Function In Hypertensive Patients Research Articles

Effect of exercise on vascular function in hypertension patients: A meta-analysis of randomized controlled trials.

The purpose of this study was to systematically evaluate the effect of exercise on vascular function in patients with pre- and hypertension. A systematic review of articles retrieved via the PubMed, Embase, EBSCO, and Web of Science databases was conducted. All the randomized controlled trials published between the establishment of the databases and October 2022 were included. Studies that evaluated the effects of exercise intervention on vascular function in patients with pre- and hypertension were selected. A total of 717 subjects were included in 12 randomized controlled trials. The meta-analysis showed that in patients with pre- and hypertension, exercise can significantly reduce systolic blood pressure (SBP) (MD = -4.89; 95% CI, -7.05 to -2.73; P < 0.00001) and diastolic blood pressure (DBP) (MD = -3.74; 95% CI, -5.18 to -2.29; P < 0.00001) and can improve endothelium-dependent flow-mediated dilatation (MD = 2.14; 95% CI, 1.71-2.61; P < 0.00001), and exercise did not reduce pulse wave velocity (PWV) (MD = 0.03, 95% CI, -0.45-0.50; P = 0.92). Regression analysis showed that changes in exercise-related vascular function were independent of subject medication status, baseline SBP, age and duration of intervention. Aerobic, resistance, and high-intensity intermittent exercise all significantly improved SBP, DBP, and FMD in pre- and hypertensive patients, however, they were not effective in reducing PWV, and this effect was independent of the subject's medication status, baseline SBP, age and duration of intervention. https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022302646.

Assessment of left atrial and left ventricular functions in hypertensive patients with sinus rhythm and atrial fibrillation using tissue Doppler imaging

If treated, hypertension (HTN) may reduce the risk of cardiovascular disease (CVD) and overall mortality (1). Life expectancy in adults is reduced by five years due to HTN, which is commonly misdiagnosed or improperly treated despite the widespread availability of effective pharmacological medicines and updated clinical recommendations (2). Hypertensive heart disease is a cardiovascular sequela of hypertension and is characterised by left ventricular hypertrophy (LVH), left atrial enlargement, left ventricular diastolic dysfunction, functional mitral regurgitation, and neuro-hormonal alterations (3). Doppler tissue imaging has paved the way for novel echocardiography modalities like as tissue tracking and strain rate imaging, which may be utilized to evaluate regional LV systolic shortening. Myocardial stretching or shortening may be determined using strain rate analysis (4).

Neutrophil-to-Lymphocyte Ratio as a Novel Marker for Early Detection of Hypertensive Nephropathy and as a Predictor of Worsening Renal Functions in Hypertensive Patients

Neutrophil-to-Lymphocyte Ratio as a Novel Marker for Early Detection of Hypertensive Nephropathy and as a Predictor of Worsening Renal Functions in Hypertensive Patients

Research progress on the correlation between sacubitril-valsartan and cognitive function in hypertensive patients

Sacubitril-valsartan can exert antihypertensive effects by blocking the effect of angiotensin Ⅱ and inhibiting the activity of enkephalinase. As a currently common antihypertensive drug, sacubitril-valsartan’s protective effects on target organs have been confirmed in more and more studies. Inhibition of enkephalinase can hinder the degradation and metabolism of beta-amyloid, deposition of which is a characteristic pathological feature of Alzheimer's disease. And hypertension itself is a risk factor for cognitive dysfunction, so long-term medications have the theoretical possibility to result in adverse effects on the cognitions of hypertensive patients. A review of various perspectives towards the effects of sacubitril-valsartan on cognitive function in patients with hypertension will be delivered.

Renal Function in Hypertensive Patients Receiving Cilnidipine and L-Type Calcium Channel Blockers: A Meta-Analysis of Randomized Controlled and Retrospective Studies

Nearly 65%-95% of chronic kidney disease (CKD) patients have hypertension. Calcium-channel blockers are the first-line drugs for the treatment of hypertension, including hypertension with diabetes. This study aims to estimate the effect of an L-type calcium channel blocker (CCB), cilnidipine, on the renal function of hypertensive patients. Randomized control trials were selected from PubMed, Embase, Google Scholar, China National Knowledge Infrastructure (CNKI), Science Direct, Elton B. Stephens Company (EBSCO), Springer, Ovid, Cochrane Library, Medline, VIP, and Wanfang databases (from the date of databases' establishment till January 2022). Data were independently evaluated following the Cochrane risk-of-bias tool. The changes in serum creatinine (SCr), urinary protein excretion (UPE), urinary protein/creatinine ratio (UPCR), and estimated glomerular filtration rate (eGFR) before and after treatment, in percentages, were extracted for the meta-analysis. The mean difference (MD) and a CI of 95% were determined using RevMan 5.3 software. A total of 11 studies were analyzed. The standardized mean difference (SMD) between cilnidipine and L-type CCBs was -0.022, suggesting a reduced SCr with cilnidipine. For UPCR, the SMD value is 1.28. Although cilnidipine reduced UPCR in all four studies, the L-type CCBs reported a slight increase in UPCR. For eGFR, the SMD value was found to be 0.693. Cilnidipine had a more favorable effect on eGFR when compared to the L-type CCBs. While cilnidipine had similar effects on SCr to that of L-type CCBs, cilnidipine showed greater improvement in UPCR, UPE, and eGFR values.

CORRELATION OF COGNITIVE STATUS WITH IMPAIRED SKIN MICROVASCULAR REACTIVITY IN NEWLY DIAGNOSED UNTREATED HYPERTENSIVES

Objective: Untreated hypertension (HT) in the early midlife is strongly correlated with mild cognitive impairment (MCI) later on, in the elderly. HT is also associated with significant microvascular alterations in several vascular beds including skin. Skin microcirculation has been correlated with microvascular alterations in other beds and has been proposed as a model of generalized microvascular dysfunction. We sought to estimate the prevalence of MCI in newly diagnosed untreated hypertensive patients (UHTs) and compare it to normotensive healthy individuals (NTs). We also investigated possible associations between MCI and parameters of skin microvascular reactivity by using a novel laser technique, namely Laser Speckle Contrast Imaging (LSCI). Design and method: We consecutively enrolled 51 individuals including 31 UHTs and 20 NTs. All patients were free from diabetes mellitus or any cardiovascular disease. Diagnosis of HT was based on conventional office BP and 24h-Ambulatory Blood Pressure Measurement (24h-ABPM) criteria, according to standard guidelines. The Montreal Cognitive Assessment test (MoCA test) was used to assess cognitive function with a score equal to or lower than 26 being suggestive of MCI for all participants. The LSCI technique combined with post-occlusive reactive hyperemia (PORH) protocol was used to assess skin microvascular reactivity. Skin microvascular results are expressed as percentage increase of cutaneous perfusion from baseline to peak condition (base to peak flux, %). Results: Base to peak flux was significantly lower in UHTs compared to NTs (211.0 ± 53.1 vs 154.0 ± 53.0 %, p &lt; 0.01). Although the prevalence of MCI did not differ between UHTs and NTs, there was also a significant positive correlation between the MoCA test score and base to peak flux in the UHTs group (r = 0.491, p = 0.02). Conclusions: Although UHTs did not present impaired cognitive status compared to NTs, they do present impaired skin microvascular reactivity which is strongly correlated with their cognitive status from the very early stages of hypertension. Early and effective treatment of essential hypertension may contribute to the prevention of MCI and the improvement of skin microvascular function in hypertensive patients.

Compliance of Static Stretching and the Effect on Blood Pressure and Arteriosclerosis Index in Hypertensive Patients.

Background: Treatment of high blood pressure is a combination of lifestyle changes and medications, and appropriateexercise therapy is recommended as one of the lifestyle-related changes. Recently, stretching, a low-intensity exercise, was reported to be antihypertensive and effective for improving arteriosclerosis, in addition to aerobic exercise. The present study investigated the short-term effects of continuous stretching and rest-induced rebound on vascular endothelial function in hypertensive patients. Methods: This study was conducted as a single-arm prospective interventional study including patients between 30 and 70 years of age undergoing treatment for hypertension from October 2019 until May 2021. The intervention consisted of six months of daily stretching, one month of rest, and another three months of stretching. We measured arteriosclerosis indices such as cardio ankle vascular index (CAVI), ankle brachial pressure index (ABI) and reactive hyperemia index (RHI), and flexibility at the baseline and one, three, six, seven, and ten months from the baseline. Results: We included a total of ten patients (three males and seven females) with an average age of 60.10 ± 6.05 years. The exercise rate for the entire period was 90% or more, and the anteflexion measurement value improved significantly before and after the intervention (p < 0.001). Blood pressure and CAVI/ABI were well controlled throughout the study period. RHI did not show any significant improvement during the initial six months, and only slightly improved by the third month (p = 0.063). Even after the rest phase and resumption of stretching, RHI remained stable. Conclusions: The compliance of the stretching program we used, evaluated by the exercise implementation rate for the entire period, was 90% or more; therefore, easy to perform and continue by hypertensive patients. However, we did not observe a significant positive effect on arteriosclerosis index or blood pressure in this study.

Left Ventricular Diastolic Function: Comparison of Slow Coronary Flow Phenomenon and Left Ventricular Hypertrophy in the Absence of Obstructive Coronary Disease.

BackgroundAn interplay of myocardial structural abnormalities and coronary arterial dysfunction underlies the worsening left ventricular compliance. The conventionally used angina drugs have demonstrated a beneficial effect on both angina and coronary flow in cases with microvascular dysfunction and non-obstructive coronary disease. Despite that, vasoactive therapy only partially affects diastolic function in this patient population.PurposeThis retrospective study was planned to evaluate the association of myocardial mass, delayed epicardial coronary flow, and vasoactive drugs with parameters of diastolic function in two cohorts with preserved left ventricular function and non-obstructive coronary disease in patients with slow coronary flow phenomenon (SCFP) and patients with the hypertensive disease and left ventricular hypertrophy.Material and methodsThe epicardial coronary flow was evaluated in 48 patients with unstable angina in the absence of coronary stenosis >50%, by applying the methods of corrected thrombolysis in myocardial infraction frame count (cTFC). The abnormalities in the left ventricular function were assessed by echocardiography using PW-Doppler of the diastolic mitral inflow and tissue Doppler imaging. Twenty-one (43.8%) patients were diagnosed with SCFP, and twelve patients (25%) had slow epicardial coronary flow, hypertensive disease, and ventricular hypertrophy (SFLVH). The remaining 15 (31.3%) were patients with ventricular hypertrophy, hypertension, and non-delayed epicardial coronary flow (NFLVH).ResultsThe patients with SFLVH showed reduced peak early diastolic lateral mitral annular velocity (e’L) when compared to SCFP (7.1±1.9cm/s vs 8.6±2.1 cm/s, p=0.045) and NFLVH (7.1±1.9 cm/s vs 8.7±1.8 cm/s, p=0.018). A borderline significant difference was observed for the peak early diastolic septal mitral annular velocity (e’S) between the patients with SFLVH and SCFP ( 7.0±1.3 cm/s vs 8.3±2.1 cm/s, p=0.057). The ratio of mitral diastolic inflow velocity to early diastolic velocity of the mitral annulus (E/e’) in the SFLVH group was a tendency higher than E/e’ of the patients with SCFP (9.8±3.1 vs. 8.2±2.1, p=0.084) and NFLVH (9.8±3.1 vs. 7.8±1.5, p=0.051) .In the group with left ventricular hypertrophy, E/e’ >10 was more frequently observed in patients with a marked delay in the epicardial flow (33.1 ± 13.1 frames vs. 25.4 ± 11.8 frames, p=0.011) and higher left ventricular mass (146.9 ± 17.7 g/m2 vs. 126.1 ± 121.5 g/m2, p=0.027).ConclusionsPatients with microvascular angina represent a diverse population. The echocardiographic parameters of left ventricular relaxation (e') and end-diastolic pressure (E/e’) are abnormally altered in the population with left ventricular hypertrophy compared to SCFP. The delayed epicardial flow further impairs diastolic function in hypertensive patients with hypertrophy and non-obstructive coronary disease.

Features of vascular motor endothelial function in hypertensive patients with chronic heart failure

Abstract Funding Acknowledgements Type of funding sources: None. The main part of the pathogenesis of arterial hypertension (AH) is a remodeling of the vascular system and the state of the vascular endothelium, which functions as a trigger mechanism for the implementation vasoregulating mechanisms. Vascular endothelium is involved in the provision of local processes of hemostasis, proliferation, migration of blood cells in the vessel wall, which is also associated with the regulation of vascular tone and the development of atherosclerosis. Purpose To study the vascular motor endothelial function in hypertensive patients with chronic heart failure (CHF). Methods Vascular mechanisms of pathogenesis have been studied in 172 patients aged (54,2±6,2) years, men 84 and women 88, with uncomplicated hypertension II-III degree. Echographic system Acuson Sequoia 512 was used for ultrasound imaging of the heart. The diameter of the brachial artery (D, mm), flow velocity (V, m/s), the ratio D/V, Δd (%) - an increase in the diameter of the artery decompression, ΔdN (%) - an increase in the diameter of the artery sample with nitroglycerin and the ratio Δd/ΔdN were measured. Results Due to the reduction in brachial artery diameter (with AH stage II 55, l% and AH stage III 48.7%, p &amp;lt;0.01) decreased blood flow velocity in the whole group is 36.4%, which is as much depended on the degree of hypertension (p &amp;lt;0.01). Conducting tests for decompression and nitroglycerin showed that reduced growth in brachial artery diameter in the total group on the decompression was compared with the normal 51.1%: in AH II degree - by 48.8% and III level by 52.2% (p&amp;lt;0.01). The test with nitroglycerin: the larger group of hypertensive patients reduced vasodilation was 21.1%, II degree - 13.8%, and III degree - 30.7% (p&amp;lt;0.01). Conducting tests for decompression showed that normal type vasodilatory response occurred only in 27.4% of patients, with II degree in 33.8% and AH III in 22% of patients. Reduced response to decompression was 60% of patients with AH II - in 43.2%, and III degree - at 56.8% and constrictor - in 12.6% of them in AH II degree at - 6.2% and 17 % at AH III. The test with nitroglycerin: normal vascular reaction occurred in 33.5% of patients, decreased in 59.9% and constrictor in 9.6% of patients. Reduced vasoconstrictor response to nitroglycerin was more common in patients with AH II degree. Cunclusion These results define the nature of the preferred choice of antihypertensive drugs such as normalizing pressure and have a positive effect on the endothelium, which is also associated with a reduction of myocardial hypertrophy and vascular wall.

Association of Office and Ambulatory Blood Pressure with Left Ventricular Structure and Function in Hypertensive Patients.

ObjectiveThe current study was to evaluate the association of office blood pressure (OBP) and 24h ambulatory blood pressure (ABP) with left ventricular (LV) structure and function in hypertensive patients. Whether the association was modified by sex was also evaluated.MethodsA total of 694 hypertensive patients without cardiovascular disease were retrospectively included from the inpatient clinic. Regression analysis was performed to evaluate the association of OBP and 24h ABP parameters with LV mass index (LVMi), e’ velocity and left ventricular hypertrophy (LVH) with adjustment for covariates including age, obesity, diabetes mellitus, obstructive sleep apnea, estimated glomerular filtration rate and antihypertensive drugs.ResultsThere was no difference in OBP by sex. Compared to women, men had a higher 24h (132.6 ± 11.3 vs 129.3 ± 10.0 mm Hg), daytime (136.6 ± 12.9 vs 132.8 ± 9.5 mm Hg) and nighttime (130.3 ± 9.2 vs 125.1 ± 6.6 mm Hg) SBP. The proportion of patients with non-dipping pattern and reverse dipper pattern was also higher in men. In the overall participants, 24h, daytime and nighttime SBP, non-dipping and reverse dipper pattern were associated with LVMi, e’ velocity and LVH, which were not observed in OBP. The magnitude of the association between 24h, daytime and nighttime SBP, non-dipping and reverse dipper pattern with LVMi, e’ velocity and LVH was stronger in men than in women (P-value for interaction <0.05).ConclusionTwenty-four-hour ABP appears to be better than OBP in association with LV structural and functional alterations, and this association was modified by sex.

Low-Intensity Resistance Exercise Combined With Blood Flow Restriction is More Conducive to Regulate Blood Pressure and Autonomic Nervous System in Hypertension Patients-Compared With High-Intensity and Low-Intensity Resistance Exercise.

Background: The effect of resistance exercise on the autonomic nervous system of patients with hypertension has not been identified. Objective: To explore a suitable resistance training method for hypertension patients to regulate blood pressure (BP) and autonomic nervous system function. Method: Forty-five hypertension patients aged between 55 and 70 years were randomly equally divided into three groups: the high-intensity resistance exercise (HE) group, the low-intensity resistance exercise combined with blood flow restriction (LE-BFR) group, and the low-intensity resistance exercise (LE) group. All patients performed quadriceps femoris resistance exercise. The exercise intensity of HE, LE-BFR and LE group was 65, 30 and 30% of one repetition maximum (1RM), respectively. The LE-BFR group used pressure cuffs to provide 130% of systolic pressure to the patient’s thighs during resistance exercise. The training program was 20 times/min/set with a 1-min break after each set, and was conducted five sets/day and 3 days/week, lasting for 12 weeks. The heart rate (HR), BP, root-mean-square of difference-value of adjacent RR intervals (RMSSD), low frequency (LF) and high frequency (HF) were evaluated before and after the first training and the last training. Result: Significant differences in HR were observed in both recovery states after the first and last training (p < 0.01). After 12 weeks of training, the recovery speed of HR in the LE-BFR group increased significantly (p < 0.01). The systolic blood pressures in the HE and LE-BFR group were significantly reduced (p < 0.05 and p < 0.01), and the differences among groups were significant (p < 0.01). In the last recovery state, the RMSSD of the LE group was significantly lower than that in the first recovery state (p < 0.01). The LF/HF ratios of the HE and LE groups in the resting and recovery states were increased significantly (all p < 0.01). LF/HF ratios in the LE-BFR group in the resting and recovery state were decreased significantly (both p < 0.01). Conclusion: Compared to HE and LE, LE-BFR could effectively decrease systolic pressure and regulate the autonomic nervous system function in hypertension patients.

Early Initiation of Irbesartan Therapy Improves Cardiac and Kidney Function in Hypertensive Patients. Is This a Novel Pathway to Reduce HFpEF Incidence?

We evaluated the impact of irbesartan (150mg once/day for 6 months) on kidney function, echocardiographic parameters and pre-clinical atherosclerosis indexes in 33 patients with newly onset of hypertension and without overt kidney dysfunction (Hypertensive Group–HTG). 15 age- and sex-matched, normotensive, healthy individuals (Normotensive Group–NTG) served as controls, without receiving any medication. After 6 months, HTG further improved its kidney function, flow-mediated dilation, diastolic function, left ventricle mass and left atrium volume implicating a cardio and reno-protective action in patients with newly onset of hypertension.

Evaluation of LV Diastolic Function in Hypertensive Patients

Evaluation of LV Diastolic Function in Hypertensive Patients

Chronic Pain and Its Association with Depressive Symptoms and Renal Function in Hypertensive Patients.

Chronic pain is a common concern and is considered to be one of the major problems in patients with chronic physical disorders. We studied the effect of pain in patients with hypertension with or without chronic kidney disease (CKD) and the association between pain and symptoms of depression. The study involved 158 hypertensive individuals (59.5% male, mean age 55 years), of whom 47 (29.8%) had CKD (estimated glomerular filtration rate < 60 mL/min/1.73 m2). Pain was assessed with the pain/discomfort domain of the EuroQol-5 D, while depressive symptoms were assessed with the depression module of the Patient health questionnaire (PHQ-9). The prevalence of chronic pain in our sample was 44.3%. Women exhibited chronic pain more often compared to men (57.1% vs. 42.9%, p < 0.001). The presence of CKD was not significantly associated with a higher prevalence of chronic pain among hypertensive patients. Depressive symptoms were significantly associated with the presence of chronic pain. These findings were confirmed in the logistic regression analysis. Chronic pain is common in hypertensive individuals and the association with depression warrants further investigation and may have practical implications in managing these patients.

Left ventricle structure and function relations with the levels of plasma markers of fibrosis in hypertensive patients with NonSTEMI

Abstract Funding Acknowledgements Type of funding sources: None. Introduction. The myocardial fibrosis lies in the basis of left ventricle remodelling in patients with hypertension. Cardiomyocites hypertrophy, fibroblasts proliferation, enlargement of interstitial collagen volume and their ratio disorders may increase severity of stroke and myocardial infarction. Purpose. The purpose of the study is to evaluate relations between the plasma levels of myocardium fibrosis markers and left ventricle remodelling, systolic and diastolic function in hypertensive patients with NonSTEMI. Methods. Were examined 138 hypertensive patients (both men and women) with NonSTEMI. The mean age of patients was 51.2 (11.2) years. Patients with arrhythmias and conduction abnormalities, diabetes mellitus and autoimmune diseases were excluded form the study. In all patients was performed ECG in 12 standard leads; EchoCG (according to ASE/EACVI 2015 recommendations); evaluation plasma levels of tissue inhibitor of metalloproteinases-1 (TIMP-1) and insulin-like growth factor 1 (IGF-1). HF NYHA functional class was determined by performing 6MWT. Statistical significance was defined at the level of methods for p &amp;lt; 0,05. Results. The averaged levels for plasma markers of myocardium fibrosis were: TIMP-1 - 322.0 (250.0; 483.5) ng/mL; IGF-1 - 160.0 (141.0; 175.0) ng/mL. Results of correlative analysis revealed relations between IGF-1 and ILV mass (R=-0.59; p &amp;lt; 0.001), and weak correlation between IGF-1 and E/e" averaged (R=-0.19; p = 0.027) (Picture 1). These negative correlations may be explained by the growth in both fibroblasts and collagen production in myocardium. Also there were positive correlations between TIMP-1 and ILV mass (R = 0.63; p &amp;lt; 0.001) and TIMP-1 and E/e" average (R = 0.37; p &amp;lt; 0.001) (Picture 1) which may be due to an increase of myocardial stiffness as the result of fibrosis activity. The results of the comparison of TIMP-1 and ICF-1 plasma levels, structural and functional parameters of the LV in groups of patients with different types of LV geometry can be seen in Table 1. Conclusion. Thus, the results of the study show that plasma markers of fibrosis was significantly higher in patients with concentric and eccentric LV hypertrophy which may reflects the higher levels of myocardium stiffness. Abstract Table 1. Abstract Figure. Picture 1.

Non-invasive myocardial work indices in arterial hypertension: relevance to hypertension grade assessed by 24-hour blood pressure monitoring

Abstract Funding Acknowledgements Type of funding sources: None. Background. A novel approach to non-invasive myocardial work (MW) assessment was shown to be of clinical value in different scenarios. It based on left ventricle (LV) pressure-global longitudinal strain (GLS) loops computation. Systolic LV pressure is assumed to be equal to brachial cuff systolic pressure. However, single blood pressure (BP) measurement during echocardiography may be influenced by many factors, e.g. «white-coat» effect. The purpose of this study was to evaluate MW indices in patients from mild to severe arterial hypertension (AH) assessed by 24-hour ambulatory blood pressure monitoring. Methods. The study enrolled 90 males (mean age 47 ± 9 years) with uncomplicated arterial hypertension (AH), divided into 3 groups (mild AH, moderate AH, severe AH). All patients underwent conventional echocardiography, speckle tracking echocardiography with LV pressure-strain loops computation and 24-hour BP monitoring at the same day. The AH grade was assessed by DABL criteria. MV indices were calculated with specific software by integrating LV global longitudinal strain data and non-invasively estimated LV pressure. The following parameters were calculated: global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE). The values are given as median and interquartile range. Results. The patients in groups were comparable by demographic and clinical characteristics. We didn"t find any difference between groups by conventional echocardiographic parameters, including LV wall thickness, LV mass index, LV ejection fraction and LV GLS. The significant difference was present between three groups in all MW indices (Table). The patients with severe AH had higher GWI, as well as GCW and GWW compared to patients with mild and moderate AH. The GWE was significantly decreased in patients with highest BP values. Conclusions. Myocardial work indices are more sensitive markers of LV function in patients with AH compared to standard parameters. Integration of systolic BP, assessed by 24-hour BP monitoring in MW analysis may potentially give more precise characteristics of LV function in hypertensive patients. Abstract Figure.

Association Between Lipid Accumulation Product and Cognitive Function in Hypertensive Patients With Normal Weight: Insight From the China H-type Hypertension Registry Study.

BackgroundHypertension is a major cardiovascular risk factor for cognitive impairment. Lipid accumulation product (LAP), an index that represents fat overaccumulation in the body, has been shown to be associated with cardiovascular disease. Nevertheless, the relationship between LAP and cognitive function in hypertensive patients with normal weight has been infrequently studied.ObjectiveThis study aimed to assess the relationship between LAP and cognitive function in hypertensive patients with normal weight.MethodsThis study included 5,542 Chinese hypertensive patients with normal weight. Cognitive function was evaluated using the Mini-Mental State Examination (MMSE). The relationship between LAP and MMSE scores was evaluated using multiple linear regression.ResultsThe mean age of the participants was 64.8 ± 9.3 years, and 2,700 were men (48.7%). The mean MMSE score was 24.5 ± 5.1 in men and 19.2 ± 6.5 in women. The mean LAP was 26.2 ± 25.5 in men and 42.5 ± 34 in women. Log10-LAP showed a significant positive association with MMSE score (men: β = 0.69, 95% CI 0.14–1.24, p = 0.015; women: β = 1.03, 95% CI 0.16–1.90, p = 0.020). When LAP was divided into 3 groups according to tertiles, participants in the third LAP tertile had higher MMSE scores for both men (p for trend = 0.04) and women (p for trend = 0.015).ConclusionLAP showed an independent positive association with MMSE in Chinese hypertensive patients with normal weight.

Left ventricular function in hypertensive diabetic patients in Morocco: Overall longitudinal strain and diastolic function

Type 2 diabetes is a major risk factor for congestive heart failure. Recent data judge that a decrease in left ventricular longitudinal myocardial deformity as well as diastolic dysfunction are apparent in the early stages of diabetic cardiomyopathy and this regardless of the presence of hypertension in type 2 diabetic patients. The objective of this study was to characterize left ventricular function in hypertensive patients with type 2 diabetes with a normal ejection fraction and to relate these results to pathogenic cardiovascular risk factors. A prospective study carried out at the Ibn Rochd University Hospital in Casablanca between March 2019 and March 2021, including hypertensive diabetics, with a duration of the two diseases greater than 1 year without coronary heart disease, or low left ventricular fraction ejection. We performed laboratory workup including microalbuminuria, glycated hemoglobin, ECG, echocardiography, and 24 hour ambulatory blood pressure. To the diabetic group was added a group of non-diabetic hypertensive controls. Diabetic patients had significantly higher blood pressure, compared to the control group. Left atrium, mitral A wave velocity, and left ventricular mass were significantly higher in subjects with diabetes, and the E/A ratio was significantly lower than in control subjects. In 22.22% of hypertensive diabetic patients, an alteration in SGL was observed versus 9.5% in the control group. In the group of diabetic patients, SGL was significantly correlated with left ventricular mass, and uncontrolled glycated hemoglobin Patients with diastolic dysfunction had significantly higher levels of microalbuminuria, heart rate and nondipper blood pressure. Longitudinal systolic deformity was linked in hypertensive diabetic patients to left ventricular mass and glycated hemoglobin level, as well as diastolic dysfunction is mainly linked to microalbuminuria.

The Usefulness of 4D Echocardiographic Modality for Assessing RV Affection in Uncontrolled Hypertensive Patients.

In many cardiovascular disorders, the contractile performance of the right ventricle (RV) is the primary determinant of prognosis. For evaluating RV volumes and function, 4 dimensional (4D)-echocardiography has become common. This research used 2D and 4D modalities to assess RV contractile performance in hypertensive patients. A total of 150 patients with essential hypertension were enrolled in this study, along with 75 age and sex-matched volunteers. Clinical evaluation and echocardiographic examination (including M-mode, tissue Doppler imaging, and 2D speckle tracking) were conducted on all participants. RV volumes, 4D-ejection fraction (EF), 4D-fractional area change (FAC), 4D-tricuspid annular plane systolic excursion (TAPSE), 4D-septal and free wall (FW) strain were all measured using 4D-echocardiography. Hypertensive patients showed 2D-RV systolic and diastolic dysfunction (including TAPSE, 2D-right ventricular global longitudinal strain, RV-myocardial performance index and average E/EaRV) and 4D-RV impairment (including right ventricular EF, FAC, RV strain and TAPSE, right ventricular end-diastolic volume and right ventricular end-systolic volume) compared to the control group. We verified the prevalence of RV systolic dysfunction in hypertension patients using the following parameters: 1) 15% of them had 2D-TAPSE < 17 mm vs. 40% by 4D-TAPSE; 2) 25% of them had 2D-GLS < 19% vs. 42% by 4D-septal strain and 35% by 4D FW strain; 3) 35% of hypertensive patients had 4D-EF < 45%; and finally; 4) 25% of hypertensive patients had 2D-FAC < 35% compared to 45% by 4D-FAC. The incidence of RV involvement was greater in 4D than in 2D-modality trans-thoracic echocardiography. We speculated that 4D-echocardiography with 4D-strain imaging would be more beneficial for examining RV morphology and function in hypertensive patients than 2D-echocardiography, since 4D-echocardiography could estimate RV volumes and function without making geometric assumptions.

Assessment of Left Ventricle Myocardial Function in Hypertensive Patients Using Three-Dimensional Speckle-Tracking Echocardiography (3D-STE)

Background: Increased myocardial fibrosis in hypertension leads to abnormalities in left ventricular diastolic function. 3D-speckle-tracking imaging (3D-STI) is a primary imaging modality used to detect early changes in the left ventricle (LV). The aim of this study was to assess the left ventricular myocardial function in hypertensive patients using 3D-speckle tracking imaging (3D-STI). Methods and Results: A case control, nonintervention, descriptive study was conducted in the Department of Ultrasound Diagnosis of Union Hospital of Tongji Medical College of Huazhong University of Science and Technology (Wuhan, Hubei, China). The study subjects included 64 patients with hypertension (HT) and, as control group, 44 normotensives. HT patients were divided into HT-I group (SBP of 130-139 mmHg or DBP of 80-89 mmHg, and HT-II group (SBP &gt;140 mmHg or DBP &gt;90 mmHg). In this study, LV geometry and function were assessed using conventional 2D- and 3D-echocardiography in a total of 108 consecutive subjects. LV volumes, global and regional strains were measured using 3D-STI. LV ejection fraction (LVEF) was in normal range in three groups, but in general, it slightly decreased in HT-II patients, compared with control and HT-I groups (62.5±2.1%, 68.0±2.2%, and 67.5±1.3%, respectively, P=0.00). Global systolic strain demonstrated a significant decrease in GLS, GCS, and GRS in the HT-II group, compared with control and HT-I groups. All regional strain parameters (longitudinal, circumferential, and radial) significantly decreased in HT-II patients, compared with control and HT-I groups. Conclusion: A significant deterioration of global LV systolic functions is found in hypertensive patients with well-preserved LVEF, especially in patients with hypertension stage II.