bluuebunny/crossref_metadata_2025_split huggingface dataset:
CENTRAL SYSTOLIC PRESSURE AND EXECUTIVE FUNCTION IN CHILDREN AND ADOLESCENTS WITH PRIMARY AND SECONDARY HYPERTENSION
Authors: Stabouli Stella , Chrysaidou Katerina , Kotsis Vasilios , Chainoglou Athanasia , Gidaris Dimos , Zafeiriou Dimitrios 
Published: April 2021

Abstract

Objective:
The aims of the present study were to assess executive function performance in children and adolescents with primary and secondary hypertension and to investigate for associations with central systolic pressure and mean ambulatory blood pressure (BP) levels.

Design and method:
The study population included 46 pediatric patients with secondary hypertension, and 46, age and sex matched, patients with primary hypertension who underwent ambulatory BP monitoring, pulse wave analysis, and assessment of executive function using Behavior Rating Inventory of Executive Function (parent version, BRIEF, and self-reported version, BRIEF SR).

Results:
Patients with secondary hypertension had higher T scores in BRIEF parent metacognition (MI) (51.19 ± 8.92 vs. 47.56 ± 7.49, p < 0.05), and BRIEF-SR MI scales (49.62 ± 9.08 vs. 42.09 ± 7.88, p = 0.001) compared to primary hypertensives. The groups did not differ in means of BRIEF parent and BRIEF-SR Behavior Regulation Index (BRI) T scores, as well as day and night mean arterial pressure (MAP) z scores, prevalence of ambulatory hypertension, and pulse wave velocity (PWV) z score. However, those with secondary hypertension tented to have higher central systolic pressure (cSP) z scores (p = 0.053), and lower body mass index (BMI) z score (p < 0.001). In the ANCOVA analysis cSP z score was associated with BRIEF parent MI (B = 0.95, 95%CI 0.02–1.87, p < 0.05), and BRI T scores (B = 1.14, 95%CI 0.07–2.21, p < 0.05), and BRIEF-SR MI T score (B = 1.481, 95%CI 0.393–2.569, p < 0.05), independent of night MAP z score, age, sex, SES, hypertension group (primary/secondary), and antihypertensive treatment (yes/no).

Conclusions:
Central systolic pressure associates with executive function performance in hypertensive youth independent of hypertension etiology and seems to have pivotal role in the lower metacognition scores in the secondary hypertension group.
FETUIN A DEFICIENCY IS ASSOCIATED WITH ARTERIAL DAMAGE IN PEDIATRIC PATIENTS WITH PRIMARY HYPERTENSION
Authors: Skrzypczyk Piotr , Stelmaszczyk-Emmel Anna , Szyszka Michal , Ofiara Anna , Panczyk-Tomaszewska Malgorzata 
Published: April 2021

Abstract

Objective:
Circulating calcification inhibitors: fetuin A (FA) and osteoprotegerin (OPG) together with soluble ligand of the receptor activator of nuclear factor kappa-B (sRANKL) have been linked to vascular calcifications and subclinical arterial damage. The aim of the study was to evaluate the relationship between FA, OPG, sRANKL and arterial damage in children with primary hypertension (PH).

Design and method:
We performed cross-sectional analysis of FA, OPG, sRANKL, peripheral and central blood pressure (BP), ambulatory blood pressure monitoring (ABPM), parameters of arterial damage including common carotid artery intima media thickness (cIMT), pulse wave velocity (PWV), augmentation index normalized to heart rate of 75 beats per minute (AIx75HR) and ECHO-tracking (ET) analysis of carotid artery stiffness in 60 patients with PH (age: 14.84 ± 3.05 years) and 20 healthy children (age 14.11 ± 2.99 years).

Results:
Children with PH had significantly higher peripheral and central BP, BP in ABPM, thicker cIMT, higher PWV, and AIx75HR. FA was significantly lower in patients with PH compared to healthy peers (340.57 ± 70.43 vs. 389.19 ± 99.22 [mg/mL], P = 0.019) without differences in OPG, sRANKL, and OPG/sRANKL and OPG/FA ratios. In children with PH, FA level correlated negatively with cIMT Z-score and ET AIx; sRANKL level correlated negatively with ABPM, systolic blood pressure (SBP), SBP load, diastolic BP load, and AIx75HR; OPG/sRANKL ratio correlated positively with SBP load, while OPG/FA ratio correlated positively with ET AIx. In multivariate analysis FA was a significant determinant of cIMT [mm] and cIMT Z-score (beta = -0.208, 95%CI (-0.407 - -0.009), P = 0.041 and beta = -0.224, 95%CI (-0.435 - -0.013), P = 0.038, respectively).

Conclusions:
In children with PH arterial damage is related to fetuin A deficiency.
AN UNUSUAL CASE OF ACUTE MITRAL REGURGITATION WITH LUPUS NEPHRITIS AND EXTRA PULMONARY TUBERCULOSIS
Authors: D'souza Monisha , R. Arunachalam 
Published: April 2021

Abstract

Objective:
Systemic lupus erythematosus belongs to the group of autoimmune disorders which can affect multiple organ systems of the body during its chronic course. It is commonly associated with cardiac manifestations. The characteristic abnormalities among cardiac lesions include Libman-
Sacks endocarditis and pericarditis, while myocarditis is relatively uncommon. Among valvular lesions, the most common complication is mitral valve regurgitation.

Design and method:
A 27 year old lady with systemic lupus erythematosus, on treatment since 1 year, was referred to our hospital with the suspicion of development of Lupus nephritis and tubercular pleural effusion. She was started on anti-tubercular therapy based on the pleural fluid analysis. As tuberculosis is prevalent in our country and her pleural fluid showed raised adenosine deaminase levels, anti-tubercular therapy was modified for renal safety but continued. Her previous reports showed the presence of subnephrotic proteinuria in urine for 6 months. She presented to the emergency department with complaints of breathlessness and chest discomfort. Her initial blood workup revealed new-onset derangement in renal parameters. Lupus nephritis was suspected.

Results:
She developed a worsening of breathlessness and was shifted to the ICU. She was given intravenous pulse steroids and monitored. Her renal dysfunction improved. She developed paroxysmal nocturnal dyspnoea with persistent tachycardia and tachypnea. A trans-thoracic echocardiogram was done which revealed a massive loculated pericardial effusion. She was conservatively managed and then shifted to the ward. After a few days, she developed sudden onset pulmonary edema and was shifted back to the ICU. Echocardiogram was repeated which showed new-onset acute severe mitral regurgitation with central jet. The patient was medically managed. Her symptoms improved and she was initiated on mycophenolate mofetil and discharged. Two months later she was admitted for renal biopsy. Lupus nephritis was confirmed. She is now on regular follow-up with significant clinical improvement.

Conclusions:
Systemic Lupus Erythematosus can involve multiple organ systems rapidly and simultaneously with a predisposition to developing other infections. This increases the risk of morbidity and mortality. Early diagnosis and timely initiation of therapy are essential in improving the survival outcomes of the patient.
IN-HOSPITAL BLOOD PRESSURE VARIABILITY AS A PREDICTOR OF LONG-TERM CARDIOVASCULAR MORTALITY IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION: ONE-YEAR FOLLOW-UP STUDY
Authors: Konstantinou K. , Tsioufis K. , Koumelli A. , Mantzouranis M. , Kolokathis K. , Milkas A. , Fragoulis C. , Kalos T. , Andrikou I. , Kasiakogias A. , Dimitriadis K. , Thomopoulos K. , Kouremeti M. , Tousoulis D. 
Published: April 2021

Abstract

Objective:
The impact of blood pressure variability (BPV) on cardiovascular morbidity and mortality has been examined through the prism of heart failure and hypertension, but not in the setting of myocardial infarction (MI). The aim of this study is to determine the association between in-hospital short-term BPV and long-term cardiovascular outcomes in MI patients.

Design and method:
A total population of 260 patients (82.2% male; mean age: 63.8 years;71.3% hypertensives, 48.1% STEMI)underwent 24-hambulatory BP measurement during hospitalization for MI. At one year a follow-up was scheduled in order to assesscardiovascular mortality. The parameters of BPV analyzed were: a) 24-h standard deviation (SD), b) the coefficient of variation (CV) and c) the average real variability (ARV) of systolic and diastolic BP.

Results:
Cardiovascular death was independently predicted by SD SBP (HR = 2.406; 95% CI: 0.865–3.947; P = 0.002)and CV SBP (HR = 3.093; 95% CI: 1.833–4.354; P < 0.001) in the entire population and separately in STEMI group[(HR = 5.485; 95% CI: 2.958–8.012; P < 0.001) and (HR = 5.521; 95% CI: 3.230–7.813; P < 0.001) respectively]but not in the NSTEMI one. ARV failed to predict mortality in either group or the entire population. Multivariate regression models were conducted for both SD SBP and CV SBP in the STEMI group,in which, both remained potent predictors of cardiovascular mortality independently ofgender, age, hypertension, DM, smoking, low density lipoprotein (LDL-C) andGFR[(HR = 6.131; 95% CI: 3.716–8.546; P < 0.001) and (HR = 5.870; 95% CI:3.609–8.131; P < 0.001) respectively].

Conclusions:
In the setting of MI, in-hospital BPV was associated with cardiovascular mortality during the one-year follow-up. These findingscould suggest a clinical need for further individualization of BP regulation in the integrative ACS management.
IMPACT OF ANGIOTENSIN-CONVERTING ENZYME INHIBITORS AND ANGIOTENSIN RECEPTOR BLOCKERS ON CORONARY HEART DISEASE EVENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF 299,871 PATIENTS
Authors: Alosaimi Manal , Roos Nur Aishah Che , Alnakhli Anwar Mansour , Cleland John , Padmanabhan Sandosh 
Published: April 2021

Objective:
To evaluate the effects of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-receptor blockers (ARBs) on risk of myocardial infarction (MI), angina & heart failure (HF) in patients with or at high-risk of cardiovascular disease (CVD).

Design and method:
A meta-analysis of randomized-controlled trials was performed. Bibliographic databases were searched until 31 July 2019 to identify all trials of ACEIs & ARBs versus control (placebo or active) & supported with head-to-head trials. Trials with at least 100 participants & at least one year's follow-up were eligible. Studies were excluded if they were redacted or combined ACEIs with ARBs. Outcomes were MI, angina pectoris & HF. Dichotomous data was analysed using risk ratio (RR) measure and its 95% confidence interval (CI) with random-effects model. A random-effects meta-regression analysis was performed to explore role systolic blood pressure (SBP) reduction achieved.

Results:
We identified 32 trials of ACEIs, 38 of ARBs compared with control & 8 direct comparison trials. Altogether, trials enrolled 299,871 patient-years of follow-up. Compared with control, ACEIs had a 16% lower MI risk (RR, 0.84; 95% CI, 0.79–0.90; p < 0.00001) & 17% lower HF (RR, 0.83; 95% CI, 0.76–0.92; p = 0.0003); while no such benefit was seen for angina (RR;1.02; 95% CI, 0.94–1.11; p = 0.63). ARBs was reduced risk of HF by 14% (RR, 0.86; 95% CI 0.81–0.91; p < 0.00001). While, no benefit was appeared with MI risk (RR,0.97; 95% CI 0.89–1.06; p = 0.55) & angina (RR, 0.99; 95% CI 0.88–1.11; p = 0.87). Trials comparing ARBs with ACEIs revealed no difference in outcomes. The meta-regression suggested that independently of BP reduction, ACEIs had a 11% lower MI (RR,0.89; 95% CI 0.81–0.98; p = 0.02) & ARBs provide a 15% reduction in HF (RR, 0.85; 95% CI 0.77–0.93; p = 0.001). Whereas, prevention of HF by ACEIs was explained mainly by SBP reduction achieved (p = 0.01).

Conclusions:
In patients with or at high-risk of CVD, ARBs and ACEIs reduced risk of HF. However, they did not appear to be case for angina. Moreover, ACEIs result in a further reduction of MI whereas ARBs had no such benefit. However, evidence from direct comparison trials suggests similar effects on all outcomes.
ISOLATED SYSTOLIC HYPERTENSION AND COMBINED SYSTOLIC-DIASTOLIC HYPERTEN-SION FOR PREDICTION OF NEW-ONSET DIABETES MELLITUS - DATA FROM A 8-YEAR-FOLLOW-UP STUDY
Authors: Tsioufis K. , Dimitriadis K. , Liatakis I. , Koutra E. , Leontsinis I. , Kouremeti M. , Iliakis I. , Karaminas N. , Thomopoulos K. , Tousoulis D. 
Published: April 2021

Objective:
Isolated systolic hypertension (ISH) and combined systolic-diastolic hypertension (CH) are related with increased cardiovascular risk, while new-onset diabetes mellitus (NOD) is linked with atherosclerosis progression. To compare the predictive role of ISH and CH for the incidence of NOD in a cohort of essential hypertensive patients.

Design and method:
We followed up 1435 non-diabetic essential hypertensives with office systolic blood pressure (BP)> or = 140 mmHg [mean age 57 years, 730 males, office BP=153/92 mmHg] for a mean period of 8 years. All subjects had at least one annual visit and at baseline underwent echocardiographic study and blood sampling for estimation of metabolic profile. Patients with baseline ISH exhibited office systolic BP > or =140 mmHg and office diastolic BP <90 mmHg, while those with CH had office systolic BP > or = 140 mmHg and office diastolic BP> or =90 mmHg. Moreover, NOD was defined if at one or more of the follow-up visits a previously non-diabetic patient reported being on insulin or an oral hypoglycemic drug or if casual plasma glucose concentration > or = 200 mg/dl or fasting glucose concentration > or = 126 mg/dl or 2-h post load glucose > or = 200 mg/dl during an oral glucose tolerance test.

Results:
The incidence of NOD over the follow-up period was 4.2% (n = 60). Patients with ISH (n = 460) compared to those with CH (n = 975) were older (65 ± 11 vs 54 ± 10 years, p < 0.0001), had at baseline lower waist circumference (94.5 ± 11 vs 99 ± 13 cm, p < 0.0001), office systolic BP (149 ± 12 vs 155 ± 13 mmHg, p < 0.0001), office diastolic BP (80 ± 8 vs 98 ± 6 mmHg, p < 0.0001), while did not differ regarding left ventricular mass index, glucose and lipid levels (p = NS for all). Univariate Cox regression analysis revealed that baseline ISH (hazard ratio = 2.143, p = 0.016) and CH (hazard ratio=1.272, p = 0.029) predicted NOD. However, in multivariate Cox regression model, CH did not turn out to be an independent predictor of NOD.

Conclusions:
In essential hypertensive patients, ISH but not CH exhibits independent prognostic value for NOD. These findings support that ISH constitutes a hypertensive phenotype of increased metabolic risk needing careful evaluation and treatment.
PREDIABETES IN NAÏVE GREEK HYPERTENSIVE PATIENTS
Authors: Papadakis J.A. , Papanikolaou K. , Theodorakopoulou V. , Papakitsou I. , Psicharaki F. , Vrentzos G. 
Published: April 2021

Objective:
Prediabetes subjects have increased risk for diabetes and cardiovascular disease. Aim of our study was to find the incidence of prediabetes, in naive hypertensives in Greece.

Design and method:
We studied 688 [304 (44.2%) were men] hypertensives, who were under neither antihypertensive nor lipid-lowering medications, and they were not diabetics. Their median age was 55 (range: 15–82) years. Prediabetes was defined by ADA criteria (fasting glucose: 100–125 mg/dl).

Results:
Two hundred forty five out of 688 patients (35.6%) met the criteria for prediabetes. It was more prevalent in males than in females (42.4% vs 30.2%, p = 0.001). On the contrary, there was no statistically significant difference in the age between the 2 groups.
Subjects with prediabetes had significantly higher body mass index (BMI) (31.5 + 5.8 vs 30.3 + 5.0; p = 0.01) when compared with the rest hypertensives.
Hypertensives with prediabetes had significantly higher systolic blood pressure (SBP) levels than the others (158.4 + 18.5 vs 155.2 + 18.6; p < 0.05), while there was no significant difference in diastolic blood pressure levels (95.0 + 11.0 vs 94.7 + 11.3; p = 0.70) between the 2 groups.
There was no significant difference in total, high density, and low density cholesterol and triglycerides serum levels between the two groups.
On the contrary hypertensives with prediabetes had significantly increased all liver functional tests than those without.

Conclusions:
Our results suggest that more than one third of naive hypertensives had prediabetes. These subjects had higher SBP levels and they were more obese. They had also increased liver functional tests, without any difference in their lipid profile.
QUINAPRIL AMELIORATES CARDIAC REMODELING IN DIABETIC RATS VIA SUPPRESSION OF EGR1 AND STAT3 ACTIVATION
Authors: Kökény Gábor , Fázsy Zseni , Fazekas Krisztina , Rosivall László 
Published: April 2021

Objective:
RAAS over activation in diabetes may induce myocardial hypertrophy and extracellular matrix accumulation even without hypertension, and ACE-inhibitors are widely used to manage blood pressure. STAT3 activation is known to promote experimental kidney remodeling, but its role in diabetic myocardium has not been elucidated. Experimental evidence shows that EGR1 contributes to myocardial remodeling, yet the effect of ACE-inhibition on myocardial EGR1 in diabetes is still unknown. Thus, we investigated whether the ACE-inhibitor quinapril could influence myocardial EGR1 and STAT3 activation in diabetic rats.

Design and method:
Male Sprague-Dawley rats (250–300 g, n=12) were ip. injected with 60 mg/kg streptozotocin to induce type-1 diabetes (DM). Half of DM rats was treated with 50 mg/kg/day quinapril in drinking water (Q) for 8 weeks. Non-diabetic littermates served as negative controls (CTL). Experimental groups were as follows (n = 6/group): 1) CTL; 2) DM; 3) DM+Q. At harvest, plasma renin activity (PRA) was assessed and myocardium was processed for histology, immunohistochemistry, mRNA and protein expression analyses. Data are presented as mean ± SD, analyzed using Kruskal-Wallis test with Dunn's post-hoc test.

Results:
PRA was elevated in diabetic groups regardless of treatment (CTL:1.3 ± 0.2, DM:2.2 ± 1.0, DM+Q:1.8 ± 1.1 ng/ml/h, p < 0.05), accompanied by myocardial (pro)renin receptor (PRR) mRNA overexpression (fold expression, CTL:1.0 ± 0,2, DM:1.8 ± 0.9, DM+Q:1.7 ± 0.5, p < 0.05). However, quinapril reduced collagen-1 mRNA expression (CTL:1.0 ± 0.3, DM:1.3 ± 0.4, DM+Q:0.7 ± 0.3, p < 0.01) and fibronectin immunoreactivity, accompanied by reduced matrix remodeling shown by the expression of both tissue inhibitor of metalloproteases TIMP1 and TIMP2 (TIMP1, CTL:0.9 ± 0.1, DM:1.6 ± 0.7, DM+Q:1.0 ± 0.5, p < 0.05; TIMP2, CTL:1.0 ± 0.1, DM:1.8 ± 0.5, DM+Q:1.1 ± 0.4, p < 0.05). Immunoblots showed that quinapril also attenuated diabetes induced EGR1 protein expression (CTL:1.0 ± 0.4, DM:1.8 ± 0.5, DM+Q:0.5 ± 0.2, p < 0.01) and STAT3 phosphorylation (CTL:1.0 ± 0.1, DM:1.4 ± 0.2, DM+Q:0.6 ± 0.1, p < 0.01), accompanied by reduced TIMP1 protein expression (CTL:0.9 ± 0.1, DM:1.5 ± 0.3, DM+Q:0.9 ± 0.3, p < 0.05) that correlated with STAT3 activity (R-square: 0.4, p = 0.03).

Conclusions:
In our rat model of type-1 diabetes, chronic quinapril treatment significantly attenuated cardiac remodeling via its direct inhibitory effect on the profibrotic myocardial EGR1 and STAT3. These results underscore the tissue-specific, blood pressure-independent beneficial effects of ACE inhibition in diabetes.
DAPAGLIFLOZIN, PIOGLITAZONE AND THEIR COMBINATION EFFECTED LEVELS OF LIPOPROTEINS AND ADIPOKINES IN PLASMA AND THEIR GENE EXPRESSION IN FAT IN RATS WITH DIABETES MELLITUS TYPE 1
Authors: Kralova Eva , Marusakova Margareta , Hadova Katarina , Klimas Jan 
Published: April 2021

Objective:
Patients with diabetes mellitus type1 (DM1) have a relative insulin deficiency with elevated triacylglycerides (TAG) production. Adipokines are important in fat distribution, inflammation, and endothelial function. Dapagliflozin (Dapa) and pioglitazone (Pio) are oral hypoglycemic drugs for the treatment of DM2. They have also pleiotropic effects on lipid profile and body weight. The effect of these drugs on lipoproteins and adipokines levels in DM1 is poorly understood.

Design and method:
DM1 in male Wistar rats was induced by a single dose of streptozotocin (STZ). Animals were then divided into five groups: Controls, diabetic animals (DM), DM treated with Dapa, DM treated with Pio, DM treated with combination DapaPio. Therapies were mixed in rat chow. Control and DM groups received standard chow. After 6 weeks of treatment serum glucose and lipid levels were determined. Visceral adipose tissue (VAT) gene expression of leptin (Lep), adiponectin (AdipoQ), hormone-sensitive lipase (HSL), lipoprotein lipase (LPL), tumor necrosis factor-alpha (TNFa) and interleukin 6 (IL6) were measured by RT qPCR and their levels in plasma were determined by ELISA method.

Results:
STZ injection led to a significant increase in both fasting and postprandial glucose levels and all levels of lipoproteins except high-density lipoproteins (HDL), which were decreased. We also found decreased levels of Lep, AdipoQ, LPL, and IL6, and increased HSL and TNFa in plasma in DM group. These results were supported by the same significant changes in gene expression in VAT. A combination of DapaPio resulted in a significant decrease in serum levels of both glucose levels. Pio and DapaPio administration decreased TAG and total cholesterol and increased HDL. Lep, AdipoQ, LPL and IL6 plasma levels were increased, and HSL, TNFa were decreased after administration of Dapa, Pio and their combination. Both monotherapy and combination significantly modulated Lep, TNFa and IL6 gene expression in VAT.

Conclusions:
DM1 in rats influenced not only glucose levels but also lipoproteins and adipokines in plasma, which could be affected by Dapa, Pio and DapaPio. Therapy can also change the gene expression of Lep, AdipoQ, TNFa, and IL6 in adipose tissue in rats with DM1.
INFLUENCE OF GONADAL STEROIDS ON AMBULATORY BLOOD PRESSURE IN TRANSSEXUALS
Authors: Stojanovic Milos , Miletic Jasmina Ciric Marija , Zarkovic Milos , Stojkovic Mirjana , Beleslin Biljana , Vujovic Svetlana 
Published: April 2021

Objective:
The effects of hormone therapy on systolic blood pressure in transsexual women are inconsistent, with most studies showing an increase. In transsexual men, testosterone therapy consistently increases systolic blood pressure and may increase diastolic blood pressure. During or following testosterone treatment in transgender men some studies observed a slight increase in systolic and diastolic blood pressure. During testosterone treatment other studies found a modest increase only in systolic blood pressure and one reported a decrease in systolic and diastolic blood pressure levels. In one study, treatment in transgender men blood pressure was expressed as mean arterial pressure, and no changes were observed. However, one study reported two case of hypertension, with return to normal blood pressure values after cessation of testosterone therapy.

Design and method:
The aim of this study was to see is there significant ambulatory blood pressure (ABPM) changes in transsexual women and in transsexual men? We have analysed ambulatory blood pressure changes in 43 male to female (MTF) and in 36 female to male (FTM) transsexuals. Validated Meditech ABPM 05 device was used to measure 24 h blood pressure changes.

Results:
In transsexual women we have found 3.2% decrease in systolic and 2.3% in diastolic blood pressure levels during or following hormone therapy. In transsexual men, testosterone therapy dependably increases 3.6% systolic and 3.2% diastolic blood pressure.

Conclusions:
Our findings support evidence of blood pressure lowering effect of oestrogens and increase of blood pressure with administration of androgens in transsexuals.