were performed for all patients. The groups were comparable in terms of age, gender structure, functional state of the kidneys. Non-parametric methods were used for statistical data analysis. To determine the prognostic significance, the ROC analysis was performed. Significant differences were considered when the p-value was p<0.001

Results:

In patients with a combined course of hypertension and chronic pancreatitis with established malnutrition, an increase in arterial stiffness was significantly more often compared to patients with normal nutritional status - 83% and 62%, respectively (p<0.001). A significantly lower level of brachial artery augmentation index was established by 43% (p<0.001) in the first group. It was established that patients with malnutrition had a significantly higher caritid-femoral pulse wave velocity

by 17.5% (p<0.001). Correlations were established between brachial artery augmentation index and serum levels of zinc (R=0.63, p<0.001), magnesium (R=0.66, p<0.001), albumin (R=0.58, p<0.001), vitamin 25(OH)D (R=0.68, p<0.001) in patients with the combined course of hypertension and chronic pancreatitis. ROC analysis revealed that serum zinc level had an excellent diagnostic power for arterial stiffness in hypertensive patients with chronic pancreatitis (AUC = 0.910). Serum albumin had very good diagnostic power for arterial stiffness in hypertensive patients with chronic pancreatitis (AUC = 0.859).

Conclusions:

Arterial stiffness may be associated with malnutrition in hypertensive patients with concomitant chronic pancreatitis.
DETECTING OBSTRUCTIVE SLEEP APNEA IN HYPERTENSIVE PATIENTS – ABPM DATA
Authors: Dumitrescu Silviu Ionel , Ionescu Ruxandra , Prisacariu Irina , Buican Luiza , Hantulie Ileana , Boingiu Rares , Cecoltan Serghei , Ciobanu Diana , Savoiu Dragos , Popovici Claudia , Stefanescu Dragos , Gurzun Magda , Stanciu Silviu , Munteanu Alice
Published: May 2024

Objective:

Obstructive sleep apnea (OSA) increases cardiovascular risk in hypertensive patients and decreases the efficacy of treatment. Our study looked at the ABPM data that could be used to diagnose OSA.

Design and method:

We evaluated 117 hypertensive patients who were previously screened for subclinical organ damage for the presence of OSA using the Epworth Sleepiness Scale (ESS), Berlin Questionnaire, and the STOP-BANG questionnaire who underwent home respiratory polygraphy (HRP). For each questionnaire, patients were divided into high-risk and low-risk. The Apnea-Hypopnea index (AHI) was scored according to AASM 2012 criteria. Patients were classified based on the AHI values without OSA (AHI <5), mild OSA (5<= AHI <15), moderate OSA (15<=AHI <30), and severe OSA (AHI =>30). After this, a 24-hour noninvasive ABPM was recorded on a working day. Subjects recorded a journal of the activities performed and the time of retiring to bed, ABPM recordings being divided into ’awake’ or ’asleep’ periods based on diary entries.

Results:

After HRP, frequencies of without OSA, mild OSA, moderate OSA, and severe OSA were 19 (16.2%), 25 (21.4%), 51 (43.5%), and 22 (18.8%), respectively. There is widespread subclinical organ damage in hypertensive patients with moderate to severe OSA (95.7%). We compared the diagnostic accuracy of the three scores in detecting moderate to severe OSA and found that Berlin had the highest sensitivity (87%) and STOP-BANG had the highest specificity (84%), area under the curve (AUC), and PPV. ESS had the lowest sensitivity (63%) and the specificity was intermediate. The hypertensive patients with moderate to severe OSA (OSA positive) compared with those without it (OSA negative) had significantly higher systolic and diastolic BP, significantly increased variability of both systolic and diastolic BP, and a significantly reduced decrease of both nocturnal systolic and diastolic BP. Almost all (94.5%) patients with a riser nocturnal profile had moderate to severe OSA.

Conclusions:

Hypertension and OSA are a common association that is frequently missed. Assessment of patients, based on clinical scores, is essential for the proper management of each case. ABPM results can be an important tool in OSA diagnosis.
INFLUENCE OF LIVER FIBROSIS ON LIPID METABOLISM IN PATIENTS WITH ARTERIAL HYPERTENSION AND NON-ALCOHOLIC FATTY LIVER DISEASE
Authors: Antyukh Karina , Grigorenko Elena , Mitkovskaya Natalya
Published: May 2024

Objective:

To study the effect of liver fibrosis on lipid metabolism in patients with arterial hypertension (AH) and non-alcoholic fatty liver disease (NAFLD).

Design and method:

A cross-sectional comparative single-center study was conducted, which involved 72 patients of working age (age 25-59 years) with stage I-II AH and NAFLD. The patients were divided into two groups depending on the presence/absence of liver fibrosis: group 1 – patients with hypertension, NAFLD+liver fibrosis (n=34), average age 47.1±8.9 years and group 2 – patients with hypertension, NAFLD without liver fibrosis (n=38), average age 48.6±8.5 years. To analyze lipid metabolism, a detailed lipid profile was performed to determine the content of total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and atherogenic coefficient (AC). All patients underwent abdominal ultrasound and liver elastography to determine the degree of fibrosis according to the METAVIR scale. Statistical analysis of the obtained data was carried out using the statistical program package SPSS 27.0 (IBM, USA). Differences were considered statistically significant at p<0.05.

Results:

When studying lipid metabolism, it was shown that the group average values of TC (5.90±0.90 mmol/l vs. 5.60±0.94 mmol/l, p<0.05), LDL-C (4.07±0.82 mmol/l vs. 3.68±0.82 mmol/l, p<0.05), TG (1.75 [1.33-2.55] mmol/l vs. 1.48 [1.17- 2.4] mmol/l, p<0.05), KA (4.36 ± 1.36 vs. 3.82 ± 0.95, p <0.05) in patients with AH and fibrosis were higher relative to the group without fibrosis. When assessing the level of HDL-C (1.10 [0.92-1.38] mmol/l versus 1.16 [1.02-1.33] mmol/l, p>0.05) in the compared groups there were significant differences not installed.

Conclusions:

The results obtained indicate a high prevalence of lipid metabolism disorders among patients of working age with arterial hypertension, non-alcoholic fatty liver disease and developed liver fibrosis, in comparison with persons with high blood pressure syndrome without fibrotic changes in the liver, which indicates an unfavorable pro-atherogenic lipid profile in this category of patients.
FEATURES OF THE DAILY BLOOD PRESSURE PROFILE IN PATIENTS WITH ARTERIAL HYPERTENSION AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Authors: Mullabaeva Guzal , Mukhamedova Shokhista , Maksudova Laziza
Published: May 2024

Objective:

To study the features of the daily blood pressure profile (DBPP) in patients with combination of arterial hypertension (AH) and chronic obstructive pulmonary disease (COPD).

Design and method:

The study included 47 patients (average age 53.1±2.5 years), 31 women, 16 men with hypertension I-II degrees. Patients were divided into 2 groups: with COPD (n=22) and without COPD (n=25). Duration AH in the group of patients with COPD was 6.5±0.54 years, without COPD 5.1±0.66 years. Exclusion criteria's were: symptomatic hypertension, cerebrovascular accidents in history, valvular heart disease, severe rhythm and conduction disorders, endocrine disorders, severe pathologies of the liver and kidneys, receiving systemic glucocorticosteroids actions. All patients underwent a study of pulmonary function (RPF) and SMAD recorders. Applied the following patient classification scheme: “dippers” (Daily index (DI) from 10 to 20%); “nondippers” (DI from 0 to 10%); “overdippers” (DI>20%); “nightpickers” (DI<0).

Results:

We identified a direct correlation between the level of PBP and age patients with a combination of hypertension and COPD during all monitoring periods (r=0.629, p=0.000 (days), r=0.645, p=0.000 (day), r=0.564, p=0.000 (night)). The same dependence was noted in individuals with hypertension without lung pathology (r=0.298, p=0.021 (days), r=0.266, p=0.04 (day), r=0.346, p=0.007 (night)). Thus, we not only did not identify significant differences in the level of PBP, but also noted general regular features of its dynamics with increasing age of patients of both groups. Comparative assessment of the heart rhythm. DBP also showed significant intergroup differences. Thus, we have established the predominance of “dippers” among patients with AH without lung pathology (51.9%), while among persons with a combination of hypertension and COPD, adequate nocturnal decrease in blood pressure was observed slightly more than in a third of patients (37.4%, p=0.125). Besides, among these patients a significantly higher number of “night pickers” was identified (25% vs. 7.5%, p=0.002), the number of “nondippers” and there were “overdippers” in the compared groups was approximately the same.

Conclusions:

Presence of COPD in patients with hypertension worsens the course of the latter, which is expressed in a significant predominance of “nightpickers” and “non-dippers” patients.
LONG-TERM CHANGES IN ARTERIAL STIFFNESS AFTER COVID-19
Authors: Bondar Svetlana , Granger Benjamin , Konradi Alexandra
Published: May 2024

Objective:

To assess if COVID-19 is associated with increase in arterial stiffness using a long-term follow-up study.

Design and method:

53 patients hospitalized for COVID-19 in 2021 and 53 age and sex-matched subjects from a proportional cohort were examined. COVID-19 convalescents were evaluated twice; the first visit was 10-16 months after hospitalization, followed by a second visit 6 months after (n=44). The VaSera device (Fukuda Denshi, Japan) was used to measure vascular age, cardio-ankle vascular index (CAVI) and ankle brachial index (ABI).

Results:

Groups did not differ by gender, smoking status, presence of hypertension or diabetes, but the control group and the second visit group differ by age (Table 1). There was no difference between the control group and COVID-19 group in vascular age and CAVI, however, there was a difference between the control group and the second visit in ABI (p=0.002). To assess the effect of COVID-19 on arterial stiffness; age, arterial hypertension, diabetes, smoking status, and systolic blood pressure were considered during analysis of covariance (ANCOVA) (Table 2). Patients in the control group and COVID-19 group did not differ in vascular age and CAVI after adjustment, but there was a trend toward increasing statistical significance at different visits. Patients in the control group and COVID-19 group differed in ABI, with statistical significance increasing at the later visit.

Conclusions:

There is an elevation in ABI in patients hospitalized with COVID-19 compared to those not affected by COVID-19. This effect becomes more pronounced over time. No statistical significance was observed for vascular age and CAVI, although an upward trend was noted. Longer follow-up is needed to provide accurate conclusions as to whether these parameters may increase after COVID-19.