bluuebunny/crossref_metadata_2025 huggingface dataset:
HEALTH-RELATED QUALITY OF LIFE AND ASSOCIATED FACTORS AMONG HYPERTENSIVE PATIENTS
Authors: Cong Duy Tran , Ngoc Hoa Chau
Published: June 2022

Objective:

To survey the health-related quality of life (HRQOL) and its associated factors among hypertensive patients.

Design and method:

A cross-sectional study was carried out from October 2013 to March 2014 to investigate treated hypertensive patients at the Cardiovascular Clinic, Cho Ray Hospital, Viet Nam. Participants who had been diagnosed with hypertension and taking antihypertensive medications, aged 18 or older, able to read or understand Vietnamese were recruited into this study. All participants were interviewed, examined, and tested to collect data including socio-demographic information, cardiovascular risk factors, co-morbidities, and target organ damages (TODs). HRQOL was assessed by the SF-36 questionnaire. The Vietnamese version of SF-36 was translated, validated in Vietnam. The instrument consists of 36 items that are scored to measure eight domains of health such as physical functioning, role physical, bodily pain, and general health, vitality, social functioning, role emotional, and mental health. Scores range from 0 (poorest health) to 100 (optimal health). All statistical analyses were performed using SPSS 22.0 version.

Results:

There were 300 hypertensive patients attending our study for 6 months. The mean age of patients was 64.0 ± 12.5. The most frequent age group was 65 years or older. The common cardiovascular risk factors were dyslipidemia (69.7%), diabetes (25.7%), and smoking (25.7%). The most often TODs were carotid atherosclerosis (41.7%), retinopathy (36.3%), left ventricular hypertrophy (27.7%), microalbuminuria (24.3%), and coronary artery disease (21.3%). The male-female ratio was 1.2. The mean scores of 4 physical health domains including physical functioning, role physical, bodily pain, and general health were 68.3; 57.2; 57.1, and 37.2, respectively. The mean scores of 4 mental health domains including vitality, social functioning, role emotional, and mental health were 55.5; 57.5; 58.7, and 48.8, respectively. In multivariate analysis, factors associated with HRQOL among hypertensive patients were age, occupation, health insurance, marital status, education level, diabetes mellitus, heart failure, coronary heart disease, stroke, transient ischemic attack, and lower extremity artery disease.

Conclusions:

Hypertensives had low HRQOL scores in all domains. Factors affecting their HRQOL should be taken into account when treating these patients.
THE RELATIONSHIP OF ARTERIAL AND MYOCARDIAL STIFFNESS WITH LEFT VENTRICLE DIASTOLIC DYSFUNCTION IN PATIENTS WITH ARTERIAL HYPERTENSION
Authors: Abdullaeva Guzal , Kevorkov Amayak , Yusupova Khafiza , Khamidullaeva Gulnoz , Sadullaeva Mohinur , Safarov Jamshid
Published: June 2022

Objective:

to study the relationship of left ventricular diastolic dysfunction (LVDD) with the degree of myocardial and arterial stiffness arterial hypertension (AH) patients.

Design and method:

Study included 219 patients with I-III stages of hypertension (ESC/ESH 2018) of both sexes. The average age of the patients was 55.8 ± 11.0 years, duration of AH was 55.8 ± 11.0 years. All patients were divided into two groups: 1 - patients with LVDD, n = 113 (51.6%) and 2 - without LVDD, n = 106 (48.4%). Echocardiographic assessment was performed in M-and B-modes. The systemic and regional stiffness of arterial bed was performed applanation tonometry using the SphygmoCor. The Intima-Media thickness (IMT) of common carotid artery was measured by duplex scanning. Statistical processing was carried out using the Statistica 10.0 program. Results are presented as M ± SD and Me [Q1; Q3].

Results:

Initial parameters of ultrasound examination of carotid arteries showed the evidence of IMT on the left and right in patients with LVDD. Left IMT in patients with LVDD was 1.0 [0.9; 1.2] mm versus 1.0 [0.8;1.1] mm in group without LVDD (p < 0.05); right IMT was 1.0 [0.9; 1.2] mm versus 1.0 [0.8;1.1] mm, respectively (p < 0.02). Analysis of the initial parameters of central hemodynamics and vascular stiffness, revealed some features. The Barberg index was lower in group of patients with LVDD than in patients without LVDD: 142.1 ± 26.3 versus 148.5 ± 28.5, respectively (p < 0.05). Arterial stiffness was higher in the group of patients with LVDD than in group of patients without LVDD. The pulse wave velocity (PWV) in the group 1 with LVDD was 10.8 ± 2.7 m/s, and in the 2 group without LVDD - 9.9 ± 2.8 m/s (p < 0.02). A direct correlation was found for LVDD with the severity of vascular remodeling, in particular with indices of right IMT (R = 0.153, p = 0.025), with left IMT (R = 0.141, p = 0.040) and with the PWV (R = 0.169, p = 0.015).

Conclusions:

Our study showed an association of the severity of arterial and myocardial stiffness with LVDD.
REDUCTION OF HEART RATE VIA P2X4 RECEPTOR ACTIVATION AS A PROMISING TREATMENT STRATEGY IN PULMONARY ARTERIAL HYPERTENSION
Authors: Ribeiro Cristiana , Neiva Rafael , Silva Diogo , Correia-De-Sá Paulo , Fontes-Sousa Ana Patricia
Published: June 2022

Objective:

Mounting evidence suggest that the ATP-sensitive ionotropic P2X4 receptor (P2X4R) improves cardiac performance and optimizes myocardial energy demand by reducing chronotropy. Here, we set to investigate whether the digitalis-like effect of the P2X4R in the sinus node was preserved in rats with right heart failure due to pulmonary arterial hypertension (PAH).

Design and method:

Male Wistar rats received a single subcutaneous injection of either monocrotaline (MCT; PAH group) or vehicle (CTRL group). Right heart failure associated to PAH normally occurs in Wistar rats 21 to 25 days after MCT administration. Myographic recordings were performed in spontaneously beating atria (chronotropic effect) isolated from both animal groups.

Results:

Baseline spontaneous atrial rate was 250 ± 5 (n = 26) bpm in CTRL and 237 ± 7 bpm (n = 23) in PAH group (p > 0.05). ATP (0.01–1 mM) concentration-dependently reduced the spontaneous atrial rate of both animal groups. The negative chronotropic effect of ATP (100 M) was smaller in PAH rats (-9 ± 2%; n = 14 vs. -22 ± 4%; n = 25, p < 0.05), but this divergence was attenuated upon increasing the concentration of ATP to 1 mM (CTRL: -54 ± 5%; n = 15 vs. MCT: -50 ± 7%; n = 8; p > 0.05). The P2X4R antagonist, 5-BDBD (10 M), attenuated the negative chronotropic action of ATP (100 M) in CTRL (from -19 ± 5% to -13 ± 3%; n = 5, p > 0.05) and PAH (from -8 ± 3% to 1 ± 8%; n = 4, p > 0.05) rats. The positive allosteric modulator of P2X4R, ivermectin (30 M), potentiated the negative chronotropic effect of ATP (100 M) in CTRL (from -31 ± 5% to -56 ± 14%; n = 5, p > 0.05) and PAH (from -12 ± 6% to -24 ± 9%; n = 4, p < 0.05). The non-selective P2XR agonist, CTP (1 mM), which contrary to ATP does not breakdown into adenosine, also decreased atrial chronotropy in CTRL (-24.31 ± 6.73%; n = 6) and PAH (-11.82 ± 1.98%; n = 6) rats.

Conclusions:

Data suggest that the negative chronotropic effect of P2X4R activation is preserved in atria of rats with heart failure associated to PAH, thus strengthening the hypothesis that heart rate reductions using this ATP-sensitive receptor may increase cardiac performance in patients with PAH-induced heart failure.
CARDIAC PROTECTION THERAPY CAN PREVENT THE ELEVATION OF CENTRAL BLOOD PRESSURE IN ADULT PATIENTS WITH CONGENITAL HEART DISEASE
Authors: Murakami Tomoaki , Horibata Yoko , Tateno Shigeru , Kawasoe Yasutaka , Niwa Koichiro
Published: June 2022

Objective:

There is no evidence of beneficial effect of cardiac protection (CP) therapy for heart failure, that is medication of renin-angiotensin system antagonists and beta blockers, in patients with congenital heart disease (CHD). However, these drugs have blood pressure (BP) lowering effect and may prevent future hypertension in CHD patients, who are high risk for hypertension. Therefore, we examine the BP lowering effect of CP in adults with CHD.

Design and method:

We enrolled 131 consecutive subjects aged > 20 years who visited the Department of Adult Congenital Heart Disease, Chiba Cardiovascular Center. The exclusion criteria were as follows: (1) a history of atrial fibrillation or frequent supra or ventricular premature beats, (2) history of cardiac operation in the past 6 months, (3) medication for hypertension, and (4) NYHA II-IV. We divided the remaining 60 patients into cardiac protection (+) and (-) and compared their brachial and central systolic BP (SBP). We defined a patient whose brachial SBP was higher than 1SD of age and sex matched control (Japanese general population) as high SBP. Moreover, we defined a patient whose central SBP was higher than 1SD of control as high central SBP.

Results:

Fifteen patients were medicated CP drugs (carvedilol 7, bisoprolol 1, enalapril 11, candesartan 2) (CP+). The mean age was 34.1 ± 13.2 years in CP- and 30.3 ± 11.4 in CP+. The brachial systolic/diastolic BP was 124.4 ± 19.7/74.6 ± 14.0 mmHg in CP- 116.7 ± 12.5/66.2 ± 12.1 mmHg in CP+. There were 14 high SBP patients in CP- and one patient in CP+ (p = 0.0535). The central SBP was 126.8 ± 21.0 mmHg in CP- and 113.2 ± 16.0 mmHg in CP+. There were 16 high central CBP patients in CP- and one patient in CP+ (p = 0.0043).

Conclusions:

The number of high central SBP in patients with CP+ was smaller than CP-. It may be obvious because the drugs used for CP have BP lowering effect. It is well known that hypertension is popular in patients with CHD. CP drugs for heart failure may prevent future cardiovascular disease in patients with CHD.
VALIDATION OF A NONINVASIVE METHOD TO ESTIMATE SUBENDOCARDIAL OXYGEN SUPPLY AND DEMAND BALANCE
Authors: Grillo Andrea , Parati Gianfranco , Salvi Lucia , Scalise Filippo , Tan Isabella , Sorropago Antonio , Sorropago Giovanni , De Censi Lorenzo , Rovina Matteo , Fabris Bruno , Moretti Francesco , Avolio Alberto , Salvi Paolo
Published: June 2022

Objective:

Evaluation of balance between subendocardial oxygen supply and demand is useful in order to assess the risk of myocardial ischemia. The subendocardial viability ratio (SEVR, also known as Buckberg index) evaluated by invasive recordings of left ventricular and aortic pressure curves represents a valid method to estimate the degree of myocardial perfusion relative to left ventricular workload. However, routine clinical use of this parameter requires a noninvasive estimation and the demonstration of its reliability.

Design and method:

Arterial applanation tonometry allows a noninvasive estimation of SEVR as the ratio of the areas directly beneath the central aortic pressure curves obtained during diastole (myocardial oxygen supply) and during systole (myocardial oxygen demand). However, this traditional method does not account for the intraventricular diastolic pressure and proper allocation to systole and diastole of left ventricular isometric contraction and relaxation, respectively, resulting in an overestimation of the SEVR values. These issues are considered in a novel method for SEVR assessment tested in this study. SEVR values were estimated with carotid tonometry by traditional and new method and compared with those evaluated invasively in 51 undergoing an cardiac catheterization for coronary angiography.

Results:

The traditional method provided significantly higher SEVR values than the reference invasive SEVR: average of differences ± SD = 44 ± 11%. The noninvasive new method showed a much better agreement with the invasive determination of SEVR: average of differences ± SD = 0 ± 8%. The new method for SEVR estimation showed a good repeatability between consecutive assessments (coefficient of variation 7.8%).

Conclusions:

A noninvasive estimation of SEVR by carotid applanation tonometry is feasible. All the main factors determining myocardial supply and demand flow should be considered in order to provide a valid estimate, in particular intraventricular diastolic pressure, left ventricular isometric contraction and relaxation.
LEFT ATRIAL RESERVOIR FUNCTION DECLINES IN HYPERTENSIVE SUBJECTS WITH DYSLIPIDEMIA
Authors: Ezhova Nadezhda , Bazdyreva Elena , Shavarova Elena , Khomova Irina , Kobalava Zhanna
Published: June 2022

Objective:

Abnormal metabolism of triglycerides and very low density lipoproteins was is involved in structural and electrical atrial remodeling as it was shown in several preclinical studies but data on such relationship with left atrium (LA) function is lacking. As far as we know, the link between LA function and dyslipidemia was never studied in hypertensive patients. We intended to compare LA reservoir function in young hypertensive subjects with or without dyslipidemia.

Design and method:

We included 87 young subjects (median of age 23 [21; 25] years, mean BMI 25,2 ± 4,5 kg/m2, median 24 hours systolic blood pressure (BP) and diastolic BP (134 [128; 145] and 79 [74,0; 87,0] mm Hg, respectively) with HTN diagnosed with 24-hours ambulatory blood pressure monitoring according to ESH guidelines criteria (2018). None of the patients was taking hypolipidemic drugs at the baseline. Patients were divided in groups according to national criteria for dyslipidemia (fasting total cholesterol > 4,9 mmol/L or low density lipoproteins (LDL) > 3,0 mmol/L or high density lipoproteins (HDL) < 1,0 mmol/L in males and < 1,2 mmol/L in females or triglycerides > 1,7 mmol/L) in which we compared left atrial longitudinal strain during reservoir phase (LASr) ratio and left atrial volume index (LAVI).

Results:

58% of patients were diagnosed with dyslipidemia. Left atrial structure and function differed in groups divided according to presence of dyslipidemia: LAVI was higher (24,7 [21,5; 28,3] vs 21,5 [17,9; 26,5] mL/m2, P = 0,045) and LASr was lower (34,9 [30,2; 40,2] vs 40,8 [33,2; 45,5] %, P = 0,017) in patients with dyslipidemia while BP levels were similar. In groups allocated according to isolated criteria for dyslipidemia LASr and LAVI did not differ except patients with or without HDL decrease. Patients with HDL deficiency had lower LASr (33,9 [28,7; 37,8] vs 39,4 [31,8; 43,8] %, P = 0,043) with similar LAVI ranges.

Conclusions:

Left atrial reservoir function is worse in hypertensive patients with dyslipidemia, in particular in those with HDL deficiency.
EFFECTS OF ACUTE NORMOBARIC HYPOXIA-INDUCED PULMONARY HYPERTENSION ON ELECTROCARDIGRAPHIC MEASURES IN POST-MYOCARDIAL INFARCTION PATIENTS
Authors: Kramer Tilmann , Hoenemann Jan , Weis Henning , Jordan Jens , Tank Jens , Rosenkranz Stephan , Baldus Stephan , Limper Ulrich
Published: June 2022

Objective:

Normobaric hypoxia induces pulmonary hypertension (PH) in healthy individuals and post-myocardial infarction (P-MI) patients. Depending on the size of the myocardial scar and the remaining left ventricular ejection fraction, P-MI patients are potentially more vulnerable to cardiac rhythm disorders than healthy individuals. Albeit of utmost importance for P-MI patients planning high altitude sojourn, data regarding effects of hypoxia on cardiac rhythm remain contradictory.

The objective was to evaluate if normobaric hypoxia-induced PH triggers electrocardiographic changes at rest and under exertion in P-MI patients.

Design and method:

At the German Aerospace Center:envihab facility, 4 non-professional male athletes (57.8 ± 3.3years) in clinically stable condition after left ventricular ST-elevation MI (3 type I and 1 type II MI, all> 1 year since event) and subsequent drug-eluting stent implantation for single-vessel coronary artery disease were exposed to normobaric hypoxia achieved by nitrogen dilution. Starting at 20.9%, oxygen content was gradually decreased to a minimum of 11.5% over a period of 19 days. Within the following 3 days hypoxia was stepwise reduced back to 20.9% oxygen. Standard 12-lead resting electrocardiogram (ECG) and transthoracic echocardiography (TTE) were performed daily. For echocardiographic detection of PH, systolic pulmonary arterial pressure (sPAP) was measured. Exercise ECG was performed under normoxia and under 17.5% oxygen.

Results:

Normobaric hypoxia with a minimum of 11.5% O2 led to elevated sPAP in TTE. Echocardiographic signs of PH were closely linked to significantly increased QTc interval using Bazett’s (from 402 ± 13 to 417 ± 25ms) and Holzmann’s (103 ± 4 to 107 ± 6%) formula compared to normoxia (all p < 0.01). In exercise ECG under hypoxia, an increased number of ventricular and supraventricular extrasystoles could be detected compared to normoxia.

Conclusions:

In clinically stable P-MI patients, exposure to normobaric hypoxia leading to PH significantly prolongs corrected QT interval and potentially triggers cardiac arrhythmias like premature beats under exertion. P-MI patients should undergo echocardiography and exercise electrocardiography in suitable facilities under hypoxic conditions prior to planned high altitude sojourn. Particularly P-MI patients with prolonged QTc interval under normoxia appear susceptible to cardiac arrhythmias due to the additional QTc interval-prolonging effect under hypoxia. Further studies are pending in this context.
DISSOCIATION BETWEEN LEFT ATRIAL AND LEFT VENTRICULAR CHANGES IN HYPERTENSIVE PATIENTS WITH ATRIAL CARDIOMYOPATHY
Authors: Shavarov Andrey , Kobalava Zhanna
Published: June 2022

Objective:

Arterial hypertension (AH) is most important cardiovascular risk factor, associated with adverse left ventricular (LV) remodeling. In according to concept of atrial cardiomyopathy (ACMP) left atrium (LA) may be a more sensitive to pressure and volume overload than LV. We tried to delineate atrial and ventricular remodeling in hypertensive patients (pts) with and without ACMP.

Design and method:

Conventional and speckle tracking echocardiography was performed on 426 hypertensive patients [mean age 63 yrs, 51% men] with LV ejection fraction > 45%. Global peak LA longitudinal strain (PALS) and strain rate (PALSR) in the reservoir © and contractile © phase were assessed. ACMP was defined as P-wave terminal force in lead V1 > 4000 V × ms and/or LA size > 4,3 sm for women and > 4,7 sm for men.

Results:

Pts with ACMP (n = 214) were significantly younger to compare with non-ACMP pts (n = 212) [60 (51; 69) vs 66 (61; 73) yrs, p < 0,001] and were less likely to have CAD [87 (41%) vs 174 (82%) pts, p < 0,001], type 2 diabetes mellitus [18 (8%) vs 47 (22%) pts, p = 0,001]. Frequency of atrial fibrillation and anamnesis of previous heart failure hospitalization did not differ between comparing groups. Pts with ACMP had significantly higher LA diameter [3,9 (3,6; 4,5) vs 3,8 (3,5; 4,0) sm, p < 0,001], LA volume index [34 (27; 42) vs 28 (22; 34) ml/m2, p < 0,001] and lower PALSr [11,7 (10,4; 14,3) vs 14,7 (11,9; 16,4) %, p = 0,003], PALSc [-12,5 (-14,9; -9,5) vs -13,9 (-15,5; -11,2) %, p = 0,04] as well as PALSRr [1,85 (1,45; 1,95) vs 2,15 (1,78; 2,31) 1/s, p = 0,01] and PALSRc [-1,75 (-2,00; -1,38) vs -1,96 (-2,20; -1,81) 1/s, p = 0,009] than non-ACMP pts. Along with that pts with ACMP had significantly lower LV end-diastolic diameter [4,8 (4,5; 5,2) vs 4,9 (4,5; 5,4) sm, p = 0,006], A [0,60 (0,53; 0,70) vs 0,62 (0,55; 0,77) m/s, p = 0,04], E/É [6,6 (5,3; 9,6) vs 7,2 (6,2; 10,5), p = 0,01] and greater LV ejection fraction [62 (58; 67) vs 58 (51; 62), p < 0,001].

Conclusions:

In hypertensive pts with ACMP more prominent LA changes were accompanied by less obvious LV abnormalities.
THE TRIGLYCERIDE- GLUCOSE INDEX: AN INDEPENDENT FACTOR OF A SUBCLINICAL LEFT VENTRICULAR DYSFUNCTION IN TREATED HYPERTENSIVE PATIENTS
Authors: Ouabdesselam Souhila , Mokhtar Omar Ait , Bendiab Nabila Taleb Soufi , Henaoui Latifa , Benkhedda Salim
Published: June 2022

Objective:

The triglyceride-glucose (TyG) index is known to be a simple surrogate marker of insulin resistance. The aim of this study was to investigate association between the TyG index and the two- dimensional longitudinal left vetricular global strain in treated hypertensive patients.

Design and method:

A total of 75 treated hypertensive patients were enrolled in this study. Anthropometric and cardiovascular risk factors were measured. The TyG index was calculated as ln[fasting triglycerides (mg/dl) × fasting glucose(mg/dl)/2]. The two- dimensional longitudinal left vetricular global strain where evaluated and express in absolute value. Others echocardiographic parameters where mesured: E/E’, left atrial volume and biological parameters: Total cholesterol, HDL cholesterol, LDL cholesterol and glomerular filtartion. Multivariable linear regression analysis was performed to identify the associations between this parameters.

Results:

Multivariable linear regression analysis showed that a higher TyG index was associated with lower global longitudinal LV strain (p = 0,04), higher body mass index (p = 0,000), higher E/E’ (p = 0,009) and lowest glomerular filtration rate (p = 0,001).

Conclusions:

A high TyG index was significantly associated with a low global longitudinal LV strain. The results suggest that the TyG index, as a simple indicator of insulin resistance, may reflect subclinical cardiac dysfunction.
LONGITUDINAL LEFT VENTRICULAR FUNCTION IN HYPERTENSIVE SUBJECTS WITH NORMAL EJECTION FRACTION: NEW INSIGHT BY SPECKLE TRACKING ECHOCARDIOGRAPHY
Authors: Hajri Samia Ernez , Messaoudi Yosra , Ernez Safia , Bouraoui Hatem , Ben Ameur Zied , Saoudi Wassim , Bouhlel Imene , Ben Abdessalem Aymen , Mahdhaoui Abdallah , Jeridi Gouider
Published: June 2022

Objective:

The aim of the current case-control study was to use speckle tracking imaging to identify subclinical longitudinal left ventricular systolic function abnormalities in hypertensive subjects with normal ejection fraction (EF).

Design and method:

Standard 2D Doppler echocardiography, tissue Doppler imaging, and 2D speckle strain imaging were performed in 50 hypertensive subjects with normal ejection fraction and 50 control subjects.

Peak systolic (S) and diastolic (E’) annular velocities were obtained by tissue Doppler imaging, whereas longitudinal myocardial strain was obtained by speckle tracking.

Results:

The two groups were comparable by age (56,4 ± 8,87 years in the hypertensives versus

55,7 ± 8,24 years in the controls, p = 0,66) and gender distribution (42% males in hypertensives vs 46% in the controls; p = 0,68). Other baseline characteristics, except for blood pressure parameters, which were predictably higher in the hypertensive subjects, were comparable between the two groups.

Among the hypertensive subjects, 28 had diastolic dysfunction.

27 hypertensives (54%) had normal geometry, 7 (14%) had excentric hypertrophy and 11(22%) had concentric hypertrophy.

LV systolic longitudinal function as assessed by systolic myocardial velocity (S) was not significantly reduced in the hypertensive group compared with controls(8,92 ± 1,46 cm/s vs. 9,15 ± 0,79 cm/s; p = 0,33).

However, global longitudinal strain (GLS) was significantly reduced compared with controls (-20,39 % ± 2,65 vs. -22,52% ± 2,3; p = 0,000). Longitudinal strain appears to be correlated with LV mass index (r = 0,293; p = 0,039), age, E/E’ ratio (R = 0,303 (IC = 0, 95 [0,023–0,506]) p = 0,032), left atrium size and duration of hypertension.

No correlation was found between GLS and systolic or diastolic blood pressure.

Conclusions:

Patients with hypertension and normal EF were demonstrated to have reduced LV systolic longitudinal function. Longitudinal strain is more sensitive than tissue Doppler imaging to assess this dysfunction.There is a significant association between age, obesity, LV mass index, impaired diastolic function and reduced LV longitudinal contractility.

Thus, LV systolic strain is early reduced during systemic hypertension and seems to be an index of global LV remodelage.
EFFECT OF AN ELECTRO-STIMULATOR DEVICE ON THE AVERAGE 24-HOUR BLOOD PRESSURE IN PATIENTS WITH MILD AND MODERATE HYPERTENSION
Authors: Youssef Ghada , Mesalm Muhammad H. , Reda Ghada , Bakhoum Sameh , Ghareeb Haytham Soliman , Ghareeb Soliman , El-Mageed Hazem Abd , Talaat Remon
Published: June 2022

Objective:

Hypertension is considered the third leading killer over the world. Non-pharmacological therapy to prevent and to manage hypertension gained more popularity worldwide. Low frequency transcutaneous electrical nervous stimulation (TENS) was found to be beneficial in decreasing systolic and diastolic blood pressures. The aim of the study was to assess the effectiveness of TENS-based device in reducing blood pressure in hypertensive patients.

Design and method:

This was a prospective interventional paired study which examined the effect of low frequency TENS device (Inferum-050) on the 24-hour ambulatory blood pressure in a cohort of 50 patients with mild and moderate hypertension (based on the European Society of Cardiology definition). The device looks like a digital watch and in the baseline visit, patients were taught to use. They were told to wear the device on the ventral aspect of the distal left forearm. turn it on and just sit and relax as the device acts automatically. Patients were instructed to use the device for 6 minutes/session, twice daily, for 14 consecutive days at home. Office and Ambulatory blood pressures were evaluated at baseline and after 14 days of device use.

Results:

The mean age of patients was 51.8 ± 15.0 years and almost half were females (n = 26, 52%). Baseline office measurements showed that 28 patients (56%) had moderate hypertension. There were statistically significant reductions of office systolic (147.9 ± 14.4 vs 159.2 ± 8.6mmHg, p < 0.001), office diastolic (88.5 ± 8 vs 96.7 ± 6.6 mmHg, p < 0.001), 24-hours ambulatory systolic (147.7 ± 14.5 vs 158.4 ± 8.2mmHg, p < 0.001) and 24-hours ambulatory diastolic blood pressures (89.1 ± 8.1 vs 95.1 ± 7.1 mmHg, p < 0.001) in follow up as compared to baseline values. Nineteen patients (38%) complained of symptoms, mostly headache and fatigue, at baseline, and most of them (n = 15, 79%) reported improvement of these symptoms at follow up.

Conclusions:

Inferum ABP-050 device could be used as a non-pharmacologic adjuvant therapy to help further reduction of blood pressure in patients with mild and moderate hypertension. Most of the symptomatic patients reported improvement of their symptoms after device use. However, further studies and larger number of patients are needed to validate these results.
THE EFFECT OF RENAL DENERVATION ON PERIPHERAL AND CEREBRAL VASOREACTIVITY IN PATIENTS WITH RESISTANT HYPERTENSION AND TYPE 2 DIABETES MELLITUS
Authors: Falkovskaya Alla , Mordovin V. , Pekarskiy S. , Manukyan M. , Zyubanova I. , Lichikaki V. , Tsoy E. , Vtorushina A. , Khunkhinova S. , Shalishev I. , Triss S.
Published: June 2022

Objective:

Vasoreactivity is fundamental mechanisms of the control of tissue perfusion, that distributes supply of blood flow according to metabolic needs and protecting the organs from changes in systemic blood pressure (BP). The presence of vascular risk factors such as hypertension (HTN) and diabetes mellitus (DM) impairs vasoreactivity, leading to an increased risk of stroke and myocardial infarction. The aim of this study was to evaluate the effect of renal denervation (RDN) on peripheral and cerebral vasoreactivity in patients with resistant HTN (RHTN) and type 2 DM at 6 month after procedure.

Design and method:

The assessment of the effect of RDN on peripheral vasoreactivity was performed in 31 patients with RHTN and type 2 DM, participants in single-arm prospective interventional studies (protocol numbers NCT02667912 and NCT01499810 at ClinicalTrials.gov) (mean age 59.1 ± 8.6 years, mean office (systolic/diastolic) BP (SBP/DBP) 167.7 ± 18.5/86.7 ± 16.6 mmHg, HbA1c 7.8 ± 1.8%, 22 (68%) men), of which cerebral vasoreactivity was evaluated in 21 patients with good visualization. All patients underwent ambulatory 24-hour BP. Flow-mediated dilation (FMD) of brachial artery and vasoreactivity of middle cerebral artery (MCA) during both breath-holding and hyperventilation testes were measured by high-resolution ultrasound at baseline and 6 month follow-up.

Results:

RDN led to a decrease in mean 24-hour BP (SBP/DBP) (from 157.5 ± 18.2/76.5 ± 9.7 to 147.8 ± 15.6/71 ± 12.8mmHg, p = 0.049/0.096) without significant changes in number of antihypertensive drugs (from 4.7 ± 0.9 to 4.5 ± 1.2, p = 0.52). There were increase in FMD (from 3.4 ± 5.5 to 7.7 ± 4.2%, p = 0.004), but vasoreactivity of MCA to hyperventilation and breath-holding test was not changed. The degree of improvement of FMD not correlated with the baseline BP and its change after RDN.

Conclusions:

According to our results, RDN in diabetic patients with RHTN improved peripheral vasoreactivity regardless of the degree of BP reduction, but did not significantly change cerebral vasoreactivity at 6 month follow up.
FEATURES OF CHANGES IN THE LEVELS OF MATRIX METALLOPROTEINASES AND THEIR INHIBITORS IN DIABETIC PATIENTS WITH RESISTANT HYPERTENSION AFTER RENAL DENERVATION
Authors: Falkovskaya Alla , Mordovin V. , Pekarskiy S. , Manukyan M. , Zyubanova I. , Lichikaki V. , Tsoy E. , Vtorushina A. , Khunkhinova S. , Gusakova A. , Moiseeva A. , Caraus A. , Tsymbalyuk E.
Published: June 2022

Objective:

The family of matrix metalloproteinases (MMPs) involved in fibrogenesis, but the effect of renal denervation (RDN) on their levels is currently insufficiently studied and highly controversial. The aim of study was to evaluate the change in MMPs and their inhibitors during 2 years after RDN in patients with resistant hypertension (RHTN) and type 2 diabetes mellitus (DM).

Design and method:

Forty three patients with RHTN and type 2 DM were included in single-arm prospective interventional studies (protocol numbers NCT01499810 and NCT02667912 on ClinicalTrials.gov) (mean age 60.6 ± 8.8 years, mean office (systolic/diastolic) blood pressure (BP) 169.7/89.1 ± 19.2/15.2mmHg, HbA1c 6.7 ± 1.4%, 17(40%) men). All patients were undergone to ambulatory 24-hour BP and assessment of lab testes (plasma concentrations of MMP-9, MMP-2, tissue inhibitor of MMP type 1 (TIMP1), TIMP-1/MMP-2 and TIMP-1/MMP-9 ratios) at baseline and at 6–12–24 months follow-up. The patients were advised not to change their medication regimen during the study.

Results:

At baseline 70%/16%/17% of patients had an elevated level of MMP-9/MMP-2/TIMP-1, respectively. At 6 months after RDN there was a significant decrease in mean 24-hour systolic/diastolic BP (SBP/DBP) (-8.8 [95%CI -1.3;-18.4]/-8.6 [95%CI -2.5;-4.7] mmHg, P < 0.05). The number of responders (patients with decrease in 24-hour SBP 10 mmHg and more) was 26 (61%). There were no significant changes in the mean levels of MMPs, TIMT1 and their ratios at 6-12-24 months follow up. At the same time, at 2 years after RDN there was a significant decrease in level of MMP-9 in responders compared with non-responders (-319.6[-2.3;-636.8] ng/mL, p = 0.04 vs 66.6 [221.4;-354.5] ng/mL, p = 0.63).

Conclusions:

Our data indicate the decrease in the MMP-9 level at 2 years after RDN only in the responders, that may be due to a decrease in the hemodynamic load and peripheral vasodilation that no longer requires the involving of proteolytic systems for an improvement in tissue blood flow.
DIAGNOSTIC PERFORMANCE OF PRE-DIALYSIS AND AMBULATORY BLOOD PRESSURE LEVELS IN MEN AND WOMEN HEMODIALYSIS PATIENTS
Authors: Karagiannidis Artemios , Theodorakopoulou Marieta , Alexandrou Maria-Eleni , Faitatzidou Danai , Baksiova Afroditi , Giamalis Panagiotis , Papagianni Aikaterini , Sarafidis Pantelis
Published: June 2022

Objective:

Ambulatory-blood-pressure (BP) control is worse in men than in women with chronic kidney disease or kidney transplantation. So far no study assessed in parallel possible effects of sex differences on the prevalence, control, and BP phenotypes according to pre-dialysis and 48-h ABPM in hemodialysis patients. Further, no study has evaluated the diagnostic accuracy of pre-dialysis BP in men and women hemodialysis patients.

Design and method:

129 male and 91 female hemodialysis patients that underwent 48-h ABPM with Mobil-O-Graph-NG were included in this analysis. Hypertension was defined as follows: (1)pre-dialysis BP greater than or equal to 140/90mmHg or use of antihypertensive agents, (2)48-h BP greater than or equal to 130/80mmHg or use of antihypertensive agents.

Results:

The prevalence of hypertension was not different between men and women with the use of pre-dialysis BP (92.2% vs 92.3%, p = 0.987, respectively) or 48-h ABPM (92.2% vs 89%, p = 0.411). With the use of pre-dialysis BP men had significantly lower control rates than women (18.5% vs 32.1%, p = 0.025); a similar pattern of worse control in men was apparent with ABPM, but the difference was not statistically significant (22.7% vs 28.4%, p = 0.360). The rate of patients with concordant lack of control by pre-dialysis and ABPM was significantly higher in men than women (65.3% vs 49.4%, p = 0.023); white-coat (14.9% vs 17.6%, p = 0.593) and masked hypertension (10.7% vs 18.8%, p = 0.101) did not differ between-groups. However, the misclassifation rate with the use of pre-dialysis BP was lower in men than women. There was moderate or at best fair agreement between pre-dialysis and ABPM with regards to the prevalence (men: kappa-statistics = 0.39, p < 0.001 and women: 0.27, p = 0.011) and control rates (kappa-statistics = 0.25, p = 0.005 and 0.17, p = 0.124, respectively). Pre-dialysis BP greater than or equal to 140/90mmHg had sensitivity/specificity of 85.9%/51.4% in men and 72.4%/54.5% in women for the diagnosis of elevated 48-h BP. Receiver-operating-curve analyses confirmed this poor diagnostic performance.

Conclusions:

The prevalence of hypertension is similar between men and women hemodialysis patients but men have worse rates of office BP control. The diagnostic accuracy of pre-dialysis BP was equally poor in men and women hemodialysis patients.
DIRECT COMPARISON OF INTERSECTING-TANGENTS VERSUS SECOND DERIVATIVE FOR DETERMINATION OF PULSE TRANSIT TIME AND PULSE WAVE VELOCITY
Authors: Tairi Amira , Obeid Hasan , Fortier Catherine , Paré Mathilde , Côté Nadège , Philibert Emy , Garneau Charles-Antoine , Duval Karine , Groupil Rémi , Agharazii Mohsen
Published: June 2022

Objective:

Arterial stiffness is a non-traditional risk factor for cardiovascular disease. Aortic stiffness is assessed by determination of pulse wave velocity using pulse transit time and the distance between carotid and femoral arteries. Transit time is obtained by using the foot-to-foot method to define the transit time through intersecting tangents algorithm or the point of maximal upstroke during systole (2nd derivative). Millasseau et al have proposed a formula for converting transit time between methods using SphygmoCor (intersecting tangents) and the Complior Analyse (2nd derivative). Based on a mathematical modeling of the proposed formula, there is discrepancy between values of pulse wave velocities, especially in subjects with higher aortic stiffness. The objective of this study is to directly compare the two methods using the same pressure waveforms obtained by the newer generation of Complior Analyse and using Millasseau’s formula.

Design and method:

In a cross-sectional study of heterogeneous subjects, aortic stiffness was assessed by the Complior Analyse device which uses 2nd derivative. The pulse waveforms were extracted and used for the analysis by custom MATLAB algorithm for intersecting tangents, and the results were compared to the formula proposed by Millasseau.

Results:

The preliminary results of the first 24 patients (men: 71%; mean age: 61 ± 18 years) show that Millasseau’s formula underestimates the transit times values by about 19% in comparison with the transit times obtained by the intersecting tangents method using MATLAB software (49,8 ± 18,8 ms vs 61,6 ± 18,6 ms; P < 0,001). This results in an overestimation of the pulse wave velocities values by about 30% (13,8 ± 3,8 m/s vs 10,6 ± 2,7 m/s; P < 0,001).

Conclusions:

Our preliminary results allow us to conclude that the values of pulse wave velocities obtained with Millasseau’s formula are overestimated values when comparing with values obtained by using the intersecting tangents method. Increasing the number of subjects will allow us to examine the possibility of a more reliable formula for converting transit times from one method to the other.
RENIN, ERYTHROPOIETIN AND VITAMIN D RELEASE FROM HUMAN DONOR KIDNEYS DURING NORMOTHERMIC MACHINE PERFUSION: PREDICTORS OF POST-TRANSPLANTATION OUTCOME?
Authors: Lin Hui , Du Zhaoyu , Bouari Dafsy , Rijkse Elsaline , Jan Danser A.H. , Minnee Robert , Hoogduijn Martin
Published: June 2022

Objective:

Normothermic (37C) machine perfusion (NMP) is a potential alternative to currently used hypothermic (4C) machine perfusion (HMP) for donor kidney preservation before transplantation. NMP allows for metabolic activity and for functional assessment of donor kidneys. The kidneys are key producers of hormones and we investigated the release of prorenin/renin, erythropoietin (EPO), and vitamin D by kidneys on machine perfusion.

Design and method:

Ten donor kidneys were subjected to HMP followed by 2 h of oxygenated NMP before transplantation. NMP perfusate was collected at three time points (0 h, 1 h, 2 h). Ten HMP perfusate samples were collected for the same measurements.

Results:

Median release rates of prorenin (196 [i.q.r 28–266] ng/hour) and renin (228 [94–302] ng/hour) in the first hour of NMP were 83- and 37-fold higher than that in HMP perfusates respectively (p = 0.0009 and p < 0.0001). Median renin release rate showed a 3.2-fold downregulation during the second hour of NMP compared to the first hour. Median EPO release rate (14 [i.q.r 8–48] mIU/min) during the first hour of NMP was 2.9-fold higher than that in HMP perfusates (p = 0.035), while it remained stable in the second hour of NMP. Active vitamin D was undetectable in HMP perfusate samples, while there was a median vitamin D secretion of 56 (i.q.r 30–83) and 28 (8–50) pmol/hour in the first and second hour of NMP respectively (p = 0.0001 and p = 0.003). We then investigated whether there were correlations between the hormone releasing capacity and donor kidney status. Prorenin release rate in the second hour of NMP was lower as cold ischemia time (CIT) until NMP of donor kidneys increased (r = -0.605; p = 0.049). EPO release showed no correlation with donor age or CIT. Donor age and vitamin D release rate during two hours of NMP are highly correlated (r = 0.652; p = 0.034). Interestingly, donation after brain death (DBD) kidneys significantly released more vitamin D than donation after circulatory death (DCD) kidneys during the first and second hour of NMP (p = 0.024 and p = 0.012).

Conclusions:

These data shows that NMP increases the hormone release capacity of transplant kidneys. Hormone release may represent a tool to assess kidney function during NMP.
UPREGULATION OF NADH/NADPH OXIDASE 4 BY ANGIOTENSIN II INDUCES PODOCYTE APOPTOSIS
Authors: Ha Tae Sun , Ha Dong Soo
Published: June 2022

Objective:

Angiotensin II induces glomerular and podocyte injury via systemic and local vasoconstrictive or non-hemodynamic effects including oxidative stress. The release of free radicals from podocytes may participate in the development of glomerular injury and proteinuria. We studied the pathophysiologic roles of oxidative stress in angiotensin II-induced podocyte apoptosis.

Design and method:

Mouse podocytes were incubated in media containing various concentrations of angiotensin II and at different incubation times and transfected by Nox4 or AT1R siRNAs or negative control scrambled siRNA for 24 h. The changes of podocyte oxidative stress and apoptosis were observed by confocal imaging, western blotting, realtime PCR, FACS and TUNEL assay according to the presence of angiotensin II.

Results:

Angiotensin II increased the generation of mitochondrial superoxide anions and reactive oxygen species levels but suppressed superoxide dismutase activity that was reversed by probucol, an antioxidant. Angiotensin II also increased NADH/NADPH oxidase 4 protein and expression in a transcriptional mechanism that was also reversed by probucol. In addition, the suppression of NADH/NADPH oxidase 4 by siRNA reduced the oxidative stress induced by angiotensin II. Furthermore, angiotensin II promoted podocyte apoptosis that was reduced significantly by probucol and NADH/NADPH oxidase 4 siRNA, and also recovered by angiotensin II type 1 receptor siRNA. In sum, angiotensin II induced podocyte oxidative stress and apoptosis through NADH/NADPH oxidase 4 and angiotensin II type 1 receptor.

Conclusions:

These findings suggest that angiotensin II promoted podocyte mitochondrial oxidative stress resulting in apoptosis via the upregulation of NADH/NADPH oxidase 4 and angiotensin II type 1 receptor and, which could be prevented by NADH/NADPH oxidase 4 inhibition and/or antagonizing angiotensin II type 1 receptor as well as antioxidants.
THE CHRONIC KIDNEY DISEASE IN AFRICA (CKD-AFRICA) COLLABORATION: A NEW PAN-AFRICAN NETWORK
Authors: George Cindy , Okpechi Ikechi G. , Woodward Mark , Kengne Andre P.
Published: June 2022

Objective:

Evidence points to an increasing prevalence of chronic kidney disease (CKD) across Africa, particularly in high-risk groups, like those with hypertension, diabetes, and HIV. However, there has not been a concerted, Africa-wide, effort to provide estimates to inform health services planning and policy development to address CKD. The CKD-Africa Collaboration seeks to fill this gap by collating data, at individual participant data (IPD) level, from African studies. The main aims of this platform are, (1) to utilize the available data from relevant prevalence studies of CKD, to provide updated and comprehensive syntheses on the burden of CKD in Africa, and (2) to link investigators in the field of CKD epidemiology and prevention, by providing a platform to plan future observational and interventional studies on CKD in Africa.

Design and method:

Establishing the CKD-Africa Collaboration followed a stepwise approach, through the identification of data sources, developing the database platform, and acquiring and processing participant-level data. Inclusion criteria: 1) observational study with primary data; 2) ethical approval; 3) minimum sample size of 300 participants and 4) participants of African descent residing in Africa.

Results:

To date, we have curated data from 42 studies conducted in 12 African countries, with a total of 37,842 participants (Fig.). The sample sizes ranges between 300 and 2,543 per study, with adults aged 18 to 100 years. In 36% of the studies data collection took place before 2010, with the remaining 64% sampled between 2010 and 2017. Overall, 74.6% of the IPD were sampled from the general population, with CKD prevalence estimates ranging from 1% to 22%. The remaining IPD were from high-risk populations, including people with hypertension, diabetes, HIV, and first-degree relatives of people with CKD. All studies used serum creatinine to estimate glomerular filtration rate, with 85.7% of these studies employing the Jaffe method. fx155

Conclusions:

This network has far-reaching potential for Africa, as it is in an ideal position to test hypotheses and compare findings across geographical and national boundaries, and to generate a new understanding of CKD progression and its complications in this under-researched context.
ASSESSMENT OF RENAL SYMPATHETIC CONTROL USING INVASIVE PRESSURE AND FLOW VELOCITY MEASUREMENTS IN HUMANS
Authors: Collard Didier , Velde Lennart Van De , Stegehuis Valérie , Delewi Ronak , Beijk Marcel , Zijlstra Ijsbrand , Winter Rob De , Vogt Liffert , Born Bert-Jan Van Den
Published: June 2022

Objective:

Renal sympathetic innervation is important in the control of renal and systemic hemodynamics and a target for pharmacological and catheter-based therapies. The effect of a physiological sympathetic stimulus using static handgrip exercise on renal hemodynamics and intraglomerular pressure in humans is unknown.

Design and method:

We recorded renal arterial pressure and flow velocity in patients with a clinical indication for coronary or peripheral angiography using a sensor-equipped guidewire during baseline, handgrip, resting, and hyperemia following intrarenal dopamine (30 ug/kg). Changes in perfusion pressure were expressed as delta mean arterial pressure, changes in flow velocity as percentage with respect to baseline. Intraglomerular pressure was estimated using a Windkessel model.

Results:

We included 18 patients with median age 57 years (range 27–85), 61% male in the final analysis. An overview of the hemodynamic responses is given in Figure 1. During static handgrip mean renal arterial pressure increased by 15.2 mmHg (range 4.2–53.0), while flow decreased by 11.2%, but with large variation between individuals (range -13.4–49.8%). Intraglomerular pressure increased with 4.2 mmHg (range -3.9–22.1). Flow velocity under resting conditions remained stable with median 100.6% (range 82.3–114.6) compared to baseline. During hyperemia, maximal flow was 180% (range 111–281), while intraglomerular pressure decreased to 33.0 mmHg [IQR 26.7–39.8]. Changes in renal pressure and flow during handgrip exercise were correlated (rho = -0.68; p = 0.002).

Conclusions:

We show that there are significant variations in the response to sympathetic stimulation following static handgrip exercise using invasive renal arterial measurements. These results demonstrate that intra-arterial renal hemodynamic measurements can be used to determine the renal effect of systemic sympathetic stimulus and allows identification of patients with higher and lower sympathetic control of renal perfusion. This may be useful in determining the response to therapeutic interventions aimed at altering renal sympathetic control.
AGING AND HYPERTENSION IN KIDNEY FUNCTION DECLINE: A 10-YEAR POPULATION-BASED STUDY
Authors: Jaques David A. , Vollenweider Peter , Bochud Murielle , Ponte Belen
Published: June 2022

Objective:

Aging is associated with a physiological decline in kidney function (KFD). In this study, we aimed to describe the impact of age on the rate of KFD and its interplay with risk factors for chronic kidney disease (CKD) in the general population.

Design and method:

Participants of European descent, aged 35 to 75, were recruited from a populational cohort in Lausanne, Switzerland. Participants with a 10-year follow-up were selected. KFD was defined as the difference in estimated glomerular filtration rate (eGFR) between baseline and follow-up, divided by the observation period. Multivariate linear regressions were used with KFD as the outcome and age as the main predictor. Hypertension (HT) was tested as a modifying factor.

Results:

We included 4’163 participants with mean age 52.2 +/- 10.4, 44.7% men, 31.9% HT and 5.0% diabetics. Mean baseline eGFR was 85.9 +/- 14.6 mL/min/1.73m2. Mean KFD was -0.49 +/- 1.08 mL/min/1.73m2 per year with 70% of participants decreasing their eGFR during follow-up. The relationship between age and KFD was non-linear and age was divided in tertiles. Old participants had faster rates of KFD as compared to young and middle-age participants (p < 0.001). A significant interaction was found between age and HT on KFD prediction (p < 0.001). In HT participants, KFD was significantly different across tertiles of age (p < 0.001). On contrary, KFD was not different across tertiles of age in non-HT participants.

Conclusions:

A physiological KFD is present over time in the general population. Age contributes non-linearly to the rate of this decline with older subjects declining the fastest. The presence of HT is a major contributing factor in this setting as KFD worsened with age only in hypertensive participants. Thus, HT represents an important pathological factor aggravating the age-related physiological decline in eGFR in the general population.