bluuebunny/crossref_metadata_2025 huggingface dataset:
HYPERREACTIVITY TO STANDING IS ASSOCIATED WITH INCREASED AMBULATORY BP A RELATIONSHIP AMPLIFIED BY ENHANCED SYMPATHOADRENERGIC ACTIVITY
Authors: Saladini Francesca , Mos Lucio , Vriz Olga , Rattazzi Marcello , Mazzer Andrea , Palatini Paolo
Published: June 2022

Objective:

Previous research showed that elevated systolic blood pressure (SBP) reaction to standing (RS), a condition that may be accompanied by sympathoadrenergic hyperactivity, is a predictor of cardiovascular events. This might be due to the influence of RS on ambulatory BP (ABP). Thus, we investigated whether RS is a determinant of ABP and if this putative relationship is stronger in a milieu of hyperadrenergic activity.

Design and method:

We studied 630 young-to-middle-age (mean age 33.6 ± 8.5 years), stage I untreated hypertensives from the HARVEST study. RS was defined as the difference between 6 SBP measurements in the orthostatic and the supine posture. Participants were divided into tertiles of SBP RS (<-5.34, -5.34–0.30 and > 0.30 mmHg, respectively) and of 24 h urinary epinephrine (UE) (<8.3, 8.3–14 and > 14 mcg/24 h, respectively). The relationship with 24 h average SBP was tested in a two-way ANCOVA adjusting for age, sex and office SBP.

Results:

Mean office SBP was 145.8 ± 10.5/93.9 ± 5.2 mmg, mean RS -3.0 ± 7.4 mmHg and median UE 10.5 (IQR, 7.0–16.0) mcg/24 h, in the entire group. Subjects in the highest UE tertile had a higher (mean ± SEM) 24 h SBP (132.2 ± 0.8 mmHg) than the lower tertiles (129.9 ± 0.7 mmHg and 129.8 ± 0.7 mmHg, p = 0.041). The same trend was observed for the RS tertiles, as 24 h SBP was 134.3 ± 0.7 mmHg in the highest tertile vs 129.5 ± 0.7 in the intermediate and 128.3 ± 0.7 mmHg in the lowest tertile (p < 0.001). 24 h SBP was positively and significantly correlated with both RS (r = 0.16 p < 0.001) and UE (r = 0.10 p = 0.028). In a two-way ANCOVA analysis a significant interaction was observed between RS and UE (p = 0.033): average 24 h SBP was 136.5 ± 1.2 mmHg in the group with the highest RS and UE levels and was 127.2 ± 1.2 mmHg in the group with the lowest RS and UE levels.

Conclusions:

Our data show that RS is a significant determinant of average 24 h SBP and that this association is amplified by sympathoadrenergic hyperactivity. This can account for the increased risk of cardiovascular events found in hypertensive subjects with hyperreactivity to standing.
THE DESIGNING EXPERIMENT OF ESSENTIAL HYPERTENSION: THE CHOICE OF A CONTROL GROUP FOR SPONTANEOUSLY HYPERTENSIVE RATS
Authors: Ranceviene Dalia , Zigmantaite Vilma , Jurevicius Jonas , Pauziene Neringa
Published: June 2022

Objective:

The spontaneously hypertensive rat (SHR) is the most widely studied animal model of essential hypertension. The Wistar-Kyoto rats (WKY) were originally bred as normotensive controls for the SHR, while the Wistar (WIS) strain is generally the most popular in research. The objective of the study was to check whether Wistar could be used as controls for SHR by comparing blood pressure levels in three groups of animals.

Design and method:

Adult male WIS (n = 5), WKY (n = 6), and SH (n = 4) rats, 20th week of age, were used. The animals were housed in the Animal Research Center of the Lithuanian University of Health Sciences under permission No. G2–137. They were kept in collective cages and allocated in a controlled environment with a light/dark cycle (12/12 h), the temperature at 22 ± 2C, and had free access to food and water. Following animal sedation, heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were measured using the on-invasive method of tail-cuff (AD Instruments IN125/R NIBP system, UK and LabChart software). Each measurement was performed ten times, and the median value was used. All measurements were performed by the same researcher in a quiet environment. Mean arterial pressure (MAP) was calculated by the following equation: DBP+1/3(SBP-DBP). The Kruskal-Wallis test was used to determine group differences. The Mann-Whitney test was used for two groups comparisons.

Results:

SHR BP values were highest, WKY - in the middle, and WIS - the lowest. Measured parameters differed statistically significantly between the three rat groups (p < 0.05) (Table 1). The two groups comparison revealed that all parameters in SHR had statistically significant differences between the WKY as well as WIS (p < 0.05), except HR in WIS. HR did not differ between SHR and WIS rats (p = 0.190). Comparing WKY and WIS groups, there was no significant difference between SBP (p = 0.284), DBP (p = 0.524), MAP (p = 0.354), except HR, which was significantly higher in WIS (p = 0.002).

Conclusions:

Adult spontaneously hypertensive rats have significant arterial hypertension. Blood pressure measurements of Wistar-Kyoto and Wistar rats do not differ, so both of them can be used as controls for hypertensive rats.
PULSE WAVE VELOCITY ASSESSMENT IN PATIENTS SEEN AT THE OUTPATIENT CLINIC OF MEDICAL SCHOOL IN BRAZIL
Authors: Paffer Matheus Toscano , Paffer Pedro Toscano , Terra Vitória , Tenório Maria Fernanda , De Castro Camila , Torres Licia , Barros Ramon , Lucena Lucas , Menezes Pedro Affonso , Barbosa Priscilla , Paffer Silvio
Published: June 2022

Objective:

Characterize the pulse wave velocity (PWV) of patients seen at the outpatient clinic of a medical school in Brazil

Design and method:

102 patients were analyzed and underwent central pressure and pulse wave velocity assessment using the Mobil O’’Graph device.

Results:

Among the 102 patients analyzed, 63 (61.7%) were female and the mean age was 58.7 years (+-13.2) and mean body mass index of 23.6 (+-17.2). Peripheral systolic pressure had a mean of 144.7mmHg (+-23.9) and peripheral diastolic pressure of 89.9mmHg (+-14.4). The central systolic pressure had a mean of 148.7mmHg (+-26.7) and central diastolic of 92.3 mmHg (+-15.0). The pulse wave velocity in the analyzed patients had an average of 7.0 m/s (+-3.1). PWV is the gold standard test for assessing arterial stiffness. The increase in this rigidity can occur for physiological reasons, being part of the physiology of aging, but also for pathological causes, with the support of increased blood pressure. This occurs because the increase in pressure generates an increase in pulsatile stress on the vascular wall, resulting in faster degradation of elastin fibers. Increased arterial stiffness also results in early return of pulse waves reflected from the periphery to the left ventricle, still in systole rather than diastole, increasing pressure in the late systole. Due to this correlation with arterial stiffness and target organ damage in hypertension, when available, pulse wave analysis is mandatory in hypertensive patients.

Conclusions:

The incorporation of this new technology using handheld devices is feasible and very useful to identify high-risk patients and be performed in a clinical setting.
PREDICTORS OF BISOPROLOL ON-TREATMENT STATUS AT THE TIME OF INCLUSION OF HYPERTENSIVE PATIENTS IN THE STUDY: POST-HOC ANALYSIS OF THE TRICOLOR STUDY
Authors: Logunova Natalia , Karpov Yuri , Khomitskaya Yunona
Published: June 2022

Objective:

To describe proportion of patients with uncontrolled hypertension (HTN) receiving bisoprolol additionally to perindopril/indapamide/amlodipine single-pill combination (SPC) and predictors of its prescription in patients included in the TRICOLOR study.

Design and method:

TRICOLOR (NCT03722524) was a multicenter, open-label, 3-month observational study that included 1 247 patients with uncontrolled HTN despite receiving antihypertensive treatment, who were initiated with the SPC in outpatient settings in Russia. Univariate logistic regression analysis was performed to describe the relationship between clinically relevant baseline (BL) patients’ characteristics and bisoprolol on-treatment status at the inclusion in the study.

Results:

At baseline 19.1% of patients (n = 238) were receiving bisoprolol. Mean age of the patients receiving bisoprolol was 60.3 ± 9.6 years, 59.2% (n = 141) of them were female. Patients receiving bisoprolol at BL had a significantly longer duration (p< 0.0001) and more severe HTN (p = 0.001) as well as more frequent concomitant comorbid status (p < 0,0001) compared to those not receiving bisoprolol at BL. They were less frequently male (40.8% vs 61.2%; p < 0.0001), had significantly higher body mass index (BMI) (30.4 ± 5.1 vs 28.8 ± 4.4 kg/m2; p < 0.0001). Statistically significant, but not clinically meaningful, relationship between bisoprolol on-treatment status at BL and BMI (OR = 1.07, 95% CI 1.03 to 1.10), waist circumference (OR 1.03, 95% CI 1.02 to 1.04), heart rate (OR 1.02, 95% CI 1.00 to 1.04) and duration of HTN (OR 1.04, 95% CI 1.02 to 1.06) were revealed. However, presence of dyslipidemia (OR 1.72, 95% CI 1.20 to 2.51), left ventricular hypertrophy (OR 1.98, 95% CI 1.25 to 3.30), chronic heart failure (OR 2.23, 95% CI 1.62 to 3.08;), coronary artery disease (OR 2.66, 95% CI 1.90 to 3.70), a history of myocardial infarction (OR 3.15, 95% CI 1.90 to 5.14), and a history of stroke / transient ischemic attack (OR 2.53, 95% CI 1.37 to 4.53) significantly increased the likelihood of being on bisoprolol at the inclusion in the study.

Conclusions:

In the post-hoc analysis of the TRICOLOR study, patients receiving bisoprolol in addition to SPC at BL had predominantly more severe HTN, with presence of concomitant cardiovascular disease.
A RANDOMIZED N-OF-1 STUDY COMPARING BLOOD PRESSURE MEASURED ON A CLOTHED ARM AND ON AN ARM WITH A ROLLED-UP SLEEVE
Authors: Lins Robert Lins
Published: June 2022

Objective:

It is recommended that blood pressure (BP) should be measured on a bare upper arm with an appropriately sized cuff. However, in practice, it is more convenient to measure BP on a bare arm below a rolled-up sleeve or on a sleeved arm. A n-of-1 randomized controlled trial was performed to assess the difference between measuring BP over or below a thin rolled-up sleeve.

Design and method:

The study subject is male, white, 72 years, with BMI 26, arm circumference 29 cm, and under stable antihypertensive treatment. BP was measured 3 times according to guidelines. The order of measurements was determined by chance and 2 devices were used: OMRON HEM-907 and Microlife Afib. 316 measurements needed to be done to detect a difference of 3 mm Hg in systolic blood pressure (SBP). Descriptive statistics and the 2-side T test were used for comparison. Significance was set at the 0.05 level.

Results:

504 measurements were performed, 50 % over a sleeve and 50 % on the bare arm below a rolled-up sleeve. The mean SBP was 116.9 ± 9. 2 (95% CI 115.7–118.0, range 96–135) and 122.8 ± 9.2 (95% CI 121.7–124.0, range 103–139, p = 0.001) mm Hg, respectively for sleeved and bare arm. The mean diastolic blood pressure (DBP) was respectively 67.6 ± 6.8 (95% CI 66.8–68.4, range 52–84) and 71.8 ± 6.8 (95% CI 71.0–72.7, range 55–85, difference p = 0.001) mm Hg. There was no significant difference (SBP 118.3 ± 6.8 vs 116.8 ± 5.9, p = 0.97; DBP 68.5 ± 5.5 vs 67.0 ± 5,0 p = 0.44) between measurements over a sleeve and on the bare arm after removing all clothes (n = 96).

Conclusions:

Blood pressure measurements over a thin sleeve were clinically significantly lower than measurements on a bare arm with rolled-up sleeve and match measurements on a completely bare arm as standard method proposed by guidelines.
ORTHOSTATIC HYPOTENSION AT DISCHARGE - ASSOCIATED CHARACTERISTICS AND OUTCOMES
Authors: Gouveia Rita , Matias Paula F. , Matos Mariana , Madureira Sergio , Veiga Hugo , Vale Catarina , Almeida Jorge , Marques Pedro S.
Published: June 2022

Objective:

Orthostatic hypotension (OH) is a fall in systolic blood pressure (BP) > = 20 mmHg or diastolic BP > = 10 mmHg in the 3 minutes after standing. OH is associated with falls, cognitive impairment and cardiovascular disease. Hospitalized patients may be particularly prone to OH and vulnerable to its consequences due to acute illness, prolonged bed rest and drug treatment. We aimed to evaluate the prevalence of OH at discharge, determine the characteristics of these patients and understand if a positive OH test (+OHt) was associated to worse outcomes.

Design and method:

Retrospective analysis of 150 patients ospitalised in an internal medicine ward, who were able to tolerate an OH test according to the European Society of Cardiology recommendations. Test was performed at discharge using Erkameter 125 Pro device validated by the European Society of Hypertension. The primary outcome was a composite of death, rehospitalization or emergency department visit for any cause. Data was analysed using IBM SPSS 28. Student t and chi-square tests were used to compare continuous and categorical variables, respectively, and Kaplan-Meier test to perform survival analysis.

Results:

Table 1 describes patients’ characteristics. 58 (39%) had a discharge + OHt but only 7 (12%) were symptomatic. Age was significantly associated with +OHt (p < 0.001), while sex, past medical history or medication at discharge weren’t. 71 primary outcome events were considered for survival analysis during a median (interquartile range) follow up of 4 (2–7) months. There were no differences between OHt result groups (p = 0.476). Although there were a small number of symptomatic +OHt patients, these had a higher event rate after discharge (p = 0.02).

Conclusions:

In an old, predominantly male population with excessive cardiovascular risk, comorbidities and polypharmacy there was a high OH prevalence at discharge. Only age seemed to correlate with OH. Short time prognosis was not affected by OH. The study limitations, small sample size, low number of events and short follow up, may have impacted the analysis. Nevertheless, patients with a symptomatic +OHt at discharge seem to be at higher event risk in which intervention could be helpful.
FEATURES OF THE DAILY BLOOD PRESSURE PROFILE IN YOUNG WOMEN ACCORDING TO PRECLINICAL CHECK UP
Authors: Evsevyeva Maria , Sergeeva Oksana , Penzova Violetta , Prokhorenko-Kolomoitsev Irina , Gachkova Irina , Ovchinnikova Olga
Published: June 2022

Objective:

The problem of effective prevention arterial hypertension (AH) is extremely important, which should be as primary and early as possible. It can be carried out at young age The aim is to evaluate the indicators of daily blood pressure monitoring (DBPM) in young women (YW) from the general population in the process of preclinical check up (PCU).

Design and method:

During the population survey in the conditions of the Stavropol City Health Center, 75 women aged 18 to 30 years were examined. In addition to risk factors (RF) screening, DBPM was also performed with determination of more than 20 indicators. In accordance with current clinical recommendations, on base of DBPM results, 4 groups with different variants of pressure regulation were distinguished: 1gr. - persistent normotension; 2gr - isolated office arterial hypertension (IOAH); 3gr - latent hypertension (LH) and 4gr. - persistent hypertension (PH).

Results:

The following distribution of examined YW in these groups was revealed: 1gr. - persistent normotonia 34.7% (26); 2gr– - IOAH 9.3% (7); 3gr. - latent hypertension 36.0% (27) and 4gr. - persistent hypertension 20.0% (15). In women with LH, indicators such as daytime and nighttime SAP, nighttime DAP and variability index of nighttime DAP were almost equal to those of peers with PH, and variability indices of daytime and nighttime DAP, as well as morning rise were significantly higher by 11.6%, 7.5% and 19.1% (p = 0.0273, p = 0.0561 and p = 0.0266). Such parameters as degree of nocturnal decrease in SAP and DAP, on the contrary, were 2–4 times less (p = 0.0570 and p = 0.0609). At the same time, office SAP and DAP in the group of LH were significantly lower compared to the group of women with PH (p = 0.0000 and p = 0.0157).

Conclusions:

The obtained results indicate the need for timely detection of LP in YW, because in terms of occurrence in such general population, it reaches level of representation of two variants of office hypertension – IOAH and PH combined. Therefore, it should be recommended to include DBPM in plan of PCU of YW who usually consider themselves practically healthy.
NON-INVASIVE CENTRAL BLOOD PRESSURE ESTIMATIONS IN PATIENTS WITH OR WITHOUT CHRONIC KIDNEY DISEASE: A PILOT PROJET
Authors: Côté Nadège , Abbaoui Yasmine , Spanneut Théo , Agharazii Mohsen , Goupil Rémi
Published: June 2022

Objective:

Central systolic blood pressure (SBP) is a better surrogate for hemodynamic strain on the myocardium, brain and kidneys. In the context of chronic kidney disease (CKD), where the blood flow to the kidneys is reduced and there is a higher degree of aortic stiffness, estimation of central BP through non-invasive methods needs to be validated. The aim of our study is to determine the accuracy of brachial and central SBP, as measured and estimated by two devices, towards the invasively measured aortic BP, in CKD patients compared to patients without CKD.

Design and method:

This is a multicenter pilot study taking place at the hospitals Hotel-Dieu de Québec and Sacré-Coeur de Montréal. Patients undergoing non-urgent coronary angiograms are undergoing evaluation of non-invasive and invasive BPs simultaneously in supine position. In brief, intraarterial aortic BPs are recorded in the aorta within 3 cm of the aortic valve for every heartbeat for 30 seconds then averaged. Non-invasive central and brachial BP measures are recorded concurrently to the intraarterial aortic BP recordings with WatchBP central and Mobil-o-graph. All measurements are recorded on the contralateral arm used for angiography.

Results:

In 34 subjects (29% female, mean age 64.2 ± 8.7). In the CKD group (n = 8, eGFR < 30 ml/min/1.73m2) and the control group (n = 26, eGFR> 30 ml/min/1.73m2). Brachial cuff-SBP underestimated aortic SBP in CKD (-10.0 ± 19.6 mmHg) but overestimated aortic SBP (3.9 ± 16.3 mm Hg) in the control group. Mobil-o-graph estimations are more precise than the brachial BP in CKD (0.0 ± 10.1 mmHg) but not in the control group (6.5 ± 14.7 mmHg). WatchBP Central SBP estimations are also more precise than the brachial BP in CKD (1.2 ± 10.8) but overestimated aortic SBP in the control group (13.4 ± 18.9).

Conclusions:

The preliminary results indicate that brachial SBP underestimates aortic SBP by in CKD as compared to controls, and that estimation of central BP by both devices provide a better estimate of aortic SBP in CKD than in controls. These preliminary results suggest that the use of central BP estimations could be beneficial for the management of hypertension in CKD.
WHITE COAT EFFECT LEVEL CORRELATED WITH THE ECHOCARDIOGRAPHIC PARAMETERS AND COMPOSITE ENDPOINT DATA IN TREATED PATIENTS WITH ARTERIAL HYPERTENSION
Authors: Andreeva Galiya , Koshelyaevskaya Yana , Smirnova Marina , Gorbunov Vladimir , Kurekhyan Armine
Published: June 2022

Objective:

The aim of our study was to determine relationship between echocardiography (Echo) left ventricular mass index (LVMI), composite endpoint data and white coat effect (WCE) level in treated patients with arterial hypertension (AH).

Design and method:

We nalysed database (treated AH patients (n = 125) with concomitant chronic diseases without exacerbation or in compensation stage). This study was prospective and included three visits every 3 months: 1 visit - screening, ambulatory blood pressure monitoring (ABPM) session, Echo; 2 - assessment of the patient’s status and the therapy effectiveness; 3- assessment of the patient’s status, ABPM session, Echo (the total number of ABPM was 239, Echo - 240). We assessed composite endpoint after 30.1 ± 7.6 months from the screening visit (the primary composite endpoint included death for any reason angina pectoris, transient ischemic attack, development of chronic heart failure, arterial revascularization, frequent ventricular extrasystoles, atrial fibrillation, secondary - deterioration of the cardiovascular diseases course and tertiary endpoint - deterioration of the arterial hypertension, concomitant diseases course). We used ANOVA for statistical analysis.

Results:

The baseline mean (M ± m) daytime systolic BP (SBP) was 125.1 ± 9.8 and diastolic (DBP) - 76.1 ± 7.0 mm Hg, age was 62.8 ± 9.0 years. We identified a positive correlation between tertiary composite endpoint data and WCE: for systolic WCE (SWCE) (F = 4.7, p < 0.031). We found correlations between WCE and Echo parameters: 1) SWCE level had with LVMI (r = 0.16, p < 0.017); 2) diastolic WCE (DWCE) had negative relationship with end-diastolic (EDD) and systolic (ESD) diameters (r = -0.181, p < 0.007 and r = -0.187, p < 0.005); with ejection fraction (EF) and posterior wall thicknesses (PWT) (r = -0.176, p < 0.008 and r = -0.142, p < 0.033). In addition, we have identified that age and duration of AH were associated with SWCE, height and body mass index (BMI) had negative correlations with DWCE (see table). Thus, SWCE level had positive correlation with tertiary composite endpoint results (F = 4.7, p < 0.031) and LVMI (r = 0.16, p < 0.017). DWCE level had negative relationships with Echo LV contractility indices (ESD, EDD, EF).

Conclusions:

Thus, only systolic WCE level had correlation with composite endpoint data and LVMI. DWCE level had negative associations with echocardiography LV contractility parameters.
BLOOD PRESSURE VARIABILITY ASSESSED WITH OFFICE, HOME AND AMBULATORY MEASUREMENTS BEFORE AND AFTER ANTIHYPERTENSIVE DRUG TREATMENT: THE REVERENT TRIAL
Authors: Kyriakoulis Konstantinos , Kollias Anastasios , Bilo Grzegorz , Soranna Davide , Liu Chang-Yuan , Pengo Martino , Zambon Antonella , Zhang Wei , Wang Jiguang , Stergiou George , Parati Gianfranco
Published: June 2022

Objective:

Blood pressure (BP) variability (BPV) can be assessed using office (OBP), home (HBP) and ambulatory BP (ABP) measurements. In this analysis BPV indices derived using all the three methods were compared before and after 10 weeks of antihypertensive drug treatment.

Design and method:

Untreated hypertensives (or treated after washout period) with elevated BPV (systolic HBP standard deviation [SD] > 7 mmHg and/or systolic daytime ABP SD > 12 mmHg), were nalysedd to ramipril 10 mg or nifedipine gastrointestinal therapeutic system (GITS) 30 mg once daily, in the context of a multicenter 10-week, prospective, nalysedd, open-label, blinded-end point study. BPV was assessed using SD and coefficient of variation (CV) [weighted SD (wSD) and weighted CV (wCV) for 24h-ABP variability) of individual measurements.

Results:

Data from 146 participants from three research centers (Athens, Milan, Shanghai) were nalysed (mean age 53 ± 10 [SD] years, males 60%, baseline systolic OBP, HBP and 24h-ABP 143 ± 10, 138 ± 10, and 143 ± 10 mmHg, respectively). Systolic CV assessed by HBP was decreased with treatment, by OBP was unchanged and by ABP increased (p < 0.05). HBP and ABP (not OBP) variability indices presented weak to moderate correlation, which was consistent before and after treatment (Table). HBP and ABP (not OBP) variability indices presented slight to fair agreement in detecting participants with high systolic BPV (top quartile of respective distribution) both before and after treatment (kappa statistic range 0.12–0.27).

Conclusions:

These data showed a moderate association between out-of-office (but not office) BPV indices both before and after administering BP lowering treatment, with reasonable agreement in detecting individuals with high BPV. Out-of-office BP measurements provide more similar BPV information than office measurements, both before and after administering antihypertensive drug treatment.
PATTERNS OF SHORT-TERM BLOOD PRESSURE VARIABILITY BY AGE IN SERIES OF EXAMS CARRIED DURING TWENTY-FIVE YEARS
Authors: Sousa Andréa Cristina , Magalhães Fabrício Galdino , Silva Suelen Benta , Simeoni Adélia Rocha , Inuzuka Sayuri , Batista Sandro Rogério , Vale Raquel Mendonça , Amaral Monica Santos , Souza Weimar Kunz Barroso , Sousa Ana Luiza Lima
Published: June 2022

Objective:

To describe patterns of short-term blood pressure variability and the association with age.

Design and method:

Cross-sectional study, with series of exams executed during 25 years. Variables used: gender, age, blood pressure values in different periods, nocturnal drop, coefficient of variation (CV) and standard deviation; normal nocturnal drop between 10% and 20% of blood pressure reduction, media of 24 hours CV-PAS was used for cutoff point. Effect sizes were calculated for differences in means – of Cohen, performed ANCOVA in all ABPM periods using the covariate sex; significance level for all nalyses 5%.

Results:

Analyzed 2073 exams, 66.3% of the female sex; medium age 58.3 years (±12.6), 29.4% were older than 65 years. The elderly, in all periods, had higher SBP media and lower of DBP. The elderly showed less BP control during nighttime (27.3%) than adults (35.3%) and more absence of nighttime drop (83.5%). Nocturnal drop in elderly was 17.7%/systolic and 36.6%/diastolic; in adults was 26.8%/52.1%, respectively. The Systolic Coefficient of Variation was higher among elderly in the 24hr period 10.8 (±3.1) x 10.0 (±2.4), daytime 10.3 (±2.9) x 9.0 (±2.4) and nighttime 9.0 (±3.0) x 8.6 (±2.8).

Conclusions:

The elderly had less pressure control during sleep and more absence of nocturnal drop; furthermore, they had a higher Systolic Coefficient of Variation in all periods.
BEHAVIOR OF PRESSURE VARIABILITY IN PATIENTS WITH ARTERIAL HYPERTENSION AND DIABETES MELLITUS WITH OR WITHOUT INSULIN USE AND THE INFLUENCE OF THE NUTRITIONAL STATE IN BRAZIL
Authors: Silva Suelen , Sousa Andrea Cristina , Sousa Ana Luíza , Vitorino Priscila , Lima Lucas , Magalhães Fabrício , Souza Weimar
Published: June 2022

Objective:

To evaluate the behavior of systolic and diastolic blood pressure variability through residential measurements in patients with hypertension and diabetes mellitus with or without insulin use associated with nutritional status.

Design and method:

Cross-sectional study, which evaluated patients undergoing prognosis and/or monitoring of arterial hypertension, who underwent blood pressure examination outside the clinic through telemonitoring by the TeleMRPA platform, between 2015 and 2020, divided into two groups: diabetic hypertensive patients with and without using insulin. Incomplete information and age under 18 and over 100 were excluded. Variables evaluated: body mass index, age, systolic and diastolic blood pressure variability obtained by home blood pressure monitoring, calculated by standard deviation. The results were presented using mean, standard deviation and inferential statistics through the unpaired t-student test, considering a confidence interval of 95% and a significance level of 5%.

Results:

57,379 patients with arterial hypertension were selected, of which 2,189 had diabetes mellitus, meeting the criteria, with a mean age of 64.1 (~ 13.02) years for patients with use, and 64.7 (~ 12.26) years for did not use insulin. The body mass index for patients who used insulin was 28.6 (~ 4.57) kg/m2 and for those who did not use it was 29.1 (~ 4.65) kg/m2, without statistical significance (p 0.171). The values of systolic blood pressure variability for patients with and without insulin use were, respectively, 11.1 (~ 4.44) and 10.0 (~ 3.93) with p = 0.0002, and for the variability of diastolic blood pressure, 6.5 (~ 2.94) and 5.9 (~ 2.67) with p = 0.017.

Conclusions:

In diabetic hypertensive patients, nutritional status was not associated with insulin use. In relation to systolic and diastolic blood pressure variability, there were higher elevations in the group that used insulin. Home blood pressure monitoring is an important alternative for monitoring blood pressure variability, which is a predictor of cardiovascular events in hypertensive and diabetic patients, and can be used reliably through telemonitoring.
POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME: DIVERSE ETIOLOGIES
Authors: Khadhar Meriam , Barbouch Samia , Hidri Hafedh , Ounissi Mondher , Bêcha Monti , Abderrahim Ezzeddine
Published: June 2022

Objective:

Posterior Reversible Encephalopathy, called PRES, is a clinico-radiological entity individualized for the first time in 1996 as a special form of hypertensive encephalopathy.

Design and method:

We collected retrospectively 8 cases of PRES Syndrome either on-specific or followed in Internal Medicine service. All patients had a confirmed diagnosis by brain MRI.

Results:

There were 5 women and 3 men, mean age was 30 years (range 16–66 years). Three patients had a past history of arterial hypertension. Two patients had moderate chronic renal failure, three had a chronic renal failure on hemodialysis, one had normal renal function and the two others were transplanted. Hypertension with diastolic blood pressure greater than 120 mmHg was noted in two patients. For the others, it was an acute and sudden increase of blood pressure usually well balanced. Neurological manifestations are on-specific, such as confusion, a prolonged critical post coma or seizure initially focal (Braved-Jacksonian) limited to brain lobe affected by the PRES which become generalized secondarily. All patients had seizures, one presented a status epilepticus. They all underwent magnetic resonance imaging (MRI). Typical imaging findings characteristically involve the white matter bilaterally in the parieto-occipital regions. Involvement of the white matter is constant. To equilibrate the systemic blood pressure, we used calcium channel blockers in all cases (nicardipine in the electric syringe pump in one case). The therapeutic goal was to maintain a mean arterial pressure between 105 and 125 mmHg.

Conclusions:

PRES is highly diverse in terms of etiologies. Our series is particular by the large number of cases of PRES compared to the literature but especially by the diversity of the etiologies of PRES. All our patients had chronic renal failure and / or underlying nephropathy.
SEASONAL VARIATION IN METEOROLOGICAL PARAMETERS AND BLOOD PRESSURE IN CROATIAN ADULT POPULATION
Authors: Jelakovic Ana , Srnec Lidija , Orlic Mirko , Premuzic Vedran , Domislovic Marija , Begic Zvonimir , Barisic Karla , Radunovic Danilo , Prelevic Vladimir , Dika Zivka , Stevanovic Ranko , Jelakovic Bojan
Published: June 2022

Objective:

There are many reports on the seasonality of cardiovascular risk factors particularly of blood pressure (BP). Our aim was to analyze association of BP with various meteorological parameters in random sample of general Croatian adult population.

Design and method:

EHUH -2 study is nation-wide survey (Croatian Science Foundation) on prevalence, treatment and control of hypertension in Croatia. In 2018–2021 a random sample of 1321 subjects were enrolled. Office blood pressure (BP) and heart rate were measured in sitting position using Omron 3 device three times and average BP values were calculated. Estimated pulse wave velocity (ePWV) was calculated using validated equation. Meteorological data (mean daily 2 m air temperature – T2m, atmosphere pressure, air humidity measured at meteorological stations according to WMO standards) were collected in Croatian Meteorological and Hydrological Service.

Results:

We found significant difference in systolic and diastolic BP, heart rate and ePWV accorss nalys (Figure 1a and Figure 2), as well significant correlation between all parameters and T2m. (Figure 3 for systolic BP). There is nonsignificant trend in association between systolic BP and air humidity. We failed to find association of diastolic BP, heart rate and ePWV with any of nalysed meteorological parameters. Furthermore, we found inverse association between systolic BP, diastolic BP and heart rate with T2m i.e. we confirmed seasonal fluctuations (Figure 1b).

Conclusions:

Our data confirmed findings of seasonal (inverse) variation between BP and T2m. Interestingly, we found association of seasonal variation and ePWV. T2m has impact on long-term BP variability but also on ePWV and should be taken into account in clinical research as well as in regular clinical work.
OBESITY AND MYELOPROLIFERATIVE NEOPLASMS: A SYSTEMATIC REVIEW
Authors: Gaman Mihnea-Alexandr , Epingeac Mirela Elena , Gaman Amelia Maria , Diaconu Camelia Cristina
Published: June 2022

Objective:

Obesity is a known trigger for carcinogenesis and its involvement is proven in the development of solid and blood cancers. However, the involvement of obesity in myeloproliferative neoplasms (MPNs), namely polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF), has not been assessed so far.

Design and method:

Systematic review in PubMed/MEDLINE from its inception to March 13th, 2022. The database was searched using specific keywords/word combinations to identify relevant papers which were further evaluated if they were original articles and investigated the role of obesity in MPNs. Reviews, case reports, meeting abstracts, letters to the editor, in vivo/in vitro studies were excluded.

Results:

The initial search yielded 88 results of which 62 remained after the exclusion of reviews/case reports (n = 26). After screening of titles/abstracts, 25 full-texts were assessed of which 18 were entered into the qualitative analysis. Most conclusions were drawn from singular studies. Two papers pointed out that obesity affects the evaluation of red cell mass in PV due to the hypovascular nature of the adipose tissue, arguing for new reference ranges in obese subjects. Adults with obesity during adolescence had an increased risk of MPNs development during adulthood. Obesity was particularly linked to the development of ET. Obese MPNs adults had an elevated number of bone marrow adipocytes, higher total symptom burden (U-shaped association with BMI), higher rate of cerebrovascular accidents (ET) and venous thrombosis, lower risk of post-PV myelofibrosis and stroke, higher survival rates. Obesity did not influence anxiety in MPNs or the occurrence of thrombosis (ET). However, lower survival rates and thrombosis-free survival were noted in MPNs patients with multiple cardiovascular risk factors. PMF patients treated with ruxolitinib who had higher BMI values registered better outcomes. Ruxolitinib-treated subjects exhibited an increase in BMI. Obesity did not influence the outcome of allogeneic bone marrow transplantation in PMF, nor did it influence the outcome of this procedure in elderly patients transplanted for myeloid malignancies.

Conclusions:

Obesity can influence the development and evolution of MPNs and should be carefully monitored. Further studies should assess the obesity paradox in MPNs.
STUDY ON HYPERTENSION-RELATED TARGET ORGAN DAMAGE IN ESSENTIAL HYPERTENSION PATIENTS WITH HYPOKALEMIA
Authors: Wang Qiongying , Zhang Haodong , Wang Wenjuan , Pei Ying , Kou Chengkun , Yu Jing
Published: June 2022

Objective:

To explore the early target organ damage in essential hypertension patients with hypokalemia,we nalysed ambulatory blood pressure, cardiac structure and function, early renal function, neck blood vessels and head imaging in patients with essential hypertension.

Design and method:

590 patients with hypertension who were nalysedsed from January 2015 to June 2021 were selected, including 257 cases with hypokalemia and 76 cases have primary aldosteronism.Collect patients’ general information, biochemistry, urine routine, office blood pressure, 24 h ambulatory blood pressure monitoring.The results were statistically nalysed by SPSS.

Results:

Compared with the essential hypertension group,average systolic blood pressure during the day, average diastolic blood pressure during the day, average systolic blood pressure at night, and average diastolic blood pressure at night, 24 h average systolic blood pressure, 24 h average diastolic blood pressure, daytime systolic blood pressure load rate, night diastolic blood pressure load rate, 24 h systolic blood pressure load rate, and 24 h diastolic blood pressure load rate were significantly higher in both the hypokalemia group and the essential hyperaldosteronism group (P < 0.05). Urinary microalbumin in the primary hypertension with hypokalemia group and primary aldosteronism group was significantly higher than that in the primary hypertension group (P < 0.05).The 24 h average diastolic blood pressure, night systolic blood pressure load rate, and 24 h systolic blood pressure load rate were all positively correlated with urine microalbumin(P < 0.05); they were negatively correlated with serum potassium ion (P < 0.05). The nighttime mean systolic blood pressure and nighttime systolic pressure load rate were independently positively correlated with urine microalbumin (P < 0.05), and serum potassium ions were independently negatively correlated with urine microalbumin by Multiple linear regression analysis (P < 0.05).

Conclusions:

Essential hypertension patients with hypokalemia have higher 24 h blood pressure and blood pressure load rate, and have more serious early renal damage than patients with normal potassiumic Otherwise, Serum potassium concentration was an independent risk factor for urinary microalbumin in essential hypertension patients with hypokalemia
THE PROGNOSTIC VALUE OF FATTY LIVER INDEX FOR CARDIOVASCULAR EVENTS IN HYPERTENSIVE PATIENTS
Authors: Siafi Eirini , Andrikou Ioannis , Thomopoulos Costas , Konstantinidis Dimitrios , Manta Eleni , Polyzos Dimitrios , Tatakis Fotis , Zammanis Ioannis , Drogkaris Sotirios , Kariori Maria , Kakouri Niki , Liatakis Ioannis , Filippou Christina , Tsioufis Konstantinos
Published: June 2022

Objective:

The prevalence of on-alcoholic fatty liver disease (NAFLD) has been increasing rapidly worldwide affecting 25–30% of population. Fatty liver index (FLI) is a validated marker of NAFLD and can be used as a screening tool for hepatic steatosis. The purpose of the study was to evaluate the relationship between FLI and the risk of major cardiovascular events in hypertensive patients.

Design and method:

903 hypertensive patients without history of cardiovascular disease participated in the study (mean age 52.7 ± 11.4 years; males 55%; baseline clinic BP 149.8 ± 15.2/95.5 ± 10.1 mmHg). Participants were prospectively evaluated for a mean follow-up period of 6.0 ± 3.3 years with at least one annual visit. The diagnosis of NAFLD was based on FLI and consequently patients were divided in two groups according to the presence of NAFLD. The primary endpoint was a composite of major cardiovascular events.

Results:

The incidence of cardiovascular events during the follow up was 8.5% (n = 77). Patients without NAFLD (n = 625) had better BP control compared to their counterparts with NAFLD (n = 278) during follow up (43% vs 33%, p = 0.02). A Cox-regression analysis indicated that age (HR 1.09 CI 1.04–1.13, p < 0.01), smoking (HR 2.4 CI 1.1–5.2, p = 0.03) and FLI (HR 2.7 CI 1.9–4.1, p < 0.001) were significant independent determinants of the outcome. The presence of NAFLD at baseline visit was also a significant independent determinant of the outcome (HR 5.2 CI 2.4–11.1, p < 0.001).

Conclusions:

FLI has an independent prognostic value for the incidence of cardiovascular events in hypertensive patients. Therefore, it could be useful in identifying patients at higher risk of cardiovascular events. Further studies will clarify whether the early treatment of NAFLD could reduce the incidence of cardiovascular disease.
ISOLATED DIASTOLIC HYPERTENSION IS NOT A BENIGN SITUATION REGARDING HYPERTENSION MEDIATED ORGAN DAMAGE IN PATIENTS WITH FIRST DIAGNOSED AND NEVER TREATED ESSENTIAL HYPERTENSION
Authors: Triantafyllidi Helen , Birmpa Dionyssia , Benas Dimitris , Fabri Anastasia , Schoinas Antonios , Thymis Ioannis , Kostelli Gavriela , Ikonomidis Ignatios
Published: June 2022

Objective:

Isolated diastolic hypertension (IDH) usually remains untreated as it is considered benign compared to isolated systolic or combined systolic/diastolic hypertension. Hypertension mediated organ damage (HMOD) needs to be assessed in each individual hypertensive patient in order to estimate cardiovascular risk. We aimed to investigate the HMOD differences between first diagnosed and never treated patients with IDH compared to normotensive subjects.

Design and method:

We studied 68 non-diabetic, first diagnosed and never-treated hypertensive patients with IDH (mean age = 49 + 9, 65% males, 24% smokers) and 30 normotensives (mean age = 51 + 10, 17% males, 20% smokers). Office and ambulatory blood pressure monitoring (24 h ABPM), CV risk factors [smoking, obesity (BMI), hyperlipidemia and HMOD [aortic stiffness (PWV), left ventricular diastolic dysfunction (EEa), cardiac hypertrophy (LVMI), coronary arteries microcirculation (CFR), carotid intima-media thickness (cIMT) were estimated in each hypertensive patient as well as normotensive subject.

Results:

IDH patients had similar age, BMI and smoking habit, decreased LDL-C and increased diastolic (89 + 9 vs. 84 + 9 mmHg, p = 0.02) and mean office BP (106 + 9 vs. 99 + 12 mmHg, p = 0.01) as well as 24 h systolic (126 + 3 vs. 119 + 6 mmHg, p < 0.001) and diastolic ABPM (84 + 4 vs. 73 + 4 mmHg, p < 0.001) compared to normotensives. Regarding HMOD, IDH patients had increased LVMI (78 + 17 vs. 68 + 19 g/m2, p = 0.03) and IMT (0.9 + 0.1 vs. 0.8 + 0.1 mm, p = 0.03) but similar PWV, E/Ea and CFR compared to normotensives. LVMI was related to diastolic (r = 0.32, p = 0.008) and mean (r = 0.32, p = 0.01) office BP in IDH patients.

Conclusions:

The presence of HMOD in patients with first diagnosed and never treated IDH underscores the need for antihypertensive treatment (life style changes and medication). As HMOD may regress with successful antihypertensive treatment, there is still time for physicians to reduce future CV events in those patients.
EFFECTS OF PARENTAL GENERATION PRENATAL FAMINE EXPOSURE ARE OBSERVED IN THE DESCENDANTS OF BESIEGED LENINGRAD RESIDENTS
Authors: Tolkunova Kristina , Moguchaya Ekaterina , Boyarinova Maria , Usoltsev Dmitry , Rotar Oxana , Konradi Aleksandra , Artomov Mykyta
Published: June 2022

Objective:

The influence of famine at early development stages may contribute to the epigenetic transgenerational inheritance of phenotypic variability. The research aims to compare the prevalence of cardiometabolic risk factors in the descendants of Leningrad Siege survivors and in control groups matched for age, sex and body mass index (BMI).

Design and method:

83 descendants (children and grandchildren) of Leningrad Siege survivors (who were exposed to famine in early childhood during Second World War) were examined. The participants were questioned and anthropometry, blood pressure measurement, biochemical blood tests were performed. 83 controls matched for gender, age, and BMI were selected from epidemiological Russian study ESSE RF (random sample of Saint-Petersburg inhabitants)

Results:

are presented in Table 1.

Table 1. Comparison of Leningrad Siege survivors’ descendants and control group.

Conclusions:

The transgenerational effect of ancestral famine contributes to a higher level of nonatherogenic cholesterol in the descendants of besieged Leningrad residents.
INFLUENCE OF CONCOMITANT ATHEROSCLEROSIS OF THE ARTERIES OF THE LOWER EXTREMITIES ON THE PARAMETERS OF ARTERIAL STIFFNESS IN PATIENTS WITH ARTERIAL HYPERTENSION
Authors: Safronenko Viktoria , Chesnikova Anna , Sementsova Nadejda , Skarzhinskaya Natalia
Published: June 2022

Objective:

To assess the effect of atherosclerosis of the arteries of the lower extremities on the parameters of arterial stiffness in patients with arterial hypertension.

Design and method:

120 patients with hypertension: group 1- patients with hypertension and manifested atherosclerosis of the lower limb arteries (AANC), group 2 - with hypertension and asymptomatic AANC, group 3 - with hypertension without AANC. The aortic augmentation index (AIXao), aortic pulse wave velocity (PWVao), the duration of the ejection period (ED) of the left ventricle (LV) and the efficiency index of subendocardial viability ratio (SEVR) were determined. Statistica 12.0 was used for statistical analysis.

Results:

The values of AIXao (%) in patients of the 1st group (38 [29; 45] %) were significantly higher than those in patients of the 2nd (30 [23;38], p < 0.017) and the 3rd (30 [21;32], p < 0.017) groups, while the indices in the patients of the 2nd and 3rd groups did not differ statistically significantly. In patients of the 1st group higher values of PWVao (11 [10.3;11.9]) were also recorded in comparison with the third group (10.3 [9,6;11.3], p = 0.03). There were no statistically significant differences between the PWVao values in patients of the 1st and 2nd (11 [10.3;11.9] and 10.4 [9.4;11.4], p> 0.05) groups, and also in patients of groups 2 and 3 (p > 0.05). Higher ED values were also determined in patients of group 1 compared with others group. No differences were found when comparing the SEVR (%) in patients of the 2nd and 3rd groups, at the same time, in the patients of the 1st group, the SEVR values were significantly lower as compared with the 2nd group (113 [92;134] and 121 [110;134], p = 0.03), and with the 3rd group (128[106;138], p < 0.017).

Conclusions:

In patients with hypertension, the development of asymptomatic AANC did not have a significant effect on the parameters of arterial stiffness, together with the presence of concomitant clinically manifested AANC led to an increase in the rigidity of the vascular wall, which indicates a higher risk of cardiovascular complications.
RELATIONSHIP BETWEEN PERIVASCULAR ADIPOSE TISSUE AND VASCULAR REMODELING
Authors: Bragina Anna , Osadchiy Konstantin , Rodionova Yuliya , Djafarova Zarema , Lobanova Mariya , Dishkaya Selen , Khalenyan Milena , Litvinenko Nadezhda , Ananeva Vera , Balutskaya Anastasia , Podzolkov Valeriy
Published: June 2022

Objective:

To study the relationship between the volume of perivascular adipose tissue (PVAT) and the vascular emodelling.

Design and method:

We examined 318 patients without manifested cardiovascular diseases (average age 63.5 ± 13.7 years). Anthropometric indicators were measured, body mass index (BMI) was calculated. Lipid profile was evaluated. Arterial wall stiffness was assessed by calculation of the cardio-ankle index (CAVI) using VaSera (VS-1000) (Fucuda Denshi, Japan). Thickness of the intima-media complex and vasomotor function of the endothelium of the brachial artery were evaluated by ultrasound using LOGIQ F6 (GE Healthcare, USA). All patients underwent multi-detector chest computed tomography in spiral mode on Toshiba Aquilion Prime scanner using standardized protocol. PVAT was detected using specialized semi-automatic software Tissue Composition Module QCTPro (Mindways Software, Inc., USA) after scanner calibration with special phantom. Statistical analysis was performed using Statistica 10.0 software (StatSoft Inc., USA).

Results:

Male to female ratio in the cohort was shifted towards males, however this difference was statistically insignificant (p = 0.066). Prevalence of hypertension in the study group was high – 268 (84.3%) patients. The majority (74.2%) of study participants had elevated BMI. Average PVAT volume was 0.3[0.2;0.4] cm³. The PVAT volume was significantly higher in obese patients vs patients with normal body mass: 0.4 [0.3;0.5] cm³ vs 0.25[0.2;0.4] cm³ (p = 0.0007). The PVAT volume was significantly higher in patients with elevated CAVI vs patients with normal CAVI: 0.4[0.3;0.5] cm³ vs 0.3[0.25;0.3] cm³ (p = 0.02). Correlation analysis revealed significant correlation between the PVAT volume and BMI (r = 0.27; p < 0.005), waist circumference (r = 0.41; p < 0.005), CAVI (r = 0.49; p < 0.05), endothelial dysfunction of the brachial arteries (r = 0.38; p < 0.05). Multiple regression analysis demonstrated significant association of CAVI with age (±SE, 0.51 ± 0.15; p = 0.002) and the volume of PVAT (±SE,0.41 ± 0.13; p = 0.005).

Conclusions:

This study demonstrated an association of PVAT volume with visceral obesity and indicators of vascular wall stiffness.