High Prevalence Of Arterial Hypertension Research Articles

Prevalence of risk factors for development of cardiovascular diseases in urban and rural areas of Eastern Croatia: a cross-sectional study.

Cardiovascular diseases are the leading global cause of death. Due to the disparities in cardiovascular risk factors between rural and urban populations, this study aims to assess the differences in the prevalence of risk factors in urban and rural areas of eastern Croatia. The cross-sectional study included 280 participants (140 from urban and 140 from rural areas) registered at studied general practice offices. Methods included e-health records, questionnaire, physical examination methods, and blood sampling for laboratory tests. The most common risk factors among participants were elevated total cholesterol (83.6%), elevated LDL cholesterol (81.8%), increased body mass index (75.0%), increased waist-hip ratio (82.9%), increased waist circumference (63.2%), and arterial hypertension (70.1%). The rural participants had a significantly higher prevalence of arterial hypertension (p = 0.023), increased body mass index (p = 0.004), increased waist circumference (p = 0.004), increased waist-hip ratio (p < 0.001), and increased LDL cholesterol (p = 0.029), while the urban participants had a significantly higher prevalence of insufficient physical activity (p < 0.001). In the examined sample, the prevalence of cardiovascular risk factors is generally high. Participants from rural areas are significantly more susceptible to cardiovascular risk factors than participants from urban areas.

Conn´s syndrome after kidney transplantation.

Conn's syndrome, defined as unilateral aldosterone-producing adenoma, accounts for 35-40% of cases of primary hyperaldosteronism. Primary hyperaldosteronism typically occurs in younger patients with poorly controlled arterial hypertension due to extracellular fluid retention, in whom at least atriple combination of antihypertensives, including adiuretic, is needed to maintain normotension. The clinical picture of arterial hypertension may be complemented by symptoms associated with hypokalaemia, such as weakness, fatigue, palpitations, convulsions, polydipsia, or polyuria. In addition to arterial hypertension and hypokalaemia, the diagnosis of Conn's syndrome relies on examination of serum renin and aldosterone concentrations, plasma renin activity, exercise or furosemide stimulation tests, and imaging studies, preferably computed tomography. The method of treatment of Conn's syndrome is adrenalectomy. In patients with primary hyperaldosteronism with underlying bilateral adrenal cortical hyperplasia or patients contraindicated for surgery, mineralocorticoid receptor antagonists are administered in combination with antihypertensives targeted for optimal blood pressure control.In the group of patients after kidney transplantation, the exact incidence of primary hyperaldosteronism is unknown. Based on across-sectional study performed in 2020, it is estimated to be approximately 15% in the group of patients with unsatisfactorily compensated arterial hypertension; in the cohort of normotensive recipients, the incidence of primary hyperaldosteronism is not documented. Diagnosis of Conn's syndrome in patients in the early period after kidney transplantation is problematic, as the prevalence of arterial hypertension in transplanted patients is high (70-90%) according to the literature. Mineral abnormalities, including hypokalaemia, are also common in the early post-transplant period, mainly due to factors such as duration of cold ischaemia, onset of graft function, donor parameters, post-transplant tubulopathy, and diuretics, the effects of immunosuppressive drugs (especially calcineurin inhibitors and corticosteroids), and possibly potassium-restricted dietary habits that the patient brings from the pre-transplant period, which may mask the effect of hyperaldosteronism on potassium.We present the case of apatient who was diagnosed with Conn's syndrome 7 months after primary kidney transplantation from adeceased donor based on persistent hypokalaemia unresponsive to replacement therapy. At the time of the first manifestation of severe hypokalaemia, the patient was treated with adual combination of antihypertensives (amlodipine at adaily dose of 5 mg and carvedilol at adaily dose of 50 mg), without the need for adiuretics.We consider the case interesting because the spectrum of mineral and acid-base abnormalities in advanced renal failure and in the early post-transplant period, as well as acid-base and mineral imbalances, including hypokalaemia, and the high prevalence of arterial hypertension in the post-transplant period, may mask the picture of Conn's syndrome (Fig. 3, Ref. 19). Text in PDF www.elis.sk Keywords: kidney transplantation, primary hyperaldosteronism, hypokalaemia, metabolic alkalosis, secondary arterial hypertension.

OR06-04 Environmental Pollutants Perfluoroalkyl Acids Potently Stimulated Aldosterone Biosynthesis

Abstract Disclosure: B. Caroccia: None. T.M. Seccia: None. G. Pallafacchina: None. M. Piazza: None. I. Caputo: None. R. Rizzuto: None. G. Rossi: None. A large environmental contamination of drinking water by perfluoroalkyl substances (PFAS) markedly increased by 8-fold the plasma levels of pentadecafluorooctanoic acid (PFOA) and perfluorooctanesulfonic acid (PFOS) in a Northern Italy population with that shows a high prevalence of arterial hypertension and cardiovascular disease. As the link between PFAS and arterial hypertension is unknown, we investigated if they could enhance the biosynthesis of aldosterone, the main mineralocorticoid hormone that has pressor effects. We exposed human adrenocortical carcinoma HAC15 cells to 1 µM or 10 µM concentration of PFOA and PFOS, alone or in combination, for 24, 48 or 72 hours and we measured changes in cell viability, aldosterone synthase (CYP11B2) mRNA, cell and mitochondrial reactive oxygen species (ROS), and aldosterone production in the absence or presence of the superoxide scavenger tempol. Experiments were also performed in the presence of 10 or 100 nM Ang II. We found that PFAS increased CYP11B2 mRNA by 3-fold and aldosterone secretion and mitochondrial ROS production by 2-fold over controls (p &amp;lt; 0.01 for all). PFAS also enhanced the effects of the aldosterone secretagogue Ang II on CYP11B2 mRNA and aldosterone secretion: 10 nM or 100 nM Ang II increased CYP11B2 mRNA by 12- and 52-fold, respectively, compared to vehicle (p &amp;lt; 0.001). Moreover, 1 µM PFAS potentiated the effect of 10 nM or 100 nM Ang II on CYP11B2 gene expression by 30- and 80-fold, respectively (p &amp;lt; 0.001). As the ROS scavenger tempol, which decreased ROS, significantly blunted the CYP11B2 gene expression induced by either PFAS alone, or by concomitant exposure to Ang II and PFAS, the effect of PFAS likely occurs via increased ROS generation. These results indicate that at concentrations mimicking those found in human plasma of exposed individuals, PFAS exert a prooxidant effect and act as potent disruptors of human adrenocortical cell function, thus implicating them as causative factors of human arterial hypertension due to aldosteronism. Presentation: Thursday, June 15, 2023

Endocrine disruptors and arterial hypertension: A developing story

Endocrine disrupting Chemicals (EDCs) are substances that interfere with hormones by several mechanisms including receptor activation or antagonism, changes in gene and protein expression, modification of signal transduction, and/or epigenetic modifications in hormone-producing cells. A survey conducted by the European Union in a Northern Italian region led to the discovery of a large environmental contamination of drinking water by perfluoroalkyl substances (PFAS). As the exposed population showed a high prevalence of arterial hypertension and cardiovascular disease, we decided to investigate if PFAS could enhance the biosynthesis of aldosterone. To this aim, we exposed human adrenocortical carcinoma HAC15 cells to PFAS and found that PFAS markedly increased aldosterone synthase (CYP11B2) gene expression and aldosterone secretion. Moreover, we found that they promoted reactive oxygen species (ROS) production in mitochondria, the organelles where aldosterone biosynthesis takes place. PFAS also enhanced the effects of the aldosterone secretagogue angiotensin II (Ang II) on CYP11B2 gene expression and aldosterone secretion. We also found that not only PFAS but also polychlorinated biphenyl 126 (PCB126), a chemical compound belonging to a different category of EDCs, can increase CYP11B2 gene expression and aldosterone secretion in adrenocortical cells. This novel information needs to be considered in the context of a widespread exposure to the most common EDC, that is excess Na+ intake, whose detrimental effects on human health occur in the setting of aldosterone production exceeding the physiological needs and lead to high blood pressure, congestion, and cardiovascular and renal damage.

Risk factors for cardiovascular disease in primary Sjögren's syndrome (pSS): a 20-year follow-up study.

Primary Sjögren's syndrome (pSS) is a systemic autoimmune disease characterized by a chronic grade of inflammation. Cardiovascular events represent the major causes of morbidity and mortality in patients with inflammatory rheumatic diseases; however, the significance and prevalence of cardiovascular disease in patients with pSS remain unclear. To determine the clinical significance of cardiovascular disease in pSS and analyze the risk of cardiovascular disease according to glandular/extraglandular involvement and positivity to anti-Ro/SSA and/or anti-La/SSB autoantibodies. A retrospective study including patients diagnosed with pSS fulfilling the 2016 ACR/EULAR classification criteria was followed and evaluated in our outpatient clinic between 2000 and 2022. The prevalence of cardiovascular risk factors with pSS was evaluated, and a possible association with clinical and immunological characteristics, the treatments received, and the impact on cardiovascular disease were determined. Univariate and multivariate regression analyses were performed in an attempt to determine potential risk factors associated with cardiovascular involvement. A total of 102 pSS patients were included. Eighty-two percent were female, with a mean age of 65±24 years and a disease duration of 12.5 ±6 years. Thirty-six patients (36%) had at least one cardiovascular risk factor. Arterial hypertension was diagnosed in 60 (59%) patients, dyslipidemia in 28 (27%), diabetes in 15 (15%), obesity in 22 (22%), and hyperuricemia in 19 (18%). History of arrhythmia was found in 25 (25%), conduction defects in 10 (10%), arterial peripheral vascular disease in 7 (7%), venous thrombosis in 10 (10%), coronary artery disease in 24 (24%), and cerebrovascular disease in 22 (22%) of patients. Patients with extraglandular involvement had a higher prevalence of arterial hypertension (p=0.04), dyslipidemia (p=0.003), LDL mean values (p=0.038), hyperuricemia (p=0.03), and coronary artery disease (p=0.01) after adjusting for age, sex, disease duration, and the significant variables in the univariate analysis. Patients with Ro/SSA and La/SSB autoantibodies had a substantially higher risk of hyperuricemia (p=0.01), arrhythmia (p=0.01), coronary artery disease (p=0.02), cerebrovascular disease (p=0.02), and venous thrombosis (p =0.03). In the multivariate logistic regression analysis, higher odds of cardiovascular risk factors were associated with extraglandular involvement (p=0.02), treatment with corticosteroids (p=0.02), ESSDAI>13 (p=0.02), inflammatory markers including ESR levels (p 0.007), and serologic markers such as low C3 levels (p=0.03) and hypergammaglobulinemia (p=0.02). Extraglandular involvement was associated with a higher prevalence of arterial hypertension, dyslipidemia, hyperuricemia, and coronary artery disease. Anti-Ro/SSA and anti-La/SSB seropositivity was associated with a higher prevalence of cardiac rhythm abnormalities, hyperuricemia, venous thrombosis, coronary artery disease, and cerebrovascular disease. Raised inflammatory markers, disease activity measured by ESSDAI, extraglandular involvement, serologic markers including hypergammaglobulinemia and low C3, and treatment with corticosteroids were associated with a higher risk for cardiovascular comorbidities. Key Points • Patients with pSS are vulnerable to cardiovascular risk factors. There is an interconnection between extraglandular involvement, disease activity, inflammatory markers, and cardiovascular risk comorbidities. • Anti-Ro/SSA and anti-La/SSB seropositivity was associated with a higher frequency of cardiac conduction abnormalities, coronary artery disease, venous thrombosis, and stroke. • Hypergammaglobulinemia, elevated ESR, and low C3 are associated with a higher prevalence of cardiovascular comorbidities. • Valid risk stratification tools to help with prevention and consensus on the management of CVDs in pSS patients are warranted.

PET-determined prevalence of coronary microvascular dysfunction and different types in a cardio-metabolic risk population.

The aim was to investigate the prevalence of "classical" (predominantly related to alterations in hyperemic MBFs) and "endogen" (predominantly related to alterations in resting MBF) normal coronary microvascular function (nCMF) or coronary microvascular dysfunction (CMD) in a clinical population without flow-limiting obstructive CAD. We prospectively enrolled 239 symptomatic patients with normal pharmacologically-stress and rest myocardial perfusion on 13N-ammonia PET/CT. 13N-ammonia PET/CT concurrently assessed myocardial flow reserve (MFR=MBF stress/MBF rest). Normal nCMF was defined by a MFR of≥2.0, while an abnormal MFR of<2.0 signified CMD. In addition, patients were subgrouped into classical and endogen type of nCMF and CMD, respectively. In the whole study population, CMD was present in 54% (130/239). The classical type was more prevalent than the endogen type of CMD (65% vs 35%, p≤0.008). The classical type of CMD was paralleled by a high prevalence of diabetes mellitus, metabolic syndrome, and obesity, while the endogen type of CMD was accompanied by a higher prevalence of arterial hypertension, obesity, and/or morbid obesity. Further, the classical type of nCMF was more frequently observed that the endogen type (74% vs. 26%, p≤0.007). The endogen type of nCMF was related to lower heart rate and/or arterial blood pressures. In this contemporary clinical study population, slightly more than half of symptomatic patients had CMD with predominance of the classical type. These observations emphasize the need for standardized reporting of CMD to gear individualized and/or intensified medical treatment to improve symptoms and/or clinical outcome in these patients.

AMBULATORY BLOOD PRESSURE MONITORING IN PATIENTS WITH MEDIAL ARTERIAL CALCIFICATION

Objective: Several studies have shown that reduced ankle-brachial pressure index (ABI) is a reliable warning sign of increased cardiovascular risk. But also ABI values above 1.3 in the presence of medial arterial calcification (MAC) are associated with increased mortality due to cardiovascular causes. Aim of the study was in a group of patients with MAC using ambulatory blood pressure monitoring (ABPM) to document frequent occurence of arterial hypertension, with also frequent diurnal pattern loss, as significant factors in patients prognosis. Design and method: We examined 41 patients (25 men, 16 women) with identified MAC. Mean age 59 years (50-79 years). All patients have been treated for diabetes mellitus, type 2, most of them, 23 (56.1 %) with insulin. The mean duration of diabetes was 12.6 years. MAC was detected by the BOSO, ABI system 100 (Germany), using the oscillometric method of measuring blood pressure. ABI value was calculated as the ratio of the value of higher pressure in the leg to a higher pressure on the upper extremities. ABPM was performed with the Cardiosoft-Tonoport V, General Electric (USA). Results: 35 patients (85,4 %) had arterial hypertension, most of them, 20 (48,8 %) grade 3 hypertension (according to ESC/ESH Guidelines). 14 patients (40 %) had a preserved diurnal rhythm (dipping), 18 (51.4 %) had it disturbed (non-dippers or risers). In 3 patients (8.6 %) we did not determine the diurnal sign for night vigil. Conclusions: In patients with MAC, we found a high prevalence of arterial hypertension, and a diurnal rhythm disorder was also very frequent. This fact may also contribute to the worsened cardiovascular prognosis of these patients. Therefore ABPM in patients with MAC is highly recommended, since subsequent cardiology management can improve their prognosis.

THE IMPACT OF HYPERTENSION ON IN-STENT RESTENOSIS IN POST-STEMI REVASCULARIZED PATIENTS

Objective: The current picture of cardiology is the result of great therapeutic advances and large clinical trials. Perhaps the most spectacular impact seen in recent decades has been among patients with coronary artery disease, whose life expectancy and quality of life have been profoundly altered by the introduction of percutaneous myocardial revascularization into practice. Design and method: The study was carried out in the Carol Davila Central Military Emergency University Hospital in Bucharest, on a group of patients with acute coronary syndrome with ST segment elevation, treated interventionally in our center through the RO-STEMI program. In the period 2015-2018, 1316 STEMI procedures were performed, of which 107 presented stent restenosis of various degrees, visually quantified by the angiographer. The presented study is observational, analytical, retrospective. This study can be considered a real world one, because the phenomenon of stent restenosis was studied and objectively correlated with clinical practice, reflecting the experience of our center. Results: HT represented an indicator present in the current study in a significant proportion - 80% of the patients in the study, being more frequent in men. A higher prevalence of arterial hypertension was observed in smoking patients. It has been noted that the presence of HT in overweight or HT associated with dyslipidemia increases the risk of AMI or other acute events (stroke). In the hypertensive patients studied, the percentage of major events was 20% higher, but without a statistically significant influence. The main risk factor incriminated in the determination and occurrence of the process of intraluminal proliferation resulting in intrastent restenosis was diabetes mellitus. In patients with DM, the percentage of events was 20% higher than in patients without DM. Diabetes, dyslipidemia, stent characteristics were independent risk factors for in-stent restenosis (p &lt;0.05). Conclusions: In conclusion, for patients with risk factors indicating PCI, identification and personalized patient management are warranted to prevent in-stent restenosis. Long-term follow-up of patients with STEMI is essential both for their prognosis and for the individualization of this population through studies.

Aldosterone Biosynthesis Is Potently Stimulated by Perfluoroalkyl Acids: A Link between Common Environmental Pollutants and Arterial Hypertension.

The large environmental contamination of drinking water by perfluoroalkyl substances (PFAS) markedly increased the plasma levels of pentadecafluorooctanoic acid (PFOA) and perfluorooctanesulfonic acid (PFOS) in a Northern Italy population with a high prevalence of arterial hypertension and cardiovascular disease. As the link between PFAS and arterial hypertension is unknown, we investigated if they enhance the biosynthesis of the well-known pressor hormone aldosterone. We found that PFAS increased aldosterone synthase (CYP11B2) gene expression by three-fold and doubled aldosterone secretion and cell and mitochondria reactive oxygen species (ROS) production over controls (p < 0.01 for all) in human adrenocortical carcinoma cells HAC15. They also enhanced the effects of Ang II on CYP11B2 mRNA and aldosterone secretion (p < 0.01 for all). Moreover, when added 1 h before, the ROS scavenger tempol abolished the effect of PFAS on CYP11B2 gene expression. These results indicate that at concentrations mimicking those found in human plasma of exposed individuals, PFAS are potent disruptors of human adrenocortical cell function, and might act as causative factors of human arterial hypertension via increased aldosterone production.

History of acute myocardial infarction in patients with acute coronary syndrome: population characterization and impact on prognosis

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Patients with a history of Acute Myocardial Infarction (AMI) continue to be underrepresented in large studies on Acute Coronary Syndromes (ACS). Purpose To characterize patients with ACS and previous AMI and to evaluate their impact on the therapeutic approach, complications and in-hospital mortality. Methods We studied 722 patients admitted to a Cardiac Intensive Care Unit with a diagnosis of ACS. We considered 2 groups: patients with previous AMI and patients without previous AMI. Age, gender, personal history, clinical and electrocardiographic presentation of the ACS, treatment at admission, left ventricular ejection fraction (EF), coronary angiography and angioplasty were recorded. The following in-hospital complications were defined: heart failure, cardiogenic shock, re-infarction, mechanical complications, stroke and major hemorrhage. In-hospital mortality was compared between both groups. Results Patients with previous AMI constituted 26.8% (194 patients) of the population studied. These had a higher prevalence of arterial hypertension (92.8% vs 71.2%; p&amp;lt;0.001), diabetes (47.9% vs 30.4%, p&amp;lt;0.001), dyslipidemia (73.6% vs 49 .2%, p&amp;lt;0.001), previous angioplasty (62.1% vs 0.0%; p&amp;lt;0.001), heart failure (14.0% vs 4.7%, p&amp;lt;0.001), arterial disease (13.5% vs 3.6%, p&amp;lt;0.001), chronic renal failure (18.7% vs 9.6%, p=0.009) and previous bleeding (5.3% vs 1.3 %, p=0.002). The D with previous AMI presented more frequently with AMI without ST elevation (62.4% vs 40.7%; p&amp;lt;0.001) and Unstable Angina (10.3% vs 5.3%, p=0.02 ) and less with ST-elevation AMI (22.2% vs 47.3%, p&amp;lt;0.001). At admission, patients with previous AMI received less therapy with unfractionated heparin (20.6% vs 30.7%; p=0.007) and more therapy with angiotensin-2 antagonists (6.2% vs 2.3% , p=0.009), nitrates (62.9% vs 49.2%, p=0.001), ivabradine (5.2% vs 1.7%, p=0.01) and diuretics (34.5% vs 22 .3%, p=0.009). The coronary angiography rate was similar between the groups, however patients with previous AMI underwent more coronary angiography via the femoral route (36.9% vs 15.7%, p&amp;lt;0.0001) and fewer angioplasties (58.5% vs 69 .5%, p=0.006). EF was slightly lower in patients with previous AMI (45.7 ± 9.3% vs 48.3 ± 10.4%, p=0.04). However, there were no differences in the presence of any of the complications considered, as well as in in-hospital mortality. Conclusion Patients with previous AMI have a higher prevalence of co-morbidities and a higher prevalence of AMI without ST elevation and Unstable Angina. The presence of previous AMI was not per se a predictor of in-hospital complications or mortality.

Psoriatic erythroderma: comparative patient profile and association with psoriatic arthritis

Background. Psoriatic erythroderma is rare and one of the most severe forms of psoriasis characterized by involvement of 8090% of body surface area.&#x0D; Aims. To compare clinical and demographic characteristics of patients with psoriasis, depending on presence of psoriatic erythroderma in medical history; to assess the association between psoriatic arthritis and a history of psoriatic erythroderma.&#x0D; Materials and methods. Patients aged 18 years and older with a duration of psoriasis of 10 years, from the psoriasis patients registry were included.&#x0D; Comparison of continuous quantitative variables was performed using t-test or MannWhitney U-test. The 2 test or Fisher's exact test was used to compare qualitative binary variables.&#x0D; The odds ratio of psoriatic arthritis in patients with and without a history of psoriatic erythroderma was calculated, unadjusted and adjusted for other independent variables.&#x0D; Results. The number of patients included in the analysis was 1,870. A history of psoriatic erythroderma (PE) had 227 (12.1%) of them. There were no significant differences in patient age at inclusion to the registry (47.1 13.1 years vs. 47.7 13.3 years), and prevalence of PE among men and women (12.6% vs. 11. 4%).&#x0D; Higher prevalence of arterial hypertension (47.9% vs 32.7%), angina pectoris (6.4% vs. 1.9%), myocardial infarction (3.2% vs. 1.0%), biliary dyskynesia (14.3% vs. 3.9%), fatty liver (12.2% vs. 7.7%), cholelithiasis (8.6% vs. 3.6%), and toxic liver disease (2.2% vs. 0.5%) among patients with vs without history of PE was found.&#x0D; Psoriatic arthritis was diagnosed in 67.0% patients with a history of psoriatic erythroderma. The odds of having psoriatic arthritis in patients with a history of psoriatic erythroderma were 4 times higher than in patients without erythroderma: 4.043 [2.9755.493]. When adjusted for sex, age, duration of psoriasis, and body mass index, the odds ratio and statistical significance were maintained: 4.064 [2.9395.619].&#x0D; Conclusions. Compared to patients without PE those with a history of psoriatic erythroderma have a greater comorbidity burden: a higher prevalence of cardiovascular diseases, diseases of the liver and biliary tract. A significant association between psoriatic arthritis and a history of PE was established.

Hypertension in female prisoners in Brazil: far beyond the biological aspects

The scope was to estimate the prevalence of arterial hypertension (AHT) and associated risk factors among female prisoners. Data from the National Health Survey of the Female Prison Population and Prison Guards were used, investigating sociodemographic variables, prison characteristics, health behaviors and conditions. Information was collected through a self-administered questionnaire, and the magnitude of the association was estimated by the odds ratio and 95% confidence interval. Of the 1,327 prisoner participants, 24.4% were hypertensive, the majority were 31 years of age or older (54.6%), and 51.5% self-reported mixed race. After adjustment for associated risk factors in the bivariate analysis, a direct relationship between age and AHT was observed, in which age equal to/over 41 years was independently associated with a 7-fold greater chance of having AHT, compared to those under 25 years of age. Those who self-reported mixed race, had high cholesterol, were obese and were also independently associated with a higher prevalence of AHT. The greater the number of people with whom the inmate shares a cell was associated with a higher prevalence of AHT, but without a dose-response relationship. The conclusion drawn is that age, race, obesity, physical inactivity and stress are risk factors for AHT in female prisoners.

Adolescent blood pressure classification curves and cardiometabolic risk factors: a comparison of the Brazilian and American references.

The American Academy of Pediatrics (AAP) adolescent blood pressure (BP) percentiles were updated in 2017, and have been used as reference in Brazil since then. However, specific BP percentiles for Brazilian adolescents were recently proposed based on data from the Study of Cardiovascular Risk in Adolescents (ERICA). To compare the prevalence of arterial hypertension according to each reference, as well as to assess the cardiometabolic risk associated with the reclassification by Brazilian BP percentiles. Data from 73 399 adolescents aged 12-17 years who participated in the ERICA study were analyzed. To assess cardiometabolic risk, 6185 adolescents who were reclassified upwards by the Brazilian reference were 1 : 1 matched with adolescents that were normotensive by both references and were of the same age, sex and height percentile. The parameters evaluated were: overweight/obesity, waist circumference, total cholesterol, triglycerides, LDL-c, HDL-c, fasting glucose, HbA1c and HOMA-ir. The classification according to Brazilian BP percentiles resulted in a higher prevalence of arterial hypertension (14%, 95% CI 13.2-14.8), when compared with the AAP percentiles (10.6%, 95% CI 10.0-11.2). The use of the Brazilian reference also resulted in higher prevalence of arterial hypertension in girls, teenagers ranging from 12 to 14 years, and those classified with adequate weight, overweight or obesity. In the case-control analysis, cardiometabolic risk factors were present more often in adolescents reclassified with arterial hypertension by the ERICA reference. The use of the BP percentiles proposed by ERICA is a sensitive method for tracking Brazilian adolescents with hypertension and higher cardiometabolic risk.

The prevalence of hypertension among patients with psoriasis in clinical practice

Background. Psoriasis is a systemic chronic immune-mediated inflammatory skin disease of a multifactorial nature that affects about 2 to 3% of the population worldwide. Given the systemic nature of the disease, the level of comorbid diseases is high, especially those associated with damage to the cardiovascular system. According to the results of various meta-analyzes, it has been proven that among patients with psoriasis, the risk of developing hypertension is high.&#x0D; Aim. To evaluate the prevalence of arterial hypertension (AH) among patients with psoriasis.&#x0D; Materials and methods. We present an open, prospective, observational clinical trial, which includes 60 patients diagnosed with psoriasis vulgaris of varying severity and psoriatic arthritis. All patients underwent clinical and laboratory tests, including the level of total cholesterol, glucose, creatinine, C-reactive protein, calculation of glomerular filtration rate. Body mass index, blood pressure level according to the Korotkov method, severity of the disease by determining psoriasis area and severity Index (PASI), dermatological quality of life index (DLQI), levels of hospital anxiety and depression according to the HADS scale were also assessed. The SCORE2 scale was used to assess cardiovascular risk in patients aged 40 to 69 years, the SCORE 2OP scale for patients aged 70 to 89 years, respectively. Cardiovascular risk was defined as low for patients under 40 years of age. All study participants were examined for the presence of AH.&#x0D; Results. The prevalence of hypertension was 25%, with prevalence among men (15%). The prevalence of hypertension is directly proportional to the severity of psoriasis (13% with hypertension in patients with severe psoriasis, 12% with hypertension with moderate psoriasis, 2% with hypertension with mild psoriasis).&#x0D; Conclusion. Given the high prevalence of AH among patients with psoriasis, it is necessary to form a multidisciplinary approach to the treatment of patients, including a thorough assessment of cardiovascular risk in clinical practice.

The role of the fibrinolytic system laboratory markers in the assessment of the cerebral small vessel disease severity

Background: Small vessel disease (SVD) is a common brain disease causing about 40% of all dementias and about 25% of ischemic strokes, which makes important the study of its pathophysiology and the search for its biomarkers. A number of studies have shown a significant role of endothelial dysfunction and nonspecific inflammation, as well as of some individual parameters of hemostasis disorders in the development of SVD.&#x0D; Aim: To identify the role of the laboratory markers of fibrinolytic system in the assessment of the severity of white matter lesions in patients with SVD.&#x0D; Materials and methods: This single center cross-sectional non-controlled observational study included 117 patients with dyscirculatory encephalopathy (chronic brain ischemia), with a mean ( SD) age of 57.7 11.5 years. Laboratory tests of the fibrinolytic system, endothelial dysfunction, markers of inflammation and for an integral assessment of plasma hemostasis were performed in all patients, including XIIa-dependent fibrinolysis, levels of plasminogen, alpha2-antiplasmin, plasminogen activator inhibitor 1 (PAI-1), fibrinogen, von Willebrand factor (vWF) and activity of blood coagulation factor VIII (FVIII), highly sensitive C-reactive protein and parameters of the thrombodynamics assay. In all the patients, brain magnetic resonance imaging was performed with the assessment of the white matter lesions by the Fazecas scale.&#x0D; Results: Depending on the identified neuroimaging SVD markers (assessed with the Fazecas scale), the patients were divided into the SVD group (n = 54) and no-SVD group (n = 63). Those with SVD were older than those without (65 9 vs 51 10 years; p 0.001), had higher prevalence of arterial hypertension (p 0.001), diabetes mellitus (p = 0.029) and past thrombotic events (p 0.001). The SVD patients, compared to those without SVD, had a higher time of XIIa-dependent fibrinolysis (7.6 2.9 vs 6.5 1.7 min, p = 0.032), higher alpha2-antiplasmin levels (111 [95117] vs 105 [95111]%, p = 0.016) and higher clot density (D) (22789 [2056726411] vs 20627 [1832422650] U, p 0.001), although the parameters were within the reference ranges. As far as the thrombodynamics is concerned, the SVD group had higher values for all test parameters, as well as higher levels of the inflammation and endothelial dysfunction markers. Increased time of XIIa-dependent fibrinolysis was associated with higher probability of periventricular and subcortical leukoareosis grade 2 by the Fazecas scale (odds ratio 1.31 [1.071.60], p = 0.009), including an increase in the size and number of gliosis areas. Higher plasminogen levels were associated with a lower probability of leukoareosis by the Fazecas scale (odds ratio 0.97 [0.950.98], p 0.001).&#x0D; Conclusion: The severity of fibrinolytic and hemostatic abnormalities correlates with the severity of brain SVD, thus forming the hypofibrinolytic and prothrombotic status of the patients with this disorder.

Could echocardiographic left atrial characterization have additive value for detecting risks of atrial arrhythmias and stroke in patients with hypertrophic cardiomyopathy?

Abstract Background Atrial arrhythmia (AA) is considered a turning point for prognosis in hypertrophic cardiomyopathy (HCM) patients. Prediction of AA and associated stroke risk in patients with HCM is an important clinical challenge as these events can occur in young subjects and significantly impact their quality of life. (1) (2) Purpose We sought to assess whether an echocardiographic evaluation focused on the left atrial (LA) characterization could estimate the occurrence of AA and stroke in HCM patients. Methods 216 HCM-patients (52±16 years old) were enrolled between 2016 and 2019. All patients underwent transthoracic echocardiography for the evaluation of left atrial volume (LAV), left ventricular global longitudinal strain (LV-GLS), peak left atrial strain (PLAS) and peak atrial contraction strain (PACS) by speckle-tracking imaging. A composite endpoint was defined as a history of AA and/or a history of stroke or peripheral embolism and/or occurrence of AA. Results The patients were followed for 2.9 years. Among the 216 patients, 78 (36%) met the composite endpoint. These patients were older (50.3±16.7 vs. 57.1±14.4 years, p=0.0035), had a higher prevalence of arterial hypertension (42.3% vs. 62.3%; p=0.005) and had higher NT-proBNP levels. LAV (37.2±15.7 vs. 47±20 ml/m2, p=0.0001) was significantly higher in patients who met the composite endpoint, whereas PLAS and PACS were significantly impaired (26.6±9.12 vs. 19.3±9.54%; p&amp;lt;0.0001 and 13.1±6.3% vs. 8.8±6.5%; p&amp;lt;0.0001, respectively). After adjustment, PLAS and PACS remained independently associated with events with an odds ratio (OR) of 0.42 for PLAS (95% CI, [0.29–0.61]; p&amp;lt;0.0001). Stroke occurred in 67% of the patients without any clinical AA. PLAS with a cut-off of under 15.5% provided event detection with 91% specificity and demonstrated a predictive value for new-onset of AA. Although there was a high correlation between PLAS and LV-GLS, LV-GLS was not associated with the events. Conclusion The impairment of LA function assessed by 2D speckle-tracking echocardiography was strongly associated with AA and the risk of stroke, even in patients without any documented AA. Its value for guiding the management of HCM-patients requires further investigation. Funding Acknowledgement Type of funding sources: None.

Additional opportunities for antihypertensive therapy improvement in young patients with arterial hypertension and concomitant obesity

Abstract The high prevalence of arterial hypertension (AH) and concomitant obesity in young patients is not only a medical but also a social problem. It is important to develop additional modern approaches to the management of young patients with AH and obesity, which will increase the effectiveness of existing antihypertensive (anti-AH) medical therapy and prevent early damage of target organs and complications. The purpose of the research was to evaluate the antihypertensive efficacy of the proposed complex treatment and its impact on quality of life in young patients with AH and obesity (or overweight). Material and methods 123 patients with AH (ESC 2018), of young age 18–44 (mean age 32.81±0.58) y.o. were examined, among them the overweight was in 40 patients, obesity - in 42 patients. The average BMI was (28.34±0.45) kg/m2. All patients were divided into 2 groups depending on the treatment: Group 1 – standard anti-AH treatment, Group 2 – modified combined therapy, which included on the background of standard anti-AH medications the dosed controlled physical exercises with its obligatory registration, a modified DASH diet with increased intake of Ca-containing products and Metformin in the presence of insulin resistance according to the HOMA index (with correction of dose depending on BMI). In dynamics the patients were performed daily blood pressure monitoring (BPM) was performed and the SF-36 questionnaire was used to assess the quality of life (QOL). Results and discussion According to BPM data in the Group 1 the average 24-hour value of SBP decreased by 12.5% (p=0.01), in Group 2 – by 20.2% (p=0.001), DBP - by 11.2% (p=0.03) and by 18.8% (p=0.01) respectively (the difference between the groups for SBP and DBP was p=0.032 and p=0.041, respectively). Assessing the degree of nocturnal blood pressure decreasing, in the Group 1 the percentage of patients with insufficient nocturnal blood pressure decreasing (non-dipper) and stable increasing (night peaker) decreased non-significantly (p=0.086), unlike the Group 2, where there was a significant (p=0.02) positive dynamics in relation to these unfavorable types of blood pressure profile. Evaluating the indicators of QOL according to SF-36, the physical component of health in the Group 1 increased by 16.7%, in Group 2 – by 33.4% (p=0.001), the mental component of health – by 13.5% and 28.9%, respectively (p=0.001). Thus, the additional use of the proposed treatment complex with the inclusion of dosed registered exercises, increased consumption of Ca-containing products and correction of insulinresistance significantly increases the effectiveness of antihypertensive medical therapy and has a positive effect on physical and mental components of QOL in young patients with AH and obesity or overweight. Funding Acknowledgement Type of funding sources: None.

Prevalence and long-term trends of arterial hypertension in adolescents aged 14-18 years in Novosibirsk (1989-2019) according to the new international guidelines for management of high blood pressure in adolescence

The high prevalence of arterial hypertension (AH) among the adult population of many countries of the civilized world, incl. Russia (about 40% among people of working age) indicates the need for early detection and prevention of this disease. Assessment of blood pressure (BP) levels in adolescence presents certain methodological difficulties. To date, 3 guidelines based on the results of large population studies of children and adolescents have been developed in the world pediatric practice. However, the application of these guidelines is still not consistent, especially regarding the assessment of BP levels in adolescence.Objective. To study the prevalence and trends of elevated BP levels, including AH, among adolescents aged 14–18 years in Novosibirsk using the main international definitions.Design and methods. In one of the districts of Novosibirsk, cross-sectional population surveys of random representative samples of schoolchildren aged 14–18 years of both sexes were carried out with an interval of 5 years. Seven screenings were carried out from 1989 to 2019, 4579 adolescents were examined. The study program for adolescents was the same for all screenings and included standard questionnaire, measurement of BP by auscultatory method, anthropometry (height, body weight, chest circumference, waist and hips), the study of nutrition by the 24-h dietary recall method, collection of family history by postal parental interviews, biochemical blood tests. BP was measured twice with an interval of 2–3 minutes (before and after filling out the questionnaire), in a sitting position, on the right arm, with an aneroid sphygmomanometer. Systolic BP was recorded with the appearance of the first Korotkoff tone (I phase), diastolic BP — with the disappearance of the tones (V phase). The average of two measurements was included in the analysis. The prevalence of elevated BP levels was assessed using international criteria. To date, several guidelines have been proposed for the diagnosis of elevated BP and AH in adolescence, using both the percentile method (4th report of NHBPEP 2004) and the methods of fixed (AAP 2017) and mixed criteria (ESH 2016 / Russian recommendations 2020). Statistical analysis was performed using the SPSS package for Windows 13,5.Results. The frequency of prehypertension according to the criteria of the 4th report was 40,3% among boys and 26,4% among girls (P &lt; 0,05), the frequency of elevated BP according to the AAP 2017 criteria was 20,4 % and 12,5% in boys and girls, respectively (P &lt; 0,05), the prevalence of high normal BP was 24,6% and 13,5% (P &lt; 0,05) according to the ESH 2016 criteria. The frequency of AH syndrome according to the AAP 2017 criteria was significantly higher when using 4th report definitions and ESH 2016. According to the criteria of 3 different guidelines, there were a fluctual trends of AH in adolescents in Novosibirsk over a 30-year period, without a pronounced trend to decrease or increase. The prevalence of AH according to the AAP 2017 criteria was 2–3 times higher than when using percentiles (4th report) or mixed (percentiles + fixed cut-off points) European criteria (ESH 2016) during all the period.Conclusions. Long-term population studies of adolescents aged 14–18 in Novosibirsk made it possible to study the frequency and trends of elevated levels of BP and AH syndrome in adolescence and to conduct a comparative study of a number of international and domestic criteria.

Could echocardiographic left atrial characterization have additive value for detecting risks of atrial arrhythmias and stroke in patients with hypertrophic cardiomyopathy?

Atrial arrhythmia (AA) is considered a turning point for prognosis in patients with hypertrophic cardiomyopathy (HCM). We sought to assess whether the occurrence of AA and stroke could be estimated by an echocardiographic evaluation. A total of 216 patients with HCM (52 ± 16 years old) were analysed. All patients underwent transthoracic echocardiography for the evaluation of left atrial volume (LAV), peak left atrial strain (PLAS), and peak atrial contraction strain. The patients were followed for 2.9 years for the occurrence of a composite endpoint including AA and/or stroke and peripheral embolism. Among the 216 patients, 78 (36%) met the composite endpoint. These patients were older (57.1 ± 14.4 vs. 50.3 ± 16.7 years; P = 0.0035), had a higher prevalence of arterial hypertension (62.3 vs. 42.3%; P = 0.005), and had higher NT-proBNP. The LAV (47 ± 20 vs. 37.2 ± 15.7 mL/m²; P = 0.0001) was significantly higher in patients who met the composite endpoint, whereas PLAS was significantly impaired (19.3 ± 9.54 vs. 26.6 ± 9.12%; P < 0.0001). After adjustment, PLAS was independently associated with events with an odds ratio of 0.42 (95% confidence interval 0.29-0.61; P < 0.0001). Stroke occurred in 67% of the patients without any clinical AA. The PLAS with a cut-off of under 15.5% provided event prediction with 91% specificity. Using a 15% cut-off, PLAS also demonstrated a predictive value for new-onset of AA. The decrease in PLAS was strongly associated with the risk of stroke, even in patients without any documented AA. Its value for guiding the management of patients with HCM requires further investigation.

BLOOD PRESSURE AND OTHER CLINICAL CHARACTERISTICS OF PATIENTS WITH MYOCARDIAL INFARCTION UNDER 50 YEARS OF AGE

Objective: Arterial hypertension is the main risk factor for the development of cardiovascular diseases throughout the world. The prevalence of acute myocardial infarction (AMI) is increasing in young adults, especially men. Previous studies have identified that risk factors for AMI included tobacco use, obesity, arterial hypertension, and diabetes may be crucial to young individuals. Compared to the elderly, the risk factors are not well studied among the young patients with AMI. Design and method: We enrolled to our study 41 patients younger than 50 years (thirty-six men) admitted to the Department of Internal I - Cardiology, University Hospital Olomouc, with first episode AMI. We collected detailed information regarding family history of premature CVD (MI/ischaemic stroke in men aged &lt; 55 and in women aged &lt; 65 years, body mass index (BMI), smoking, hypertension, dyslipidemia, diabetes mellitus (DM). Hypertension was defined, according to ESH/ESC (European Society of Hypertension, European Society of Cardiology) guidelines, based on repeated blood pressure measurements, medical history and ongoing blood-pressure-lowering treatment. Results: Among 41 young patients with AMI (average 46 ± 3,4 years old), 15 patients (36,6%) had a known diagnosis of arterial hypertension prior to admisison. Mean level of systolic blood at admission were 128,6 ± 18,22 mmHg, diastolic blood pressure 81,35 ± 12,49 mmHg, mean heart rate was 76,32 ± 13,11 bpm. Uncontrolled arterial hypertension was diagnosed at admision in 6 patients, newly diagnosed hypertension in 4 patients. In our group, we diagnosed ST-elevation MI (STEMI) in 54 % of patients, NSTEMI in 46%. Mean level of TRPI was 24051,43 ± 32860,98 ng/l, NTproBNP was 731,1 ± 1019,92 pg/ml. Mean LDL-cholesterol was 3,26 ± 0,83 mmol/l. We newly diagnosed diabetes mellitus in 2 patients, mean HbA1c was 38,42 ± 9,43 (mmol/mol). Conclusions: In our group of young patients with myocardial infarction was prevalence of uncontrolled hypertension 17%. Compared to a group of healthy patients (data from literature), we found out a higher prevalence of arterial hypertension in our group.