bluuebunny/crossref_metadata_2025 huggingface dataset:
Isolated diastolic hypertension is not a benign situation regarding hypertension mediated organ damage in patients with first diagnosed and never treated essential hypertension
Authors: Triantafyllidi H , Birmpa D , Benas D , Fambri A , Schoinas A , Thymis I , Kostelli G , Ikonomidis I
Published: October 2022

Background

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

Methods

From 550 first diagnosed and never-treated hypertensive and non-diabetic patients, we studied 81 patients with IDH (mean age = 49±9, 63% males, 26% smokers) and 53 normotensives (mean age = 51±13, 30% males, 28% smokers). Office and ambulatory blood pressure monitoring (24h ABPM), CV risk factors [smoking, obesity (BMI), hyperlipidemia and HMOD [aortic stiffness (PWV), left ventricular diastolic dysfunction (EEa), cardiac mass (LVMI) and cardiac hypertrophy (LVH), coronary arteries microcirculation (CFR), carotid intima-media thickness (cIMT) were estimated in each hypertensive patient as well as normotensive subject.

Results

IDH patients had similar age, BMI, lipid profile, central systolic BP and smoking habit, and increased systolic (139±12 vs. 133±18, p=0.03), diastolic (89±9 vs. 84±9 mmHg, p=0.02) and mean office BP (106±9 vs. 82±9 mmHg, p<0.001) as well as 24h systolic (125±3 vs. 119±6 mmHg, p<0.001) and diastolic ABPM (84±4 vs. 73±4 mmHg, p<0.001) compared to normotensives. Regarding HMOD, IDH patients had LVH in 7/81 (9%). Increased LVMI (79±18 vs. 69±18 g/m2, p=0.01) and IMT (0.9±0.2 vs. 0.8±0.1 mm, p=0.01) but similar PWV, E/Ea and CFR were found compared to normotensives. In multiple regression analysis (age and weight were used as independent variables), LVMI was independently related to office systolic (Beta=0.26, p=0.02) and diastolic BP (Beta=0.28, p=0.01) as well as central diastolic BP (r=0.38, p=0.04) while no relationship was found between LVMI and 24h ABPM.

Conclusions

The presence of HMOD in IDH in first diagnosed and never treated patients with arterial hypertension underscores the need for antihypertensive treatment (life style changes and medication). As HMOD may regress with successful antihypertensive treatment, there is still time for physicians to reduce future CV events in those patients.

Funding Acknowledgement

Type of funding sources: None.
Sympathetic nervous system activity and unattended blood pressure measurement
Authors: Manta E , Andrikou I , Dimitriadis K , Drogkaris S , Siafi E , Filippou C , Tatakis F , Thomopoulos C , Konstantinidis D , Tsioufis K
Published: October 2022

Background/Introduction

Sympathetic nervous system activation plays a crucial role in the pathophysiology and variability of hypertension. It has been hypothesized that measurement of unattended blood pressure (BP) may provide additional information to conventionally attended BP measurement, as it can lead to the limitation of the white coat effect.

Purpose

The aim of this study was to demonstrate the relationship of sympathetic nervous system activation and BP measurement variations with and without medical supervision.

Methods

We studied 103 untreated hypertensive patients, who underwent muscle sympathetic nerve activity (MSNA) estimation by microneurography. Both unattended (patient alone in the room, an oscillometric device programmed to perform 3 BP measurements at 1-minute intervals, after 5 minutes of rest) and attended BP measurements were conducted in all participants, with the same device, on the same day of MSNA recording in random order. Patients were divided into two groups based on the difference between attended and unattended BP. In group A, patients had unattended BP greater than attended BP (n=31) and in group B, patients had unattended BP lower than attended BP (n=72). The two groups were compared regarding the median value of MSNA recordings in our population (median MSNA = 63 bursts per 100 heartbeats).

Results

The two groups did not differ as regards both attended SBP levels (group A: 142.3±15.4 mmHg, group B: 145.6±13.7 mmHg, p=0.29) and attended DBP levels (group A: 89.2±9.8 mmHg, group B: 91.2±11.5 mmHg, p=0.25). A difference was observed concerning unattended SBP levels (group A: 152±16.3 mmHg, group B: 142.5±13.8 mmHg, p=0.03) and unattended DBP levels (group A: 94.4±10.3 mmHg, group B: 85.2±11.8 mmHg, p<0.01). Higher levels of MSNA were recorded in patients in group A when compared to group B, although this difference was not statistically significant (66.8±15.6 vs. 61.6±14.8 bursts per 100 heartbeats, p=0.11). Higher percentage of patients in group A had MSNA levels greater than the median value of MSNA compared to group B (68% vs 46% respectively).

Conclusions

In the present study, we found that the majority of patients who exhibit higher BP during the unattended measurement also record high MSNA values, suggesting a more stimulated sympathetic nervous system. On the contrary, most of the patients who can calm down during the unattended measurement exhibit lower levels of MSNA. More patients are needed to fully determine the clinical significance of this observation.

Funding Acknowledgement

Type of funding sources: None.
Inter-field strength agreement of left atrial assessment at 1.5T and 3T
Authors: Alfuhied A , Ayton S , Gulsin G S , Parke K S , Wormleighton J V , Moss A , Graham-Brown M P M , Arnold J R , McCann G P , Singh A
Published: October 2022

Background

The agreement of left atrial (LA) volumetric and strain parameters between 1.5 and 3-tesla cardiovascular magnetic resonance (CMR) is not known. We aimed to investigate inter-field strength agreement of LA measurements in healthy volunteers scanned at both field strengths on the same day.

Methods

22 healthy volunteers were prospectively recruited and randomized to undergo scanning at either 1.5T or 3T first, immediately crossing over to the other field strength and scanned by the same radiographer. Steady-state free precession cines were analyzed blinded using Medis Suite. LA volumes and LA emptying fraction (LAEF) were calculated using the biplane area length method. LA strain (LAS) was assessed on 4- and 2-chamber and average values were calculated for LA reservoir, conduit, and booster pump function. Data were compared with paired t-tests and agreement was assessed by Bland-Altman plots and intra-class correlation coefficients (ICC).

Results

The median age was 32.5 (IQR 27.5, 42.5) and 45% were male. Key results are shown in the table and figure. There were no significant differences in the LA volumetric or strain mean values between 1.5T and 3T, although Bland-Altman analysis demonstrated a slightly positive bias at 1.5T for LAVmax, LAEF and LAS parameters. The inter-field strength agreement was excellent for LA volumes, reservoir and conduit strain (ICC >0.85, p<0.001), whilst LAEF showed good agreement (ICC=0.77, p=0.001). LAS at booster pump showed poor agreement, with the lowest ICC. The limits of agreement on Bland-Altman analysis were comparable for LAEF and LAS at reservoir.

Conclusion

There was excellent inter-field strength agreement for LA volumes, reservoir and conduit strain, suggesting that measurements can be used interchangeably between field strengths. Booster pump LAS had poor agreement, which is likely due to the fact that this measurement is less reproducible than volumes and reservoir/conduit LAS.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): National Institute for Health Research (NIHR)
High-normal blood pressure in midlife is a stronger predictor for development of hypertension in women than in men
Authors: Ohldieck A E , Kringeland E , Midtbo H , Tell G S , Gerdts E
Published: October 2022

Background

Identification of modifiable risk factors in midlife may optimize prevention of hypertension. Sex differences in the multifactorial development of hypertension is not well understood.

Purpose

To explore the associations of health factors in midlife, with incident hypertension 26 years later, in women and men.

Methods

In the community-based Hordaland Health Study (HUSK) 1025 women and 703 men were examined at age 42 years (baseline) and re-examined after 6 and 26 years. Patients with hypertension at baseline were excluded. Attended blood pressure (BP) was measured in triplets. High-normal BP was identified as BP 130–139/85–89 mmHg. Incident hypertension was identified as BP ≥140/90 mmHg or patient reported use of antihypertensive drugs on the last study visit. The association of health factors at baseline and changes during midlife, with incident hypertension at follow-up were explored in sex specific multivariable logistic regression analyses. Models were adjusted for baseline body mass index (BMI), high-normal BP, heart rate, physical activity, daily smoking, education, serum cholesterol, and serum triglycerides. Results are presented as odds ratios (OR), 95% confidence intervals (CI) and p-values.

Results

At baseline, average BP was 119/73 mmHg in women and 126/76 mmHg in men (p<0.001). A high-normal BP was found in 26% of women and 47% of men (p<0.001). After 26 years of follow-up, 39% of women and 45% of men had developed hypertension (p<0.05). In multivariable logistic regression analyses, high-normal BP at baseline, was the strongest predictor of incident hypertension in both sexes, but significantly stronger in women (OR 4.8, 95% CI 3.4–6.9) than in men (OR 2.1, 95% CI 1.5–2.8), p<0.01 for sex interaction (Table 1). Increase in BMI from first to second study visit was significantly associated with incident hypertension in both sexes (both p<0.01). And an increase in serum triglycerides from first to second visit was significant only in women (p<0.05).

Conclusions

High-normal BP in midlife was a particularly strong risk factor for development of hypertension later in life and significantly stronger in women. An increase in BMI in midlife was associated with incident hypertension but did not differ between sexes. Awareness of sex differences in modifiable health factors in midlife enable improved prevention of hypertension.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): University of Bergen
Microcirculation and blood pressure/heart rate response during exercise stress testing in hypertensive patients
Authors: Liatakis I , Konstantinidis D , Tatakis F , Drogkaris S , Zamanis I , Kariori M , Polyzos D , Siafi E , Thomopoulos C , Kakouri N , Andrikou I , Dimitriadis K , Tsioufis K
Published: October 2022

Background/Purpose

A hypertensive response during exercise has been associated with adverse cardiovascular outcomes in general population and hypertensive patients. On the other hand, microcirculation is the major site of control of vascular resistance and thus has a key role in the etiopathogenesis of hypertension. The aim of our study was to investigate the presence of a possible correlation between blood pressure and heart rate response during exercise with a microcirculation index (capillary rarefaction) in a cohort of hypertensive patients.

Methods

We studied 105 untreated patients with stage I-II essential hypertension (70% men, mean age: 59.5 years, mean office blood pressure: 150/92mmHg). Patients with diabetes mellitus, secondary hypertension, atherosclerotic cardiovascular disease, heart failure, significant chronic renal or pulmonary disease and any other systemic illness or orthopedic problems that would not allow maximal effort on a treadmill were excluded. All participants underwent maximal exercise testing, using the Bruce protocol, as well as nail-fold videocapillaroscopy assessment by using VideoCap 3.0 videomicroscope.

Results

A significant negative correlation between diastolic BP at minute-1 of the recovery phase and capillary density expressed in capillaries/mm was revealed (Pearson's r=−0.365, p=0.043). A significant negative correlation was also observed between capillary density and peak heart rate (Pearson's r=−0.364, p=0.024) as well as between heart rate increase from stage 1 to 2 and capillary density (Pearson's r=−0.746, p=0.013).

Conclusions

Our study shows that in a small cohort of hypertensive patients, capillary rarefaction was associated with a steeper increase in heart rate during exercise, as well as with a higher peak heart rate and higher diastolic blood pressure values during the recovery phase. These findings suggest that new indices such as capillary rarefaction may provide insights into possible autonomic dysfunction and could also be taken into account in the assessment of hypertensive patients.

Funding Acknowledgement

Type of funding sources: None.
Association between nocturnal blood pressure dipping and chronic kidney disease
Authors: Motiejunaite J , Alencar De Pinho N , Arnoult F , Vrtovsnik F , Tabibzadeh N , Flamant M , Vidal-Petiot E
Published: October 2022

Introduction

Management of blood pressure (BP) in chronic kidney disease (CKD) is critical for preventing cardio-renal complications. While increasing attention has been given to discrepancies between office and ambulatory BP control in this population, information on nocturnal BP decrease patterns (dipping) in CKD is still scarce.

Purpose

We aimed at describing nocturnal BP dipping patterns and its predictors in patients with CKD.

Methods

We analysed data from patients with CKD stages 1 to 5 referred for kidney function testing from September 2006 to January 2022, including 24-hour urine collection, gold-standard measurement of glomerular filtration rate (GFR) using clearance of a radioisotopic tracer, as well as ambulatory BP measurement (ABPM) in a single tertiary hospital in Paris, France. A total of 1177 ABPM were available in 642 participants. The magnitude of dipping was calculated as the difference between day- and night-time systolic BP (SBP), in percentage of daytime SBP. Participants were then categorized as extreme-dippers (≥20%), dippers (10% to <20%), non-dippers (0% to <10%), or reverse-dippers (<0%). Factors associated with a less than 10% dipping were analysed with crude and adjusted logistic regression models including a random intercept to deal with clustering of measurements within patients.

Results

Participants (mean age 56±15 years; 35% female, mean GFR 49±21 mL/min per 1.73 m2) consisted of 8% extreme-dippers, 37% dippers, 40% non-dippers, and 15% reverse-dippers. The prevalence of non- or reverse-dipping increased with CKD severity, from 36% in CKD stage 1 to 65% in CKD stages 4–5 (Figure). In crude analyses, African origin, a lower measured GFR, a higher daytime SBP, diabetes, a higher number of antihypertensive medications and a higher 24-hour urinary sodium to potassium ratio (24h Na/K) were associated with abnormal dipping status. In the multivariable adjusted regression, non or reverse dipping was independently associated with measured GFR (odds ratio [OR, 95% confidence interval] per 10 ml/min/1.73 m2 decrease = 1.16 [1.06–1.26], p=0.001), daytime ambulatory SBP (OR per 10 mmHg decrease = 1.17 [1.06–1.28], p=0.001), African origin (OR= 1.56 [1.04–2.34], p=0.03) and 24h Na/K (OR per 1-unit increase = 1.20 [1.06–1.37], p=0.006).

Conclusions

The prevalence of nocturnal non-or reverse dipping BP profiles increases substantially across the spectrum of CKD. Measured GFR, ambulatory daytime SBP, African origin and 24-hour urinary sodium to potassium ratio are independent predictors of abnormal nocturnal BP decrease and thus may help in cardiovascular risk stratification in this population. More research is needed on whether nocturnal dipping may be a treatment target to reduce cardiorenal complications.

Funding Acknowledgement

Type of funding sources: None.
Angiotensin receptor blockers are equally effective in women and men; a systematic review and meta-analysis
Authors: Laven S , Mohseni-Alsalhi Z , Meijs D , Vaes E , Wilmes N , Van Luik E , Vesseur M , De Haas S , Spaanderman M , Ghossein-Doha C
Published: October 2022

Background

Hypertension is the leading risk factor for cardiovascular disease (CVD) and is the most substantial and neglected health burden in women. While treatment of high blood pressure is essential in the global prevention strategies of CVD it is assumed that effectiveness of pharmacological treatment may be hampered by sex differences. However, it is still not known whether sex differences exist in the effect of the antihypertensive medications.

Purpose

To evaluate sex-stratified effects for angiotensin receptor blockers (ARBs) on blood pressure (BP) and cardiac function in female compared to male hypertensive participants.

Methods

A series of systematic reviews and meta-analysis was performed. PubMed and EMBASE were systematically searched for studies evaluating the effects of the five major groups of antihypertensive medication from 1945 to May 2020. Randomized control trials and observational studies in humans (≥18 years) were included investigating beta-blockers (BB), angiotensin converting enzyme inhibitors (ACE-I), angiotensin receptor blockers (ARB), calcium channel blockers (CCB), and diuretics. In this study data on ARB's was analyzed. Studies had to present both baseline and follow-up measurements of at least one of the outcome variables of interest and present their data in a sex-stratified manner. Data on BPand cardiac function where retrieved from studies. Risk of bias was assessed using the Cochrane risk of bias tool.

Results

The search strategy resulted in 73,867 hits. After first screening based on title and abstract, 15,130 articles where suitable for full test screening. After excluding all studies that matched the exclusion criteria, 205 studies with 15,570 participants where eligible for analysis for the five antihypertensive drugs. Studies investigating ARB's (n=17) where used in this review. Seven trials (41%) had a low risk of bias. ARB decreased BP significantly and comparably in both women and men. Systolic BP −18.2 mmHg (95% CI, −24.8 to −11.5) vs −20.1 mmHg (95% CI, −26.7 to −13.6) and diastolic BP −11.6 mmHg (95% CI, −14.7 to −8.4) vs −12.3 mmHg (95% CI, −16.4 to −8.1). LVEF did not change significantly in either group. LV mass was only reported in males and did not change significantly −11.8 g (95% CI, −25.6 to 1.9).

Conclusion

Our meta-analysis shows that based on the current studies, no sex differences exists in the effect of ARB on blood pressure or cardiac function.

Funding Acknowledgement

Type of funding sources: None.
Intensive reduction of high normal blood pressures: PRINT-TAHA9 randomized clinical trial
Authors: Attar A , Sayadi M , Borazjani R
Published: October 2022

Background

Currently, the best treatment strategy for patients with (Prehypertension) a high normal blood pressure (130 mmHg < systolic blood pressure [SBP]<140 mmHg) is controversial. While the ESC guideline does not recommend treating high normal blood pressure, the ACC/AHA recommends pharmacological treatments in these patients if the 10-year ASCVD risk is above 10%.

Purpose

We aimed to determine whether pharmacological reduction of SBP to a normal level (<120mmHg) would prevent cardiac morbidity and mortality in patients with high normal blood pressure levels.

Methods

We randomly assigned 466 persons with high normal blood pressure (130 mmHg < SBP<140 mmHg and a DBP<90 mm Hg) and an increased cardiovascular risk (10-year ASCVD risk ≥7.5%), but without diabetes, and apparent clinical cardiovascular diseases to standard treatment (n=235) which consisted of clinical follow up till SBP goes above 140 mmHg and then staring medications to keep SBP<140 mmHg or to the intensive treatment (n=231) receiving pharmacological SBP reduction to <120 mmHg upon enrollment. The primary composite outcome was myocardial infarction, stroke, heart failure, or death.

Results

Throughout the 1.66 years of follow-up, a primary outcome event was confirmed in 5 participants (0.13% per year) in the intensive-treatment group and 16 (0.39% per year) in the standard-treatment group (hazard ratio (HR), 0.31; 95% confidence interval [CI], 0.11 to 0.85; P=0.024). Rates of serious adverse events were not increased by intensive-treatment (HR, 1.78; 95% CI, 0.68 to 2.03; P=0.57).

Conclusion

Based on this clinical trial, intensive SBP reduction may probably be beneficial for primary prevention of cardiovascular morbidity and mortality in patients with high normal blood pressure level.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Shiraz University of Medical Sciences
Effect of blood pressure reduction on cardiovascular outcomes in patients with different baseline cardiovascular risk: systematic review and meta-analysis of randomized trials
Authors: Manta E , Thomopoulos C , Drogkaris S , Dimitriadis K , Polyzos D , Kariori M , Filippou C , Siafi E , Tatakis F , Konstantinidis D , Tsioufis K
Published: October 2022

Background/Introduction

Blood pressure (BP) lowering is accompanied by a reduction on cardiovascular (CV) outcomes and death in hypertensive patients. There is no data on the effect of lowering BP in patients stratified according to their baseline CV risk as indicated by SCORE 2.

Purpose

The aim of this meta-analysis was to demonstrate the impact of BP-lowering treatment on the occurrence of CV events in these previously reported patients.

Methods

A systematic review in electronic databases (Pubmed and CENTRAL, years: 1966 to 9/2021) was conducted to identify randomized trials that study the effect of BP-lowering treatment against placebo or less aggressive BP reduction on 6 fatal or non-fatal CV outcomes and all-cause death. Selected studies reported outcomes in patients without a history of previous CV disease. In each study, baseline cardiovascular risk was estimated using SCORE-2. Risk ratios (RR) were calculated together with their 95% confidence interval (CI) under the random-effects model.

Results

The analysis was composed of 54 studies, of which 12 trials included patients with low-to-moderate CV risk, (n=21,192 patients), 13 trials with high CV risk patients (n=66,886) and 29 trials with very high CV risk patients (n=79,061). For a standard SBP/DBP reduction of 10/5 mmHg, the relative risk of the combined outcome of major CV events (i.e., myocardial infarction, stroke, and heart failure) was decreased by 27% (95% CI, 22–35%) in the category of very high-risk patients. This reduction was significantly greater (p=0.02) compared to high-risk trials (0.90 [95% CI, 0.77–1.04]). CV death showed a significant reduction in the high-risk group of patients compared to the low-moderate risk group (p=0.005), as well as in the very high-risk group compared to the low-moderate risk group (p=0.001). The same pattern was observed for all-cause death in the very high-risk group compared to the high-risk group (p=0.045).

Conclusions

With the present meta-analysis, we observed that the greatest benefit from BP lowering in primary prevention in the occurrence of CV events and mortality is observed in patients at higher baseline cardiovascular risk, as calculated by the SCORE-2.

Funding Acknowledgement

Type of funding sources: None.
The differential effects of antihypertensive drugs on central blood pressure: nebivolol versus telmisartan (ATD-CBP)
Authors: Lim S , Yu C W , Kim J H , Cha J J , Kook H D , Joo H J , Park J H , Choi C U , Hong S J , Lim D S
Published: October 2022

Background

Central blood pressure and central pulse pressure have a better correlation with the risk of cardiovascular disease compared to those of peripheral measurement. In a previous study, a second-generation beta-blocker showed poor CBP-lowering effects. However, the effect on CBP by third-generation beta-blockers is not fully elucidated. Thus, this randomised study investigated whether nebivolol-based hypertension treatment may confer advantages over telmisartan, an angiotensin II receptor-blocker, in reducing CBP.

Methods

This was a prospective, randomised, multicentre, open-label, controlled trial that evaluated 98 hypertensive patients. Patients received either nebivolol- (N=49) or telmisartan-based (N=49) treatment for hypertension for 12 weeks with a target BP of ≤140/80. The primary outcome was the difference in change from baseline central systolic BP (cSBP) after 12 weeks.

Results

There were no significant differences between the two groups in baseline central and peripheral SBP. The mean change in cSBP from baseline (ΔcSBP) was −17.2±3 mmHg for nebivolol group (P<0.001) and −29.9±3 mmHg for telmisartan group (P<0.001). The difference in ΔcSBP between the two groups was significant (12.7mmHg, 95% confidence interval [CI], 4.13 to 21.2; P=0.004). Peripheral SBP (pSBP) decreased less in nebivolol group compared to telmisartan group (−18.0±3 in nebivolol group vs. −26.3±3 in telmisartan group, P=0.032). After adjusting for reduction in pSBP, reduction in cSBP was higher in telmisartan group compared to nebivolol group, as shown by the ratio of changes in cSBP and pSBP (ΔcSBP/ΔpSBP; 0.67 for nebivolol group vs. 1.11 for telmisartan group, P=0.080), albeit without statistical significance.

Conclusions

Nebivolol-based hypertension treatment may have less potent CBP-lowering effects compared to telmisartan. However, larger-scale studies are warranted to further elaborate our findings.

Funding Acknowledgement

Type of funding sources: None.
Age-related differences in longitudinal associations between alcohol intake and arterial stiffness, pressure wave reflection, and inflammation in male employees
Authors: Takahashi T , Shina K , Nakno H , Fujii M , Iwasaki Y , Matsumoto C , Yamshina A , Tomiyama H , Chikamori T
Published: October 2022

Backgrounds

While arterial stiffness and abnormal pressure wave reflection are independent cardiovascular risk, the difference of their association with alcohol intake have not been fully clarified.

Aim

This prospective observational study, which utilized repeated annual measurements performed over a 9-year period, applied mixed model analyses to examine age-related differences in longitudinal associations between alcohol intake and arterial stiffness, pressure wave reflection, and inflammation.

Methods

In 4016 middle-aged (43±9 years) healthy Japanese male employees, alcohol intake, brachial-ankle pulse wave velocity (baPWV), radial augmentation index (rAI), and serum C-reactive protein (CRP) levels were measured annually during a 9-year study period. Based on the questionnaire, alcohol intake was classified as non-drinker, mild-moderate drinker (ethanol 1–20 g/day) and heavy drinker (>20 g/day).

Results

The estimated marginal mean baPWV (non-drinkers = 1306 cm/s, mild-moderate drinkers = 1311 cm/s, and heavy drinkers = 1337 cm/s, P<0.01) and that of rAI showed significant stepped increases in an alcohol dose-dependent manner in the entire cohort, but an increase in rAI was not observed in subjects aged ≥50 years. The estimated slope of the annual increase in baPWV, but not rAI, was higher for heavy drinkers than for non-drinkers (slope difference, 2.73; P<0.01), especially for subjects aged <50 years. The estimated marginal mean of the serum CRP levels was lower for drinkers than for non-drinkers.

Conclusion

In middle-aged male Japanese employees, alcohol intake may attenuate inflammatory activity. While alcohol intake may exacerbate the progression of arterial stiffening in a dose-dependent manner without mediating inflammation, especially in subjects under 50 years of age, it may promote pressure wave reflection abnormalities with aging at earlier ages without further exacerbation at older ages.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Omroncarpis
Value of blood pressure measurement earlier versus later in life to predict cardiovascular mortality
Authors: Leiherer A , Ulmer H , Muendlein A , Saely C H , Fraunberger P , Mader A , Sprenger L , Maechler M , Vonbank A , Larcher B , Brozek W , Nagel G , Zitt E , Concin H , Drexel H
Published: October 2022

Hypertension is a potent risk factor for cardiovascular morbidity and mortality. High blood pressure (BP) correlates closely with all-cause and cardiovascular mortality.

The purpose of this study was to compare the value of systolic blood pressure earlier versus later in life to predict cardiovascular mortality.

In a cardiovascular observation study (OS) we prospectively recorded fatal cardiovascular events over up to 19 years in 1282 patients of whom 570 had the Metabolic Syndrome (MetS) at baseline. These patients had participated in a health survey (HS) 15 years prior to the OS baseline. BP was measured both at the HS and at the baseline of the OS.

We found that the increase in cardiovascular mortality matched the increase of BP in the HS in a linear way but this is not the case for BP assessed at the OS (figure). A cox regression analysis revealed that each millimeter of mercury (mm Hg) increased the risk for cardiovascular death by 2% (HR = 1.02 [1.01–1.03], p<0.001). Applying a stratification for the presence of MetS, we found that in both groups BP was a significant predictor of cardiovascular mortality (HRMetS = 1.02 [1.01–1.02], p<0.001 and HRnoMetS = 1.02 [1.01–1.03], p<0.001). In contrast, BP as measured at the baseline of the OS was not significantly associated with cardiovascular death during follow-up neither in the total population nor in any subgroup (HR = 1.00 [0.99–1.01], p=0.652; HRMetS = 1.00 [0.99–1.01], p=0.468 and HRnoMetS = 1.00 [0.99–1.01], p=4.66).

We thus conclude that BP assessed earlier in life is a better predictor of cardiovascular mortality than BP assessed later in life.

Funding Acknowledgement

Type of funding sources: None.
Totum-854 reduction of blood pressure is associated with tissue remodeling in aorta and heart of SHR rat
Authors: Ripoche D , Michaux A , Pialoux V , Vallier M , Langhi C , Chavanelle V , Otero Y F , Peltier S , Sirvent P
Published: October 2022

Introduction and purpose

Arterial Hypertension (AHT) is a major cause of premature death worldwide. We have developed Totum-854 (T-854), a polyphenol-rich botanical composition to reduce the risk of developing AHT. We assessed the acute and chronic effects on blood pressure in spontaneous hypertensive rats (SHR).

Method

Acute protocol: 12-week-old SHR rats received randomly in a cross-over design, a dose of vehicle (VEH, 1% Tween 20), Captopril (50mg/kg) and T-854 (1250mg/kg) per os with at least 48h-wash-out interval between two gavages. Arterial pressure was recorded during 24h post-gavage, thanks to a radio-telemetry device (HD-S10, DSI) directly into the abdominal aorta. Baseline arterial pressure was measured before oral gavage during 90 min.

Chronic study

18-week-old SHR rats received vehicle (VEH, 1% Tween 20) or T-854 (1000mg/kg) per os once a day for 8 weeks. Arterial pressure was recorded before the oral gavage for 90 min once a week with a radio-telemetry device (HD-S10, DSI). Delta (Δ) SBP and ΔDBP were calculated by subtracting baseline blood pressure (before the start of oral gavage) to measured blood pressure every week. At the end of supplementation, rats were euthanized, and aorta and heart were sampled. Aorta was embedded in paraffin and Masson's trichrome staining was performed in slides obtained by a microtome. Media thickness was measured with ImageJ. For the heart, mRNA was extracted using Trizol and cardiac hypertrophy/fibrosis gene expression was evaluated by RT-qPCR.

Results

Acute supplementation with T-854 exhibited an intermediate profile between VEH and Captopril response for change in SBP and DBP curves. SBP and DBP were reduced in comparison to VEH with 24h-AUC decreased by 93.6±67.8 mmHg h and 70.8±54.6 mmHg h for captopril and T-854, respectively.

When T-854 was administered chronically during 8 weeks, ΔSBP and ΔDBP evolution were significantly different in comparison to VEH group (p<0.05). These curves were maintained under vehicle curves from the 2nd week of supplementation and until the end of the study. After 8 weeks of T-854 supplementation, tissue analysis showed a decrease of 10% on the aorta media thickness in T-854 supplemented rats (p<0.05). Cardiac MMP-2 gene expression was also lower in T-854 group compared to VEH (p=0.059).

Conclusion

T-854 24h-post-gavage acute effect on blood pressure in hypertensive SHR rats suggests a rapid effect, with a decrease in blood pressure few hours after oral administration. Moreover, chronic T-854 supplementation prevents AHT development in SHR. In conclusion, T-854 appears as an efficient strategy to prevent HTA suggesting also a protective role of T-854 on vascular and heart structure and function.

Funding Acknowledgement

Type of funding sources: None.
Long-term decline of renal function in patients with resistant and non-resistant arterial hypertension
Authors: Ramik Z , Vaclavik J , Kocianova E , Kamasova M , Kvapil T , Jelinek L
Published: October 2022

Background

The negative effect of arterial hypertension on renal function is well known. Until present, the detrimental effect of resistant arterial hypertension (RAH) on kidneys was not clearly defined.

Purpose

To assess the deterioration of renal function in patients with RAH in comparison to patients with non-resistant arterial hypertension (AH) during a long term follow-up.

Methods

We retrospectively reviewed records of 307 patients followed between May 2007 and January 2019 in an Hypertension Excellence Centre of a tertiary hospital. In all patients we assessed basic demographic characteristics, co-morbidities, laboratory findings, secondary causes of AH, medication, blood pressure including ambulatory blood pressure monitoring, studies and invasive procedures (CT, MRI, coronarography). We statistically evaluated differences in both groups and compared the decline of renal function.

Results

160 patients had resistant and 147 patients non-resistant hypertension. Patients were followed for a mean of 6 years. Patients with RAH were older (58.1±10.8 years vs. 51±13 years), more frequently diabetics (39.3% vs. 8.7%), had more frequent exposure to diagnostic studies and invasive procedures (86,5% vs. 64%).

Age at baseline visit and diabetes mellitus were established as statistically significant independent risk factors. Linear mixed effect model adjusted to age and diabetes demonstrated that patients with RAH have increased decline of renal function than patients with AH: patients with AH had mean increase of creatinine +0.24 μmol/l per year, while patients with RAH + 2.12 μmol/l per year (P=0.005). Similarly the decrease of eGFR in patients with AH was −0.66 compared to −1.5 mL/s/1.73 m2 per year in patients with RAH (P=0.005).

Figures 1 and 2 show the difference in mean slope of creatinine and eGFR in patients with resistant and non-resistant hypertension (based on linear mixed effect models)).

Conclusion

Patients with resistant hypertension had faster decline of renal function in comparison to patients with non-resistant hypertension independently on age and diabetes. Further studies are needed to determine the key factors affecting renal function decline in both subgroups.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): University Hospital Olomouc, Palacky University Olomouc, Faculty of Medicine, Czech Republic
Pericardial fat from a single horizontal long axis cardiac magnetic resonance cine image: a validation study against three-dimensional cardiac computed tomography
Authors: Zamani S K , Aldiwani H , Razipour A , Wei J , Kwan A C , Berman D S , Dey D , Bairey Merz C N , Nelson M D
Published: October 2022

Background

Excess fat accumulation around the heart (i.e., pericardial fat) is positively associated with cardiovascular disease. Pericardial fat is composed of two distinct depots: (1) epicardial fat, which is a metabolically active adipose tissue located between the heart and the pericardium, and (2) paracardial fat, which is the fat deposit in the mediastinum outside of the parietal pericardium. Both depots are visible on the horizontal long axis cardiac magnetic resonance (CMR) cine (i.e., four chamber view), offering an attractive opportunity to quantify pericardial fat from standard CMR cine images.

Purpose

To validate pericardial fat area measured from a single horizontal long axis CMR cine against whole-heart volumetric non-contrast cardiac computed tomography (CT) measurements.

Methods

To accomplish our goal, we leveraged 25 cases from the Women's Ischemia Syndrome Evaluation – Coronary Vascular Dysfunction Continuation cohort who underwent both cardiac MRI and cardiac CT within a median of 35 days apart. For MRI, pericardial fat area was measured from a single high resolution steady state free precession cine image in the horizontal long axis imaging plane using commercially available software (CVI42 V5.13.5, Circle Cardiovascular Imaging, Figure 1A). For CT, pericardial fat volume was measured using a fully automated deep learning algorithm (QFAT 2.0, Figure 1A).

Results

Fat area measured from a single horizontal long axis cine image was closely related to fat volume measured by three-dimensional cardiac CT, with strong correlations for epicardial fat (R2=0.72, p<0.01, Figure 1B), paracardial fat (R2=0.80, p<0.01, Figure 1C), and pericardial fat (R2=0.91, p<0.01, Figure 1D).

Conclusions

Measuring pericardial fat area, and its constituent parts, from a single horizontal long axis cine image is both feasible and strongly related to reference standard pericardial fat volume by cardiac CT.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): National Institutes of Health
Statins benefit in androgen levels and target organ damage in hypertensive males with erectile dysfunction
Authors: Angelis A , Aggeli K , Dimitroglou I , Aznaouridis K , Ioakeimidis N , Georgakopoulos C , Zisimos K , Koukos M , Verveniotis A , Synodinos A , Lekoudi E , Alexopoulou K , Tsiamis E , Vlachopoulos C , Tsioufis K
Published: October 2022

Background

Statins may benefit cardiovascular physiology by cholesterol independent or pleiotropic actions. Target organ damage (TOD) amplifies cardiovascular risk in essential hypertension and endogenous testosterone (TT) exhibit vasoprotective effects. Erectile dysfunction (ED) is frequent in hypertensive middle aged men when androgen levels typically fall, impairing thus quality of life.

Purpose

To investigate the effect of statins in TT and TOD in hypertensive middle aged men with ED, independently of cholesterol levels.

Methods

248 hypertensive ED males (mean age: 57 yo) with no history of diabetes mellitus or overt cardiovascular disease enrolled the study. Of those 95 (38%) were on statin therapy for treatment of dyslipidemia. There were all screened for the presence of microalbuminuria, defined as urinary albumin loss 30–300 mg in a 24 h urine volume collection. TT, total cholesterol (Tchol) and low density lipoprotein (LDL) levels were measured on blood samples taken before 09:00 am. All individuals underwent a non invasive evaluation of the carotid-femoral pulse wave velocity (PWV), estimation of central pressures and augmentation index (AIx) a parameter of wave reflection amplification (Sphygmocor device). ED severity was assessed by the SHIM-5 score (range: 0–25) and higher values indicate a better erectile ability.

Results

In bivariate analysis statin use was positively related to TT (p<0.05 – Figure 1) and negatively to microalbuminuria, Tchol and LDL (p<0.005). Moreover TT was negatively related to PWV, AIx, microalbuminuria (all p<0.005) and positively to the SHIM-5 score (p: 0.003). By linear regression analysis association of TT to statins remained significant after correction for age, BMI, PWV, AIx, Tchol and LDL levels.

Conclusions

Statin therapy benefits endogenous testosterone in hypertensive middle aged men with ED and so lessens TOD and enhances erectile ability independently of cholesterol levels. In such population group pleiotropic effects of statins may help restoring androgen levels, decrease cardiovascular risk and ameliorate quality of life.

Funding Acknowledgement

Type of funding sources: None.
Increased cancer incidence in children after cardiac catheterization within the first 8 years of life, a single center experience between 1999 and 2013
Authors: Scholtissek H , Sheho N , Spix C , Kretschmer A , Hager A , Ewert P , Meierhofer C , Stern H
Published: October 2022

Background

Children with congenital heart disease are exposed to ionising radiation early in their lives when tissue sensitivity for radiation is highest. This might provoke DNA fractures and cancer development. Our first study with an observation period from 1980–1998 showed a 4.4-fold increased cancer risk for children who had at least one cardiac catheterization in the first year of life.

Objectives

This study aimed to reassess the risk of cancer for children who underwent at least one cardiac catheterization between 1999 and 2013 with a follow-up of seven years.

Methods

This retrospective, single-center study included 2765 children who underwent at least one cardiac catheterization before eight years of age between January 1999 and December 2013. 1688 received their first cardiac catheterization in the first year of life, 1074 between first and eighth year of life. Catheterization and patient data were obtained from our database, and cancer diagnoses up to age 15 were matched with German Childhood Cancer Registry. For each tumor patient and for each of the 60 randomly selected control patients cumulative effective radiation doses were calculated.

Results

37667.16 person-years were evaluated. A total of ten patients developed a malignant tumor, while 5.82 were expected (SIR 1.72; CI 0.82–3.16; p=0.0722). Eight of these ten tumors developed in patients who received their first cardiac catheterization in the first year of life, while 3.99 were expected (SIR 2.0; CI 0.71–3.62; p=0.1095). The cancer group performed an average of 3.7 cardiac catheterizations per patient, with a mean cumulative effective dose of 24,79mSv. In the control group consisting of 60 patients, 2.1 cardiac catheterizations were performed per patient with an average cumulative effective dose of 21.04mSv. Three of the ten tumor patients have chromosomal abnormalities. The cancers observed are two leukemia, two lymphoma, two CNS tumors, one osteosarcoma, two nephroblastoma and one hepatoblastoma.

Conclusion

There is still an increased risk of cancer development for children with congenital heart disease exposed to ionizing radiation early in life. However, due to technical development and increased sensitivity to this fact, we observed a decrease in cancer disease compared to our previous study with catherization between 1980 and 1998.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Stiftung Kinderherz
Epicardial adipose tissue of atrioventricular grooves is a reliable and early MRI biomarker of the effect of metabolic diseases on atrial myocardium
Authors: Bialobroda J , Bouazizi K , Zarai M , Kachenoura N , Clement K , Aron-Wisnewsky J , Hatem S , Redheuil A
Published: October 2022

Introduction

Epicardial adipose tissue (EAT), the visceral adipose tissue surrounding the heart, is implicated in a host of cardiovascular diseases playing a transducer role between systemic metabolic conditions and the myocardium, as illustrated by higher risk of atrial fibrillation in patients with diabetes or obesity. MRI affords comprehensive and non-invasive insights into myocardial structure, function and tissue properties. However, the clinical usefulness of whole atrial EAT is limited by its challenging measurability in clinical routine in several imaging modalities, including MRI.

Purpose

We hypothesized that atrioventricular groove epicardial adipose tissue (GEAT) which can be measured routinely based on established anatomic landmarks may be: 1) a relevant surrogate of atrial EAT and 2) a relevant imaging biomarker to characterize atrial alterations in patients with varied degrees of metabolic disorders.

Methods

Ninety-nine patients from the METACARDIS cohort (EU FP7) who had MRI, all in sinus rhythm and without overt clinical heart disease, were divided into 4 groups based on distinct metabolic profiles: metabolic syndrome (MS, n=24), severe obesity (SO, BMI ≥35 kg/m2, n=17), type-2 diabetes (T2D, n=41) and healthy controls (n=17). Atrioventricular groove EAT volume was measured from cine SSFP MRI images in four-, three-, two-chamber and short-axis views; atrial EAT volume was measured from four- and two-chamber views. Native T1-mapping values of EAT at the anterior atrioventricular groove excluding the coronary vessels were measured from the MOLLI sequence (basal short-axis slice).

Results

We found a high correlation between GEAT and atrial EAT volumes (r=0.96; p<0.0001) indicating that GEAT may reflect global atrial EAT volume. Next, we compared GEAT volume across study groups and found an increased GEAT volume in the 3 groups of patients with metabolic diseases compared to controls, with a significantly higher volume in MS (4.7±1.5 ml), SO (4.1±1.2 ml), and T2D (3.7±1.1 ml) than in Controls (2.6±0.6 ml; p≤0.001, p≤0.01, p≤0.05, respectively). In addition, T2D patients had lower native T1 values within GEAT compared to healthy controls (250±26 ms versus 280±31 ms; p≤0.01).

Conclusion

Atrioventricular groove EAT can be easily measured from conventional cine SSFP MRI images and could be used as a surrogate of global atrial EAT. Both volume and properties of GEAT are related to the metabolic status of patients. Furthermore, given its pure epicardial origin and pericoronary distribution, GEAT appears as a relevant biomarker of metabolic impacts on atrial myocardium.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Annee-recherche, Agence Regionale de Sante Ile-de-France