bluuebunny/crossref_metadata_2025 huggingface dataset:
ACCESS TO AFFORDABLE ANTI-HYPERTENSIVE MEDICINES AND ITS ASSOCIATION WITH ADHERENCE AND BLOOD PRESSURE CONTROL AMONG HYPERTENSIVE PATIENTS AT A TEACHING HOSPITAL IN GHANA
Authors: Harrison Mark Amankwa , Marfo Afia Frimpomaa A. , Buabeng Kwame Ohene , Nelson Frempomaa , Acheampong Franklin , Ankrah Daniel Nii Amoo
Published: April 2021

Objective:

To determine multiple anti-hypertensive medicines affordability and accessibility and their association with adherence and blood pressure control among hypertensive patients attending the Korle Bu Teaching Hospital.

Design and method:

It was a cross-sectional study of hypertensive patients attending the Korle Bu Teaching Hospital Polyclinic in Ghana. Systematic sampling was used to administer a questionnaire to 310 patients treated for hypertension. Data on ten generic anti-hypertensive medicine prices at the hospital and two private pharmacies were collected to determine out-of-pocket affordability. Availability of the medicines at the hospital and percentage available at patients’ home or acquired by them was collected to determine accessibility. Adherence was measured using a validated 8-item scale.

Results:

Questionnaires retrieved were 304. Some health insurance patients (19.4%) made out-of-pocket payments. One hundred and twenty three (40.5%) and 77 patients (25.3%) could not afford 4 anti-hypertensive medicines at the private pharmacy and the hospital respectively. Availability at the hospital was 60%. Continuous access at the hospital was 14.8%. Overall access (medicine acquisition or percentage available at patients’ home) was 74.9% (SD ± 41.3). Only 18.1% were highly medication adherent. Blood pressure control was 41.8%. Out-of-pocket affordability was not significantly associated with adherence (regression beta coefficient = 0.005; p-value = 0.281) but it was positively associated with blood pressure control with statistical significance (R = 0.12, p = 0.037). Obtaining medicines with health insurance only was more likely to result in blood pressure control than with health insurance plus out-of-pocket payments (OR = 2.185; 95% CI, 1.215 – 3.927). Access was positively associated with adherence, and this was statistically significant (R = 0.17; p = 0.03). Access at the hospital was more likely to result in blood pressure control (OR = 1.642; 95% C.I, 0.843 – 3.201). Patients who had controlled blood pressure had a higher adherence score than those who had uncontrolled blood pressure [6.048 (1.701) versus 5.847 (1.744); p = 0.319].

Conclusions:

Accessibility was lower than the WHO target. A significant proportion of patients didn’t have out-of-pocket affordability. Obtaining drugs free was more likely to result in blood pressure control. Access to affordable anti-hypertensive medicines is associated with adherence and blood pressure control.
HIGH PREVALENCE OF HIGH BLOOD PRESSURE AND EXCESSIVE BLOOD PRESSURE REDUCTION IN PATIENTS WITH “CONTROLLED” ARTERIAL HYPERTENSION AFTER MYOCARDIAL INFARCTION AND STROKE
Authors: Pavelko Mykhailo , Oshtuk Yaroslav , Yagensky Andriy
Published: April 2021

Objective:

Arterial hypertension (AH) is important risk factor and its control is a cornerstone of primary and secondary prevention. On the other hand, excessive blood pressure (BP) reduction may be harmful, especially in patients with the history of ischemic events. To assess AH control we performed 24-hours ambulatory blood pressure monitoring (ABPM) in patients with AH in remote period after myocardial infarction (MI) or ischemic stroke (IS) in whom AH was believed to be controlled accordingly BP office measurements.

Design and method:

64 patients with AH and previous (at least 6 months after) MI (39 patients, 64.1% men) and IS (25 patients, 36.0% men) with normal office BP (120–139 mm Hg/60–89 mm Hg) during two consecutive visits were involved into the study. ABPM was performed and mean values of systolic BP (SBP) and diastolic BP (DBP) were assessed. Excessive BP reduction (EBPR) was considered as SBP below 100 mm Hg at daytime. Prolonged EBPR was considered as EBPR more than 1 hour of consecutive measurements.

Results:

Groups did not differ significantly in age, body mass index, glomerular filtration rate, number of antihypertensive drugs, prevalence of diabetes. Mean 24-hour SBP was higher in IS group (131.9/76.4 ± 11.7/7.3 mm Hg) comparing to 118.5/71.3 ± 11.0/9.0 mm Hg in MI group (p < 0,00001 for both SBP and DBP). Mean 24-hour SBP higher than 140/90 mm Hg was found in 28.0% patients in IS and only in 2.6% patients in MI group (p = 0.002). Much more episodes of EBPR were detected in MI than in IS group (10.2 ± 10.8 vs 4.0 ± 3.9, p = 0.008) and number of patients with at least one prolonged EBPR was also higher in MI group (23.1% vs 8.0%). Patients with prolonged EBPR did not differ significantly in age, body mass index, glomerular filtration rate, prevalence of diabetes and number of antihypertensive drugs.

Conclusions:

Around a quarter of patients in remote period after IS had high BP levels whereas similar proportion of patients after MI had prolonged episodes of excessive hypotension during ABPM. Office BP measurements may be not sufficient to detect inadequacy of AH control in secondary prevention.
A PERSPECTIVE OF PRIVATE HEALTH CARE PROVIDERS IN THE STATE OF MADHYA PRADESH ON ADOPTING KEY STRATEGIES OF INDIA HYPERTENSION CONTROL INITIATIVE
Authors: Krishna Ashish , Pathni Anupam Khungar , Sharma Bhawna , Shivashankar Roopa , Shrivastava Suyesh , Hering Dagmara
Published: April 2021

Objective:

The India Hypertension Control Initiative (IHCI) has been implemented in public health facilities of three districts of Madhya Pradesh (MP). In India, more than 70% of outpatient visits take place in the private health sector. To achieve the Government of India's goal of a 25% relative reduction in the prevalence of raised blood pressure (BP) by 2025, it is critical to expand the implementation of quality hypertension treatment. This study aimed to assess the perspective of private practitioners (PPs) on adopting the core strategies of the IHCI in Bhopal district of MP

Design and method:

A semi-structured detailed interview was purposely applied to 30 PPs who were familiar with IHCI to obtain their opinions on standardised hypertension treatment protocols, patient-centred services and easy-to-use information system in their private practice. Verbatim data were recorded and analysed thematically using the Microsoft 2010.

Results:

Only 11 PPs followed the State approved hypertension treatment protocol. Among the remaining 19 PPs, the major reasons for not adopting protocol were (1) limited availability of single component hypertension drugs (13 PPs), (2) preferences for single fixed combinations drug (10 PPs) and (3) fear of losing patients due to a lack of immediate BP control or drug-related adverse effects (7 PPs). None of the interviewed doctors had resources to provide patient-centred care and use the information system. Overall, the interviewed doctors identified that free supply of standard treatment protocols (12 PPs), inclusion of single-pill combinations in treatment protocol (10 PPs), increasing number of staff for follow-up visits and patient education (19 PPs), IT-based solutions for patient records (17 PPs), employee incentives (5 PPs) and preparation of national data sharing policies (5 PPs) are the key actions to accelerate the adoption of IHCI strategies in the private sector.

Conclusions:

This exploratory study suggests that engagement of the private sector in IHCI is feasible. Future studies should focus on ensuring the wider availability of hypertension treatment protocol drugs and developing a simple user-friendly digital platform for patient monitoring.
FIXED COMBINATIONS IN ACHIEVEMENT TARGET LEVEL OF BLOOD PRESSURE IN PATIENTS WITH ARTERIAL HYPERTENSION
Authors: Rekovets Oksana , Sirenko Yuriy , Torbas Olena , Kushnir Svitlana , Primak Galina , Sirenko Olexandr , Krushynska Nina , Ponomareva Galina
Published: April 2021

Objective:

Aim. Evaluate the therapeutic efficacy of fixed triple combination of valsartan / amlodipine / hydrochlorothiazide compared a double fixed combination of valsartan / amlodipine in patients with arterial hypertension.

Design and method:

The study included 50 patients with moderate and severe arterial hypertension. Patients were divided into 2 groups. The first group (n = 25) received fixed triple combination of 160 mg valsartan / 5 mg amlodipine / 12.5 mg hydrochlorothiazide once daily, in the morning for 1 month. Patients in the second group (n = 25) received a double fixed combination of 160 mg valsartan / 5 mg amlodipine once a day, in the morning for 1 month. If necessary, dose was titrated to 320/10 / 12.5 mg (valsartan / amlodipine / hydrochlorothiazide) or 320/10 mg (valsartan / amlodipine). After 3 months of treatment was control of therapy.

Results:

The average age of patients 54.9 ± 1.8 (25–75) years, BMI 31.2 ± 0.7 kg / m2. Office SBP/DBP at the beginning 161.7 ± 1.8/98.5 ± 1.4 mmHg, HR 70.7 ± 1.4 beats / min. 24 SBP/DBP 143.8 ± 1.1/92.4 ± 1.2 mm Hg. 24HR 71.5 ± 1.5 beats / min. The decrease 24SBP/DBP was 18.0 / 16.1 mm Hg (p < 0,05) on (val/aml) and 23,8 / 20,7 mm Hg (p < 0,05) on (val/aml/HTZ). The decrease day time SBP/DBP - 19.4 / 17.8 mm Hg (p < 0,05) on (val/aml) and 17,8 / 22,6 mm Hg (p < 0,05) on (val/aml/HTZ). Decrease mean nocturnal SBP/DBP 17.0 / 12.1 mm Hg (p < 0,05) on (val/aml) and 20,5 / 18,2 mm Hg (p < 0,05) on (val/aml/HTZ) combination. Achievement of target BP at ABPM was 77.3% - in the double (val/aml) combination and 95.2% in the triple (val/aml/HTZ) combination.

Conclusions:

The triple fixed combination (val/aml/HTZ) was more effective in reducing blood pressure with daily monitoring compared to a double fixed (val/aml) combination which was not increase in side effects.
CARDIOVASCULAR RISK FACTORS IN HYPERTENSION PATIENTS: VIEW IN 15–20 YEARS
Authors: Zelenenka Liliia
Published: April 2021

Objective:

Introduction. According to the latest clinical research great attention to provide a study of the clinical conditions that contribute to increase the risk for cardiovascular complications. The combinations essential hypertension (EH) and mellitus diabetes (MD) causes the development of fatal and nonfatal cardiovascular events.

Purpose. The aim of the study was to identify possible factors of MD in patients with EH the I-II stage with normoglycemia in a 15–20 year follow up.

Design and method:

Methods. We examined 54 patients with EH I-II st. Reexamined were conduct in the same conditions in 15–20 years. All patient divided in two groups: 1-st gr. (n = 39) – pts with only EH, 2-nd gr. (n = 15) – pts with comorbidy status (EH and diabetes). The frequency of development MD in our research consisted 27,8%.

Results:

Results. At the basing examine groups were same by age, gender, hemodynamics parameters and the structural data of the EhoCG. But initial body mass index (BMI) (kg/m2) were more higher (p < 0,013) in pts of 2-nd gr. (30,41 ± 0,44) than in pts of 1-st gr. (27,94 ± 0,44) and glycemia - (p < 0,002) in pts of 2-nd gr. - 5,93 ± 0,35 mmol/l and 4,61 ± 0,15 mmol/l in pts of 1-st gr.

The results of re-examination (in 15–20 years) demonstrated reliable increase indicators between the 1-st and the 2-nd groups of BMI (0,21 ± 0,06 and 0,47 ± 0,11, p < 0,05), hemodynamics parameters: systolic blood pressure (BP) (−0,97 ± 4,06 and 33,46 ± 5,43, p < 0,0001), diastolic BP (−6,23 ± 2,67 and 6,77 ± 3,00, p < 0,027), and pulse BP (5,26 ± 2,33 and 26,69 ± 4,87, p < 0,0001).

Conclusions:

Conclusion. The results of this study showed that the following risk factors: the presence of initial obesity (BMI = 30,41 ± 0.44 kg/m2) with increasing normal blood glucose (5,93 ± 0.35 mmol/l), uncontrolled arterial (systolic, diastolic and pulse) hypertension associated with the risk of development of diabetes mellitus in patients with EH during a long period of time (in 15–20 years).
SURVEY OF ACCESSIBILITY, AVAILABILITY, PRICE AND AFFORDABILITY OF ESSENTIAL MEDICINES AND DIAGNOSTIC TECHNOLOGIES FOR THE CLINICAL MEASURE AND TREATMENT OF HYPERTENSION ON PRIMARY
Authors: Yirga Zelalem , Fang Jing , Sugerman Davi , Asrat Anemaw
Published: April 2021

Objective:

To assess the accessibility, availability and affordability of essential drugs and diagnostic technologies for the clinical measure and treatment of hypertension on primary health care unit of West Gojjam, Ethiopia 2020

Design and method:

Facility-based cross-sectional survey was conducted from march16/2020-march30/2020 at 40 primary health care unit drug outlets of west Gojjam. Data was collected with an interviewer administered structured data collection tool and analyzed using SPSS version 23 ad Microsoft excel 2016. Medicines prices was compared with facilities and sectors. The daily wage of the lowest paid government worker was used to measure affordability.

Results:

The mean availability of essential drugs and diagnostic technologies at the primary health care units of west Gojjam was 62.5% and 67.5% respectively. The number of days wage needed for getting essential antihypertensive medications was two or more working days. All the available essential antihypertensive medications was in generic brands and not affordable for one month course of treatment.

Conclusions:

Essential anti-hypertensive medications and diagnostic medical technologies for the clinical measure and treatment of hypertension are available at fairly high, but unaffordable for the wage of unskilled government worker, and for money peoples living udder the poverty line of the country. The national NCD program should give an emphasis on improvement of access to affordable essential anti-hypertensive medications and diagnostic technologies for the diagnosis and treatment of hypertension at primary health care units.
THE PROTECTIVE EFFECT AND MECHANISM OF HSP47 IN HYPERTENSIVE INTRACEREBRAL HEMORRHAGE
Authors: Wen Hongyan
Published: April 2021

Objective:

Hypertensive intracerebral hemorrhage (ICH) has a high mortality rate, but there is no effective treatment,so how to prevent it has become a top priority. Heat shock protein 47 (HSP47) is a molecular chaperone for collagen synthesis and is responsible for transporting procollagen from the endoplasmic reticulum to the golgi lumen, effectively maintaining the three-dimensional structure of collagen. Absence of HSP47 may affect collagen synthesis and the stability of extracellular matrix (ECM), further damaging the stability of blood vessels. Therefore, we aimed to explore the role of HSP47 in ICH.

Design and method:

Spontaneous hypertensive ICH of mice were induced by angiotensin II and L-NAME We found that the level of HSP47 gradually decreased with the increase of modelling days. The adeno-associated virus was delivered into brain by stereotactic injection to overexpress HSP47.

Results:

The incidence of ICH were decreased significantly in mice by HSP47 overexpression. At the same time, the number and size of ICH in mice were significantly reduced. Experimental results show that HSP47 overexpression was sufficient to enhance ECM integrity and reduce VSMC apoptosis before ICH.

Conclusions:

These results suggest that HSP47 may have a protective effect on hypertensive ICH. Therefore, we emphasize that overexpression of HSP47 may be a new strategy for clinical treatment of hypertensive ICH.
BLOOD PRESSURE MEASUREMENT AND MONITORING BY INTERNAL MEDICINE SPECIALISTS IN GERMANY IN VIEW OF THE SPRINT TRIAL
Authors: Unger Leonie , Mengden Thomas
Published: April 2021

Objective:

There are continuous discussions about the optimal target blood pressure values, not least due to the publication of the SPRINT study, where unattended ambulatory office blood pressure (AOBP) was used for blood pressure (BP) measurement. The aim of the following online survey was to examine how BP measurement and the management of hypertensive patients are handled in everyday practice by internal medicine specialists in Germany and to compare it with the current guidelines.

Design and method:

An online questionnaire with ten questions concerning methods of BP measurement was sent to 15,884 internal medicine specialists as an email via the mailing list of the German Society of Internal Medicine (DGIM). Of these, 731 took part in the survey, which corresponds to a response rate of 4 %. The statistical evaluation was carried out with MS Excel.

Results:

The standard auscultatory measurement with an aneroid manometer is the leading method used by 44 % and in 95 % of the cases, it is measured in the presence of medical staff, i.e., attended. With 53 %, more than half of the respondents only take one measurement. A group of 36 % take two or more measurements. Of these, the largest percentage with 28 % takes the last value, closely followed by 26 %, who use the average value. The first or lowest value is each used by 17 %, while a minority of 12 % use the highest value. A majority of two-thirds measures without any time reference to taking medication (66 %). Ambulatory and Home BP are used by the majority for therapy control, according to the survey (fig.)

Conclusions:

The guidelines are not implemented correctly in many places and the approach to managing hypertension patients varies considerably. Possible reasons for this might be a lack of time in everyday practice and not always specifically formulated specifications in the recommendations of the professional associations, which leads to ambiguities. Measurement using unattended AOBP is rarely used in Germany. To be able to transfer the results from SPRINT, this measurement method would first have to be established.
HOSPITAL PHARMACISTS’ KNOWLEDGE ABOUT CARDIOVASCULAR DISEASE RISK FACTORS
Authors: Ukoha-Kalu Blessing Onyiny , Adibe Maxwell Ogochukw , Ukwe Chinwe Victoria , Anosike Chibueze , Isah Abdulmuminu
Published: April 2021

Objective:

This study aimed to assess hospital pharmacists knowledge of cardiovascular disease (CVD) risk factors and their practice of primary prevention of CVD.

Design and method:

This was a prospective cross sectional survey of all the Hospital pharmacists in Federal Medical Centre Lokoja (FMCL), and Kogi State Specialist Hospital (KSSH) both in Lokoja L.G.A of Kogi State Nigeria. A Questionnaire on diagnostic cut-off for common cardiovascular diseases (CVD) and practice of primary prevention of CVD was used for the study. The Statistical Package for Social Sciences (SPSS for windows, Version 16.0. SPSS Inc. 2007.Chicago, USA) software was used for data analysis. Continuous data were presented as mean ± standard deviation while categorical data were presented as percentages and frequencies.

Results:

About half, 20(46.5) of the hospital pharmacist were less than 40 years with a mean age of 43.44 years. The hospital pharmacist had poor knowledge of diagnostic cut-off for common cardiovascular disease risk factors. Also, the hospital pharmacists had poor practice of primary prevention of cardiovascular diseases. Age, gender and years of practice were associated with knowledge of CVD risk factors while age alone was associated with practice of primary prevention of CVD.

Conclusions:

Hospital pharmacists have a poor knowledge of CVD risk factors and also a poor practice of primary prevention of CVD.
PREVALENCE OF HYPERTENSION SELF CARE ACTIVITIES AMONG HYPERTENSIVE PATIENTS RECEIVING CARE IN A SECONDARY HEALTH CARE FACILITY IN KOGI STATE NIGERIA
Authors: Ukoha-Kalu Blessing Onyiny , Adibe Maxwell Ogochukw , Isah Abdulmuminu , Ukwe Chinwe Victoria
Published: April 2021

Objective:

This study aimed to access the Hypertension self care activities of hypertensive patients receiving care in a Secondary health care facility in Kogi state Nigeria.

Design and method:

This was a prospective cross sectional study conducted among Hypertensive patients receiving care in the Kogi State Specialist Hospital in Lokoja, Kogi state. All hypertensive patients visiting the Kogi State Specialist Hospital during the period of study and have given consent were allowed to participate in the study. A profoma was designed to collect the socio-demographic and clinical characteristics like the blood pressure, weight (in Kilograms) and height (in meters) while the hypertension self-care activity levels effect (H-SCALE) questionnaire was used to collect information on self care activities. The data cleaning was conducted in Microsoft excel after which information were exported and analysed using the Statistical Package for Social Sciences (SPSS for windows, Version 16.0. SPSS Inc. 2007.Chicago, USA) software.

Results:

More than half of the patients under study 183 (61.4%) were adherent to their medication. However, almost all the patients 305 (99.1%) and 308 (100%) did not adhere to low salt diets and physical activity respectively. A majority of the patients 266 (87.0%) admitted not to be smoking while more than half of the patients 221 (63.1) did not follow good weight management practices. About three-fourth of these patients did not abstain from drinking alcohol. Although more of the males (31.5%) adhered to their medications more than the females (27.9%), this was not statistically significant. More of those who adhered to their medications, had a low salt diet, engaged in physical activity and weight management practices had a source of income. Patients who had obtained a formal education had a better medication adherence, adhered to low salt diets, engaged in weight management practices and smoked less when compared to those who had no formal education. It was observed that patients who have had hypertension for a longer time adhered more to their medications.

Conclusions:

In conclusion, adherence to hypertension self care activities was low. This could lead to an increased risk of hypertension related complications.
PREDICTION OF MAJOR CARDIOVASCULAR AND CEREBROVASCULAR OUTCOMES FOR OLDER PEOPLE WITH HYPERTENSION AND FRAILTY: LINKED PRIMARY CARE ELECTRONIC HEALTH RECORDS COHORT STUDY
Authors: Todd Oliver , Wilkinson Chris , Hollinghurst Joe , Akbari Ashley , Sheppard James , McManus Richard J. , Rockwood Kenneth , Lyons Ronan , Gale Chris P. , Hall Marlous , Clegg Andrew
Published: April 2021

Objective:

For older people, the association of blood pressure (BP) with cardiovascular outcomes may vary according to the degree of frailty. We investigated whether frailty improved the prediction of major adverse cardiovascular or cerebrovascular events (MACCE) among older people with hypertension treated for primary prevention.

Design and method:

Retrospective cohort study using population-scale electronic health record data from the Welsh Secure Anonymised Information Linkage (SAIL) databank, linked to hospital outcomes from Patient Episode Database for Wales (PEDW), and death outcomes from Office for National Statistics. Inclusion criteria were age > 65 years, BP recorded in primary care in 2007, and diagnosis of hypertension. Exclusion criteria were established cardiovascular disease (stroke, myocardial infarction or heart failure). We extracted the minimum BP measurement on the day the patient first attended primary care in 2007, and BP-lowering treatment over one year prior. Cardiovascular risk was measured using QRISK-3, and frailty using the electronic frailty index (eFI). Time-to-event analysis measured first ever MACCE (stroke, myocardial infarction, heart failure or cardiovascular death) through 10-years follow-up.

Results:

The analytic cohort comprised 145,598 patients, registered in 502 general practices. The mean age was 75-years (SD 7); 62% were female; 17% were in the most deprived Townsend quintile. Using the QRISK-3 cardiovascular risk score, 29% (IQR 21 – 39) were predicted to suffer coronary heart disease or stroke over 10-years. The unadjusted risks for MACCE were all increased with increasing severity of frailty (Figure).

Compared with robust participants, living with frailty was associated with significantly higher MACCE events despite adjustment for known cardiovascular risk factors (increased risk of 38% in mild frailty, 84% in moderate frailty and 117% in severe frailty). The addition of frailty to a model that was already adjusted for cardiovascular risk factors and BP-lowering treatment improved measures of model fit (AIC reduced from 248,829 to 247,409; BIC reduced from 249,023 to 247,579).

Conclusions:

Our study provides population-based evidence that the degree of frailty is a useful prognostic factor in older people who are at high risk of cardiovascular outcomes in the management of hypertension.
ARTERIAL HYPERTENSION IN A PATIENT OPERATED FOR CONN ADENOMA: ABOUT A CASE
Authors: Thabet Maissa , Romdhane Wiem , Anoun Jihed , Hassine Imen Ben , Karmeni Monia , Fredj Fatma Ben , Anis Mzabi , Laouani Chadia
Published: April 2021

Objective:

Conn's adenoma is a rare cause of high blood pressurr. It is the second surgically curable cause of hypertension after renal artery stenosis. Its recurrence after surgery remains rare.

Design and method:

We report a case.

Results:

Mr B.M, 60 years old, with a history of diabetes, hypertensive and right adrenalectomy for Conn's adenoma, admitted for investigation of dysphagia and high blood pressure. On examination, the blood pressure was 17/10, the pulses are present and symmetrical. Skin examination revealed sclerodactyly, subcutaneous calcinosis and raynaud's syndrome. The blood ionogram showed hypokalaemia while the renal workup noted chronic renal failure. Urinary cortisol and plasma cortisol were normal. The adrenal CT scan showed a left adrenal nodule. A contralateral recurrence of Conn's adenoma associated with CREST syndrome was strongly suspected. The decision was to intensify the antihypertensive treatment.

Conclusions:

Hypertension can be multifactorial: metabolic syndrome, Conn's adenoma and systemic disorder. A recurrence of an operated Conn's adenoma should be systematically sought in the presence of persistent elevated blood pressure levels.
ARTERIAL HYPERTENSION REVEALING A TIGHT AORTIC COARCTATION IN A YOUNG PATIENT: ABOUT A CASE
Authors: Thabet Maissa , Romdhane Wiem , Hassine Imen Ben , Fakhfakh Rym , Anoun Jihed , Karmeni Monia , Fredj Fatma Ben , Mzabi Anis , Laouani Chadia
Published: April 2021

Objective:

Coarctation of the aorta is an obstructive lesion responsible for high blood pressure (hypertension). The diagnosis of coarctation is usually made during the first months of life but can be mentioned much later, especially when there is no other associated heart disease.

Design and method:

we report a case of a tight aortic coarctation in a young person revealed by arterial hypertension.

Results:

Mr K.H, 24 years old, with no notable pathological history, admitted for fever, cough and purulent sputum. At the examination the patient was polypneic, BP was 16/7, cardiac auscultation revealed a diastolic murmur to the aortic focus and reduced femoral pulses.

Infectious endocarditis was suspected. Transesophageal ultrasound showed grade IV aortic insufficiency, aortic bicuspid, aneurysmal dilatation of the ascending aorta, and absence of endocardial adenoids. The thoracic angio scanner noted a short and tight stenosis of the aortic isthmus, a funnel dilation of the arch of the aorta with a significant aneurysmal dilation of the ascending aorta without signs of dissection, a focus of right lower lobar pneumonia. The diagnosis of hypertension secondary to coartation of the aorta was then retained. The patient was put on antibiotic therapy for his infectious lung disease, on antihypertensive treatment.

Conclusions:

This clinical fact underscores the importance of measuring blood pressure during any examination of a patient. Indeed, an isthmic coarctation can be easily ignored because, apart from hypertension, the damping of the femoral pulses is often the only clinical sign.
EARLY EVIDENCE FOR THE EFFECTIVENESS OF SOUTH AFRICA'S LEGISLATION ON SALT RESTRICTION IN FOODS: THE AFRICAN-PREDICT STUDY
Authors: Strauss-Kruger Michel , Wentzel-Viljoen Edelweiss , Ware Lisa J. , Van Zyl Tertia , Charlton Karen , Schutte Aletta E.
Published: April 2021

Objective:

South Africa was one of the first countries to adopt mandatory regulation in 2016 to lower the salt content of a wide range of processed foods. To assess the effectiveness of this regulation, we determined the change in salt intake of young adults over a mean follow-up time of 4.56-years spanning the implementation of the regulation. Since young populations have a higher salt intake, salt reduction may have a greater long-term impact as a preventative strategy in this age group.

Design and method:

This study included baseline (N = 668; aged 24.9 ± 3 years; 47.8% black; 40.7% men) and follow-up data for the first 311 participants (aged 29.9 ± 3.09 years; 51.1% black; 43.4% men) tracked over time as part of the African-PREDICT study. Participants had baseline data before 30th June 2016, and follow-up from 2018 - 2020. Estimated salt intake at baseline and follow-up was calculated from 24-hour urinary sodium excretion.

Results:

The median salt intake of the population (N = 668) at baseline was 7.88 g/day (IQR: 5.67). In those followed (N = 311), salt intake reduced from baseline [median (IQR): 7.91 g/day (5.83)] to follow-up [median (IQR): 7.26 g/day (5.30)] in the total group [median difference (IQR): -0.82 g/day (7.02); p = 0.007], with a greater reduction observed in black adults [N = 159, median difference (IQR): -1.35 g/day (7.91); p = 0.003]. Reduced salt intake was more pronounced in black adults from a low (p = 0.007) and middle socio-economic status (p = 0.009), compared to a high socio-economic status (p = 0.27).

Conclusions:

Our preliminary findings suggest that South Africa's mandatory salt reduction regulation for processed foods has been effective in lowering salt intake in young adults by a magnitude of ∼0.82 g salt/day. Our study supports the effectiveness of “upstream” sodium reduction interventions at population level that may impact on the health and economic burden of countries.
IN MILD HYPERTENSIVE PATIENTS 24-HOUR AVERAGE HEART RATE IS ASSOCIATED WITH EARLY CARDIAC DAMAGE AND ENDOTHELIAL DYSFUNCTION
Authors: Rus Horatiu , Poinareanu Ionut , Bobescu Elena
Published: April 2021

Objective:

To investigate the correlation of 24-hour average heart rate (HR) in untreated and recently diagnosed mild hypertensives, and evaluate their association with subclinical initial signs of cardiac target organ damage (TOD), and endothelial dysfunction.

Design and method:

A total of 400 outpatients with initial diagnosis of mild hypertension were recruited between December 2017 and November 2019. Ambulatory electrocardiogram and blood pressure (BP) were monitored in all patients. According to the 24-hour average HR, patients were divided into fast HR group (24-hour average HR > 75 beats/minute, n = 220) and non-fast HR group (24-hour average HR less or equal to 75 beats/minute, n = 180) We evaluate endothelial dysfunction by flow mediated vasodilatation (FMD) at the level of brachial artery. We use echocardiography to determine the presence of initial signs of (TOD), (presence of signs of left ventricular hypertrophy left ventricular mass indexed for height (LVMi) > 48 g/m2 for men and > 44 g/m2 for women and/or increased left atrial volume 4-chamber indexed for body surface area (LAVi) > 34 ml/m2).

Results:

Endothelial dysfunction, LVMi and LAVi, 24-hour average HR, night and day average HR, diastolic BP, and daytime systolic BP were higher, while nocturnal BP drop rate was lower in patients with fast HR group than those in non-fast HR group (all P < 0.04). Twenty-four-hour HR, the degree of endothelial dysfunction and TOD increased significantly with increases of office BP (P < 0.04). The 24-hour average HR and resting HR were correlated positively with the presence of TOD (r = 0.159, 0.262, respectively, both P < 0.01), and degree of endothelial dysfunction (r = 0.155, 0.260, respectively, both P < 0.01). Multivariate linear regression analysis showed that the level of BP (B = 17.420, 16.540), nocturnal BP drop rate (B = 1.652, 1,586), and 24-hour average HR (B = 0.558, 0.5442) were correlated with the presence of TOD and FMD cuantified endothelial dysfunction.

Conclusions:

In patients with initial diagnosis of mild hypertension, 24-hour average heart rate is associated with the early cardiac damage and endothelial dysfunction, confirming the participation of increased heart rate in initial cardiac and vascular changes in human hypertension.
BODY-MASS INDEX AND BLOOD PRESSURE AS DISEASE MODIFIERS IN DYSTROPHINIC CARDIOMYOPATHY
Authors: Rodoman Iulia , Palii Ina , Sacara Victoria , Pirtu Lucia
Published: April 2021

Objective:

Introduction: Duchenne muscular dystrophy (DMD) is one of many neuromuscular diseases, that commonly creates severe disability and early death. Cardiomyopathy associated with DMD is an increasingly acknowledged presentation of this neuromuscular disorder, significantly increasing morbidity and mortality, as well as the requirement for cardiological treatment.

Design and method:

Purpose: is to review literature data relatively the presence of elevated blood pressure values and body mass index in children with DMD and their impact on the development of heart disease.

Results:

Several studies have published cross-sectional data about the prevalence of hypertension and increased BMI in children with DMD. Wong et al., 2017 reported that 25.5% of patients on daily steroids aged 10–13 years had systolic hypertension. In patients aged 13–16 years, they reported systolic hypertension in 10.3% of patients. Corticosteroid treatment is thus an essential part of the standards of care in DMD and is recommended from the age of 4 to 5 years onward. Ricotti et al., 2013 observed hypertension in 5% of the patients aged 3–15 years on intermittent steroids while in a study by Braat et al., 2015, 45% of the patients had hypertension. In N.M. van de Velde et al., 2019, study increased BMI, but not systolic blood pressure, was related to early myocardial deformation defined by peak systolic GLS in young DMD patients < 11 years of age. Prevalence of obesity has been described up to 73% in steroid-native DMD patients < 13 years and higher BMI was associated with longer duration and higher cumulative dose in ambulant DMD patients using prednisone (Lamb et al., 2016). In Barber et al. study, 2013 use of corticosteroids has managed to prolongation of the ambulant stage in DMD by almost 3 years. It has also been correlated with a delayed onset of dystrophinic cardiomyopathy in Markham et al., 2008 and Davidson et al., 2014 studies.

Conclusions:

The results of this review suggest that factors influencing afterload, such as increased blood pressure and BMI, may play a role in the deterioration of cardiac function in DMD.
TOTUM-854 PREVENTS L-NAME-INDUCED ARTERIAL HYPERTENSION IN MICE
Authors: Bolea Gaetan , Ripoche Doriane , Meyer Gregory , Lejoubioux Florian , Michaux Arnaud , Otero Yolanda , Peltier Sebastien , Sirvent Pascal , Reboul Cyril
Published: April 2021

Objective:

Arterial Hypertension (HTA) is a major cause of premature death worldwide, with an estimated global prevalence of 1.13 billion people. Polyphenolic compounds have been shown promising effects in the context of HTA management. We have developed Totum-854 (T-854), a polyphenol-rich botanical composition to reduce the risk of developing AHT. We assessed the chronic effect of T-854 on preventing the development of N(G)-Nitro-L-arginine-methyl ester (L-NAME)-induced AHT in mice.

Design and method:

Twelve-week-old C57Bl6/J mice were divided into 3 groups: Control (n = 11), L-NAME (n = 11), and L-NAME + T-854 (n = 11). L-NAME (100 mg/kg/day) was dissolved in drinking water. Mice were gavaged once a day for three weeks with either T-854 (450 mg/kg) or vehicle. The arterial pressure was assessed using the CODA® Tail-Cuff System every week for three weeks. Effects of T-854 on in vitro angiotensin-converting enzyme (ACE) activity was also assessed by a HPLC-UV method.

Results:

Body weight evolution was not significantly different between the 3 groups over the study period. As expected, L-NAME increased systolic (SBP; from 105 ± 3 to 130 ± 1 mmHg, p < 0.0001), diastolic (DBP; from 77 ± 3 to 97 ± 2 mmHg, p < 0.0001) and mean (MBP; from 86 ± 3 to 108 ± 2 mmHg, p < 0.0001) blood pressure along the 3 weeks of treatment. Interestingly, in T-854-supplemented mice, SBP was significantly reduced from the first week of supplementation and DBP and MDP from the second week of supplementation. After three weeks of supplementation, T-854 lowered the SBP by 16% (p < 0.0001), the DBP by 20% (p < 0.05) and the MBP by 18 % (p < 0.01), in comparison to L-NAME mice. Moreover, in vitro experiments showed an inhibitory effect of T-854 on ACE activity.

Conclusions:

In conclusion, this study showed that T-854 prevents L-NAME-induced HTA in mice. ACE inhibition may partly explain the preventive effects of T-854 on HTA development in this model. T-854 is a promising new approach for the prevention of HTA.
EARLY ASSESSMENT OF HYPERTENSION MEDIATED ORGAN DAMAGE IS CAPABLE OF PREDICTING CARDIOVASCULAR EVENTS IN FIVE YEARS FOLLOW-UP OF PATIENTS WITH HYPERTENSION AT A CENTER IN MENDOZA
Authors: Renna Nicolás Federico , Williams Bryan , Farez Beder , Repetto Martin , Bernasconi Pablo , Murua Mario , Ramirez Jesica , Miatello Roberto
Published: April 2021

Objective:

Hypertension-mediated organ damage (HMOD) is a powerful predictor of mortality in hypertensive patients. The objective of the work was to determine the prognostic value of the early detection of HMOD in patients with a recent diagnosis of hypertension.

Design and method:

It is an analytical observational and prospective study that included all patients referred to Hypertension Unit of Hospital Español de Mendoza from January 2015 to December 2019 who met the following criteria: 1- Patients diagnosed with hypertension last 5 years; 2- Has been done a ABPM, 3- That has been done a Colour Doppler Echocardiography (CDE) with preserved ejection fraction and 4- a record of clinical history in the hospital that allowed obtaining the data and personal history. Exclusion criteria: 1- Patients who presented atrial fibrillation at the time of the Doppler echocardiogram study; 2- Any studies had missing or erroneous data, 3- Vital state could not be verified at the end of study, 4-Presence of any valve disease and 5- Ejection fraction of less than 40%, 5- Minor patients 16 years old. Variables and Measurements: ABPM; Colour Doppler Echocardiography (CDE) and patient data features;

Results:

Of the total of patients, 51% were women and 7,8% patients were diagnosed with diabetes mellitus. 196 endpoints were recorded during 60 months of evaluation. Men and patients with diabetes mellitus had a significantly greater number of events using the K-M (Hazard ratio 1.55 CI = 1.17 to 2.0 and Hazard ratio 1.77 CI = 1.04 to 3.0). In CDE, E/A ratio of the transmission flow (HR 1.43 HR CI 1.13–1.81). The nocturnal PP showed a clear association with the occurrence of events (HR 190 HR CI 17.9 to 2022). Evaluation of morning pressure alone did not show associations with cardiovascular risk.

Conclusions:

The most important finding of the study was to find that a population with a diagnosis of arterial hypertension of less than 5 years, with low cardiovascular risk, the pressure of daytime, nighttime and morning surge was a predictor of hard cardiovascular events. So was the E / A ratio of left ventricular transmitral flow.
LEVELS OF IMMUNOGLOBULIN G AND MARKERS OF VASCULAR INFLAMMATORY RESPONSE AS PREDICTORS OF POSSIBLE VASCULAR COMPLICATIONS IN PATIENTS WITH ARTERIAL HYPERTENSION AFTER SARS-COV-2
Authors: Petelina Tatiana , Natalia Musikhina , Elena Yaroslavskaya , Elena Gultyaeva , Ksenia Avdeeva , Elena Gorbatenko , Lyudmila Gapon , Ekaterina Zueva , Anastasia Shcherbinina
Published: April 2021

Objective:

To investigate the level and relationship of specific immunoglobulin G (IgG) antibodies to SARS-CoV-2 with laboratory parameters of vascular inflammatory response (VIR) during follow-up of patients with arterial hypertension (AH) in 3 months after disease onset.

Design and method:

Retrospective, single-center observational study included 76 confirmed cases of COVID-19 associated with pneumonia (April-May 2020). Gr.1 consisted of 32 patients without AH; Gr.2 involved 44 AH patients, including 18 patients with metabolic disorders (abdominal obesity and impaired carbohydrate metabolism). Complete blood count, biochemical and hemostatic parameters were determined on the day of admission. Comprehensive analysis of clinical instrumental and laboratory parameters, including blood pressure, heart rate, IgG (positivity rate), cytokines, NT-pro BNP, endothelial dysfunction markers, cystatin C, glucose and others was performed in 3 months after discharge.

Results:

In Gr.1, IgG was negatively associated with hemoglobin, red blood cell volume, neutrophils, creatine phosphokinase, homocysteine, those were supplemented by NT-pro BNP, interleukin-6, lactate dehydrogenase, creatinine (p < 0.0001–0.034) in Gr.2 and additionally, D-dimer level, transforming growth factor and P-selectin (p < 0.001–0.036) in metabolic disorders subgroup. Therewith, in patients aged over 40 years, positive association of IgG with levels of SBP and DBP (p < 0.011 and 0.034), MDRD (p < 0.01) was registered. Correlation and regression analysis revealed greater association of IgG level < 12.9 with vascular inflammatory markers, and IgG level > 12.9 with thrombogenic parameters.

Conclusions:

IgG might be a sensitive indicator of VIR and can play a role in predicting possible unwanted vascular complications in AH patients after suffering from SARS-CoV-2.
PLASMA ACE2 ACTIVITY IS INCREASED IN PATIENTS RECOVERED FROM SARS-COV-2 INFECTION: IMPLICATIONS FOR THE PROLONGED CONSEQUENCES OF COVID-19
Authors: Patel Sheila , Juno Jennifer , Lee Wen Shi , Wragg Kathleen , Hogarth P. Mark , Kent Stephen , Burrell Louise
Published: April 2021

Objective:

COVID-19 caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), utilises the catalytic site of membrane-bound angiotensin converting enzyme 2 (ACE2) for cell entry. It is thought that endocytosis of ACE2 results in a decrease in membrane bound ACE2 expression, and disruption of the local tissue renin angiotensin system protection. In this study, we hypothesised that SARS-CoV-2 infection would be associated with shedding of ACE2 leading to increased plasma ACE2 activity.

Design and method:

Australians aged > 18 years (n = 66) who had recovered from SARS-CoV-2 infection (positive result by PCR testing) and uninfected controls (n = 70) were recruited. Serial samples were available in 23 recovered SARS-CoV-2 patients. Plasma ACE2 activity was measured using a fluorescent substrate-based assay and levels were compared using the Mann-Whitney or Kruskal–Wallis test. Serial ACE2 activity were analysed using the Friedman test for repeated measures. Post-hoc analysis was performed with a Bonferroni correction. Two-tailed P-values < 0.05 were considered significant.

Results:

Controls and SARS-CoV-2 recovered patients were matched for age (mean ± SD, 54 ± 11 vs. 53 ± 14 years, p = 0.47) and gender (53% vs. 59% male, p = 0.49). There were no significant differences (p > 0.05) in the proportion of hypertension, obesity, diabetes, cardiovascular disease, or use of anti hypertensive, lipid lowering, and anti-platelet medications between the controls and SARS-CoV-2 patients. Plasma ACE2 activity at median 35 days post-infection [interquartile range 30–38 days] was 97-fold higher in SARS-CoV-2 patients compared to controls (5.8 [2–11.3] vs. 0.06 [0.02–2.2] pmol/min/ml, p < 0.0001). Plasma ACE2 activity was significantly different across disease severity (p = 0.033), with severe COVID-19 associated with higher ACE2 activity compared to mild disease (11.2 [8.3–23.2] vs. 5.4 [1.8–9.0] pmol/min/ml, p = 0.027). Men recovered from SARS-CoV-2 had higher ACE2 levels compared to women (9.2 [5.8–15.3] vs. 2.1 [0.2–5.1] pmol/min/ml, p < 0.0001). In 23 patients who had serial blood samples at 63 [56–65] and 114 [111–125] days post infection, median ACE2 activity remained persistently elevated with no differences between time-points (p > 0.05).

Conclusions:

Plasma ACE2 activity is elevated after SARS-CoV-2 infection and remains elevated post-infection. Our findings indicate the need for ongoing investigation to determine if ACE2 levels identify people at risk of prolonged illness following COVID-19.
LOW AWARENESS, TARGET ORGAN DAMAGE AND CARDIOVASCULAR COMPLICATIONS OF HYPERTENSION IN LOW RESOURCE SETTING
Authors: Onwubere Basden , Ejim Emmanuel , Ogah Okechukwu
Published: April 2021

Objective:

This paper reviews the current picture of low awareness, target organ damage, and cardiovascular complications in Africa using available literature as well as meta-analyses. Sub-Saharan Africa typically consists mostly of a low resource setting.

Design and method:

Meta-analyses of publications on hypertension and related cardiovascular complications in Africa were carried out. An extensive literature search was carried out. Publications were mainly from various locations in Sub-Saharan Africa (SSA).

Results:

A meta-analysis of 37 publications showed the prevalence of hypertension varied extensively between and within studies. Prevalence was higher in urban than in rural populations; it was also higher with increasing age in most studies. Less than 40% were previously diagnosed. Of these less than 30% were on drug treatment, and less than 20% had blood pressure within the defined normal range. Ogah and Rayner identified 38 publications from Sub-Saharan Africa mostly conducted in urban areas: two national surveys (Malawi and Mozambique), 14 in rural settings, 16 in urban communities, one each in semi-urban and semi-urban/rural settings, and four in both rural and urban communities (figure 1)

The treatment status for South African black males with hypertension showed that 20% were aware of their condition, 14% of them were on treatment and only 7% were controlled. ; these figures were respectively 47%, 29%, and 15% for women (Steyn et al) Of 219 hypertensives, in a population in Ghana 104 (47.5%) had evidence of target organ damage. Other studies from Tanzania, Sudan, South Africa, and Nigeria showed a significantly low level of Awareness, significant Target Organ Damage mostly at the time of diagnosis. Generally in Nigeria and most, some other African countries, complications of hypertension contributes significantly to Hospital admissions (Onwubere et al)

Conclusions:

It is observed that in most parts of Africa, hypertension presents with earlier and more severe target organ damage compared to developed country settings. This results from the late presentation, ignorance of the need for regular medical checks, paucity of adequate medical facilities, poverty, sub-standard drugs, and ethnic and genetic factors.