Group Of Hypertensive Patients Research Articles

The Relationship Between Right Ventricular Longitudinal Strain and Adverse Outcome in Hypertensive Patients: 10-year Follow-up.

Previous studies showed the importance of right ventricular (RV) remodeling in patients with arterial hypertension and RV longitudinal strain was recognized as very sensitive parameter for detection of subtle cardiac impairment. However, its clinical importance in arterial hypertension has not been established so far. The present study aimed to evaluate the association between RV longitudinal strain (global and free-wall) on adverse outcomes measured by MACE in the large group of hypertensive patients who were followed for mean period of 10 years. This retrospective study finally included 544 hypertensive patients who underwent full echocardiographic examination including 2D speckle tracking imaging. between January 2010 and December 2014. MACE was considered as the primary outcome and it was defined by all-cause mortality, cardiovascular mortality, myocardial infarction, coronary artery by-pass, coronary stent implantation, stroke, development of heart failure, and occurrence of atrial fibrillation during follow-up. Patients who experienced MACE were older than those who did not. There was no difference in demographic and clinical parameters between MACE and non-MACE patients. There was no difference in RV diameter, but MACE patients had higher RV wall thickness. RV systolic function parameters were similar between the two groups. RV global and free-wall longitudinal strain were significantly lower in MACE patients (-22.3 ± 3.6 vs. -24.7 ± 3.9%, p < 0.001 and - 25.8 ± 4.2 vs. -28.1 ± 4.5%, p < 0.001; respectively). Reduced RV GLS [OR 1.10; 95%: 1.02-1.20] and reduced RV free-wall longitudinal strain [OR 1,21; 95%CI: 1.05-1.39] were independently of clinical and echocardiographic parameters related with adverse outcome measured by MACE. RV GLS and RV free-wall longitudinal strain were independently related with adverse outcomes during 10-year follow-up in initially uncomplicated hypertensive patients.

Impact of Community Proactive Health Management Application on Electronic Health Literacy and Self-Management of Hypertensive Patients.

Investigating the impact of the Community Proactive Health Management Application on electronic health literacy, self-management level, and blood pressure in hypertensive patients within the community. Between September and November 2020, two communities in Hengyang City, Hunan Province, China were selected as the intervention and control groups using convenience sampling. Subsequently, 30 hypertensive patients from each of the two communities were randomly selected to participate as study subjects. The control group patients received foundational hypertension management, whereas the intervention group received additional care through the Community Proactive Health Management Application. Following a 3-month period, the intervention group exhibited significantly higher total scores (t=2.193, p=0.032) and application dimension scores (t=2.605, p=0.012) for electronic health literacy compared to the control group. The total scores of electronic health literacy scale for both the intervention (t=-5.671, p<0.001) and control (t=-3.613, p=0.001) groups were higher after the intervention compared to before. The total score of the self-management scale (t=3.872, p<0.001), as well as the scores for the treatment management (t=6.580, p<0.001) and habit management dimensions (t=2.315, p=0.024) of hypertensive patients in the intervention group, were significantly higher than those in the control group. The self-management scores of both groups of hypertensive patients showed a significant increase compared to preintervention levels (intervention group t=-14.391, p<0.001; control group t=-6.584, p<0.001). The intervention group exhibited a statistically significant decrease in systolic blood pressure compared to the control group (Z=-2.036, p=0.042). Following the intervention, both groups exhibited a significant reduction in systolic and diastolic blood pressure levels compared to preintervention levels (all p<0.001). The Community Proactive Health Management Application has the potential to enhance the electronic health literacy and self-management capabilities of hypertensive patients, enabling them to engage in better health management, reduce hypertension levels, and elevate their overall quality of life.

Uncontrolled blood pressure among the established hypertensive elderly people in Jashore, Bangladesh: A cross‐sectional type of observational study

AbstractObjectivesHypertension is one of the major modifiable risk factors for cardiovascular mortality and morbidity throughout the world. Increased life expectancy leads to increase prevalence of non‐communicable diseases among the elderly people including Bangladesh. However, different studies reported high prevalence of uncontrolled hypertension ranging from 52.6% to 67.9% among the elderly people in different countries. With this view, we aimed to assess the frequency of uncontrolled blood pressure (BP) among the elderly hypertensive people and its associated risk factors and treatment pattern in Bangladesh.MethodologyThis cross‐sectional type of observational study recruited 246 eligible hypertensive elderly patients attending in 250 Bedded General Hospital, Jashore, Bangladesh dated from 1st July to 31st December 2022. A structured questionnaire was developed and data on associated risk factors, treatment pattern and current blood pressure (BP) measurement were collected by face‐to‐face interview for the purposive sampling technique.ResultsThe mean age of our study patients was 72 ± 7 years with a male and female ratio nearly 1:1. Of the total hypertensive patients aged over 65 years or more, 56.5% remained with uncontrolled hypertension even on their prescribed antihypertensive medications. The mean systolic (SBP) and diastolic (DBP) blood pressure were significantly high (P &lt; 0.001) as 167 ± 22 mm Hg and 95 ± 11 mm Hg, respectively, among the uncontrolled hypertensive patients. However, we noticed the mean SBP and DBP among the total hypertensive patients were also significantly high (P &lt; 0.001) as 148 ± 27 mm Hg and 87 ± 13 mm Hg, respectively. In this study, we reported that the mean number of last prescribed antihypertensive medications used by the total patients was 2 ± 1 (P =0.224) which was similar among the controlled and uncontrolled hypertensive patient groups. Among the elderly hypertensive patients, the most commonly prescribed antihypertensive medications were Amlodipine 39.8% (P =0.006), Olmesartan 29.3% (P = 0.186), Losartan 24.4% (P = 0.127), Bisoprolol 15.0% (P = 0.266) and Atenolol 14.6% (P = 0.224).ConclusionWe noticed high frequency of uncontrolled blood pressure among the elderly hypertensive patients, despite of using multiple antihypertensive medications in Jashore, Bangladesh.

A quantitative MRI comparative study of imaging markers for cerebral small vessel disease in the middle-aged and elderly patients with and without hypertension

Objective: To explore the difference of MRI markers of small cerebral vascular disease in middle-aged and elderly patients with hypertension and non-hypertension. Methods: A cross-sectional study. The clinical data of 316 patients who underwent head MRI with susceptibility weighted imaging scans at the Affiliated Zhongda Hospital of Southeast University from November 2013 to August 2022 were retrospectively analyzed, including 190 males and 126 females, with the age of (71.6±8.9)years. According to the history of hypertension, the patients were divided into hypertension group(n=259) and the non-hypertension group(n=57). The patients in the non-hypertension group were further divided into abnormal blood pressure group on admission (n=19) and normal blood pressure group on admission (n=38). The imaging features of different CSVD dimensions in the patient's images were quantified or graded and compared between hypertensive and non-hypertensive patient groups. Deep learning methods were employed to segment white matter lesions, and voxel-wise analysis was conducted to investigate the differences in whole-brain white matter lesion probability between patients in both groups. Spearman correlation analysis was used to analyze the correlation between hypertension and small cerebral vascular disease. Results: Compared with the non-hypertensive group, the cerebral microhemorrhage count, deep microhemorrhage count, basal ganglia level lacunae count, perivascular space (EPVS) grade of hemioval center level and EPVS grade of basal ganglia level were higher in the hypertensive group (all P<0.05). The cerebral microhemorrhage count [3.0(1.0, 15.0) vs 1.0 (0, 4.2)], deep microhemorrhage count [1.0 (0, 7.0) vs 1.0 (0, 4.2)] and EPVS classification at basal ganglium level [2.0(1.0, 3.0) vs 1.0(1.0, 2.0)] in the group with history of hypertension were higher than those in the group with normal blood pressure at admission (all P<0.05). The EPVS grade at the central level of the semiovale in the hypertension group was higher than that of the group with normal blood pressure at admission [2.0(1.0, 2.0) vs 1.0 (1.0, 2.0)], and also higher than that of the group with abnormal blood pressure at admission [2.0(1.0, 2.0) vs 1.0(1.0, 2.0)](both P<0.05). Voxel-by-voxel analysis showed no significant difference in the probability of white matter lesions in the whole brain between patients with and without a history of hypertension, but patients with a history of hypertension showed more extensive para-ventricular white matter hypersignaling than those without a history of hypertension. Spearman correlation analysis showed that hypertension grade was correlated with the number of microbleeding lesions in depth (r=0.149), the number of lacunae lesions in the center of the hemioval (r=0.209), and the number of lacunae lesions in the basal ganglia (r=0.204) (all P<0.05). Conclusions: Chronic hypertension can affect different dimensions of small vessel disease imaging, primarily manifested in the increases of deep microbleed counts and the EPVS grade.

Approximation to the economic cost of healthcare for hypertensive patients diagnosed with COVID-19.

Many researchers have focused their studies on hypertension due to its over-representation among COVID-19 patients. Both retrospective and observational studies conducted close to the Wuhan area have reported that hypertension is the most common comorbidity observed in patients affected by COVID-19. Our objective is that patients with arterial hypertension have a worse prognosis in terms of evolution leading to higher costs. A retrospective cross-sectional study was conducted. A total of 3,581 patients from La Paz University Hospital (LPUH) during the period between 15 July 2020 and 31 July 2020 were included in this study. It should be noted that 40.71% of the patients were hypertensive. As expected, hypertension was associated with men, among whom we observed a higher prevalence and a higher age (median age of 77 years (IQI: 65-85) versus 52 years (IQI: 37-64), p-value < 0.001). Hypertensive patients had a higher prevalence of dyspnea (52.14% vs. 47.15%, p-value = 0.004) and altered awareness (14.89% vs. 4.30%, p-value <0.001). The non-parametric Kaplan-Meier curve estimates the survival of patients in the two study groups. We can see how patients with hypertension have a higher associated mortality, with the difference being statistically significant, p-value (log-rank) = 0.004. Only for the appearance of complications during hospitalization, the group of hypertensive patients reached the figure of €1,355,901.71 compared to the total of 421,403.48 € for normotensive patients. Our study shows the worse clinical evolution of patients with COVID-19 in terms of associated morbidity and mortality. It also shows that the cost of managing patients with hypertension is greater than that of managing normotensive patients.

Effect of Foot Hidrotheraphy (Soak Feet Warm Water) Against Blood Pressure in Hypertensive Patients: A Literature Review

Background: Hypertension is a medical condition characterized by a continuous increase in blood pressure in the body's arteries. Purpose: This study aims to analyze the effect of foot hydrotheraphy ( warm water foot soak) on blood pressure in hypertensive patients with a literature review approachMethods: The author uses a literature review approach in compiling this paper, which involves exploring the 2018-2023 literature from national and international sources accessed through Google Scholar and Pubmed, which discusses the application of Foot Hydrotherapy as a method to reduce blood pressure.Results: The results showed a significant decrease in systolic (SBP) and diastolic (DBP) blood pressure after the application of hydrotherapy in patients with hypertension, with a decrease in SBP reaching 14.09 mmHg and DBP by 9.51 mmHg, while in pregnant women there was a decrease in SBP by 17.71 mmHg and DBP by 10.85 mmHg. Elderly people with hypertension also experienced a decrease in SBP by 14.04 mmHg and DBP by 9.03 mmHg after hydrotherapy. The temperature of hydrotherapy in hypertensive pregnant women is 40o-43oC to lower blood pressure, while temperatures of 37o-39oC are used to achieve a relaxing effect.Conclusion: Warm water hydrotherapy is considered an effective method in the management of blood pressure in various groups of hypertensive patients.

Effects of prolonged face mask use among patients with hypertension or diabetes during the COVID-19 pandemic.

We aimed to investigate the impacts of prolonged mask use on patients with hypertension or diabetes during the COVID-19 pandemic. This study included patients with hypertension or diabetes who visited the outpatient department of Nanjing Yimin Hospital between 1 February 2022 and 31 January 2023. We compared the change in blood pressure (BP) and fasting plasma glucose in patients with hypertension or diabetes and adjustments to treatment between the group with prolonged mask-wearing group (≥20 hours/week) and the control group (<20 hours/week). Compared with the control group of hypertensive patients, the prolonged mask-wearing group had significantly higher diastolic blood pressure (DBP) and mean arterial pressure (MAP). These two groups had had similar DBP and MAP 1 year earlier. Likewise, the prolonged mask-wearing group of patients with diabetes had a greater need than the control group for upgraded treatment to reach their therapeutic goals. This study suggests that prolonged mask use by patients with hypertension or diabetes has negative effects on hypertension and plasma glucose control. BP and plasma glucose monitoring should be improved in these patient populations and their treatment should be adjusted in a timely manner.

Medical Measures in Hypertensives Considered Resistant.

Patients with resistant hypertension are the group of hypertensive patients with the highest cardiovascular risk. All rules and guidelines for treatment of hypertension should be followed strictly to obtain blood pressure (BP) control in resistant hypertension. The mainstay of treatment of hypertension, also for resistant hypertension, is pharmacological treatment, which should be tailored to each patient's specific phenotype. Therefore, it is pivotal to assess nonadherence to pharmacological treatment as this remains the most challenging problem to investigate and manage in the setting of resistant hypertension. Once adherence has been confirmed, patients must be thoroughly worked-up for secondary causes of hypertension. Until such possible specific causes have been clarified, the diagnosis is apparent treatment-resistant hypertension (TRH). Surprisingly few patients remain with true TRH when the various secondary causes and adherence problems have been detected and resolved. Refractory hypertension is a term used to characterize the treatment resistance in hypertensive patients using ≥5 antihypertensive drugs. All pressor mechanisms may then need blockage before their BPs are reasonably controlled. Patients with resistant hypertension need careful and sustained follow-up and review of their medications and dosages at each term since medication adherence is a very dynamic process.

Mode of Presentation of Hypertension in a Group of Hypertensive Patients in Erbil

Mode of Presentation of Hypertension in a Group of Hypertensive Patients in Erbil

Differential Modulation of Markers of Oxidative Stress and DNA Damage in Arterial Hypertension.

Patients with arterial hypertension have an increased risk of developing tumors, particularly renal cell carcinoma. Arterial hypertension is linked to DNA damage via the generation of oxidative stress, in which an upregulated renin-angiotensin-aldosterone system plays a crucial role. The current study investigated surrogates of oxidative stress and DNA damage in a group of hypertensive patients (HypAll, n = 64) and subgroups of well (HypWell, n = 36) and poorly (HypPoor, n = 28) controlled hypertensive patients compared to healthy controls (n = 8). In addition, a longitudinal analysis was performed with some of the hypertensive patients. Markers for oxidative stress in plasma (SHp, D-ROM, and 3-nitrotyrosine) and urine (8-oxodG, 15-F2t-isoprostane, and malondialdehyde) and markers for DNA damage in lymphocytes (γ-H2AX and micronuclei) were measured. In HypAll, all markers of oxidative stress except malondialdehyde were increased compared to the controls. After adjustment for age, this association was maintained for the protein stress markers SHp and 3-nitrotyrosine. With regard to the markers for DNA damage, there was no difference between HypAll and the controls. Further, no significant differences became apparent in the levels of both oxidative stress and DNA damage between HypWell and HypPoor. Finally, a positive correlation between the development of blood pressure and oxidative stress was observed in the longitudinal study based on the changes in D-ROM and systolic blood pressure. In conclusion, we found increased oxidative stress in extensively treated hypertensive patients correlating with the level of blood-pressure control but no association with DNA damage.

Fourteen weeks of multicomponent training associated with flexibility training modifies postural alignment, joint range of motion and modulates blood pressure in physically inactive older women: a randomized clinical trial.

Background: Body relaxation and pain reduction are some of the reported benefits of flexibility training (through active stretching exercises), however their effects on posture and blood circulation are uncertain. We aimed to investigate the effects of flexibility training (through active stretching exercises) in combination with multicomponent training (MT) on blood pressure (BP), and the correlation with changes in body alignment and flexibility in physically inactive women. Methods: Women aged 60-70years were into three groups: multicomponent training group (MT), multicomponent training plus flexibility training group (FT), and control group (CG). After randomization, the resting blood pressure was measured and the participants were reallocated into subgroups according to pressure values >130/80mmHg (This classification is according to the American Heart Association (AHA), resulting in the subgroups: flexibility training (FT); flexibility training for hypertensive patients (FTSAH); multicomponent training (MT); multicomponent training for hypertensive patients (MTSAH); control group (CG); control group of hypertensive patients (CGSAH). The interventions lasted 14weeks. Systolic (sBP) and diastolic (dBP) BP, range of motion (flexion and extension), and postural analysis by asymmetry in the frontal plane and asymmetry in the sagittal plane, displacement and the flexibility test were collected before (Pre) and after training (Post). In total, 141 women participated in the study (without SAH: FT = 23, MT = 20, and CG = 21; with SAH: FTSAH = 28, MTSAH = 23, and CGSAH = 26). Results: Systolic blood pressure, in the pre and post moments were: FT (116 ± 6.7 vs. 114 ± 4.7); FTSAH (144 ± 16.5 vs. 121 ± 10.1); MT: (120 ± 6.8 vs. 121 ± 7.3); MTSAH: (137 ± 10.6 vs. 126 ± 13.0); CG: (122 ± 5.3 vs. 133 ± 19.2); and CGSAH: (140 ± 9.7 vs. 143 ± 26.2), presenting an F value (p-value - group x time) of 12.00 (<0.001), with improvement in the groups who trained. The diastolic blood pressure in the pre and post moments were: FT (71 ± 4.7 vs. 74 ± 6.8); FTSAH (88 ± 9.6 vs. 70 ± 12.0); MT: (74 ± 4.5 vs. 77 ± 11.7); MTSAH: (76 ± 10.4 vs. 76 ± 10.2); CG: (69 ± 7.11 vs. 82 ± 11.4); and CGSAH: (76 ± 13.4 vs. 86.6 ± 7.7), presenting an F value (p-value - group x time) of 8.00 (p < 0.001), with improvement in the groups who trained. In the Elastic Net Regression, sBP was influenced by height (β: -0.044); hip flexion (β: 0.071); Shoulder extension (β: 0.104); low back flexion (β: 0.119) and dBP (β: 0.115). In the Elastic Net Regression, dBP was influenced by asymmetry in the sagittal plane variables (0.040); asymmetry in the frontal plane (β: 0.007); knee flexion (β: -0.398); BM (β: 0.007); Shoulder flexion (β: -0.142); Hip flexion (β: -0.004); sBP (β: 0.155) and Ankle Flexion (β: -0.001). Conclusion: The displacement of the asymmetry in the frontal plane and asymmetry in the sagittal plane, and the increase in the flexion position in the hip, lumbar, head, and knee regions, influenced the highest-pressure levels. Multicomponent training associated with flexibility training promoted improvement in body alignment, COM, and joint angles, and decreased blood pressure.

Abstract P393: Uromodulin Genotype And Response To Loop Diuretics - The BHF UMOD Genotype Blinded Trial

Background: Genome-wide association studies identified the major A allele of SNP rs13333226 to be associated with increased BP and uromodulin excretion. Observational studies indicate those with rs13333226-AA genotype have greater BP lowering in response to loop diuretics. Methods: This genotype blinded multi-centre trial (NCT03354897) enrolled hypertensive participants without diabetes aged ≥18 years with home SBP &gt;135 mmHg and/or DBP &gt;85 mmHg despite treatment with ≥1 non diuretic antihypertensive drug for ≥3 months. Participants were prescribed torasemide 5mg daily for 16 weeks with ABPM BP measured at baseline, 8 and 16 weeks. Primary endpoint was change in 24h ABPM SBP between baseline and end of treatment by genotype (AA vs AG/GG). Results: We screened 251 patients, with 222 prescribed torasemide; 174 had genotype data and took ≥80% of dispensed torasemide over the study period. Drop in mean ABPM SBP at 16 weeks compared to baseline was twice as large for AA than AG/GG genotypes (AA -6.57 mmHg change (95% CI -8.44, -4.69), p&lt;0.0001; AG/GG -3.22 (-5.93, -0.51) mmHg change, p=0.021). Mean ABPM SBP in AA group steadily declined from 139 mmHg at baseline to 132.6 mmHg at end of treatment, in contrast, the AG/GG group began with a marginally lower value mean ABPM SBP, showed a marked drop at 8 weeks, followed by a rebound at 16 weeks, ending slightly higher than those in the AA group. Conclusions: The rs13333226-AA genotype identifies a group of hypertensive patients who show a larger, more stable BP reduction in response to torasemide adding further support for a biological uromodulin-NKCC2 interaction, and a role for genotype directed earlier use of loop diuretics in hypertension management.

Hipertansiyon ve Diyabet Hastalarının Algılanan Stres ve Depresyon Düzeyleri ile İlaç Uyumlarının Değerlendirilmesi

Objective: The aim of this study was to determine the perceived stress and depression level of diabetes and hypertension patients who applied to the family medicine outpatient clinic and to investigate its relationship with the treatment compliance of the patients. Methods: A total of 201 people over the age of 18 who were followed up in the family medicine outpatient clinic with the diagnosis of Hypertension and Diabetes were included in the study. The study consisted of three different groups of hypertension patients, diabetes patients and healthy volunteers. Beck Depression Scale, Perceived Stress Scale, Morisky Medication Adherence Scale-8 and sociodemographic data questionnaire were administered to the participants by face-to-face interview technique. Results: In our study, depression and perceived stress scores were lower in the healthy group compared to the other groups (p&amp;lt;0.05). Morisky medication adherence scale scores were 5.7±2.18 and 5.39±2.29 in the HT and DM patient groups, respectively, and 46.3% had a low compliance score. Factors such as education level, presence of additional disease, dietary compliance, physical activity status, and smoking were found to play an active role in medication compliance (p&amp;lt;0.05). It was observed that patients with high depression and stress scores had low adherence to medication adherence (p&amp;lt;0.001). Conclusion: Hypertensive and diabetic patients with high depression and perceived stress scores were found to have low adherence to medication adherence.

A psychological intervention based on cognitive‐behavioural therapy reduces psychopathological symptoms that indirectly influence the heart rate via cortisol in hypertensive patients: Preliminary results of a pilot study

AbstractObjectiveThis study aimed at assessing the effectiveness of cognitive‐behavioural therapy (CBT) integrated with psychoeducation in a group of hypertensive patients with clinically significant psychopathological symptoms.MethodsOne hundred hypertensive patients completed the Symptom Checklist‐90‐Revised. Of them, 17 scored above the clinical range (cut‐off = 0.75) on the Global Severity Index and were included in the study. Psychological distress was assessed again after the intervention (T1) and 6 months after the end of treatment (T2). In addition, the cortisol dosage and the heart rate (HR) measurement were collected at both T0 and T2. Then, mediation analyses were carried out to calculate whether psychopathological distress might predict HR through elevated serum cortisol levels, at both T0 and T2.ResultsThe psychological intervention (CBT integrated with psychoeducation) reduced most of the psychopathological symptoms (anxiety, depression, somatisations, obsessions and compulsions, hostility, interpersonal sensitivity and paranoid ideation) but not cortisol dosage and HR measurement. However, psychological distress indirectly predicted HR via cortisol at T0 but not at T2.ConclusionThese results suggest and encourage the replicability of data in larger sample sizes and the comparison with a control group. Nevertheless, these results highlight a need for a multidimensional assessment of disorders affecting the mental and physical spheres of patients to support their overall well‐being.

The relationship between the systemic immune-inflammation index and reverse-dipper circadian pattern in newly diagnosed hypertensive patients.

Although hypertension is considered high intravascular pressure, impairing circadian blood pressure (BP) has been shown to potentially contribute to poor clinical outcomes. Systemic immune-inflammation index (SII), based on platelet, neutrophil, and lymphocyte counts, has been established as a strong prognostic marker in cardiovascular disease. The role of inflammation in the pathogenesis of hypertension is a well-known issue and inflammatory markers are associated with BP variability. We aimed to investigate whether there is a relationship between circadian BP changes and SII in newly diagnosed hypertensive patients. The study population consisted of 196 newly diagnosed hypertensive patients without LVH. In total, 76 (38%) patients had a dipper BP pattern, 60 (31%) patients had a non-dipper BP pattern, and 60 (31%) patients had a reverse-dipper BP pattern. SII was calculated according to Multivariate logistic regression analysis revealed SII and HDL-C as an independent predictors of reverse-dipper circadian pattern in newly diagnosed hypertensive patients. The cut-off value of the SII for reverse-dipper hypertension in a ROC curve analysis was>639.73with 63.3% sensitivity and 84.2% specificity. Our study showed that the SII level was higher in the reverse-dipper hypertension patient group than in the dipper and non-dipper hypertension groups. Furthermore, SII was an independent predictor of newly diagnosed reverse-dipper hypertensive patients. The high SII value in newly diagnosed hypertensive patients can be used as an early warning parameter to identify reverse-dipper hypertension patients.

Inflammation, oxidative stress and mitochondrial dysfunction in the progression of type II diabetes mellitus with coexisting hypertension.

Type II diabetes mellitus (T2DM) is a metabolic disorder that poses a serious health concern worldwide due to its rising prevalence. Hypertension (HT) is a frequent comorbidity of T2DM, with the co-occurrence of both conditions increasing the risk of diabetes-associated complications. Inflammation and oxidative stress (OS) have been identified as leading factors in the development and progression of both T2DM and HT. However, OS and inflammation processes associated with these two comorbidities are not fully understood. This study aimed to explore changes in the levels of plasma and urinary inflammatory and OS biomarkers, along with mitochondrial OS biomarkers connected to mitochondrial dysfunction (MitD). These markers may provide a more comprehensive perspective associated with disease progression from no diabetes, and prediabetes, to T2DM coexisting with HT in a cohort of patients attending a diabetes health clinic in Australia. Three-hundred and eighty-four participants were divided into four groups according to disease status: 210 healthy controls, 55 prediabetic patients, 32 T2DM, and 87 patients with T2DM and HT (T2DM+HT). Kruskal-Wallis and χ2 tests were conducted between the four groups to detect significant differences for numerical and categorical variables, respectively. For the transition from prediabetes to T2DM, interleukin-10 (IL-10), C-reactive protein (CRP), 8-hydroxy-2'-deoxyguanosine (8-OHdG), humanin (HN), and p66Shc were the most discriminatory biomarkers, generally displaying elevated levels of inflammation and OS in T2DM, in addition to disrupted mitochondrial function as revealed by p66Shc and HN. Disease progression from T2DM to T2DM+HT indicated lower levels of inflammation and OS as revealed through IL-10, interleukin-6 (IL-6), interleukin-1β (IL-1β), 8-OHdG and oxidized glutathione (GSSG) levels, most likely due to antihypertensive medication use in the T2DM +HT patient group. The results also indicated better mitochondrial function in this group as shown through higher HN and lower p66Shc levels, which can also be attributed to medication use. However, monocyte chemoattractant protein-1 (MCP-1) levels appeared to be independent of medication, providing an effective biomarker even in the presence of medication use. The results of this study suggest that a more comprehensive review of inflammation and OS biomarkers is more effective in discriminating between the stages of T2DM progression in the presence or absence of HT. Our results further indicate the usefulness of medication use, especially with respect to the known involvement of inflammation and OS in disease progression, highlighting specific biomarkers during disease progression and therefore allowing a more targeted individualized treatment plan.

NOVEL BIOMARKERS OF KIDNEY CELL PATHOLOGY, INFLAMMATION AND FIBROSIS IN CONTROLLED AND UNCONTROLLED HYPERTENSION

Objective: A significant reduction in kidney function is needed to detect a decrease in estimated glomerular filtration rate (eGFR), and only a minority of patients with hypertension (HT) have elevated urinary albumin excretion (UAE), leaving these biomarkers insensitive for early hypertensive organ damage. Low-grade inflammatory processes and fibrosis may have a key role in the pathogenesis of HT and HT-mediated kidney damage. Finding a panel of biomarkers related to HT and kidney damage at an early stage, that varies with modifiable risk factors, may aid targeted treatment. Several biomarkers of kidney cell pathology, markers of inflammation and fibrosis are of interest. In this nationwide cross-sectional multicentre study, we aimed to assess the associations between biomarkers and hypertension in four groups of patients; (1) healthy controls, (2) controlled HT, (3) uncontrolled HT, (4) uncontrolled HT with presence of kidney damage based on UAE and eGFR. We hypothesized that: (1) plasma levels of biomarkers are different between the 4 groups, (2) plasma levels of biomarkers are associated with the different HT groups. Design and method: Hypertensive patients (n = 183) were &gt; = 18 years old with eGFR &gt;30 mL/min/1.73m2, prescribed &gt; = 2 antihypertensive agents and on a stable treatment regimen for at least 4 weeks. Age and sex matched healthy controls had undergone kidney donation assessment (n = 39). Biomarkers were analyzed in duplicate by a custom made Luminex bead-based immunoassay. The ethics committee approved the studies. All patients signed written informed consent. Results: Plasma levels of IL-1RA, NGAL and uromodulin were significantly different between healthy controls (n = 39) and hypertensive patients (n = 183). Levels of IL-1RA and NGAL were significantly different between the three groups of hypertensive patients. In multivariable models on hypertensive subjects none of the biomarkers were associated with uncontrolled HT (n = 126). IL-18, vWF-A2, NGAL and uromodulin were associated with uncontrolled HT with presence of kidney damage (n = 65). None of the biomarkers were associated with any of the HT groups after adjustment for eGFR. Conclusions: Selected biomarkers may add information to identify hypertensive patients at risk for kidney damage, but further and longitudinal analysis are needed.

PROGNOSTIC IMPACT OF RENIN ANGIOTENSIN ALDOSTERONE SYSTEM INHIBITOR IN HYPERTENSIVE PATIENTS UNDERGOING TRANSCATHETER AORTIC VALVE IMPLANTATION

Objective: The purpose of this study was to determine the prognostic impact of baseline treatment with RAAS inhibitors (RAASi) on all-cause mortality in a population of patients with severe AS who underwent transcatheter aortic valve implantation (TAVI). Design and method: The study included 373 patients with AS who had undergone TAVI. Analyses were undertaken on the subgroup of hypertensive individuals (n 327) with 2 years of follow-up. Clinical characteristics were compared using Kruskal-Wallis non-parametric test for independent samples and study-stratified multivariable Cox proportional hazards regression models was built according to baseline RAASi therapy status. A second analysis was undertaken by categorizing patients receiving RAASi medication (n 222) into those receiving angiotensin II receptor blockers (ARBs) (n 110) and those receiving angiotensin-converting enzyme inhibitors (ACEi) (n 112). Results: Taking RAASi at baseline in the hypertensive patients group was significantly related to gender (Women 56,8%), heart failure (25,7%), chronic kidney disease (CKD) (25,7%), atrial fibrillation (AF) (19,4), being on calcium-channel blocker (26,6%) or anti-platelet therapy (68,5%) (all p &lt; 0,05). All-cause mortality occurred in 23 (10,4%) of the patients on RAASi, 9 (8,2%) on ARBs and 14 (12,4%) on ACEi. In univariate COX regression model treatment with a RAASi was related with a reduction in 2-year all-cause mortality (EXP 0.46, p 0.011). After multivariable correction for significant confounders the association was not statistically significant (p = 0.08). Analyzing ACEi ARBs separately baseline ARB therapy was associated with significant reduction in all-cause mortality (EXP 0.44, p 0.028) (Figure) that was confirmed in multivariate analysis (EXP 0.42, p 0.038) with no impact in baseline ACEi use (Table). Heart failure (EXP 2.87, p &lt; 0.001), atrial fibrillation (EXP 2.39, p 0.005) and chronic kidney disease (EXP 2.08, p 0.02) were all related with an increased 2-year all-cause mortality, but after multivariable correction only heart failure remained statistically significant. Conclusions: ARBs, but not ACEi, are independently associated with a decreased risk of 2-year all-cause death in a cohort of hypertensive patients with severe AS who underwent TAVI. While it is true that these results have molecular basis, additional research is required to corroborate these findings.

ONGOING ANTI-HYPERTENSIVE TREATMENT DOESN’T IMPACT ON OUTCOME ON MEDIUM-LONG TERM SEQUELAE OF PATIENTS WITH MODERATE TO SEVERE COVID-19 PNEUMONIA

Objective: One “hot” topic that remains to be elucidated is the possible role of anti-hypertensive drugs on middle and long term outcome of COVID-19 pneumonia. Namely, ACE2 receptor is highly expressed on the surface of cardiac and pulmonary cells, and it is used by coronaviruses, to enter host cells; specifically, the interaction between the “spike” protein of coronaviruses and ACE2 has been identified as a key factor for the virus transmission. This makes the role of ACE-inhibitors and Angiotensin Receptor Blockers (ARBs) drugs extremely controversial and their role – if any – is still to be elucidated. Moreover, it is still unclear whether these drugs may have any impact on SARS-CoV-2 sequelae. Design and method: In this retrospective study, we analysed a group of 70 hypertensive unvaccinated patients treated in our Medicine ward for moderate to severe COVID-19 pneumonia during pandemic who survived and accepted to undergo a follow-up visit after a mean of 260 days including phone interview, standard laboratory tests, chest x-ray and/or chest computed tomography, spirometry with evaluation of DLCO. Patients were divided in three groups according to hypertensive treatment: ACE-inhibitors (n. 27) or ARBs (n. 21) or other anti-hypertensive medication. The considered groups where homogeneous (see table) Results: As shown in the table, biochemical, radiological and respiratory data were not significantly different. Again, we did not find any significant difference in terms of number of non-specific radiological alterations (i.e. ground-glass opacities, irregular linear/reticular opacities), lung fibrosis, spirometry data, DLCO diffusion, persisting effort dyspnoea. Biochemical data were, once more, substantially super-imposable in the two groups Conclusions: In conclusion, in our study, we could not detect any difference in middle-long term outcome nor in complication type or number in the groups of hypertensive patients undergoing different treatments. This result seems to support and to strengthen the idea that ACE-inhibitors and ARBs do not play a significant role on onset, evolution and middle-long term outcome of moderate to severe COVID-19 pneumoniae: although the number of follow-up patients is very small, we did not find any difference in sequelae in both groups.

Clinical and laboratory characteristics of COVID-19 in hospitalized hypertensive patients

Objective. To identify clinical and laboratory differences of COVID-19 in patients with hypertension (HTN), as well as to identify factors associated with its severe course in these patients. Design and methods. A retrospective analysis of case histories of 940 patients with COVID-19 was performed. Statistical analysis was carried out by the method of contingency tables using Pearson's Chi-square test with Bonferroni correction, multiple logistic regression analysis and ROC-analysis were also applied. Results. The group of patients with COVID-19 and HTN showed a number of significant differences compared with the group of patients without HTN history. The study group was characterized by higher rates of females, people over 65, patients with severe COVID-19. They were more likely to have diabetes mellitus, coronary heart disease, and chronic kidney disease. On admission, in the group of HTN patients, leukocytosis and elevated blood glucose levels were more common, as well as pneumonia, shortness of breath and low saturation (p &lt; 0,05). Multivariate logistic regression analysis showed that the presence of coronary heart disease (odds ratio (OR) = 3,492, 95 % confidential interval (CI): 2,016-6,048), leukocytosis (OR = 1,376, 95 % CI: 1,540-7,703), thrombocytopenia (OR = 1,779, 95 % CI: 1,031-3,071) and low SpO2 saturation (OR = 3,265, 95 % CI: 1,996-5,341) were associated with severe COVID-19 in hypertensive patients. ROC-analysis showed that the combination of the identified factors increases power of their association with the severe COVID-19 in HTN patients (AUC = 0,766). Conclusions. 1. Some indicators of hospitalized COVID-19 patients with HTN are different compared to patients with no HTN history. 2. Factors associated with severe COVID-19 in individuals with HTN do not differ from those in the general population of COVID-19 patients. 3. Severe COVID-19 in patients with HTN was strongly associated with the low SpO2 saturation and the presence of concomitant coronary heart disease.