Concomitant Hypertension Research Articles

Abstract #1395812: Patterns and Influence of Cardio-Metabolic Insufficiency in Patients with Essential Hypertensive Disease and Concomitant Type 2 Diabetes Mellitus

Metabolic syndrome diseases, MSD (Hypertension, Adiposity, Diabetes mellitus and Dyslipidemia) are interrelated diseases with very high morbidity and mortality rates, thus requiring the search for new and effective treatment options [1]. The objective of the research was to study the patterns and influence of cardio-metabolic insufficiency in patients with essential hypertensive disease (EHD) and concomitant type 2 diabetes mellitus (T2DM). 105 patients (56 females and 49 males), aged 41-70 years were examined for 3 months. The average age was (60.5±2.5) years. Group I (GI) included 25 patients with treatment-compensated essential hypertensive disease, II stage, 1-2 degree; Group II (GII) - 25 patients with subcompensated type 2 diabetes mellitus (glycated hemoglobin (HbA1C) - from 7.0 to 11.0%); Group III (GIII) - 55 patients with treatment-compensated essential hypertensive disease, II stage, 1-2 degree and concomitant subcompensated type 2 diabetes mellitus (HbA1C - from 7.0 to 11.0%). The control group consisted of 15 practically healthy volunteers, 10 (66.7%) females and 5 (33.3%) males, aged (62.5±4.5) years. The groups were randomized according to age, sex, BMI, duration of EHD and T2DM. In addition to general clinical examination conducted including blood lipid levels – triglycerides (TG), LDL, HDL, total cholesterol (TC); glucose metabolism was assessed using HbA1C index. Statistical analyses of the results of the research were carried out using "Statistica 13.4 for Windows" and Student’s t-test series. Research was conducted with strict adherence to the Declaration of Helsinki (DoH) 2013 concerning human research. More severe dyslipidemia (and a higher risk of cardiovascular disease) was found in patients with type 2 diabetes mellitus and concomitant essential hypertension [2, 3]. Dyslipidemia was more pronounced in patients with EHD and concomitant T2DM. TG, LDL and TC levels were 20.14%, 28.72% and 24.21% higher compared with GI (p<0.05). HDL was 13.7% lower in GII compared with GI (p<0.05). HbA1C in GIII patients was (9.41±0.42) % and in GII patients was (7.21±0.45) % (p<0.05). Correlations between HbA1C with TG, LDL and TC levels were (r=+0.42; r=+0.60; r=+0.49 respectively, p<0.05). Correlations between SBP (systolic blood pressure) with TG, LDL and TC were (r=+0.41; r=+0.52; r=+0.45 respectively, p<0.05). Correlations between HbA1C and SBP was (r=+0.62; p˂0.05). In patients with essential hypertensive disease and concomitant type 2 diabetes mellitus, there is a remarkable tendency towards cardio-metabolic insufficiency as evidenced by increase in systolic blood pressure, hyperglycemia, and dyslipidemia.

Genetic, clinical, and pathological study of patients with severe hypertension-associated renal microangiopathy.

Severe hypertension may be a prominent manifestation of complement-mediated thrombotic microangiopathy. Furthermore, patients with severe hypertension-associated thrombotic microangiopathy may present with concurrent hematologic abnormalities that mimic complement-mediated thrombotic microangiopathy. Whether or not severe hypertension-associated thrombotic microangiopathy is associated with genetic susceptibility in complement- and/or coagulation-pathway genes remains unclear, and there is thus a need to identify clinicopathological clues to distinguish between these entities. Forty-five patients with concomitant severe hypertension and thrombotic microangiopathy on kidney biopsy were identified retrospectively. Whole-exome sequencing was performed to identify rare variants in 29 complement- and coagulation-cascade genes. Clinicopathological features were compared between patients with severe hypertension-associated thrombotic microangiopathy and complement-mediated thrombotic microangiopathy with severe hypertension. Three patients with pathogenic variants diagnostic of complement-mediated thrombotic microangiopathy and two with anti-factor H antibody positivity were diagnosed with complement-mediated thrombotic microangiopathy with severe hypertension. Among the 40 patients with severe hypertension-associated thrombotic microangiopathy, 53 rare variants of uncertain significance were found in the analyzed genes in 34 (34/40, 85%) patients, of whom 12 patients harbored two or more variants. Compared with complement-mediated thrombotic microangiopathy patients with severe hypertension, patients with severe hypertension-associated thrombotic microangiopathy were more likely to have left ventricular wall thickening (p < 0.001), less-severe acute glomerular thrombotic microangiopathy lesions including mesangiolysis and subendothelial space widening (both p < 0.001), and less arteriolar thrombosis formation (p < 0.001). Rare genetic variants involving complement and coagulation pathways can be found in patients with severe hypertension-associated thrombotic microangiopathy; their role needs further investigation. Cardiac remodeling and acute glomerular TMA lesions may help to differentiate between severe hypertension-associated thrombotic microangiopathy and complement-mediated thrombotic microangiopathy with severe hypertension.

Longitudinal changes in blood pressure and fasting plasma glucose among 5,398 primary care patients with concomitant hypertension and diabetes: Anobservational study and implications for community-based cardiovascular prevention.

To assess longitudinal changes in blood pressure (BP) and fasting plasma glucose (FPG) in primary care patients with concomitant hypertension and type 2 diabetes mellitus (T2DM), and to explore factors associated with patients' inability to improve BP and FPG at follow-up. We constructed a closed cohort in the context of the national basic public health (BPH) service provision in an urbanised township in southern China. Primary care patients who had concomitant hypertension and T2DM were retrospectively followed up from 2016 to 2019. Data were retrieved electronically from the computerised BPH platform. Patient-level risk factors were explored using multivariable logistic regression analysis. We included 5,398 patients (mean age 66 years; range 28.9 to 96.1 years). At baseline, almost half [48.3% (2,608/5,398)] of patients had uncontrolled BP or FPG. During follow-up, more than one-fourth [27.2% (1,467/5,398)] of patients had no improvement in both BP and FPG. Among all patients, we observed significant increases in systolic BP [2.31 mmHg, 95% confidence interval (CI): 2.04 to 2.59, p < 0.001], diastolic BP (0.73 mmHg, 0.54 to 0.92, p < 0.001), and FPG (0.12 mmol/l, 0.09 to 0.15, p < 0.001) at follow-up compared to baseline. In addition to changes in body mass index [adjusted odds ratio (aOR)=1.045, 1.003 to 1.089, p = 0.037], poor adherence to lifestyle advice (aOR = 1.548, 1.356 to 1.766, p < 0.001), and unwillingness to actively enrol in health-care plans managed by the family doctor team (aOR = 1.379, 1.128 to 1.685, p = 0.001) were factors associated with no improvement in BP and FPG at follow-up. A suboptimal control of BP and FPG remains an ongoing challenge to primary care patients with concomitant hypertension and T2DM in real-world community settings. Tailored actions aiming to improve patients' adherence to healthy lifestyles, expand the delivery of team-based care, and encourage weight control should be incorporated into routine healthcare planning for community-based cardiovascular prevention.

Impact of correction of homocisteinemia on clinical outcomes of lung damage associated with COVID-19 coronavirus infection

Aim. To assess the effect of serum homocysteine levels on treatment outcomes in patients with COVID19-associated lung damage, depending on the use of folic acid in complex treatment.Materials and methods. An open, prospective comparative study included 71 hospitalized adult patients with COVID-19-associated lung disease who did not require mechanical ventilation. The main group included 51 patients who received folic acid 15 mg per day in a complex treatment in a fixed combination with pyridoxine hydrochloride and cyanocobalamin. The comparison group included 20 patients in whose therapy folic acid was not used.Results. The use of folic acid was accompanied by a decrease in serum homocysteine concentration by 2.120 (-0.230; 3.680) µmol/L (p=0.004). When constructing a logistic regression model, the effect of a decrease in serum homocysteine (OR 1.289; 95% CI 1.026‒1.620; p=0.029), methylenetetrahydrofolate reductase MTHFR C677T genotype (OR 10.897; 95% CI 1.240‒95.772; p=0.031) on the achievement of 7th day of hospitalization, the cessation of isolation of SARS-CoV-2 virus RNA from the respiratory tract. Multiple linear regression analysis showed an association between the duration of hypoxemic respiratory failure, determined with SaO2≤93%, with the degree of change in serum homocysteine concentration after treatment, single nucleotide polymorphisms of methylenetetrahydrofolate reductase MTHFR C677T, methionine synthase MTR A2756G and methionine synthase reductase MTRR A66G, initial volume of lung damage ≥50% according to CT data, indicators of D-dimers, C-reactive protein, hemoglobin, platelets, concomitant hypertension, diabetes mellitus (R=0.699; R2=0.489; p=0.005).Conclusion. The dynamics of the decrease in serum homocysteine after treatment is an important predictor of the cessation of isolation from the respiratory tract of the SARS-CoV-2 virus RNA on the 7th day of treatment, reducing the duration of hypoxemic respiratory failure in patients with lung damage associated with COVID-19 infection.

IMPACT OF PULMONARY DENERVATION ON QUALITY OF LIFE AFTER COMPLEX MITRAL VALVE SURGERY

Relevance. In recent years, concepts for assessing the quality of life have been developed. According to the WHO definition, quality of life is a person's perception of his position in life, culture and value system, it is associated with his goals, expectations, standards and concerns. Approximately three people out of every thousand have pulmonary hypertension for various reasons. This can lead to decreased exercise tolerance, quality of life, increased hospital admissions, and early death. An objective assessment of the quality of life of such patients will help achieve better clinical outcomes for patients and develop new treatments. Purpose of the study is to assessment of changes in the quality of life of patients with mitral valve disease associated with atrial fibrillation and high pulmonary hypertension (systolic blood pressure over 40 mmHg) during the first 24 months after radiofrequency denervation of the pulmonary arteries according to the SF-36 and MLHFQ questionnaires. Materials and Methods. The general population of patients (n = 202) with mitral heart disease, concomitant atrial fibrillation and high pulmonary hypertension was divided into several groups according to the complexity of surgical treatment: patients of the 1st group (n = 62) underwent only surgical correction of the mitral valve pathology (repair or replacement); patients of the 2nd group (n = 89) – surgical correction of the mitral valve pathology, as well as the Maze IV procedure using the AtriCure© bipolar ablator; patients of the 3rd group (n = 51) received complex surgical treatment by correcting mitral valvular pathology, performing the Maze IV procedure, as well as using radiofrequency denervation of the pulmonary arteries. The quality of life was assessed over several periods: initially, 6 months later, 1 and 2 years after surgical treatment. The scores were also converted to physical health component scores and mental health component scores. Results. The initial data of patients from different subgroups according to the criteria of the SF-36 questionnaire were comparable with each other. The indicators of the physical component and the psychological component of SF-36 characterize the 3rd group of patients with a lower level of quality of life in terms of the physical component, although no significant intergroup differences were found. Quality of life indicators after 6 months show positive changes in patients of all study groups without significant intergroup differences. Based on the results of 12 months, the greatest dynamics of the parameters of the questionnaire in terms of physical and mental components was observed in the 3rd group of patients. After 24 months, there is a significant advantage in changes in the indicators of patients of the 3rd group for all categories of the questionnaire. The target level after 6 months in the 3rd group was 100%, in the 2nd and 1st – 85.3% and 40.7%, respectively, maintaining differences up to 24 months. Conclusions. The use of a circular radiofrequency pulmonary artery denervation procedure is associated with a significant improvement in health status in assessing the quality of life of patients who have not undergone correction of pulmonary hypertension.

Association of diabetes, hypertension, and their combination with basal symptoms and treatment responses in overactive bladder patients.

Introduction: Pelvic hypoperfusion caused by atherosclerosis has been proposed as a cause of lower urinary tract dysfunction including overactive bladder syndrome (OAB). Limited data indicate that OAB patients with concomitant diabetes or hypertension, known risk factors of atherosclerosis, may exhibit greater baseline OAB symptoms and slightly smaller therapeutic responses to treatment, but the impact of a combined presence of diabetes and hypertension has not been reported. Therefore, we have explored whether the combined presence of both comorbidities is associated with greater baseline OAB symptoms than that of either comorbidity alone. Secondary questions were exploration of the impact of either comorbidity on baseline symptoms, and of the impact of either comorbidity alone and their combination on therapeutic responses. Methods: Data from two non-interventional studies applying treatment with propiverine ER 30 or 45mg/d for 12weeks were analyzed. Results: Number of urgency episodes in the combination group was greater than with each comorbidity alone. The impact of comorbidities on baseline intensity of incontinence, frequency or nocturia or Patient Perception of Bladder Condition was less consistent or absent. Either comorbidity alone was associated with a smaller % improvement of symptoms, and their combination had a greater effect than either alone. However, all attenuations associated with comorbidity were small relative to the overall improvement. Conclusions: We conclude that comorbidities of diabetes and hypertension have detectable effects on OAB symptoms and treatment responses, but the small magnitude of these alterations does not justify changing existing paradigms for the clinical management of OAB.

Chronic kidney disease and pregnancy: an interdisciplinary assessment of gestational risks and complications. A literature review

Chronic kidney disease represents a heterogeneous group of diseases characterized by changes in the kidneys structure and functions. It significantly increases the risks of adverse maternal and perinatal outcomes. These risks increase with worsening renal dysfunction corresponding to an increase in the degree of proteinuria and arterial hypertension. Anatomical and physiological changes in the kidneys during pregnancy are characterized by dilatation of the pelvicalyceal system, a decrease in systemic and renal vascular resistance, and an increase in the glomerular filtration rate. These clinically significant changes can complicate the diagnosis of the renal dysfunction, as well as its progression. Pregnancy can affect the kidney as it can manifest as declining kidney function, especially in the context of concomitant arterial hypertension and proteinuria, while chronic kidney disease, regardless of the stage, contributes to a higher risk of adverse pregnancy outcomes including preeclampsia, premature birth and fetal growth restriction.&#x0D; Optimization strategies of pregnancy outcomes include strict control of blood pressure, treatment of hypertension and proteinuria, and prevention of preeclampsia. The latter is difficult to diagnose in pregnant women with chronic kidney disease. Serum markers such as soluble fms-like tyrosine kinase 1 and placental growth factor may aid in definitive diagnosis. The choice of delivery mode in women with chronic kidney disease should be based on common obstetric indications. A multidisciplinary team, including an obstetrician-gynecologist, a nephrologist, an anaesthesiologist and a neonatologist, must focus on preconception medical care, antenatal care and treatment of pregnant women with chronic kidney disease for a successful pregnancy outcome.

Intracranial hypertension after cerebral venous thrombosis-Risk factors and outcomes.

Cerebral venous thrombosis (CVT) is a special cerebrovascular disease that accounts for around 0.5%-1.0% of all strokes and often occurs in younger adults. Intracranial hypertension is the most frequent symptom of acute CVT due to venous occlusion. This study aimed to ascertain the risk factors for intracranial hypertension after CVT and to investigate whether intracranial hypertension at diagnosis may affect patient outcomes. We performed a retrospective cohort analysis of all patients treated for acute/subacute CVT at our department between 2018 and 2021. Logistic regression analysis was performed to identify potential risk factors associated with intracranial hypertension after CVT and clinical outcomes at the 6-month follow-up. A total of 293 acute/subacute CVT survivors were eligible for inclusion, with 245 patients (83.60%) experiencing concomitant intracranial hypertension at diagnosis. In the multivariable regression analysis, hereditary thrombophilia (OR 2.210, 95% CI 1.148-4.254, p = 0.018) and thrombosis location of superior sagittal sinus (SSS) and right lateral sinus (LS) (OR 4.115, 95% CI 1.880-9.010, p = 0.000) were independently associated with intracranial hypertension. 83.67% of patients with intracranial hypertension after CVT had favorable functional outcomes (mRS score, 0-2), whereas they more often had residual visual impairment (15.51% vs. 4.17%, p = 0.036) at follow-up. The risk factors for residual visual impairment were papilledema (OR 2.971, 95% CI 1.231-7.170, p = 0.015) and visual disturbances at diagnosis (OR 2.869, 95% CI 1.123-7.327, p = 0.028), thrombosis location (SSS and right LS [OR 10.811, 95% CI 4.208-27.773, p = 0.000]; SSS and left LS [OR 3.139, 95% CI 1.409-6.995, p = 0.005]), and CVT recurrence (OR 4.763, 95% CI 1.556-14.584, p = 0.006). Intracranial hypertension is the most common clinical symptom of acute CVT. At follow-up, patients with intracranial hypertension after CVT were more prone to develop residual visual impairment.

Cytokine imbalance and progression of changes in the liver parenchyma in patients with non-alcoholic fatty liver disease and essential hypertension

Objective — to determine the relationship between the activity of pro‑ and anti‑inflammatory cytokines and liver functional parameters in patients with non‑alcoholic fatty liver disease (NAFLD) and hypertension (HTN), depending on the degree of liver parenchyma damage. Materials and methods. The study included 120 people, divided into 3 groups: 49 patients (67.3% women) with NAFLD and concomitant HTN (main group); 51 patients (58.5% women) with isolated NAFLD (comparison group) and 20 relatively healthy individuals (55.0% women and 45.0% men) of the control group. In the main group, 55.1% of patients had steatosis, 44.9% had steatohepatitis. In the comparison group, 58.8% had steatosis, 41.2% had steatohepatitis (χ2=0.141, p=0.707). The assessments included body mass index (BMI), levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST), γ‑glutamine transpeptidase, interleukin 8 and 10 (IL‑8, IL‑10), alkaline phosphatase (ALP), De Ritis index (AST/ALT ratio). The diagnosis of NAFLD and HTN was established in accordance with the local and international recommendations. Ultrasound examination of the liver was performed according to the standard method in fasting condition. Results. Body mass index corresponded to the normal or increased body weight: in the main group — 27.8 [26.6; 28.5] kg/m2 and 27.3 [24.2; 28.3] kg/m2 in the comparison group, in the control group — 24.3 [21.9; 26.0] kg/m2 (p&lt;0.001 and p=0.004 respectively). The results of the biochemical analysis showed a significant (p&lt;0.001) predominance of AST and ALT in patients with steatohepatitis compared to patients with steatosis, both in the main/group (AST=56.5 [54.0, 57.0] U/l and ALT=47.0 [44.5; 49.0] U/L, respectively), and in the comparison group (AST=45.0 [43.0; 48.0] U/l and ALT 39.0 [35.0; 42.0] U/L, respectively). The analysis of correlational relationships in patients with steatohepatitis, stronger relationships were found, both between the systemic increase in blood pressure, and between the cytokine’s levels and liver functional parameters. Thus, in patients of the main group with steatohepatitis, an inverse relationship was determined between the levels of AST and anti‑inflammatory IL‑10 (r=–0.588, p=0.004), the levels of GGTP (r=–0.407 p=0.060) and the levels of albumin (r=– 0.466, p=0.069). In patients of the comparison group and steatohepatitis, an inverse correlation was determined between the levels of diastolic blood pressure and GGTP (r=0.490, p=0.024). GGTP levels were also inversely correlated with AST levels (r=–0.508, p=0.019) and directly with IL‑8 and IL‑10 levels (r=0.438, p=0.049 and r=0.373, p=0.096). IL 10 demonstrated a strong negative correlation with albumin levels (r=–0.604, p=0.004). IL‑8 levels showed a direct correlation with IL‑10 (r=0.431, p=0.051) in this subgroup of patients. Conclusions. The presence of concomitant hypertension in patients with NAFLD was associated with more active progression compared to patients with isolated NAFLD. Correlation analysis showed gradual exhaustion of anti‑inflammatory protection and increase of pro‑inflammatory activity as changes in liver parenchyma progressed, especially in patients with comorbid NAFLD and HTN course. That allows us to consider HTN as a prognostically unfavorable risk factor for the development and progression of the liver parenchyma fibrosis.

The frequency of hypertension and other risk factors in patients undergoing large joint arthroplasty: a real-world study

Background. The population of patients undergoing large joints arthroplasty has a high prevalence of comorbidities, such as hypertension and other cardiovascular diseases, obesity, diabetes, chronic kidney disease, etc., that are independent risk factors for the postoperative complications, especially of the thromboembolic events.Aim. To evaluate the prevalence of hypertension and other risk factors in patients undergoing large joint arthroplasty in real-world practice.Materials and methods. The study included an unselected sample of patients (n=82) who underwent arthroplasty of large joints in December 2022 at the Clinic of Traumatology, Orthopedics and Joint Pathology of the I.M. Sechenov First Moscow State Medical University. A detailed history was collected from all patients and, if necessary, a laboratory and instrumental examination was performed to assess the presence of target organ damage.Results. Sixty-two patients (81.7%) had hypertension; among them 12.6% had no previous antihypertensive therapy. The average body mass index (BMI) was 31.3±5.2 kg/m2 confirming the high prevalence of obesity in this population. All obese patients had concomitant hypertension (n=62), and 6 people (7.3%) with a BMI over 40 kg/m2 had signs of obstructive sleep apnea syndrome. Diabetes mellitus (DM) was diagnosed in 13 people (15.9%); in all cases it was type 2 diabetes. Chronic kidney disease (CKD) stage 2-4 was diagnosed in 67 people (81.7%), and all these patients had concomitant obesity and hypertension.Conclusion. Based on the analysis of published literature and a sample of patients from real-world practice, the main population undergoing the arthroplasty of large joints include elder patients, and the vast majority of them have multiply comorbidities (obesity, hypertension, CKD) that are not only the independent risk factors for poor prognosis, but also exacerbate the other concomitant conditions and further increase the risk of complications. It is necessary to conduct large prospective studies with specific evaluation of various cohorts of patients undergoing arthroplasty of large joints including a pharmacoeconomic analysis to determine the need and scope of further examination in this population with a high risk of perioperative complications.

Risk of End-Stage Renal Disease in Patients With Systemic Lupus Erythematosus and Diabetes Mellitus: A Danish Nationwide Cohort Study.

The risk of end-stage renal disease (ESRD) is increased in patients with systemic lupus erythematosus (SLE). This study was undertaken to determine whether diabetes mellitus (DM) increases ESRD risk in a large inception cohort of SLE patients. By means of the Danish National Patient Registry, we identified 3,178 adult patients diagnosed as having SLE between January 1, 1996, and July 31, 2018. DM was defined as the date of first hospital contact for DM or date of a first prescription of an antidiabetic drug. ESRD was defined as first registration of dialysis, renal transplant, or terminal renal insufficiency in the Danish National Patient Registry. ESRD incidence was compared between SLE patients with DM (SLE-DM) and those without DM (SLE-non-DM). Hazard ratios (HRs), adjusted for sex, age, educational level, and occupational status at baseline were calculated for sex, age, educational level, and hypertension (at baseline or during follow-up) strata. The overall hazard ratio (HR) was also adjusted for hypertension. The SLE-DM group included 290 patients, of whom 77% were female, compared with 85% of the 2,859 patients in the SLE-non-DM group. SLE-DM patients had a 3 times higher risk of ESRD compared with SLE-non-DM patients (multivariable-adjusted HR 3.3 [95% confidence interval 1.8-6.1]). In stratified multivariable-adjusted analyses, DM increased the rate of ESRD in women and men, patients ≥50 years old at baseline, those with low educational level at baseline, and those with concomitant hypertension. Our findings indicate that SLE patients with DM have a markedly higher risk of developing ESRD compared with SLE patients without DM.

Prevalence of primary aldosteronism in patients with concomitant hypertension and obstructive sleep apnea, baseline data of a cohort.

Obstructive sleep apnea (OSA) and primary aldosteronism (PA) often coexist in hypertension, whereas whether hypertensive patients with OSA should be screened for PA is controversial and whether gender, age, obesity and OSA severity should be considered is unexplored. We explored cross-sectionally prevalence and associated factors of PA in co-existent hypertension and OSA by considering gender, age, obesity and OSA severity. OSA was defined as AHI ≥5 events/h. PA diagnosis was defined, based on the 2016 Endocrine Society Guideline. We included 3306 patients with hypertension (2564 with OSA). PA prevalence was significantly higher in hypertensives with OSA than in those without OSA (13.2 vs 10.0%, P = 0.018). In gender-specific analysis, PA prevalence was significantly higher in hypertensive men with OSA, compared to non-OSA ones (13.8 vs 7.7%, P = 0.001). In further analysis, PA prevalence was significantly higher in hypertensive men with OSA aged <45 years (12.7 vs 7.0%), 45-59 years (16.6 vs 8.5%), and with overweight and obesity (14.1 vs 7.1%) than did their counterparts (P < 0.05). For OSA severity, men participants showed increased PA prevalence from non to moderate OSA and a decrease in the severe OSA group (7.7 vs 12.9 vs 15.1 vs 13.7%, P = 0.008). Young and middle age, moderate-severe OSA, weight, and blood pressure showed a positive independent association with PA presence in logistic regression. In conclusion, PA is prevalent in co-existent hypertension and OSA, indicating the need for PA screening. Studies are needed for women, older and lean population due to the smaller samples in this study.

Cardiovascular Risk Factors in Patients With Sudden Sensorineural Hearing Loss: A Systematic Review and Meta-analysis.

The interruption of vascular supply to the inner ear is one of several proposed etiologies of sudden sensorineural hearing loss (SSNHL). The increased presence of cardiovascular risk factors may predispose patients to SSNHL through this pathway. This systematic review and meta-analysis studies the presence of cardiovascular risk factors in patients diagnosed with SSNHL. Databases included PubMed/Medline, OVID, EMBASE, Cochrane, and Web of Science. Inclusion criteria included studies featuring SSNHL patients presenting with 1+ cardiovascular risk factors. Exclusion criteria included case reports and studies without outcome measures. Two investigators independently reviewed all manuscripts and performed quality assessments using validated tools. Of 532 identified abstracts, 27 studies met inclusion criteria (19 case-control, 4 cohorts, 4 case series). Of these, 24 underwent meta-analysis encompassing a total of 77,566 patients (22,620 SSNHL patients, 54,946 matched controls). The mean age was 50.43 years. SSNHL patients were more likely to have concomitant diabetes (odds ratio [OR]1.61 [95% confidence interval [CI]: 1.31, 1.99; p < .00001]) and hypertension (OR 1.5[95% CI: 1.16, 1.94; p = .002]). An increased standard mean difference of total cholesterol of 11.09 mg/dL (95% CI; 3.51, 18.67; p = .004) was noted in the SSNHL group compared with the controls. No significant differences in smoking, high-density lipoprotein, triglycerides, or body mass indexwere detected. Patients presenting with SSNHL have a significantly higher risk of concomitant diabetes, hypertension, and higher total cholesterol in comparison to matched controls. This may indicate a higher cardiovascular risk profile in this population. More prospective and matched cohort studies are needed to understand the role of cardiovascular risk factors in SSNHL.

THE COMPLIANCE OF PSYCHIATRIC PATIENTS WITH HYPERTENSION TO MEDICATION AND FOLLOW-UP DURING THE COVID-19 PANDEMIC

IntroductionThe current SARS Covid-19 pandemic has negatively affected primary care and health system services provided to chronically ill patients, such as patients with Diabetes Mellitus, Dyslipidemia and Hypertension.ObjectivesThe recording of the number of unfulfilled scheduled visits of Psychiatric patients who are monitored in the Pathological Outpatient Clinic of Arterial Hypertension at the Psychiatric Hospital of Attica due to non-attendance, before the pandemic (9/2018 -2/2020) and during its evolution (3/2020-2 /2022).MethodsThe study was done retrospectively and included 1515 patients with a Psychiatric history and concomitant Hypertension who were examined at Outpatient Clinics during the aforementioned time intervals. The rates of missed scheduled visits, as well as discontinuation of treatment without a doctor’s indication were compared and the statistical method used was χ2 with a significance level of p&lt;0.05.ResultsThe percentage of scheduled appointments that did not take place due to patient no-shows during the pre-pandemic period was 22% (550/2500). During the pandemic the non-attendance rate increased to 36% (1132/3145). The increase in the rate of missed appointments was statistically significant with p&lt;0.001. Correspondingly, the difference in recorded discontinuation of treatment was statistically significant, 26% (523/2011) versus 33% 743/2252).ConclusionsΣτην παρούσα μελέτη διαπιστώνεται στατιστικά σημαντική αύξηση της μη προσέλευσης Ψυχιατρικών ασθενών στα Παθολογικά Εξωτερικά Ιατρεία τη περίοδο της πανδημίας. Επίσης το πρόβλημα της μη συμμόρφωσης στη συνιστώμενη αγωγή διογκώθηκε καθώς καταγράφηκε μεγαλύτερο ποσοστό μη συνιστώμενης διακοπής αγωγής για την Αρτηριακή Υπέρταση .Disclosure of InterestNone Declared

Serum Asprosin Level as a New Biomarker in Differentiating Familial Mediterranean Fever Attacks.

Introduction Familial Mediterranean fever (FMF) is a recessively inherited disease characterized by recurrent attacks of fever and sterile polyserositis. Recently, some proteins originating from adipose tissue have been demonstrated to play a critical role in the inflammatory process. Asprosin is a new adipokine secreted by adipose tissue, and proinflammatory cytokines have been determined to increase with the decrease of circulating asprosin. This study was designed to evaluate the level of asprosin in the acute attack and attack-free period in FMF patients. Materials and methods A total of 65 FMF patients were evaluated for this cross-sectional case-control study. Those who were obese and had concomitant diabetes mellitus, hypertension, heart failure, and rheumatological disease were excluded from the study. The patients were divided into two groups: attack-free period and attack period. Fifteen healthy individuals who were not obese and had no additional disease were included as the control group. Demographic data, gene analyses, laboratory findings, and symptoms were recorded at the time of diagnosis. Serum asprosin level was studied by enzyme-linked immunosorbent assaytest in the outpatient clinic controls of the patients. Asprosin levels and other laboratory findings were compared between the attack, attack-free, and control groups. Results Of the patients included in the study, 50% were in the attack period, and 50% were in the free-attack period. The mean age of the FMF patients was 34±10 years. Asprosin level in the control [median (interquartile range (IQR))=30.4 (21.5-57.7) ng/mL] group was significantly higher than the attack [median (IQR)=21.5 (17.5-28) ng/mL] and attack-free [median (IQR)=19(18.7-23) ng/mL] groups (p=0.001). C-reactive proteinand sedimentation levels were significantly higher in the attack group compared to the other two groups (p<0.001). There was a moderate correlation between C-reactive proteinand asprosin levels (Ro=-0.314, p=0.01). The cut-off value of serum asprosin level was determined as 21.6 ng/mL; sensitivity was 78%, and specificity was 77% (p<0.001). Conclusion The study demonstrated that the serum asprosin levels of FMF patients with acute attack were lower than those in the attack-free periods and healthy controls.Asprosin is likely to have a role in the anti-inflammatory cascade.

Therapeutic Strategy for Patients with Concomitant Pulmonary Artery Hypertension and Hypertrophic Obstructive Cardiomyopathy: A Rare Case Report

Combined cases of hypertrophic obstructive cardiomyopathy (HOCM) and pulmonary arterial hypertension (PAH) are rare and have a management dilemma. Although preload is crucial in the management of HOCM, anti-PAH agents dramatically change the preload, leading to improving or worsening heart failure in patients with HOCM. We had a 74-year-old woman with Sjogren-syndrome-associated PAH. Her heart failure worsened following the initiation of anti-PAH agents due to an incremental preload on the left ventricle, whereas HOCM clinically developed following the termination of anti-PAH agents and progressing anorexia due to the progression of the left ventricular outflow obstruction. Careful monitoring of the left ventricular outflow obstruction during initiation/termination of anti-PAH agents and medical intervention to the HOCM are highly recommended.

Benzodiazepine-Receptor Agonist Utilization in Outpatients with Anxiety Disorder: A Retrospective Study Based on Electronic Healthcare Data from a Large General Tertiary Hospital.

Benzodiazepine-receptor agonists (BZRAs), including benzodiazepines (BZDs) and drugs related to BZDs (Z-drugs), are commonly used for anxiety, but often have side effects. We retrospectively investigated the utilization and prescription characteristics of BZRAs for patients with anxiety disorders in a large tertiary care general hospital between 2018 and 2021, based on electronic healthcare records. We also examined the pattern of simultaneous consumption of multiple BZRA drugs, and the diseases coexisting with anxiety that are associated with this. The numbers of patients and BZRA prescriptions increased over the 4 years. Moreover, 7195 prescriptions from 694 patients contained two or more BZRAs, of which 78.08% contained both BZDs and Z-drugs, 19.78% contained multiple BZDs, and 2.14% contained multiple Z-drugs. For anxiety patients with concomitant Alzheimer's disease or Parkinson's disease, and dyslipidemia, they were more likely to consume multiple BZRAs simultaneously, whereas patients with concomitant insomnia, depression, hypertension, diabetes, or tumors were less likely to consume multiple BZRAs (all p < 0.05). Furthermore, older patients who consume multiple BZRAs simultaneously may have higher probabilities of long-term drug use. Better interventions supporting standardized BZD utilization may be needed to minimize the side effects of inappropriate BZRA administration.

Prevalence and risk factors of chronic kidney disease among patients with type 2 diabetes mellitus at a tertiary care hospital in Nepal: a cross-sectional study

ObjectiveTo estimate the prevalence of chronic kidney disease (CKD) among patients with type 2 diabetes mellitus (T2DM) and determine the sociodemographic and clinical risk factors associated with CKD.Design and settingsCross-sectional...

Preliminary results of whole exome sequencing in a clinical hypertrophic cardiomyopathy cohort in India

Abstract Funding Acknowledgements Type of funding sources: None. Background Hypertrophic cardiomyopathy (HCM), characterized by unexplained left ventricular hypertrophy and outcomes ranging from normal life expectancy to heart failure and sudden cardiac death, has a global prevalence of about 1 in 500. Genetic testing helps to improve care of patients with HCM and their family members as children of carriers have a 50% chance of inheriting the disease. However, there is limited availability, awareness and application of genetic testing modalities, particularly whole exome sequencing (WES), in the management of HCM in India. Purpose This study aimed to analyze the results of WES in a clinical HCM cohort in India. Methods Patients with unexplained moderate to severe cardiomyopathy presenting to our centre from 2017 to 2022 and consenting for genetic testing were included in the study. Following a thorough clinical diagnostic process including 3-generational family history, electrocardiogram and echocardiogram in all patients and exercise stress test, Holter monitoring and cardiac magnetic resonance imaging where applicable, pre-test counseling was provided and WES performed using genomic DNA isolated from whole blood samples. A total of 33 affected individuals including 1 affected family member from 32 families were processed for genetic testing. A multidisciplinary team comprising of cardiologist, cardiothoracic surgeon, physician with expertise in cardiogenetics, geneticist and genetic counselor carried out the study in a tertiary cardiac centre. Results Age of the probands (n=32) at the time of the study was 47.8±15.9 years and 24 (75%) were males. There was concomitant hypertension in 11 (34%), type 2 diabetes mellitus in 6 (19%), arrhythmias in 6 (19%) and coronary artery disease in 2 (6%) probands. Obstructive HCM was present in 2 (6%) probands. Disease-causing significant variants (Pathogenic/Likely pathogenic) were detected in 8 (25%, Table), variants of uncertain significance in 17 (53%) and no significant variants were detected in 7 cases. Cascade genetic testing of significant variants among 7 family members of 4 probands showed segregation of the pathogenic variant in 4 asymptomatic carriers. Conclusions The yield of whole exome sequencing in a clinical HCM cohort in India was 25%. Of note the rare variants of uncertain significance in the cardiomyopathy genes makes genetic counseling and disease management challenging. However, large-scale studies in the context of Indian population are expected to bring clarity on the role of these variants in disease manifestation. A multidisciplinary team approach incorporating genetic testing modalities such as whole exome sequencing and cascade screening is the way forward in the comprehensive management of patients with HCM and their families.

Development and Validation of a Nomogram for Predicting Blood Pressure Change Failure in Patients with Pheochromocytoma and Concomitant Hypertension after Adrenalectomy.

(1) Background: Pheochromocytoma is a common cause of secondary hypertension, which is considered curable; nevertheless, some patients still suffer from hypertension after adrenalectomy. Therefore, we developed and validated a nomogram for predicting blood pressure change failure in patients with pheochromocytoma and concomitant hypertension after adrenalectomy. (2) Methods: The development cohort of this study consisted of 259 patients with pheochromocytoma who underwent adrenalectomy at our center between 1 January 2007 and 31 December 2018. Each patient's clinicopathologic data were recorded. LASSO (the least absolute shrinkage and selection operator) regression was used to reduce and select the features of the data. Furthermore, we used multivariate logistic regression analysis to develop the prediction model. An independent cohort of 110 consecutive patients from 1 January 2019 to 31 December 2021 was used for validation. The performance of this nomogram was assessed with regard to discrimination, calibration, and clinical usefulness. (3) Results: 40.9% and 46.4% of patients experienced blood pressure change failure in the development and validation cohorts of this study, respectively. We found that older patients with a longer duration of hypertension and concomitant cardiovascular events were more likely to suffer from blood pressure change failure. In the validation cohort, the model manifested great discrimination with an AUROC (area under the receiver operating characteristic) of 0.996 (p < 0.001) and good calibration (unreliability test, p = 0.359). Decision curve analysis demonstrated that the model was clinically useful. (4) Conclusions: This study presented a reliable nomogram that facilitated individualized preoperative prediction of blood pressure change failure after adrenalectomy in patients with pheochromocytoma, which may help decision-making in perioperative treatment and follow-up strategies.