bluuebunny/crossref_metadata_2025 huggingface dataset:
LINKING ULTRASOUND ASSESSMENT OF RENAL ARTERIES TO THE CARDIOVASCULAR AND RENAL EVENTS AT HYPERTENSIVE PATIENTS WITH OR WITHOUT DIABETES MELLITUS
Authors: Gavrila Adrian Ion , Mehedintu Anca
Published: June 2023

Objective:

The objective of the study was to estimate how the ultrasound parameters of the renal arteries correlate with cardiovascular and renal events at hypertensive patients (pts), with or without diabetes mellitus (DM).

Design and method:

50 hypertensive pts (mean age 59.5±9.4 years, 52% males) = group 1 and 50 hypertensive pts with DM, matched for age and sex (mean age 61.4±10.5 years, 54% males) = group 2. Vascular ultrasound parameters performed in renal arteries were: peak systolic velocity (PSV), resistance index (RI), end-diastolic velocity (EDV), systolic acceleration time (SAT), renal versus aortic systolic velocity ratio (RAR). All pts were evaluated during one year, in order to detect the following complications: unstable angina (UA), non-ST-segment elevation myocardial infarction (NSTEMI), ischemic stroke (IS), renal dysfunction (RD): microalbuminuria, proteinuria, chronic kidney disease.

Results:

In group 1, UA was significantly associated with higher RI (0.79±0.07 vs 0.61±0.08, p = 0.04). In the same group, RD was found in a significant higher proportion at pts with longer SAT (74±1.1 ms vs 47±1.3 ms, p = 0.01).

In group 2, UA was also significantly associated with greater RI (0.76±0.04 vs 0.58±0.05, p = 0.02). NSTEMI was significantly more frequent at pts with greater RI (0.80±0.08 vs 0.59±0.07, p = 0.01) and with higher RAR (3.5±0.2 vs 2.2±0.3, p = 0.04). In the same group, RD was found in a significantly higher proportion at pts with longer SAT (71±1.3 ms vs 43±1.2 ms, p = 0.02) and with higher RAR (3.8±0.2 vs 2.3±0.1, p = 0.04).

Conclusions:

Higher RI and greater RAR seem to predict a worse midterm outcome (one year) concerning cardiovascular events at hypertensive pts, especially with DM.

Moreover, greater RAR appears to have more powerful midterm prognostic value for incidence of acute coronary syndromes without ST-segment elevation at hypertensive pts with DM.

Longer SAT may have a relatively good correlation with the development of RD in both groups of pts.
BASELINE REMNANT CHOLESTEROL MODIFIES THE EFFECT OF INTENSIVE BLOOD PRESSURE CONTROL ON CARDIOVASCULAR OUTCOMES IN PATIENTS WITH TYPE 2 DIABETES: THE ACCORD-BP TRIAL
Authors: Chen Chao-Lei , Nie Zhi-Qiang , Feng Yingqing
Published: June 2023

Objective:

The equivocal benefit of intensive blood pressure lowering in patients with diabetes may be partially due to the neglected residual cardiovascular risk. However, it remains uncertain whether residual cholesterol (RC) level affect the benefit of intensive blood pressure lowering in patients with diabetes. We aimed to determine whether the treatment difference of intensive versus standard blood pressure therapy on risk of cardiovascular events (CVD) in the ACCORD-BP trial depended on baseline RC level.

Design and method:

Participants in the ACCORD-BP trail were divided into two groups based on baseline RC levels (low RC: < 31 mg/dL and high RC: 31mg/dL and higher). We report the primary outcomes identical to those used in the original ACCORD trial, which included nonfatal myocardial infarction, nonfatal stroke, and/or incident cardiovascular death. Adjusted hazard ratios (aHR) with 95% confidence intervals (CI) estimated from stratified Cox regression models were used to quantify the association between intensive therapy and incident CVD for the 2 different baseline RC groups.

Results:

The incident rate was significantly lower in the intensive-therapy group as compared with standard-therapy group in the low RC group (log-rank P = 0.029) but not in the high RC group (log-rank P = 0.74). Compared with standard therapy, intensive therapy was associated with a lower risk of incident CVD among participants with low RC (aHR: 0.71; 95% CI: 0.53 to 0.94), but not among participants with high RC (aHR: 1.04; 95% CI: 0.80 to 1.35). The same pattern was observed for nonfatal stroke (aHR [95% CI] in participants with low RC: 0.48 [0.25-0.93]; aHR [95% CI] in participants with high RC: 0.76 [0.41-1.41]). Subgroup analyses revealed that the protective effect of intensive therapy against CVD events among the low RC group was not influenced by sex, previous CVD at baseline, assignment to intensive glycemic control, systolic or diastolic blood pressure at baseline, and baseline low-density lipoprotein cholesterol levels.

Conclusions:

Intensive blood pressure lowering therapy was effective at preventing incident CVD events in the ACCORD-BP trial participants with low baseline RC level but not in those with high RC level.
THE GREAT PRETENDER: COULD A PHEOCHROMOCYTOMA MANIFEST ITSELF AS A SEIZURE?
Authors: Miletic Marija , Stojanovic Milos , Tancic-Gajic Milina , Vujovic Svetlana
Published: June 2023

Objective:

Seizures are defined as transient occurrence of signs or symptoms due to the abnormally excessive or synchronous neuronal activity in the cerebral cortex. Pheochromocytomas and paragangliomas (PPGL) are chromaffin cell tumors arising from the adrenal medulla in 80–85% of patients and from extra-adrenal sympathetic tissue in 10–20% of patients. PPGL has been referred to as ‘‘the great mimic’’ disease. We present a patient with pheochromocytoma possibly disguised as seizures.

Design and method:

A 44 years old woman was referred to University Clinic of Endocrinology by radiologist. Two years earlier she had syncopal crises . She complained of headache, heart palpitation and malaise, heart palpitations and fatigue during exertion and sense of panic. The maximal self-measured blood pressure was 160/100 mmHg, the pulse is 90-100 beats per min. Abdominal US: a hyperechoic change, 76x65mm was seen, then described in the right lobe of the liver. The following year she had two commotional crises of consciousness and spasms of the extremities . She had a non-specific slowing of FC on EEG on the right for 1-2 seconds. MSCT abdomenal : in the right adrenal gland, a mass 144 x 90mm, with clear borders, pressing into the liver and pushing the right kidney,. The 24h urine was collected, which confirmed a norepinephrine secreting pheochromocytoma. We administered long acting alpha blocking agent preoperatively. The complete surgical excision of the right adrenal mass was done, pathohistological diagnosis: Pheochromocytoma. The last EEG after sleep deprivation performed 2 months postoperatively was described as normal. The patient had no headache or seizure.

Results:

PPGLs have a notable ability of boosting NE levels systemically and hypertension, the most common sign of PPGL could facilitate the permeability of blood brain barrier to NE. Studies showed NE could play its anticonvulsant property at an appropriate concentration but has a proconvulsant effect in either too high or too low concentrations .

Conclusions:

The definite pathogenetic mechanisms explaining how PPGL can cause seizures are far from being clearly understood, though “the great pretender” should be considered as a possible etiological factor of seizures.
PARAGANGLIOMA AS CAUSE OF RESISTANT ARTERIAL HYPERTENSION: A CASE REPORT
Authors: Gulkevych Oksana , Mishchenko Larysa , Bezrodna Larysa , Bozhenko Galyna , Logvynenko Alla , Bezrodnyj Volodymyr
Published: June 2023

Objective:

Approximately 3%of patients with resistant arterial hypertension are diagnosed with pheochromocytoma. On other hand, paragangliomas of the head and neck are rare, representing <0,5% of all head and neck tumors. They arise in a number of locations along the carotid sheath.

Design and method:

Herein, we present the case of a 66-year-old Caucasian woman (BMI 29,3 kg/m2) with resistant arterial hypertension (BP 160-170/100-110 mmHg while taking antihypertensive drugs: valsartan 320 mg/day, hydrochlorothiazide 25 mg/day, amlodipin 10 mg/day) and episodic headaches. Over the last 5 years prior to presentation, she had resistant hypertension and each year normal urinary metanephrine level and CT scan of the abdomen.

Results:

At the presentation a tumor (4,6x3,6x2,9 cm) was detected by ultrasound in the left submandibular region and laboratory tests detected a normal plasma metanephrine level - 0,16 nmol/l (reference values <0,36 nmol/l) and normal plasma 3-methoxytyramine level -<0,06 nmol/l (reference values<0,15 nmol/l) and increased plasma normetanephrine level - 3,25 nmol/l (reference values<1,05 nmol/l.

The tumor was surgically removed and a carotid paraganglioma was confirmed histologically.

After surgery, patient's blood pressure is controlled (130/80 mmHg) by taking a fixed combination valsartan 80/hydrochlorothiazide 6,25 mg /day).

Conclusions:

Patients with resistant arterial hypertension should be screened for secondary hypertension, even if such screening has already been done in previous years.
IS THERE A DOSE OF CYPROTERONE ACETATE LOW ENOUGH TO AVOID HYPERTENSION DEVELOPMENT IN YOUNG TRANSGENDER WOMEN?
Authors: Kuzior Agnieszka , Rios-Gomez Carlos , Santana-Ojeda Borja , Leon-Durango Ricardo Jose De , Hernandez-Lazaro Alba , Arnas-Leon Claudia , Acosta-Calero Carmen , Ortiz-Hernandez Catherine Pino , Perez-Rivero Jennifer Maria , Martinez-Martin Francisco Javier
Published: June 2023

Objective:

Cyproterone acetate (CPA) is a progestagen receptor agonist and androgen receptor antagonist widely used in gender-affirming hormonal therapy (GAHT) for transgender women. It is devoid of the mineralocorticoid blocking effect of native progesterone, thus its combination with oestradiol may elicit hydrosaline retention and hypertension. In a retrospective analysis we have found that using CPA for 5 years in young transgender women increases very significantly their SBP and their incidence of hypertension. Due to risks such as meningioma and liver toxicity, the European Medicines Agency (EMA) recommends avoiding doses >10 mg/day if possible; however, present guidelines for GAHT recommend doses up to 100 mg/day. While lower doses may be effective and safer, the dose-dependence for hypertension development with CPA has not been studied. We undertook to study the association between the cumulative dose of CPA in young transgender women and their incidence of hypertension.

Design and method:

Retrospective review of the clinical records of female transgender people <30-years-old treated with oestradiol + CPA for 5 years. All subjects gave informed consent. They were stratified by quartiles of cumulative CPA intake. We were unable to use doses < 25 mg/day, as only 50 mg pills are available.

Results:

Data were obtained from 56 subjects. The global adjusted annualized incidence of hypertension 4.96% vs. 0.98% in the reference population (transgender women treated with oestradiol without antiandrogen). By quartiles the incidences were 2.52%/4.13%/5.76%/7.31%, p <0.001 (Figure 1A). Their global adjusted SBP increase was 14 vs. 3 mmHg; by quartiles 7/11/16/22 mmHg, p <0.001 (Figure 1B).

Conclusions:

We found a clear dose-dependence for the incidence of hypertension associated with CPA in young transgender women, but even the lowest doses we were able to manage did significantly increase the risk. We cannot however rule out that doses as low as 10 mg/day may be effective and safer. We believe that the present recommendations of high CPA doses for GAHT should be reconsidered.
PRIMARY ALDOSTERONISM: THE EFFECT OF SPECIFIC TREATMENT ON RENAL FUNCTION
Authors: Concistrè Antonio , Petramala Luigi , Ricca Ilaria Della , Servello Adriana , Circosta Francesco , Cavallaro Giuseppe , Letizia Claudio
Published: June 2023

Objective:

The aim of the study was to evaluate the changes in eGFR in patients with idiopathic primary aldosteronism (IHA) and with aldosterone-secreting adenoma (APA) after specific therapy.

Design and method:

From January 2018 to March 2022, we consecutively enrolled 99 patients with PA distinguishing 75 with IHA (mean age 53.41±11.97 years) and 24 with PA (average age 48.79±8.96 years). We evaluated anthropometric, biochemicals and hemodynamic parameters at diagnosis and 12 months after pharmacological or surgical therapy.

Results:

Patients with IHA, pharmacologically treated with mineralocorticoid receptor antagonists (MRAs), showed a higher incidence of chronic renal failure and a faster progression of renal damage than in patients with APA who underwent unilateral adrenalectomy. The reduction of eGFR was significantly greater in patients with IHA than in APA (92.03±17.58 vs 86.63±18.89 mL/min/1.73m2, p <0.001). Systolic blood pressure (SBP) levels and increased aldosterone-to-renin ratio were found to be independent predictors of renal function decline (ß = 0.034; p = 0.045 and ß = 0.248; p = 0.032, respectively).

Conclusions:

Our results show that patients with PA undergoing surgical treatment have a better renal outcome than those receiving drug therapy. An early diagnosis of APA would allow intervention before renal damage occurs.
PHEOCHROMOCYTOMA AS A RARE CAUSE OF MYOCARDIAL INFARCTION
Authors: Avetisyan Kristine , Chirkinyan Mkrtich , Mnacakanyan Anahit
Published: June 2023

Objective:

A 41-year-old man was admitted to the cardiac care unit with acute chest pain radiating to his left arm. For the previous 20 years, he had episodes of high blood pressure accompanied by shivering, sweating, anxiety, and headaches. Electrocardiography revealed ST elevation in the II, III, and aVF leads, as well as reciprocal ST depression in the I and aVL leads. Echocardiography showed hypokinesis of the mid inferior and basal inferior segments. Troponin level increased from 0.005 to 0.177 ng/ml. Aneurysms in the coronary arteries were discovered during an urgent coronary angiography. The patient was prescribed aspirin, angiotensin-converting enzyme inhibitor, and calcium channel blocker and discharged from the hospital.

Design and method:

Further testing included computed tomography (CT) of the aorta and coronary arteries. The aorta had no pathological findings, but the right coronary artery was dilated in the middle segment. A CT scan of the abdomen revealed a mass in the left adrenal gland, and later abdominal and retroperitoneal magnetic resonance imaging revealed a lipid-poor left adrenal mass. Biomarkers of adrenal gland function were evaluated and blood adrenalin (150 pg/ml normal range ‹125pg/ml) and noradrenalin (680pg/ml normal range ‹600pg/ml) levels were mildly elevated. The 24-hour urinary vanillylmandelic acid level was elevated (76,6umol vs. the normal range of 68umol). Cortisol and aldosterone levels in the blood were within normal ranges. Lateral transperitoneal adrenalectomy was eventually performed successfully.

Results:

Histological examination of the mass revealed a pheochromocytoma. The patient's blood pressure returned to normal after the left adrenalectomy, and episodes of sweating and anxiety accompanied by an acute increase in blood pressure disappeared.

Conclusions:

Pheochromocytoma is a rare neuroendocrine tumor that can cause life-threatening cardiovascular complications such as myocardial infarction and cardiac arrhythmias. Unfortunately, the clinical pattern of pheochromocytoma frequently remains without typical manifestations and needs detailed laboratory and radiological confirmation. This case emphasizes the importance of a comprehensive assessment of the patient with arterial hypertension, even in the presence of subclinical sympathetic overactivity.
INTERMACHINE VARIABILITY BETWEEN THE SPHYGMOCOR CVMS AND SPHYGMOCOR XCEL DEVICE IN YOUNG HEALTHY ADULTS: A PILOT STUDY
Authors: Vandecruys Marieke , Smet Stefan De , Leunis Sofie , Beir Jasmine De , Nagler Evi , Calders Patrick , Monbaliu Diethard , Cornelissen Véronique , Craenenbroeck Amaryllis H. Van
Published: June 2023

Objective:

Carotid-femoral pulse wave velocity (cf-PWV) is considered the gold-standard measure for arterial stiffness. The SphygmoCor CVMS uses applanation tonometry on the carotid and femoral arteries, synchronized with an ECG signal. The more recent SphygmoCor XCEL eliminates the need for ECG gating by utilizing leg cuff detection of the femoral pulse in conjunction with carotid tonometry. The latter method is more time-efficient, but may yield different cf-PWV values. The aim of this pilot study is to validate the use of the SphygmoCor XCEL against the SphygmoCor CVMS.

Design and method:

Measurements of the right carotid and femoral artery were conducted using the SphygmoCor CVMS (AtCor Medical), immediately followed by the SphygmoCor XCEL (AtCor Medical). These measurements were performed under standardized conditions, namely in a fasted state and after 15 minutes of rest in a supine position in a quiet room (20̊). All measurements were done in triplicate and were repeated when they did not meet the quality control guidelines, as defined by the manufacturer. The mean difference and SD of the difference between the two devices was calculated and visualized through scatter plot and Bland-Altman analysis. Correlation coefficient as well as intraclass correlation (ICC) was calculated.

Results:

A total of nine (5 females) non-smoking, physically active individuals were included, with a MEDIAN age of 21 years (21-36) and MEDIAN BMI of 21.8 (18,4-25,8). Mean cf-PWV measured by SphygmoCor CVMS was 8.11 ± 0.69 m/s and by SphygmoCor XCEL was 7.61 ± 0.16 m/s. Measurements by both techniques were significantly correlated (R = 0,75; P<0,05; Fig1). The mean difference between the two measurement techniques was 0.50 ± 0.81 m/s, which is ‘acceptable’ according to the ARTERY Society guidelines. Bland-Altman analysis revealed limits of agreement ranging from -1.09 to 2.09 m/s. A ‘moderate’ agreement was documented (ICC = 0.51).

Conclusions:

In this pilot study, the SphygmoCor XCEL demonstrated acceptable agreement with the SphygmoCor CVMS. Bland-Altman plots show that with higher cf-PWV values, there could be a tendency towards overestimation of the cf-PWV by the SphygmoCor EXCEL. Further validation is needed in larger cohorts and other populations.
ARTERIAL STIFFNESS IS A DETERMINANT OF THE WHITE-COAT EFFECT IN YOUNG SUBJECTS IN THE INITIAL STAGES OF HYPERTENSION
Authors: Saladini Francesca , Rattazzi Marcello , Vriz Olga , Mos Lucio , Garavelli Guido , Cozzio Susanna , Mazzer Andrea , Garbelotto Raffaella , Palatini Paolo
Published: June 2023

Objective:

The white-coat effect (WCE) evaluated from the difference between office and ambulatory blood pressure (BP) is often pronounced in young hypertensive subjects chiefly in people with isolated systolic hypertension (ISHY). The WCE in this setting is considered to merely reflect the alarm reaction to doctor's visit and to be a benign phenomenon. However, the WCE might be amplified in subjects with stiffer arteries. The aim of this study was to investigate whether the WCE in the young is influenced by individual vascular characteristics and whether this putative association may differ according to hypertension subtype.

Design and method:

We examined 371 young-to middle age participants (mean age 31.1±8.7 years, 74.7% males). BP phenotypes were identified using ambulatory BP with a 24-hour BP cut-off of 130/80 mmHg. ISHY was present in 24.2 % of participants, isolated diastolic hypertension in 20.0%, systolic-diastolic hypertension in 30.1%, and normotension in 25.7%. Vascular stiffness was assessed by radial-carotid pulse wave velocity (PWV) and vascular compliance by radial tonometry. 24-hour urinary catecholamines were measured with HPLC in 101 participants. The association of WCE with arterial functional indexes was assessed with multivariable linear regression analysis controlling for ambulatory BP. Improvement in the models was expressed by the difference in the Akaike index(↗ AIC)

Results:

In the whole group, PWV was a significant predictors of the WCE with a ↗AIC of 9.9 (p = 0.001). In addition, a negative association was found between the WCE and large artery (p = 0.001) or small artery (p = 0.002) compliance. Twenty-four-hour urinary epinephrine and nor-epinephrine were totally unrelated to WCE. PWV was a significant predictor of the WCE also among the participants with ISHY with a ↗AIC of 8.2 (p = 0.002). This association was not present in the participants with isolated diastolic hypertension (p = 0.15) or systolic-diastolic hypertension (p = 0.28).

Conclusions:

These data indicate that arterial stiffness rather than sympatho-adrenergic activity is an important determinant of the surrogate measure of the WCE in young subjects in the initial stage of hypertension. This association was confirmed in the subgroup of participants with ISHY suggesting that in some individuals ISHY may not be a benign condition.
ESTIMATED PULSE WAVE VELOCITY AND ALL-CAUSE AND CARDIOVASCULAR MORTALITY IN GENERAL POPULATION - (EHUH STUIDY -CROATIAN SCIENTIFIC FOUNDATION)
Authors: Radunovic Danilo , Blagus Luka , Bosnjak Vito , Domislovic Marija , Glavic Mihaela Marinovic , Kos Jelena , Vrkic Tajana Zeljkovic , Pecin Ivan , Jelakovic Ana , Premuzic Vedran , Dika Zivka , Domislovic Viktor , Prelevic Vladimir , Gellineo Lana , Capak Krunoslav , Jelakovic Bojan
Published: June 2023

Objective:

Carotid-femoral pulse wave velocity (cfPWV) was recommended by guidelines as biomarker and independent predictor of cardiovascular (CV) events. Measurements of cfPWV is demanding and expensive method. It was suggested that an estimated PWV (ePWV) could be used. Our aim was to analyze the predictive role of ePWV for CV and all-cause mortality in general population.

Design and method:

In stratified random sample of 1087 subjects from the general Croatian adult population (EH-UH study) (men 42.4%, average age 53 +/-16) subjects were followed for 17 years. Mortality data were obtained from Croatian Institute of Public Health. In the follow-up period 1060 patients had all the data on death. ePWV was calculated using formula: ePWV = 9.587-0.402 × age + 4.560 × 10-3 × age2-2.621 × 10-5 × age2 × MBP + 3.176 × 10-3 × age × MBP-1.832 × 10-2 × MBP. MBP = (DBP) + 0.4(SBP-DBP).

Results:

At the end of follow up period 228 deaths (all-cause mortality 20.9%; CV, stroke, cancer, dementia and degenerative diseases, cold, others 43.4%, 10.5%, 28.5%, 5.2%, 3.1%, 9.3%, respectively). In the 2nd ePWV tertile there were more deaths due to cancer than from CV disease (46% vs. 30%), while in the 3rd tertile we observed opposite (20.5% vs. 51.04%). In the analysis of survival of subjects classified into the ePWV tertiles when all-cause and CV death and mortality were observed, the probability of survival of the 3rd tertile compared to the 2nd and 1st tertiles were significantly lower (p< 0.001 Log Rank test (Mantel-Cox)) (Figure 1). In unadjusted model, in Cox regression ePWV was significant predictor for CV death and for each increase of 1m/s there was 14% increase risk for CV death. In multivariate analyses ePWV was neither independent predictor for all-cause nor for CV mortality (p>0.05). However, in u subgroup of subjects with higher CV risk we found ePWV to be a significant predictor of CV deaths (ePWV (m/s) β 1.108; p<0.029; HR 3.03,95% CI 1.118-8.211).

Conclusions:

In general population ePWV is associated with higher all-cause and CV mortality, although not independently of other risk factors. However, in a subgroup of subjects with high CV risk, ePWV was significant and independent predictor of CV mortality. Further studies are needed before ePWV could be recommended in general clinic work.
OBESITY AND DYSLIPIDEMIA IN WOMEN LIVING IN THE CROATIAN RURAL AREA DAMAGED BY AN EARTHQUAKE. “THE SILENT KILLER HUNT”- CROATIAN SOCIETY OF HYPERTENSION PROJECT
Authors: Prgomet Luka , Bilic Katarina , Skelin Juraj , Vogrinc Dora , Vujanic Sara , Vuksic Antonia , Zeljko Lucija , Jelakovic Bojan
Published: June 2023

Objective:

Obesity is a worldwide health issue that negatively impacts many aspects of normal life. There are many tests and parameters that can give insight into someone's health status, one of them being the lipid panel.

Our aim was to assess the association between anthropometric parameters and lipid status (HDL, LDL, total cholesterol and triglycerides) of women in the Croatian rural area damaged by an earthquake.

Design and method:

We collected blood samples of 165 female subjects (opportunistic screening), In addition, we measured by using a metabolic scale with a body composition monitor: three different fitness indicators: body mass index (BMI), waist circumference (WC) and mid-upper arm circumference (MIAC).

Results:

Average values of BMI, WC, and MIAC were 29.8 ± 6.04 kg/m2, 98.1 ± 15.90 cm, 31.6 ± 4.30 cm, respectively, and average values of LDL-cholesterol, HDL-.cholesterol, triglycerides, and total cholesterol were 3.34 ± 0.93 mmol/l, 1.44 ± 0.33 mmol/l, 1.57 ± 0.90 mmol/l, 5.48 ± 1.08 mmol/l, respectively. HDL-cholesterol shows a significant negative correlation with the BMI (r = -0.168, p = 0.031) WC (r = -0.168, p = 0.032) MIAC (r = -0.200, p = 0.010) and a significant positive correlation of triglycerides with BMI (r = 0.162, p = 0.038) WC (r = 0.244, p = 0.002); MIAC (r = 0.174, p = 0.026).

Conclusions:

Based on the given results we can conclude that the prevalence of dyslipidemia in women living in rural areas is very high. Observed association with HDL-cholesterol and triglycerides with anthropometric measures points to a need to consider those two lipid parameters equally serious as total and LDL cholesterol. Simple and reliable measurements, like waist circumference and BMI, could be used in the assessment of someone's health status since they provide us with valuable insights into their lipid profile.
VISCERAL FAT IS ASSOCIATED WITH HIGH BLOOD PRESSURE IN A RURAL POPULATION FROM THE CROATIAN RURAL AREA DAMAGED BY AN EARTHQUAKE
Authors: Petrinovic Martina , Abramovic Inga , Lonic Jakov , Mestrovic Dora , Sovic Ariana , Strabic Adrijana , Jelakovic Bojan
Published: June 2023

Objective:

This study aimed to find whether there is an association between an increased percentage of visceral fat and high blood pressure in the rural population.

Design and method:

Blood pressure (BP) was measured following ESH guidelines using Microlofe oscillometric device. Visceral fat was measured using a metabolic scale with a body composition monitor. Subjects who had a visceral fat of 11 % or less were categorized as group 1, whereas participants with a visceral fat of 12 % or more were categorized as group 2. The collected data were statistically analyzed with the help of Jamovi 2.2

Results:

The measurements showed a statistically significant difference between the mean diastolic BP of the tested groups (80 mmHg vs. 83.4 mmHg; p = 0.014). We failed to find differences in systolic BP (p>0.05)

Conclusions:

In this study, we proved the association between high visceral fat percentage and elevated diastolic BP. Some of the potential mechanisms linking obesity to hypertension include metabolic, endothelial and vascular dysfunction, maladaptive inflammatory response and neuroendocrine imbalances.
GLOBAL PREVALENCE OF HYPERTENSION AMONG ART-NAÏVE ADULTS LIVING WITH HIV: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Ebasone Peter Vanes , Dzudie Anastase , Peer Nasheeta , Kengne Andre Pascal
Published: June 2023

Objective:

Cardiometabolic diseases have been suggested to be more frequent in people living with HIV (PLWH), resulting from the chronic inflammatory effects of the virus, effects of antiretroviral therapy (ART) and other factors that operate in the general population. Most studies have focused on assessing the prevalence of hypertension in PLWH on ART. Therefore, this study aimed to estimate the global prevalence of hypertension in the ART-naïve PLWH and to compare the prevalence among ART-naïve, ART-treated and HIV-negative subgroups. PROSPERO Registration: CRD42021226001.

Design and method:

We searched PubMed-MEDLINE, CINAHL, SCOPUS, Academic-Search Premier, Africa-Wide Information and Africa-Journals Online databases to identify relevant studies published before September 2022. We included Cross-sectional, cohort and case-control studies reporting baseline data on the prevalence of hypertension among ART-naïve adults living with HIV, worldwide. Two authors independently screened, selected, extracted data, and conducted methodological quality assessments. Data reported were pooled using random-effects meta-analysis.

Results:

Eighty studies across five continents comprising 204,876 ART-naive PLWH with mean/median ages ranging from 32 – 50 years were included. Most studies were from Africa; 43 (54%). The pooled prevalence of hypertension was 13.6% (95%CI: 10.5 - 17.0) among 39 studies that used a standard definition of hypertension (The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: JNC 7). The prevalence was 13.8% (95%CI: 10.4 - 17.5) based on a blood pressure cut-off of 140/90 mmHg only. There was no significant difference in hypertension prevalence by region, age, CD4 count, viral load, and publication year. Among the 9 studies that reported the prevalence by ART and HIV status, it was 9.6% (95%CI: 5.3 – 14.8), 17.7% (95%CI: 9.6 – 27.4) and 19.3% (95%CI: 10.1 – 30.5) in the ART-naïve, ART-treated and HIV negative subgroups respectively (p = 0.044). There was substantial heterogeneity (all I2 >90%, and all p<0.0001). There was no evidence of publication bias (all Egger test p >0.1286).

Conclusions:

The prevalence of hypertension in ART-naïve adults living with HIV worldwide is lower than in ART-treated and HIV-negative adults and does not differ by age, CD4 count, viral load, publication year and region.
ACTUAL AND PERCEIVED BLOOD PRESSURE AND LDL-CHOLESTEROL CONTROL IN HYPERTENSIVE PATIENTS WITH DYSLIPIDEMIA: A CROSS-SECTIONAL EPIDEMIOLOGICAL STUDY IN CROATIA (SNAPSHOT STUDY)
Authors: Pecin Ivan , Johnson Neil , Bayle Sabine
Published: June 2023

Objective:

Assess BP and LDL-C control rates and cardiovascular (CV) risk in hypertensive patients with dyslipidemia in Croatia, based on stricter recommendations from recent European guidelines, and compare them with physicians’ assessment.

Design and method:

The cross-sectional observational multicenter epidemiological SNAPSHOT study involved 116 general practitioners in Croatia and included 1298 hypertensive patients with dyslipidemia.

Results:

91.7% of patients had additional risk factors. 57.9% were 65 years-old or older (65.8±9.7 years), 47.3% men, 42.6% obese (mean BMI 29.6±4.6 kg/m2) and 17.6% smokers. 55.4% had comorbidities: diabetes mellitus (34.1%), coronary artery disease (21.0%), and peripheral arterial disease (9.6%). Mean systolic/diastolic BP was 135.5±13.3 / 80.3±8.5 mmHg, total cholesterol 203.2±52.7 mg/dL, HDL-C 53.9±13.8 mg/dL, LDL-C 119.4±45.1 mg/dL, triglycerides 160.8±109.7 mg/dL.

Cardiovascular risk was estimated by investigators as “high”/“very high” for 30.1% and 31.4% of patients, respectively, whereas calculated CV risk according to guidelines (SCORE CHART 2-OP) was “high”/“very high” for 38.0% and 38.5% of patients, respectively. These results showed that 46.6% of investigators estimated CV risk accurately, while 34.3% underestimated it.

Hypertension was treated in 99.1% of patients and BP considered as controlled by investigators in 79.5% of patients, whereas actual control based on guidelines’ recommendations was achieved by 23.9%. Similarly, dyslipidemia was treated in 79.4% of patients and LDL-C considered as controlled by investigators in 54.2%, whereas actual control was achieved by only 12.8% according to guidelines. Only 2.9% of patients were actually controlled for both BP and LDL-C whereas 45.3% of patients were considered as controlled for both BP and LDL-C by investigators.

66.4% of patients were treated with single-pill combinations for hypertension, 8.6% for dyslipidemia, and only 5.5% received treatment for both hypertension and dyslipidemia in a single pill.

Conclusions:

Actual BP and LDL-C control rates in Croatia remain rather low and are often overestimated by physicians. Physicians often underestimate CV risk, which is difficult to evaluate in clinical practice. Improving physician education about guidelines’ recommendations and need for treatment intensification could offer an opportunity to further improve risk factor control. Single-pill combination usage for dyslipidemia and for both hypertension and dyslipidemia remains rather low.
EFFECT OF EXPOSURE TO AMBIENT PM2.5 ON BLOOD PRESSURE AND HYPERTENSION AMONG PARTICIPANTS OF THE GLOBALLY CONDUCTED MAY MEASUREMENT MONTH 2018-2019
Authors: Anand Kritika , Mandal Siddhartha , Beaney Thomas , Mcardle Harsha , Poulter Neil , Prabhakaran Dorairaj
Published: June 2023

Objective:

Low-middle-income countries (LMICs) face most of the burden of air pollution and increasing incidence and mortality from increased blood pressure (BP) and hypertension. Yet, there is a paucity of studies linking air pollution and BP conducted in LMICs. We aim to extend the spatial coverage of the evidence using data from countries with different income and air pollution levels. We investigated the effect of exposure to short and long-term ambient PM2.5 on BP and prevalent hypertension in 125,198 participants from 29 countries during May Measurement Month (MMM) BP screening campaigns in 2018 and 2019.

Design and method:

We conducted a cross-sectional study using satellite-derived data on monthly average PM2.5 and assigned exposure (averaged for 1month, 3months, 6 months, and 1 year) to participants for the month in which BP measurement was recorded based on the coordinates of the MMM screening site. We used generalized additive models with penalized splines for BP and generalized linear models for prevalent hypertension, accounting for potential confounders and country-level clustering effects.

Results:

Short and long-term exposure to ambient PM2.5 was associated with increased SBP and DBP at an individual level but not at the country level. We found the relationship non-linear, with significantly higher effects beyond 70ug/m3. An interquartile range increase (17.6ug/m3) in annual PM2.5 was associated with a higher prevalence of hypertension with an odds ratio of 1.12 [95% CI: 1.09, 1.15]. Stratified analysis showed that individuals with high BMI and those with hypertension, particularly among those untreated and participants with comorbidities, were more susceptible to the effect of air pollution on BP.

Conclusions:

More high-quality data are required to evaluate individual air pollution exposure (using robust and granular data) with cardiovascular risk factors such as BP and major adverse cardiovascular events. Meanwhile, health policies promoting air pollution reduction are needed, particularly for those at the highest risk.
ETHNIC DIFFERENCES IN THE PREVALENCE OF MASKED HYPERTENSION PHENOTYPES: ISOLATED AMBULATORY, ISOLATED HOME, AND DUAL MASKED HYPERTENSION
Authors: Fujiwara Takeshi , Kario Kazuomi , Mcmanus Richard
Published: June 2023

Objective:

Ethnic differences in the prevalence of masked hypertension (MH) are known. However, no studies have examined whether there are ethnic differences in the prevalence of MH phenotypes, assessed by ambulatory blood pressure (ABP) or home blood pressure (HBP), or both. The object was to investigate the ethnic differences in the prevalence of MH phenotype in individuals without a previous diagnosis of hypertension (NHT) and those with a diagnosed hypertension (HT).

Design and method:

Cross-sectional ABP, HBP, office blood pressure (OBP) and characteristic data were compared in 1,588 participants (mean age 61.8±10.4 years, 49.2% males, 80.1% HT, White British 16.8%, South Asian 9.9%, African Caribbean 10.6%, Japanese 62.7%) from combined database of the UK and Japan in clinical practice. Isolated ambulatory MH was defined as normal OBP (<140/90 mmHg) and HBP (<135/85 mmHg) and elevated daytime ABP (> = 135/85 mmHg), isolated home MH as normal OBP and daytime ABP (<135/85 mmHg) and elevated HBP (> = 135/85 mmHg), and dual MH as normal OBP and elevated daytime ABP and HBP.

Results:

Among participants with any phenotype of MH in NHT (n = 129) or HT (n = 356), 31.0% and 36.0% had isolated ambulatory MH, 29.5% and 25.3% isolated home MH, and 39.5% and 38.7% dual MH, respectively. For the diagnostic accuracy of HBP against daytime ABP for MH, there were no differences among groups in NHT; low sensitivity (50-73%), but moderate specificity (74-88). In HT, Japanese showed lower sensitivity (38%) than others (72-79%). There were no differences in specificities (78-94%) among groups. In diagnostic agreements of MH between ABP and HBP monitoring, Japanese showed lower reproducibility both in NHT and HT (Kappa statistic, 0.28 and 0.38, respectively) than other groups (0.38-0.52 and 0.51-0.55). In multivariate logistic regression analysis, Japanese in NHT showed higher odds ratio (OR) for isolated ambulatory MH and those in HT showed lower OR for isolated home MH compared with White British: 4.01 (p = 0.016), 0.36 (p = 0.004), respectively.

Conclusions:

In Japanese population compared with White British, HBP alone might underestimate the prevalence of MH and ABP could behave as a complementary to HBP.
THE HIGH-ENERGY DIET/STREPTOZOTOCIN TREATED MUNICH WISTAR FRÖMTER RATS: A NEW EXPERIMENTAL MODEL OF DIABETES INDUCTION IN ESTABLISHED KIDNEY DISEASE
Authors: Vega-Martín Elena , González-Moreno Daniel , Sanz-Gómez Marta , Guzmán-Aguayo Ana Karen , Manzano-Lista Francisco Javier , Aránguez Isabel , Kreutz Reinhold , Fernández-Alfonso María S.
Published: June 2023

Objective:

Chronic kidney disease (CKD) is especially prevalent in patients with diabetes mellitus (DM). We aim to induce diabetes in the Munich Wistar Frömter (MWF) rat, a genetic model of established CKD.

Design and method:

16-week-old male MWF rats (n = 10 rats/group) were fed standard chow (MWF) or a high fat/high-sucrose diet for 6 weeks together with streptozotocin administration (STZ; 15mg/Kg i.p.) at the start of dietary exposure (MWF-D).

Results:

Water intake, urine excretion, GTT and HOMA-IR index evidenced the development of diabetes in MWF-D rats. Albuminuria was higher in MWF with no further effect of diabetes. However, renal expression of Kim-1 and Ngal, markers of renal damage, AT1R, AT2R and Collagen 1A1 were significantly higher in MWF-D rats. Perirenal adipose tissue (PRAT) amount was significantly higher in MWF-D rats and exhibited an upregulation of TNF-alpha and profibrotic factors (TGF-beta and Collagen 1A1), together with a downregulation of IL-10. Although blood pressure was not further increased by the induction of diabetes, heart weight and left ventricular wall thickness were higher in MWF-D, coincident with a reduction in systolic volume, but without a change in the ejection fraction.

Conclusions:

We propose the MWF-D rat as an experimental model of NDKD and suggest a strong relation between alterations in PRAT and increased renal damage.
POLYMORPHIC VARIANTS OF AGT (RS4762) AND GNB3 (RS5443) GENES AS PREDICTORS OF ESSENTIAL ARTERIAL HYPERTENSION DEVELOPMENT
Authors: Voroniuk Kseniia , Sydorchuk Larysa , Hinhuliak Oleksandr , Repchuk Yuliia , Semianiv Marianna , Sokolenko Alina , Biletsky Semen , Ivashchuk Sergiy , Petrynych Oksana , Kazantseva Tetiana , Dzhuriak Valentyna
Published: June 2023

Objective:

To evaluate the role of the polymorphism of AGT genes (rs4762) and GNB3 genes (rs5443) in the development of the essential arterial hypertension separately and by combining their polymorphic variants.

Design and method:

The case-control study involved 100 patients with EAH stage II, 1-3 degrees of blood pressure (BP), high and very high cardiovascular risk. Among the patients there were 21% (21) men, 79% (79) women. The mean age of patients was 59.86±6.22y.o. The control group consisted of 60 almost healthy individuals, relevant in age (49.13±6.28y.o.) and gender distribution (63% - women, 37% - men). To study of polymorphism of AGT (rs4762) and GNB3 (rs5443) genes was performed a qualitative polymerase chain reaction (PCR) in real time.

Results:

The mutated T-allele of the AGT gene (rs4762) occurs in 15.97% of hypertensive residents of Northern Bukovyna, that is more frequent than in healthy individuals by 9.72% (p = 0.023); homozygous mutations of the AGT gene were not found in the control group at all. Whereas, the relative frequency of polymorphic variants of the GNB3 gene (rs5443, 825C>T) did not differ significantly between groups. The wild C-allele statistically significantly prevails over the mutated T-allele in both groups according to the AGT (rs4762) and GNB3 (rs5443) genes (p<0.001).

Binary logistic regression confirmed an increase in the risk of hypertension inheritance according to dominant and additive models in minor T-allele carriers of the AGT gene (rs4762) almost 3 times higher than in C-allele homozygotes (p = 0.04 and p = 0.03). Inheritance of EAH is not associated with polymorphic variants of the GNB3 gene (rs5443).

Conclusions:

The T-allele of the AGT gene (rs4762) increases the risk of hypertension almost 3 times, whereas, polymorphic variants of the GNB3 gene (rs5443) are not predictors of EAH in the observed.
FUNCTIONAL ANALYSIS OF AN NF1 SPLICING MUTATION THAT CAUSED EXON SKIPPING AND LED TO A TRUNCATED PROTEIN IN NEUROFIBROMATOSIS TYPE 1
Authors: Lu Yiting , Zhang Di , Tian Tao , Yang Kunqi , Zhou Xianliang , Fan Peng
Published: June 2023

Objective:

Neurofibromatosis type 1 (NF-1) is caused by mutations in the NF1 gene that encodes neurofibromin, a negative regulator of RAS proto-oncogene. Approximately one-third of the reported pathogenic mutations in NF1 are splicing mutations, suggesting that splicing mutations are not rare. The objective of this study was to identify the pathogenicity of splicing mutation in a Chinese family with NF-1 and determine the effects of the pre-mRNA splicing mutation by in vitro functional analysis.

Design and method:

Next-generation sequencing was used to screen candidate mutations and Sanger sequencing was performed for validation. We performed a minigene splicing assay to determine the effect of the splicing mutation on NF1 expression and three-dimensional structure models of wild-type and mutant-type neurofibromin were generated using SWISS-MODEL and PROCHECK method, respectively.

Results:

Next-generation sequencing analysis identified a pathogenic splicing mutation c.479 + 1G>C in NF1 in the proband who had typical pigmental lesions and severe renal artery hypertension. We speculated that the causative mutation originated from the proband's mother who died of glioma. The minigene splicing assay showed that the c.479 + 1G>C mutation caused the skipping of exon 4, leading to a Glutamine to Valine substitution at position 97 in neurofibromin and an open reading frame shift terminating at codon 108. Three-dimensional modelling of neurofibromin showed that several major domains were missing in the truncated protein, which would have affected its function.

Conclusions:

The splicing mutation c.479 + 1G>C identified in a Chinese pedigree with NF-1 caused the skipping of exon 4 and resulted in a truncated protein. Our findings would be of great significance for the molecular diagnosis and management of NF-1 and showed that the minigene splicing assay is a powerful tool for analyzing mRNA expression outcomes caused by donor splicing site variation.
POTASSIUM, URINARY METABOLOMICS, BLOOD PRESSURE AND GLUCOSE METABOLISM: THE AFRICAN-PREDICT STUDY
Authors: Strauss-Kruger Michél , Pieters Marlien , Zyl Tertia Van , Jacobs Adriaan , Gafane-Matemane Lebo , Schutte Aletta , Louw Roan , Mels Carina
Published: June 2023

Objective:

A potassium deficient diet is associated with a higher risk of type 2 diabetes and hypertension. Both conditions occur more frequently in Black populations, who consume less potassium-rich foods than what is typically observed in White populations. Metabolomics is a useful tool in nutritional epidemiology and may help identify metabolic pathways involving potassium and its relationship with diabetes and cardiovascular disease. Recognizing metabolic pathways that may be dysregulated by potassium deficiency could help procure more accurate entry points for prevention and intervention strategies involving diet.

Design and method:

This study included 440 White and 350 Black adults from the African-PREDICT study (aged 20-30 years). We measured 24-hour BP and collected 24-hour urine samples to determine potassium and sodium concentrations. Fasting plasma glucose levels were determined. Amino acids and acylcarnitines were measured in spot urine using liquid chromatography-tandem mass spectrometry.

Results:

Black participants had lower urinary potassium than Whites (36.6 vs. 51.1 mmol/day) (p<0.001). In the total group 24-hour urinary potassium associated positively with 2-aminoadipic acid (r = 0.111; p = 0.002), C3-[propionylcarnitine] (r = 0.091; p = 0.014), C4-[butyrylcarnitine] (r = 0.094; p = 0.009) and C5-[valerylcarnitine] (r = 0.072; p = 0.043) after Pearson (q <0.05) and partial correlations adjusting for sex, ethnicity, age, and waist circumference. With ethnic stratification these relationships remained statistically significant only in White participants. In accordance, Na/K+ ratio was inversely related to 2-amino adipic acid (r = -0.085; p = 0.018), C3- (r = -0.077; p = 0.038), C4- (r = -0.125; p<0.001) and C5-carnitine (r = -0.104; p = 0.004) in the total group. In the total group, 2-aminoadipic acid (r = 0.086; p = 0.031) and C4-carnitine (r = 0.088; p = 0.026) in turn were positively associated with 24-hour SBP and negatively with fasting plasma glucose [2-aminoadipic acid (r = -0.139; p<0.001), C3-carnitine (r = -0.083; p = 0.044), C4-carnitine (r = -0.115; p = 0.004) and C5- (r = -0.124; p = 0.002)].

Conclusions:

Our study highlights the important consideration of ethnic differences when investigating nutrient-metabolome relationships. Only in White adults did we observe a positive association of urinary potassium, with 2-aminoadipic acid and short chain acylcarnitines, which in turn related positively to blood pressure and negatively with plasma glucose levels. In White adults, early metabolomic changes related to potassium intake may contribute to BP regulation and glucose homeostasis.
GENETIC ASSOCIATION STUDY BETWEEN T-786C NOS3 POLYMORPHISM AND ESSENTIAL HYPERTENSION IN AN ALGERIAN POPULATION OF THE ORAN CITY
Authors: Amrani Asma , Kiando Soto Romuald , Treard Cyrielle , Jeunemaitre Xavier , Bouatia-Naji Nabila
Published: June 2023

Objective:

We aim in this study to analyze the relationship between NOS3 -786T/C, a common genetic variant and HTN in a sample of the Algerian population of the Oran city.

Design and method:

A case-control study has been performed on 154 subjects including 77 hypertensives and 77 normotensives. The recruitment of these subjects was done in local Health Centers of the city of Oran, West Algeria. Consent was obtained from all participants. Polymerase chain reaction (PCR) combined with restrictive fragment length polymorphism (RFLP) was used to genotype the NOS -786T/C variant.

Results:

The distribution of the allelic frequencies did not differ between cases and controls. However, after adjustment with the age, sex, and body mass index, we observed a significant association between NOS -786C allele and HTN status.

Conclusions:

Our results indicate that the C allele of the NOS3 gene is associated with an increased risk of essential hypertension in this sample of the Algerian population of Oran city.