Prevalence Of Arterial Hypertension Research Articles

Vascular risk profile and changes of arterial hypertension after surgical revascularization in adult Moyamoya patients

Moyamoya disease (MMD) is a rare stenoocclusive cerebral vasculopathy often treated by neurosurgical revascularization using extracranial-intracranial bypasses to prevent ischemic or hemorrhagic events. Little is known about the vascular risk profile of adult MMD patients compared to the general population. We therefore analyzed 133 adult MMD patients and compared them with data from more than 22,000 patients from the German Health Update database. Patients with MMD showed an age- and sex-adjusted increased prevalence of arterial hypertension, especially in women between 30 and 44 years and in patients of both sexes between 45 and 64 years. Diabetes mellitus was diagnosed significantly more frequently in MMD patients with increasing age, whereas the vascular risk profile in terms of obesity, nicotine and alcohol consumption was similar to that of the general population. Antihypertensive medication was changed one year after surgical revascularization in 67.5% of patients with a tendency towards dose reduction in 43.2% of all patients. After revascularization, physicians need to be aware of a high likelihood of changes in arterial hypertension and should adjust all other modifiable systemic vascular risk factors to achieve the best treatment possible.

Risk Factors and Biomarkers for Interstitial Lung Disease and Pulmonary Arterial Hypertension in Systemic Sclerosis: Experience of Two Tertiary Centers in Turkey

Purpose: To define the clinical and laboratory characteristics of patients with systemic sclerosis (SSc), and to investigate the risk factors affecting the prevalence of interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH), which are important causes of morbidity and mortality. Patients and methods: 88 patients with SSc were compared according to the presence of ILD and PAH. ILD was confirmed by chest computed tomography, and PAH was suspected and considered probable PAH when right ventricular systolic pressure was >40 mmHg according to echocardiography. Results: Of the 88 patients, 44.3% had diffuse-type and 55.7% had limited-type SSc. Diffuse type, percentages of positive anti-scleroderma-70 (anti-Scl70) antibody and anti-centromere antibody, white blood cell (WBC), platelet, erythrocyte sedimentation rate (ESR), smoking, and presence of the sclerodactyly and telangiectasia differed significantly in SSc with ILD group. The positive titer of anti-Scl70 antibody (odds ratio (OR)=6.124, p=0.004), platelet count (OR=0.138, p=0.002), ESR (OR=1.042, p=0.035) and presence of telangiectasia (OR=10.571, p=0.001) were associated with ILD in patients with SSc. Also, while diffuse-type (OR=0.223, p=0.010), the presence of sclerodactyly (OR=11.112, p=0.028) and telangiectasia (OR=3.861, p=0.020) were risk factors for the development of ILD in nonspecific interstitial pneumonia pattern, anti-Scl-70 antibody positivity (OR=12.921, p=0.019) and high ESR (OR=1.034, p=0.030) were found to be risk factors for the development of usual interstitial pneumonia pattern. Conclusion: Positive titer of the anti-Scl70 antibody, diffuse type, presence of telangiectasia, and high ESR were independently associated with ILD in SSc patients.

Undiagnosed arterial hypertension in a Latin American country, 2019 to 2021

To determine the factors associated with undiagnosed hypertension. A quantitative, observational, retrospective, cross-sectional and analytical study was carried out in people aged 15 years and over included in the Demographic and Family Health Survey from 2019 to 2021 in Peru. A statistical analysis was carried out using the corrected F test, and crude and adjusted prevalence ratio (aPR), with a 95% confidence interval (95%CI) for inferential analysis, through Poisson regression with robust variance. Likewise, the CSPLAN analysis was carried out for complex samples according to the sample design and taking into account the weighting factor. In the multivariate analysis, a significant association was found between the factors male sex (aPR: 1.22; 95%CI: 1.19-1.26), age from 30 to 49 years (aPR: 0.94; 95%CI: 0.92-0.96), native ethnicity (aPR: 1.07; 95%CI: 1.04-1.10), having health insurance (aPR: 0.91; 95%CI: 0.89-0.93), suffering from some permanent limitation (aPR: 0.83; 95%CI: 0.76-0.91) and diabetes mellitus (aPR: 0.59; 95%CI: 0.55-0.64). No significant association was found with educational level, language, Afro-Peruvian ethnicity, or alcohol or tobacco consumption (p > 0.05). The prevalence of undiagnosed arterial hypertension is high, 69.5%. The associated factors are male sex, native ethnicity, age between 30 and 49 years, having health insurance, suffering from some permanent limitation and having diabetes mellitus.

ARTERIAL HYPERTENSION IN PATIENTS LONG TERM AFTER LIVER TRANSPLANTATION

Objective: Cardiovascular diseases are one of the most frequent causes of death of patients after liver transplantation (LTx). The aim of this retrospective clinical study was to estimate the prevalence of arterial hypertension among patients after successful LTx. Design and method: Two hundred forty three patients, aged 49.5±11.7 years (91 women, 152 men) after successful LTx who completed 24 months follow-up were studied. Diagnosis of hypertension was based on the following criteria: office blood pressure equal or higher thab 140/90 mmHg during two separate visit or use of antihypertensive pharmacotherapy. Results are presented as means with standard deviation. Results: The prevalence of hypertension in patients before LTx was 28.8%. Twenty four months after LTx the prevalence of hypertension increased significantly to 67.5% (p<0.001, Q Cochrane test). Therefore, annual incidence for arterial hypertension during 24 months after LTx was 18.5%. Systolic and diastolic blood pressure 24 months after LTx were 135.3 ± 18.1, and 86.4 ± 10.7 mmHg, respectively. Number of patients treated with immunosuppressive regimen based on tacrolimus or cyclosporine A or everolimus were 204 (84%), 22 (9%) and 17 (7%), respectively. Prevalence of arterial hypertension in patients treated with immunosuppressive regimen based on tacrolimus, cyclosporine A or everolimus was 63.7%, 86.4% and 88.2% respectively (p=0.01; tacrolimus vs cyclosporine p=0.03; tacrolimus vs everolimus p=0.04). Patients with arterial hypertension were treated with 1.7 ± 1.2 antihypertensive drugs. Beta-adrenergic antagonists were used by 52.2%, calcium channel antagonists by 40.9%, diuretics by 32.1%, angiotensin converting enzyme inhibitors by 28.3%, angiotensin 2 receptor antagonists 8.2% and alfa-adrenergic antagonists by 6.3% patients with arterial hypertension. Conclusions: 1. Arterial hypertension occurs in nearly 70% of patients long term after LTx. 2. Immunosuppressive regimen might influence the prevalence of arterial hypertension in liver transplant recipients. 3. High prevalence of arterial hypertension in patients after LTx needs special attention and specific treatment in order to reduce increased cardiovascular morbidity and mortality observed in these patients.

THE PREVALENCE AND RISK FACTORS FOR ARTERIAL HYPERTENSION IN CHILDREN WITH IDIOPATHIC NEPHROTIC SYNDROME

Objective: Arterial hypertension (AH) is claimed to be an uncommon finding in children with idiopathic nephrotic syndrome (INS). The study aimed to analyze blood pressure, prevalence, and risk factors of AH in children with INS. Design and method: In 153 children with INS (9.32±3.84 years, 100 boys), we evaluated systolic and diastolic blood pressure (mm Hg, Z-scores), age at onset of the disease, anthropometric data, response to steroids, results of kidney biopsy, number of INS relapses, and medications. Results: The mean age at disease onset was 4.39±2.38 years; 67 patients had steroid-sensitive nephrotic syndrome (SSNS), 12 frequently relapsing nephrotic syndrome (FRNS), 58 steroid-dependent nephrotic syndrome (SDNS), and 16 steroid-resistant nephrotic syndrome (SRNS). Kidney biopsy was performed in 26: 5 – minimal change disease, 11 – mesangial proliferation, 10 – focal and segmental glomerulosclerosis. AH at disease onset was found in 10 (6.5%) patients in the following 11 (7.2%) after corticosteroid initiation. The observation period was 4.93±3.80 years, and AH was found in 31 (20.3%) – in 3 (4.5%) patients with SSNS, 2 (16.7%) with FRNS, 20 (34.5%) with SDNS, and 6 (37.5%) with SRNS. Patients with AH had lower height Z-score (-0.46±1.20 vs. 0.18±1.15, p=0.006), higher BMI Z-score (1.15±1.10 vs. 0.41±1.09, p<0.001), number of INS relapses (8.32±6.78 vs. 4.41±3.82, p<0.001), and current prednisone dose (0.49±0.67 vs. 0.18±0.29 [mg/kg/24h], p<0.001). Systolic blood pressure Z-score at the end of observation correlated with age (r=-0.192, p=0.017), BMI Z-score (r=0.368, p<0.001), and present prednisone dose [mg/kg/24h] (r=0.186, p=0.021), diastolic blood pressure Z-score with BMI Z-score (r=0.231, p=0.004), and number of INS relapses (r=0.163, p=0.044). In Cox Proportional Hazard presence of SDNS and SRNS were the only predictors of AH (SDNS: HR=4.80, 95CI(1.30-17.75), SRNS: HR=4.77, 95CI(1.06-21.53)). Conclusions: 1. Approximately one-third of patients with SDNS and SRNS develop arterial hypertension in the course of the disease. 2. Steroid dependence and steroid resistance are the strongest predictors of AH in children with INS. Other determinants of blood pressure elevation in this group of patients are high BMI and a high number of relapses.

ARTERIAL HYPERTENSION AND BLOOD PRESSURE RESPONSE TO EXERCISE IN ATHLETES

Objective: Arterial hypertension is one of the most important risk factors for cardiovascular disease and the most common pathological finding in the examination of athletes. On the other hand, physical activity leads to a reduction in blood pressure and is thus an essential part of a regimen in the treatment of hypertension. People who wish to engage in sport at the competitive level should be pre screened by a stress test. A number of those examined have resting hypertension and a part has an exaggerated response to exercise. Our aim was to determine what proportion of the tested athletes had each hypertensive phenotypes and exercise BP hyperresponsiveness. Furthermore, we wanted to compare the prevalence of arterial hypertension between different types of sporting activity - mixed, endurance, strength and skill. Design and method: We retrospectively analyzed data from 1,733 adult athletes who underwent stress testing at two sports medicine centers between 2019 and 2023. The mean age was 24.9 years, 69% of the subjects were male and the relative performance was on average 4.08 W/kg. Clinical data at rest and during exercise were measured and recorded. Subsequently, the data were statistically processed. Results: A total of 431 (24.9%) subjects met the criteria for arterial hypertension when resting blood pressure was measured. Z 182 (10.5%) had isolated systolic hypertension and 104 (6%) had isolated 19 (1.1%) subjects had exertional hypertension. Elevated diastolic blood pressure occurs significantly more frequently in athletes with skill or strength type sports than in athletes with mixed type sports (24.0% and 24.2% vs. The hypertensive response to exercise occurs significantly more frequently in athletes with strength-type sports than in athletes with mixed-type sports (4.5% vs. 0.7%, p = 0.006). Conclusions: The higher incidence of resting and exertional arterial hypertension in specific types of sports should lead to more intensive diagnosis and care for these specific types of athletes. The definition of exertional pressure hyperreaction is currently inconsistent. Longer follow-up of individuals with borderline and pathological values could lead to more effective indication for testing and subsequent treatment and regimen measures.

ALBUMINURIA IS AN IMPORTANT PREDICTOR FOR ALL CAUSE MORTALITY IN GENERAL RURAL POPULATION

Objective: Albuminuria stands as a robust predictor of both cardiovascular and all-cause mortality, despite that there remains a notable gap in understanding how albuminuria's association with mortality varies across subgroups defined by sex, comorbidities and estimated glomerular filtration rate (eGFR). The aim of this study was to determine whether the association between albuminuria and mortality differs according to eGFR, sex, and comorbidities. Design and method: This prospective observational study includes 857 adult subjects from the ENAH rural study in Croatia. Albuminuria, the ratio of urinary albumin to creatinine (ACR) was subsequently categorized into two levels as >30mg/g (group A) and <30mg/g (group B). Results: Subjects from the group A were older (70.5 vs. 49.0 years), had a higher BMI (29.7 vs. 27.4 kg/m2), and lower eGFR (69.3 vs. 85.2 ml/min/1.73m2). They had higher prevalence of arterial hypertension (AH) (78.2% vs. 53.3%) and diabetes (DM) (30.8% vs. 11.9%) (p<0.001 for both). A significantly higher mortality rate (64.1% vs. 27.3%, p<0.001) was observed in Group 1 compared to the group 2. In logistic regression analysis the highest odds of mortality were observed for ACR>30mg/g (OR=2.43, 95%CI=1.40-4.19, p=0.002), followed with male gender (OR=1.79, 95%CI=1.28-2.49, p<0.001), DM (OR=1.71, 95%CI=1.10-2.67, p=0.018), eGFR < 60 (OR=1.71, 95%CI 1.00-2.94 and AH (OR=1.55, 95%CI=1.06-2.27, p=0.025). Conclusions: Our study underscores the significant impact of albuminuria on all-cause mortality in general rural population indicating that this diagnostic tool should be included in everyday clinical work.

ARTERIAL HYPERTENSION AS A COMPONENT OF METABOLIC SYNDROME IN MEN IN AN OPEN URBAN POPULATION

Purpose. To determine blood pressure (BP) levels and the prevalence of arterial hypertension (AH), as a component of metabolic syndrome, in men of an open urban population aged 25–64 years. Materials and methods. A one-time epidemiological study was conducted on a representative sample of men 25–64 years old, formed from the electoral lists of citizens of the city of Tyumen in the amount of 1000 people, the response was 85.0%. To analyze the prevalence of AH as a component of the metabolic syndrome, the NCEP ATP III (2004), IDF (2005), All-Russian Scientific Society of Cardiology (2009) assessment criteria were used. Results. The levels of systolic BP in men of the Tyumen population were high due to the average age groups of 35–44 and 45–54 years; in the same groups there was a significant increase in the average values and percentile distribution of the trait. According to the levels of diastolic BP in men of the Tyumen population, a directional age trend of the indicator was formed with a significant increase in its levels in each subsequent age group. In terms of the prevalence of AH, the standardized indicator in the male population of Tyumen 25–64 years old was 59.8%; a positive relationship was established with age in the younger and older age categories. Conclusion. Thus, the study results obtained in an open urban population, which identified the most vulnerable age categories of men with regard to the development of metabolic syndrome, represent a scientific basis for the formation of a preventive program in the region.

Letter to the editor regarding "Prevalence of arterial hypertension in hospitalized pediatric patients"

Letter to the editor regarding "Prevalence of arterial hypertension in hospitalized pediatric patients"

Significance of Hypoalbuminemia in the Development of Thromboembolic Complications in Severe Cases of SARS-CoV-2 Coronavirus Infection.

The course of coronavirus disease 2019 (COVID-19) is associated with the progression of a wide range of complications, among which thrombosis and thromboembolism are of particular importance. The significance of hypoalbuminemia in the development of thromboembolic complications (TECs) in patients with a severe course of COVID-19 is currently under active discussion. The objective of our study was to evaluate the significance of hypoalbuminemia in the development of TECs in patients with severe SARS-CoV-2 coronavirus infection. In a single-center observational retrospective study, case histories of 1,634 patients with a verified diagnosis of SARS-CoV-2 coronavirus infection were analyzed. Patients were divided into two groups according to the presence of TECs: 127 patients with venous TECs constituted the main group and 1,507 patients, in whom the course of COVID-19 was not complicated by the development of TECs, constituted the comparison group. The patients with TECs were older, and the prevalence of arterial hypertension, coronary heart disease, chronic heart failure, chronic kidney disease, and diabetes mellitus was higher than that in the comparison group. A single-factor regression analysis showed that a decrease in albumin levels of less than 35 g/L is associated with an eightfold increase in the risk of developing TECs in patients with severe SARS-CoV-2 coronavirus infection (area under the curve (AUC): 0.815, odds ratio (OR): 8.5389, 95% confidence interval (CI): 4.5637 - 15.977, P < 0.001). The sensitivity of the method was 76.34%, and the specificity was 72.58%. The study revealed that hypoalbuminemia is a predictor of development of TECs in severe cases of SARS-CoV-2 coronavirus infection.

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.

Prognostic role of mesangial IgM deposition in IgA nephropathy: a long-term cohort study

Background The clinical significance of mesangial immunoglobulin (Ig) M deposition in IgA nephropathy (IgAN) has been less explored and remains a topic of debate. Therefore, our study aimed to investigate the prognostic value of mesangial IgM deposition in a long-term follow-up cohort of IgAN patients. Methods A unicentric retrospective study was conducted on 93 consecutive IgAN patients (median age 41 years, 68% male, eGFR 48.7 mL/min, proteinuria 1.1 g/g) from 2010 to 2015. They were followed until end-stage kidney disease (ESKD), death, or until the end of the study in January 2021, with a median follow-up of 7 years. An independent pathologist evaluated the IgM immunofluorescence pattern, Oxford MEST-C score, and transmission electron microscopy (TEM) lesions following a comprehensive protocol. Results In our cohort, 70% had mesangial IgM-positive deposits, while 30% were IgM-negative. Both groups were similar in age, sex, prevalence of arterial hypertension, Charlson comorbidity scores, kidney function (eGFR and proteinuria), pathology findings (Oxford MEST-C score, IgG and C3 immune deposition), and TEM analysis. Treatment with RASI and immunosuppression, and death rates were also comparable. However, 37% of IgM-positive patients progressed to ESKD, significantly higher than the 11% in the IgM-negative group. Univariate and multivariate Cox proportional hazards regression analyses identified lower eGFR, higher Oxford MEST-C score, and mesangial IgM deposits as independent factors associated with shorter kidney survival. Conclusions Our study highlights mesangial IgM deposition as a potential risk factor for ESKD in patients with advanced IgAN, laying a foundation for further research in this area.

Prevalence of arterial hypertension in young elite athletes with a hypertensive type of response to physical activity

Aim of the study: to assess the prevalence of arterial hypertension in athletes with high BP values during an exercise test.Methods: out of 2313 athletes 14–18 (15.5 ± 1.4) years old, according to the results of VEM, 128 (6 %; 60 m) people with high blood pressure values at maximum load were identified, 86 (67 %) of them underwent ABPM. The patient were divided into 2 groups: with normal — 62 (72 %) and high office BP – 24 (28 %).Results: athletes with high office BP values had a significantly higher BMI. We did not note any significant differences in ABPM between the two groups. 71 % had arterial hypertension, 65 % had masked arterial hypertension.Conclusions: in young elite athletes with high values of BP during exercise, 71 % are diagnosed arterial hypertension according to ABPM; in 65% masked arterial hypertension has detected, which dictates the need for ABPM in this group of athletes.

Management and outcomes of spontaneous coronary artery dissection: a systematic review of the literature.

Contemporary management of spontaneous coronary artery dissection (SCAD) is still controversial. This systematic review of the literature aims to explore outcomes in the patients treated with conservative management vs. invasive strategy. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed when we extensively searched three electronic databases: PubMed, ScienceDirect, and Web of Science, for studies that compared conservative vs. invasive revascularization treatment outcomes for patients with SCAD from 2003 to 2023. The outcomes of interest were all-cause death and major adverse cardiovascular events (MACE), including acute coronary syndrome (ACS), heart failure (HF), need for additional revascularization, target vessel revascularization (TVR), SCAD recurrence, and stroke. The systematic review included 13 observational studies evaluating 1,801 patients with SCAD. The overall mean age was 49.12 +/- 3.41, and 88% were females. The overall prevalence of arterial hypertension was 33.2%, hyperlipidemia, 26.9%, smoking, 17.8%, and diabetes, 3.9%. Approximately 48.5% of the patients were diagnosed with non-ST elevated myocardial infarction (NSTEMI), 36.8% with ST elevated myocardial infarction (STEMI), 3.41% with unstable angina, 0.56% with stable angina, and 0.11% were diagnosed with various types of arrhythmias. The left anterior descending artery (LAD) was the most common culprit lesion in 51% of the patients. There were initially 65.2% of conservatively treated patients vs. 33.4% that underwent percutaneous coronary intervention (PCI) or 1.28% that underwent coronary artery bypass graft (CABG). SCAD-PCI revascularization was associated with a variable range of PCI failure. The most common complications were hematoma extension and iatrogenic dissection. SCAD-PCI revascularization frequently required three or more stents and had residual areas of dissection. The overall reported in-hospital and follow-up mortality rates were 1.2% and 1.3%, respectively. The follow-up range across studies was 7.3-75.6 months. The authors reported variable prevalence of MACE, recurrent SCAD up to 31%, ACS up to 27.4%, TVR up to 30%, repeat revascularization up to 14.7%, UA up to 13.3%, HF up to 17.4%, and stroke up to 3%. Our results highlight that conservative treatment should be the preferred method of treatment in patients with SCAD. PCI revascularization is associated with a high prevalence of periprocedural complications. SCAD poses a considerable risk of MACE, mainly associated with TVR, ACS, and recurrent SCAD.

Consumo de adoçantes não nutritivos e prevalência de hipertensão arterial sistêmica em adultos e idosos de uma capital do Nordeste brasileiro

ABSTRACT Objective To characterize the consumption of Non-nutritive sweeteners and to verify the association between the intake of these additives and the prevalence of Systemic Arterial Hypertension in adults and the elderly in a Brazilian capital. Methods This was a cross-sectional household and population-based study carried out with 489 individuals aged 20 years and older residents of Teresina, Piauí, Brazil. Complex probabilistic cluster sampling was used. Sociodemographic, economic, lifestyle and diseases diagnosis, such as SAH diagnosis, data were obtained by self-report. Weight, height, waist circumference and blood pressure were measured. Data on food consumption and Non-nutritive sweeteners consumption were obtained using 24-hour dietary recall. The association between the consumption of Non-nutritive sweeteners and the prevalence of Systemic Arterial Hypertension was verified using Poisson regression. Results The most commonly consumed types of Non-nutritive sweeteners were cyclamate and saccharin and the main source of consumption was tabletop sweeteners. The consumption of Non-nutritive sweeteners was well below the Acceptable Daily Intake. Mean systolic blood pressure and diastolic blood pressure were higher in women and men who consumed Non-nutritive sweeteners (p=0.04), respectively. Individuals who consumed Non-nutritive sweeteners had a 36% higher prevalence of Systemic Arterial Hypertension compared to non-consumers (p=0.04), after adjustments. Female consumers of Non-nutritive sweeteners had a 31% higher prevalence of Systemic Arterial Hypertension (No-BreakpNo-Break=0.04). Conclusion The consumption of Non-nutritive sweeteners was positively associated with the prevalence of Systemic Arterial Hypertension. It is therefore important to continue studies investigating the possible health consequences of consuming these substances.

Clinical and treatment profiles of arterial hypertension in Mexico during the COVID-19 pandemic: a cross-sectional survey endorsed by the "Collaborative Group on Arterial Hypertension".

Arterial hypertension is highly prevalent in Mexico; nevertheless, there are limited insights regarding its management during the COVID-19 pandemic. Here, we estimate the prevalence of clinical and treatment profiles of arterial hypertension and explore associated factors for undiagnosed and uncontrolled hypertension using a cross-sectional survey endorsed by the Collaborative Group on Arterial Hypertension from the Mexican Institute of Social Security. Our survey was conducted from May to November 2021 using the May-Measurement Month 2021 protocols of the International Society of Hypertension. Arterial hypertension (defined as: blood pressure [BP] ≥140/90 mmHg, previous diagnosis, or taking antihypertensives) and its clinical and treatment profiles were classified according to the World Hypertension League Expert Committee. Mixed-effects logistic regression models were used to explore associated factors for undiagnosed and uncontrolled hypertension. Among 77,145 screened participants (women: 62.4%; median age: 46 [IQR: 32-59] years), the prevalence of arterial hypertension was 35.7% (95% CI: 35.3-36.0, n = 27,540). Among participants with arterial hypertension, 30.9% (95% CI: 30.4-31.5, n = 8,533) were undiagnosed, 6.6% (95% CI: 6.3%-6.9%, n = 1,806) were diagnosed but untreated, 43.4% (95% CI: 42.9-44.0, n = 11,965) had uncontrolled hypertension, and only 19% (95% CI: 18.6%-19.5%, n = 5,236) achieved hypertension control (BP < 130/80 mmHg). Explored associated factors for undiagnosed and uncontrolled hypertension include being men, living in the central and southern regions, lower educational attainments, higher use of pharmacological agents, and previous COVID-19 infection. Our findings suggest that adverse arterial hypertension profiles, mainly undiagnosed and uncontrolled hypertension, were highly prevalent during the context of the COVID-19 pandemic in Mexico.

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.

Chronic Thromboembolic Pulmonary Hypertension after Pulmonary Embolism in SARS-CoV-2

Introduction: Chronic thromboembolic pulmonary disease (CTEPD) consists of persistent pulmonary vascular obstruction on imaging and involves long-term functional limitations, with or without chronic thromboembolic pulmonary hypertension (CTEPH). The aim of this study was to evaluate the incidence and risk factors of both persistent pulmonary vascular defects and CTEPH after hospitalization in patients with COVID-19 and PE during a 2-year follow-up. Methods: A prospective observational study was carried out in a tertiary hospital center. Patients were hospitalized between March 2020 and December 2021 with a diagnosis of PE during SARS-CoV-2 infection. Patients received anticoagulant treatment for at least 3 months and were followed up for 2 years. Between the third and fourth months after discharge, all patients were evaluated for the presence of residual thrombotic defects by CTPA and/or perfusion pulmonary scintigraphy. Clinical findings, lung function tests with DLCO, exercise capacity, and echocardiograms were also assessed. Results: Of the 133 patients included, 18% had persistent thrombotic defects on lung imaging at follow-up. The incidence of CTEPD was 0.75% at 2 years of follow-up. Patients with persistent defects were significantly older, had a higher prevalence of systemic arterial hypertension, higher D-dimer and NT-proBNP levels, and more severe PE at diagnosis. Furthermore, there was a higher prevalence of right ventricular dysfunction on echocardiogram at diagnosis of PE (25.0% vs. 2.7%, p = 0.006). This was the only variable independently related to persistent defects in multivariate analyses (OR: 8.13 [95% CI: 1.82–36.32], p = 0.006). Conclusion: The persistence of thrombotic defects after PE is a common finding after SARS-CoV-2 infection, affecting 18% of the population. However, the incidence of CTEPH appears to be lower (0.75%) in COVID-19-related PE compared to that previously observed in PE unrelated to COVID-19.

Avaliação Cintilográfica e Ecocardiográfica em Portadores de Variantes Patogênicas ou Provavelmente Patogênicas do Gene TTR sem Envolvimento Cardíaco Manifesto

Abstract Background: Transthyretin amyloidosis (ATTR) is an infiltrative disease caused by abnormal protein deposition mainly in the heart and peripheral nervous system. When it affects the heart, the disease presents as restrictive cardiomyopathy; when it affects the peripheral and autonomic nervous system, it manifests as polyneuropathy, and is called familial amyloid polyneuropathy (FAP). There are two ATTR subtypes: wild-type ATTR, where there is no mutation, and mutant ATTR (ATTRm), which is characterized by a mutation in the gene encoding the transthyretin protein (TTR). In both subtypes, cardiac involvement is the major marker of poor prognosis. Objectives: To assess the prevalence of subclinical cardiac involvement in a sample of patients with TTR gene mutation by using pyrophosphate scintigraphy and strain echocardiography; to compare scintigraphy and strain findings; to evaluate the association between neurological manifestations (FAP) and subclinical cardiac involvement; and to analyze whether there is an association between any specific mutation and cardiac involvement. Methods: This is a cross-sectional study with carriers of the TTR gene mutation, without cardiovascular symptoms or changes in electrocardiographic or conventional echocardiographic parameters. All patients underwent pyrophosphate scintigraphy and strain echocardiography. Subclinical cardiac involvement was defined as a Perugini score ≥ 2, heart-to-contralateral lung (H/CL) ratio ≥ 1.5 at 1 h, H/CL ≥1.3 at 3 h, or global longitudinal strain (GLS) ≤ −17%. Descriptive and analytical analyses were performed and Fisher's exact test and Mann–Whitney test were applied. A value of p &lt; 0.05 was considered significant. Results: The 23 patients evaluated had a median age of 51 years (IQR 37–57 years), 15 (65.2%) were female, 12 (52.2%) were Pardo, nine (39.1%) had systemic arterial hypertension, and nine (39.1%) had a previous diagnosis of FAP. Of the nine patients with FAP, 8 (34.8%) were on tafamidis. The associated mutations were Val142IIe, Val50Met, and IIe127Val. The median GLS in the sample was −19% (−16% to −20%). Of the 23 patients, nine (39.1%; 95% CI = 29–49%) met criteria for cardiac involvement, six (26%) by the GLS-based criteria only. There was no association between having FAP and being an asymptomatic carrier, as assessed by strain echocardiography and pyrophosphate scintigraphy (p = 0.19). The prevalence of systemic arterial hypertension, diabetes mellitus, dyslipidemia, smoking, and reduced GLS did not differ between groups. Septal e’ wave velocity was the only variable that significantly differed between individuals with and without reduced GLS, with an area under the ROC curve of 0.80 (95% CI = 0.61–0.98, p = 0.027). The best diagnostic accuracy was achieved with a septal e’ velocity ≤ 8.5 cm/s. There was no association between mutation type and preclinical cardiac involvement, nor between tafamidis use and lower degree of cardiac involvement (37.5% versus 40.0%, p = 0.90). Conclusion: Subclinical cardiac involvement was common in a sample of TTR mutation carriers without cardiac involvement. Reduced left ventricular GLS was the most frequent finding. There was no association between the presence of amyloid polyneuropathy and subclinical cardiac involvement. Type of mutation was not associated with early cardiac involvement. In this sample, the use of tafamidis 20 mg/day was not associated with a lower prevalence of subclinical cardiac involvement.

Scintigraphic and Echocardiographic Study of Patients with Pathogenic or Probably Pathogenic Variants of the TTR Gene without Overt Cardiac Involvement.

Transthyretin amyloidosis (ATTR) is an infiltrative disease caused by abnormal protein deposition mainly in the heart and peripheral nervous system. When it affects the heart, the disease presents as restrictive cardiomyopathy; when it affects the peripheral and autonomic nervous system, it manifests as polyneuropathy, and is called familial amyloid polyneuropathy (FAP). There are two ATTR subtypes: wild-type ATTR, where there is no mutation, and mutant ATTR (ATTRm), which is characterized by a mutation in the gene encoding the transthyretin protein (TTR). In both subtypes, cardiac involvement is the major marker of poor prognosis. To assess the prevalence of subclinical cardiac involvement in a sample of patients with TTR gene mutation by using pyrophosphate scintigraphy and strain echocardiography; to compare scintigraphy and strain findings; to evaluate the association between neurological manifestations (FAP) and subclinical cardiac involvement; and to analyze whether there is an association between any specific mutation and cardiac involvement. This is a cross-sectional study with carriers of the TTR gene mutation, without cardiovascular symptoms or changes in electrocardiographic or conventional echocardiographic parameters. All patients underwent pyrophosphate scintigraphy and strain echocardiography. Subclinical cardiac involvement was defined as a Perugini score ≥ 2, heart-to-contralateral lung (H/CL) ratio ≥ 1.5 at 1 h, H/CL ≥1.3 at 3 h, or global longitudinal strain (GLS) ≤ -17%. Descriptive and analytical analyses were performed and Fisher's exact test and Mann-Whitney test were applied. A value of p < 0.05 was considered significant. The 23 patients evaluated had a median age of 51 years (IQR 37-57 years), 15 (65.2%) were female, 12 (52.2%) were Pardo, nine (39.1%) had systemic arterial hypertension, and nine (39.1%) had a previous diagnosis of FAP. Of the nine patients with FAP, 8 (34.8%) were on tafamidis. The associated mutations were Val142IIe, Val50Met, and IIe127Val. The median GLS in the sample was -19% (-16% to -20%). Of the 23 patients, nine (39.1%; 95% CI = 29-49%) met criteria for cardiac involvement, six (26%) by the GLS-based criteria only. There was no association between having FAP and being an asymptomatic carrier, as assessed by strain echocardiography and pyrophosphate scintigraphy (p = 0.19). The prevalence of systemic arterial hypertension, diabetes mellitus, dyslipidemia, smoking, and reduced GLS did not differ between groups. Septal e' wave velocity was the only variable that significantly differed between individuals with and without reduced GLS, with an area under the ROC curve of 0.80 (95% CI = 0.61-0.98, p = 0.027). The best diagnostic accuracy was achieved with a septal e' velocity ≤ 8.5 cm/s. There was no association between mutation type and preclinical cardiac involvement, nor between tafamidis use and lower degree of cardiac involvement (37.5% versus 40.0%, p = 0.90). Subclinical cardiac involvement was common in a sample of TTR mutation carriers without cardiac involvement. Reduced left ventricular GLS was the most frequent finding. There was no association between the presence of amyloid polyneuropathy and subclinical cardiac involvement. Type of mutation was not associated with early cardiac involvement. In this sample, the use of tafamidis 20 mg/day was not associated with a lower prevalence of subclinical cardiac involvement.