bluuebunny/crossref_metadata_2025 huggingface dataset:
A POSITIVE FAMILY HISTORY, PARTICULARLY IN THE MOTHER, IS AN IMPORTANT DETERMINANT FOR THE DEVELOPMENT OF ARTERIAL HYPERTENSION
Authors: Horvat Petra , Alagic Marieta , Andelic Ana Marija , Abramovic Inga , Ivankovic Iva , Zdilar Ana Marija , Domislovic Marija , Glavic Mihaela Marinovic , Jelakovic Bojan
Published: May 2024

Objective:

A positive family history is one of the non-modifiable risk factors directly linked to arterial hypertension (AH). This study aimed to show the influence of a positive family history of AH on the incidence of AH in the studied population.

Design and method:

A total of 1784 participants (a random sample of the general adult population in Croatia included in the ’Epidemiology of Hypertension in Croatia -2’ project) were examined. Data were systematically collected through a structured questionnaire.

Results:

Analysis showed a statistically significant difference in having a positive family history of AH in at least one parent between those having AH and the normotensive group (59.2% vs. 51.6%; p=0.002). Furthermore, 14.5% of subjects with AH and 9.4% of normotensive subjects reported at least one of the grandmothers with a history of AH (p=0.001). A significant correlation was observed for individuals reporting a positive history of AH in their paternal grandmother (p=0.004) and maternal grandfather (p=0.009), reported by 8.8% and 6.4% of subjects with AH, respectively, as opposed to 5.5% and 4.5% of the normotensive subjects. The most significant difference was found for a positive family history of AH in the mother, reported by 46.5% of subjects with AH and 38.5% of normotensive subjects (p<0.001). Regression analysis indicated a statistically significant association between a positive family history of AH in the mother and an increased odds ratio for developing AH (OR 1.36 95% CI 1.11-1.66, p=0.003). Conversely, a positive family history on either the paternal or maternal side, at least one of the grandfathers, father, and paternal grandfather failed to exhibit a significant correlation with the occurrence of AH.

Conclusions:

Our study affirmed the importance of family history for arterial hypertension, which should be an elementary part of taking medical history. Subjects who had mothers with arterial hypertension were at higher risk of having AH themselves which is in line with the previous notion that the mother's hypertensive status is more important than the father's.
DIFFERENCES BETWEEN SCORE, FRAMINGHAM RISK SCORE AND ESTIMATED PULSE WAVE VELOCITY-BASED VASCULAR AGE CALCULATION METHODS - DATA FROM THREE GENERATIONS HEALTH PROGRAM IN HUNGARY
Authors: Gyöngyösi Helga , Szollosi Gergo József , Csenteri Orsolya , Jancsó Zoltán , Móczár Csaba , Torzsa Péter , Andréka Péter , Vajer Péter , Nemcsik János
Published: May 2024

Objective:

Early vascular ageing contributes to cardiovascular (CV) morbidity and mortality. There are different possibilities to calculate vascular age including methods based on CV risk scores, but different methods might identify different subjects with early vascular ageing. We aimed to compare SCORE and Framingham Risk Score (FRS)-based vascular age calculation methods on subjects that were involved into a national screening program in Hungary. We also aimed to compare the distribution of subjects identified with early vascular ageing based on estimated pulse wave velocity (ePWV).

Design and method:

The Three Generations for Health program focuses on the development of primary health care in Hungary. One of the key elements of the program is the identification of risk factors of CV diseases. Vascular ages based on SCORE and FRS were calculated based on previous publications and were compared with chronological age and with each other in the total population and in patients with hypertension or diabetes. ePWV was calculated based on a method published previously. Supernormal, normal, and early vascular ageing were defined as <10%, 10-90% and >90% ePWV values of the participants.

Results:

99 231 subjects were involved in the study and among them 49 191 patients had hypertension (HT) and 15 921 patients had diabetes (DM). Chronological age of the total population was 54.0 (48.0 – 60-0) years, while SCORE and FRS vascular ages were 59.0 (51.0 – 66.0) and 64.0 (51-80) years, respectively. In HT patients chronological, SCORE and FRS vascular ages were 57.0 (51.0 – 62.0), 63.0 (56.0 – 68.0) and 79.0 (64.0 – 80.0) years, respectively. In DM patients chronological, SCORE and FRS vascular ages were 58.0 (52.0 – 62.0), 63.0 (56.0 – 68.0) and 80.0 (76.0 – 80.0) years, respectively. Based on ePWV, FRS identified patients with elevated vascular age with high sensitivity (97.3%), while in case of SCORE, the sensitivity was much lower (13.3%).

Conclusions:

In conclusion, different vascular age calculation methods can provide different vascular age results in a population-based cohort. The importance of this finding for the implementation into CV preventive strategies requires further studies.
THE EFFECT OF THE PRESENCE OF ACCESSORY RENAL ARTERIES ON BIOCHEMICAL PARAMETERS OF RENAL FUNCTION AND BLOOD PRESSURE REGULATION
Authors: Delalic Didi , Jug Juraj , Brezni Tanja , Prkacin Ingrid
Published: May 2024

Objective:

The effect of having accessory renal arteries on hemodynamics and renal function has been studied in different populations, yielding variable results – from a significant correlation between the presence of accessory renal arteries and increased arterial blood pressure and/or serum creatinine and renin to no correlation whatsoever. The aim of this study was to evaluate the effects of the presence of accessory renal arteries on biochemical parameters related to renal function and hemodynamics in a Croatian population.

Design and method:

This was a retrospective single-center study. Data was collected from the hospital informatics system on patients with accessory renal arteries managed in the arterial hypertension clinic of a tertiary care center. Patient data obtained between 2012 and 2023 was included. In order to be included into the study, patients needed to have available data on laboratory parameters, hemodynamics and an image of a multi-slice computed tomography intravenous contrast-enhanced scan of the aorta and renal arteries. Patients without all of the aforementioned data were excluded from the study. Data was analyzed using the JASP open-source statistical software. Statistical significance was set at a threshold of p < 0.05.

Results:

155 patients in total were included in the study – 80 without accessory renal arteries and 75 with one or more accessory renal arteries. The distribution of age and gender was equivalent between the two groups. The group with accessory renal arteries had significantly higher mean arterial pressures (100 mmHg vs 95.7 mmHg, p = 0.016), lower estimated glomerular filtration rates calculated by CKD-EPI 2021 formulas (80 mL/min/1.73m2 vs 96 mL/min/1.73m2, p < 0.001) and had a significantly higher number of antihypertensive medications in their therapy (3 vs 1.5 different types of medications, p < 0.001). There were no significant differences between other measured parameters (serum electrolytes, renin, aldosterone, aldosterone/renin ratio).

Conclusions:

The results of this study indicate that the presence of accessory renal arteries might have an effect on the success of antihypertensive therapy and that these patients may represent a distinct phenotypic group that requires a personalized approach.
POLYCYSTIC OVARY SYNDROME (PCOS) AND ITS TREATMENT AS CAUSE OF SECONDARY ALDOSTERONISM: A DOG CHASING ITS TAIL
Authors: Cozzo Domenico , Ferrier Claudia , Ogna Valentina Forni
Published: May 2024

Objective:

Polycystic Ovary Syndrome (PCOS) is a complex endocrine-metabolic disorder affecting about 7% of childbearing women. PCOS is characterized by anovulation, hyperandrogenism, insulin resistance and it is associated with an increased cardiovascular risk.

PCOS patients may exhibit high blood pressure and signs of hydro-saline retention. Therefore, clinicians would be interested in performing hormonal screening for secondary hypertension.

Design and method:

We perform the aldosterone/direct renin concentration ratio as a screening test for primary aldosteronism (PA). The test was proceed after serum potassium correction and previous a wash-out period of interfering medications.

The recumbent saline suppression test was performed with infusion of 2L NaCl 0.9% in 4 hours under standardized salt intake (9gr/24h).

Aldosterone and direct renin were determined by chemiluminescent immunoassay technology (DiaSorin®).

Results:

A 33yrs old woman attended our renal outpatient clinic because of recurrent episodes of generalized swelling, diuresis contraction and fluid retention. The patient, known for PCOS, was treated with combined oral contraceptives and loop diuretics. She had no history of hypertension, but she repeatedly displayed very high aldosterone values.

Clinical examination was unremarkable, in-office and home blood pressure values were normal. Laboratory data showed normal renal function and the absence of acid-base disorders; serum potassium was at lower limit of normal. A CT-scan showed normal adrenal glands.

We performed a recumbent saline suppression test, previous a wash-out period of oral contraceptives (> 6 weeks) and loop diuretics (> 2 weeks).

The results listed below are consistent with a baseline hyperaldosteronism with normal aldosterone adrenal response to volume expansion, excluding PA.

Several years before, the same results were presented, without suspension of the oral contraceptives.

Conclusions:

In patients with PCOS the increased adrenal production of aldosterone is usually secondary and independent from the renin-aldosterone axis (direct stimulation of adrenal zona glomerulosa via testosterone).

Other iatrogenic factors may affect the renin-aldosterone values, such us the use of oral contraceptives and diuretics.

Therefore, a confirmatory test performed under standardized conditions is often required, in order to exclude primary versus secondary forms of hyperaldosteronism.
ASSESSMENT OF ANGIOTENSIN II-INDUCED CALCIUM SIGNALS IN PRIMARY HUMAN ADRENOCORTICAL CELLS
Authors: Ajjour Hala , Lenzini Livia , Pallafacchina Giorgia , Carrocia Brasilina , Rosii Gian Paolo
Published: May 2024

Objective:

Primary aldosteronism (PA), a common form of secondary hypertension, is characterized by an increase of cytosolic intracellular Ca2+ concentrations [Ca2+]i.

Our aim is to investigate transients and oscillations of [Ca2+]i in a human model of isolated CD56+ aldosterone-producing adenoma (APA) cells and normal surrounding adrenocortical (NAC) cells.

Design and method:

We monitored [Ca2+]i, in CD56+ NAC and APA cells in basal condition and after Angiotensin II (Ang II) stimulation using Fura-2 dye and live confocal microscopy, and we developed a custom-made pipeline to analyze calcium signals in terms of frequency and peak parameters like amplitude, full width at half maximum (FWHM) and area under the curve (AUC). To investigate the potential role of the two-pore domain K+ TASK- 2 channel in regulating Ca2+ signals, TASK-2 channels of NAC cells were pharmacologically inhibited using Quinidine (20 microM) 20’ prior to [Ca2+]i imaging acquisition.

Results:

Resting [Ca2+]i basal levels in NAC (n=11) were higher (0.76 a.u.+- 0.04) than in APA (n=12) (0.56 a.u.+- 0.05, p= 0.0087). NAC TASK-2 inhibition decreased resting [Ca2+]i to 0.58 a.u. +- 0.07 (p > 0.05). Spontaneous Ca2+ activity was higher in NAC with significant higher amplitude and AUC parameters compared to APA cells. Quinidine further increased spontaneous activity in NAC while decreased Amplitude and AUC. For both cell types stimulation with 2 doses of Ang II concentrations [10 -8 and 10 -9 mM], higher Ang II doses promoted higher Ca2+ peak parameters, amplitude and AUC, and a significant decrease in events frequency. Comparison between APA and NAC revealed that, regardless of Ang II dose, first Ca2+ transient parameters are intensified in NAC. However, APA showed consistent elevated subsequent Ca2+ oscillations parameters (Amplitude and AUC), frequency, and degree of oscillation compared to NAC cells stimulated with similar Ang II doses. NAC TASK-2 inhibited cells, when stimulated with [10 -9 mM] Ang II, displayed only increased subsequent peak parameters.

Conclusions:

The bias-free approach designed to quantitatively assess [Ca2+]i signals, revealed significant differences in [Ca2+]i dynamics of human NAC and APA cells.
RISK OF MAJOR ADVERSE CARDIAC EVENTS IN HYPERTENSIVE PATIENTS WITH OBSTRUCTIVE SLEEP APNEA AND METABOLIC SYNDROME: RESULTS OF A LONGITUDINAL COHORT STUDY
Authors: Abulimiti Ayinigeer , Luo Qin , Heizhati Mulalibieke , Li Nanfang
Published: May 2024

Objective:

Obstructive sleep apnea (OSA) and metabolic syndrome (MS) may act synergistically and possibly accelerate the initiation and progression of cardiovascular events disease. We examined the joint effect of OSA and MS on the risk of major adverse cardiovascular events (MACE) in hypertensives in a Longitudinal cohort study.

Design and method:

We conducted a retrospective cohort study enrolling 3134 participants, no history of myocardial infarction (MI), coronary revascularization, unstable angina, and hospitalization for heart failure at baseline, from the Urumqi Research on Sleep Apnea and Hypertension study. An apnoea-hypopnoea index (AHI) of greater than or equal to 5 events per hour recorded by PSG was defined as the diagnostic criterion for OSA. MS was defined using the updated National Cholesterol Education Program Adult Treatment Panel III criteria (ATP III). The outcome was the composite of MACE, which included cardiac death, MI, coronary revascularization, unstable angina and hospitalization for heart failure. We divided participants into four groups for the primary exposure according to the presence/absence of OSA or MS. The Kaplan-Meier method helped to calculate the cumulative incidence of MACE in different groups. Cox proportional hazards regression models were used to evaluate the association of OSA and/or MS with the risk of MACE.

Results:

During a median follow-up period of 7.06 years (interquartile range: 6.18-8.08 years), 190 incident MACE were identified. Overall, after adjusting for confounding variables, participants with OSA and MS were associated with a 2.51-fold and 1.60-fold increased risk of MACE with corresponding HRs (95% CI) of 2.51 (1.01, 6.21) and 1.60 (1.10, 2.31), compared with participants without OSA and MS, and participants with OSA or MS, respectively. Similar results were obtained in various subgroup and sensitivity analyses.

The combination of OSA and MS was associated with the highest risk of MACE among participants who in younger age, and have shorter duration of hypertension. Sensitivity analyses further validated our primary findings.

Conclusions:

Combination of OSA and MS in hypertension could significantly increase the risk of MACE, suggesting that recognition and treatment of OSA and MS may decrease the cardiovascular risk in hypertensives.
ACUTE EFFECTS OF SODIUM CHLORIDE OR ITS SUBSTITUTE POTASSIUM CHLORIDE ON VASCULAR FUNCTION IN HEALTHY VOLUNTEERS
Authors: Rammo Randa , Stock-schröer Annika Marie , Kantauskaite Marta , Rump Lars Christian , Streese Lukas , Stegbauer Johannes
Published: May 2024

Objective:

High blood pressure, one of the most important risk factors for cardiovascular mortality, leads to vascular dysfunction and subsequently to arteriosclerosis, stroke, kidney and heart failure. High salt intake and low potassium intake are associated with high blood pressure and an increased risk of cardiovascular disease and mortality. Partial replacement of sodium with potassium led to a lower risk of cardiovascular events and death in a long-term follow-up study. However, the exact mechanism remains unclear. Our aim was to investigate the acute effects of sodium or potassium intake on vascular health to unravel the underlying mechanisms leading to vascular adaptations.

Design and method:

Six male and nine female healthy individuals (mean age 31 years) were randomized to either 9g of sodium chloride (high salt group), 6g of sodium chloride (regular salt group) or 6 g of sodium chloride plus 3g of potassium chloride group (substitution group). Individuals received a salty soup with the corresponding sodium or potassium load. Blood analyses, blood pressure, body composition and macro- as well as microvascular measurements were performed before as well as four (t4) and 24 hours (t24) after soup intake. To investigate macrovascular health, carotid-to-femoral pulse wave velocity was analyzed. Microvascular health was measured by investigating retinal vessel diameters.

Results:

The high (139±2mmol/l vs. 143±2mmol/l p=0,003) and regular salt group (140±2mmol/l vs. 141±0,6 mmol/l p=0,029) showed both higher serum sodium concentrations at t4 compared to baseline. These higher values were normalized at t24. The serum sodium concentration of the substitution group showed no statistically significant difference between timepoints. The substitution group showed improved microvascular health, quantified by higher arteriolar-to-venular diameter ratio from baseline to t4 (0,86±0,09 vs. 0,89±0,08 p=0,005). These improvements were regressive at t24 (0,88±0,09). No statistically significant changes were found on pulse wave velocity. The high and regular salt group showed no statistically significant differences at any timepoint on micro- or macrovascular health parameters.

Conclusions:

Replacement of sodium by potassium seems to improve microvascular function directly after potassium intake. These results might explain the long-term beneficial effects of potassium on cardiovascular outcomes.
ROLE OF CAROTID ULTRASONOGRAPHY IN RECLASSIFYING TOTAL CARDIOVASCULAR RISK
Authors: Stathopoulou Panagiota , Komnianou Aikaterini , Menti Ariadni , Kyriakoulis Konstantinos , Stergiou George , Kollias Anastasios
Published: May 2024

Objective:

The estimation of total cardiovascular risk (CVR) is essential for optimal treatment decisions including drug treatment initiation and treatment goals. The aim of this study was to evaluate the contribution of ultrasonographic identification of asymptomatic carotid atherosclerosis in the reclassification of the CVR compared to the reference Systematic COronary Risk Evaluation 2 (SCORE2) algorithm.

Design and method:

Individuals aged 40-69 years, without established cardiovascular disease or diabetes and at least 1 CVR factor (hypertension, hyperlipidemia, smoking) were assessed by blood pressure (BP) measurements, blood tests and carotid ultrasonography. According to SCORE2 they were classified into 3 CVR categories: (i) low-moderate, (ii) high, and (iii) very high CVR. According to carotid ultrasonography they were classified into 3 CVR categories: (a) no plaque: low-moderate CVR, (b) plaque(s) with <50% stenosis: high CVR, (c) plaque(s) with >= 50% stenosis: very high CVR.

Results:

140 participants were analyzed (age 57±7 years, male 49%, smokers 24%, treated for dyslipidemia 37%, treated for hypertension 51%, body mass index 28±5 kg/m2, systolic BP 127±14 mmHg, LDL-cholesterol 121±35 mg/dl). Based on SCORE2 the CVR of the participants was categorized as low-moderate 41%, high 50%, and very high 9%, while based on carotid ultrasonography the respective percentages were 33%, 65%, and 2%. 48% of the individuals (53% of men; 45% of women), identified as low-moderate CVR based on SCORE2 were reclassified into a higher risk category by carotid ultrasonography. On the contrary, 23% the individuals (28% of men; 15% of women) categorized as high CVR by SCORE2 were reclassified as low-moderate CVR by carotid ultrasonography. The agreement between the two methods for the 3 CVR categories was 70% for low-moderate CVR (kappa 0.33, P<0.001), 59% for high CVR (kappa 0.18, P=0.03), 90% for very high CVR (kappa 0.09, P=NS). Among 94 individuals classified as high or very high CVR based on carotid ultrasonography, only 4 had LDL-cholesterol <70 mg/dl.

Conclusions:

These preliminary findings suggest that carotid ultrasonography appears to have considerable reclassification value for CVR estimation in middle aged individuals with important implications in optimizing treatment.
PERIPHERAL ARTERIAL STIFFNESS PREDICTS INDEPENDENTLY FUNCTIONAL OUTCOME AFTER ISCHEMIC STROKE
Authors: Kaminski Krzysztof , Kowalczyk Kamil , Kwarciany Mariusz , Narkiewicz Krzysztof , Karaszewski Bartosz , Gasecki Dariusz
Published: May 2024

Objective:

Aortic stiffness is a strong predictor of morbidity in various clinical conditions, including ischemic stroke. However, the prognostic significance of the peripheral arterial stiffness, defined as radial -carotid pulse wave velocity - for functional outcome in ischemic stroke remains unknown.

Design and method:

We enrolled 189 patients (126 males, age 62.9±11.9 years, mean±SD) with acute ischemic stroke (NIHSS score at admission 6.4±5.1 points). Radial-carotid pulse wave velocity (CR PWV), peripheral blood pressure (BP) and heart rate (HR) were measured (SphygmoCor®) within several (6±2) days after stroke onset. Functional outcome was evaluated 90 days after stroke using the modified Rankin Scale (mRS) with an mRS score of 0 to 1 considered as an excellent outcome.

Results:

In univariate analysis, age, severity of stroke, heart rate, previous stroke, predicted stroke functional outcome. By contrast, CR PWV had no significant predictive value for stroke outcome (8.91±1.66 vs 8.56±1.50 m/s; p=0.14). In a multivariate analysis, the predictive value of CR PWV was significantly associated with functional outcome (OR, 1.34; 95% CI, 1.77–1.01; p=0.04) after adjustment for covariates, with higher values of CR PWV being associated with better prognosis.

Conclusions:

We found that the CR PWV in patients in the subacute phase of ischemic stroke is associated with functional outcome independently of traditional neurologic and hemodynamic factors. This PWV index might be useful in clinical practice, including therapeutic decisions, but needs broader studies in patient populations of stroke subtypes.
THE IMPACT OF WINTER SWIMMING ON FUNCTIONAL MICROVASCULAR CHANGES
Authors: Kaczmarczyk Karolina , Matuszewska Urszula , Sajdak Wojciech , Dabrowska Edyta , Michnowska Aleksandra , Hellmann Marcin , Wolf Jacek , Narkiewicz Krzysztof , Dabrowska-kugacka Alicja , Lasocka Zofia
Published: May 2024

Objective:

Microcirculation plays an important role in the development of cardiovascular control. Therefore, the aim of our study was to investigate the impact of winter swimming on functional changes in cutaneous microcirculation Flow-mediated skin fluorescence (FMSF) is a novel and non-invasive technique assessing microvascular function based on the measurements of nicotinamide adenine dinucleotide hydrogen (NADH) fluorescence intensity in the epidermis and post occlusive reactive hyperemia test. NADH intensity changes in response to blockage and release of blood flow in the brachial artery, which corresponds to microvascular function.

Design and method:

FMSF examinations were performed before and after the winter swimming period lasting from November 2022 to April 2023 in 37 subjects (mean age 46±4,0 years, 65% women). The mean frequency of winter swimming activity was 1,3 times per week. We analysed the following variables: the ischemic response (IRmax and IRindex) – the ratio of relative to baseline maximal increase in fluorescence intensity during cuff occlusion and the hyperaemic response after cuff release (HRmax and HRindex). Flowmotion, measured at baseline (FM) and at reperfusion (FM(R)), reflects flow oscillations. Normoxia oscillatory index (NOI) represents the proportion of endothelial and neurogenic blood flow oscillations in relation to all oscillations detected in low frequency range. The hypoxia sensitivity (HS), measured during reperfusion, reflects the intensity of flowmotion related to myogenic oscillations.

Results:

The statistical analysis revealed following results according to the winter swimming:

Conclusions:

Increase in microvascular oscillations denoted by NOI and HS suggests a beneficial impact of winter swimming on cutaneous microcirculation. Improvement in microcirculation performance may partly explain lowering of cardiovascular risk in regular winter swimmers.
ORTHOSTATIC RESPONSE OF PERIPHERAL AND CENTRAL BLOOD PRESSURE IN PATIENTS WITH HYPERTENSION AND ATHEROSCLEROTIC CAROTID STENOSIS
Authors: Ionov Mikhail , Gurevich Alexandra , Sagynbaeva Ay -Churek , Emelyanov Igor , Vanyurkin Almaz , Rotar Oxana , Boyarinova Maria , Moguchaia Ekaterina , Kolesova Ekaterina , Chernyavskiy Mikhail , Konradi Alexandra
Published: May 2024

Objective:

To determine the frequency and severity of orthostatic responses of central and peripheral blood pressure (BP) during the Active Stand Test (AST) in patients with arterial hypertension (HTN) and hemodynamically significant stenosis of the internal carotid artery (ICA).

Design and method:

The intervention group included patients aged 18 years and older with HTN and ICA stenosis >50% (NASCET) of atherosclerotic origin. Patients with HTN without ICA lesions were considered as controls. In all patients AST was performed with the measurement of peripheral BP in the sitting and standing positions after 3 minutes. Orthostatic hypotension (OH) was diagnosed as per current Guidelines: fall of systolic (S)BP equal or more than 20 mmHg or diastolic BP equal or more than 10 mmHg during AST. In the intervention group, central BP assessment during AST and pulse wave contour analysis were also performed.

Results:

There were 77 patients in the intervention group (69±8 years, 44 men) and 77 patients in the control group (68±6 years, 43 men). According to the dynamics of peripheral BP, OH was diagnosed in 21 patients (27%) in the intervention group and in 17 patients (22%) in the control group (p=0,46), but systolic OH was more frequently observed in the former (21 vs. 9 patients; p=0.015). The reduction in central systolic (S)BP was more pronounced than delta peripheral SBP (p =0.001). Changes in peripheral SBP during AST were associated with the presence of a significant ICA lesion (beta in ICA =0.201, p=0.03) and baseline SBP (beta= -0.348, p=0.001). The same variables (the fact of ICA lesion and baseline SBP) mostly explained the development of systolic OH (OR 2.95 (95% CI [1.1-7.7], p=0.03 and beta= 0.437, p<0.001, respectively).

Conclusions:

Asymptomatic OH occurred in 27% of patients with HTN and ICA stenosis, more frequently in the form of isolated systolic OH. The amplitude of central SBP reduction significantly exceeded the dynamics of peripheral SBP The presence of carotid stenosis and higher initial values of peripheral SBP associated with the dynamics of SBP in standing and the occurrence of OH.
HIGH SALT DIET EFFECTS ON CEREBRAL AND SYSTEM HEMODYNAMICS IN RESPONSE TO BREATH HOLDING TEST AND HYPERVENTILATION
Authors: Drenjancevic Ines , Dumancic Dijana , Stupin Ana , Goswami Nandu , Debeljak Zeljko
Published: May 2024

Objective:

High salt (HS) diet impairs endothelium-dependent vasodilation in many vascular beds, including cerebral microcirculation, and may affect vascular resistance. The aim of present study was to determine if 7-day HS diet affected cerebral and system hemodynamics in response to breath holding test (BHT) and hyperventilation in healthy young persons.

Design and method:

In this controlled intervention study 27 persons participated (F:21, M:6, age range 19-24). Participants consumed 7-day low salt (LS) diet (<2.3g NaCl/day) and afterwards 7-day of HS diet (>11.2g NaCl/day). Blood and urine analysis and anthropometric measurements were performed after each diet. Arterial blood pressure, heart rate and heart rate variability (HRV), cerebral and systemic hemodynamic parameters were recorded simultaneously with transcranial Doppler ultrasound and the Task Force® Monitor in response to BHT and hyperventilation.

Results:

The subjects remained normotensive during both protocols. After hyperventilation test, HS diet did not affect parameters of cerebral or systemic hemodynamics. HRV was more decreased after HS diet, while baroreceptor sensitivity (BRS) decreased in both LS and HS diet. Similar lack of effects of HS diet on cerebral and system hemodynamics was observed in BHT. Urine concentration of noradrenaline and vanillylmandelic acid was significantly decreased by HS diet.

Conclusions:

Results suggest that HS diet suppresses sympathetic activity. However, physiological hemodynamic responses to BHT and hyperventilation are preserved, which could be contributed to salt-resistant phenotype of participants and some, still unexplained (chemoreceptors-mediated) compensatory mechanisms preserving cerebral and systemic blood flow.
CLINICAL DETERMINANTS OF THE MACROVASCULAR REACTIVITY RESPONSE AS ASSESSED BY FLOW MEDIATED SLOWING IN PEOPLE AT RISK FOR CARDIOVASCULAR DISEASE
Authors: Decorte Elise , Cauwenberghs Nicholas , Claes Jomme , De Wilde Camille , Michielsen Matthijs , Bekhuis Youri , Hansen Dominique , Van Craenenbroeck Emeline , Goetschalckx Kaatje , Claessen Guido , Kutznetsova Tatiana , De Smedt Delphine , Cornelissen Véronique
Published: May 2024

Objective:

Non-invasive methods assessing endothelial function may enhance cardiovascular risk evaluation in primary care. Previous research showed that flow-mediated slowing (FMS) of the brachial-radial pulse wave velocity (PWV) reflects cardiovascular risk, but larger studies on the FMS response in at-risk populations are required to further unravel its clinical and added value for cardiovascular risk stratification. We investigated clinical correlates on the FMS response in people at risk for cardiovascular disease.

Design and method:

We collected baseline FMS data from a subsample of 157 participants enrolled in the PRIORITY-trial. Participants had at least one of following risk factors: systolic blood pressure (BP) / diastolic BP between 130/80 – 159/99mmHg and/or antihypertensive treatment, prediabetes with fasting plasma glucose of 5.6-6.9mmol/L or HbA1c 5.7%-6.4%, diabetes mellitus, obesity (BMI > 30kg/m2), or evidence of subclinical diastolic dysfunction.

We continuously recorded brachial-radial PWV using a Vicorder in supine position at rest and after 5-minutes of supra-systolic occlusion of the upper arm. Stepwise linear regression analyses assessed clinical correlates of the FMS response. We illustrated the effect of important correlates on the FMS response by plotting the estimated marginal means for each FMS post-occlusion interval by the mean and one standard deviation.

Results:

The study sample was on average 60.2±11.2 years and included 74 women(47.1%). Until 180 seconds post-occlusion, lower FMS response was significantly associated with higher DBP and higher triglycerides levels (P<0.05 for 0-180s intervals). Higher age only correlated with less decline in brachial-radial PWV in the 60 to 90 seconds post-occlusion interval (P=0.050). Participants with elevated triglycerides or elevated DBP or both exhibited significantly less decline in brachial-radial PWV as compared to those with average or below average levels (Figure1).

Conclusions:

In individuals at increased risk for cardiovascular disease, worse macrovascular reactivity was associated with hypertriglyceridemia and high DBP. Our findings suggest that the use of FMS may have clinical value for cardiovascular risk evaluation and highlight the importance of optimal control of triglycerides and DBP for adequate cardiovascular risk management. More studies are needed for assessing the additive value of such testing for cardiovascular disease prediction and management.
IMPACT OF ENDOVASCULAR ABDOMINAL AORTIC ANEURYSM REPAIR ON VENTRICULO-ARTERIAL PERFORMANCE AND LEFT ATRIAL FUNCTION: COMPARATIVE PILOT STUDY
Authors: Dadanski Emil , Olszanecka Agnieszka , Zydzik Lukasz , Stopa Marek , Bochenek Michal , Kolodziejski Marcin , Krawczyk Kacper , Piwowarczyk Marek , Rajzer Marek
Published: May 2024

Objective:

Ventriculo-arterial (VA) coupling characterizes the interaction between myocardial contractile function and the load opposed by the arterial circulation. Clinically, measurable indicators allowing for non-invasive cardiovascular performance assessment include pulse wave velocity (PWV), left ventricular (GLS) and left atrial strain (LA strain). Endovascular repair of the aortic aneurysm is related with changes in arterial properties, yet the impact of these changes on left ventricular and atrial function remains unclear.

Aim: This study aimed to compare selected parameters of cardiovascular performance between individuals post-endovascular abdominal aortic aneurysm repair and age- and sex-matched group of hypertensive individuals without aortic aneurysm.

Design and method:

The study group comprised 36 patients who underwent endovascular stent grafting of the abdominal aorta (mean time from surgery 21,8±8,9 months). Control group included 43 hypertensives matched for age, sex and BMI. In all subjects structured echocardiographic examination was performed, including evaluation of LA strain, left ventricular ejection fraction (EF) and GLS.

Carotid-femoral PWV using SphygmoCor device was measured in all participants. Statistical analysis was conducted using SPSS statistics software.

Results:

The study and control groups did not differ in age (68,9±8,7 vs 67,6±6,6 years; p >0.05), sex (M/F: 32/4 vs 38/5; p>0.05) or BMI (28,9±4,9 vs 29,7 kg/m2; p>;0.05). The study group exhibited significantly higher PWV compared to controls (10,02±1,98 vs 8.99±1,08 m/s; p<0.05).

Furthermore, in the study group lower left ventricular ejection fraction (54,7±9,2 vs 59,0± 5,72%; p<0,01), lower absolute values of LV GLS (16,3±2,5 vs 19,0±3,2%, p=0,05) and lower LA strain (23,5±6,2 vs 29,5±10,8%; p<0.01) were observed.

Conclusions:

This pilot study suggests that changes in arterial stiffness related to endovascular aortic aneurysm repair are associated with worse left ventricular systolic function and left atrial performance. Elucidating their etiology and dynamics necessitates further investigation through prospective studies that account for confounding factors, such as other risk factors that may influence the outcomes of the assessed parameters.
CLUSTER ANALYSIS OF PULSE WAVE VELOCITY LONGITUDINAL TRENDS IN HYPERTENSIVE PATIENTS
Authors: Eula Elisabetta , Cesareo Marco , Pappaccogli Marco , Veglio Franco , Bruno Rosa Maria , Milan Alberto , Rabbia Franco
Published: May 2024

Objective:

Arterial stiffness (AS) is an important predictor of cardiovascular disease and mortality. Its trend over time, assessed through multiple measurements, is still largely unexplored. The aim of this study was to assess the determinants of trajectories of carotid-femoral pulse wave velocity (PWV) in a cohort of Italian hypertensive adults.

Design and method:

From a population of 2581 hypertensive patients referred to Hypertension Unit of Internal Medicine Division at University Hospital Città della Salute e della Scienza of Turin (Italy) from 2005 to 2023, those who had at least 3 PWV recordings over time were included in this study. Those with rare vascular diseases were excluded. Cluster analysis of PWV trajectories was performed using K-means method.

Results:

A total of 271 patients were included. Median follow-up time was 4.5 [0.6-8.4] years). Three clusters of PWV trends were identified: low-stable (A, n=126), high-increasing (B, n=107), and high-stable (C, n= 38) clusters. Patients in the clusters B and C were progressively older than those in cluster A (60.4±8.9 and 65.8±10.3 vs. 51.9±13.3 years, respectively). Mean BP (MBP) and PWV at baseline were progressively higher in the high-increasing and high-stable clusters compared to the low-stable one (MBP was 103±15 and 111±22 mmHg in clusters B, and C vs. 97±11mmHg in cluster A; PWV was 10.1±0.7 and 13.6±1.4 m/s in clusters B, and C vs. 7.8±0.9 m/s in cluster A; all p<0.001). There were no significant differences in sex distribution or anti-hypertensive treatment among the clusters.

On multinomial regression analysis, older age and higher MBP at baseline were independently associated to increased probability of belonging to either B or C clusters when compared to the low-stable one.

Conclusions:

Through multiple PWV assessment in hypertensive patients during a large time span, this study shows that patients with less favorable arterial stiffness behavior present higher PWV values at baseline. Older age and higher MBP at baseline are associated with worse evolution of PWV over time.
KLOTHO GENE VARIANTS (RS9536314) CORRELATES WITH DEVELOPMENT OF HYPERTENSIVE DISORDERS OF PREGNANCY AND HIGHER RATE OF MISCARRIAGE
Authors: Tunesi Francesca , Simonini Marco , Gerosa Camilla , Smid Maddalena , Citterio Lorena , Zagato Laura , Candiani Massimo , Vezzoli Giuseppe , Manunta Paolo , Lanzani Chiara Livia
Published: May 2024

Objective:

Hypertensive disorders of pregnancy (HDP) are one of the leading causes of maternal and fetal morbidity and mortality worldwide. The incidence of HDP ranges from 4 to 25%. HDP are classified into four types: preeclampsia (PE), gestational hypertension (GH), superimposed preeclampsia, and chronic hypertension (CH). The gene Klotho (KL) is involved in several biological processes in the pathophysiology of HDP, including angiogenesis, the synthesis of antioxidant enzymes, endothelial nitric oxide generation, and endothelial dysfunction prevention. This study aims to evaluate the relationship between the incidence of HDP and the KL rs9536314 polymorphism, already associated with hypertension.

Design and method:

Most of the patients were enrolled during pregnancy in the outpatient clinic for HDP at San Raffaele Hospital; the remaining were enrolled it the outpatient clinic for hypertension at San Raffaele Hospital. A total of 142 patients were recruited: 19 PE (13.4%), 26 CH (18.3%), 39 GH (27.5%) and 58 controls (40.8%). Anamnestic interview was conducted to all of them. All patients signed informed consent and samples were taken for genotyping.

Results:

Caesarean section was more frequent in pathological pregnancy (p<0.001). Also, medically assisted procreation is more frequent in them (p<0.001). In normal pregnancies woman have a later delivery date (p<0.001). History of CH was more frequent in women with HDP than in those without (p< 0.001). KL variant with the minor allele (GG) is more prevalent in patients with normal pregnancy (p=0.01), even after adjusting for primary clinical factors like method and age of conception and mode of delivery. The same SNP also proved to be less correlated with the presence of a history of multiple miscarriage (p=0.04), which instead was positively correlated with the concomitant presence of autoimmune pathologies.

Conclusions:

The study therefore highlighted the role of the rs9536314 polymorphism of the KL gene in HDP. It suggests an association of the TT allelic variant with both the development of the hypertensive disorders of pregnancy and with the history of miscarriage. More data are needed to confirm this evidence and the potential role of Klotho protein in hypertensive disorders of pregnancy.
CLINICAL, LABORATORY AND ECHOCARDIOGRAPHIC VARIABLES ASSOCIATED WITH UNCONTROLLED RESISTANT HYPERTENSION IN WOMEN
Authors: Stevanovic Angelina , Dwklwva Milica , Smiljic Sonja , Popovic Biljana Pencic
Published: May 2024

Objective:

High blood pressure is the most deadly risk factor for women worldwide. Resistant hypertension (RH) is defined as office and ambulatory blood pressure (BP) requiring 4 or more antihypertensive medications, whether controlled or uncontrolled. Women are at greater risk of developing resistant hypertension than men.

Design and method:

1119 resistant hypertensive patients diagnosed by ambulatory BP monitoring as true RH patients were divided into two groups: controlled RH (CRH) group, n = 489 and uncontrolled RH (URH), n = 630.

The body mass index (BMI) was calculated and all patients were evaluated for nonmodifiable risk faktors, which included age and sex, and modifiable risc factors and concomitant diseases, such as smoking, use of alcohol, Dyslipidemia, Obesity, Diabetes mellitus, Ischemic heart disease, Renal disease and Cerebrovascular disease.

Laboratory evaluation included fasting glycemia, creatinine, uric acid, lipids, microalbuminuria.

Conventional and TDI echocardiography were performed in all patients, included E/Em (ratio of diastolic velocities), left ventricular mass index (LVM) and left atrial volume index (LAVI) were calculated according to the recommendation (ASE/EACVI). Statistical analysis included bivariate logistic regression.

Results:

Patients with URH were older (72±9.8 vs 71±10.7;p=0,01), more obese (28.0±4.0 vs 27.6±3.3;p=0.036), they also had higher prevalence of Diabetes mellitus (241(38.3%) vs 141(28.8%);p=0,001) and significantly more often in menopause or postmenopause (402(63.8%) vs 287(58.7%); p=0.046). LAVI (43.7±17.7 vs 40.2±15.0;p=0,001), LVEDV (183.3±46.3 vs 177.3±48.7;p=0,038), LVESV (82.2±24.9 vs 78.2±24.8,;p=0,007)), LVMI (116.2±23.2 vs 111.2±22.9;p=0,0003), E/Em (15.0±3.7 vs 14.5±3.8;p=0.038) and uric acid (356.3±106.7 vs 340.1±103;.p=0,028) were significantly higher in this group.

Uncontrolled RH associated with older age (0.987(0.975-0.999); p=0,032), obesity (0.968(0.936-1.000);p=0,049) and diabetes (1.467(1.132-1.901);p=0,004), but not with menopause. Having left ventricular hypertrophy (0.992(0.987-0,998);p=0,008), increased LAVI (0.991(0.984-0.999);p=0.023) and higher uric acid (1.001 (1.000-1.003), p =0.038) are also associated with URH.

Conclusions:

The prevalence of uncontrolled RH in women was high, despite optimal therapy. Hypetension remains uncontrolled in patients who are older, obese, with diabetes, left ventricular hypertrophy, and in menopause. Higher uric acid level also seems to have a negative influence on the control of the disease. High prevalence of poor blood pressure control motivates promotion of new therapeutic strategies and lifestyle changes.
COMPARISON BETWEEN WOMEN AND MEN IN THE TREATMENT OF HYPERTENSION: THE REAL-WORLD OBSERVATIONAL PROSPECTIVE DATA FROM DISCOVERY STUDY
Authors: Šabovicˇ Miso , Pejkov Hristo , Kovacˇevic´-Preradovic´ Tamara , Kušljugic´ Zumreta , Kuprešak Drasko , Jatic´ Zaim , Urinov Oybek , Caraus Alexandru , Bajraktari Gani , Gruev Ivan , Vintila Vlad Damian , Csanádi Zoltan , Batjargal Sodgerel
Published: May 2024

Objective:

The 2023 ESH guidelines strongly emphasize the lack of data on women, both in randomized clinical trials and in real-world data. It is not known whether the considerable efforts to equalize the treatment of women and men have led to changes in routine practice, which was the main aim of our study.

Design and method:

The DISCOVERY study is a large real-world prospective observational study investigating the treatment of patients with hypertension and/or hypercholesterolemia in primary or secondary care in 10 countries in 2021 and 2022. Patients of both sexes over 18 years were included. Investigators (301 GPs, 127 internists, 271 cardiologists) treated the patients according to their usual routine. They collected data on admission and up to 12 weeks after admission so that treatment characteristics could be analyzed. The physicians were not informed about the aim (comparison of women vs. men) of the study to avoid information bias.

Results:

The study included 11,287 patients, 93.6% of whom had hypertension at baseline that was either newly diagnosed (N=2247) or previously treated (N=8280; 86.6% inadequately treated). Patients were recruited in consecutive order. Slightly more women (53.2%, mean age 62.2±11.3 years, 94% with hypertension) than men (46.8%, mean age 58.6±12.3 years, 93.2% with hypertension) were included. There were no significant differences in mean blood pressure (women 156/92mmHg, men 157/93mmHg) and in antihypertensive treatment (mainly monotherapy). There were several gender-specific differences such as age, body mass index, physical activity, smoking status and comorbidities that did not affect the results. At the second observation, blood pressure had decreased significantly (p<0.001) and consistently. Mean pressure in women was 130/80mmHg and in men 131/81mmHg. The blood pressure target < 140/90mmHg was achieved by 73.2% of women and 72.1% of men. The prescribed antihypertensive medications did not differ between women and men, being mainly single-pill combinations (71.6% for women, 71.5% for men).

Conclusions:

The study showed no differences in the treatment of hypertension between women and men under real-world conditions. The effectiveness was quite good, mainly achieved by single-pill combinations, although the treatment can still be improved.
IMPACT OF SEX ON THE ASSOCIATION BETWEEN AORTIC WAVE REFLECTION AND LEFT ATRIAL FUNCTION IN HYPERTENSIVE PATIENTS WITH RECURRENT ATRIAL FIBRILLATION
Authors: Kokhan Elizaveta , Kiyakbaev Gayrat , Kobalava Zhanna
Published: May 2024

Objective:

Hypertension is the leading cause of atrial fibrillation (AF). However, the exact mechanism of the relation between high blood pressure and arrhythmia is still incompletely understood. Although the systolic loading sequence likely affects ventriculoatrial coupling, the data concerning the relationship between central aortic pressure and left atrial (LA) function including depending on sex is scarce.

Purpose: To assess the impact of sex on the association between aortic wave reflection parameters and LA function in patients with AF and hypertension.

Design and method:

45 men and 46 women with paroxysmal or persistent AF and hypertension were enrolled in the study. The parameters of LA size and function included in our analyses were: LA minimum volume (LAVmin), LA maximum volume (LAVmax), LA emptying fraction (LAEF), and LA expansion index (LAEI). The parameters of central aortic pressure were estimated using applanation tonometry method. All patients had sinus rhythm at the time of the study.

Results:

There were no significant differences between men and women in most clinical and demographic parameters. Both groups had similar LV mass index, but women had worse diastolic function (E/E’: 7.1 vs 9,8; p<0.001). Men and women had similar LAVmax index, however, women had worse LAEF (49 vs 39%; p=0.004) and LAEI (98 vs 64%; p=0.02).

Despite similar central systolic, diastolic pressure and pulse wave velocity, women had higher aortic augmentation index (Aix) [33 vs 25%; p<0.001], even adjusted by HR (Aix75) [34 vs 26%; p<0.001]. In a multivariate regression analysis, in men LAEF was significantly associated with height (p=0.02), weight (p=0.046), E’ (p<0.001), and E/E’ (p<0.001), whereas in women with E’ (p=0.003) and Aix75 (p=0.04), and GFR (p=0.02).

Conclusions:

Patients of both genders had similar structural patterns of LA remodeling, but women characterized by more impaired LA function parameters. As according to previous reports, women had higher wave reflection parameters (Aix and Aix75). In multiple regression analysis, only in women did LAEF significantly relate to Aix75. It might indicate a higher susceptibility of the women's LA to increased hemodynamic overload caused by wave reflection.