Risk Of Arterial Hypertension Research Articles

Influence of Aortic Arch Morphology on Renal Perfusion in Patients with Coarctation of the Aorta: An Exploratory Study

Objectives: The configuration of the aortic arch, particularly a Gothic arch shape, in individuals with corrected coarctation of the aorta (CoA) has been associated with a decreased systolic wave amplitude across the arch, which could potentially impair renal perfusion and elevate the risk of arterial hypertension. This study aims to explore the relationship between the morphological characteristics of the aortic arch and their impact on renal perfusion in patients with CoA. Methods: Seventy-one subjects with corrected CoA underwent continuous 24 h ambulatory blood pressure monitoring, computed tomography to assess the aortic arch, and renal perfusion scanning. Subjects were stratified into three groups based on the height-to-width (H/W) ratio of their aortic arch: Group 1 with a H/W ratio of <0.65, Group 2 with a H/W ratio between 0.65 and 0.85, and Group 3 with a H/W ratio of >0.85. Results: Groups 1 and 2 (53,78% and 62.63%) presented with a higher hypertension prevalence of elevated blood pressure than Group 3 (38.89%). Notable variations were observed among the subjects in the time to peak perfusion (Tmax) in the left kidney across the groups. Group 1 showed a median Tmax at 0.27, Group 2 at 0.13, and Group 3 at −0.38 (p-value = 0.079). The differences in Tmax for the right kidney followed a similar trend but were not statistically significant (Group 1 at 0.61, Group 2 at 0.22, and Group 3 at 0.11; p-value = 0.229). Conclusions: This study suggests that variations in the aortic arch morphology might not significantly influence renal perfusion in CoA patients. This indicates the potential adaptability of the renal blood flow, which appears to compensate for reduced perfusion, thus minimizing adverse effects on the kidney function. This adaptability suggests an inherent physiological resilience, emphasizing the need for further targeted research to understand the specific interactions and impacts on treatment strategies for CoA.

Arterial hypertension in infants with congenital diaphragmatic hernia following surgical repair.

Pulmonary hypertension (PH) and cardiac dysfunction are established comorbidities of congenital diaphragmatic hernia (CDH). However, there is very little data focusing on arterial hypertension in CDH. This study aims to investigate the incidence of arterial hypertension in neonates with CDH at hospital discharge. Archived clinical data of 167 CDH infants who received surgical repair of the diaphragmatic defect and survived for > 60days were retrospectively analyzed. Blood pressure (BP) values were averaged for the last 7days before discharge and compared to standard BP values for sex, age, and height provided by the AHA in 2004. BP values reaching or extending the 95th percentile were defined as arterial hypertension. The use of antihypertensive medication was analyzed at discharge and during hospitalization. Arterial hypertension at discharge was observed in 19 of 167 infants (11.3%) of which 12 (63%) were not receiving antihypertensive medication. Eighty patients (47.9%) received antihypertensive medication at any point during hospitalization and 28.9% of 152 survivors (n = 44) received antihypertensive medication at discharge, although in 45.5% (n = 20) of patients receiving antihypertensive medication, the indication for antihypertensive medication was myocardial hypertrophy or frequency control. BP was significantly higher in ECMO compared to non-ECMO patients, despite a similar incidence of arterial hypertension in both groups (13.8% vs. 10.1%, p = 0.473). Non-isolated CDH, formula feeding, and minimal creatinine in the first week of life were significantly associated with arterial hypertension on univariate analysis. Following multivariate analysis, only minimal creatinine remained independently associated with arterial hypertension. Conclusion:This study demonstrates a moderately high incidence of arterial hypertension in CDH infants at discharge and an independent association of creatinine values with arterial hypertension. Physicians should be aware of this risk and include regular BP measurements and test of renal function in CDH care and follow-up. What is Known: • Due to decreasing mortality, morbidity is increasing in surviving CDH patients. • Pulmonary hypertension and cardiac dysfunction are well-known cardiovascular comorbidities of CDH. What is New: • There is a moderately high incidence of arterial hypertension in CDH infants at discharge even in a population with frequent treatment with antihypertensive medication. • A more complicated hospital course (ECMO, higher degree of PH, larger defect size) was associated with a higher risk for arterial hypertension.

Distribution of the SLC2A9 genotype and its association with the uric acid level in patients with arterial hypertension and atrial fibrillation

Asymptomatic hyperuricemia (HU) is widespread in the population and is one of the main risk factors for cardiovascular diseases. Evidence of numerous studies supports the association between increased uric acid (UA) levels and the risk of arterial hypertension (HTN) and/or atrial fibrillation (AF). One of the causes for an increase in UA levels and a significant risk factor for HU is the polymorphism of the SLC2A9 gene, a highly specific urate transporter in proximal renal tubule cells, encoding the GLUT9 protein.The aim of the study is to investigate the frequency of genotypes and alleles of the SLC2A9 gene rs734553 polymorphic variant and its association with the UA level in patients with HTN and AF, as well as in healthy individuals. 141 patients, including 50 healthy patients (group 1), 68 – with HTN and AF (group 2), 23 – with HTN (group 3) were examined.In the overall group of patients, the frequencies of the SLC2A9 gene rs734553 polymorphism were as follows: AA – 46.1 % (n = 65), AC – 36.2 % (n = 51), CC – 17.7 % (n = 25). According to the genotyping results of patients, in group 1 the AA genotype was 64 % (n = 32), AC – 22 % (n = 11), CC – 14 % (n = 7); in group 2 – 32.4 % (n = 22), 48.5 % (n = 33) and 19.1 % (n = 13); in group 3 47.8 % (n = 11), 30.4 % (n = 7) and 21.7 % (n = 5), respectively. The CC genotype patients (420 [413; 424] μmol/l) and the AC genotype patients (330 [284; 412] μmol/l) had higher uricemia values than those with the AA genotype (310 [281; 341] μmol/l) ( p = 0,003). HU with the AA genotype in group 2 was diagnosed in 2 (2.9 %) patients, with the AC genotype in 12 (17.6 %), and with the CC genotype in 10 (14.7 %) patients; in group 3 – 1 (4.3 %), 1 (4.3 %) and 3 (13 %), respectively. One patient (2 %) with HU in group 1 had the CC genotype.The distribution of genotype and allele frequencies of the SLC2A9 gene rs734553 polymorphic variant and its association with the UA level in patients with HTN and AF, as well as in healthy individuals were established. In patients with HTN and AF, the AC genotype occurred 3 times more often and the CC genotype occurred 2 times more often than in healthy patients. HU occurred significantly more often ( р = 0.003) in the group of patients with HTN and AF and the CC genotype, as well as in patients with the CC genotype.

Assessing the Risk of Hypertension in Chronic, Elderly Patients during the COVID-19 Pandemic: A Prospective Study.

This study considers care management for older chronic patients during and after the COVID-19 pandemic. To identify groups of variables at previous time points as a basis for deriving efficient classification models during and after a pandemic situation and to quantify the effect of each variable within the model to predict levels of worsening risk in diastolic and systolic arterial hypertension (AHT). In this prospective longitudinal study, data were collected at three time points: before, during, and after the COVID-19 pandemic period. The study included 148 patients with an average age of 81.6 years. During the study period, mean systolic blood pressure among this population rose by 5 mmHg to 128.8 mmHg; the number of patients with systolic blood pressure > 140 mmHg rose by 45.3%; among those with diastolic blood pressure > 90, the number rose by 41.2%; mean triglycerides levels rose to 152.6 mg/dL; cholesterol levels rose to 147 mg/dL; and LDL cholesterol rose to 112.2 mg/dL. Meanwhile, mean levels of HDL cholesterol decreased to 46.5 mg/dL. Binary-response logistic regression models were constructed to identify the most relevant variables for predicting AHT risk during and after the pandemic. The heart rate (OR = 1.79; 95% CI: 1.22-2.72) and body mass index (OR = 1.75; 95% CI: 1.08-2.94) variables were significant at the population level (p < 0.05) for diastolic and systolic AHT in the pandemic period risk models. The body mass index variable was also significant for diastolic AHT in the post-pandemic period risk model (OR = 1.97; 95% CI: 1.32-2.94), whilst the triglycerides variable was significant in the systolic AHT post-pandemic period risk model (OR = 1.49; 95% CI: 1.01-1.86). Bad control of arterial hypertension in older patients with chronic disease is associated with elevated levels of LDL cholesterol, total cholesterol, systolic blood pressure, heart rate and triglycerides, and lower levels of HDL cholesterol.

ПРОГНОЗИРОВАНИЕ РАЗВИТИЯ АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИИ У МОЛОДЫХ МУЖЧИН С ВЫСОКИМ НОРМАЛЬНЫМ АРТЕРИАЛЬНЫМ ДАВЛЕНИЕМ

High normal blood pressure (HNBP) is known to be associated with an increased risk of arterial hypertension (AH) development. The purpose of the study is to identify predictors of the development of AH in young men with HNBP, to assess their prognostic significance. Materials and methods. From a sample of 50 men aged 18-29 years with registered HNBP, groups were formed: group 1 – 18 patients with AH diagnosed within 10 years, group 2 – 32 patients in whom AH was not diagnosed. Cardiovascular risk factors, indicators of 24-hour blood pressure monitoring, bicycle ergometry, heart rate variability (HRV) during an active orthostatic test, echocardiography, and pulse wave velocity were analyzed. Results. Predictors of the development of AH in young men with HNBP are HRV indicators during active orthostatic test (ΔSDNN, ΔHF) and bicycle ergometry indicators (heart rate (HR) at the end of the physical load, diastolic BP (DBP) at the end of the recovery period). Conclusions. Predictors of the development of AH in young men with HNBP are ΔSDNN and ΔHF during active orthostatic test, HR in peak physical load and the level of DBP in the recovery period of bicycle ergometry (sensitivity – 88.89%, specificity – 93.75%, accuracy – 92.0%). The resulting prognostic model can be used as a method for determining the individual risk of AH development.

Seasonal Fluctuations in Hemodynamic Characteristics in Patients with Increased Meteosensitivity: a Survey

INTRODUCTION. Currently, the Russian Federation occupies one of the first places among the developed countries of the world in terms of mortality from cardiovascular diseases, 3–5 times higher than in developed countries. Arterial hypertension, smoking, diabetes mellitus, obesity, and other risk factors contribute to the onset and progression of cardiovascular diseases, and lifestyle modification and reduction in risk factor levels can slow their development. An increase in physical activity along with a decrease in the total calorie content of food is mandatory for reducing body weight. When combining physical exercises with climatotherapy (health path, physical exercises in the open air), it is necessary to take into account external meteorological conditions, as well as increased meteosensitivity of some patients, which are able to neutralize the therapeutic effects achieved by using, for example, health path.&#x0D; AIM. To study the frequency and seasonality of the main meteopathic reactions in patients with cardiovascular diseases.&#x0D; MATERIALS AND METHODS. We conducted a verbal and communicative examination of 735 patients with a body mass index of 25 kg/m2 and over, who were treated in the health resort complex “Vulan“. The analysis of patients’ answers about arterial pressure increases and complaints about other meteopathic reactions during the year according to self-monitoring data was carried out. Macroclimatic characteristics of the location of the health resort complex were also studied. The study was performed as part of the research work under the state assignment of the Ministry of Health of the Russian Federation, reg. No. 121040200110-0.&#x0D; RESULTS. It was revealed that the highest frequency of increased blood pressure recorded by patients is registered in March, October, November and December, the lowest is recorded in May, June and August. At the same time, the frequencies of other meteopathic reactions, such as fear, anxiety, shortness of breath, and others, are evenly distributed throughout the year.&#x0D; CONCLUSION. The study evaluated the natural climatic factors of the resort located on the Black Sea coast of the North Caucasus, by the example of the health resort complex “Vulan“ in connection with the search of favorable seasons for the treatment of cardiological patients with increased meteosensitivity. The results obtained allow us to make proposals to supplement the current regulatory documents with the data on the identified favorable periods of health resort treatment for cardiologic patients, expanding the seasonality for referring patients to the resorts of the Black Sea coast of the North Caucasus.

Co-Occurrence of Familial Mediterranean Fever and Hematologic Malignancies: Case Report Series

Introduction: Familial Mediterranean Fever (FMF) is an autosomal recessive genetic disorder primarily found among individuals of Mediterranean descent, including Armenians, Italians, Greeks, Arabs, Turks and Jews. In the Armenian population, approximately 90% of FMF cases are associated with three main mutations (M694V, V726A, and M680I) in two alleles of MEFV gene, while more than 300 MEFV variants have been reported worldwide. The homozygous M694V genotype is associated with frequent renal failure due to amyloidosis. Clinical manifestations of FMF include periodic attacks of diffuse serositis with pain and fever that are treated with colchicine or biologic therapy. There is a scarcity of data on patients with FMF and hematologic malignancies. Limited data makes it difficult to generate evidence-based recommendations for the management of these patients, which is mostly based on expert opinions or few case reports. Here we report the case series of patients from Armenia with simultaneous presence of FMF and hematologic malignancies (FMFHM) and evaluate their management challenges. Methods: Data was collected from the Armenian National Registry of Blood Disorders, at the Hematology Center after Prof. R. Yeolyan, and through personal interviews conducted with each patient. Hematology Center is the only institution in Armenia managing hematologic malignancies. We have analyzed 8 patients diagnosed with both FMFHM during 2000-2020, treated in the pediatric (1 patient) and adult (7 patients) hematology departments. Results: 8 patients with FMFHM were identified, from which 4 were diagnosed with myeloproliferative neoplasms (MPN), 2 with acute leukemia (AL), and 2 with non-Hodgkin lymphoma (NHL). The median age of patients was 46, range 20-60 years. Only 5 (62.5%) of patients were regularly taking colchicine for FMF, while the rest refused it. Four MPN patients received treatment only with oral medications (tyrosine kinase inhibitors, hydroxyurea). Autologous hemopoietic stem cell transplantation (auto-HSCT) was performed in 1 NHL patient after indicated 1 st and 2 nd line immuno-chemotherapy. Another 2 AL patients and one NHL patient received protocol-based respective chemotherapy regimens. Moderate gastrointestinal (GI) complications (e.g., epigastric pain, nausea, vomiting, intestinal discomfort) was experienced by 7 (87.5%) patients. Allergic reactions (e.g., moderate skin rash, itching) were seen in 5 patient (62.5%), of which one developed severe anaphylactic shock. A patient with FMF and PMF had ischemic stroke caused by thrombi. Arterial hypertension occurred in 3 (37.5%). Only in one patient reduction of colchicine dosage was performed (1mg/day was reduced to 0.6mg/d), because of interaction with imatinib. The rest of patients received chemotherapy and colchicine treatment as indicated. All 8 patients are alive, 5 of them are in hematologic or molecular remission, two of which received concurrent colchicine treatment. One patient in remission developed renal failure due to FMF (colchicine was refused). Two patients with MPN treated with colchicine experienced disease stabilization. Conclusion: In conclusion, the concurrent appearance of FMFHM may potentially increase the risk of GI side effects, allergic complications, and arterial hypertension, however definitive conclusions require further investigations in larger patient cohorts. While the overall treatment responses were largely positive, the association between MEFV and HM mutations warrants deeper exploration to provide more precise drug administration recommendations for colchicine and cancer medications. Future studies in this area will contribute to a better understanding of the interplay between these conditions and guide optimal treatment strategies.

Male patients with first diagnosed and never treated essential hypertension accompanied by organ damage are at high risk for non-alcoholic fatty liver disease indicated by Hepatic steatosis index

Abstract Background Non-alcoholic fatty liver disease (NAFLD) is closely related to the metabolic syndrome as well as to arterial hypertension and overall cardiovascular (CV) disease. We aimed to investigate if those first diagnosed and never treated patients with essential hypertension at high risk for NAFLD, measured by the Hepatic Steatosis Index (HSI), already have an impaired CV risk profile estimated by increased blood pressure burden and accompanied by the presence of hypertension-mediated organ damage (HMOD). Methods We studied 300 non-diabetic, first diagnosed and never-treated young hypertensive patients [mean age=51+11 years, 60% males, 32% smokers]. Ambulatory blood pressure monitoring (24h ABPM), CV risk factors [smoking, obesity (BMI), hyperlipidemia and HMOD [aortic stiffness (PWV), left ventricular diastolic dysfunction (EEa), cardiac hypertrophy (LVMI), coronary arteries microcirculation (CFR), carotid intima-media thickness (cIMT) and endothelial dysfunction (PBR5-25)] were estimated in each patient before treatment initiation. HIS was calculated as 8 times (ALT/AST ratio) +BMI (+2, if female; +2, if diabetes mellitus). Increased HIS levels predispose for augmented risk for NAFLD. Results The whole hypertensive population was divided regarding HSI median value=39.5 in two groups, Group A (higher risk for NAFLD group, n=150, age=50+10, 59% males, 33% smokers) and Group B (lower risk for NAFLD group, n=150, age=51+11, 60% males, 31% smokers). Group A patients had increased BMI (32+5 vs. 27+3, p&amp;lt;0.001), systolic night-time ABPM (127+15 vs. 124+11, p=0.05), office systolic (152+19 vs. 145+17 mmHg, p=0.004) and diastolic BP (94+11 vs. 90+11 mmHg, p=0.002), central systolic BP (146+20 vs. 137+15, p=0.006), Chol (216+39 vs. 206+35, p=0.02), LDL (138+35 vs.130=33 mg/dl, p=0.04) and Trigl (139+75 vs. 112+63, p=0.001), E/Ea (7+2 vs. 6+2, p=0.01) and LVMI (83+18 vs. 79+17, p=0.03) compared to Group B. All other studied demographic, laboratory, ABPM and HMOD parameters (PWV, MAU, CFR and cIMT) were similar between groups. HSI was related to BMI (p&amp;lt;0.001) and office BP, both systolic (p=0.001) and diastolic (p=0.008) in total population as well as to LVMI (r=0.17, p=0.02) in males. Finally, in multiple regression analysis, we found that HSI was independently associated with LVMI (beta=0.14, p=0.05) only in male hypertensives. Conclusions Patients first diagnosed arterial hypertension and augmented CV risk (smoking, obesity, hyperlipidemia, BP burden and HMOD) are also at high risk for NAFLD. As successful antihypertensive treatment may lead to HMOD regression, probably there is still time for those patients to be treated for hypertension disease and hyperlipidemia and quit smoking, in order to reduce future CV risk.LVMI and HSI in male hypertensives

Iron Metabolism Dysregulation and Atherosclerotic Changes in Obstructive Sleep Apnoea

The Syndrome of obstructive sleep apnoea (OSA) is associated with an increased risk of arterial hypertension, metabolic syndrome, diabetes mellitus type 2, brain-vascular damages and atherosclerosis. The aim of this study is to assess the connection between iron metabolism dysregulation in OSA and atherosclerotic changes of carotid arteries. Thirty-five OSA patients with brain-vascular atherosclerotic evidences were included in this study; changes were evaluated by carotid artery intima-media thickness (IMT) and flow-mediated dilatation (FMD). Their results were compared to an equal number of healthy volunteers. Haematological and biochemical assays were performed in all participants in the study. Serum hepcidin levels are statistically significantly increased in OSA patients with atherosclerotic a. carotis changes (101.9±10.1 µg/L) compared to the control group (18.5±2.5 µg/L); $$P&lt;0.001$$. Serum homocysteine levels are significantly higher in OSA than in healthy people. Average IMT (1.22±0.19) and ABI (1.71±0.14) values in OSA patients with atherosclerotic a. carotis changes are increased in comparison to the control group (0.34±0.07, 1.11±0.06, resp.); $$P&lt;0.001$$. Serum vitamin B12 levels were lower in OSA patients with atherosclerotic changes in carotid arteries (71.7±9.9 pmol/L) compared to the controls (449.7±21.4 pmol/L); $$P&lt;0.001$$. A connection between iron homeostasis and atherosclerotic changes was established during this study. Increased hepcidin and homocysteine concentrations might be connected to an elevated risk of cardio- and brain-vascular diseases in OSA. The use of these markers in the routine practice may be very useful for early atherosclerosis assessment in OSA.

Glycaemic control in comorbid patients: an important element of CVD progression prevention

There is a clear and specific bidirectional relationship between diabetes mellitus and cardiovascular disease. It is known that cardiovascular disease in patients with diabetes occurs 2–5 times more often than in people without diabetes. CVD itself, and it is cardiovascular outcomes, are the main cause of death in patients with diabetes mellitus, both in men and women. In diabetes mellitus, there is a high risk of coronary heart disease, myocardial infarction, arterial hypertension, and acute cerebrovascular accident, and patients with diabetes may experience painless acute myocardial infarction associated with the presence of autonomic cardiac neuropathy. Much more often in diabetes mellitus there are various rhythm disturbances, including paroxysmal forms of atrial fibrillation, which increase the risk of death by 1.8–2 times. Currently, numerous international clinical studies have convincingly demonstrated that improved glycemic control causes a significant reduction in the risk of late macroand microvascular complications of diabetes mellitus. The concept of dysglycemia includes disorders of glycated hemoglobin (HbA1c), fasting glycemia, postprandial glycemia, hypoglycemia, and glycemic variability. Dysglycemia increases the risk of developing type 2 diabetes mellitus and cardiovascular diseases, and their poor prognosis. HbA1c is the “gold standard” for monitoring glycemic control, but this indicator does not provide complete information about daily and intraday changes in glucose levels. Variability (not level) of fasting glucose determines cardiovascular mortality in patients with type 2 diabetes mellitus. Achieving glucose stability may become an additional therapeutic goal for the management of this category of patients with diabetes mellitus, and low glycemic variability is currently assessed as an additional target. Algorithms of specialized medical care for patients with diabetes mellitus recommend that patients with type 2 diabetes mellitus carry out self-monitoring, depending on the type of treatment taken and the degree of carbohydrate metabolism compensation. An important aspect of the technical impact on the adherence of patients to self-control and treatment of diabetes mellitus is the availability of convenient communication between the patient and the doctor, in particular, the possibility of contact remotely via a computer and mobile phone. In conclusion, the possibilities of a new model of the Contour® glucometer line, the Contour® Plus One glucometer, are considered.

The Protective Effect of Polymorphisms rs2681472 and rs17249754 of the ATP2B1 Gene Against Coronary Artery Disease and Hypertension is Abolished by Tobacco Smoking.

Aim To study the relationship of single nucleotide polymorphisms rs2681472 and rs17249754 in the ATP2B1 gene with risk of ischemic heart disease (IHD) and arterial hypertension (AH) among residents of Central Russia and to evaluate the trigger role of smoking as a risk factor for development of IHD and AH in carriers of ATP2B1 gene polymorphic variants.Material and methods The study included DNA samples from 1960 residents of Central Russia of Slavic origin. Among them, there were 1261 patients with cardiovascular diseases and 699 healthy persons. The vast majority of patients had both IHD and AH. Genotyping was performed using the iPLEX technique on a MassARRAY-4 genomic mass-spectrometer. The relationship of ATP2B1 alleles, genotypes, and haplotypes with the risk of diseases was calculated by logistic regression analysis with adjustments for sex and age.Results Carriage of AG and GG (rs2681472) genotypes and GA (rs17249754) genotype was associated with a reduced risk of both IHD (p=0.0057 and p=0.022 for rs2681472 and rs17249754, respectively) and AH (p=0.016 and p=0.036, respectively). Rare rs2681472G-rs17249754G and rs2681472A-rs17249754A haplotypes were associated with a reduced risk of IHD (odds ratio, OR, 0.22; 95 % CI: 0.11-0.46, p=0.0001) and AH (OR, 0.22; 95 % CI: 0.10-0.47, p=0.0001). Analysis of the groups stratified by the smoking status showed that in smokers, the studied polymorphic variants did not have a protective action with respect of either IHD or AH. However, in non-smokers, the genotypes AG and GG rs2681472 (OR, 0.62; 95 % CI: 0.47-0.80, p=0.0004) and GA rs17249754 (OR, 0.61; 95 % CI: 0.47-0.81, p=0.0004) were associated with a reduced risk of IHD and AH (OR, 0.63; 95 % CI: 0.48-0.83, p=0.0004 for rs2681472; OR, 0.63; 95 % CI: 0.48-0.83, p=0.001 for rs17249754), as well as the carriage of the minor alleles rs2681472‑G and rs17249754‑A.Conclusion It was shown for the first time that the polymorphic variants rs17249754 and rs2681472 of the ATP2B1 gene are associated with a reduced risk for IHD and AH only in non-smokers.

Cardiometabolic Risk Factors in Mexican Adults With Congenital Heart Disease

BackgroundIn recent decades, adults living with congenital heart disease (ACHD) have improved their survival, thus increasing their predisposition to the onset of cardiometabolic risk factors and chronic health conditions. ObjectivesThe purpose of this study was to describe cardiometabolic risk profiles in the ACHD population and their relationship to congenital heart disease (CHD) lesion complexity. MethodsWe performed a cross-sectional study from ACHD in a third-tier referral center in Mexico City. The association between cardiometabolic risk factors and CHD complexity was estimated using logistic regression models. ResultsOur study cohort included 1,171 ACHD patients (median age: 31 [IQR: 23.2-42.7] years, male 63.6%). Cardiac diagnosis was classified as mild (44.9%), moderate (37.8%), and severe (17.2%) CHD complexity. Low high-density lipoprotein cholesterol (55%) was the most common cardiometabolic risk factor; followed by insulin resistance (54.5%) and prediabetes (52.4%). Patients with mild and moderate CHD had a higher prevalence of obesity and metabolic syndrome, while patients with severe CHD had a higher prevalence of hyperuricemia and subclinical hypothyroidism. In the logistic regression analysis, the severity of CHD was associated with higher odds of hyperuricemia (moderate CHD, OR: 1.87; 95% CI: 1.20-2.93; P = 0.010; severe CHD, OR: 2.75; 95% CI: 1.64-4.62; P < 0.001) and lower risks of metabolic syndrome (OR: 0.61; 95% CI: 0.41-0.91; P = 0.010), prediabetes (OR: 0.58; 95% CI: 0.42-0.81; P < 0.001), and arterial hypertension (OR: 0.49; 95% CI: 0.33-0.74; P < 0.001) compared with mild CHD complexity. ConclusionsWe observed high rates of cardiometabolic risk factors in Mexican ACHD patients and these risk profiles varied by CHD lesion complexity. These results highlight the need for ongoing metabolic health surveillance in the ACHD population.

High levels of blood pressure among Brazilian overweight and obese children and adolescents

Background: Arterial hypertension (AH) is a growing problem globally, bringing various health consequences. Numerous surveys show that the risk of AH is higher in overweight and obese individuals than in eutrophic ones. However, the number of data that investigates blood pressure in obese pediatric populations is still small. Therefore, this study aims to assess the prevalence of hypertension in overweight and obese children and adolescents. Methods:Retrospective cross-sectional study with children and adolescents from two health services in different regions of Brazil and distinct socioeconomic profiles. All children and adolescents seen between 1998-2020, aged 5-17 years, with a body mass index greater than +1 standard deviation (Z-score), were enrolled in the study. Blood pressure was measured once with the patient lying down and at rest. American Academy of Pediatrics guidelines were used to classify the patient’s blood pressure levels. Results: 691 patients were evaluated (49% male). Of these, 47.6% had hypertension. The prevalences of hypertension among overweight and obese subjects were 38.8% and 51.5% (p = 0.002), respectively. In addition, obese people were 1.67 times more likely to have hypertension than overweight people. Males had a higher prevalence of hypertension (52.1% vs. 43.3%; p = 0.002) and were 1.3 times more likely to have high blood pressure values. Conclusion: The prevalence of hypertension was high in overweightand obese children and adolescents from two pediatric outpatient clinics. Males and subjects with obesity were at significantly higher risk of having hypertension.

The association between arterial hypertension and menarcheal age.

Menarche, as a milestone of puberty, may have a long-term effect on health. The present study investigated the association of age at menarche with the incidence of arterial hypertension. A total of 4747 post-menarcheal participants of the Tehran Lipid and Glucose Study who met the eligibility criteria were selected. Demographic, lifestyle, reproductive, and anthropometric data, as well as risk factors for cardiovascular diseases, were collected. Participants were classified according to their age at menarche: group I: ≤11years, group II: 12-15years, and group III: ≥16years. A Cox proportional hazards regression model was used to estimate the associations between age at menarche and arterial hypertension outcomes. The generalized estimating equation models were used to compare the trend of changes in systolic and diastolic blood pressure between the three groups. The mean age of participants at baseline was 33.9 (13.0). At the end of the study, 1261 (26.6%) participants had arterial hypertension. Women in group III had a 2.04-fold higher risk of arterial hypertension than those in group II. The mean changes in systolic and diastolic blood pressure were 29% (95% CI: 0.02-0.57) and 16% (95% CI: 0.00-0.38) higher for women in group III compared with group II. Late menarche could be a risk factor for arterial hypertension, so it is necessary to pay more attention to age at menarche in cardiovascular risk assessment programs.

Assessment of daily blood pressure parameters in patients after injury

ABSTRACT. Many studies have highlighted the impact of various significant risk factors on the occurrence of arterial hypertension. However, few papers have examined the effect of psychoemotional factors as important contributors to the risk of arterial hypertension for such a specific population group as contracted servicemen performing military service under conditions of performing special tasks. Furthermore, there is a lack of data on the daily profile of blood pressure in this particular group of individuals. This thesis aims to substantiate the claim that injury, as a risk factor, greatly influences changes in the daily profile of blood pressure. The study examined 118 patients, divided into an experimental group (65 people) and a control group (53 people). The daily profile of blood pressure was assessed using continuous ambulatory blood pressure monitoring. Questionnaires were used to evaluate the quality of sleep, anxiety, and depression. The findings indicated that the patients of the experimental group, following trauma, exhibited a higher index of systolic and diastolic blood pressure duration, while the mean values remained within the normal range. Additionally, these patients more frequently exhibited a blood pressure profile characterized by an insufficient nocturnal decrease in blood pressure, known as non-dipping. This could be attributed to impaired sleep quality, as well as subclinically significant manifestations of anxiety and depression caused by stress. The early detection of changes in the index of systolic and diastolic blood pressure duration, along with deviations in the daily blood pressure profile observed through continuous ambulatory blood pressure monitoring, would enable specialists to promptly address alterations in the hemodynamics of these patients and prescribe appropriate therapy. Therefore, psychoemotional stress in people who have experienced trauma is one of the trigger mechanisms for increased blood pressure. If left unaddressed, this can progress to persistent arterial hypertension.

Fruitand vegetableintake and the risk of arterial hypertension in China: A prospective cohort study.

Population-based epidemiological evidence regarding the association between fruitand vegetable intake and the incidence of hypertension is inconsistent. This prospective cohort study aimed to investigate the associationbetween fruitand vegetable intake and the risk of new-onset hypertension. Based on the project of Prediction for Atherosclerotic Cardiovascular Disease Risk in China (China-PAR), 58,981 Chinese adults without hypertension at baseline were included. Information on fruitand vegetable intake was collected using a food-frequency questionnaire. Cox proportional hazards models were performed to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of incident hypertension. During 640,795 person-years of follow-up, 21,008 new cases of hypertension were recorded. Compared with participants in the lowest quintile (Q1) of total fruit and vegetable(TFV) intake, the HRs (95% CIs) of incident hypertension were 0.90 (0.86-0.95), 0.85 (0.81-0.90), 0.82 (0.78-0.86), and 0.83 (0.78-0.88) for the Q2 to Q5 group (p trend < 0.001), respectively. In further analyses categorizing participants according to the recommended intake level (500 g/day), we found that increasing the intake of TFV, even though it was still insufficient for the recommendation, also had a protective effect against the incident hypertension. When considering the intake of fruit or vegetable separately, we found similar trends as the TFV intake. These results suggest that a higher intake of fruit and vegetable is beneficial for preventing hypertension in Chinese adults.

VARIATIONS IN THE PERCEPTION OF BITTER TASTE MAY MODULATE THE RISK OF HYPERTENSION

Objective: The perception of bitter taste conditioned by the TAS2R38 gene (combined Proline/Alanine/Valine and Isoleucine phenotypes) may be associated with food consumption. Individuals with one copy of PAV are bitter tasters, with two copies of AVI are non-bitter tasters, and with AAV &lt; AAI &lt; PAI are intermediate bitter tasters. Consumption salt balance is determined by the function of the epithelial sodium channels that lead to its preference and the bitter taste receptors associated with its aversion. In turn, a chronic high salt intake was associated with the inhibition of bitter receptors with less salty taste aversion leading to potential higher consumption and risk of hypertension. The objective was to evaluate the influence of bitter taste perception on the risk of arterial hypertension. Design and method: DNA from 339 individuals was quantified and genotyped by reverse transcription followed by polymerase chain reaction (RT-PCR). Blood pressure was determined by standard methods. Arterial hypertension was diagnosed in 141 individuals who were compared with 198 normotensive individuals. Thyroid functional status is determined by clinical history, physical examination, FT4, FT3, TSH, antiperoxidase, antithyroglobulin, and TRAB antibodies. Hypothyroidism at 33.3%, hyperthyroidism 14.3% and euthyroidism 52.35%. Statistics: chi2 and t-Student, considering significance &lt;0.05. Results: The frequencies of the TAS2R38 diplotypes were: PVI/PVI (26%); PVV/PVI (0.9%); PVV/AVI(10.6%); PVV/AVV(0.9%); AVV/AVV(2.4%); PAI/PVI(0.3%); PAV/PVI(5.95%); PAV/AVI(37.5%); AAV/AAV(12.7%); PAV/AAV(2.75%) and PAV/AAI(0.3%). The TAS2R38 AAV/AAV and PAV/AAV diplotypes showed a lower risk of hypertension adjusted for thyroid dysfunction, compared to the remaining diplotypes of this gene, with OR = 0.458[0.236-0.887], p = 0.021. Other diplotypes showed no significant association. Conclusions: Individuals with bitter tasting associated with AAV genotypes may be less likely to develop hypertension compared to other bitter tasters. The lower risk of hypertension in these genotypes may be associated with greater functionality of bitter taste receptors associated with aversion to salt intake. In conclusion, the genetic polymorphisms of the bitter taste gene may influence the risk for arterial hypertension and may therefore be considered potential future therapeutic targets. The absence of bitter-insensitive individuals (AVI/AVI) in this sample limits the understanding of the influence of these genotypes on the risk of hypertension.

THE PLASMA HDL-SUBFRACTION PROFILE IN HYPERTENSIVE PATIENTS WITH HIGH HDL-CHOLESTEROL LEVELS

Objective: The evaluation of cardiovascular risk (CVR) in arterial hypertension includes the estimation of high density lipoprotein (HDL-C). Although HDL-C is considered as a favorite CVR factor, the exact role that HDL-C subfraction profile play in the pathogenesis of atherosclerosis, especially in higher than usual HDL-C levels (&gt;60 mg/dl) is currently under investigation. The aim of this study was to evaluate the plasma HDL subfraction profile of high HDL-C levels in hypertensive patients compared to normotensive subjects. Design and method: We studied 74 hypertensive patients (60 + 13 years, 62 females) and 24 normotensives, apparently healthy subjects (49 + 14 years, 22 females) with HDL-C equal or above 55 mg/dl. Cholesterol, HDL-C, and TG were determined enzymatically while LDL-C was calculated using the Friedewald formula. Plasma HDL particles were separated and determined electrophorically using Lipoprint System HDL Subfractions Kit. Aortic stiffness (c-f PWV) and central BP (cBP) were evaluated by carotid-femoral pulse wave velocity (Complior apparatus). Results: We found that hypertensive patients had increased age, BMI, office systolic and diastolic BP, PWV compared to normotensives. Regarding HDL, 10 HDL fractions were separated: fractions 1-3 were denoted as Large-HDL (L-HDL), fractions 4-7 constituted the Intermediate-HDL (I-HDL), and fractions 8-10 were denoted as Small-HDL (S-HDL) subfraction. Although HDL-C levels were similar between groups (76 + 13 vs. 81 + 17 mg/dl, p = 0.10), the percent distribution (%) of L-HDL was lower in hypertensives compared to normotensives (29.8±4.7% vs. 36.6±6.3%, p&lt;0.001), % I-HDL was similar while % S-HDL was increased (27.3±3.7% vs. 20.4±4.4%, p&lt;0.001). We found a significant negative correlation between L-HDL and SBP (rho = -0.48, p = 0.01) as well as cBP (rho = -0.52, p = 0.008) in younger hypertensive females before menopause (n = 26, 49 + 5 years). Conclusions: L-HDL particles, the most antiatherogenic HDL-C subfraction, were reduced in hypertensive patients with high HDL-C levels compared to normotensive subjects, suggesting that these patients are probably less protected against CV disease compared to normotensive subjects with similar HDL-C and LDL-C levels. Therefore, plasma HDL-subfraction profile might replace the HDL-C evaluation as a better biomarker of CVR in hypertensive patients, especially females before menopause.

DYSLIPIDEMIA AND HYPERGLYCEMIA IN HYPERTENSIVE PATIENTS ASSOCIATE WITH GNB3 (RS5443) AND NOS3 (RS2070744) GENES’ ALLELIC STATE

Objective: More than 700 million people worldwide live with untreated essential arterial hypertension (EAH). The objective of the study was to evaluate the risks of metabolic disorders in EAH patients depending on guanine nucleotide-binding protein-↓3 subunit (GNB3, rs5443) and endothelial nitric oxide synthase (NOS3, rs2070744) genes’ allelic state. Design and method: The cohort case-control study involved 100 EAH patients (moderate-very high cardiovascular risks, aged 45-65 years) and 48 practically healthy (control). Metabolic disorders were evaluated by glucose blood value and lipids panel: total cholesterol (TC), triglycerides (TG), Low-, and High- density lipoprotein cholesterol (LDL-C, HDL-C) levels. The atherogenic index (AI) was calculated by the equation: (TC-HDL-C)/HDL-C. GNB3 (rs5443) and NOS3 (rs2070744) genotyping perfrmed by TaqMan probes in CFX96 Real-Time PCR Detection System. Results: Hyperglycemia (&gt;6.1 mmol/l), hypertriglyceridemia (TG&gt;1.7 mmol/l) and decreased HDL-C (&lt;1.2 mmol/l) were relatively more common in EAH patients than in the control group by 36.11% (⇙2 = 17.88; p&lt;0.001), 23.61% (⇙2 = 6.43; p = 0.011) and 25.0% (⇙2 = 8.32; p = 0.004) respectively. Therefore, the fasting hyperglycemia increases the EAH risk in the examined population ninefold [OR95%CI:2.86-27.08; p&lt;0.001], hypertriglyceridemia and decreased HDL-C elevates the risk almost 3 and 3.5 times as well [OR95%CI:1.23-5.56; p = 0.009 and OR95%CI:1.46-8.71; p = 0.003], respectively. The risk of metabolic disorders (dyslipidemia and hyperglycemia) in EAH patients does not depend on NOS3 gene polymorphism (rs2070744). Contrary, in T-allele patients of the GNB3 gene (rs5443) prevailed subjects with elevated LDL-C (&gt;3.0 mmol/l) over those with CC-genotype by 13.89% (p = 0.05). Other parameters of lipid metabolism and hyperglycemia did not differ significantly between GNB3 (rs5443) genes allelic state. However, the mutational T-allele of the GNB3 gene (825C&gt;T) increases the risk of hyperlipidemia 8.5 times [OR 95%CI:0.99-72.70; p = 0.05] due to atherogenic LDL-C, with the protective role of CC-genotype [OR = 0.12; OR 95%CI:0.01-1.0; p = 0.048]. Conclusions: Fasting hyperglycemia, hypertriglyceridemia and lowered HDL-C, enhance the arterial hypertension risk 3-9 times (p&lt;0.01). The polymorphic site of GNB3 (rs5443) gene, but not NOS3 (rs2070744) gene associate with hyperlipidemia in hypertensive patients.

Risk Effects of rs1799945 Polymorphism of the HFE Gene and Intergenic Interactions of GWAS-Significant Loci for Arterial Hypertension in the Caucasian Population of Central Russia

The aim of this case-control replicative study was to investigate the link between GWAS-impact for arterial hypertension (AH) and/or blood pressure (BP) gene polymorphisms and AH risk in Russian subjects (Caucasian population of Central Russia). AH (n = 939) and control (n = 466) cohorts were examined for ten GWAS AH/BP risk loci. The genotypes/alleles of these SNP and their combinations (SNP-SNP interactions) were tested for their association with the AH development using a logistic regression statistical procedure. The genotype GG of the SNP rs1799945 (C/G) HFE was strongly linked with an increased AH risk (ORrecGG = 2.53; 95%CIrecGG1.03-6.23; ppermGG = 0.045). The seven SNPs such as rs1173771 (G/A) AC026703.1, rs1799945 (C/G) HFE, rs805303 (G/A) BAG6, rs932764 (A/G) PLCE1, rs4387287 (C/A) OBFC1, rs7302981 (G/A) CERS5, rs167479 (T/G) RGL3, out of ten regarded loci, were related with AH within eight SNP-SNP interaction models (<0.001 ≤ pperm-interaction ≤ 0.047). Three polymorphisms such as rs8068318 (T/C) TBX2, rs633185 (C/G) ARHGAP42, and rs2681472 (A/G) ATP2B1 were not linked with AH. The pairwise rs805303 (G/A) BAG6-rs7302981 (G/A) CERS5 combination was a priority in determining the susceptibility to AH (included in six out of eight SNP-SNP interaction models [75%] and described 0.82% AH entropy). AH-associated variants are conjecturally functional for 101 genes involved in processes related to the immune system (major histocompatibility complex protein, processing/presentation of antigens, immune system process regulation, etc.). In conclusion, the rs1799945 polymorphism of the HFE gene and intergenic interactions of BAG6, CERS5, AC026703.1, HFE, PLCE1, OBFC1, RGL3 have been linked with AH risky in the Caucasian population of Central Russia.