Heart Failure In Hypertensive Patients Research Articles

Vericiguat on C-reactive Protein Level and Prognosis in Patients with Hypertensive Heart Failure.

Hypertensive heart failure (HHF) has a high incidence and poor prognosis. This article evaluated the efficacy and safety of Vericiguat in HHF and analyzed the relationship between C-reactive protein (CRP) levels and patient prognosis. 110 HHF patients were divided into Placebo and Vericiguat groups. Cardiac function was assessed by echocardiography and 6-minute walk test (6MWT). Blood samples were collected to detect the levels of N-terminal pro-brain natriuretic peptide (NT-proBNP), cardiac troponin I (cTnI), endothelin (ET-1), nitric oxide (NO), and CRP. Left ventricular end systolic diameter (LVESD) and left ventricular end diastolic dimension (LVEDD) were reduced, the left ventricular ejection fraction (LVEF) and 6MWT were increased, and the serum levels of NT-proBNP, cTnI, ET-1, NO, and CRP were decreased in Vericiguat group as against Placebo group; The total effective rate was 76.4% in Placebo group and 92.7% in Vericiguat group (P < 0.05). The adverse reaction rate was 10.9% and 9.1% (P > 0.05). The proportion of persons with poor prognosis and no improvement of cardiac function in patients with highly expressed CRP before treatment was higher as against patients with low expression of CRP (P < 0.05). Highly expressed CRP is an independent risk factor for poor prognosis. Vericiguat is safe and effective in improving cardiac function in HHF patients.

Exploring Predictive Factors for Heart Failure Progression in Hypertensive Patients Based on Medical Diagnosis Data from the MIMIC-IV Database.

Heart failure is associated with a significant mortality rate, and an elevated prevalence of this condition has been noted among hypertensive patients. The identification of predictive factors for heart failure progression in hypertensive individuals is crucial for early intervention and improved patient outcomes. In this study, we aimed to identify these predictive factors by utilizing medical diagnosis records for hypertension patients from the MIMIC-IV database. In particular, we employed only diagnostic history prior to hypertension to enable patients to anticipate the onset of heart failure at the moment of hypertension diagnosis. In the methodology, chi-square tests and XGBoost modeling were applied to examine age-specific predictive factors across four groups: AL (all ages), G1 (0 to 65 years), G2 (65 to 80 years), and G3 (over 80 years). As a result, the chi-square tests identified 34, 28, 20, and 10 predictive factors for the AL, G1, G2, and G3 groups, respectively. Meanwhile, the XGBoost modeling uncovered 19, 21, 27, and 33 predictive factors for these respective groups. Ultimately, our findings reveal 21 overall predictive factors, encompassing conditions such as atrial fibrillation, the use of anticoagulants, kidney failure, obstructive pulmonary disease, and anemia. These factors were assessed through a comprehensive review of the existing literature. We anticipate that the results will offer valuable insights for the risk assessment of heart failure in hypertensive patients.

ASSOCIATION OF THE METABOLIC SCORE FOR INSULIN RESISTANCE WITH INCIDENT HEART FAILURE IN PATIENTS WITH HYPERTENSION

Objective: The association of the metabolic score for insulin resistance (METS-IR) with heart failure (HF) risk in hypertensive patients remains uncertain. This study aimed to examine the relationship of the METS-IR with incident HF in hypertensive patients. Design and method: A total of 12,066 patients, free of prior HF, were enrolled. Using multivariable Cox regression models, hazard ratios (HRs) and 95% confidence intervals (CIs) for HF were calculated. Results: 464 incident HF events were identified over a median follow-up of 5.00 years. Increases in METS-IR per SD were linked to a higher risk of HF (adjusted HR: 1.17; 95% CI: 1.07, 1.28). When METS-IR was evaluated as quartiles, compared with those in the first quartile, the adjusted HRs (95% CI) of incident HF in participants in the second, third, and fourth quartiles were 1.02 (0.77, 1.35), 1.26 (0.97, 1.64), and 1.43 (1.10, 1.85), respectively. Each 1 SD increase in METS-IR was significantly associated with a 17% increase in HF incidence after multivariate adjustment using Model 3. However, restricted cubic spline analysis showed no dose-response connection between METS-IR and HF risk (P for non-linearity = 0.113). Conclusions: In summary, the current investigation has discovered that elevated METS-IR is associated with an increased risk of HF in hypertensive patients. If more research supports our findings, METS-IR might be a helpful and practical indicator for the early identification of hypertensive patients at high risk of HF.

75. The Association of Intravenous Nitrates Dosing Regimens on Blood Pressure Reduction and ICU Admission Rates among Acute Hypertensive Heart Failure Patients in Emergency Settings: A Systematic Review, Meta Analysis, and Meta-Regression

75. The Association of Intravenous Nitrates Dosing Regimens on Blood Pressure Reduction and ICU Admission Rates among Acute Hypertensive Heart Failure Patients in Emergency Settings: A Systematic Review, Meta Analysis, and Meta-Regression

10. The Association of Intravenous Nitrates Dosing Regimens on Blood Pressure Reduction and ICU Admission Rates among Acute Hypertensive Heart Failure Patients in Emergency Settings: A Systematic Review, Meta Analysis, and Meta-Regression

10. The Association of Intravenous Nitrates Dosing Regimens on Blood Pressure Reduction and ICU Admission Rates among Acute Hypertensive Heart Failure Patients in Emergency Settings: A Systematic Review, Meta Analysis, and Meta-Regression

Association between triglyceride glycemic index and ejection fraction preserved heart failure in hypertensive patients.

The triglyceride-glucose (TyG) index is regarded as an independent predictor of cardiovascular disease consequences and a reliable surrogate measure of insulin resistance (IR). However, the correlation analysis between triglyceride glucose index and heart failure with preserved ejection fraction in patients with essential hypertension remains unknown. A single-center, retrospective study was conducted with patients diagnosed with essential hypertension at the First Affiliated Hospital of Xinjiang Medical University, from December 2018 to September 2020. Participants were selected based on specific inclusion and exclusion criteria, with their clinical data and laboratory tests collected. The study employed Spearman's correlation analysis, logistic regression models, restricted cubic spline plots, and receiver operating characteristic (ROC) curves to investigate the relationships between the TyG index and HFpEF. Out of 1,602 enrolled hypertensive patients, 992 were included in the analysis after applying exclusion criteria. Patients were categorized into tertiles based on the TyG index, which showed that patients in the highest tertile had characteristics associated with a higher risk of HFpEF, including age, body mass index (BMI), systolic blood pressure (SBP), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and left ventricular mass index (LVMI). A significant, independent association between the TyG index and HFpEF was confirmed, with an odds ratio (OR) of 5.127 (95% CI [3.894-6.856]). Furthermore, an S-shaped nonlinear relationship was observed between the TyG index and the incidence of HFpEF (nonlinear p < 0.001). TyG index (AUC: 0.824, 95% CI [0.795-0.854]), NT-proBNP (AUC: 0.840, 95% CI [0.816-0.864]), and LVMI (AUC: 0.847, 95% CI [0.820-0.875]) showed good predictive ability for HFpEF. In addition, the TyG+LVMI combination demonstrated the strongest predictive ability (AUC: 0.907, 95% CI [0.887-0.927]). The study underscores a significant association between IR, as indicated by the TyG index, and the development of HFpEF in hypertensive patients. It highlights the critical role of metabolic dysfunction in the pathophysiology of HFpEF, advocating for a broader perspective on cardiovascular risk management.

Assessment of global and segmental strain in heterozygous APE1/Ref-1 transgenic mice using cardiac magnetic resonance imaging

Abstract Background Apurinic/apyrimidinic-endonuclease1(APE1/Ref-1) is a redox factor necessary for DNA binding and transcription regulator in ROS generation. The association between APE1/Ref-1 and heart failure(HF) has been observed in previous studies. Heterozygous APE1/Ref-1 transgenic mice displayed endothelial cell dysfunction with systemic hypertension. Global strain(GS) measures the myocardium's deformation along its axis and is known to be a sensitive marker of subclinical HF in hypertensive patients with preserved ejection fraction. Purpose This study aims to investigate the functional dynamics and GS of the heart in heterozygous APE1/Ref-1 mice to help identify the association between APE1/Ref-1 and early signs of HF and translate to clinical applications. Methods A study was conducted to assess the functional parameters of both the left ventricle(LV) and right ventricle (RV) and perform LV global and segmental strain analysis using cardiac magnetic resonance imaging(CMR) in heterozygous APE1/Ref-1 transgenic mice(n=4) and wild type mice (n=4) of age 10-12 weeks. A 7T CMR scanner and FSE T1 sequence were used to acquire short-axis views of mouse cardiac images. LV and RV functional parameters including ejection fraction(EF), stroke volume(SV), cardiac output, peak filling rate, peak emptying rate and strain indices including global circumferential strain, global radial strain, segmental circumferential strain, and segmental radial strain were calculated with a software dedicated to analyzing CMR images. Global LV and RV function was quantified both manually and using an AI-based algorithm of LV and RV segmentation. The strain analysis was performed using the strain medical image tracking toolbox module. Additionally, reproducibility testing was done to validate the accuracy of AI-driven calculations. Results We found that heterozygous APE1/Ref-1 mice displayed a decrease in SV(8.00±0.01ul vs 9.75±0.96ul, p=0.01) and LVEF(58.75±2.63% vs 66.50±2.89%, p=0.007) compared to controls while the functional parameters of RV were similar. Interestingly, the circumferential strain rate of LV was significantly reduced in APE1/Ref-1 mice compared to controls(p&amp;lt;0.001), particularly in the systolic phase. In addition, the study showed that manually-calculated and AI-derived indices were within an acceptable margin of error, rendering the AI system reproducible and reliable in calculating volumetric parameters and strain of the mice's hearts. Conclusions This study demonstrated that LV global circumferential strain rate, along with SV and LVEF decreased in heterozygous APE1/Ref-1 transgenic mice. These parameters could serve as markers for assessing early functional changes of mice hearts in a non-invasive manner. Volumetric and strain indices measured by AI-based analysis of mouse CMR images are reproducible parameters for cardiovascular research in small animals.LV strain analysis of mice CMRTable of volumetric parameters

Abstract 13250: Establishing Partition Values and Clinical Phenotype for Heart Failure Patients With Abnormal Left Atrial Function Index: A Cross-Sectional Analytical Study

Introduction: Left atrial function index (LAFI) has recently been validated for global estimation of left atrial (LA) function. LA dysfunction is critical to developing overt heart failure (HF), and getting the best tool for assessing its function is critical to HF prevention. This study attempts to establish cut-off values for LAFI among HF patients and identify which HF phenotype is associated with abnormal LAFI. Hypothesis: Is there any association between abnormal LAFI and changes in LV function? Methods: This cross-sectional study was conducted at the Delta State University Teaching Hospital, Nigeria. We recruited 80 hypertensive HF patients and 40 healthy normotensive controls. LAFI = (LAEF x LVOT-VTI)/LAESVI. (LAEF = left atrial emptying fraction; LAESVI = left atrial end-systolic volume index; LVOT-VTI = left ventricular outflow tract velocity time integral). Relationships between variables were determined using an independent student’s t-test, and a P-value of &lt;0.05 was significant. Results: In the control arm, the LAFI reference range was estimated to be 24.07-76.24. Abnormal LAFI was defined as LAFI &lt; 24 and 77.5% of the individuals with HF were found to have abnormal LAFI. There was no difference in age (61.83±7.48 vs. 63.22±6.75, p=0.46), BMI (28.27±4.47 vs. 29.52±5.91, p=0.33) and systolic BP (127.34±19.28 vs. 120.94±19.94, p=0.22) of hypertensive HF patients with LAFI &lt;24 and LAFI ≥24. Those with abnormal LAFI had lower EF (45.04±11.06 vs. 63.73±14.73, p&lt;0.0001), FS (25.75±8.26 vs 32.49±8.64, p=0.003) and SV (57.16±13.30 vs. 64.99±16.94, p=0.02). However, E/E’ (15.62±5.61 vs. 9.2±3.22, p&lt;0.0001) and LAVI (37.22±5.80 vs. 16.48±5.65, p&lt;0.0001) were higher among patients with lower LAFI. Contrarily, E/A (1.87±0.97 vs. 1.87±0.83, p=0.98) and TAPSE (17.87±3.67 vs. 19.54±2.47, p=0.06) did not show any difference among the groups. Conclusions: This study shows that abnormal LAFI was associated with impaired LV function and it is crucial to deploy this non-invasive modality of cardiac assessment in hypertensive patients. Early identification of abnormal left atrial mechanics is pertinent to preventing overt HF, especially in parts of the world where access to advanced cardiovascular care is limited.

Correlation between left atrial strain and left ventricular diastolic function in hypertensive patients.

Early detection of asymptomatic diastolic dysfunction is essential to prevent the development of heart failure in hypertensive patients. Current studies suggest that left atrial strain contributes to the evaluation of left ventricular diastolic function, but there are fewer studies on the correlation between left atrial strain and diastolic function in hypertensive patients. In this study, we applied a two-dimensional speckle tracking technique to evaluate the changes in left atrial strain in hypertensive patients, and to investigate the relationship between left atrial strain and left ventricular diastolic function. A total of 82 hypertensive patients who were visited the Department of Cardiology at the Third Xiangya Hospital of Central South University from July 2021 to January 2022, were enrolled for this study, and 59 healthy subjects served as a control group. According to the number of left ventricular diastolic function indexes recommended by the 2016 American Society of Echocardiography Diastolic Function Guidelines (mitral annular e´ velocity: Septal e´<7 cm/s, lateral e´<10 cm/s, E/e´ ratio>14, left atrial volume index>34 mL/m2, peak tricuspid regurgitation velocity>2.8 m/s), the hypertensive patients were divided into 3 groups: Group Ⅰ (0 index, n=36 ), Group Ⅱ (1 index, n=39), and Group Ⅲ (2 indexes, n=7). Two-dimensional speckle tracking technique was used to measure left atrial reservoir strain (LASr), conduit strain, and contraction strain, and to analyze the correlation between left atrial strain and left ventricular diastolic function in hypertensive patients. The LASr, left atrial conduit strain (LAScd), and LASr/(E/septal e´) of the hypertension group were lower than those of the control group, and E/LASr was higher than that of the control group. There was no significant difference in left atrium volume index between the 2 groups (P>0.05). Compared with Group Ⅰ, LASr, LAScd, and LASr/(E/septal e´) were decreased in Group Ⅱ and Group Ⅲ, LASr/(E/septal e´) was also decreased in Group Ⅲ compared with Group Ⅱ (all P<0.05). Compared with Group Ⅰ, E/LASr was increased in Group Ⅲ. LASr was positively correlated with septal e´, lateral e´, E, and E/A, and negatively correlated with E/septal e´. The changes of left atrial function in patients with early hypertension are earlier than those of left atrial structure. Left atrial strain and its combination with conventional ultrasonographic indices [LASr/(E/septal e´)] of diastolic function are potentially useful in assessing left ventricular diastolic function in hypertensive patients.

Echocardiographic Correlates of Left Atrial Function Index Among Hypertensive Heart Failure Patients: A Cross-Sectional Study.

Background Heart failure contributes to the global burden of cardiovascular diseases, with hypertensive heart failure affecting individuals in their productive age group and leading to high economic losses and disability-adjusted life years. The left atrium, on the other hand, contributes significantly to left ventricular filling in heart failure patients, and the left atrial function index is an excellent tool for assessing left atrial function among heart failure patients. The study aimed to evaluate some parameters of systolic and diastolic function as correlates and potential predictors of the left atrial function index among hypertensive heart failure cohorts. Materials and methods The study was conducted at Delta State University Teaching Hospital, Oghara. Eighty (80) patients with hypertensive heart failure who met the inclusion criteria were enrolled in the cardiology outpatient clinics. The left atrial function index was calculated using the following formula: LAFI = (LAEF x LVOT-VTI)/LAESVI. (LAFI = left atrial function index; LAEF = left atrial emptying fraction; LAESVI = left atrial end-systolic volume index; LVOTVTI = outflow tract velocity time integral). The data were analysed using IBM Statistical Product and Service Solution Version 22. Relationships between variables were determined using analysis of variance, Pearson correlation, and multiple linear regressions. Significance was assessed at p<0.05. Result It was discovered that the left atrial function index correlated with ejection fraction (r = 0.616, p = 0.001), fractional shortening (r = 0.462, p = 0.001), and the ratio of early transmitral flow to early myocardial contractility, E/E' (r =-0.522, p = 0.001). However, there was no correlation with stroke volume (r = 0.38, p = 0.11); the ratio of early transmitral flow to late transmitral flow, E/A (r = -0.10, p = 0.11); isovolumetric relaxation time, IVRT (r = -0.171, p = 0.11);and tricuspid annular plane systolic excursion, TAPSE (r =0.185, p = 0.10). Of the variables that correlated with left atrial function index, left ventricular ejection fraction and the ratio of early transmitral flow to early myocardial contractility (E/E') were found to be independent predictors of left atrial function index. Conclusion Left ventricular ejection fraction and the ratio of early transmitral flow to early myocardial contractility reflect changes in the left atrial function index, and as such, they should be used as surrogates for its assessment, especially in low- and medium-income countries where left atrial function index estimation is not routinely done.

A Comparative Study of Left Atrial Function Index of Hypertensive Heart Failure Patients Versus Controls in a Teaching Hospital, Sub-Saharan Africa.

The left atrium contributes significantly to the left ventricular filling as it functions as a reservoir, conduit, and pump. These functions are referred to as the phasic function of the left atrium and they are assessed using left atrial volumes. The left atrial function index on the other hand is a rhythmic independent composite index which is a better marker of left atrial function. The study therefore aimed at comparing left atrial function (using the left atrial function index) among hypertensive heart failure patients, patients with hypertension but not in heart failure, and normotensive patients. The study was a cross-sectional analytical study that was carried out at Delta State University Teaching Hospital, Nigeria. A total of 80 hypertensive heart failure patients, 80 hypertensive, and 40 normotensive patients who met the inclusion criteria were recruited from the cardiology clinics using the convenience sampling method. The left atrial function index was determined using the volumetric method. Significance was assessed atp< 0.05. The left atrial function index (21.13 ± 8.83 versus 42.28 ± 10.40 versus 50.47 ± 14.37,p= 0.001) of the hypertensive heart failure group was significantly lowest when compared with the hypertensive (p< 0.001) and normotensive (p< 0.001) groups. Although the left atrial function index of the hypertensive group (42.28 ± 10.40) was lower than the normotensive group (50.47 ± 14.37), it was however not found to be significant (p= 0.12). Also, the left atrial function index was significantly (p= 0.001) worse among the patients with heart failure with reduced ejection fraction (13.5 ± 5.94) compared to heart failure with preserved ejection fraction (40.81 ± 12.12). Left atrial function index was lowest among hypertensive heart failure patients compared with hypertensive and normotensive cohorts, and it was worse among heart failure with reduced ejection fraction patients. However, there was no significant difference between the left atrial function index of the hypertensive and normotensive groups. As a result, we recommend that the left atrial function index should be incorporated into the routine echocardiographic assessment of patients in our day-to-day clinical practice and large studies should be carried out to determine the cut-off value for the left atrial function.

Prediabetes and incident heart failure in hypertensive patients: Results from the Swedish Primary Care Cardiovascular Database

Backgrounds and aimsThe cardiovascular risk conferred by concomitant prediabetes in hypertension is unclear. We aimed to examine the impact of prediabetes on incident heart failure (HF) and all-cause mortality, and to describe time in therapeutic blood pressure range (TTR) in a hypertensive real-world primary care population. Methods and resultsIn this retrospective cohort study, 9628 hypertensive individuals with a fasting plasma glucose (FPG) in 2006–2010 but no diabetes, cardiovascular or renal disease were followed to 2016; median follow-up was 9 years. Prediabetes was defined as FPG 5.6–6.9 mmol/L, and in a secondary analysis as 6.1–6.9 mmol/L. Study outcomes were HF and all-cause mortality. Hazard ratios (HR) were compared for prediabetes with normoglycemia using Cox regression. All blood pressure values from 2001 to the index date (first FPG in 2006–2010) were used to calculate TTR. At baseline, 51.4% had prediabetes. The multivariable-adjusted HR (95% confidence intervals) was 0.86 (0.67–1.09) for HF and 1.06 (0.90–1.26) for all-cause mortality. For FPG defined as 6.1–6.9 mmol/L, the multivariable-adjusted HR were 1.05 (0.80–1.39) and 1.42 (1.19–1.70), respectively. The prediabetic group had a lower TTR (p < 0.05). ConclusionsPrediabetes was not independently associated with incident HF in hypertensive patients without diabetes, cardiovascular or renal disease. However, prediabetes was associated with all-cause mortality when defined as FPG 6.1–6.9 mmol/L (but not as 5.6–6.9 mmol/L). TTR was lower in the prediabetic group, suggesting room for improved blood pressure to reduce incident heart failure in prediabetes.

Chinese Herbal Medicine Reduces the Risk of Heart Failure in Hypertensive Patients: A Nationwide, Retrospective, Cohort Study.

BackgroundHypertension (HTN) is the leading preventable risk factor for cardiovascular disease worldwide. Patients with HTN are at higher risk for heart failure (HF). The currently available therapeutic approaches for HTN do not always optimally control blood pressure or are not suitable for hypertensive patients who have a higher number of comorbidities. This study aimed to determine whether Chinese herbal medicine (CMH)-based interventions could reduce the risk of HF in hypertensive patients.MethodsThis retrospective study randomly selected 2 million enrollees from the National Health Insurance Research Database and identified 507,608 patients who were newly diagnosed with HTN in 2000–2017. After 1:1 frequency-matching by age, sex, index year, income, urbanization, duration of HTN, comorbidities and antihypertensive medications, we selected 8,912 eligible patients in each group. During 16 years of follow-up, 380 CHM users and 426 CHM non-users developed HF, representing incidence rates of 6.29 and 7.43 per 1,000 person-years, respectively.ResultsCHM users had significantly lower HF risk compared with CHM non-users (adjusted HR = 0.85, 95% CI 0.74–0.98). The markedly predominant effect was observed in those receiving CHM products for more than 180 days (adjusted HR = 0.65). The frequently prescribed formula, Jia-Wei-Xiao-Yao-San, and the single herbs Ge Gen, Huang Qi, Du Zhong, Huang Qin, and Chuan Xiong were significantly associated with lower risk of HF.ConclusionsThis population-based study revealed decreased HF risk in hypertensive patients with CHM use. These findings may provide a reference for HF prevention strategies and support the integration of CHM into clinical intervention programs that provide a favorable prognosis for hypertensive patients.

Sleep-disordered breathing in heart failure patients with different etiologies.

BackgroundThe prevalence of sleep‐disordered breathing (SDB) is closely related to the severity of heart failure (HF), and the severity of HF is different in patients with HF of different etiologies. Hypothesis: This study aimed to explore the prevalence of SDB in patients with HFof different etiologies.MethodsHospitalized HF patients were consecutively enrolled. All patients underwent portable overnight cardiorespiratory polygraphy. Patients were divided into five groups according to the etiology of HF: ischemic, hypertensive, myocardial, valvular, and arrhythmic. The prevalence of SDB and clinical data was compared among the five groups.ResultsIn total, 248 patients were enrolled in this study. The prevalence of SDB in HF was 70.6%, with the prevalence of obstructive sleep apnea (OSA) at 47.6% and central sleep apnea (CSA) at 23.0%. Patients were divided into five groups: ischemic, hypertensive, myocardial, valvular, and arrhythmic. The prevalence of SDB among the five groups was 75.3%, 81.4%, 77.8%, 51.9%, and 58.5% (p = .014), respectively. The prevalence of OSA among the five groups was 42.7%, 72.1%, 36.1%, 37.0%, and 49.1% (p = .009), whereas the CSA was 32.6%, 9.3%, 41.7%, 14.8%, and 9.4% (p < .001), respectively.ConclusionsSDB is common in HF patients. The prevalence and types of SDB varied in HF with different etiologies, which may be related to the different severities of HF. SDB was highly prevalent in patients with ischemic, hypertensive, and myocardial HF. Hypertensive HF patients were mainly complicated with OSA, while myocardial HF patients were mainly complicated with CSA. Both conditions were highly prevalent in ischemic HF patients. The prevalence of SDB was relatively low in valvular and arrhythmic HF patients, and OSA was the main type.

Brain Natriuretic Peptide Levels in Hypertensive Heart Failure Patients with and without Diabetes Mellitus: A Cross-sectional Study

Introduction: Heart Failure (HF) is a major disorder causing mortality and morbidity in the elderly population. Brain Natriuretic Peptide (BNP) is considered as the gold standard biomarker for diagnosis of HF. Aim: To find the association of plasma BNP levels with heart failure in hypertensive patients with and without diabetes mellitus. Materials and Methods: This cross-sectional study consisted of 35 hypertensive heart failure patients who attended the Outpatient General Medicine Department at Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India, between March 2020 to December 2020. The patients who belonged to class IV heart failure of the New York heart association were included. Total 35 HF patients were divided into two groups. Group 1 included 10 patients with hypertensive heart failure without diabetes mellitus. Group 2 included 25 patients with hypertensive heart failure with diabetes mellitus. Parameters such as Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), waist to hip ratio, Body Mass Index (BMI), Ejection Fraction (EF), transmitral filling velocities (E/A ratio), Left Ventricular Posterior Wall Thickness (LVPW), Left Ventricular Internal Dimension in diastole (LVIDd) and BNP level, random plasma glucose and HbA1c % were assessed in all the patients. Student’s t-test and Mann-Whitney U test were used to statistically analyze the data and p-value ≤ 0.05 was considered statistically significant. Results: Mean age of patients were 65.80±12.72 years in group 1 and 66.56±11.72 years in group 2. All patients in group 1 and most of the patients in group 2 (15,42%) were males. All the patients were in the obese category (BMI&gt;27 kg/m2 ). Serum BNP level was 1365 (243-3680) ng/L in group 1 and 691 (44.7-4261) ng/L in group 2, but this difference was not statistically significant (p-value=0.23). Echocardiography showed significant differences in left ventricular internal dimension in diastole, left ventricular posterior wall thickness and E/A ratio-integrated between hypertensives and hypertensives with diabetes mellitus. Serum BNP had a significant positive correlation with systolic blood pressure (r=0.33, p-value=0.05). There were highly significant differences in random plasma glucose and glycated haemoglobin between the groups. Conclusion: Plasma BNP levels were associated with systolic blood pressure in heart failure patients with hypertension. The significance of association is the same in hypertensives with diabetes mellitus. Thus, BNP as a biomarker plays a major role in the prediction of heart failure. But BNP could not differentiate whether the heart failure was due to hypertension alone or due to associated metabolic conditions.

Endotrophin is significantly associated with disease severity and increased risk of adverse outcome in HFpEF but not in HFrEF patients

Abstract Introduction The global burden of heart failure (HF), with either reduced (HFrEF) or preserved (HFpEF) ejection fraction, has increased dramatically over the past years, and HFpEF is projected to become the dominant type of HF. Fibrogenesis, promoted by fibroblast activity, plays an important role in the pathology of HF regardless of subtype, causing impaired cardiac function. Endotrophin is a bioactive molecule released from collagen type VI during its maturation, and it is a marker of fibroblast activity. The aim of this post-hoc analysis was to confirm the previously observed prognostic potential of endotrophin (measured by PRO-C6) for adverse outcome in HFpEF and to test its prognostic abilities in HFrEF. Methods 234 patients with hypertension and either HFrEF (30.3%) or HFpEF (69.7%) were included for analysis. 43.2% were NYHA Class II, 52.5% NYHA Class III and 2.5% NYHA Class IV. 53.4% of patients had a previous history of atrial fibrillation. The cohort did not include diabetic patients. Cardiac function was assessed by echocardiography and standard clinical measures, including left ventricle ejection fraction (EF), blood pressure (BP) and measurement of N-terminal natriuretic brain-peptide (NT-proBNP). Circulating endotrophin was quantified at baseline in serum by means of an enzyme-linked immunosorbent assay, PRO-C6. Results PRO-C6 levels increased significantly with disease severity in HFpEF patients (NYHA Class III vs II, p=0.0003), but not in HFrEF patients (NYHA Class III vs II, p=0.33). In HFpEF patients, PRO-C6 was able to discriminate between patients that were hospitalized for HF (AUC=0.69, p&amp;lt;0.001), died from cardiovascular (CV) causes (AUC=0.74, p&amp;lt;0.001), or by any other cause (AUC=0.73, p&amp;lt;0.001). PRO-C6 was not associated with none of these outcomes in HFrEF patients (AUC=0.56, p=0.42; AUC=0.53, p=0.73; AUC=0.56, p=0.53, respectively). Adding PRO-C6 to a risk prediction model containing age, sex, body mass index and systolic BP significantly increased the discriminatory power of the model for mortality (deltaAUC=0.037, p=0.04). When looking at patients stratified in PRO-C6 tertiles, patients in the upper tertile had a significantly higher risk of mortality (p&amp;lt;0.0001, hazard ratios 3 vs 1=4.1, 3 vs 2=3.5, respectively) and HF hospitalization (p&amp;lt;0.0001, hazard ratio 3 vs 1=4.4, 3 vs 2=1.6, respectively) compared to tertiles 1 and 2. Conclusion In this population of hypertensive HF patients, circulating endotrophin, measured by PRO-C6, was increased with increasing disease severity, and associated with a higher risk of adverse outcome in HFpEF, but not in HFrEF patients. The data presented here suggest a potential role of endotrophin in HFpEF pathophysiology and further underline the differences between HFpEF and HFrEF. These data confirm previous observations, and strengthen the usefulness of endotrophin, measured by the PRO-C6 biomarker, as a prognostic tool aiding in assessment of HFpEF patients. Funding Acknowledgement Type of funding sources: None.

OBESITY PARADOX AND HYPERTENSION: NEW INSIGHTS IN HEART FAILURE PATIENTS

Objective: Heart failure (HF) is more prevalent among obese and overweight individuals than among normal weight people, although there is a survival advantage for obese and overweight patients compared with normal weight or low weight patients, the so-called obesity paradox in HF. On the other hand, obesity increases the risk of hypertension and the relationship between HF and hypertension is well-established; however, the prognostic role of obesity has not been investigated sufficiently in hypertensive HF patients. Design and method: Patients with HF were evaluated in a cross sectional study. Office blood pressure (BP), both systolic (SBP) and diastolic (DBP), the duration in years from the first diagnosis of hypertension and body mass index (BMI) were recorded as well. The prognostic role of obesity was evaluated according to the number of hospitalizations for HF in the last six months and in the last year. Results: A total of 306 consecutive male patients with HF participated in the study. Overweight were 45,8%, obese 37,2% and normal weight 16,9% of patients according to BMI. Both SBP and DBP had a negative correlation with the number of hospitalizations for HF in the last six months and in the last year (r = -0.174, p = 0.008, r = -0.190, p = 0.004 for systolic, and r = -0,130, p = 0.049, r = -0.155 and p = 0.018 for diastolic, respectively). Overweight, obese and lean participants did not differ in BP, both SBP and DBP, and in their HF morbidity according to hospitalizations (p = 0.075, p = 0.271, and p = 0.407, respectively). Patients with hypertension had higher values of BMI (p = 0.032), but office SBP and DBP did not have any correlation with BMI. Also, BMI did not differ among patients with or without hypertension, and although BMI had a negative correlation with the number of hospitalization for HF, that was not significant (r = -0.062, p = 0.346). Conclusions: Our study provides some new insights regarding to the relationship between obesity and office BP in HF patients. Obese is highly prevalent in HF patients with or without hypertension, but the association between BMI and morbidity according to the number of hospitalizations has not been found to be significant in hypertensive patients.

Endothelial dysfunction and C-reactive protein predict the incidence of heart failure in hypertensive patients.

AimsEndothelial dysfunction and heart failure are associated, but no prospective studies demonstrated that impaired endothelium‐dependent vasodilation predicts incident heart failure. We designed this study to test whether endothelial dysfunction is associated with incident heart failure in a group of hypertensives.Methods and resultsWe enrolled 735 White never‐treated hypertensive outpatients free from heart failure, diabetes, chronic kidney disease, and previous cardiovascular events. Endothelium‐dependent vasodilation was investigated by intra‐arterial infusion of acetylcholine, and laboratory determinations were obtained by standard procedures. During the follow‐up [median 114 months (range 26–206)], there were 208 new cases of heart failure (3.1 events/100 patient‐years). Dividing the study population in progressors and non‐progressors, we observed that progressors were older, showed a higher prevalence of being female, and had a higher baseline heart rate, glucose, insulin, Homeostatic Model Assessment (HOMA), creatinine, and high‐sensitivity C‐reactive protein (hs‐CRP) mean values, while estimated glomerular filtration rate and maximal acetylcholine‐stimulated forearm blood flow were lower. In the multiple Cox regression analysis, female gender [hazard ratio (HR) = 1.454, 95% CI = 1.067–1.981], fasting glucose (HR = 1.186, 95% CI = 1.038–1.357), hs‐CRP (HR = 1.162, 95% CI = 1.072–1.259), HOMA (HR = 1.124, 95% CI = 1.037–1.219), acetylcholine‐stimulated forearm blood flow (HR = 0.779, 95% CI = 0.695–0.874), and estimated glomerular filtration rate (HR = 0.767, 95% CI = 0.693–0.849) maintained an independent association with the outcome. Successively, testing the interaction between forearm blood flow and hs‐CRP, we observed that patients who have hs‐CRP values above the median and forearm blood flow under the median show a higher risk of developing heart failure (HR = 7.699, 95% CI = 4.407–13.451).ConclusionsThe present data demonstrate that an impaired endothelium‐dependent vasodilation and hs‐CRP predict development of incident heart failure in hypertensives.

Relationship between resting heart rate and incident heart failure in patients with hypertension: The Kailuan Cohort Study in China.

An elevated heart rate increases the risk of cardiovascular disease, but the relationship between resting heart rate (RHR) and the risk of heart failure (HF) in hypertensive patients is unclear. This study was performed to assess the relationship between elevated RHR and incident HF in hypertensive patients. In total, 16286 hypertensive patients from the Kailuan cohort were enrolled and underwent three physical examinations. According to mean RHR based on quartile, the hypertensive patients were divided into four groups: Q1 (mean RHR≤69bpm), Q2 (69bpm<mean RHR≤74bpm), Q3 (74bpm<mean RHR≤79bpm), and Q4 (mean RHR>79bpm). The cumulative mortality rate was analyzed by using the Kaplan-Meier method, with comparisons among RHR quartiles. Cox proportional hazards regression models and restricted cubic spline models were established to evaluate the association between RHR and risk of incident HF. After adjustment for confounders, the hazard ratio (HR) for HF was 1.97(95% CI: 1.28-3.04, P<.001) in the fourth quartile compared to the first quartile. Each 1-standard deviation [10 (beats/min)] increase in RHR was associated with a 40% increase in the risk of incident HF. Restricted cubic spline models presented a linear relationship between RHR and incident HF. Our study suggests that elevated RHR is associated with an enhanced risk of HF in hypertensive patients.

Linoleic acid improves assembly of the CII subunit and CIII2/CIV complex of the mitochondrial oxidative phosphorylation system in heart failure

BackgroundLinoleic acid is the major fatty acid moiety of cardiolipin, which is central to the assembly of components involved in mitochondrial oxidative phosphorylation (OXPHOS). Although linoleic acid is an essential nutrient, its excess intake is harmful to health. On the other hand, linoleic acid has been shown to prevent the reduction in cardiolipin content and to improve mitochondrial function in aged rats with spontaneous hypertensive heart failure (HF). In this study, we found that lower dietary intake of linoleic acid in HF patients statistically correlates with greater severity of HF, and we investigated the mechanisms therein involved.MethodsHF patients, who were classified as New York Heart Association (NYHA) functional class I (n = 45), II (n = 93), and III (n = 15), were analyzed regarding their dietary intakes of different fatty acids during the one month prior to the study. Then, using a mouse model of HF, we confirmed reduced cardiolipin levels in their cardiac myocytes, and then analyzed the mechanisms by which dietary supplementation of linoleic acid improves cardiac malfunction of mitochondria.ResultsThe dietary intake of linoleic acid was significantly lower in NYHA III patients, as compared to NYHA II patients. In HF model mice, both CI-based and CII-based OXPHOS activities were affected together with reduced cardiolipin levels. Silencing of CRLS1, which encodes cardiolipin synthetase, in cultured cardiomyocytes phenocopied these events. Feeding HF mice with linoleic acid improved both CI-based and CII-based respiration as well as left ventricular function, together with an increase in cardiolipin levels. However, although assembly of the respirasome (i.e., CI/CIII2/CIV complex), as well as assembly of CII subunits and the CIII2/CIV complex statistically correlated with cardiolipin levels in cultured cardiomyocytes, respirasome assembly was not notably restored by dietary linoleic acid in HF mice. Therefore, although linoleic acid may significantly improve both CI-based and CII-based respiration of cardiomyocytes, respirasomes impaired by HF were not easily repaired by the dietary intake of linoleic acid.ConclusionsDietary supplement of linoleic acid is beneficial for improving cardiac malfunction in HF, but is unable to completely cure HF.