Group Of Hypertensive Patients Research Articles

Effect of one-day intermittent fasting on 24-hour blood pressure profile in hypertensive and normotensive patients with overweight and obesity

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): National Academy of Medical Science of Ukraine Background The modification of eating behavior is an integral part of cardiovascular disease prevention. Intermittent fasting is a modern approach towards diet correction. However, insufficient data exists on its effect and safety on daily blood pressure and lipids. The aim of this paper was to assess the response of blood pressure, blood lipids and creatinine to acute intermittent fasting (IF) in hypertensive and normotensive patients with overweight and obesity. Methods A cohort of 65 hypertensive patients and 45 young normotensive patients with overweight and obesity included. All patients were monitored for 24 hours by Ambulatory Blood Pressure monitoring by ABMP50 Machine. All hypertensive patients were on stable antihypertensive therapy for at least 3 months and had met target office blood pressure levels. Fasting glucose (FG), blood lipids, creatinine, uric acid and high sensitive C-reactive protein (hCRP) were measured before and after fasting. All patients were asked to fast (F) for 16 hours for the first time in their lives. At the end of the fasting period, all participants in the study rated their subjective state from 1 to 10. Statistical analyses were conducted by IBM SPSS Statistics 22. Results The reaction of blood pressure on intermitted fasting was similar in both groups. Decrease of day systolic blood pressure (SBP) as well as increase of night diastolic blood pressure (DPB) was observed in both groups (TABLE 1). No significant changes of daily BP were observed in normotensive patients. Daily heart rate increased in 1st group by 1,5% (p=0.003) and decreased in 2nd group by 4,2% (p=0,002). At the same time daily SBP decreased in the group of hypertensive patients. The hypertension group (65 patients) rated their subjective state higher than 5 points and expressed that fasting was easy for them, age median 57 (51:61) years old. The normotensive group rated themselves below 5 points and expressed the difficulty of fasting and low quality of sleep, age median 26 (25:45) years old. The median BMI in 1st group 32,1 (30:35) in 2nd group 27,4 (25:30) kg/m2. The mean FG before fasting in the 1st group was 5,45(±0,61) mmol/l in the 2nd group was 4,75 (±0,55) mmol/l and after IF in the 1st group 5,36 (±0,73) mmol/l in the 2nd group 4,58 (±0,64) mmol/l (p>0.05). In hypertension group the mean of hCRP decreased from 9.95±8.02 to 4.68±2.88 (p=0.04). The level of blood creatinine and GFR had not significant changes. Conclusion One-day intermittent fasting leads to a change in blood pressure, does not cause hypotension, and is tolerated favorably in obese patients with hypertension on stable antihypertensive therapy.

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 <0.01) decreased blood flow velocity in the whole group is 36.4%, which is as much depended on the degree of hypertension (p <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<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<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.

EHypertension: A prospective longitudinal multi‐omics essential hypertension cohort

eHypertension: A prospective longitudinal multi‐omics essential hypertension cohort

Gentamicin-Induced Antibacterial Activity is Attenuated by L-Captopril

Objective: Captopril is a long-acting human angiotensin-converting enzyme (ACE) inhibitor that has been used to treat hypertension and heart failure for many years. In this study, it was aimed to determine the antimicrobial activity of L-captopril on Methicillin-Resistant Staphylococcus aureus MRSA and Methicillin-Sensitive Staphylococcus aureus (MSSA) clinical isolates and, demonstrate the combination activity of captopril with ciprofloxacin (CXP) and gentamicin (GEN), which are among antistaphylococcal chemical agents. Method: The minimum inhibitor concentration (MIC) and minimum bactericidal concentration (MBC) were determined using the microdilution technique in 96-well microtiter plates. The activity of L-captopril and CXP or GEN combination against MRSA and MSSA clinical isolates was determined by the micro-broth checkerboard assay method. Results: The captopril MIC value was determined to be 2.5 mg/ml in all bacteria strains tested. The captopril/CXP combination had an indifferent effect in the other strains tested except for one MRSA isolate. The captopril/GEN combination had an antagonistic effect in all strains studied and increased the MIC 2-4 fold. The captopril/GEN combination was found to reduce the bactericidal activity of gentamicin. Conclusions: The study results suggest that exposure to these drugs may lead to multidrug resistance in S. aureus bacteria. Especially in the hypertensive patient group, the induced resistance in any S. aureus infections should be taken into consideration while using captopril and, it should be considered that this antagonism may cause an increase in S. aureus infections.

Gaisbock Syndrome: A Review of Contemporary Studies, Pathogenesis, Complications, and Possible Treatment.

Gaisbock syndrome is the term ascribed to several conditions initially observed by Felix Gaisbock, MD, (from Innsbruck, Tyrol, Austria) in 1905 when he described a group of hypertensive male patients who had high hematocrit levels, normal leukocyte counts, and no splenomegaly. These patients had an overweight, stocky habitus, a plethoric appearance with suffusion of the eyes, tense and anxious personalities, a cigarette smoking habit, vascular disease, headaches, and facial rubor. Later studies identified alcoholism, diuretic therapy, and physical or emotional stress as additional risk factors that might contribute to the onset of this syndrome. This review revisits Gaisbock syndrome based on recent literature, and will highlight contemporary studies that have established an association between erythrocytosis and hypertension and associated risk factors. Several mechanisms help explain the pathophysiology underlying Gaisbock's observations, and these include psychiatric disorders resulting in chronic stress, volume contraction secondary to diuretics and hypertension, and obstructive sleep apnea with nocturnal hypoxemia and erythropoietin production. Complications associated with this syndrome include the formation of microthrombi with cerebral infarction; treatment should focus on the management of hypertension and a reduction in risk factors, such as obesity, cigarette smoking, and alcohol use. Gaisbock syndrome involves several clinical disorders, has a complex pathogenesis, and leads to a better understanding of the causes of erythrocytosis during patient evaluation.

Descriptive Study of Blood Donors' Blood Pressure in the Population of Male Donors in Tehran in 2017-2018

Introduction: Hypertension is one of the most important preventable risk factors for cardiovascular disease. This observational study aimed to depict the role of regular blood donation on the systolic and diastolic blood pressure (SBP and DBP, respectively) in hypertensive patients in comparison with normotensive people. Methods: This study was performed as a cross-sectional descriptive study on 546 blood donors of Vesal Blood Donation Center in Tehran who donated between 1 and 4 times in the period of 2016-2017. Donors were divided into two groups (hypertension and normal blood pressure) based on the systolic blood pressure (SBP) and diastolic blood pressure (DBP) at the time of the first donation. The trend of changes in blood pressure after each donation (second, third and fourth donation) was assessed using SPSS ver. 16 and One way-ANOVA statistical test. Results: In the group of hypertensive patients, after four blood donations, systolic and diastolic blood pressure showed a statistically significant decrease after three or four donations.Systolic blood pressure in this group after the fourth donation decreased from the mean of 149.1 to 141.6 mm Hg (P = 0.03) and diastolic blood pressure decreased from 90.04 to 86.08 mm Hg (P = 0.04 also), respectively. Decreased blood pressure was also observed in the normal group, although this significant decrease was not reported (P> 0.05). Conclusion: Our results corroborated a down-regulatory effect of regular blood donation on BP in hypertensive people. These findings are rather encouraging people toward voluntary blood donation and can be considered in therapy-related issues.

Serum Calprotectin Level as an Inflammatory Marker in Newly Diagnosed Hypertensive Patients.

Background Hypertension is one of the leading causes of cardiovascular mortality. Although the pathogenetic process involved is not yet fully understood, the disease involves endothelial damage and inflammation. Calprotectin is an inflammatory marker that rises in parallel with disease activity in conditions such as systemic inflammatory diseases, infection, and atherosclerosis. The purpose of this study was to evaluate inflammation through serum calprotectin levels in newly diagnosed primary hypertension patients. Methods Forty-nine newly diagnosed hypertensive patients and 38 healthy adults were included in the study. Patients' office blood pressure values, biochemical findings, and demographic characteristics were recorded. Serum calprotectin levels were measured using ELISA. Parameters affecting serum calprotectin levels and determinants of hypertension were evaluated. Results Serum calprotectin levels were 242.8 (72.4–524) ng/mL in the control group and 112.6 (67.4–389.8) ng/mL in the hypertensive patient group, the difference being statistically significant (p=0.001). There was no correlation between serum calprotectin levels and other parameters (blood pressure values, age, gender, serum creatinine, uric acid, and calcium levels) in the hypertensive group. A lower serum calprotectin level was found to be independently related to hypertension (β = −0.009, p=0.005). Serum calprotectin at a cutoff level of 128.6 ng/mL differentiated hypertensives from healthy controls with a sensitivity of 69.4% and specificity of 68.4% (AUC = 0.767). Conclusions The results of this study were the opposite of our hypothesis that a higher calprotectin level may reflect subclinical endothelial damage in newly diagnosed hypertensive patients. Further comparative studies involving patients at different stages of hypertension may contribute to clarifying the relationship between calprotectin and hypertension. We conclude that molecular studies seem essential for understanding the place of calprotectin in hypertension-associated inflammation, a complex process.

Comparison of the radial and brachial artery flow-mediated dilation in patients with hypertension.

Blood flow-mediated dilation (FMD) is a noninvasive assessment of vascular endothelial function in humans. The study of the FMD in hypertensive (HT) patients is an important factor supporting the recognition of the early mechanisms of cardiovascular pathologies, and also of the pathogenesis related to hypertension. To investigate whether FMD measured on the radial artery (FMD-RA) using high-frequency ultrasounds can be used as an alternative to FMD assessed with the lower frequency system on the brachial artery in patients with HT. The simultaneous measurements of FMD-RA and FMD measurements in the brachial artery (FMD-BA) were performed on 76 HT patients using 20 MHz and 7-12 MHz linear array probes, and were compared to the FMD measured in healthy groups. All quantitative data are presented as mean ± standard deviation (SD); the p-values of the normality and tests for variables comparisons are listed. The agreement of the FMD-RA and FMD-BA in HT patients was assessed with the Bland-Altman method, and using the intraclass correlation coefficient (ICC). In some statistical calculations, the FMD-RA values were rescaled by dividing them by a factor of 2. The mean FMD-RA and FMD-BA in HT patients were 5.16 ±2.18% (95% confidence interval (95% CI): [4.50%, 5.82%]) and 2.13 ±1.12% (95% CI: [1.76%, 2.49%]), respectively. The FMD-RA and FMD-BA values of HT patients were significantly different than those in respective control groups. The p-values of Mann-Whitney-Wilcoxon tests were less than 0.05. The Bland-Altman coefficient for both measurement methods, FMD-RA and FMD-BA, was 3%, and the ICC was 0.69. Our findings show that FMD-RA, supplementary to FMD-BA measurements, can be used to assess endothelial dysfunction in the group of HT patients. In addition, the FMD-RA measurements met the criteria of high concordance with the FMD-BA measurements.

Right Heart Pulmonary Circulation Unit Response to Exercise in Patients with Controlled Systemic Arterial Hypertension: Insights from the RIGHT Heart International NETwork (RIGHT-NET).

Background. Systemic arterial hypertension (HTN) is the main risk factor for the development of heart failure with preserved ejection fraction (HFpEF). The aim of the study was was to assess the trends in PASP, E/E’ and TAPSE during exercise Doppler echocardiography (EDE) in hypertensive (HTN) patients vs. healthy subjects stratified by age. Methods. EDE was performed in 155 hypertensive patients and in 145 healthy subjects (mean age 62 ± 12.0 vs. 54 ± 14.9 years respectively, p < 0.0001). EDE was undertaken on a semi-recumbent cycle ergometer with load increasing by 25 watts every 2 min. Left ventricular (LV) and right ventricular (RV) dimensions, function and hemodynamics were evaluated. Results. Echo-Doppler parameters of LV and RV function were lower, both at rest and at peak exercise in hypertensives, while pulmonary hemodynamics were higher as compared to healthy subjects. The entire cohort was then divided into tertiles of age: at rest, no significant differences were recorded for each age group between hypertensives and normotensives except for E/E’ that was higher in hypertensives. At peak exercise, hypertensives had higher pulmonary artery systolic pressure (PASP) and E/E’ but lower tricuspid annular plane systolic excursion (TAPSE) as age increased, compared to normotensives. Differences in E/E’ and TAPSE between the 2 groups at peak exercise were explained by the interaction between HTN and age even after adjustment for baseline values (p < 0.001 for E/E’, p = 0.011 for TAPSE). At peak exercise, the oldest group of hypertensive patients had a mean E/E’ of 13.0, suggesting a significant increase in LV diastolic pressure combined with increased PASP. Conclusion. Age and HTN have a synergic negative effect on E/E’ and TAPSE at peak exercise in hypertensive subjects.

The features of the composition of the gut microbiota in patients with hypertension and abdominal obesity

The aim of this work was to study the features of the composition of the gut microbiota (GM) in patients with arterial hypertension (AH), which occurs against the background of abdominal obesity (AO). Materials and methods. The paper presents the data on examination of 70 patients with AH of 2–3 degrees (46 patients with AO and 24 patients without obesity – with normal body weight (NBW)). The control group included 20 apparently healthy individuals with NBW. The patients underwent detailed standard clinical, laboratory and instrumental examination. Determination of the quantitative composition of GM was carried out by the method of polymerase chain reaction with hybridization-fluorescence detection of results in real time using the test system “COLONOFLOR-16 (biocenosis)” (“ALFA-LAB”). In this work, a statistical analysis of the obtained data was carried out using standard methods and Microsoft Excel 17.0. Results. A significant change in the composition of GM were found in patients with AH, which proceeds against the background of AO, in comparison with apparently healthy individuals and with patients with AH without obesity (with NBW). In the group of AH patients with the presence of AO, significant decrease in the number of Lactobacillus spp., Bifidobacterium spp., Faecalibacterium prausnitzii and Аkkermansia muciniphila was found in comparison with apparently healthy individuals. The number of Faecalibacterium prausnitzii and Аkkermansia muciniphila in these patients was also significantly lower than in hypertensive patients with NBW. At the same time, the ratio of Bacteroides fragilis/Faecalibacterium prausnitzii was significantly higher than in the control group and the group of hypertensive patients without obesity – with NBW. Conclusions. The results of the study indicate a possible role for the deficiency of such representatives of GM as Lactobacillus spp., Bifidobacterium spp., Faecalibacterium prausnitzii and Аkkermansia muciniphila and an increase in the ratio of Bacteroides fragilis/Faecalibacterium prausnitzii in the pathogenesis of AH, which occurs against the background of AO.

Short-term effect of angiotensin-converting enzyme inhibitor on retinal vessel diameter in patients with systemic hypertension

Purpose To determine the retinal vessel diameter changes after angiotensin-converting enzyme (ACE) inhibitor treatment in a group of hypertensive patients. Methods This study included 60 treatment-naive hypertensive patients who were treated with ACE inhibitor. Sixty healthy volunteers served as control group. An optical coherence tomography scan protocol including the measurement of peripapillary retinal vessel diameters was performed at baseline and at 1st month. The diameters of superior temporal artery (STA), inferior temporal artery (ITA), superior temporal vein (STV), inferior temporal vein (ITV), superior nasal artery (SNA), inferior nasal artery (INA), superior nasal vein (SNV) and inferior nasal vein (INV) were statistically compared. Results The baseline diameters of the STA, ITA, SNA, and INA were significantly decreased in the patient group compared with the control group (all p < 0.05). There was a significant increase at 1st month after the treatment in comparison to baseline measurements (all p < 0.05). When compared with the controls, only the diameter of SNV showed a significant decrease at baseline (p = 0.031). After the treatment, the diameters of SNV and INV were significantly increased compared with baseline measurements (p = 0.049 and p = 0.035, respectively). There were no significant differences between the control group and the patient group at 1st month (all p > 0.05). Conclusion Short-term treatment with ACE inhibitor led to a significant improvement in the retinal vessel diameters of patients with hypertension.

Renal Acoustic Radiation Force Impulse Elastography in Hypertensive Nephroangiosclerosis Patients

Objective: Hypertensive nephroangiosclerosis (HN) represents the second most common cause of chronic kidney disease. Kidney damage secondary to high blood pressure favors the appearance of serum and urinary changes, but also imaging, highlighted by ultrasonography (B-mode, Doppler, Acoustic Radiation Force Impulse Elastography). Acoustic Radiation Force Impulse Elastography (ARFI) represents a new imagistic method which characterizes renal stiffness in the form of shear wave velocity (SWV). Aim: This study aims to investigate renal stiffness in HN patients, and to assess the correlations between it and urinary albumin/creatinine ratio (UACR), estimated glomerular filtration rate (eGFR), and intrarenal resistive index (RRI). Material and Methods: This cross-sectional study was performed on a group of 80 HN patients and 50 healthy, sex and age-matched, as controls. UACR (urinary immunoturbidimetry), eGFR (Jaffe method), RRI, and renal SWV (Siemens Acuson 2000) were determined in all patients and controls. Data were expressed as mean ± standard deviation. Statistical analysis was done by means Pearson’s test and t-Student test, p values of less than 0.05 were considered statistically significant. Results: UACR, eGFR, RRI and SWV showed statistically significant differences between the HN patients and controls (p &lt; 0.0001). In the hypertensive patients group, statistically significant correlations were observed between the SWV and UACR (r = −0.7633, p &lt; 0.00001), eGFR (r = 0.7822, p = 0.00001), and RRI (r = −0.7978, p = 0.00001). Conclusions: Kidney sonoelastography characterizes imagistically the existence of intrarenal lesions associated with essential hypertension, offering a new diagnosis method for these patients.

Is there a difference between normotensive and hypertensive patients in terms of blood parameters and cardiovascular diseases?

Objectives: It has been stated in various studies that there is a difference in some blood parameters between hypertensive and normotensive patients for a long time. Mean platelet volume (MPV), and red blood cell distribution width (RDW), have been studied in hypertensive patient groups in many studies. Hypertension is a classic risk factor for ischemic stroke and myocardial ischemia, as known. In our study, we examined whether there was a difference between hypertensive patient groups and normotensive patients in terms of blood parameters such as MPV and RDW, and the incidence of stroke and myocardial infarction. Methods: Blood samples and twenty-four-hour ambulatory blood pressure monitoring (ABPM) results of 552 patients admitted to our outpatient clinic with a pre-diagnosis of hypertension were retrospectively analyzed. According to ABPM results, we divided the study participants into four groups; dippers, non-dippers, extreme dippers, and normotansives. Complete blood count and biochemical test results were found in the database of our hospital for all patients and differences between groups were investigated. Results: One hundred seventy three normotensives (Group 1) (mean age, 47.4 ± 15.4 years), 210 non-dippers (Group 2) (mean age, 53.8 ± 15.8 years), 67 extreme dippers (Group 3) (mean age, 49.1 ± 15.9 years) and 102 dippers (Group 4) (mean age, 52.2 ± 12.5 years). Daytime mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) and night-time mean SBP and DBP were significantly different in groups (Group 1: 117 [90-193] mmHg and 71 [55-87] mmHg; Group 2: 137 [107-188] mmHg and 83 [107-188] mmHg; Group 3: 143 [115-193] mmHg and 88 [56-122] mmHg; and Group 4: 140.5 [116-173] mmHg and 76 [55-124] mmHg), p &amp;lt; 0.001; respectively. MPV and RDW levels were different in all four groups (p &amp;lt; 0.001). We found a significant difference in the rates of stroke and coronary artery disease between the four groups (p = 0.018 and p = 0.002, respectively). In the ROC curve analysis MPV had sensitivity of %77. 8 and specificity of 78. 1% for stroke when the cut-off value MPV was 9.25 (Area under curve: 0.808, 95% confidence interval: 0.726-0.889, p &amp;lt; 0.001). Conclusions: In our study, MPV and RDW levels and the rates of stroke and cardiovascular disease were significantly higher in non-dipper patients compared to other groups.

A Biochemical Analysis of Patients with COVID-19 Infection.

Several studies have demonstrated that age, comorbidities, and abnormalities in different clinical biomarkers can be important to understand disease severity. Although clinical features of COVID-19 have been widely described, the assessment of alterations of the most common biochemical markers that are reported in patients with COVID-19 still has not been well established. Here, we report clinical and blood biochemical indicators of 100 patients with COVID-19. Throat-swab upper respiratory samples were obtained from patients and real-time PCR was used to confirm SARS-CoV-2 infection. Gender, age, and clinical features such as diabetes mellitus, hypertension, and smoking habits were investigated. Biochemical parameters were categorized and analyzed according to these clinical characteristics. Triglycerides, GPT, and ALP are the biochemical markers that changed the most in the group of hypertension patients. Cholesterol and triglycerides were significantly different (P=0.01; P=0.04, respectively) between diabetic and nondiabetic patients with COVID-19. Potassium levels were significantly different (P=0.03) when comparing smokers with nonsmoker patients. Our results suggest several potential biochemical indexes that changed in patients with COVID-19 and whether certain comorbidity and clinical characteristics influence these markers.

Short-term effect of angiotensin converting enzyme inhibitor on choroidal vascularity

PurposeTo determine the effect of angiotensin-converting enzyme (ACE) inhibitors on choroidal vascularity using the binarization method in a group of treatment-naïve hypertensive patients. MethodsThere were 48 treatment-naive hypertensive patients who were diagnosed according to the "2013 European Society of Hypertension/European Society of Cardiology" guideline and started angiotensin-converting enzyme inhibitor perindopril (Coversyl) in the study. As a control group, 48 healthy volunteers were randomly selected among people who attended the outpatient clinic for routine ophthalmological examination. Enhanced-depth imaging optical coherence tomography (EDI-OCT) images were captured at baseline and at 1 month after treatment. Binarization of the EDI-OCT images was performed by Image-J software. The choroidal thickness (CT), total choroidal area, luminal area, stromal area, and choroidal vascularity index (CVI) were measured. ResultsThere was a statistically significant increase in CT at all locations (subfoveal, nasal, and temporal) at 1 month after treatment compared with baseline (for all, p˂0.001). Choroidal structural parameters and the mean CVI were statistically significantly increased at 1 month after treatment (for all, p˂0.001). When compared, there was no statistically significant difference for the vascular parameters between the control group and the patient group at 1 month (for all, p>0.05). ConlusionA statistically significant improvement was demonstrated in the choroidal vascular parameters except for the stromal area after treating with an ACE inhibitor in a group of hypertensive patients.

Associations between Socio-Demographic Factors and Hypertension Management during the COVID-19 Pandemic: Preliminary Findings from Malaysia.

The perspectives of hypertensive patients on the state of hypertension control during the ongoing pandemic restrictions have not been extensively studied in Malaysia. Therefore, this study aimed to assess the impact of socio-demographic factors, health literacy, and adherence on the overall hypertension management in a group of Malaysian hypertensive patients during the COVID-19 pandemic. An anonymous, online cross-sectional study was conducted over three months that involved a group of Malaysian adults with hypertension. A validated, self-administered 30-item questionnaire was prepared in Malay and English languages on Google Forms. The link was then distributed to participants on social media (Facebook and WhatsApp). Following survey validation, a pilot study with 30 participants who met the inclusion criteria was carried out. The total scores for health literacy, adherence, and pandemic impact on hypertension control were calculated and compared across all independent variables. In a total of 144 study participants, controlled blood pressure was reported in 77% (N = 111). There were good levels of adherence and health literacy scores but moderate levels of pandemic impact scores. The total adherence scores showed a statistically significant difference between age groups (χ2 = 6.48, p = 0.039) and those who reported having controlled and uncontrolled blood pressure (U = 1116, p = 0.001). Moreover, the analysis revealed statistically significant differences in total pandemic impact scores based on the age group (χ2 = 15.008, p = 0.001), household income (χ2 = 6.887, p = 0.032), employment (U = 1712, p = 0.006), and marital status (U = 520.5, p < 0.001). The youngest age group (18–39) years, the lowest income group, unemployed and unmarried individuals, had significantly higher pandemic impact scores. This denotes that those individuals were more prone to be negatively affected by the pandemic regarding their hypertension management. Most participants reported relatively controlled blood pressure and good levels of health literacy as well as adherence amidst the pandemic. To a moderate extent, study participants perceived that the pandemic had a negative effect on hypertension management. The perceived negative impact of the pandemic was attributed to several socio-demographic factors, such as age, household income, employment, and marital status.

Myocardial strain and left ventricular geometry: a meta-analysis of echocardiographic studies in systemic hypertension.

Evidence on systolic dysfunction, as assessed by left ventricular (LV) mechanics, in hypertensive heart disease phenotyped by abnormal LV geometric patterns is still limited. Thus, we performed a systematic meta-analysis of 2D/3D speckle-tracking studies in order to provide an updated comprehensive information on this topic. The PubMed, OVID-MEDLINE, and Cochrane library databases were analyzed to search for articles published from the inception up to 31 January 2021. Studies were identified by using MeSH terms and crossing the following search items: 'myocardial strain', 'left ventricular mechanics', 'speckle tracking echocardiography', 'systolic dysfunction', 'hypertensive heart disease', 'left ventricular hypertrophy', left ventricular remodeling", 'concentric hypertrophy', 'eccentric hypertrophy'. Overall, data of 267 normotensive controls and 712 hypertensive patients (234 normal geometry, 97 LV concentric remodeling, 176 eccentric LVH, and 205 concentric LVH) from eight studies were considered. Pooled ejection fraction was similar in normotensives and in the whole group of hypertensive patients: (SMD 0.037 ± 0.05, confidence interval (CI): 0.14/0.07, P = 0.51) as well as in hypertensive subgroups. LVMI, and E/e' gradually increased from hypertensive patients with normal geometry and concentric remodeling, to patients with eccentric and concentric LVH. LV global longitudinal strain (GLS) was lower in all hypertensive groups compared with normotensive controls, in particular, in the eccentric (SMD 1.14 ± 0.22, CI: 0.69/1.59, P < 0.0001) and concentric LVH group (SMD 1.37 ± 0.21, CI: 0.95/1.79, P < 0.0001). The meta-analysis restricted to hypertensive patients showed that GLS gradually deteriorated from hypertensive patients with normal LV geometry, across those with concentric remodeling, to participants with eccentric and concentric LVH (-19.5 ± 0.6 versus -18.8 ± 0.73 versus -17.6 ± 0.66 versus -16.5 ± 0.6%, P < 0.001 for trend). Statistical significance was reached when GLS of the concentric and eccentric LVH group but not the concentric remodeling was compared with the normal geometry one. The present meta-analysis confirms that GLS performs better than ejection fraction in identifying systolic dysfunction in the hypertension setting. More importantly, it suggests that this occurs in patients with altered LV structure and geometry, such as LVH.

Prevalence of hyperuricemia in cerebrovascular accidents and its correlation with their outcome

Introduction: Cerebrovascular accident or stroke is a disease of the vascular system of the brain.According to ICD 11, stroke is classified as a neurological disease and not under the circulatorysystem. It is the second leading cause of death worldwide. It cannot be said that high Serum UricAcid [SUA] amongst patients with cerebrovascular accidents is directly correlated with theiroutcome. The present study planned to estimate uric acid levels and their association in acute strokepatients, both ischemic and hemorrhagic. Method: A total of 100 stroke patients admitted under theneurology department were included in the study. Brain imaging (CT/MRI) was performed. Theserum uric acid was estimated. Results: Out of a total of 100 patients, 74 were males, and 26 werefemales. Nine patients were less than 45 years old and 91 patients were 45 and above. Thirty-ninepatients had ischemic, and 61 patients had a hemorrhagic stroke, respectively. Out of 100 patients,23 patients had normal uric acid levels (&lt;7mg/dl). Seventy-seven patients were with high uric acidlevels. The mean serum uric acid concentration in male patients was 8.48±2.7and 9.20±2.7 infemales. Among the total 100 cases, 69 survived, and the remaining 31 were among the non-survivor group at the time of discharge. Mean serum uric acid in stroke survivors was 8.5±2.6mg/dl, while in non-survivors, it was 8.6±2.2 mg/dl. There was no significant difference between thelevels of uric acid among survivors and non-survivors. Conclusions: The prevalence ofhyperuricemia (&gt;9mg/dl) amongst stroke patients was 77% in the present study. The values ofserum uric acid were significantly elevated in the patients aged &gt; 45 years. The serum uric acidvalues were high among the group of hyperglycemic and hypertensive patients at the time ofadmission. There was no significant difference between the levels of uric acid among survivors andnon-survivors.

A Comprehensive Analysis of Biochemical Indexes in Patients with COVID-19 Infection

Several studies have demonstrated that age, comorbidities and abnormalities in different clinical biomarkers can be important to understand disease severity. Although clinical features of COVID-19 have been widely described, the assessment of alterations of the most common biochemical markers that are reported in patients with COVID-19 still has not been well established. Here, we report clinical and blood biochemical indicators of 100 patients with COVID-19. Throat-swab upper respiratory samples were obtained from patients and real-time PCR was used to confirm SARS-CoV-2 infection. Gender, age and clinical features such as diabetes mellitus, hypertension and smoking habits were investigated. Biochemical parameters were categorized and analyzed according to these clinical characteristics. Triglycerides, GPT, and ALP are the biochemical markers that changed the most in the group of hypertension patients. Cholesterol and triglycerides were significant difference (p=0.01; p=0.04, respectively) between diabetic and non-diabetic patients with COVID-19. Potassium levels were significantly different (p=0.03) when comparing smoker with non-smoker patients. Our results suggest a number of potential biochemical indexes that changed in patients with COVID-19 and whether certain comorbidity and clinical characteristics influence these markers.Funding Information: No funding has been received for this project. Declaration of Interests: We declare no competing interests. Ethics Approval Statement: Informed consent was obtained from patients. The study has been approved by the Institutional Review Board.

The effect of resistant hypertension on in-hospital mortality in patients hospitalized with COVID-19.

Hypertension is a major concomitant disease in hospitalized patients with COVID-19 (Coronavirus disease 2019) infection. The adverse effect of hypertension on prognosis in COVID-19 is known. Nevertheless, it is not known how COVID-19 progresses in resistant hypertensive patients. In this study, we aimed to examine the effect of resistant hypertension (ResHT) on in-hospital mortality in patients hospitalized with COVID-19. In our single-center retrospective study, included 1897 COVID-19 patients. The patients were divided into three groups according to the non-hypertensive (n = 1211), regulated HT (RegHT) (n = 574), and ResHT (n = 112). These three groups were compared according to demographic features, clinical signs, laboratory findings, and follow-up times. The median age of the study population was 62 (50–72 IQR) and 1000 (52.7%) of patients were male. The total mortality of the study population was 18.7% (n = 356). Mortality rates were similar in the hypertensive patient group (27.5% for the RegHT and 32.1% for ResHT, p = 0.321). In a multivariable analysis, ResHT was independently associated with a significantly increased risk of in-hospital mortality of COVID-19, while no significant increased risk was observed with RegHT [respectively, Odds Ratio (OR) = 2.013, Confidence Interval (CI) 1.085–3.734, p = 0.026 and OR = 1.194, CI 0.795–1.794, p = 0.394]. Also, age, male gender, chronic renal failure, lymphocyte, procalcitonin, creatinine, and admission SpO2 levels were determined as independent predictors of in-hospital mortality. In our study, it was found that ResHT was an independent predictor of mortality in patients hospitalized with COVID-19; however, this situation was not found in RegHT.