bluuebunny/crossref_metadata_2025 huggingface dataset:
ACUTE PANCREATITIS REVEALING MAJOR HYPERTRIGLYCERIDEMIA
Authors: Mezghani Ines , Marrakchi Rim , Ayedi Mohsen , Boudaya Mariem , Lahiani Najeh , Jammoussi Kamel , Turki Mouna , Kacem Faten Hadj , Abid Mohamed
Published: June 2023

Objective:

Severe hypertriglyceridemia is a common risk factor for acute pancreatitis and atherosclerotic vascular disease. Our aim was to report a rare case of acute pancreatitis due to major hypertriglyceridemia.

Design and method:

We report a case of acute pancreatitis revealing major hypertriglyceridemia.

Results:

A 53-year-old man, was hospitalized in May 2022 in endocrinology departement with abdominal pain, nausea,vomiting and alteration of general condition.

History: high blood pressure, type 2 diabetes, alcohol consumption and family history of high blood pressure, type 2 diabetes, dyslipidemia. Clinical examination showed defense on palapation in epigastrium and right flank. Biochemical analyses were as follows: hypertriglyceridemia at 76.42 mmol/L associated with hypercholesterolemia at 17.58 mmol/L, LDL-C = 2.25 mmol/L, HDL-C = 2.12 mmol/L, hyperglycemia = 10.62 mmol/L, HBA1C = 8.1%, Lipasemia = 281 UI/L. Abdominal ultrasound did not show lithiasis, abdominal CT scan revealed pancreatitis.

The diagnosis of acute pancreatitis due to major hypertriglyceridemia was made.

The patient was treated by plasmapheresis and triglyceride level was reduced to 2.5 mmol/L. The lipidogram showed an isolated elevation of VLDL and defined hypertriglyceridemia as Familial hyperlipoproteinemia type 4.

Conclusions:

Familial hyperlipoproteinemia type 4 syndrome is an uncommon condition. Acute pancreatitis secondary to severe hypertriglyceridemia is a condition with a high risk of mortality which requires prompt clinical suspicion and treatment.
PREVALENCE OF OVERWEIGHT AND OBESITY IN EAST KAZAKHSTAN
Authors: Markabayeva Akbayan , Kerimkulova Aiman
Published: June 2023

Objective:

The prevalence of overweight and obesity is an increasing public health problem in many developing countries with varying ethnic- and gender specific patterns. Sporadic publications in local literature suggest that the prevalence of overweight in Kazakhstan is also increasing, although most of these studies were small and performed only in large cities (Alma-Ata, Astana) while the information from other parts of the country is scarce. Our aim was to assess the prevalence of overweight and obesity across genders and main ethnic groups in three administrative districts in East Kazakhstan.

Design and method:

Altogether, 1755 adults (59.7% women) aged 18-91 years living in in three administrative districts, i.e. the Maiskii and Lebiazhinskii districts of the Pavlodar region and Glubokovskii district of the East Kazakhstan region participated in a cross-sectional study. The study population was selected based on the automated state medical registry, covering the population exposed to nuclear test fallout. Height and weight were measured and body mass index (BMI) was calculated. The prevalence of overweight (BMI between 25.0 and <30.0 kg/m2) and obesity (BMI more 30.0 kg/m2) was studied across genders and main ethnic groups – Kazakhs, Russians.

Results:

The overall prevalence of overweight and obesity were 42.3% (95%CI: 41.2-43.5) and 17.4% (95%CI: 16.1-18.4) among men and 43,1% (95%CI: 42.4-43.8) and 23.3% (95%CI: 20.3-26.7) among women. The prevalence of overweight and obesity among Kazakhs (41.9%, 95%CI: 40.2-43.6; 18.7%, 95%CI: 17.3-20.0) and among Russians (44.5%, 95%CI: 43.1-45.9; 24.9%, 95%CI: 23.2-25.5).

Conclusions:

Our results suggest that more than a half of the population of East Kazakhstan is at least overweight and almost every fourth is obese. We have not observed ethnic or gender differences in the studied outcomes.
SERUM PARATHORMONE, VITAMIN D AND CARDIOVASCULAR RISK FACTORS
Authors: Mancusi Costantino , Fucile Ilaria , Luca Nicola De , Iaccarino Guido
Published: June 2023

Objective:

The aim of this study is to evaluate the associations of serum 25-OHD and PTH concentrations with blood pressure and hypertension mediated target organ damage including left ventricular hypertrophy (LVH) and carotid intima-media thickness (IMT).

Design and method:

This observational retrospective study included 98 patients admitted at Hypertension Research Center of Federico II University Hospital in Naples without CKD. We collected serum 25-OHD, PTH, creatinine, BMI, lipid profile, blood glucose and office blood pressure. All patients underwent carotid doppler ultrasound and echocardiography.

Results:

Mean age of the participants was 53±17 years and 69% were men.

Pearson's correlation analysis indicated that PTH levels correlated directly with age, diabetes, dyslipidemia, hypertension, fasting glucose, on statin therapy, left ventricular mass and inversely with the GFR, total cholesterol, LDL and vit D level. Vit. D levels correlated inversely with PTH, diabetes and carotid plaque.

Multivariate regression models indicated that PTH was significantly associated with higher fasting glucose and with vit D while Vit D was associated with lower GFR and PTH level.

Conclusions:

In a population at high cardiovascular risk, Vit. D and PTH are not directly associated with hypertension but might influence association with other cardiovascular risk factors and markers.
PREVALENCE OF CARDIOVASCULAR RISK FACTORS, LIFESTYLE AND SOCIAL DETERMINANTS DURING SCREENING IN A PERIURBAN POPULATION
Authors: Malik Koussoh Simone , Amangoua Annita , Meless David , Ake Michèle , Guinan Jean - Claude , Oga Serges , Adoubi Anicet , Ndindin Claude
Published: June 2023

Objective:

Analyze the relationship between some cardiovascular risk factors, which are hypertension, diabetes, obesity, and social and lifestyle determinants in a West African adult population during a screening.

Design and method:

This cross-sectional study was conducted in a peri-urban population in West Africa (Côte d’Ivoire) and included adults aged 18 and over. Sociodemographic data (age, sex, marital status, education, occupation) were collected. A history of diabetes and hypertension was sought. Lifestyle data (tobacco and alcohol consumption) and some cardiovascular risk factors were collected. Blood pressure was measured with an OMRON M6 electronic blood pressure monitor in the sitting position after 5 minutes of rest. Capillary blood glucose was measured with a glucometer in fasting participants. Weight was measured by a scale and the catch on the ID document.

Results:

The survey involved 380 persons, 39.8% were men and 60.2% women. The average age was 40.4 ± 13.8 years. Almost half of the population had no education. More than a quarter (25.20%) of the respondents drank alcohol and 46% of the individuals had a liberal profession. The prevalence of hypertension was 39.2%. Hypertension affected 41.6% of men and 58.4% of women; Women were more hypertensive than men (p = 0.03). Hypertension was present in about half of the individuals with no education (49%) and slightly more than a quarter of individuals living with a partner. Diabetes was present in about 10% of individuals. The prevalence of obesity was 17.1%. This obesity concerned 60.2% of women. Women were more likely to have hypertension than men. Individuals with no education were more likely to have hypertension than individuals with education.

Conclusions:

In this peri-urban population, the prevalence of hypertension is high, approaching two fifths of the population. Women, people with no education and those living in couples were more hypertensive.
AMBULATORY BLOOD PRESSURE LEVELS AFFECT THE ASSOCIATION OF INTRADIALYTIC HYPERTENSION WITH ADVERSE CARDIOVASCULAR EVENTS IN HEMODIALYSIS PATIENTS
Authors: Iatridi Fotini , Theodorakopoulou Marieta , Georgiou Areti , Karpetas Antonios , Pella Eva , Tsouchnikas Ioannis , Giamalis Panagiotis , Papagianni Aikaterini , Sarafidis Pantelis
Published: June 2023

Objective:

Patients with intradialytic hypertension (IDH) display also higher ambulatory blood pressure (BP) levels during the whole 44-h interdialytic interval compared to patients without the phenomenon. Sustained high 44-h ambulatory BP levels is a potential risk factor for cardiovascular events and mortality in these individuals. The aim of this study is to evaluate the influence of elevated 44-h BP levels on the high cardiovascular risk of individuals with IDH.

Design and method:

A total of 242 hemodialysis patients with valid 48-h ABPM with Mobil-O-Graph-NG had an extended follow up for a median of 57.8 months. IDH was defined as: rise in SBP greater or equal to 10 mmHg from pre- to post-dialysis and post-dialysis SBP greater or equal to 150 mmHg. The primary end-point was a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, resuscitation after cardiac arrest, hospitalization for heart failure, coronary or peripheral revascularization procedure. The secondary endpoint was cardiovascular mortality.

Results:

45 patients with and 197 without were included in this prospective analysis. Cumulative freedom from the primary and secondary endpoint was significantly lower for patients with IDH (logrank-p = 0.019), while freedom from the secondary endpoint did not differ significantly between the two groups (logrank-p = 0.321). Patients with IDH presented a significantly higher risk for the composite endpoint (HR = 1.651, 95%CI[1.083, 2.516]), without, however, showing a significant difference in the risk for cardiovascular mortality (HR = 1.320, 95%CI[0.762, 2.288]). After adjustment for 44-h SBP, the association of IDH with the primary endpoint slightly attenuated, while the association with the secondary outcome had no significant changes (HR = 1.421, 95%CI[0.906, 2.228] and HR = 1.270, 95%CI[0.708, 2.276], for primary and secondary outcome respectively).

Conclusions:

IDH is associated with higher risk for adverse cardiovascular outcomes. High ambulatory BP during the interdialytic interval contributes to the excess cardiovascular risk observed in this population.
GLYCEMIC VARIABILITY IN PATIENTS WITH TYPE 2 DIABETES MELLITUS: CLINICAL IMPLICATIONS AND PHARMACOLOGICAL CONSIDERATIONS
Authors: Howsawi Alanood , Alem Manal
Published: June 2023

Objective:

Glycemic variability (GV), independently of glycemic control, has emerged as a prognostic marker in patients with type 2 diabetes mellitus (DM). In this study, we assessed the prognostic value of GV for predicting major adverse cardiovascular events (MACE) in our local population. We also assessed its prognostic value for diabetic microvascular complications (DMC) and its relationships with antidiabetic medications.

Design and method:

This was a retrospective cohort study that recruited 680 patients with type 2 DM across 2015-2017. MACE were defined as: the composite of; total death, myocardial infarction (MI), stroke, hospitalization due to heart failure, revascularization. GV was calculated for two glycemic control markers: glycated hemoglobin (G-Hb) and fasting blood sugar (FBS); via 3 metrics- standard deviation (SD), coefficient of variation (CV), and variability independent from the mean (VIM). Cox proportional hazard models and Kruskal-Wallis tests were used in the statistical analysis.

Results:

105 events classified as MACE were identified in 86 patients and 104 DMC in 98 patients in an average follow-up period of 78.43 months. GV was found to be an independent predictor of MACE, particularly for FBS-CV but not a predictor of DMC. FBS-CV > 17.51% as compared with < 17.51% was a significant and independent predictor of MACE, with HR 1.589 (95% CI; 1.022, 2.472) (P = 0.040) (Table 1 & Figure 1). DMC were predicted mainly by the duration of type DM, and by the glycemic control; similarly represented by G-Hb and FBS. Patients on metformin, and dipeptidyl peptidase (DPP) 4 inhibitors, had the lowest GV, as compared with patients whose treatments included insulin/sulphonylureas (P<0.001).

Conclusions:

In our population, GV predicted MACE: with FBS-CV superior to the “gold standard” glycemic control marker G-Hb. Further, GV may be explained, partially at least, by the choice of antidiabetic medications: this finding might contribute to the cardiovascular protection attributed to one class rather than another.
HYPERTENSION AS A RISK FACTOR FOR MORTALITY AND THE DEVELOPMENT OF CHRONIC KIDNEY DISEASE AFTER AN EPISODE OF ACUTE KIDNEY INJURY WITH FULL RECOVERY IN THE ELDERLY
Authors: Mahmoud Nouha Ben , Hamouda Mouna , Salem Meriem Ben , Salah Manel Ben , Bchir Sirine , Letaief Ahmed , Aloui Sabra , Skhiri Habib
Published: June 2023

Objective:

Acute kidney injury (AKI) is a real public health problem due to its severity and its consequences in the short, medium and long term. Hypertension is a very common disease in our country.

Design and method:

We undergone a retrospective study which was carried out in the nephrology department of Fattouma Bourguiba hospital in Monastir.

We included patients aged > 65 years, who had an AKI with full recovery who had been hospitalized between January 2002 and December 2015. Our study aimed to assess the impact of hypertension on mortality and the development of chronic kidney disease (CKD) after an episode of AKI.

Results:

Our population was made up of 67 men and 60 women, 30.1% had multiple comorbidities. Pre renal Aki represented the predominant mechanism of AKI which was retained in our study with a rate of 40% and dehydration as the main aetiology in 70 patients.

In the short term, 15 patients had progressed to CKD. The mean overall survival in our study was 159 months with a high risk of mortality in elderly (patients aged >65 years), who had multiple comorbidites, hypertensive, diabetics, with vascular disease, Charlson Cmorbidity index >5, who presented with hyperkaleamia >5.5 and pre renal mechanism of the AKI episode.

Conclusions:

Hypertension is a real public health problem impacting the short, medium and long term prognosis of patients who have had an episode of AKI with full recovery
THE SIGNIFICANCE OF COMBINING INTER-LIMB BLOOD PRESSURE DIFFERENCES IN PREDICTING THE FUTURE CARDIOVASCULAR RISK IN ELDER CHINESE: THE NORTHERN SHANGHAI STUDY
Authors: Shi Jieying , Yu Shikai , Xu Yawei , Zhang Yi
Published: June 2023

Objective:

The three indexes derived from the inter-limb systolic blood pressure difference (ISBPD), namely inter-arm (IASBPD) and -leg (ILSBPD) systolic blood pressure differences and ankle-brachial index (ABI), were proved associated with cardiovascular morbidity and mortality, respectively. Whether the combination of the three indexes can improve the prediction of future cardiovascular risk remains unclear. We aimed to explore the clinical significance of combining IASBPD, ILSBPD, and ABI in predicting future cardiovascular risk in a large cohort of elderly Chinese.

Design and method:

A total of 3095 participants (mean age: 71±6 years) derived from the Northern Shanghai Study were included in the present analysis. According to the number of abnormal ISBPDs (IASBPD> = 20 mmHg, ILSBPD> = 20 mmHg, and ABI< = 0.9), the participants were divided into three groups: Group 0 (without abnormal ISBPD, n = 2507), 1 (with 1 abnormal ISBPD, n = 418), and 2 (with> = 2 ISBPDs, n = 170). The study endpoint was defined as the composite major adverse cardiovascular events (MACEs) including non-fatal myocardial infarction (MI), and non-fatal stroke, and all-cause mortality. Survival analysis and Cox proportional hazards models were performed to compare the rates of the endpoint between groups. The discriminative ability of ISBPDs and ABI was compared using R2, C-index, NRI, and IDI.

Results:

During a median follow-up period of 5.4 years (interquartile range 4.4-7.3 years), 325 events (10.5%) were observed, with 40 non-fatal MI, 101 non-fatal stroke, and 205 deaths. Survival Analysis indicated the highest rates of the endpoint in Group 2, followed by Group 1 and Group 0 (P<0.001). In Cox regression model, after adjustment for possible confounding factors, Group 2 showed significantly higher risk of events than that of Group 0 (HR: 1.50, 95% CI: 1.06-2.13); Group 1 also showed higher risk of events compared to Group 0, but did not reach statistical significance (HR: 1.25; 95%CI: 0.94 to 1.65). The addition of IASBPD and ILSBPD on ABI improved the prediction of cardiovascular risk (net reclassification improvement 4%,95%CI: -0.05 to 0.13), after adjusted for potential confounders.

Conclusions:

The combination of ISBPDs may help to better predict the future cardiovascular risk in the elderly.
WHO BENEFITS MORE, IN TERMS OF LIPID PROFILE?
Authors: Barata Érica , Monteiro Filipa , Leão António , Abecasis Francisca , Beirão Pedro , Cunha Vitoria
Published: June 2023

Objective:

As important as finding and treating the specific cause of a cerebral vascular event is gauging, monitoring and treating the cerebrovascular risk factors that may contribute to and/or aggravate it, with the lipid profile having particular prominence.

To comparatively analyse the control of the lipid profile, between gender, throughout the Hypertension Consultation

Design and method:

We conducted a retrospective study including patients who attended the Hypertension Consultation from 1 January to 31 May 2022. This group was divided into two subgroups (female or male) and subsequently compared regarding the evolution of the mean values of LDL-cholesterol, -HDL, and triglycerides from the first to the last appointment they attended.

Results:

Overall, a decrease in LDL-cholesterol and triglycerides was obtained in both subgroups. The reduction of these two parameters was greater in the female group. The values of LDL-cholesterol did not change substantially.

Conclusions:

Pharmacological and non-pharmacological therapy of dyslipidaemia proved to be effective, safe and well tolerated in the group of patients with cerebrovascular disease, regardless of gender. The female gender was the one that benefited most from these measures throughout the follow-up in hypertension consultation. The widely recognised difficulty in modifying HDL in these patients was also evident.
CEREBRAL OXYGENATION DURING EXERCISE DETERIORATES WITH ADVANCING CHRONIC KIDNEY DISEASE
Authors: Theodorakopoulou Marieta , Dipla Konstantina , Zafeiridis Andreas , Faitatzidou Danai , Koutlas Aggelos , Gkoura Eleni , Gakidi Katerina , Doumas Michael , Papagianni Aikaterini , Sarafidis Pantelis
Published: June 2023

Objective:

Cognitive impairment and exercise intolerance are common in CKD. Cerebral perfusion and oxygenation play a major role in both cognitive function and exercise execution. This study aimed to examine cerebral oxygenation during a mild physical stress in patients at different CKD stages and controls without CKD.

Design and method:

Ninety-participants (18 per CKD-stage 2,3a,3b,4 and 18 controls) underwent a 3-min intermittent-handgrip-exercise at 35% of their maximal-voluntary-contraction(MVC). During exercise, cerebral oxygenation (oxyhemoglobin-O2Hb, deoxyhemoglobin-HHb, total-hemoglobin-tHb) was assessed by near-infrared-spectroscopy. Indices of microvascular (muscle-hyperemic-response) and macrovascular function (cIMT and PWV), cognitive and physical activity status were also evaluated.

Results:

No differences in age, sex and BMI were detected among-groups. The MMSE score was significantly reduced with advancing CKD stages (Controls: 29.2±1.2 Stage 2: 28.7±1.0 Stage 3a: 27.8±1.9 Stage 3b: 28.0±1.8 Stage 4: 27.6±1.5; p = 0.019). Similar trends were observed for physical activity levels and handgrip strength. The average response in cerebral oxygenation during exercise was lower with advancing CKD stages (O2Hb: Controls: 2.50±1.54, Stage-2: 1.30±1.05, Stage-3a: 1.24±0.93, Stage-3b: 1.11±0.89, Stage-4: 0.97±0.80micromol/l; p<0.001)). The average tHb response(index of regional-blood-volume) showed a similar decreasing trend (p = 0.003); no differences in HHb among groups were detected. In univariate linear analysis older age, lower eGFR, Hb, microvascular hyperemic response, and increased PWV were associated with poor O2Hb response during exercise; in the multiple model, eGFR was the only parameter independently associated with the O2Hb response.

Conclusions:

Brain activation during a mild physical task appears to decrease with advancing CKD as suggested by the smaller rise in cerebral oxygenation. This may contribute both to impaired cognitive function and reduced exercise tolerance with advancing CKD.
ETHNIC DIFFERENCES IN RISK FACTORS FOR COGNITIVE DECLINE AND DEMENTIA, IN INDIVIDUALS WITH DIABETES: RESULTS FROM THE ADVANCE TRIAL
Authors: Harris Katie , Gong Jessica , Shah Mitva , Hajat Shakoor , Xu Ying , Carcel Cheryl , Woodward Mark , Chalmers John
Published: June 2023

Objective:

Ethnic differences in risk factors for dementia remain underexplored. This project will estimate ethnic differences on the associations between risk factors, and treatment effects, with cognitive decline (CD) and/or dementia, in individuals with type 2 diabetes (T2D).

Design and method:

This study uses the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial of 11,140 individuals with T2D from 20 countries. Multivariable adjusted multinomial logistic regression models were used to examine the associations between baseline characteristics and odds of subsequent CD/dementia, by Asian and non-Asian ethnicity.

Results:

There were 4242 (38%) participants of Asian ethnicity. During 5-years (median) follow-up, 1827 participants (40% Asian) had CD/dementia (1718 with CD only (41% Asian); 21 with dementia only (19% Asian); 88 with CD and dementia (32% Asian)), and 929 (30% Asian) died without CD/dementia.

Participants of Asian ethnicity had a higher odds of CD/dementia than non-Asians (odds ratio [OR] [95% confidence interval (CI)], 1.25 [1.09, 1.44]). In both Asians and non-Asians, older age, longer diabetes duration was associated with greater odds of CD/dementia; higher years at education completion and taller stature reduced the odds of CD/dementia.

Higher baseline cognitive function was associated with a lower odds of CD/dementia in non-Asians 0.93 [0.90, 0.96], but not in Asians 1.01 [0.97, 1.04]. Stroke/transient ischaemic attack, retinal disease, higher body mass index, waist circumference, and current smoker (vs. never), were associated with a higher odds of CD/dementia in non-Asians but not in Asians. Moderate/vigorous physical activity vs none/mild was associated with a higher odds of CD/dementia in Asians 1.26 [1.10, 1.45] but a lower odds in non-Asians 0.81 [0.68, 0.97].

There was no evidence that intensive glucose control (vs. standard control) or blood pressure lowering (vs. placebo) conferred a lower risk of CD/dementia, overall nor by ethnicity.

Conclusions:

People of Asian ethnicity had a 25% higher risk of CD/dementia than non-Asians in this study. There were some differential effects of risk factors for CD/dementia by ethnicity. More data from Asian populations are required to verify ethnic differences and the mechanisms that underlie these differences.
DETERMINANTS OF OFFICE BLOOD PRESSURE VARIABILITY AND INSTABILITY IN CHILDREN, ADOLESCENTS AND YOUNG ADULTS
Authors: Theodosiadi Aikaterini , Ntineri Angeliki , Kollias Anastasios , Kyriakoulis Konstantinos , Menti Ariadni , Ntousopoulos Vasileios , Stathopoulou Panagiota , Zeniodi Maria , Stambolliu Emelina , Vazeou Andriani , Stergiou George S.
Published: June 2023

Objective:

To evaluate the determinants of office blood pressure (BP) variability and instability within a single visit in young individuals.

Design and method:

Apparently healthy individuals aged 6-25 years referred for elevated blood pressure (BP) were subjected to triplicate office BP measurements in a single visit and 24h ambulatory BP monitoring. BP variability and instability were assessed separately for systolic and diastolic BP using: (i) standard deviation (SD) (ii) coefficient of variation (CV) (iii) average real variability (ARV) (iv) maximum office BP (Max) (v) maximum-minimum office BP difference (MMD) (vi) ratio of difference between 1st-3rd measurement to the average office BP (Relative change). White-coat effect was defined as the difference between office and daytime ambulatory BP.

Results:

320 individuals were analyzed (mean age 13.6±3.6 years, 66.8% males, BMI z-score 1.12±0.96, average office BP 122.6±16.6/72.6±10.7 mmHg, 24h ambulatory BP 119.3±11.5/67.8±6.8). Based on office and 24h ambulatory BP, 21.3% of the participants had white-coat hypertension, 8.1% masked and 16.6% sustained hypertension. Age was associated with SD (r = 0.23, p<0.001), CV (r = 0.11, p<0.05), Max (r = 0.54, p<0.001) and MMD (r = 0.23, p<0.001) of office systolic BP, and Max (r = 0.29, p<0.001) and ARV (r = 0.12, p<0.05) of diastolic. In multivariable log-linear regression models [(independent variables: age, sex, BMI z-score, heart rate, office BP, white-coat effect (> = 5/6 mmHg systolic/diastolic, 75th centile)], office BP was an independent determinant for indices of systolic BP variability and instability [SD (↓ = 0.01, p<0.001), ARV (↓ = 0.01, p<0.001), Max (↓ = 0.01, p<0.001), MMD (↓ = 0.01, p<0.001) and Relative change (↓ = 0.001, p<0.05)], and for CV (↓ = -0.06, p<0.001) and Max (↓ = 0.01, p<0.001) of diastolic. White-coat effect was a significant determinant for CV of office systolic BP (↓ = 0.15, p<0.05) and Relative change of office diastolic BP (↓ = 0.03, p<0.05).

Conclusions:

These results suggest that in healthy children, adolescents, and young adults the indices of office BP variability and instability within the first visit seem to be determined by the level of office BP and the magnitude of the white-coat effect.
RISK FACTORS FOR ARTERIAL STIFFNESS IN ADOLESCENCE
Authors: Sokolovic Imana , Sokolovic. Sekib
Published: June 2023

Objective:

To investigate the arterial stiffness and risk factors in adolescence.

Arterial stiffness often (AS) results from the degenerative process of the media layer of elastic arteries causing rigidity of the arteries. Arterial stiffness increases with age and it is associated with several risk factors as a disease predictor. But, arterial stiffness can be also increased in a healthy arteries as well. The increased sympathetic activity promotes vasoconstriction of resistant blood vessels i.e. arteries and arterioles that result in peripheral vasoconstriction. Adolescence age is the most important period of life for promoting future health. The certain dynamic risk factors in adolescence like, emotional dysregulation, psychological family stress, education pressure, lack of sleep, gambling, substance abuse, smartphone overuse and obesity can cause arterial stiffness.

Design and method:

The prospective open randomized study was designed. Adolescence age between 10 and 19 years have been investigated for increased arterial stiffness and risk factors. The inclusion criteria was healthy adolescence, while exclusion criteria was any disorder present. Arterial stiffness, non-invasive blood pressure and pulse wave datas have been measured using Agedio device. The risk factors were evaluated in every subject. The vascular age have been outlined as the final measure.

Results:

The preliminary results indicate the increase of Augmentation Index and Coefficient of Reflection. The average percentage of Augmentation Index was 40% and Coefficient of Reflection 65% (normal value 28% and 60% respectively). The main risk factors were educational pressure, lack of sleep and smartphone influence. The vascular age was on average, 3 years higher than biological age.

Conclusions:

Arterial stiffness in adolescence is increased mainly by peripheral vasoconstriction, manifested with Augmentation index and Coefficient of wave Reflection.
IMPACT OF ANTHROPOMETRIC AND METABOLIC PARAMETERS ON LEFT VENTRICULAR MASS IN YOUTHS
Authors: Annaloro Alessandra , Invernizzi Chiara , Ponce Francisco , Deutsch Christine , Lurbe Empar , Grassi Guido , Alvarez Julio
Published: June 2023

Objective:

Even though childhood obesity is an increasing epidemic, little is known about obesity on mediated organ damage. Left ventricular mass index (LVMI) is the main parameter assessing the presence of abnormalities on the heart in children and adolescents, however there is a lack of knowledge on its association with obesity status. Therefore, the objective of the study is to assess the impact of weight status, hemodynamic and metabolic parameters on LVMI.

Design and method:

Seventy-eight patients aged 5-16 yr attending the outpatient clinic of cardiovascular risk were enrolled and assessed for anthropometric variables, office blood pressure (OBP), laboratory blood tests (uric acid, lipid, and glycemic profile), and 2-D echocardiography was performed for cardiac mass and geometry evaluation. In addition, patients were classified based on the presence of insulin resistance.

Results:

The mean age of patients was 12.03 yr and males were 53.8%. Ten subjects were normal weight, 11 overweight, 39 obese, and 18 severely obese.

No significant differences in values of OBP were observed among weight groups: 65 (83.3%) were normotensive, 7 high normal (9%), and 6 hypertensives (8%).

A statistically significant positive correlation was observed between LVMI and obesity markers (BMI r = 0.383, waist circumference r = 0.461); Relative wall thickness and left atrial diameter were significantly correlated with BMI and waist circumference.

BP parameters were not correlated to other variables, and differences in LVMI among BP phenotypes were non-significant, although a weak correlation was observed with systolic OBP (r = 0.291).

When dividing the population by insulin resistance, adjusted by age, sex, and pubertal status, LVMI was significantly higher in the insulin-resistant group (32.34 g/m 2.7 (6.47) vs 37.27 g/m 2.7 (12.1), p = 0.037).

Conclusions:

Obesity and insulin resistance are the main determinants of LVMI in our population. In a cohort of children and adolescents with similar characteristics by laboratory parameters, obesity still appears to induce early preclinical damage at cardiac level in terms of mass and geometry irrespectively of the blood pressure phenotype.
FACTORS ASSOCIATED WITH POOR BLOOD PRESSURE CONTROL IN SEDENTARY NOMADIC HYPERTENSIVES IN SOUTHERN ALGERIA
Authors: /Abdelhalim Taleb Taleb , Farah Hamida , Yousra Djebbar , Abdelghani Bachir Cherif
Published: June 2023

Objective:

the objectives of this study were to determine the proportion of uncontrolled hypertension in a nomadic hypertensive population and to investigate the factors associated with this poor control.

Design and method:

this is a descriptive cross-sectional study including 135 sedentary nomads recruited with known hypertension, without distinction of sex or skin color. The blood pressure was taken between eight and 12 a.m., on both arms, in the supine position, after resting for an average of five minutes. We looked for the classic cardiovascular risk factors (age greater than or equal to 50 years for men and 60 years for women, physical inactivity, overweight/obesity, tobacco, diabetes and dyslipidemia) and calculated the overall cardiovascular risk according to the model of framingham. A sbp greater than or equal to 140 mmhg and/or a dbp greater than or equal to 90 mmhg was considered as uncontrolled blood pressure. A univariate and then multivariate analysis by logistic regression (using the spss program version 22.0) were carried out in search of factors associated with poor blood pressure.

Results:

of the 135 hypertensives, 62 were women (46%), sex ratio is 1.2. The modifiable cardiovascular risk factors in addition to hypertension were dominated by dyslipidemia (19.9%) and diabetes (13.2%). The global cardiovascular risk calculated according to the framingham method was low in 19.3%, moderate in 24.0%, high in 14.8% and very high in 10.9% of cases. The proportion of uncontrolled hypertension was 73.8% (n = 118 including 76 women and 42 men). This poor blood pressure control was linked (multivariate analysis) to age greater than or equal to 60 years, physical inactivity, low socioeconomic level, high to very high cardiovascular risk, antihypertensive monotherapy, duration of treatment greater than or equal to ten years, associated treatment and non-adherence to treatment.

Conclusions:

three quarters of hypertensives in our study were poorly controlled by antihypertensive treatment. The factors of this poor control were age greater than or equal to 60 years, low socioeconomic status, high to very high cardiovascular risk, antihypertensive monotherapy, duration of treatment, associated treatment and non-compliance with treatment.
CIRCADIAN BLOOD PRESSURE PROFILE IN RELATION TO LOW BACK PAIN DISABILITY INDEX
Authors: Stolarz-Skrzypek Katarzyna , Góra Katarzyna , Skrzypek Maciej , Kaleta Blazej , Wróbel Piotr , Rajzer Marek , Wojciechowska Wiktoria
Published: June 2023

Objective:

Cross-sectional observations within population cohorts have linked low back pain with hypertension in men, but not in women. The aim of the current study was to analyze 24-hour blood pressure profile in hypertensive men and women reporting low back pain.

Design and method:

The study group included 85 hypertensive patients (29 M/56 F, mean age 60.6 +/- 8.3 years) with episodes of low back pain during 3 weeks before examination. All patients received antihypertensive medications in the scheme of combination therapy and none of them was on chronic painkillers. Standardized questionnaire was used to collect information on life style factors. Twenty-four hour blood pressure monitoring was provided (Spacelabs 90207) and values of 24h, daytime and nighttime blood pressure were calculated, as well as nighttime blood pressure dipping. Oswestry Low Back Pain Disability Questionnaire was used to calculate disability index. Multivariable regression was used to asses the association between blood pressure an disability index, while accounting for covariates.

Results:

In the whole study population, no association was found between disability index and 24-hour systolic (parameter estimate: -0.053 +/- 0.23 mm Hg per 1 point increase in disability index, p = 0.86) or diastolic blood pressure (-0.018 +/ 0.14 mm Hg per 1 point increase, p = 0.90). When analyzing men and women separately, we observed in women increased daytime diastolic blood pressure with increasing disability index (+0.29 +/- 0.16 mm Hg, p = 0.044), that resulted in more prominent day-night difference with increasing disability index (+0.42 +/- 0.14% per 1 point increase in disability index). Blood pressure values over 24 hours or nighttime blood pressure was not associated with disability index. None of associations between blood pressure values and low back pain disability index were not found in men.

Conclusions:

Low back pain, as assessed by standardized questionnaire of disability index, is associated with elevated daytime blood pressure in hypertensive women, that might lead to more difficulties in achieving target blood pressure in this group of patients.
CLINICAL AND DEMOGRAPHIC CHARACTERISTICS OF PATIENTS WITH COEXISTENT HYPERTENSION AND TYPE 2 DIABETES MELLITUS: RESULTS FROM THE LARGEST RETROSPECTIVE EMR STUDY FROM INDIA
Authors: Natarajan Vidhya , Dalal Jamshed , Chandra Praveen , Chawla Rajeev , Hazra Prakash , Chawla Manoj , Ponde Chandrashekhar , Naqvi Mujtaba , Gaurav Kumar , Dhanaki Gauri , Rathod Rahul , Kotak Bhavesh
Published: June 2023

Objective:

Common end-organ manifestations of diabetes and hypertension predispose patients to develop cardiovascular diseases (CVD). The data on coexistent hypertension and diabetes mellitus (dual disease) in India is scarce. In patients with dual disease CVD risk is amplified, therefore necessitating better understanding of their current clinical characteristics and care gaps.

Design and method:

This was an EMR based, retrospective, multicenter, cross sectional, database study to evaluate the demographic and clinical profile of adult patients with age more than 18 years having coexistent Hypertension and Type 2 Diabetes in India. Data of patients with Type 1 Diabetes Mellitus, Familial Hypercholesterolemia and pregnant females were excluded

Results:

Data of 6722173 (6.7 million approx.) patients with age more than or equal to 18 years registered in EMR from January 2021 to December 2021 was extracted from the EMR database. Out of these patients, 279072 (4.15%) patients were found to have coexistent hypertension and diabetes mellitus. Mean age was noted to be 57.9 years and 52% of them were males. The mean BMI of the patients was 28.07 kg/m2, and 72% of patients had an above normal BMI (>24.99). The mean SBP and DBP in mmHg were noted to be 141.08 and 84.05, respectively. Only 9.3% and 22% of patients had a normal SBP and normal DBP, respectively. The mean HbA1c of the patients was 8.47% with only 27.7% of patients having HbA1C <7%. ARBs (16.2 %) and combination of anti-hypertensive with diuretics (10.9 %) were most used for hypertension. Biguanides and its combination with sulphonylureas were used in 53.5% and 32% of patients with diabetes, respectively.

Conclusions:

The findings suggests that control of dual disease in India is inadequate despite current therapy being offered, this puts patients at a higher risk for early-onset CVD. Hence, there is an urgent need to create awareness and optimize management of coexistent hypertension and diabetes.
PROGNOSTIC IMPACT OF FRAILTY ON FUNCTIONAL AUTONOMY IN OLDER ADULTS WITH HYPERTENSION
Authors: Ceolin Ludovica , Rivasi Giulia , Turrin Giada , Tortu’ Virginia , Capacci Marco , Rossi Lorenza , Corsi Carolina , Mossello Enrico , Ungar Andrea
Published: June 2023

Objective:

To date, few studies have evaluated frailty in older adults with hypertension and the most appropriate tool to quantify frailty in this population has yet to be identified. The present study aimed to investigate the prognostic impact of frailty on decline of functional autonomy in a sample of hypertensive older adults.

Design and method:

We performed a longitudinal observational study including patients aged 75 or older evaluated at the Hypertension Clinic and Memory Clinic of the Division of Geriatric and Intensive Care Medicine, Careggi Hospital, Florence. Participants underwent a multidimensional geriatric assessment including frailty evaluation using three frailty scales (Fried Frailty Phenotype, Clinical Frailty Scale [CFS], Frailty Index) and two physical performance measures (gait speed and Short Physical Performance Battery [SPPB]). The primary outcome was reduction of autonomy in daily activities according to the Barthel Index (functional decline). The predictive performance of different frailty measures was evaluated based on ROC curve analysis, sensitivity, specificity and accuracy.

Results:

Among 99 hypertensive older adults (mean age 81, 59% women, median follow-up 13 months), functional decline occurred in 39% of patients. Participants with functional decline had a higher prevalence of cognitive impairment and frailty according to all the frailty scales used and a worse physical performance. Frailty Index and CFS showed the best predictive performance (AUC 0.715 and 0.708, respectively), followed by physical performance measures (AUC 0.691). All frailty measures showed good specificity (66-79%) and moderate sensitivity (54-70%). Gait speed showed the highest accuracy (71%) and achieved 57% sensitivity and 79% specificity, resulting in better predictive performance than the SPPB.

Conclusions:

The CFS and gait speed - easily applicable even in non-geriatric settings – may represent useful instrument to detect frailty and predict functional decline in hypertensive older adults.
GLUCOSE METABOLISM AND ATRIAL FIBRILLATION IN HYPERTENSIVE PATIENTS
Authors: Lytra Thekla , Kyvelou Stella Maria , Biotis Nikolaos Vythoulkas , Anastasiou Theocharis , Karpanou Evaggelia , Vyssoulis Gregory
Published: June 2023

Objective:

We evaluated the association of abnormal glucose metabolism with risk of atrial fibrillation in hypertensive patients.

Design and method:

The study comprised 34.280 consecutive patients (51,87% males, mean age 58 years) with uncomplicated essential hypertension. The diagnosis of hypertension was based upon repeated office blood pressure measurements, 24 hours ambulatory blood pressure monitoring, clinical and laboratory evaluation. Patients were divided into four metabolic groups: normal glucose (NG), impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and type 2 diabetes mellitus (DM2). Then subdivided into three subgroups: sinus (SR), paroxysmal (PAF) and sustained (SAF) atrial fibrillation. Average glucose (eAG), hemoglobin A1c (HbA1c), insulin, homeostatic model assessment for insulin resistance (HOMA-IR) and the variation of them in relation to rhythm were assessed in each subgroup, corrected for confounders.

Results:

Among the patients (45,3%) with NG there was significant difference of all glucose metabolic parameters in correlation to three rhythms (glucose p = 0,004, eAG, HbA1c, insulin, HOMA-IR, p<0,001). These indices were higher, in SAF and in PAF compared to the SR subgroup (glucose p = 0,011, the rest indices p<0,001).

In group IFG (20,3%), comparison of three rhythm indicated significant difference of glucose indices (glucose, eAG p<0,05, HbA1c, insulin, p<0,001) and they were increased in PAF in contrast to SR patients (p<0,05). Additionally, the insulin and the HbA1c were higher in SAF comparison the SR patients, (p<0,05). The eAG was comparably higher in SAF versus the PAF group, (p<0,05).

In group IGT (17,3%), the patients had difference in levels of indices depending the rhythm (eAG, HbA1c, insulin, HOMA-IR p<0,05). Particularly the patients with SAF had higher levels of insulin and HOMA-IR than those who had SR (p<0,05).

In group T2DM (16,9%), there was significant difference in glucose parameters dependent the rhythm (glucose p = 0,031, insulin p = 0,002, eAG, HOMA-IR, HbA1c p<0,001). The subgroup PAF showed higher values in eAG, HbA1c, HOMA-IR, (p<0,05) and the subgroup SAF in glucose, insulin, eAG, HOMA-IR (p<0,05), HbA1c (p<0,001) in compare to SR subgroup, respectively.

Conclusions:

Prediabetes and diabetes increase the risk of atrial fibrillation in hypertensive patients in a level response way.
SAFETY AND FEASIBILITY OF HYPOXIA EXPOSURE IN PATIENTS WITH PRIOR MYOCARDIAL INFARCTION
Authors: Hönemann Jan-Niklas , Gerlach Darius , Hoffmann Fabian , Kramer Tilmann , Weis Henning , Zaha Vlad G. , Sadek Hesham , Herwarden Andonuis E. , Olthaar Andre , Reuter Hannes , Baldus Stephan , Levine Benjamin D , Jordan Jens , Tank Jens , Limper Ulrich
Published: June 2023

Objective:

In mice, normobaric hypoxia exposure corresponding to 8,000 m altitude after myocardial infarction reactivated cardiomyocyte proliferation and improved left ventricular ejection fraction (LVEF). Translating these findings to patients might be limited by hypoxia-induced pulmonary hypertension and myocardial ischemia.

Design and method:

We conducted a feasibility and safety study at the: envihab facility in 4 patients who had experienced myocardial infarction with fully revascularized LAD-stenosis as culprit lesion 37-104 months prior study entry. Their peak VO2 ranged from 32 - 43 ml/kg/min. The study comprised a two-days baseline, 19 days normobaric hypoxia, and two-days recovery. We gradually lowered atmospheric oxygen to 0.118 FIO2, which is equivalent to 4500 m, and maintained that level for 4.5 days. We obtained transthoracic echocardiography, magnetic resonance imaging, and determined Troponin I, NTproBNP at baseline, during 0.118 FIO2, and recovery.

Results:

Except for symptoms of acute mountain sickness, hypoxia was well tolerated as severe adverse reactions did not occur and pulmonary hypertension rapidly abated during recovery. During the last 10 days of hypoxia, peripheral oxygen saturation was continuously <90%.

LVEF was 50.7±11.0 % (mean±SD) baseline, 57.6±11.2% at 0.118 FIO2, and 57.3±11.2% during recovery. Furthermore, echocardiographic LV global longitudinal strain was -15.28±5.4% at baseline and -17.28±7.56 % in recovery. Magnetic resonance imaging confirmed these findings.

NTproBNP diminished (baseline: 203±209 pg/ml, 0.118 FIO2: 122±101/pg/ml, recovery: 85±66 pg/ml) and Troponin I concentrations remained in the reference range throughout the study. In the patient with the largest LVEF increase following hypoxia, an additional 12 weeks follow-up measurement showed stable improvements in LVEF (baseline: 36%, recovery: 48%, 12 weeks follow-up: 47%), left ventricular strain, NTproBNP, and exertional dyspnea.

Conclusions:

Our study provides evidence regarding safety and potential of hypoxia exposure after myocardial infarction and lays the foundation for future studies assessing hypoxia-influences on cardiac regeneration.

However, our findings have to be interpreted with caution given the small sample size and the selected patient population.
MINOCA: HYPERTENSION IS NOT AN IMPORTANT RISK FACTOR
Authors: Fethi Moussaoui , Radia Bali Tabet , Tyeb Bensaada , Abderrahim Meziane Tani
Published: June 2023

Objective:

We studied the epidemiological, clinical and prognostic profile of the MINOCA population then compared them to patients with obstructive coronary artery disease and finally we established an etiological analysis of the MINOCA population.

Design and method:

Descriptive prospective study spread over a period of 36 months from January 2018 to January 2021 involving a total number of 585 patients undergoing coronary angiography at the cardiology department of CHU Tlemcen for a reason for acute myocardial ischemia. We defined the patients as having acute myocardial ischemia with obstructive coronary artery disease (AMI-CO) if there was revascularization or plaque > 50% and as having MINOCA if there was < 50% obstruction or a mechanism without plaque. Patients who did not have coronary angiography or who received thrombolytics before angiography were excluded.®

Results:

Of 585 patients undergoing angiography, 525 (89.74%) had AMI-CO, 60 (10.25%) had a MINOCA.

Men were 4 times more likely to have MINOCA than women (78.3% versus 21.7%; odds ratio at 3.61). MINOCA patients were more likely to be without traditional cardiac risk factors (7.9% vs. 2.1%; P < 0.001) but more predisposed to non-traditional risk factors than AMI-CO patients (3.7% against 1.8%; P = 0.026).

Smoking is the only traditional risk factor frequent in the MINOCA population versus AMI-CO (P at 0.001).

Hypertension is not an important risk factor for MINOCA (38% versus 51%; P = 0.066).

Depression, stress, drug addiction, DVT history and autoimmune disease history are more frequent in the MINOCA population versus AMI-CO (P < 0.05).

STEMI are more found in the MINOCA population versus AMI-CO (P = 0.001).

In terms of prognosis, the MINOCA population had a better prognosis: less risk of recurrence than the AMI-CO population 6.7% versus 10.45% (P = 0.03) also less mortality 0% versus 2.3% (P = 0.237).

Conclusions:

The patients with MINOCA were more men, smokers, depressed, stressed, drug addicts with hypercoagulable states compared to patients with obstructive coronary artery disease (AMI-CO) however they had a better quality of life and a good prognosis.