bluuebunny/crossref_metadata_2025 huggingface dataset:
PREVALENCE, AWARENESS AND CONTROL OF HYPERTENSION WITH OFFICE BLOOD PRESSURE MEASUREMENTS AND AMBULATORY BLOOD PRESSURE MONITORING IN KIDNEY TRANSPLANT RECIPIENTS
Authors: Loutradis Charalampos , Korogiannou Maria , Xagas Efstathios , Marinaki Smaragdi , Argyris Antonios , Protogerou Athanasios , Sarafidis Pantelis , Boletis John
Published: April 2021

Objective:

The prevalence of hypertension in patients with chronic kidney disease (CKD) is estimated to 80–90% as determined by ambulatory blood pressure monitoring (ABPM), while adequate control is achieved in only 20–30% of these patients. Until now, few reliable data exist on the prevalence and blood pressure (BP) control in kidney transplant recipients, as determined by ABPM. The objective of this study is to examine these epidemiologic characteristics of hypertension in kidney transplant recipients using ABPM.

Design and method:

150 kidney transplant recipients were included in this study. They underwent 24-hour ABPM with the Mobil-O-Graph NG device. Hypertension was defined as follows: (1) office BP (oBP) > or = 140/90 mmHg or use of antihypertensive agents, (2) ambulatory BP > or = 130/80 mmHg or use of antihypertensive agents. Awareness of arterial hypertension was determined according to their past medical history. Adequate control was defined as oBP <140/90 or 24-hr BP <130/80 mmHg.

Results:

Prevalence of hypertension was 88.0% according to office BP measurements and 93.3% according to ABPM data (p = 0,112 and kappa-statistics = 0,531, p < 0,001). Totally, 26,7% had office BP > or = 140/90 and 58,7% 24-hr BP > or = 130/80 mmHg (p < 0,001). Awareness of arterial hypertension was 88,6% irrespectively of the method (p = 0,987).83.3% of the patients were receiving antihypertensive agents. Adequate control according to office BP measurements had 69,7% of the hypertensive patients, whereas only the 37.1% of them achieved adequate control according to ABPM (p < 0,001 and kappa-statistics = 0,205, p = 0,005). In hypertensive patients, office BP > or = 140/90 mmHg was of poor predictive value in the diagnosis of 24-hour BP > or = 130/80 mmHg (AUC: 0,590, 95%CI: 0,499–0,681, sensitivity: 34,1%, specificity: 83,9%, positive predictive value: 75,0%, negative predictive value: 47,3%).

Conclusions:

The prevalence of arterial hypertension in kidney transplant recipients is extremely high. Office BP readings is a poor marker for assessment of BP control, as there appears to be a huge difference between office and ABPM in the rates of hypertension control.
EVOLUTION OF TRANSIT TIME BETWEEN THE SYSTOLIC AND DIASTOLIC PRESSURE PEAKS OF THE RADIAL PULSE WAVEFORM AFTER KIDNEY TRANSPLANTATION
Authors: Philibert Emy , Obeid Hasan , Paré Mathilde , Côté Nadège , Fortier Catherine , Goupil Remi , Agharazii Mohsen
Published: April 2021

Objective:

The transit time between peak systolic and peak diastolic digital volume pulse had been proposed as a measure of arterial stiffness. Indeed, the height of an individual divided by such transit time can be used to estimate a pulse wave velocity. In a cohort of patients with end-stage kidney disease, we aim to examine whether the reduction of aortic stiffness that occurs after kidney transplantation (KTx), translates into improvement of radial artery systolic-diastolic pulse transit time.

Design and method:

Before and three months after KTx, we recorded radial pressure waveforms using applanation tonometry in 62 patients. We used a two gaussian method to break down the radial pressure waveforms to extract transit time. Radial waveforms were recorded over a 10 seconds period and ensemble-averaged (using in house-MATLAB program) to obtain a single waveform and then modelled using two Gaussian functions. Transit time (dT) was determined as the difference between the first systolic peak (T1) and the early diastolic peak (T2). Generalized transfer function was used to estimate central blood pressures. Carotid-radial and carotid-femoral pulse wave velocities (cr-PWV, cf-PWV) were also measured.

Results:

62 patients (66% male, mean age: 48 ± 14 years, mean eGFR: 66 ± 17 ml/min/1.73m2) were assessed. After KTx, there was a significant reduction in cr-PWV (9.49 ± 1.50 to 8.94 ± 1.34, p = 0.001) and cf-PWV (11.56 ± 2.65 to 10.19 ± 1.72, p < 0.001), as well as in central and peripheral blood pressure (p < 0.001). While T1 significantly declined (0.184 [0.172–0.199] to 0.179 [0.164–0.194]s, p = 0.008), there were no significant changes in transit time (0.139 [0.119–0.165] to 0.134 [0.118–0.178]s, p = 0.390) nor in T2 (0.325 [0.293–0.361] to 0.319 [0.283–0.357]s, p = 0.119).

Conclusions:

Contrary to our expectation, three months after KTx, we did not observe a significant change in transit time. Our results suggest that transit time between the systolic and diastolic pressure peaks of the radial pulse waveform may not be used as a marker of arterial stiffness. We propose that the radial artery pressure wave integrates information from both upstream and downstream vascular beds and so the transit time cannot be used as a reliable surrogate for arterial stiffness.
MINERALOCORTICOID RECEPTOR ANTAGONIST HAS BENEFICIAL RENAL EFFECTS IN A NEW MOUSE MODEL OF DIABETIC NEPHROPATHY
Authors: Posada Ixchel Lima , Ramirez Roberto Palacios , Bonnard Benjamin , Genty Marie , Jaisser Frederic
Published: April 2021

Objective:

Diabetic nephropathy (DN) is the leading cause of chronic kidney disease (CKD). Several studies have demonstrated beneficial effects of mineralocorticoid receptor (MR) antagonists in DN.

To characterize a new model of diabetic nephropathy and test the effect of MR antagonism using canrenoate.

Design and method:

C57BL6 mice underwent 5/6 nephrectomy and after 4 weeks they were split in the following groups: CKD (n = 7), CKD+ 60% fat diet (CKD+HFD) (n = 9) and CKD+HFD+canrenoate 30 mg/kg/day (CKD+HFD+CAN) (n = 9) for 8 weeks. We assessed renal function, kidney fibrosis, albuminuria and molecular markers of DN by RT-PCR. RNAseq analysis was carried out. The comparison between the groups was performed by one-way-ANOVA, results were considered significant with p < 0.05.

Results:

There were no differences in creatinine clearance between the groups. The HFD cause increased renal fibrosis (0.956 ± 0.1503 vs 3.001 ± 0.6754; p = 0.0205) and urinary albumine/creatinine ratio (262.5 ± 73.83 vs 2042 ± 281.1; p < 0.0001). These increases were prevented by treatment with canrenoate. In concordance with the increased interstitial fibrosis, mRNA levels of profibrotic molecules such as IL-10 and FSP-1 were increased by HFD, an effect fully prevented by canrenoate. Gene expression of the inflammatory cytokine IL-6 was increased in CKD HFD group compared to CKD alone (p = 0.0395) and this was prevented by canrenoate. RNAseq comparison between CKD and CKD-HFD groups indicated enrichment in the CKD-HFD group of pathways for inflammatory response, epithelial mesenchymal transition and allograft rejection, interferon, IL6-JAK-STA3 signaling.

Conclusions:

Nephrectomized mice fed a HFD are a good model of DN. MR antagonism improves the renal fibrosis and the albuminuria but not plasma creatinine and urea in the time period studied. Our results highlight the MR as a good therapeutic target to improve the prognosis of DN patients.
META-ANALYSIS OF DEDICATED RENAL OUTCOME TRIALS ASSESSING THE CARDIO-RENAL EFFICACY OF SODIUM-GLUCOSE CO-TRANSPORTER-2 INHIBITORS IN PATIENTS WITH CHRONIC KIDNEY DISEASE AND ALBUMI
Authors: Patoulias Dimitrios , Imprialos Konstantinos , Stavropoulos Konstantinos , Toumpourleka Maria , Koutsampasopoulos Konstantinos , Katsimardou Alexandra , Papadopoulos Christodoulos , Doumas Michael
Published: April 2021

Objective:

Chronic kidney disease (CKD) represents a frequent co-morbidity of type 2 diabetes mellitus (T2DM), affecting 30–50% of all patients, while diabetes is the leading cause of end-stage kidney disease (ESKD) worldwide. Severity of CKD is strongly and positively associated with the 10-year risk for cardiovascular death. Thus, appropriate treatment options that can delay CKD progression and ameliorate the impact of the rest cardiovascular risk factors are required.

Design and method:

We sought to determine the renal and cardiovascular efficacy of sodium-glucose co-transporter-2 (SGLT-2) inhibitors in patients with CKD and albuminuria, pooling data from the dedicated renal outcome trials, namely the Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation (CREDENCE) trial and the trial evaluating the effects of dapagliflozin on patients with chronic kidney disease and albuminuria, with or without diabetes (DAPA-CKD). We assessed the following efficacy outcomes: end-stage kidney disease (ESKD), renal death, renal replacement therapy or kidney transplantation, cardiovascular death, cardiovascular death/hospitalization for heart failure (HF).

Results:

We pooled data in a total of 8,705 patients with CKD. SGLT-2 inhibitor treatment was shown to decrease the risk for ESKD by 31% compared to placebo. In addition, SGLT-2 inhibitor treatment resulted in a significant decrease in the risk for renal replacement therapy or kidney transplantation by 29%, and a non-significant decrease in the risk for renal death. Regarding cardiovascular outcomes, SGLT-2 inhibitor was shown to decrease the risk for the composite outcome of cardiovascular death or HF hospitalization by 29%, and the risk for cardiovascular death by 21%.

Conclusions:

SGLT-2 inhibitor treatment confers significant renal and cardiovascular benefits in patients with CKD and albuminuria, with or without T2DM.
DETECTION OF CHANGES IN RENAL BLOOD FLOW USING ARTERIAL SPIN LABELING MRI
Authors: Kannenkeril Dennis , Janka Rolf , Bosch Agnes , Jung Susanne , Kolwelter Julie , Striepe Kristina , Ott Christian , Martirosian Petros , Schiffer Mario , Uder Michael , Schmieder Roland E.
Published: April 2021

Objective:

Alteration in kidney perfusion is an early marker of renal damage. Magnetic resonance imaging (MRI) with arterial spin labeling (ASL) is a noninvasive approach to measure renal blood flow (RBF) without the use of contrast media. The purpose of this study consisting of two experiments was to evaluate whether both acute and short-term changes in RBF could be detected using ASL-MRI technique.

Design and method:

RBF as assessed by cortical (CRBF), medullary, and total renal blood flow (TRBF) were measured by ASL-MRI using FAIR True-FISP sequence. In the first experiment with 11 normotensive healthy individuals (NT) and 11 hypertensive patients (HT), RBF was measured at baseline and after both feet were covered with cold ice packs (cold pressor test) that activates the sympathetic nervous system. In the second experiment, RBF was measured in patients with chronic kidney disease (CKD) before and after a pharmacological intervention.

Results:

A significant reduction in CRBF (p = 0.042) and a trend in TRBF (p = 0.053) were observed in response to the activation of the sympathetic nervous system in both NT individuals and HT patients (Table 1). In the second experiment, a trend towards reduction of CRBF (p = 0.051) and TRBF (p = 0.059) has been detected after pharmacological intervention. An evaluation of RBF measurements between three different study populations reveals that TRBF were significantly lower in patients with HT (309.5 ± 17.3 mL/100 g/min) and CKD patients (260.4 ± 29.1 mL/100 g/min) compared to NT individuals (338.7 ± 30.0 mL/100 g/min) (NT vs. HT-p = 0.014, NT vs. CKD-p = 0.004). TRBF was also lower in patients with CKD compared to HT (p = 0.047).

Conclusions:

Our data indicate that both acute and short-term changes in RBF could be detected using ASL-MRI. Moreover, we were able to detect differences in RBF between healthy and diseased individuals by needing only small sample size per group. Thus, ASL-MRI offers an advantage in conducting clinical trials compared to other technologies.
CAROTID-FEMORAL PULSE WAVE VELOCITY, PULSE WAVE ANALYSIS AND 24-HOUR AMBULATORY BLOOD PRESSURE MEASUREMENT IN PATIENTS WITH CHRONIC KIDNEY DISEASE
Authors: Ekart Robert , Hojs Radovan
Published: April 2021

Objective:

Increased arterial stiffness and arterial hypertension are known risk factors for vascular damage and are an independent predictor of cardiovascular events. Pulse wave analysis of the radial artery (PWA) is a simple method for assessing various hemodynamic parameters in the central aorta. The aim of our study was to investigate the relationship between arterial stiffness measured by carotid femoral pulse wave velocity (cfPWV), PWA parameters and 24-hour ambulatory blood pressure measurement (ABPM) in patients with chronic kidney disease (CKD).

Design and method:

We conducted a cross-sectional study in a cohort of 87 non-dialysed CKD patients. cfPWV and PWA were investigated non-invasively using applanation tonometry (SphygmoCor®,Atcor, Australia). ABPM was measured with the monitor BR -102 (Schiller, Switzerland). Cardiovascular (CV) risk factors (urinary albumin/creatinine ratio, NT -pro-BNP, troponin I, cystatin C, cholesterol, LDL, HDL, triglycerides, lipoprotein Lp(a)) were measured. The patients were divided into two groups according to the median cfPWV: lower cfPWV group (cfPWV < 11.58m/s, n = 44), higher cfPWV group (cfPWV > 11.58m/s, n = 43).

Results:

The mean age of the patients was 60 ± 13.4 years, 65.5% were men, 24.1% had diabetes, 43.7% were smokers. Further descriptive data for all patients and both groups are presented in Table 1. With the t-test we found a significant difference between both groups regarding age (P < 0.0001), but not regarding the biochemical CV risk factors. Patients with higher cfPWV had statistically significant higher central aortic systolic pressure (P < 0.0001) and pulse pressure (P < 0.0001), lower subendocardial viability ratio (P = 0.003), higher 24 h systolic ABPM (P < 0.0001) and 24 h pulse pressure (P < 0.0001).

Conclusions:

The results of our study show that non-dialysis CKD patients with higher cfPWV levels also have higher systolic and pulse pressure (central aorta and 24 h ABPM).
CHANGES IN CAROTID LOCAL STIFFNESS DURING A SIX-YEARS FOLLOW UP IN A GENERAL POPULATION: THE VOBARNO STUDY
Authors: Paini Anna , Aggiusti Carlo , Stassaldi Debora , Bertacchini Fabio , Capellini Sara , Arnoldi Chiara , Salvetti Massimo , Muiesan Maria Lorenza
Published: April 2021

Objective:

Local carotid stiffness (Carotid PWV) is an independent predictor of cardiovascular events but few data are available on the progression of Carotid stiffness over time. The aim of the present longitudinal study was to analyze the progression of local carotid stiffness over a 6-year period in a general population in Northern Italy (Vobarno Study).

Design and method:

123 subjects, age 55 ± 4 years (42% males, hypertension in 43% at baseline visit), underwent a baseline (BL) and a follow up (FU) visit, 6.2 ± 0.5 years apart. In all subjects laboratory examinations, measurements of blood pressure (BP) and of Carotid PWV (using an echotracking approach) were performed at BL and at FU. Progression rate of Carotid PWV (δCarotid_PWV/Year) was defined as (Carotid PWV at FU-Carotid PWV at BL)/years of FU.

Results:

In the overall population, Carotid PWV increased from 6.39 ± 1.41 at BL to 6.79 ± 1.18 m/s at FU (p < 0.05). δCarotid_PWV/Year was inversely related to BP (mean BP: r = -0.193, p < 0.05; pulse pressure: r = -0.1.81, p < 0.05) and to Carotid PWV at BL (r = -0.669, p < 0.001). No other correlation was observed between δCarotid_PWV/Year and demographic or laboratory parameters at BL. δCarotid_PWV/Year was also related to changes over time in BP values (δSystolicBP: r = 0.291, p < 0.01; δDiastolicBP: r = 0.266, p < 0.01; δMeanBP: r = 0.310, p < 0.0001).

At multivariate analysis the variables independently related to the annual progression rate of Carotid PWV were Carotid PWV and mean BP at BL (beta -0.68, p < 0.0001, and beta 0.20, p < 0.05, respectively) and changes in mean BP during follow-up (beta 0.18, p < 0.05).

Conclusions:

In a general population sample in Northern Italy the main determinants of the increase in local carotid stiffness during a 6 years FU were local carotid stiffness and mean BP at BL and change in mean BP over time.
ASSOCIATION BETWEEN URIC ACID AND PULSE WAVE VELOCITY IN HYPERTENSIVE PATIENTS AND GENERAL POPULATION: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Maloberti Alessandro , Rebora Paola , Andreano Anita , Triglione Nicola , Piccinelli Enrico , Palazzini Matteo , Occhi Lucia , Sun Jinwei , De Chiara Benedetta , Grassi Guido , Valsecchi Grazia , Giannattasio Cristina
Published: April 2021

Objective:

The association between Serum Uric Acid (SUA) and Pulse Wave Velocity (PWV), has been extensively evaluated but with some discrepancies in results. A further limitation refers to the fact that only few data were analyzed taking into account the possible effects of gender. The purpose of this study was to estimate the association between SUA and arterial stiffness in general population and hypertensive patients, as a whole population and as divided by gender, by pooling results from existing studies.

Design and method:

Carotid-femoral and brachial-ankle PWV (cf- and ba-PWV) have been analysed separately and subgroup analyses by gender are reported.

Results:

Among 692 potentially relevant works, 24 paper were analysed. 7 studies referred to cf-PWV in the general population with an overall positive association at adjusted analysis for both males and females (0.07 - 95%CI: 0.03; 0.11 and 0.06 - 95%CI: 0.03; 0.09, respectively). 12 studies referred to ba-PWV in the general population with the finding of a positive association at adjusted analysis for females (0.04 - 95%CI: 0.01;0.07), but not for males (0.13 - 95%CI: -0.09;0.34). In hypertensive patients only 4 studies evaluated cf-PWV and 1 ba-PWV with only one study (with cf-PWV) finding positive association.

Conclusions:

The association between SUA and cf-PWV resulted significant in general population in both males and females while it was only significant for female regarding ba-PWV. Furthermore, the few available studies found no significant relationship between SUA and both cf- and ba-PWV in hypertensive subjects.
THE VARIABILITY OF REPEATED MEASUREMENTS OF ARTERIAL STIFFNESS BIOMARKERS: A SHORT-TERM LONGITUDINAL STUDY IN A WIDE RANGE OF NORMOTENSIVE AND HYPERTENSIVE PARTICIPANTS
Authors: Podrug Mario , Sunjic Borna , Bekavac Anamarija , Vajagic Maja , Mudnic Ivana , Boban Mladen , Jeroncic Ana
Published: April 2021

Objective:

Arterial stiffness (AS) biomarkers, such as pulse wave velocity and augmentation indices, are predictive of future cardiovascular events in subjects free of overt cardiovascular disease and are regarded as indicators of atherosclerosis and subclinical organ damage. As the surrogate endpoints of future cardiovascular events, they are emerging as an appealing therapeutic target. However, the variability of intrasubject measurements might hinder their use in clinical practice.

Design and method:

In this study, we estimate the reproducibility of intrasubject measurements of AS biomarkers: pulse wave velocity and central augmentation index, measured by oscillometry (Arteriograph) and applanation tonometry (SphygmoCor) devices. Thirty-six participants evenly distributed across different genders, BMI categories, ages, and hypertensive status were enrolled in the study. Participants visited the laboratory for three days, one week apart. On each visiting day, they came in the morning and afternoon (6 visits in total). All measurements were performed in accordance with the ARTERY society recommendations and in double by two operators who received the necessary training and performed measurements in a randomized order. Linear mixed models were used to analyze the nested data grouped by a participant and a visiting day.

Results:

Based on the interim analysis of 451 recordings that passed the quality control, we found that a device type and BMI category significantly affected pulse wave velocity in intrasubject measurements. As for the central augmentation index, it was a device and a time of the day (morning/afternoon) that affected its variability within a participant. An operator or interaction between an operator and a device did not affect measurements of these biomarkers.

Conclusions:

Since expected intersubject PWV variability due to different devices or BMI allows for differences to extend 10% of the observed population-based range, the identification of weak/moderately effective agents used in de-stiffening therapies might be hampered. For cAIx, this variability was somewhat less pronounced.
THE IMPACT OF MASKED HYPERTENSION ON ARTERIAL STIFFNESS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Antza Christina , Doundoulakis Ioannis , Vazakidis Polychronis , Stabouli Stella , Kotsis Vasilios
Published: April 2021

Objective:

Arterial stiffness, expressed by carotid-femoral pulse wave velocity (c-f PWV), is recognized as independent predictor for future cardiovascular disease. The aim of this study was to investigate for the first time the impact of masked hypertension (MH) on c-f PWV, in untreated patients.

Design and method:

PubMed and Cochrane Library were searched systematically to identify studies comparing c-f PWV levels between normotensives, hypertensives, and MH. Meta-analysis was performed to compare the difference c-f PWV levels between these groups. New Castle Ottawa quality assessment scale for case-control studies was used to assess study quality.

Results:

MH patients had significantly increased c-f PWV values compared to the normotensive groups (d = 0.95, 95% CI: 0.42 to 1.48, P < 0.01). Moreover, the hypertensive population was found to have statistically significant increased values of c-f PWV compared to MH (d = -0.74, 95% CI: -0.96 to - 0.52, P = 0.18). Finally, there was no statistically significant difference between MH and white coat hypertension population (d = 0.06, 95% CI: -1.04 to 1.15, P < 0.001).

Conclusions:

MH population have statistically significant increased values of c-f PWV compared to the normotensive group. These results demonstrate the severity of MH and the importance of evaluating blood pressure with out-of-office measurements in the untreated population.
SUBCLINICAL VASCULAR DAMAGE IN PATIENTS WITH SEVERE DYSLIPIDEMIA DEPENDING ON BLOOD PRESSURE LEVELS: 5-YEAR FOLLOW-UP RESULTS
Authors: Alieva Asiiat , Boyarinova Maria , Rotar Oxana , Konradi Alexandra , Shlyakhto Evgeny
Published: April 2021

Objective:

The aim of the present study was to estimate the 5-year dynamics of vascular subclinical parameters in patients with severe dyslipidemia depending on blood pressure levels.

Design and method:

1600 apparently healthy Saint-Petersburg inhabitants aged 25–65 years were randomly selected (sample from ESSE-RF national epidemiology survey) in 2013. All participants signed informed consent and filled in the questionnaire regarding risk factors, concomitant diseases and therapy. 134 patients with severe dyslipidemia (LDL-C>4,9 mmol/l, or medication prescribed for dyslipidemia) were selected and invited for follow-up visit in 2018. Fasting lipids, glucose (Abbott Architect 8000) and vital signs were obtained. Cardio-ankle vascular index (CAVI) and ankle brachial index (ABI) were measured by VaSera VS-1500 (Fukuda). Measurement of intima-media thickness (IMT) was performed by My Sono U6 (Samsung). Statistical analysis was performed using SPSS Statistics 20.

Results:

Among 134 patients 45 were male and 89 - female. Only 46 patients (34.3%) were taking statins. There was a significant difference in mean levels of SBP/DBP at the visits 1 and 2 (132.25 ± 17.22/80.92 ± 9.34 and 133.98 ± 20.06/81.02 ± 11.62 mm Hg respectively, p < 0.001 for both), creatinine (67.82 ± 10.34 and 70.86 ± 11.94 mmol/l, p < 0.001) and lipid profile dynamics (TC – 6.93 ± 1.44 and 6.41 ± 1.46 mmol/l respectively, p < 0.001; LDL-C – 4.81 ± 1.27 and 4.29 ± 1.31 mmol/l respectively, p < 0.001).

Table 1. Prevalence of subclinical vascular damage - 5-year observation.

Conclusions:

Prevalence of statin intake is still not high, even among patients with severe dyslipidemias. 5-year observation demonstrates more rapidly progressing artheriosclerosis according to CAVI in hypertensive patients. CAVI could be tested in further studies as the instrument of cumulative BP control being a marker of exposure of high BP levels.
PARALLEL CHANGE IN PERIPHERAL AND NONAUGMENTED CENTRAL PULSE PRESSURE WITH AGE
Authors: Alfie Jose , Barochiner Jessica , Morales Margarita Susana , Cuffaro Paula Edit , Aparicio Lucas Sebastian
Published: April 2021

Objective:

Peripheral pulse pressure (PP) decreases in parallel to stroke volume during young adulthood, reaching a nadir in midlife. We postulate that during the same period, the progressive augmentation produced by wave reflection could overcome the effect of a decrease in forward pressure wave on central PP. The aim of the study was to evaluate the contribution of forward and backward pressure waves to the age related change in central PP and its expression at the brachial level.

Design and method:

This is a cross-sectional analysis of a cohort of 212 unmedicated hypertensive patients (16–93 years). Central PP (applanation tonometry of the radial pulse) and carotid-femoral pulse wave velocity (PWV) were assessed with a SphygmoCor device (operator index >70%). Central pressure waveform was calibrated with brachial SBP and DBP (OMRON 705). Augmentation pressure (AP) was calculated as the difference between the second and first systolic peaks. Forward pressure wave (nonaugmented central PP) was calculated as central PP - AP. Age was stratified in 3 groups: <30, 31–60 and >60 years. Comparisons were tested by ANOVA.

Results:

Peripheral PP showed two peaks, one before age 30 and another after age 60, with a nadir between 31–60 years (59 ± 15, 48 ± 10 mmHg and 58 ± 12 mmHg; in < 30, 31–60 and >60 years respectively; ANOVA <0.001). Forward pressure wave changed in parallel to peripheral PP, describing two peaks, one before 30 years and one after 60 years, and a nadir at 41–50 years (33 ± 8, 27 ± 6 and 32 ± 7 mmHg; in<30, 31–60 and >60 years respectively; ANOVA <0.001). In contrast, AP increased steadily with age (0.2 ± 5, 8 ± 6 and 15 ± 6 mmHg; in <30, 31–60 and >60 years respectively; ANOVA <0.001), in parallel to PWV (6.2 ± 1, 7.1 ± 1 and 8.7 ± 1.5 m/s, respectively; <0.001). As a result (figure), augmented central PP remained constant before increasing after age 60 (35 ± 7, 35 ± 8 and 47 ± 11 mmHg; at <30, 31–60 and >60 years respectively; ANOVA <0.001).

Conclusions:

Peripheral and nonaugmented central PP exhibited a parallel U shape relationship with age. The progressive increase in AP masked the nadir in forward pressure wave and minimized peripheral amplification.
A SNAPSHOT FROM AN EASTERN EUROPEAN REGISTRY ON FIBROMUSCULAR DYSPLASIA
Authors: Yaneva-Sirakova Teodora , Ivanova Raya , Dodova Rumiana , Kaneva Radka , Vassilev Dobrin
Published: April 2021

Objective:

To evaluate the specific characteristics of patients with fibromuscular dysplasia (FMD) with various localizations and clinical manifestations (or without). The diagnosis is made with angiography.

Design and method:

This is a case series of 27 consecutive patients with FMD, who were diagnosed in the Cardiology clinic of UMHAT “Alexandrovska” for a period oof 4 years. The diagnosis is based on angiographic criteria, but in several cases an intravascular ultrasound (IVUS) was needed for confirmation, because of discrepancies with the universal understanding for the angiographic image and localization of lesions.

Results:

The mean age at the time of diagnosis was about 58 years; males were 6 (22%). Renal localization had 17 (63%); extracranial localization – 7 (26%); intracranial – 2 (7.4%); other (3.7%). The age at diagnosis was relatively high. Nine (33%) of the patients underwent interventional treatment in accordance with the contemporary guidelines. Both groups intervened/non-intervened should be routinely followed (at least with ultrasound) in order to properly assess their cardiovascular risk.

Conclusions:

All the cases were scheduled for angiography for a variety of symptoms: neurological, cardio-vascular, or for embolization of a renal cell carcinoma. Although there are clear criteria for the diagnosis of FMD, in several cases an IVUS was needed for confirmation and exclusion of the differential diagnoses. In the future, clear IVUS criteria may be reasonable to be included in the diagnostic process, especially in cases with borderline angiographic morphology or in those without any typical clinical manifestation.
SALT INTAKE ASSESSMENT BY 24-HOUR URINARY SODIUM EXCRETION IN LITHUANIAN POPULATION: PILOT STUDY
Authors: Zakauskiene Urte , Macioniene Ernesta , Sukackiene Diana , Simanauksas Kazys , Zabuliene Lina , Banys Valdas , Miglinas Marius
Published: April 2021

Objective:

High salt intake is associated with increased arterial blood pressure, high risk of other preventable cardiovascular diseases, reduced life expectancy and higher mortality. WHO and the World Hypertension League strongly recommend to take less than 2000 mg of sodium (or less than 5 g of salt) per day1. However, in many countries the average daily intake of sodium still remains about 4000 mg (10 g of salt).

Until now there were no investigations in Lithuania for evaluating sodium (and salt) intake in the population based on reliable methods.

Aim of the study is to perform a pilot study and evaluate intake of sodium by 24-hour urinary sodium excretion and correlations with arterial blood pressure in Lithuanian population.

Design and method:

A study of randomly selected 237 healthy individuals of age 18–69 years old was performed. Each participant collected 24-hour urine samples and the blood pressure was measured 3 times. 15 subjects were excluded due to incomplete urine collection or incomplete data. 222 subjects were included in a statistical analysis.

Results:

An average salt intake was calculated using 24-hour urinary sodium excretion. The result was – 8,81 g/d [2,15; 25,54] of salt. 85% of subjects exceeded the recommended salt consumption value. Results varied between groups: mean salt consumption in males 10,77 (±4,79)g/d vs. females 7,46 (±3,41)g/d (p < 0,001); in age groups < 45 years old 8,57 (±3,9)g/l vs. > 45 years old 9,08 (±4,69)g/d (p > 0,05). A quartile classification revealed that individuals with higher salt consumption had significantly higher systolic arterial blood pressure (p = 0,02).

Conclusions:

A pilot study of 24-hour urinary sodium excretion revealed higher than recommended salt intake in Lithuania. Males use more salt. Higher salt intake correlates with higher blood pressure.

The study will be continued to collect more detailed assessment of the population's sodium status and to formulate a public health policy strategy.
AN EXAMINATION ABOUT EVALUATION OF BLOOD PRESSURE AND PULSE WAVE VELOCITY IN HEALTHY YOUTHS WITH FITNESS HABITS
Authors: Yokoi Toyohiko , Kobayashi Miyu , Fukumura Yuma , Fujiwara Fumiya , Yokoyama Chinatsu , Ohara Ayaka , Nakano Saki , Fukushima Yamato , Hirata Yuta , Hokonohara Tatsuki , Takayama Kouki
Published: April 2021

Objective:

Pulse Wave Velocity (PWV) was an examination to measure the level of atherosclerosis in many medical institution. Previous report showed that Risk factor of atherosclerosis as hypertension, diabetes mellitus, hyperlipidemia, aging, smoking made the PWV fast. On the other hand, PWV in non-smoking youths were correlative with obese and hyperlipidemia (Internal Med. 2005), and familial history (our data at ESH 2013).

Correlation PWV with other risk factors and its preventional methods were not elucidated. Here, in this study, first, we paid attention to the relationship between PWV and Familial History (FH) and Blood Pressure (BP) in Healthy, non-smoking youths without abnormal data of blood test in medical examination (blood sugar, lipid, liver and renal function). And next, we noticed to the difference in risk mitigation due to the presence or absence of exercise habits.

Design and method:

Non-smoking healthy youths, 72 men and 30 women with chance fitness habits (CFH), 36 men and 15 women with daily fitness habits (DFH), without abnormal data of blood test in medical examination was entry in this study. Medical examination by interview was done to all of them. If he or she had a familial history of hypertension, diabetes mellitus, hyperlipidemia, ischemic heart disease, cerebrovascular disease in parents, it counted as two point, and also in grandparents, as one point by each risk factor. And in this study, called three former risk factors as “disease risk (DR)”, two latter risk factors as “outbreak risk (OR)”.

Results:

Mean PWV was faster in men and women with CFH than those with DFH. Next these data into ascending-order, and devided into “low PWV (LP)” and “high PWV (HP)” bound on the median. PWV recorded HP is faster than recorded LP with CFH and DFH, recorded HP is faster than recorded LP with CFH but these difference in men and women with DFH has tendency to shirink statistically.

Conclusions:

We conclude that familial history and BP may correlate with PWV in healthy youths with chance fitness habits especially in HP. But daily fitness habits pretend to rise their BP.
RENALASE PROTECTS AGAINST SALT-INDUCED RENAL INJURY BY REGULATING NECROPTOSIS
Authors: Wang Yang , Yuan Yue , Yan Yu , Chen Chen , Wang Ke-Ke , Gao Ke , Chu Chao , Ma Qiong , Liao Yue-Yuan , Hu Jia-Wen , Fu Bo-Wen , Li Min , Sun Yue , Mu Jian-Jun
Published: April 2021

Objective:

Renalase, an enzyme that can metabolize catecholamine, was recently reported to attenuate ischaemic and toxic renal injury. The aim of the study was to investigate the functions and regulation mechanisms of renalase in protection against salt-induced renal injury.

Design and method:

1. A total of 515 Chinese participants from 124 families were eligible for this study in 2004. We followed up this cohort in 2009, 2012 and 2018, respectively. 30 tagging SNPs from necroptosis-related genes (RIPK1, RIPK3 and MLKL) were genotyped to investigate the associations with necroptosis and the incidence of subclinical renal damage (SRD).

2. To investigate the role of necroptosis in the development of salt-induced renal injury and the protective effects of renalase on salt-induced renal injury, cultured HK-2 cells, renalase knockout (KO) mice and SS rats were treated with high salt and recombinant renalase exogenously. Necroptosis related to key regulators, apoptosis, inflammation, reactive oxygen species production were analyzed.

Results:

1. During 14 years of follow-up, 38 (11.8%) participants developed SRD. RIPK1 SNP rs3736724, MLKL SNPs rs11640974 and rs12924203 were significantly associated with SRD incidence over 14 years. Gene-based analysis found that MLKL was significantly associated with SRD incidence over 14-year follow-up (P = 0.036) after adjustment for multiple testing.

2. High salt significantly increased the proportions of apoptotic and necrotic cells, and the expressions of related necroptosis (RIPK1, RIPK3 and MLKL) in a dose-dependent manner. Besides, high salt increased MDA, NADPH content and suppressed SOD; and increased TNF-alpha, IL-6, and MCP-1 levels. Knockdown of RIPK1, RIPK3 or MLKL with small interfering RNA (siRNA) significantly abrogated the aforementioned effects. Consistent with in vitro findings, high salt diet significantly increased necroptosis in SS rats.

Recombinant renalase significantly decreased apoptosis and necroptosis in high salt-treated HK2 cells and SS rats. Similarly, renalase KO mice exacerbated kidney injury in animals subjected to high-salt intake, and administering renalase inhibited necroptosis and reduced salt-induced renal injury.

Conclusions:

Our results suggest that necroptosis plays an important role in salt-induced renal injury, and renalase protects against renal injury by inhibiting necroptosis.
THE ROLE OF STATIN THERAPY IN ADIPOSE TISSUE
Authors: Sanidas Elias , Papadopoulos Dimitrios , Velliou Maria , Zerva Kanella , Tsakalis Konstantinos , Fotsali Anastasia , Iliopoulos Dimitrios , Mantzourani Marina , Toutouzas Konstantinos , Barbetseas John
Published: April 2021

Objective:

The hormones of adipose tissue, so called adipokines, possess either anti-inflammatory (apelin) or pro-inflammatory (chemerin) properties affecting local and systemic inflammation. Nonetheless, statins have potent anti-inflammatory effects in tissues and organs contributing to favorable outcomes. The aim of this study was to calculate apelin and chemerin adipokines plasma levels in patients with impaired lipid levels receiving statins exploring another potential pleotropic impact of statin therapy.

Design and method:

Overall, 127 patients were studied. Of them, 66 were treated with statins and 61 were not. Apelin and chemerin plasma levels were measured by the Elisa method.

Results:

Apelin levels were higher in patients treated with statins while chemerin levels were lower. No significant differences in demographic characteristics, arterial hypertension and diabetes mellitus were observed between the two groups (Table).

Conclusions:

The anti-inflammatory adipokine apelin was increased in patients receiving statins whereas the pro-inflammatory adipokine chemerin was decreased underlining an alternative anti-inflammatory effect of statin therapy.
EFFECT OF THE DIETARY APPROACHES TO STOP HYPERTENSION (DASH) DIET ON BLOOD PRESSURE IN ADULTS WITH AND WITHOUT HYPERTENSION: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CON
Authors: Filippou C. , Tsioufs K. , Thomopoulos C. , Mihas C. , Dimitriadis K. , Sotiropoulou L. , Chrysochoou C. , Nihoyannopoulos P. , Tousoulis D.
Published: April 2021

Objective:

The dietary approaches to stop hypertension (DASH) diet is recognized as an effective dietary intervention to reduce blood pressure (BP). However, among randomized controlled trials (RCTs) investigating the DASH diet mediated BP reduction there are significant methodological and clinical differences.

To comprehensively assess the effect of the DASH diet on BP levels in adults with and without hypertension, accounting for underlying methodological and clinical confounders.

Design and method:

We systematically searched Medline and the Cochrane Collaboration Library databases and identified 30 RCTs (n = 5,545 participants) that investigated the BP effects of the DASH diet compared to a control diet in hypertensive and nonhypertensive adults. Both random-effects and fixed-effect models were used to calculate the averaged attained systolic BP (SBP) and diastolic BP (DBP) differences during follow-up. Subgroup and meta-regression analyses were also conducted.

Results:

The DASH diet reduced SBP and DBP significantly more compared to control diet (difference in means: -3.2 mm Hg; 95% CI: -4.2, -2.3; P < 0.001, and -2.5 mm Hg; 95% CI: -3.5, -1.5; P < 0.001, respectively). Hypertension status did not modify the effect on BP reduction. The DASH diet compared to control diet reduced SBP levels in a higher extent in trials with sodium intake > 2.400 mg/day compared to trials with sodium intake < or = 2,400 mg/day, while both SBP and DBP were reducedmore in trials with mean age < 50 years compared to trials of older participants. The quality of evidence was rated as moderate forboth outcomes according to the Grading of Recommendations, Assessment, Development and Evaluation approach.

Conclusions:

The adoption of the DASH diet was accompanied by significant BP reduction in adults with and without hypertension, while higher daily sodium intake and younger age enhanced the BP lowering effect of the intervention. This meta-analysis was registered in the International Prospective Register of Systematic Reviews as CRD42019128120.
ACTION ON SALT CHINA (ASC): RATIONALE AND DESIGN
Authors: Zhang Puhong , He Fengjun , Li Yuan , Li Xinhua
Published: April 2021

Objective:

Salt intake in China is high, over twice the maximum WHO recommendation. Unlike in most developed countries where salt intake mainly comes from pre-packaged food, the salt consumed in China is mainly (around 80%) added during cooking. Initiated in 2017, Action on Salt China (ASC) aims to develop, implement and evaluate a comprehensive and tailored salt reduction programme, for national scaling-up.

Design and method:

ASC consists of six programmes working in synergy to increase salt awareness and to reduce the amount of salt used during cooking at home and in restaurants, as well as in processed foods. Since September 2018 in six provinces across China, two health campaigns on health education and processed foods, respectively have started, in parallel with four cluster randomised controlled trials (RCTs): (1) Application-based Intervention Study (AIS), where a mobile application is used to achieve and sustain salt reduction in schoolchildren and their families; (2) Housewife-based Intervention study (HIS), where family chefs receive support in using less salt in home cooking; (3) Restaurant-based Intervention Study (RIS), targeting restaurants consumers, cooks, and managers; and (4) Comprehensive Intervention Study (CIS), which is a real-world implementation and evaluation of all available interventions in the three other RCTs. To explore the experience, barriers, facilitators and effectiveness of delivering a comprehensive salt reduction intervention, these RCTs will last for one year (stage 1), followed by nation-wide implementation (stage 2). In AIS, HIS and CIS, the primary outcome of salt reduction will be evaluated by 24-h urinary sodium excretion in more than 6030 participants. In RIS, the salt reduction in restaurant-provided dishes will be measured by laboratory food analysis of the five best-selling dishes from each of the 192 restaurants. Secondary outcomes will consist of process evaluation, changes in knowledge, attitude and practice (KAP) on salt intake, and economic evaluation (Figure 1).

Results:

The baseline investigation of the four RCTs in ASC were completed before December 2018. After about one-year intervention, the mid-term follow-up investigation has already been initiated at some sites. As scheduled, the mid-term evaluation can be completed before June 2020.
KNOWLEDGE AND ATTITUDES AMONG THE GENERAL PUBLIC TOWARDS SALT CONSUMPTION IN OMAN
Authors: Al-Riyami Hassan , Alabdasalam Qusay , Al-Khayari Ali , Musharafi Hilal Al , Al-Alawi Ziyad , Nadar Sunil K.
Published: April 2021

Objective:

Increased dietary salt intake is a major health concern. Many steps have been taken worldwide to increase awareness. The aim of our study was to assess the knowledge and attitudes of the general public in Oman regarding the dangers of high salt intake.

Design and method:

This was a cross sectional questionnaire based survey that was conducted among the general public in Oman. The questionnaire was based on the WHO questionnaire which has been previously validated. It was translated into Arabic by local professionals and translated back to English to check the accuracy of the translation. The questionnaire was distributed at public events and also electronically via google docs. All individuals aged 18 and above were invited to fill in the questionnaire.

Results:

A total of 1214 respondents (age 34 + 10 years, 65.8% male, 69.4% employed,14.2% hypertensive) answered the questionnaire. More than two thirds of the participants felt that they were consuming the right amount of salt (69.4%) while only 6.7% thought that they were consuming more than they should. Most of the respondents always add salt while cooking (80%), and sometimes or always add salt at the table (61.4%). Most (90.7%) were aware that excess salt can cause diseases such as hypertension and that it is either somewhat important (51.2%) or very important (43.2%) to reduce salt in the diet. However only 42% said that they actively try to reduce salt in their diet. Only around a quarter check the label of the food for salt content before they buy. Only 54 (4.4%) said they knew what the recommended limit of salt intake is, but only 5 got it correct. By binary regression, the factors that determine whether or not a person tries to reduce salt in diet were age, sex, educational level and occupation (all p < 0.001). However, being hypertensive was not a predictor.

Conclusions:

Although most people in Oman in our sample appear to be aware of the dangers of high salt intake, only a few are actively trying to reduce it. More educational activities are required to improve awareness especially among the hypertensive patients.
LENGTH OF RESIDENCE IN ITALY AND CARDIOVASCULAR RISK PROFILE OF FIRST-GENERATION CHINESE MIGRANTS
Authors: Modesti Pietro Amedeo , Marzotti Ilaria , Calabresi Maria , Bartoletti Alessio , Pellegrino Alessio , Mascherini Gabriele , Galanti Giorgio
Published: April 2021

Objective:

The length of residence in the host country was found to be associated with progressive modifications in cardiovascular risk profile of immigrant population. This association has been attributed to lifestyle and dietary changes that usually accompany migration. Little information is available regarding changes in CV risk of first-generation Chinese migrants in Europe.

The objective was to explore the association between the length of residence in Italy with modifications in cardiovascular risk profile of first-generation Chinese migrants living in Prato, Italy.

Design and method:

Chinese first-generation migrants (2133 women and 1426 men) aged 14 to 80 were enrolled in a cross-sectional survey starting from 2014. Participants underwent questionnaire administration, antropometric and blood pressure measurements, and laboratory investigations (fasting glucose, total cholesterol, triglycerides). The relationship between length of residence in Italy (12 ± 6 years, range 1–32) and hypertension, type 2 diabetes, body mass index, high cholesterol (more than 240 mg/dl), and triglycerides (more than 200 mg/dl) was investigated with linear univariate and multivariate (also adjusted for age, sex, and education) regression analysis.

Results:

At multivariate linear regression analysis an increase in years of residence in Italy was associated with a progressive increase in the prevalence of arterial hypertension and a reduction in hypercholesterolemia.

Conclusions:

An increase in years of residence in Italy is associated with a progressive increase in the prevalence of arterial hypertension and a reduction in hypercholesterolemia while no changes in the prevalence of type 2 diabetes mellitus are detected. The identification of factors responsible for such variation is now a priority to guide the implementation of specific prevention policies.