bluuebunny/crossref_metadata_2025 huggingface dataset:
ORTHOSTATIC HYPOTENSION IN COVID 19 – CATCH IT IF YOU CAN!
Authors: Birligea Maria Mihaela , Badila Elisabeta , Bartos Daniela , Weiss Emma Alexandra , Balahura Ana-Maria
Published: June 2022

Objective:

The relationship between COVID-19 and blood pressure (BP) has raised great concern since the discovery of Angiotensin Convertase Enzyme 2 (ACE 2) – mediated mechanism of action for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV2). Hypertension (HTN) itself proved to be a risk factor for more severe Coronavirus Disease 19 (COVID -19). However less studies focus on the trend of blood BP for patients with COVID-19 during the initial phase of disease.

Design and method:

We present the case of a 71 years old woman with grade 2 HTN previously controlled with diuretic and betablocker therapy that came to our hospital with dyspnea, cough and debilitating fatigue progressively worsened in the last 10 days. The patient also related the first episode of syncope in her life the night before the presentation.

Results:

The clinical evaluation revealed a conscious, euvolemic, with polypnea and a peripheral saturation in oxygen of 86%, corrected to 95% with 9 liters oxygen/minute via simple face mask and a BP of 110/70 mmHg with a ventricular rate of 45 beats per minute in supine position. The assessment of BP values while standing showed a value of 78/60 mmHg after 1 minute and 58/40 mmHg after 3 minutes, while the ventricular rate increased overall to 65 beats per minute. ECG was remarkable only for mild bradycardia and computed tomography pulmonary angiogram excluded pulmonary embolism. The patient was admitted with severe COVID-19 accompanied by severe orthostatic hypotension and bradycardia. Continuous telemonitoring showed only mild bradycardia. Under standard COVID 19 treatment, after 10 days, her symptoms had resolved with no residual orthostatic hypotension or bradycardia.

Conclusions:

In conclusion this case reflects the life-threatening dysautonomia caused by SARS-COV 2 infection. More concern should be placed on this type of fragile patients, taking into account both the macroscopic implications of being confined to bed for a long period of time and the microscopic butterfly effect caused by the binding of the virus on the widespread ACE 2 in the lungs, heart, kidneys and digestive tract.
RED BLOOD CELL COLOUR VARIATION AS A MARKER OF CALCIUM DISTRIBUTION: WHAT ROLE DOES IT HAVE IN HEART FAILURE PATIENTS WITH HYPERTENSION AND LONG COVID?
Authors: Kyya Yulian , Barnett Olga , Halkevych Marta , Labinska Olha
Published: June 2022

Objective:

Red blood cell (RBC) role is both passive action, oxygen delivery to the tissues as well as carbon dioxide to the lungs and active action involvement in the regulation of vascular tone.

The aim was to investigate pathophysiological and ultrastructural changes of RBC in heart failure (HF) patients with hypertension (HT) and long Covid.

Design and method:

In total 12 patients with HF of Coronary Artery Disease origin, HT, and long Covid were examined. Mean age of patients was 62 ± 5.8 years. The control group consisted of 10 apparently healthy people. The functional state and ultrastructure of RBC were studied using electron microscopy.

Results:

During ultrastructure examination, structural pathologies of RBC in HF patients with HT and long Covid were revealed. RBC anisocytosis and poikilocytosis as structural damage variations in size and shape were found respectively. Reticulocytes were found much more often in HF patients with HT and long Covid than in the control group. In healthy control group, RBC had a typical discoid shape. In the presence of long Covid, both calcification as a marker of RBC apoptosis and destruction was also detected (Fig.1). Neutrophil extracellular traps (NETs) were found in RBC surrounding (Fig.1).

Conclusions:

Altered RBC function has important implications for HF patients with HT and long Covid. RBC has been shown to induce endothelial cell dysfunction and to increase cardiac injury as well as increased inflammatory processes in long Covid. The presence of HF, HT and long Covid leads to RBC calcification and activation of blood cell apoptosis. Prognostic role of RBC calcium distribution in combination with other important prognostic measures, such as biomarkers like Thrombospondin - 1, NT-proBNP and ST2 is subject of interest and requires further research.
NEW ONSET OF HYPERTENSION IN PATIENTS ADMITTED FOR INFECTION WITH SARS-COV-2 VIRUS
Authors: Stirban Raluca , Grigore Cristiana , Dragoi Doina , Balaceanu Beatrice , Gurau Cristian-Dorin , Voiculet Cornelia , Zaharia Magda , Zara Octavian , Popa Gelu , Giuglea Carmen , Calin Camelia , Dina Ion , Balaceanu Alice
Published: June 2022

Objective:

The aim of the study was to assess the clinical particularities and the lab tests in patients hospitalized for SARS-COV2 infection, with new onset of hypertension on admission.

Design and method:

We performed a retrospective study on 217 patients admitted to a Clinical Emergency Hospital between January 2021 and October 2021.

Results:

We had 217 patients admitted in internal medicine clinic for infection with SARS-COV2 virus, most of them with moderate and severe form of disease. From them, 148 patients had hypertension, 83.78% with medical history of hypertension and 16.22% with new onset of high blood pressure on admission. Patients were aged between 23 and 99 years, with an average age of 65 years. In comparison, the patients with new onset of hypertension (subgroup 1) were aged between 37 and 90 years, with an average age of 66 years. The most affected group of age was 60–69 years.

In subgroup 1, the gender distribution was: 58.33% male, 41.66% female.

At admission, the stages of SARS-COV2 infection in subgroup 1, according to CT examination, were severe in 52.38%, moderate 19.04%, and mild 28.57% of patients.

As comorbidities in subgroup 1: cancer in 8.33%, metabolic syndrome 54.16%, dyslipidemia 4.16%, obesity 50%, type II diabetes mellitus 45.83%, chronic heart failure in 12.5% of cases (37.5% NYHA I class, 54.16% NYHA II class and 8.3% NYHA III class), atrial fibrillation in 12.5%, atherosclerosis in 16.66%, anxiety disorders in 4.16% and dementia in 8.33% of cases.

High levels of inflammatory markers in Subgroup 1: CRP in 95.83%, procalcitonin in 87.5%, ferritin 79.16%, D-dimers in 83.33%, troponin 4.16%, NT-proBNP in 50% of cases.

Decreased GFR was found in 65.21% of patients. Microalbuminuria was present in 29.16% of patients.

The antihypertensive medication during hospitalization was: diuretics in 45.83%% of cases, betablockers in 33.34%, calcium blockers in 8.33%, angiotensin converting enzyme inhibitors in 16.67%.

Conclusions:

Hypertension with new onset during SARS-COV2 infection and its persistence in post-covid syndrome may have complex pathogenic mechanisms and require personalized therapeutic decision.
TREATMENT WITH BLOCKERS OF THE RENIN-ANGIOTENSIN SYSTEM DOES NOT AFFECT RENAL FUNCTION IN PATIENTS WITH SEVERE COVID-19 ADMITTED TO INTENSIVE CARE UNIT
Authors: Salvo Francesco , Gallo Elisa , Botto Anna , Risoli Alessio , Parola Paolo , Tenio Rita , Nicoletti Ilaria , Valesano Paolo , Blangetti Ilaria , Morganti Alberto
Published: June 2022

Objective:

Patients with severe COVID-19 admitted to Intensive Care Units (ICU) are often challenging because of the complications related to co-existing diseases. Among these hypertension is highly prevalent and blockers of renin-angiotensin system (RAS-B) are frequently reported as home drug therapy. However the influence of these medications on renal function and mortality is matter of debate.

Design and method:

We retrospectively analyzed clinical data and drug treatment of 90 patients (F/M 25/65) admitted in our ICU for severe COVID-19, with lung disease severity expressed as pO2/fractional inspired oxygen (P/F) below 300 mmHg. In normotensive (n = 35) and hypertensive patients previously treated with (n = 35) or without (n = 20) RAS-B, we compared systolic and diastolic blood pressure (SBP and DBP, mmHg), serum creatinine (SC, mg/dl) and potassium (SK, mEq/L) baseline and SC peak values reached during the admission in ICU. Rate of renal replacement therapy (RRT) and mortality were also recorded.

Results:

Baseline mean SBP and DBP were within the normal limits and similar in normotensive and in both groups of hypertensive patients while P/F was 157 ± 71 in normotensives and 137 ± 64 vs. 94 ± 30 respectively in hypertensives with and without RAS-B. In the latter two groups, baseline, SC and SK were similar (respectively 1 ± 0.5 vs. 1 ± 0.8 and 4 ± 0.6 vs. 4 ± 0.6) and peak SC values were similar as well (respectively 1.74 ± 1.3 vs. 1.71 ± 1.7). Among the seven patients who needed RRT three and four respectively were on and off treatment with RAS-B. Overall mortality was slightly but not significantly higher in hypertensive than in normotensive patients (31/55, 56% and 15/35, 43%) but similar in those with and without RAS-B (19/35, 54% and 12/20, 60%).

Conclusions:

These preliminary data suggest that in patients with severe COVID-19 admitted to ICU, the use of RAS blockers for the treatment of hypertension prior to the infection does not affect renal function, the need of RRT and mortality.
NIGHT-TIME BLOOD PRESSURE ASSESSED BY HOME VS. AMBULATORY MONITORING IN ADULTS WITH TYPE 2 DIABETES: ASSOCIATION WITH PRECLINICAL TARGET ORGAN DAMAGE
Authors: Bountzona Ioanna , Kollias Anastasios , Kyriakoulis Konstantinos , Destounis Antonios , Asimakopoulou Athina , Ntineri Angeliki , Stergiou George S.
Published: June 2022

Objective:

To evaluate the relationship of night-time blood pressure (BP) assessed by home (HBP) or ambulatory BP (ABP) monitoring with preclinical target organ damage in adults with type 2 diabetes (DM2).

Design and method:

Hypertensive adults with DM2 or pre-diabetes on stable treatment were subjected to (i) 24 h ABP monitoring (20 min intervals, Microlife WatchBP O3), (ii) HBP monitoring (7 days with duplicate morning/evening measurements and 3 nights with 3 measurements/night, Microlife WatchBP Home-N), and measurement of (iii) echocardiographic left ventricular mass index (LVMI), (iv) carotid intima-media thickness (cIMT), (v) aortic pulse wave velocity (PWV) and ankle-brachial index (ABI), (Microlife PWV/ABI), (vi) urine albumin-creatinine ratio (ACR) in 2 different morning samples.

Results:

Seventy individuals were analyzed (mean age 65.2 ± 9.7 years, 47 males, body mass index 31.6 ± 4.8 kg/m2, 59 with DM2 and 11 with pre-DM). Daytime HBP was slightly higher than daytime ABP (mean difference 2.4 ± 9.3/0.5 ± 4.9 mmHg, systolic/diastolic, p < 0.05/NS). Similarly, night-time HBP was slightly higher than night-time ABP (2.1 ± 6.5/0.8 ± 5.0 mmHg, p < 0.05/NS). There was strong correlation between ABP and HBP (daytime r = 0.77/0.77 and night-time 0.88/0.80, systolic/diastolic) (all p < 0.05). Night-time ambulatory/home pulse pressure presented the following correlation coefficients with indices of target organ damage: LVMI r = 0.23/0.15; cIMT 0.28/0.28; ABI -0.21/-0.23; PWV 0.04/0.05; ACR 0.57/0.50 (p = NS for HBP-ABP comparisons). The agreement between night-time HBP and ABP in identifying individuals with nocturnal hypertension was 81% (kappa statistic = 0.63) and in detection of non-dippers 73% (kappa = 0.44).

Conclusions:

Night-time HBP monitoring in hypertensive adults with DM2 is feasible, strongly associated with night-time ABP and gives similar correlations with preclinical target organ damage. These methods also present substantial agreement in identifying individuals with nocturnal hypertension.
THE RISK OF COMBINED PATHOLOGY OF DIABETES MELLITUS AND TUBERCULOSIS
Authors: Semianiv Marianna , Semianiv Ihor
Published: June 2022

Objective:

The aim of the study is a comprehensive retrospective assessment of the prevalence, features, course of treatment of multidrug-resistant tuberculosis and diabetes mellitus.

Design and method:

Our study is based on analysis of statistical data obtained from a retrospective study of 762 case histories and cases of MDR-TB in the register of tuberculosis patients for 2015-2019.

Results:

Depending on the type of TB case in our patients, we found that in both groups of the study the recurrence of TB prevailed – 49 cases (55.7%) against TB 39 cases (44.3%) of people in the main group; 363 cases (53.9%) against 311 (46.1%) in the control group (p < 0.05). The rate of successful treatment in gr.2 is probably higher than in gr. 1 (64.7% vs. 61.4%; (p < 0.05)). However, a more significant probable difference is characterized by the treatment rate, which in the main group is 27.3% versus 40.3% in the control group (almost 2 times; p < 0.05). The rate of ineffective treatment, which in patients with comorbidity was 27.3% (almost every third patient) against 17.6% in group 2 is also important for scientists and practitioners.

Conclusions:

There is a clear tendency to an increase the combined pathology and chemoresistance in the structure of the incidence of tuberculosis, the proportion of recurrences of tuberculosis in the presence of diabetes mellitus The pulmonary tuberculosis developed significantly more often in middle-aged patients with type 2 diabetes mellitus with moderate and severe states, the subcompensated form, with a complicated course. In patients with diabetes more often was registered a common tuberculous process in the lungs (79.5% of patients) and in all 100% of patients with syntropy bacterial excretion was registered, as well in all 100% of patients with syntropy bacterial excretion was registered. The rate of successful treatment for the presence of MDR-TB / diabetes syntropy is probably lower in the main group (61.4% vs. 64.7%; (p < 0.05)).
EFFECT OF EMPAGLIFOZIN ON 24-HOUR BLOOD PRESSURE, BRACHYAL ENDOTHELIAL DYSFUNCTON, AND LEFT VENTRICULAR DIASTOLIC FUNCTION, IN PATIENTS WITH TYPE-2 DIABETES MELLITUS
Authors: Rus Horatiu , Poinareanu Ionut , Bobescu Elena
Published: June 2022

Objective:

Arterial hypertension is present in the majority patients with type-2 diabetes mellitus (DM) and is an important risk factor for heart failure and cardiovascular mortality. Previous data suggests that sodium-glucose transporter 2 (SGLT-2) inhibitors can effectively manage hyperglycemia, but also reduce blood pressure (BP) levels and the incidence of heart failure and death in these patients. The aim of this study is to evaluate the effects of empaglifozine on ambulatory blood pressure (BP) levels and endothelial dysfunction in patients with type-2 DM.

Design and method:

We evaluate 100 adult patients type-2 DM on monotherapy or combination therapy with metformin, sulphonylurea, DDP-4 inhibitor, or insulin, 50 from them (active group) being treated with empaglifozin 10 mg/day for 12 weeks. All study participants underwent 24-h ambulatory BP monitoring, endothelial dysfunction appreciated through flow mediated vasodilation(FMD) at the level of brachial artery, and left ventricular diastolic function with tissue Doppler derived E/e’ ratio at baseline and study-end.

Results:

Baseline demographic, clinical and laboratory parameters were similar in the two groups (age 62.72 ± 7.73 vs. 56.64 ± 10.35; p = 0.514). During follow-up, 24-hour brachial SBP decreased in the active (131.97 ± 12.42 vs. 124.27 ± 11.25; p < 0.001), but was similar in control group (129.85 ± 11.41 vs. 128.74 ± 12.25, p = 0.822).

Endothelial dysfunction significantly improve only in the empaglifozin group (5.1 ± 2.9/6.1 ± 3.00 vs 5.2 ± 2.8/5.1 ± 3.1; p = 0.001. Left ventricular diastolic function appreciated through E/e’ ratio improve in empaglifozin group (12.5 ± 8.00 /7.5 ± 6.00; p = 0,004), and remain altered in control group (11.8 ± 9.00 /11.3 ± 10.00; p = 0,862).

Conclusions:

Treatment with empaglifozin in diabetic patients produce clinically meaningful reductions in 24-hour brachial pressure, improve endothelial function and has an positive effect on left ventricular diastolic function. Besides Improvement in glycemic control, the positive effect on left ventricular function and vascular function and reactivity, may contribute to the cardiovascular benefits of the medication.
CANAGLIFLOZIN IS MORE EFFECTIVE THAN PERINDOPRIL TO IMPROVE RENAL HYPERFILTRATION AND URINARY ALBUMIN EXCRETION IN TYPE 2 DIABETES PATIENTS
Authors: Ramirez Agustin Jose , Pessana Franco , Sanchez Maria Jose , Sanchez Ramiro Ariel
Published: June 2022

Objective:

Introduction: Albumin urinary excretion and glomerular hyperfiltration is frequently found in diabetes and hypertension. Although converting enzyme inhibitors and iSGLT2 could stabilize renal function in long term trials, short information was available in comparative studies.

Aims: To evaluate, in type 2 diabetic patients (T2DM) with arterial hypertension, the effects of either canagliflozin or perindopril on glomerular filtration rate (GFR) and microalbuminuria, after 6 months treatment

Design and method:

Methods: 15 patients with T2DM (59 ± 4y; 10 females) received, on top of their treatment, canagliflozin 300 mg daily while other 15 T2DM patients (62 ± 4y, 8 females), received perindopril 10 mg daily. Laboratory parameters determined at baseline and after a 6-month continued treatment included: HbA1C, fasting blood glucose, GFR, 24hs microalbuminuria and 24 h ambulatory blood pressure monitoring.

Results:

Results:

After 6 months under canagliflozin a decrease in HbA1C (from 8.1 ± 0.5 to 7.0 ± 0.4%; p < 0.05), SUA (from 7.9 ± 1 to 6.7 ± 2mg%; p < 0.05), microalbuminuria (from 90 ± 28 to 48 ± 14 mg/24 h; p < 0.01), GFR (from 148 ± 6 to 131 ± 4 ml.min; p < 0.01) and mean 24 h blood pressure (from 154 ± 6/96 ± 5 to 141 ± 3/86 ± 4mmHg; p < 0.05). However, under perindopril a decrease was only observed on GFR (from 137 ± 4 to 123 ± 7 ml.min; p < 0.01) microalbuminuria (from 88 ± 32 to 70 ± 27 mg/24hs; p < 0.05) and 24 h blood pressure (from 152 ± 7/98 ± 7 to 139 ± 6/84 ± 5mmHg; p < 0.05). Perindopril failed to change SUA or Hb A1C.

Conclusions:

Conclusions:

Compared to perindopril, canagliflozin seems to be more effective in improving renal function by involving additional mechanisms including amelioration of glycemia and uric acid plasma levels.
PREVALENCE OF DIABETES AND PREDIABETES AMONG ADULTS WITH HIV IN AFRICA: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Peer Nasheeta , Nguyen Kim , Hill Jillian , Kengne Andre-Pascal
Published: June 2022

Objective:

Debate is ongoing on the relationship between HIV infection and type 2 diabetes mellitus with increased risk and no difference described in European populations. A systematic review and meta-analysis were conducted to 1) determine the pooled prevalence of diabetes and prediabetes among people living with HIV (PLWH) in Africa, and 2) examine the magnitude of diabetes and prediabetes by sociodemographic characteristics, body mass index, definitions used for diabetes and prediabetes diagnoses, and HIV-related characteristics.

Design and method:

A comprehensive search of major databases was conducted for original research articles published between 2000 and 2021. Relevant studies in English and French were included, irrespective of study design, data collection techniques and diagnostic definitions used. Study-specific estimates were pooled using random effects models to generate the overall prevalence of diabetes and prediabetes for each diagnostic definition and relevant sub-groups. Data analyses were conducted using the R statistical software and the “meta’’ package.

Results:

Of the 2211 records initially screened, 54 were selected from 346 full-text articles assessed for eligibility. Most included studies were from South Africa (n = 15), Tanzania (n = 7), Ethiopia (n = 6), with four each from Cameroon, Malawi and Uganda. All studies were cross-sectional by design and clinic-based, except for four population-based studies. The proportion of men ranged from 16–52%. Mean/median age ranged from 29–62 years. Diabetes prevalence was 4.8% (95%CI: 4.02–5.59) among 101,704 participants; biochemical testing combined with self-reported diabetes yielded a higher prevalence (oral glucose tolerance test: 6.2%, 95%CI: 2.5–11.3; fasting blood glucose: 6.4%, 95%CI: 4.9–8.1) than self-reported diabetes prevalence alone (3.7%, 95%CI: 2.5–5.2). Prediabetes prevalence was 13.7% (95%CI: 10.21–17.59) among 13,502 participants. There were no statistically significant differences in diabetes or prediabetes prevalence by sub-groups examined, including CD4 count, and antiretroviral treatment status and duration.

Conclusions:

Diabetes prevalence in PLWH in Africa probably reflects that of general populations with similar influences. The lower prevalence of self-reported diabetes vs. biochemical testing with self-report possibly demonstrates suboptimal diabetes detection in this vulnerable group who are in regular contact with healthcare services. The high prevalence of prediabetes likely foreshadows a substantial increase in future diabetes in African PLWH.
CARDIOVASCULAR EFFICACY OF GLUCAGON-LIKE PEPTIDE-1 RECEPTOR AGONISTS: A META-ANALYSIS OF CARDIOVASCULAR OUTCOME TRIALS
Authors: Patoulias Dimitrios , Katsimardou Alexandra , Boulmpou Aristi , Siskos Fotios , Stavropoulos Konstantinos , Imprialos Konstantinos , Koutsampasopoulos Konstantinos , Kassimis George , Papadopoulos Christodoulos , Doumas Michael
Published: June 2022

Objective:

Type 2 diabetes mellitus (T2DM) has gradually evolved as a metabolic pandemic. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are currently considered an attractive treatment option for diabetic patients with established atherosclerotic cardiovascular disease or for those with multiple risk factors.

Design and method:

We sought to update previous relevant meta-analyses, pooling data from the published cardiovascular outcome, placebo-controlled trials until 12th December 2021. We utilized data from published reports, also searching relevant supplementary appendices for any missing data. We evaluated the composite outcome of a major adverse cardiovascular event (MACE).

Results:

We pooled data from 9 trials for a total of 64,236 enrolled participants with T2DM assigned either to GLP-1RA treatment or placebo. GLP-1RA treatment resulted in a significant decrease in the risk for MACE by 11% (RR = 0.89, 95% CI; 0.82–0.95, I2 = 53%). No subgroup difference was detected between once-daily, once-weekly or continuous subcutaneous infusion of a GLP-1RA vs. placebo (p = 0.06). No publication bias was detected.

Conclusions:

Herein we demonstrated that GLP-1RAs provide a significant reduction in the risk for MACE in patients with T2DM regardless of type or frequency of administration.
“WHICH ONE SHOULD I CHOOSE, A GLP-1RA OR A SGLT2 INHIBITOR? OR MAYBE BOTH?’’. A POOLED ANALYSIS OF CARDIOVASCULAR OUTCOME TRIALS
Authors: Patoulias Dimitrios , Katsimardou Alexandra , Toumpourleka Maria , Imprialos Konstantinos , Stavropoulos Konstantinos , Karagiannis Asterios , Papadopoulos Christodoulos , Doumas Michael
Published: June 2022

Objective:

Glucagon-like peptide 1 receptor agonists (GLP-1RAs) and sodium–glucose cotransporter 2 (SGLT2) inhibitors are prioritized for the treatment of patients with type 2 diabetes mellitus (T2DM) to reduce major adverse cardiovascular events (MACE), hospitalization for heart failure (HF), cardiovascular death, or chronic kidney disease (CKD) development and progression, regardless of glycemic control. A question that inevitably arises is whether these drug classes can be combined in clinical practice, and if there is a synergistic cardio-protective effect with such a combination.

Design and method:

We sought to determine whether the SGLT-2 inhibitor/GLP-1RA combination confers or not a greater risk reduction on “hard’’ cardiovascular outcomes, compared to each drug class alone, by pooling relevant data from intention to treat analyses of the relevant cardiovascular outcome trials. We set as primary efficacy outcome the occurrence of a major adverse cardiovascular event (MACE), defined as the composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, and as secondary efficacy outcome the occurrence of hospitalization for HF.

Results:

Concerning the primary efficacy outcome, we showed that treatment with SGLT-2 inhibitor/GLP-1RA combination compared to GLP-1RA/placebo resulted in a non-significant decrease in the risk for MACE (RR = 0.89, 95% CI; 0.67 – 1.19, I2 = 0%). When we compared treatment with SGLT-2 inhibitor/GLP-1RA combination with SGLT-2 inhibitor/placebo combination, we demonstrated again a non-significant effect in the risk for MACE (RR = 0.87, 95% CI; 0.68 – 1.10, I2 = 0%). Regarding the secondary efficacy outcome, treatment with SGLT-2 inhibitor/GLP-1RA combination conferred a significant risk reduction by 71% (RR = 0.29, 95% CI; 0.13 – 0.65, I2 = 5%), compared to GLP-1RA/placebo combination. In addition, a similarly significant decrease by 66% was shown for the SGLT-2 inhibitor/GLP-1RA combination compared to SGLT-2 inhibitor/placebo combination (RR = 0.34, 95% CI; 0.15 – 0.76, I2 = 0%).

Conclusions:

SGLT-2 inhibitor/GLP-1RA combination is not superior to SGLT-2 inhibitor or GLP-1RA monotherapy treatment for the prevention of MACE. However, subjects with HF might benefit from such a combination, since that combination is associated with a significant decrease in the risk for HF hospitalization, ranging from 66 to 71%.
BENEFICIAL EFFECT OF SODIUM-GLUCOSE CO-TRANSPORTER-2 INHIBITORS ON RIGHT VENTRICULAR SYSTOLIC FUNCTION IN PATIENTS WITH TYPE 2 DIABETES MELLITUS: A PILOT, OBSERVATIONAL STUDY
Authors: Patoulias Dimitrios , Toumpourleka Maria , Katsimardou Alexandra , Zografou Ioanna , Imprialos Konstantinos , Stavropoulos Konstantinos , Karagiannis Asterios , Papadopoulos Christodoulos , Doumas Michael
Published: June 2022

Objective:

Cardiovascular disease remains the leading cause of mortality among patients with type 2 diabetes mellitus (T2DM). Sodium-glucose co-transporter-2 (SGLT-2) inhibitors is a new class of antidiabetics, conferring a significant cardiovascular risk reduction. However, underlying mechanisms are not fully understood. Right ventricular (RV) function is adversely affected early in the course of diabetes. Herein we sought to determine the effect of long-term use of SGLT-2 inhibitors on RV function.

Design and method:

In this pilot, observational study, we enrolled 20 patients with T2DM and stable antidiabetic and antihypertensive treatment over the last 6 months. Patients were planned to undergo a thorough echocardiographic assessment of RV function twice, before and 6 months after initiation of a SGLT-2 inhibitor. We set as primary efficacy outcome the change in tricuspid annular plane systolic excursion (TAPSE).

Results:

Mean age of participants was 62.8 ± 7.9 years, with a mean T2DM duration of 8.7 ± 6.1 years. Thirteen subjects were administered dapagliflozin, while the rest 7 were prescribed empagliflozin. Due to special regulations imposed in the context of coronavirus disease-19 (COVID-19) pandemic, mean treatment duration and follow-up period was 9.35 ± 3.4 months. SGLT-2 inhibitors led to a significant increase in TAPSE from 2.01 ± 0.23 to 2.12 ± 0.15 cm (p = 0.022). The result was significant for dapagliflozin (p = 0.015), while administration of empagliflozin resulted in a non-significant increase in TAPSE (p = 0.28). However, no significant difference between the two SGLT-2 inhibitors was shown (p = 0.7). Change in TAPSE was significant in subjects with prior history of cardiovascular disease (p = 0.024), while it was non-significant for subjects without previous cardiovascular disease (p = 0.26). Other parameters of RV function or RV dimensions were unchanged.

Conclusions:

This is the first study to assess the effect of long-term treatment with SGLT-2 inhibitors on RV function in subjects with T2DM, demonstrating a significant increase in TAPSE.
INCREASED INCIDENCE OF IMPAIRED FASTING GLUCOSE (IFG) AMONG HYPERTENSIVE PATIENTS NAÏVE TO HYPOLIPIDEMIC TREATMENT
Authors: Papadakis John A. , Ioannou Petros , Theodorakopoulou Vasiliki , Papanikolaou Kostas , Papazachariou Antria , Malikides Onoufrios , Filippatos Theodosios
Published: June 2022

Objective:

Impaired fasting glucose (IFG) predisposes to future development of type 2 diabetes mellitus (T2DM) and may also be associated with increased cardiovascular disease (CVD) risk. Hypertension is an established CVD risk factor. The aim of this study was to assess the prevalence of IFG and the associated anthropometric and metabolic disturbances in patients with hypertension.

Design and method:

Consecutive hypertensive patients not on any hypolipidemic treatment and without a diagnosis of T2DM were included. IFG was defined as a serum glucose > 100 mg/dl according to American Diabetes Association criteria.

Results:

The total sample consisted of 1381 participants; between them 78 patients were diagnosed to have T2DM and they were excluded from the analyses leaving a final sample of 1303 hypertensive patients [41.0% men; median age 58 (range: 15–90) years] not on any hypolipidemic treatment and without a diagnosis of T2DM. IFG was identified in 469 patients (36%). IFG was more prevalent in males than in females (42.4% vs 31.8%, p < 0.001). Patients with IFG had greater body mass index (BMI), waist-to-hip ratio, systolic blood pressure, pulse pressure, triglycerides, alanine aminotransferase, gamma-glutamyl transferase and uric acid serum levels compared with patients with normal serum glucose levels.

Conclusions:

This study reveals that in a sample of patients with hypertension one out of three has IFG. This is more prevalent among men. IFG is associated with the presence of a more aggravated anthropometric and biochemical profile possibly associated with an increased CVD risk.
ATHEROSCLEROSIS AND INCIPIENT NEPHROPATHY IN DIABETIC PATIENTS
Authors: Nelaj Ergita , Kecaj Irida , Gjata Margarita , Tase Mihal
Published: June 2022

Objective:

The association between nephropathy, particularly microalbuminuria, and cardiovascular disease, is becoming increasingly apparent. Atherosclerotic process is a combination of fatty degeneration (atherosis) and of vessel stiffening (sclerosis) of the arterial wall. The aim of the study was to assess relationship between diabetic nephropathy and structural changes in arteries, such as carotid intima – media thickness (IMT).

Design and method:

We selected 80 adults with type 2 diabetes. 47 were women and 33 were men, mean age 51 ± 14. They were divided into three groups based on albuminuria status: Group I = no albuminuria (<30 mg albumin/g creatinine), numbers of patients 27; Group II = microalbuminuria (30 to 300 mg/g) numbers of patients 26; and Group III = macroalbuminuria (>300 mg/g) numbers of patients 27. Albuminuria was measured by collection of fasting random urine specimen on arrival to the clinic, usually in the morning. The IMT was measured by a B-mode ultrasound, 10 MHz transducer.

Each group was evaluated for body mass index (BMI), glycosylated hemoglobin (HbA1C), lipid profile, blood pressure.

Results:

Systolic blood pressure in the II-group was 143.3 ± 15.2mmHg and significantly higher (p < 0.01) than in the I-group (132.5 ± 18.1mmHg) and III-group (139.8 ± 18.9mmHg). No significant differences in age, smoking and kind of antihypertensive agent used were found between three groups. IMT level in the II-group was 1.28 ± 0.35 mm and significantly higher than in the I and III group (1.09 ± 0.28 mm; 1.19 ± 0.44 mm, respectively). There were no significant differences in HbA1C, lipid or serum creatinine between three groups

Conclusions:

The carotid IMT was significantly higher in the patients with microalbuminuria and so, the last one is associated with structural changes in arteries.
SUBCLINICAL VASCULAR DAMAGE IN YOUNG ADULTS WITH TYPE 1 DIABETES MELLITUS
Authors: Marcon Denise , Tagetti Angela , Giontella Alice , Bortolotti Stefano , Bonafini Sara , Piona Claudia Anita , Carletti Lorenza , Trombetta Maddalena , Maffeis Claudio , Fava Cristiano
Published: June 2022

Objective:

Type 1 Diabetes (T1DM) is a chronic disease, whose prevalence is increasing, especially during childhood. Patients are affected by several complications, including macrovascular complications, that can be diagnosed early as subclinical vascular damage. The aim of our study was to assess possible associations between markers of subclinical arterial damage and traditional cardiovascular risk factors with a special focus on peripheral (pBP) and central blood pressure (cBP).

Design and method:

The study included 172 adolescents (100 male and 72 female) whose mean age was 24,72 ± 8,66 years, mean duration of the disease was 13,45 ± 9,58 years and mean BMI was 23,32 ± 3,22 kg/m2. 40 of the subjects (23,5%) had a BMI > or = 25 kg/m2. Peripheral blood pressure was assessed using a mercury sphygmomanometer. Central blood pressure, PWV and PWA were evaluated with a tonometer (SphygmoCor Xcel). CIMT and carotid distensibility (DC) were measured by a high-resolution echo-doppler analysis, using a 5–13 MHz probe, and then further elaborated with a dedicated hardware (Cardiovascular Suite, Quipu, Pisa, Italia). Finally, several metabolic parameters were measured in plasma.

Results:

In our sample, 17 patients (10,1%) could be classified as hypertensive by sphygmomanometer (systolic and diastolic pBP: pSBP and/or pDBP > or = 140/90mmHg) and 48 patients (27,9%) as hypertensive (cSBP and/or cDBP > or = 130/80mmHg) by central BP estimate. 116 patients (68,8%) had DC under the range of normality and 1 patient PWV (0,6%) above 10 m/sec. Glycaemic control was relatively poor (glycated haemoglobin 7,83 ± 0,98%). In multivariable models, cSBP was associated with markers of subclinical arterial damage [cIMT (beta = 0,288 ± 0,001, p < 0,001), AIx75 (beta = 0,257 ± 0,071, p = 0,001), PWV (beta = 0,374 ± 0,007, p < 0,001), DC (beta = -0,149 ± 0,055, p = 0,029)].

Conclusions:

Among subclinical vascular damage indices, carotid distensibility was the most altered in this sample of young adults with T1DM. But all the investigated markers showed a close association with BP values rather than with the other traditional cardiovascular risk factors. Further studies are warranted to better define the role of BP, especially cBP, in the stratification of cardiovascular risk in T1DM patients.
THE ASSOCIATION OF EGFR AND ALBUMINURIA WITH SYSTOLIC HYPERTENSION IN PATIENTS WITH DIABETES
Authors: Georgianou E. , Markakis K. , Georgianos P. , Zografou I. , Sachinidis A. , Sabanis C. , Doumas M.
Published: June 2022

Objective:

Large epidemiological studies have shown that the prevalence of hypertension increases in parallel with the staging of chronic kidney disease. However, it remains unclear whether the decline in estimated-glomerular-filtration-rate (eGFR) or the severity of albuminuria is a stronger determinant of systolic hypertension.

Design and method:

In 483 outpatients with diabetes, the eGFR was determined using the CKD-EPI equation and albuminuria was assessed by measuring the albumin-to-creatinine ratio (ACR) in a random urine specimen. Triplicate automated office blood pressure (BP) recordings were obtained with the validated device HEM-705 (Omron, HealthCare) under standardized conditions requiring an at least 5-minute seated rest period in a quiet room.

Results:

The average office systolic BP was 138.3 ± 19.4 mmHg, whereas 69.6% of the patients were being treated with an average of 2.2 ± 1.1 antihypertensive medications daily. In univariate linear regression analysis, office systolic BP was associated with age, body mass index (BMI), antihypertensive drug use, the number of prescribed antihypertensive medications, severity of albuminuria and decline in eGFR. In multivariate analysis, however, it was logUACR (P = 0.022) and not eGFR (P > 0.05) the factor that remained a significant determinant of office systolic BP. Other parameters associated with office systolic BP in the multivariate model were higher age (P = 0.014), BMI (P = 0.012) and the number of prescribed antihypertensive medications (P = 0.045).

Conclusions:

The present study suggests that the severity of albuminuria and not the decline in eGFR is possibly a stronger determinant of systolic hypertension in patients with diabetes.
SGLT2I - A POTENTIAL ANTIHYPERTENSIVE AGENT IN HYPERTENSION PATIENTS WITH TYPE 2 DIABETES MELLITUS
Authors: Doan Long
Published: June 2022

Objective:

Sodium Glucose cotransporter 2 inhibitor is a class of treatment type 2 diabetes mellitus (T2DM) recently recommended in treatment patient with heart failure. We evaluated the effect of BP lowering of this agent in patients with T2DM.

Design and method:

A prospective study in all hypertensive patients with T2DM admitted to Cardiology Department of Hue Central Hospital between 12/2020 and 05/2021 who had not been treated with SGLT2i. There were 236 patients don’t meet exclusion criterias, in which 110 patients received Dapagliflozin 10 mg daily with OMT and 126 patients received OTM. The patients were followed up at the hospital and 2 months after discharge. Measurement of upper arm blood pressure (BP) with Omron HEM-7121.

Results:

The mean age was 66.77 ± 15.53. The patient had 9 (0–40) year history of hypertension and 5 (0–37) year history of T2DM. The baseline BP was 146.29 ± 19.17 / 83.78 ± 13.1 mmHg, no significant difference in baseline BP in the 2 groups of patients. The results after 2 months showed, in the group of patients in with SGLT2i, there was a significant decrease in the mean SBP value compared with the group of patients with OTM of 5.95 mmHg (95%CI: 2.08 - 9.82, p = 0.003) but the decrease in DBP was not significantly different (95% CI: -0.09 - 5.40, p = 0.058). Subgroup analysis showed that in the group of patients with resistant hypertension, the group of patients using SGLT2i reduced DBP more than the group of patients with OTM by 2.77 mmHg (95%CI: 1.89 - 4.24, p = 0.005) but was not significant for SBP. In contrast, in the group of patients with isolated systolic hypertension, the SBP in the group of patients using SGLT2i decreased more than the group of patients without using SGLT2i about 8.91 mmHg (95%CI: 6.20 - 11.24, p = 0.035). These results were not observed in patients with heart failure and CKD.

Conclusions:

SGLT2i has shown potential to be used as an antihypertensive agent in patients with heart failure and chronic kidney disease and shows dominant efficacy in patients with isolated systolic pressure and resistant hypertension.
DIGITAL INTERVENTIONS TO DRIVE SELF-MANAGEMENT IN PEOPLE WITH HYPERTENSION IN NIGERIA
Authors: Ogboye Ayoposi , Rahman K. M. Jawadur , Odukwe Adaora , Mobisson Nneka
Published: June 2022

Objective:

To examine whether a higher number of virtual interactions with health coaches through a digital health platform would lead to a greater reduction in blood pressure than people with a lower number of interactions.

Design and method:

The participants were 447 people with hypertension or a baseline blood pressure value of 140/90 mmHg or higher (female, 77.6%. male, 20.8%. Average age 43.9 years) enrolled on the CompleteHealthô platform between April 2018 and April 2021 who had entered a subsequent blood pressure value after 6 months of enrollment. The change in blood pressure was calculated as the difference between their blood pressure after 6 months and their first blood pressure value entered on CompleteHealthô. Engagement after 6 months was defined across two levels: minimally engaged members who had at most 1 interaction with a health coach and highly engaged members who had more than 1 interaction with a health coach. Given that the members are generally low-income people, we determined more than 1 interaction as a significant threshold for engagement.

By enrolling on mDoc Healthcare’s digital platform, CompleteHealthô, people were given access to self-care support via a virtual coach. They tracked their health metrics via the app, were given access to tele-education classes and community forums, and the coach provided health education and digital nudges on healthy behaviours to take, including regular blood pressure checks.

Results:

After 6 months, of the 447 people, 374 (83.7%) were highly engaged while 73 (16.3%) were minimally engaged. Highly engaged members saw an average reduction in their systolic and diastolic blood pressures of 13.6 mmHg and 10.4 mmHg respectively, while minimally engaged members saw reductions of 5.8 mmHg and 4.9 mmHg in their systolic and diastolic blood pressures. Limitations were that this did not take into account asynchronous engagement on the platform e.g. self-tracking, review of education messages etc.

Conclusions:

The results of the retrospective study show that increased engagement with a digital self-care intervention drives a higher reduction in blood pressure for people living with hypertension or an elevated blood pressure level.
PERSON-CENTREDNESS IN HYPERTENSION MANAGEMENT USING INFORMATION TECHNOLOGY (PERHIT): A RANDOMISED CONTROLLED TRIAL IN PRIMARY HEALTH CARE
Authors: Andersson Ulrika , Kjellgren Karin , Hoffmann Mikael , Wennersten André , Nilsson Peter , Midlöv Patrik
Published: June 2022

Objective:

Few studies address results from use of new technology and patient participation in hypertension management. The PERHIT Study is a multicentre randomised controlled trial with the aim to evaluate the effects of a person-centred approach using a web-based, interactive self-management system through the patient´s own mobile phone on blood-pressure and well-being. Primary aim is the degree of achieved blood pressure (BP) control after eight weeks and one year. In addition, person-centeredness, usefulness, daily life activities in relation to BP values, awareness of risk and health care costs are studied.

Design and method:

The PERHIT study was performed in four regions in southern Sweden. Following inclusion, more than 900 patients from 31 primary health care centres were randomised to two groups. In the intervention group (INT), patients were provided with a web-based self-management support system including a home-BP monitor. For eight consecutive weeks, they measured BP and performed self-reports regarding well-being, symptoms, lifestyle, medication intake and side effects every evening via their mobile phone. They could also receive motivational messages and reminders throughout the intervention period. Both patients and professionals had access to graphic feedback of reported values through a secure web portal. Patients in the control (CON) group received standard treatment as usual.

Results:

The primary outcome (BP < 140/90 mmHg) was achieved by 48.5% and 47.1% in the INT, and by 40.4% and 40.9% in the CON group after 8 weeks (p = 0.016) and 12 months (p = 0.067), respectively. Both patients and professionals experienced the system as a useful resource for communication regarding BP and lifestyle. They described that it could be used to support a constructive and person-centred partnership between patients and professionals.

Conclusions:

Blood pressure control was significantly better after eight weeks, but not after one year, following an intervention based on use of mobile phones, feedback and interaction between patients and primary care professionals compared to standard care. The system can be a tool toward a new way of working and help patients reach a controlled BP and play a role in a more person-centred and individually adapted hypertension management.
TELEMEDICINE AND HEALTH POLICY CHANGES IN RESPONSE TO RESTRICTIONS RELATED TO COVID-19 PANDEMICS IN LATVIA
Authors: Sen Sevinc Elif , Sokolova Emma , Jeniceka Aleksandra , Bikava Ieva
Published: June 2022

Objective:

Remote consultations are quickly emerging to give more access to real-time, high-quality, efficient, and cost-effective healthcare in the current COVID-19 pandemic.

Objective is to investigate the changing experiences of remote consulting for patients in Latvia and plan effective health policies, to provide a full analysis of the policy for telemedicine applications and solutions based on the current conditions.

Design and method:

Materials and approaches include an examination of normative documents as well as a variety of informational sources. The information offered is mostly based on national strategy papers, official reports, and scientefic publications on Tele-medicine implementation.

Results:

Telemedicine’s range will continue to expand, connecting patients and providers internationally as providers look to expand globally. This will not only help improve the long-term policies about health but may also provide patients with rare diseases alternative avenues to seek highly specialized care. Telemedicine strategy must react faster than ever during the COVID-19 epidemic. Latvia has reacted to Covid pandemics and have noticable implemented new possibilities to provide new approaches provided by telemedicine: providing remote consutlations to patients in different sectors, using E-referrals that were implemented but not sufficiently used before, providing more possibilites to provide remote services also for consiliums, physician-physiscan online consultations. New ICT tools were used for patient remote monitoring. The normative regulation, stategical decisions and changes in long-term policy documents haven’t been changed, so there are limitations to provide the telemedice expansion or stable use after the emengency situation ends. Health policies about telemedicine have another key role with to pursuing that.

Conclusions:

Telemedicine is fast expanding, demand for this service is rising. Although not a replacement for face-to-face consultations, this study illustrates that remote consulting can be an acceptable adjunct to traditional face-to-face consultations. More research is required to identify overall safety and applicability. Digital Health Strategy in Latvia is still on developing stage. Changes or legislation to clarify Telemedicine are still in the process. It is important to provide a good environment for Telemedicine to expand, setting strategies and visions on how those new approaches will be regulating normatively and administratively.
MULTIPLE ENDOCRINE NEOPLASIA TYPE 2A IN A FAMILY WITH RET C.1901G>A AND NOVEL SLC12A3 MUTATIONS
Authors: Zhao Lin , Yang Kun-Qi , Fan Peng , Meng Xu , Zhou Xian-Liang
Published: June 2022

Objective:

In recent years, there has been a lot of controversy about the factors affecting the penetrance of multiple endocrine neoplasia type 2A(MEN2A). Some studies considered it may be related to gene mutations. In the present study, we aimed to support the hypothesis that RET gene mutation affect the penetrance of MEN2A and study the effects of novel SLC12A3 variants in MEN2A.

Design and method:

Peripheral blood samples were collected from the proband and his relatives. Whole-exome sequencing and Sanger sequencing were performed to identify the gene mutations. The protein structure prediction with comparative modelling was used to predict the effects of novel gene variants on protein function. We also used the clinical examinations to evaluate the phenotypes of patients comprehensively.

Results:

Genetic analysis identified RET c.1901G>A and novel variants in SLC12A3 c.3070_3079delinsCAG in the proband and his mother. The patients carrying the novel SLC12A3 variants didn’t show the typical clinical manifestations of Gitelman syndrome because of heterozygosity. But it is theoretically explained that the novel variants of SLC12A3 may affect the function of protein. We also found SLC12A3 gene was not expressed in typical target organs of MEN2A.We are the first to describe compound RET c.1901G>A and SLC12A3 mutations in one family with MEN2A. Our study supports the hypothesis that RET gene mutations affect the penetrance of MEN2A. The novel variants in SLC12A3 may be disease causing, but it is not significantly related to the clinical phenotype of MEN2A in our study.

Conclusions:

RET gene mutation affect the penetrance of MEN2A. The novel variants in SLC12A3 may affect the function of protein, but it is not significantly related to the clinical phenotype of MEN2A.We need more studies about the phenotypes and related mechanisms of gene mutations to guide individual treatment.